Estimating A Reference Standard Segmentation With Spatially Varying Performance Parameters: Local MAP STAPLE

PubMed Central

Commowick, Olivier; Akhondi-Asl, Alireza; Warfield, Simon K.

2012-01-01

We present a new algorithm, called local MAP STAPLE, to estimate from a set of multi-label segmentations both a reference standard segmentation and spatially varying performance parameters. It is based on a sliding window technique to estimate the segmentation and the segmentation performance parameters for each input segmentation. In order to allow for optimal fusion from the small amount of data in each local region, and to account for the possibility of labels not being observed in a local region of some (or all) input segmentations, we introduce prior probabilities for the local performance parameters through a new Maximum A Posteriori formulation of STAPLE. Further, we propose an expression to compute confidence intervals in the estimated local performance parameters. We carried out several experiments with local MAP STAPLE to characterize its performance and value for local segmentation evaluation. First, with simulated segmentations with known reference standard segmentation and spatially varying performance, we show that local MAP STAPLE performs better than both STAPLE and majority voting. Then we present evaluations with data sets from clinical applications. These experiments demonstrate that spatial adaptivity in segmentation performance is an important property to capture. We compared the local MAP STAPLE segmentations to STAPLE, and to previously published fusion techniques and demonstrate the superiority of local MAP STAPLE over other state-of-the- art algorithms. PMID:22562727

Bowel anastomoses: The theory, the practice and the evidence base

PubMed Central

Goulder, Frances

2012-01-01

Since the introduction of stapling instruments in the 1970s various studies have compared the results of sutured and stapled bowel anastomoses. A literature search was performed from 1960 to 2010 and articles relating to small bowel, colonic and colorectal anastomotic techniques were reviewed. References from these articles were also reviewed, and relevant articles obtained. Either a stapled or sutured gastrointestinal tract anastomosis is acceptable in most situations. The available evidence suggests that in the following situations, however, particular anastomotic techniques may result in fewer complications: A stapled side-to-side ileocolic anastomosis is preferable following a right hemicolectomy for cancer. A stapled side-to-side anastomosis is likely also preferable after an ileocolic resection for Crohn’s disease. Colorectal anastomoses can be sutured or stapled with similar results, although the incidence of strictures is higher following stapled anastomoses. Following reversal of loop ileostomy there is some evidence to suggest that a stapled side-to-side anastomosis or sutured enterotomy closure (rather than spout resection and sutured anastomosis) results in fewer complications. Non-randomised data has indicated that small bowel anastomoses are best sutured in the trauma patient. This article reviews the theory, practice and evidence base behind the various gastrointestinal anastomoses to help the practising general surgeon make evidence based operative decisions. PMID:23293735

Design and structure of stapled peptides binding to estrogen receptors.

PubMed

Phillips, Chris; Roberts, Lee R; Schade, Markus; Bazin, Richard; Bent, Andrew; Davies, Nichola L; Moore, Rob; Pannifer, Andrew D; Pickford, Andrew R; Prior, Stephen H; Read, Christopher M; Scott, Andrew; Brown, David G; Xu, Bin; Irving, Stephen L

2011-06-29

Synthetic peptides that specifically bind nuclear hormone receptors offer an alternative approach to small molecules for the modulation of receptor signaling and subsequent gene expression. Here we describe the design of a series of novel stapled peptides that bind the coactivator peptide site of estrogen receptors. Using a number of biophysical techniques, including crystal structure analysis of receptor-stapled peptide complexes, we describe in detail the molecular interactions and demonstrate that all-hydrocarbon staples modulate molecular recognition events. The findings have implications for the design of stapled peptides in general.

Outcomes of mechanical stapling for postlaryngectomy open pharyngotomy closure.

PubMed

Paddle, Paul; Husain, Inna; McHugh, Lauren; Franco, Ramon

2017-03-01

A total laryngectomy (TL) is performed as a primary or salvage therapy for laryngeal carcinoma. Pharyngotomy closure after TL is typically performed using manual sutures. Automatic stapling devices are routinely used in thoracoabdominal surgery, but have not been widely accepted for use in pharyngotomy closure. Previously described closed stapling techniques of pharyngeal closure do not allow direct evaluation of surgical margins and are limited to endolaryngeal disease. We describe an open technique for pharyngotomy closure using a mechanical stapling device. Retrospective review. A review was conducted of 16 total laryngectomies performed from May 2008 to August 2015 utilizing an Ethicon Endopath ETS Compact-Flex 45 stapler. Sixteen patients (15 male, one female), mean age 69 years, received open TL (14 salvage, two primary) with endostapler pharyngeal closure and primary tracheoesophageal puncture (TEP). Surgical time averaged 218 minutes. Median time to swallowing was 4 days (range, 2-240 days) and mean hospital stay 6 days (range, 3-10 days). Fistula incidence was 31% (5/16) overall and 36% (5/14) in the postradiation patients. Mechanical stapling is a simple method for postlaryngectomy open pharyngotomy closure. This technique allows evaluation of margins, easy primary TEP, and the opportunity for early swallowing and shorter hospital stays. In addition, it can be performed for closure of salvage laryngectomies with rates of fistula formation similar to that found in the literature using suture closure techniques. Future studies are necessary to compare oncological results and surgical complications between the open and closed stapling techniques and to traditional suture closure. 4 Laryngoscope, 127:605-610, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

Novel Structures of Self-Associating Stapled Peptides

PubMed Central

Bhattacharya, Shibani; Zhang, Hongtao; Cowburn, David; Debnath, Asim K.

2012-01-01

Hydrocarbon stapling of peptides is a powerful technique to transform linear peptides into cell-permeable helical structures that can bind to specific biological targets. In this study, we have used high resolution solution NMR techniques complemented by Dynamic Light Scattering to characterize extensively a family of hydrocarbon stapled peptides with known inhibitory activity against HIV-1 capsid assembly to evaluate the various factors that modulate activity. The helical peptides share a common binding motif but differ in charge, the length and position of the staple. An important outcome of the study was to show the peptides share a propensity to self-associate into organized polymeric structures mediated predominantly by hydrophobic interactions between the olefinic chain and the aromatic side-chains from the peptide. We have also investigated in detail the structural significance of the length and position of the staple, and of olefinic bond isomerization in stabilizing the helical conformation of the peptides as potential factors driving polymerization. This study presents the numerous challenges of designing biologically active stapled peptides and the conclusions have broad implications for optimizing a promising new class of compounds in drug discovery. PMID:22170623

The tissue-selecting technique: segmental stapled hemorrhoidopexy.

PubMed

Lin, Hong-Cheng; Lian, Lei; Xie, Shang-Kui; Peng, Hui; Tai, Jian-Dong; Ren, Dong-Lin

2013-11-01

We describe a technique for the management of prolapsing hemorrhoids, with the aim to minimize the risk of anal stricture and rectovaginal fistula and to reduce the impact of the stapling technique on rectal compliance. This modified procedure was successfully applied in China, and preliminary data showed promising outcomes (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A117).

[Historical review and future orientations of the conventional vascular microanastomoses].

PubMed

Leclère, F M P; Schoofs, M; Mordon, S

2011-06-01

Microvascular surgery has become an important method for reconstructing surgical defects due to trauma, tumors or after burn. The most important factor for successful free flap transfer is a well-executed anastomosis. The time needed to perform the anastomosis and the failure rate are not negligible despite the high level of operator's experience. During the history, many alternatives were tried to help the microsurgeon and to reduce the complications. A Medline literature search was performed to find articles dealing with non-suture methods of microvascular anastomosis. Many historical books were also included. The non-suture techniques can be divided into four groups based on the used mechanism of sutures: double intubation including tubes and stents, intubation-eversion including simple rings, double eversion including staples and double rings, and wall adjustement with adhesives or laser. All these techniques were able to produce a faster and easier microvascular anastomosis. Nevertheless, disadvantages of the suturless techniques include toxicity, high cost, leakage or aneurysm formation. More refinement is needed before their widespread adoption. Thus, laser-assisted microvascular anastomosis using 1,9 μm diode laser appeared to be a safe and reliable help for the microsurgeon and may be further developed in the near future. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

[Manual suture versus/or mechanical suture from the Austrian viewpoint].

PubMed

Kronberger, L; Germann, R

1987-01-01

A general inquiry was made at surgical units and university clinics in Austria about the anastomosis techniques used between 1980 to 1985. The result was that in 90.3% the suture was made by hand and in 9.7% by machine. The first mentioned was performed as double row inverting suture by 66% of our surgeons, and only in 30% as an all-layer suture. The stapler-technique was mostly preferred for the oesophago-jejunostomy and the high and lower resection of the rectum. A leakage of the suture line was observed in 3.9% after sewing by hand and in 6.3% after stapling. The total lethality finally was 1.4% for hand made suture and 1.8% for apparative suture.

Probing the origin of structural stability of single and double stapled p53 peptide analogs bound to MDM2.

PubMed

Guo, Zuojun; Streu, Kristina; Krilov, Goran; Mohanty, Udayan

2014-06-01

The stabilization of secondary structure is believed to play an important role in the peptide-protein binding interaction. In this study, the α-helical conformation and structural stability of single and double stapled all-hydrocarbon cross-linked p53 peptides when bound and unbound to MDM2 are investigated. We determined the effects of the peptide sequence, the stereochemistry of the cross-linker, the conformation of the double bond in the alkene bridge, and the length of the bridge, to the relative stability of the α-helix structure. The binding affinity calculations by WaterMap provided over one hundred hydration sites in the MDM2 binding pocket where water density is greater than twice that of the bulk, and the relative value of free energy released by displacing these hydration sites. In agreement with the experimental data, potentials of mean force obtained by weighted histogram analysis methods indicated the order of peptides from lowest to highest binding affinity. Our study provides a comprehensive rationalization of the relationship between peptide stapling strategy, the secondary structural stability, and the binding affinity of p53/MDM2 complex. We hope our efforts can help to further the development of a new generation p53/MDM2 inhibitors that can reactivate the function of p53 as tumor suppressor gene. © 2014 John Wiley & Sons A/S.

Parallelization of Unsteady Adaptive Mesh Refinement for Unstructured Navier-Stokes Solvers

NASA Technical Reports Server (NTRS)

Schwing, Alan M.; Nompelis, Ioannis; Candler, Graham V.

2014-01-01

This paper explores the implementation of the MPI parallelization in a Navier-Stokes solver using adaptive mesh re nement. Viscous and inviscid test problems are considered for the purpose of benchmarking, as are implicit and explicit time advancement methods. The main test problem for comparison includes e ects from boundary layers and other viscous features and requires a large number of grid points for accurate computation. Ex- perimental validation against double cone experiments in hypersonic ow are shown. The adaptive mesh re nement shows promise for a staple test problem in the hypersonic com- munity. Extension to more advanced techniques for more complicated ows is described.

[Technical considerations on 222 cases of esophageal anastomosis using a stapler].

PubMed

Liboni, A; Zamboni, P; Mari, C; Uzzau, A; Salomoni, C; Brunelli, G; Buccoliero, F; Donini, I

1989-05-01

The Authors report their experience with 222 esophagoenteric anastomoses, performed in 211 cases for malignant neoplasms (middle and lower third) of the esophagus or stomach. Particularly, they have performed 4 Sujura operations, 31 esophagogastric, 4 esophagocolic, 183 esophagojejunal anastomoses utilizing SPTU, ILS and EEA circular stapler. GIA was used in the preparation of the stomach before esophagogastroplasty. Mortality rate of the manual period (1970-1980: 114 cases operated) was 14.5% versus 2.2% of the stapling period (1981-1987: 222 cases operated). From the technical point of view reasons of the superiority of stapled technique are discussed and summarized as follows: 1) space not favourable for handsewn anastomoses; 2) stapled technique allows the surgeon to save anastomoses vascularization; 3) the stapler performs the suture simultaneously so to reduce tensile strength on the anastomoses and the fragile esophageal wall especially; 4) stapled agraphes are fixed in three points vs. the two points of the handsewn stitches.

Long-term clinical results of double-pursestring stapled hemorrhoidopexy in a selected group of patients for the treatment of chronic hemorrhoids.

PubMed

Arroyo, Antonio; Pérez-Legaz, Juan; Miranda, Elena; Moya, Pedro; Ruiz-Tovar, Jaime; Lacueva, Francisco-Javier; Candela, Fernando; Calpena, Rafael

2011-05-01

The aim of this prospective controlled trial was to evaluate the long-term clinical and manometric results of stapled hemorrhoidopexy performed by expert surgeons in a selected group of patients for the treatment of chronic hemorrhoids. This study took place in the outpatient clinic and at the Day Surgery Unit attached to the University Hospital of Elche. From March 2003 to May 2005, 200 consecutive patients with third-degree hemorrhoids and treated with double-pursestring stapled hemorrhoidopexy with a PPH33-03 stapler were included in the study. Demographic, manometric, and clinical features were analyzed, as well as the variables related to surgery, postoperative course, and follow-up. Manometry was repeated at the 6-month, 1-year, and 5-year follow-up. Median follow-up was 110 months. Four patients (2%) reported daily rectal bleeding. One patient with active rectal bleeding was taken for reoperation within the first 12 postoperative hours. Seventy percent of patients reported pain ≤ 2 on the first postoperative day, 85% on the fourth postoperative day, and 95% on the seventh postoperative day. Pain was measured with a linear analog scale from 0 to 10 (0 = no pain; 10 = unbearable pain). Seventeen patients (8.5%) reported tenesmus during the first week. Eight patients (4%) reported persistent pain: in 5 patients, the pain resolved within the next 6 months; 2 patients presented with anal fissure; and 1 patient required the removal of the staples. Two patients (1%) reported residual soiling at the 5-year revision. Fourteen patients (7%) experienced recurrence with symptomatic prolapse. Six (3%) underwent further surgery: stapled hemorrhoidopexy was indicated again in 2 patients, and 4 patients underwent a Milligan-Morgan open hemorrhoidectomy, because they did not have a uniform prolapse. Six patients required treatment with rubber band ligation. There were no statistically significant differences between preoperative and postoperative manometric values. The new PPH33-03 stapler, the learning process of the modified surgical procedure, and the correct selection of patients will overcome the main objections to stapled hemorrhoidopexy.

Reconstruction of the esophagojejunostomy by double stapling method using EEA™ OrVil™ in laparoscopic total gastrectomy and proximal gastrectomy

PubMed Central

2011-01-01

Here we report the method of anastomosis based on double stapling technique (hereinafter, DST) using a trans-oral anvil delivery system (EEATM OrVilTM) for reconstructing the esophagus and lifted jejunum following laparoscopic total gastrectomy or proximal gastric resection. As a basic technique, laparoscopic total gastrectomy employed Roux-en-Y reconstruction, laparoscopic proximal gastrectomy employed double tract reconstruction, and end-to-side anastomosis was used for the cut-off stump of the esophagus and lifted jejunum. We used EEATM OrVilTM as a device that permitted mechanical purse-string suture similarly to conventional EEA, and endo-Surgitie. After the gastric lymph node dissection, the esophagus was cut off using an automated stapler. EEATM OrVilTM was orally and slowly inserted from the valve tip, and a small hole was created at the tip of the obliquely cut-off stump with scissors to let the valve tip pass through. Yarn was cut to disconnect the anvil from a tube and the anvil head was retained in the esophagus. The end-Surgitie was inserted at the right subcostal margin, and after the looped-shaped thread was wrapped around the esophageal stump opening, assisting Maryland forceps inserted at the left subcostal and left abdomen were used to grasp the left and right esophageal stump. The surgeon inserted anvil grasping forceps into the right abdomen, and after grasping the esophagus with the forceps, tightened the end Surgitie, thereby completing the purse-string suture on the esophageal stump. The main unit of the automated stapler was inserted from the cut-off stump of the lifted jejunum, and a trocar was made to pass through. To prevent dropout of the small intestines from the automated stapler, the automated stapler and the lifted jejunum were fastened with silk thread, the abdomen was again inflated, and the lifted jejunum was led into the abdominal cavity. When it was confirmed that the automated stapler and center rod were made completely linear, the anvil and the main unit were connected with each other and firing was carried out. Then, DST-based anastomosis was completed with no dog-ear. The method may facilitate safe laparoscopic anastomosis between the esophagus and reconstructed intestine. This is also considered to serve as a useful anastomosis technique for upper levels of the esophagus in laparotomy. PMID:21599911

Initial experience with the use of fibrin sealant for the fixation of the prosthetic mesh in laparoscopic transabdominal preperitoneal hernia repair.

PubMed

Langrehr, J M; Schmidt, S C; Neuhaus, P

2005-08-01

Laparoscopic inguinal hernia repair offers more rapid recovery and less pain than with the traditional open approach. However, injury to the nerves of the lumbar plexus with subsequent chronic pain or neuralgia has a reported incidence of 2% during laparoscopic hernia repair, particularly when the transabdominal preperitoneal technique (TAPP) is used. These complications are inherent to the use of staples for fixation of the mesh. To avoid nerve irritation, we considered the use of fibrin sealant for the fixation of the mesh instead of staples. The aim of this study was to evaluate this technique and to compare the short-term follow-up of these patients with patients who underwent the staple repair technique. This is the first reported use of fibrin sealant in laparoscopic TAPP hernia repair. Between September and November 2004, we performed 17 consecutive laparoscopic hernia repairs (TAPP) in 14 patients (3 bilateral hernias) with primary hernias. The prosthetic mesh was fixed (10 x 15 cm) with 1 ml fibrin. The fibrin was applied using a special laparoscopic applicator. The peritoneum was closed with absorbable sutures. The postoperative course of these patients was compared with a cohort of matched patients who received the traditional staple fixation of the prosthetic mesh. Patients were evaluated at a median follow-up of 10.4 months (3.8-16.0 months). All patients underwent postoperative physical examinations. No recurrent hernia was found. There were 2 seromas and one hematoma in the stapled group. In the stapled group, one patient had pain in the area of the lateral femoral cutaneous nerve. There was no postoperative complication in the non-stapled group. Fibrin fixation of the mesh during laparoscopic transabdominal preperitoneal inguinal hernia repair is feasible without higher risk of recurrences. In addition the fibrin fixation method may decrease postoperative neuralgia and reduce the incidence of postoperative seromas and hematomas.

Suture Products and Techniques: What to Use, Where, and Why.

PubMed

Regula, Christie G; Yag-Howard, Cyndi

2015-10-01

There are an increasing number of wound closure materials and suturing techniques described in the dermatologic and surgery literature. A dermatologic surgeon's familiarity with these materials and techniques is important to supplement his or her already established practices and improve surgical outcomes. To perform a thorough literature review of wound closure materials (sutures, tissue adhesives, surgical tape, and staples) and suturing techniques and to outline how and when to use them. A literature review was conducted using PubMed and other online search engines. Keywords searched included suture, tissue adhesive, tissue glue, surgical tape, staples, dermatologic suturing, and suturing techniques. Numerous articles outline the utility of various sutures, surgical adhesives, surgical tape, and staples in dermatologic surgery. In addition, there are various articles describing classic and novel suturing techniques along with their specific uses in cutaneous surgery. Numerous factors must be considered when choosing a wound closure material and suturing technique. These include wound tension, desire for wound edge eversion/inversion, desired hemostasis, repair type, patient's ability to care for the wound and return for suture removal, skin integrity, and wound location. Careful consideration of these factors and proper execution of suturing techniques can lead to excellent cosmetic results.

An alternative continence tube for continent urinary reservoirs: evaluation of surgical technique, pressure and continence study in an ex-vivo model.

PubMed

Honeck, Patrick; Michel, Maurice Stephan; Trojan, Lutz; Alken, Peter

2009-02-01

Despite the large number of surgical techniques for continent cutaneous diversion described in literature, the creation of a reliable, continent and easily catheterizable continence mechanism remains a complex surgical procedure. Aim of this study was the evaluation of a new method for a catheterizable continence mechanism using stapled pig intestine. Small and large pig intestines were used for construction. A 3 or 6 cm double row stapling system was used. Three variations using small and large intestine segments were constructed. A 3 or 6 cm long stapler line was placed alongside a 12 Fr catheter positioned at the antimesenterial side creating a partially two-luminal segment. Construction time for the tube was measured. The created tube was then embedded into the pouch. Pressure evaluation of the continence mechanism was performed for each variation. Intermittent external manual compression was used to simulate sudden pressure exposure. All variations were 100% continent under filling volumes of up to 700 ml and pressure levels of 58 +/- 6 cm H(2)O for large intestine and 266 ml and 87 +/- 18 cm H(2)O for small intestine, respectively. With further filling above the mentioned capacity suture insufficiency occurred but no tube insufficiency. Construction time for all variations was less than 12 min. The described technique is an easy and fast method to construct a continence mechanism using small or large intestine. Our ex vivo experiments have shown sufficient continence situation in an ex-vivo model. Further investigations in an in-vivo model are needed to confirm these results.

[Local recurrence following anterior rectum resection--manual versus stapler suture].

PubMed

Metzger, U; Weber, W; Weber, E; Linggi, J; Buchmann, P; Largiadèr, F

1985-04-01

A retrospective study was carried out on 88 hand sewn and 34 stapled anastomoses following anterior resection to evaluate the impact of suture technique on local recurrence rate. The patient groups were comparable with one exception: there were significantly more Dukes C lesions resected and sutured using the stapling gun (35% versus 15%, X2 = 6.33, p less than 0.05). Stage-corrected recurrence rate was similar in both groups, Dukes A: 8%, Dukes B 21%, Dukes C 52%, all recurrences being detected within 24 months following operation. Significantly fewer protective colostomies were needed using the staple gun (15% versus 34%, X2 = 4.50, p less than 0.05). Otherwise, no significant difference or benefit was observed comparing the two suture techniques.

[An alternative continence mechanism for continent catheterisable micturation].

PubMed

Honeck, P; Alken, P

2010-01-01

The creation of a stable, reliable, continent and easily catheterisable continence mechanism is an essential prerequisite for the construction of a continent cutaneous urinary reservoir. Although a substantial number of surgical methods has been described, construction is still a complex surgical procedure. The aim of this study was the evaluation of a new method for a continence mechanism using stapled small or large intestine. Small and large pig intestine was used for construction. For stapling the tube a 3 cm or 6 cm double row stapling system was used. Two variations using small and large intestine segments were constructed (IL 1, COL 1, COL 2). A 3 or 6 cm long stapler line was placed alongside a 12 Fr catheter positioned at the antimesenterial side creating a partially two-luminal segment. The open end of the non-catheterised lumen and the opposite intestinal end were closed by continuous sutures. The created tube was then embedded into the pouch. Pressure evaluation was performed for each variation. Intermittent external manual compression was used to simulate sudden pressure exposure. Construction times for the IL 1 and COL 1 variations were 10 +/- 1.5 min and 6.2 +/- 1.3 min for COL 2. All variations showed no leakage during filling or external compression. The maximum capacity was lower for the IL 1 compared to the COL variation. The maximum pressure levels reached did not differ significantly. The described technique is an easy and fast method to construct a continent and easy to catheterize continence mechanism using small or large intestine.

Rapid totally diverting loop sigmoid colostomy with noncontaminating rectal irrigation.

PubMed

Sachatello, C R; Maull, K I

1977-08-01

Loop sigmoid colostomy employing a stapling device and catheter irrigation of the distal segment is less time-consuming and has lest potential for contamination than the standard double-barrel colostomy. Unlike the standard loop colostomy, it is totally diverting.

Surgical Techniques at Cesarean Delivery: A U.S. Survey

PubMed Central

Lyell, Deirdre J.; Power, Michael; Murtough, Katie; Ness, Amen; Anderson, Britta; Erickson, Kristine; Schulkin, Jay

2016-01-01

Objective  To assess the frequency of surgical techniques at cesarean delivery (CD) among U.S. obstetricians. Methods  Members of the American College of Obstetrician Gynecologists were randomly selected and e-mailed an online survey that assessed surgical closure techniques, demographics, and reasons. Data were analyzed using SPSS (IBM Corp., Armonk, New York, United States), descriptive statistics, and analysis of variance. Results  Our response rate was 53%, and 247 surveys were analyzed. A similar number of respondents either “always or usually” versus “rarely or never” reapproximate the rectus muscles (38.4% versus 43.3%, p  = 0.39), and close parietal peritoneum (42.5% versus 46.9%, p  = 0.46). The most frequently used techniques were double-layer hysterotomy closure among women planning future children (73.3%) and suturing versus stapling skin (67.6%); the least frequent technique was closure of visceral peritoneum (12.2%). Surgeons who perform double-layer hysterotomy closure had fewer years in practice (15.0 versus 18.7 years, p  = 0.021); surgeons who close visceral peritoneum were older (55.5 versus 46.4 years old, p  < 0.001) and had more years in practice (23.8 versus 13.8 years practice; p  < 0.001). Conclusion  Similar numbers of obstetricians either reapproximate or leave open the rectus muscles and parietal peritoneum at CD, suggesting that wide variation in practice exists. Surgeon demographics and safety concerns play a role in some techniques. PMID:28825004

A standardized safe hepatectomy; selective Glissonean transection using endolinear stapling devices.

PubMed

Fujii, Masahiko; Shimada, Mitsuo; Satoru, Imura; Morine, Yuji; Ikemoto, Tetsuya; Soejima, Yuji

2007-01-01

Selective clamping of Glisson's pedicle at the hilum is effective for systematized hepatectomy. Because of the development of stapling devices, a Glissonean transection using a surgical stapler has been used widely. However, the risk of accidental stapling of the biliary confluence still remains. In this paper we report about a case that underwent selective Glissonean transection using an endolinear stapling device. We used this standardized technique in five patients without any major complications. The particular case to which we refer was a 71-year-old woman with hepatocellular carcinoma in the right lobe. The anterior and posterior branches of Glisson's pedicle were independently divided using an endolinear stapling device. The right hepatic lobectomy was achieved with little bleeding and in addition there was a shortened operation time and the postoperative course was uneventful. In the patient with liver cirrhosis, postoperative complications often related to liver failure. We herein advocate a standardized safe hepatectomy using endolinear stapling devices. We believe that the shortened operative time and decreased risk of complications by selective Glissonean transection as well as hepatic vein transection using stapling devices contribute to the improved short-term outcome.

Current Developments and Unusual Aspects in Gastrointestinal Surgical Stapling.

PubMed

Frattini, Francesco; Amico, Francesco; Rausei, Stefano; Boni, Luigi; Rovera, Francesca; Dionigi, Gianlorenzo

2015-11-01

Stapling devices are used in gastrointestinal, gynecologic, thoracic, and many other surgeries to resect organs, transect tissues, and anastomose different structures. These devices became widely accepted standard practice in many gastrointestinal operations, especially since the successful advent of minimally invasive surgery. Despite the relevant advantages related to the use of a surgical stapler, we must also consider that these instruments may be at risk of failure. When any component fails, the patient is at risk of operative morbidity. Gastrointestinal surgical stapling technique still needs refinement in order to increase its reliability. Staple line reinforcement has been widely used and seems to effectively reduce anastomotic complications. Literature provides us with examples of studies supporting both bleeding and leakage reduction after staple line reinforcement, but high-quality evidence is not available to date. Semi-absorbable and nonabsorbable materials have been the earliest available. The use of bioabsorbable staple line reinforcement materials has recently become more widespread, and these materials are more widely used these days. Powered staplers were made available to the market some time ago and represent a rather unheard of aspect of endosurgical stapling. Despite powered staples being supposedly convenient compared with manual ones only one relevant article was found when searching the U.S. National Library of Medicine for "powered stapler." New surgical stapling devices are constantly developed and introduced on the market. Results with such devices depend on the stapler features but also surely vary according to the surgeon experience.

A powered vascular staple for the application of segmental bronchial closure in thoracoscopic anatomic segmentectomy.

PubMed

Kuroda, Hiroaki; Yoshida, Tatsuya; Sakao, Yukinori

2017-12-01

We used the powered vascular staple (PVS) instead of the conventional staple technique [the utilization of the powered linier cutter (PLC)] or ligation for total 23 segmental or subsegmental bronchi with less than 10 mm in the bronchial luminal size on computed tomography (CT) in thoracoscopic segmentectomy. Our results suggested that the availability of the PVS represents a novel advance in the armamentarium and may have a possibility of being pervasive widely however, more observative periods and further sample accumulation are needed.

Double quick, double click reversible peptide "stapling".

PubMed

Grison, Claire M; Burslem, George M; Miles, Jennifer A; Pilsl, Ludwig K A; Yeo, David J; Imani, Zeynab; Warriner, Stuart L; Webb, Michael E; Wilson, Andrew J

2017-07-01

The development of constrained peptides for inhibition of protein-protein interactions is an emerging strategy in chemical biology and drug discovery. This manuscript introduces a versatile, rapid and reversible approach to constrain peptides in a bioactive helical conformation using BID and RNase S peptides as models. Dibromomaleimide is used to constrain BID and RNase S peptide sequence variants bearing cysteine (Cys) or homocysteine ( h Cys) amino acids spaced at i and i + 4 positions by double substitution. The constraint can be readily removed by displacement of the maleimide using excess thiol. This new constraining methodology results in enhanced α-helical conformation (BID and RNase S peptide) as demonstrated by circular dichroism and molecular dynamics simulations, resistance to proteolysis (BID) as demonstrated by trypsin proteolysis experiments and retained or enhanced potency of inhibition for Bcl-2 family protein-protein interactions (BID), or greater capability to restore the hydrolytic activity of the RNAse S protein (RNase S peptide). Finally, use of a dibromomaleimide functionalized with an alkyne permits further divergent functionalization through alkyne-azide cycloaddition chemistry on the constrained peptide with fluorescein, oligoethylene glycol or biotin groups to facilitate biophysical and cellular analyses. Hence this methodology may extend the scope and accessibility of peptide stapling.

Staple line reinforcement during sleeve gastrectomy with a new type of reinforced stapler.

PubMed

El Moussaoui, Imad; Limbga, Augustin; Mehdi, Abdelilah

2018-04-01

Bleeding and staple-line leak, are the most common complications of laparoscopic sleeve gastrectomy. To decrease the incidence of this complications, a variety of intraoperative reinforcement of staple line is used. Reinforced GIA™ is a new automatic suture device with pre-attached synthetic tissue reinforcement, but no study has evaluated its use in sleeve gastrectomy. The objective of this study is to evaluate the efficacy and safety of this new staple line reinforcement technique in laparoscopic sleeve gastrectomy. We conducted a retrospective review of 290 patients who underwent laparoscopic sleeve gastrectomy between January 2013 and January 2016 in which reinforced GIA™ or standard GIA™ was used. Patients preoperative characteristics, Operative time, staple line leaks, staple line bleeds, stenosis, and complications requiring reoperation were collected. A total of 187 laparoscopic sleeve gastrectomy were performed with standard GIA and 103 with reinforced GIA™. Patient characteristics were not significantly different between the groups. The average operating time in the standard GIA group is 57.41±16.44 min against 50.9±14.12 min in the reinforced GIA group (P=0.006). Two staple line leaks developed in the standard GIA group and reoperated against no patients in the reinforced GIA group, without significant difference between the both groups (P=0.66). Staple line bleeds are less in the reinforced GIA group, only 23 (22.3%) against 78 (41.7%) cases in the standard GIA group (P=0.001). No patients of both groups developed gastric sleeve stenosis. During laparoscopic sleeve gastrectomy, the use of a reinforced stapler significantly reduces the operative time and staple line bleeding. No significant difference is evidenced in terms of reduction of staple line leaks with this reinforced stapler.

Maize genotype and food matrix affect the provitamin A carotenoid bioefficacy from staple and carrot-fortified feeds in Mongolian gerbils (Meriones unguiculatus)

USDA-ARS?s Scientific Manuscript database

Biofortification of staple crops to increase provitamin A carotenoids is a promising technique to alleviate vitamin A deficiency. ß-Carotene (ßC) and ß-cryptoxanthin (ßCX) are low in typical maize but higher in biofortified varieties. In vitro screening methods evaluate bioaccessibility of carotenoi...

Production of Exocytic Vesicular Antigens by Primary Liver Cell Cultures

DTIC Science & Technology

1990-05-08

cells should be plated over the basement membrane proteins, and for optimal results, a second layer of protein should be precipitated over the cells...culture as two layer (two gelatin coated nylon sheets stapled together) and single layer carriers seeded with cells (Table 2). From the performance results...summarized in table 2, it can be seen that double sheets of 2% gelatin: 6% glutaraldehyde (carrier II) made the best carriers. A double layer of

Preparation and Characterization of Nitinol Bone Staples for Cranio-Maxillofacial Surgery

NASA Astrophysics Data System (ADS)

Lekston, Z.; Stróż, D.; Jędrusik-Pawłowska, M.

2012-12-01

The aim of this work was to form NiTi and TiNiCo body temperature activated and superelastic staples for clinical joining of mandible and face bone fractures. The alloys were obtained by VIM technique. Hot and cold processing was applied to obtain wires of required diameters. The martensitic transformation was studied by DSC, XRD, and TEM. The shape memory effects were measured by a bend and free recovery ASTM F2082-06 test. The superelasticity was recorded in the tension stress-strain and by the three-point bending cycles in an instrument equipped with a Hottinger force transducer and LVDT. Excellent superelastic behavior of TiNiCo wires was obtained after cold working and annealing at 400-500 °C. The body temperature activated shape memory staples were applied for fixation of mandibular condyle fractures. In experiments on the skull models, fixation of the facial fractures by using shape memory and superelastic staples were compared. The superelastic staples were used in osteosynthesis of zygomatico-maxillo-orbital fractures.

A randomized study comparing skin closure in cesarean sections: staples vs subcuticular sutures.

PubMed

Rousseau, Julie-Anne; Girard, Karine; Turcot-Lemay, Lucile; Thomas, Nancy

2009-03-01

We sought to compare postoperative pain according to the skin closure method (subcuticular sutures vs staples) after an elective term cesarean section. A randomized controlled trial of 101 women was performed. Women were randomly assigned to subcuticular sutures or staples. Operative technique and postoperative analgesia were standardized. Stratification was used for primary vs repeat cesareans. Analog pain and satisfaction scales ranging from 0-10 were completed at postoperative days 1 and 3, and at 6 weeks postoperatively. A digital photograph of the incision was taken at 6 weeks postoperatively and evaluated by 3 independent blinded observers. Pain at 6 weeks postoperatively was significantly less in the staple group (0.17 vs 0.51; P = .04). Operative time was shorter in that group (24.6 vs 32.9 minutes; P < .0001). No difference was noted for incision appearance and women's satisfaction. Staples are the method of choice for skin closure for elective term cesareans in our population.

Why water will be the driving force behind agricultural sustainability

USDA-ARS?s Scientific Manuscript database

In the latter half of the 20th century, world population more than doubled to 6 billion, staple food prices in constant dollars decreased dramatically, and the nutritional status of the world's population improved. The Green Revolution is cited as accounting for this paradox; but often ignored is th...

Anatomic Outside-In Reconstruction of the Anterior Cruciate Ligament Using Femoral Fixation with Metallic Interference Screw and Surgical Staples (Agrafe) in the Tibia: An Effective Low-Cost Technique.

PubMed

Diego, Ariel de Lima; Stemberg Martins, de Vasconcelos; Dias, Leite José Alberto; Moreira, Pinto Dilamar; Beltrão, Teixeira Rogério; Coelho, de Léo Álvaro; de Lima, Silveira Leonardo; Krause, Gonçalves Romeu; Carvalho Krause, Gonçalves Marcelo; Carolina Leite, de Vasconcelos Ana; Dias Costa, Filho Carlos Frederico; Lana Lacerda, de Lima

2017-01-01

An anterior cruciate ligament (ACL) rupture is a frequent injury, with short and long-term consequences if left untreated. With a view to benefitting as many patients as possible and preventing future complications, we created a low-cost ligament reconstruction technique. The present article describes an anatomic ACL reconstruction technique. The technique involves single-band reconstruction, using flexors tendon graft, outside-in tunnel perforation, femoral fixation with metal interference screw and surgical staples (Agrafe) in the longitudinal position. We present a simple, easy-to-reproduce technique that, when executed on patients with good bone quality, primarily in the tibia, is effective and inexpensive, favoring its large scale application.

Anatomic Outside-In Reconstruction of the Anterior Cruciate Ligament Using Femoral Fixation with Metallic Interference Screw and Surgical Staples (Agrafe) in the Tibia: An Effective Low-Cost Technique

PubMed Central

Diego, Ariel de Lima; Stemberg Martins, de Vasconcelos,; Dias, Leite, José Alberto; Moreira, Pinto, Dilamar; Beltrão, Teixeira, Rogério; Coelho, de Léo, Álvaro; de Lima, Silveira, Leonardo; Krause, Gonçalves, Romeu; Carvalho Krause, Gonçalves, Marcelo; Carolina Leite, de Vasconcelos, Ana; Dias Costa, Filho, Carlos Frederico; Lana Lacerda, de Lima,

2017-01-01

Background: An anterior cruciate ligament (ACL) rupture is a frequent injury, with short and long-term consequences if left untreated. With a view to benefitting as many patients as possible and preventing future complications, we created a low-cost ligament reconstruction technique. Method: The present article describes an anatomic ACL reconstruction technique. Results: The technique involves single-band reconstruction, using flexors tendon graft, outside-in tunnel perforation, femoral fixation with metal interference screw and surgical staples (Agrafe) in the longitudinal position. Conclusion: We present a simple, easy-to-reproduce technique that, when executed on patients with good bone quality, primarily in the tibia, is effective and inexpensive, favoring its large scale application. PMID:29290851

Design of stapled DNA-minor-groove-binding molecules with a mutable atom simulated annealing method

NASA Astrophysics Data System (ADS)

Walker, Wynn L.; Kopka, Mary L.; Dickerson, Richard E.; Goodsell, David S.

1997-11-01

We report the design of optimal linker geometries for the synthesis of stapledDNA-minor-groove-binding molecules. Netropsin, distamycin, and lexitropsinsbind side-by-side to mixed-sequence DNA and offer an opportunity for thedesign of sequence-reading molecules. Stapled molecules, with two moleculescovalently linked side-by-side, provide entropic gains and restrain theposition of one molecule relative to its neighbor. Using a free-atom simulatedannealing technique combined with a discrete mutable atom definition, optimallengths and atomic composition for covalent linkages are determined, and anovel hydrogen bond `zipper' is proposed to phase two molecules accuratelyside-by-side.

Techniques of stapler-based navigational thoracoscopic segmentectomy using virtual assisted lung mapping (VAL-MAP)

PubMed Central

Murayama, Tomonori; Nakajima, Jun

2016-01-01

Anatomical segmentectomies play an important role in oncological lung resection, particularly for ground-glass types of primary lung cancers. This operation can also be applied to metastatic lung tumors deep in the lung. Virtual assisted lung mapping (VAL-MAP) is a novel technique that allows for bronchoscopic multi-spot dye markings to provide “geometric information” to the lung surface, using three-dimensional virtual images. In addition to wedge resections, VAL-MAP has been found to be useful in thoracoscopic segmentectomies, particularly complex segmentectomies, such as combined subsegmentectomies or extended segmentectomies. There are five steps in VAL-MAP-assisted segmentectomies: (I) “standing” stitches along the resection lines; (II) cleaning hilar anatomy; (III) confirming hilar anatomy; (IV) going 1 cm deeper; (V) step-by-step stapling technique. Depending on the anatomy, segmentectomies can be classified into linear (lingular, S6, S2), V- or U-shaped (right S1, left S3, S2b + S3a), and three dimensional (S7, S8, S9, S10) segmentectomies. Particularly three dimensional segmentectomies are challenging in the complexity of stapling techniques. This review focuses on how VAL-MAP can be utilized in segmentectomy, and how this technique can assist the stapling process in even the most challenging ones. PMID:28066675

Pelvic flexure enterotomy closure in the horse with a TA-90 stapling device: A retrospective clinical study of 84 cases (2001–2008)

PubMed Central

Rosser, Julie; Brounts, Sabrina; Slone, Don; Lynch, Tim; Livesey, Michael; Hughes, Faith; Clark, Carol

2012-01-01

Our objective was to compare survival and complication rates of horses undergoing pelvic flexure enterotomy closure with a TA-90 stapler to those with hand-sewn closure. Medical records of horses undergoing pelvic flexure enterotomy between 2001 and 2008 were reviewed. History, clinical signs, surgical findings, surgical techniques, and post-operative complications were recorded. Long-term outcome was established by telephone questionnaire. Of 84 pelvic flexure enterotomies performed, 70 were stapled and 14 were hand-sewn. Seventy-seven horses survived to discharge (91.7%). There were no significant associations between survival and closure technique (P = 0.69). Follow-up was available for 54 horses; 50 survived long-term (93.0%). No statistical significance was identified between long-term survival and closure method (P = 0.39). Forty horses went on to athletic performance (80.0%). TA-90 stapled closure of pelvic flexure enterotomies is a safe technique resulting in survival and complication rates equivalent to those of hand-sewn closure. PMID:23204584

Assessment of the use of disposable skin staplers in bowel anastomoses to reduce laparotomy time in penetrating ballistic injury to the abdomen.

PubMed Central

Howell, G. P.; Ryan, J. M.; Morgans, B. T.; Cooper, G. J.

1991-01-01

Laparotomy and anastomosis of the small bowel after penetrating injury to the abdomen is a lengthy procedure. This paper describes the use of skin staplers for bowel anastomosis and presents the results of a short series of experiments upon dead pigs to compare the staple technique with conventional handsewn anastomosis. The time taken to perform each small bowel anastomosis, the integrity of the anastomosis and the skill required were assessed. The staple technique was considerably faster (mean construction time: 5.4 min, range 4-6 min) than the handsewn technique (mean construction time: 12 min, range 10-14 min), at least halving the anastomosis time (Kolmogorov two-sample test P = 0.05). In addition, the stapled anastomosis had a higher intraluminal failure pressure (mean failure pressure: 65 cmH2O, 6.37 kPa, range 30-70 cmH2O) than the handsewn anastomosis (mean failure pressure: 38.6 cmH2O, 3.78 kPa, range 10-70 cmH2O). Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:2018326

Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates.

PubMed

Fleetwood, V A; Gross, K N; Alex, G C; Cortina, C S; Smolevitz, J B; Sarvepalli, S; Bakhsh, S R; Poirier, J; Myers, J A; Singer, M A; Orkin, B A

2017-03-01

Anastomotic leak (AL) increases costs and cancer recurrence. Studies show decreased AL with side-to-side stapled anastomosis (SSA), but none identify risk factors within SSAs. We hypothesized that stapler characteristics and closure technique of the common enterotomy affect AL rates. Retrospective review of bowel SSAs was performed. Data included stapler brand, staple line oversewing, and closure method (handsewn, HC; linear stapler [Barcelona technique], BT; transverse stapler, TX). Primary endpoint was AL. Statistical analysis included Fisher's test and logistic regression. 463 patients were identified, 58.5% BT, 21.2% HC, and 20.3% TX. Covidien staplers comprised 74.9%, Ethicon 18.1%. There were no differences between stapler types (Covidien 5.8%, Ethicon 6.0%). However, AL rates varied by common side closure (BT 3.7% vs. TX 10.6%, p = 0.017), remaining significant on multivariate analysis. Closure method of the common side impacts AL rates. Barcelona technique has fewer leaks than transverse stapled closure. Further prospective evaluation is recommended. Copyright © 2017. Published by Elsevier Inc.

A simplified technique for continent urinary diversion: an all-stapled colonic reservoir.

PubMed

Parra, R O

1991-12-01

A simple continent colonic reservoir was constructed in its entirety with the aid of surgical stapling techniques in 17 men and 10 women. In 5 men an orthotopic pouch was created and in the rest a continent stoma was designed. Detubularization of the entire colonic segment assures a low pressure system with disruption of directional peristaltic activity. The ureters are implanted by simply burying them in a mucosal furrow. Operative time required for the creation of the reservoir (excluding time for cystectomy) has ranged between 70 and 140 minutes (mean 95.4 minutes). With a followup of 9 to 60 months (mean 22.8 months) continence has been achieved in all but 1 patient with no ureteral reflux or obstruction. Urodynamically the pouch has achieved a large capacity (mean 750 cc) with low filling pressures (8.1 cm. water) because of technical ease of construction together with a shortened operative time due to the stapling techniques. This form of bladder replacement offers an option for select patients in whom continent urinary diversion is contemplated.

Frequency of Dehiscence in Hand-Sutured and Stapled Intestinal Anastomoses in Dogs.

PubMed

Duell, Jason R; Thieman Mankin, Kelley M; Rochat, Mark C; Regier, Penny J; Singh, Ameet; Luther, Jill K; Mison, Michael B; Leeman, Jessica J; Budke, Christine M

2016-01-01

To determine the frequency of dehiscence of hand-sutured and stapled intestinal anastomoses in the dog and compare the surgery duration for the methods of anastomosis. Historical cohort study. Two hundred fourteen client-owned dogs undergoing hand-sutured (n = 142) or stapled (n = 72) intestinal anastomoses. Medical records from 5 referral institutions were searched for dogs undergoing intestinal resection and anastomosis between March 2006 and February 2014. Demographic data, presence of septic peritonitis before surgery, surgical technique (hand-sutured or stapled), surgery duration, surgeon (resident versus faculty member), indication for surgical intervention, anatomic location of resection and anastomosis, and if dehiscence was noted postoperatively were retrieved. Estimated frequencies were summarized and presented as proportions and 95% confidence intervals (CI) and continuous outcomes as mean (95% CI). Comparisons were made across methods of anastomosis. Overall, 29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure. © Copyright 2015 by The American College of Veterinary Surgeons.

Linear stapler closure of the pharynx during total laryngectomy: a 15-year experience (from closed technique to semi-closed technique)

PubMed Central

Altissimi, G; Frenguelli, A

2007-01-01

Summary Personal experience in performing linear stapler closure of the pharynx during 70 total laryngectomies is reported. Laryngeal staplers (55 and 60 cm) with an angled handle were used, permitting vertical closure with 19 or 20 metal staples in a double row. A closed technique was initially used, but, over the years, this has gradually been replaced by the semi-closed technique to avoid trapping the suprahyoid part of the epiglottis between the jaws of the stapler. The stapler is inserted below the larynx after having separated it from all muscular and neurovascular connections, and after performing a mini-pharyngotomy at the vallecula epiglottica in order to extract the epiglottis, evert it ventrally and suture it to the hyothyroepiglottic space. The jaws of the stapler are closed and the staples are fired while the flaps of the mini-pharyngotomy are raised above the jaws. The scalpel is inserted above the stapler to remove the larynx. When the stapler is opened, the vertical linear suture of the pharynx is evident and can be examined. This procedure takes only a few minutes to perform. It guarantees a long-term stable watertight closure, dramatically reduces contamination of the operating field by pharyngeal secretions, and permits rapid healing time, greatly lowering patient management costs. In the cases presented here, there was a 1.8% rate of pharyngocutaneous fistulae in patients who were not radiated, whereas the rate was 13.1% in pre-radiated patients. In agreement with the international literature, this procedure does not increase the rate of fistulae and, in fact, it seems to reduce it. Moreover, it is particularly indicated for pre-radiated patients. Nevertheless, the Authors recommend reserving this type of procedure to cases in which, based on meticulous pre-operative assessment by means of endoscopy and imaging, the endolaryngeal site of the tumour has been assessed and there is no need for peri-operative exploration of the pharynx or tongue base. PMID:17883187

Early tension loss in an anterior cruciate ligament graft. A cadaver study of four tibial fixation devices.

PubMed

Grover, Dustin M; Howell, Stephen M; Hull, Maury L

2005-02-01

The tensile force applied to an anterior cruciate ligament graft determines the maximal anterior translation; however, it is unknown whether the tensile force is transferred to the intra-articular portion of the graft and whether the intra-articular tension and maximal anterior translation are maintained shortly after ligament reconstruction. Ten cadaveric knees were reconstructed with a double-looped tendon graft. The graft was looped through a femoral fixation transducer that measured the resultant force on the proximal end of the graft. A pneumatic cylinder applied a tensile force of 110 N to the graft exiting the tibial tunnel with the knee in full extension. The graft was fixed sequentially with four tibial fixation devices (a spiked metal washer, double staples, a bioabsorbable interference screw, and a WasherLoc). Three cyclic loading treatments designed to conservatively load the graft and its fixation were applied. The combined loss in intra-articular graft tension from friction, insertion of the tibial fixation device, and three cyclic loading treatments was 50% for the spiked washer (p = 0.0004), 100% for the double staples (p < 0.0001), 64% for the interference screw (p = 0.0001), and 56% for the WasherLoc (p < 0.0001). The tension loss caused an increase in the maximal anterior translation from that of the intact knee of 2.0 mm for the spiked washer (p = 0.005), 7.8 mm for the double staples (p < 0.0001), 2.7 mm for the interference screw (p = 0.001), and 2.1 mm for the WasherLoc (p < 0.0001). The tensile force applied to a soft-tissue anterior cruciate ligament graft is not transferred intra-articularly and is not maintained during graft fixation. The loss in tension is caused by friction in the tibial tunnel and wrapping the graft around the shank of the screw of the spiked washer, insertion of the tibial fixation device, and cyclical loading of the knee. The amount of tension loss is sufficient to increase the maximal anterior translation.

10 CFR 2.304 - Formal requirements for documents; signatures; acceptance for filing.

Code of Federal Regulations, 2010 CFR

2010-01-01

... documents. In addition to the requirements in this part, paper documents must be stapled or bound on the left side; typewritten, printed, or otherwise reproduced in permanent form on good unglazed paper of... not less than one inch. Text must be double-spaced, except that quotations may be single-spaced and...

Trends in crop water productivity: Why the new green revolution must be blue-green

USDA-ARS?s Scientific Manuscript database

In the latter half of the 20th century, world population more than doubled to 6 billion; staple food prices in constant dollars decreased dramatically; and the nutritional status of the world's population improved. The Green Revolution is cited as accounting for this paradox; but often ignored is th...

Cancer of the rectum--sphincter-saving operation. Stapling techniques.

PubMed

Fazio, V W

1988-12-01

The techniques of restoring intestinal continuity after rectal resection for cancer have evolved throughout this century. For the most part, circular staplers have displaced the other pioneering and innovative techniques that our mentors and predecessors devised to improve the quality of life for our patients. With new technology, so also emerge new problems. Although the future likely will render many of our present techniques obsolete, for example, with refining of tissue adhesives, it is incumbent on us to recognize the limits of our present array of weapons and the limits placed on us by the biology of the tumor. About the latter, this means maintaining intellectual honesty in conducting a good cancer operation; about the former, we have to recognize that most of the pitfalls of stapling are preventable or correctable.

Implementation of a New High-Volume Circular Stapler in Stapled Anopexy for Hemorrhoidal Disease: Is Patient's Short-Term Outcome Affected by a Higher Volume of Resected Tissue?

PubMed

Grotenhuis, Brechtje A; Nonner, Joost; de Graaf, Eelco J R; Doornebosch, Pascal G

2017-11-02

Stapled anopexy is a safe technique for the treatment of hemorrhoids but carries a higher risk of recurrence, which might be caused due to the limited volume of resected tissue. In this study, we investigated the introduction of a high-volume circular stapling device; in particular whether an increased amount of resected tissue could affect patients' short-term postoperative outcome. Between 2011 and 2015, stapled anopexy was performed for hemorrhoids and/or anal prolapse in 141 patients (n = 25 conventional PPH-3©-stapler versus n = 116 high-volume CHEX©-stapler). In this prospectively collected dataset, operation details and short-term postoperative outcome were compared. With the high-volume stapler, a significantly higher amount of tissue was resected: 9.8 g (range 6.2-11.4) vs. 6.4 g (range 4.9-8.8) with the conventional stapler, p < 0.01. Postoperative short-term outcome did not differ in terms of readmission and complication rates. In all 5 patients who underwent a redo operation for residual hemorrhoids or prolapse, the high-volume stapler was used in the primary operation. A high-volume stapling device for stapled anopexy was introduced safely with a significantly higher amount of resected tissue without a worse short-term outcome. However, it remains unclear whether higher stapling volumes may lead to improved long-term outcome with less reinterventions. © 2017 S. Karger AG, Basel.

Use of disposable stapler in operative cystogastrostomy for pancreatic pseudocyst.

PubMed

Yunoki, Y; Takeuchi, H; Yasui, Y; Tanakaya, K; Konaga, E; Hamazaki, K

1999-01-01

Surgical stapling techniques are widely used in gastrointestinal surgery. These procedures are excellent in convenience and safety. We describe here a new practical application of the surgical disposable stapler, Auto Suture Premium Plus CEEA 34 circular stapler, for the operative drainage of a large symptomatic pancreatic pseudocyst. A 68 year-old man underwent an operative cystogastrostomy using this instrument. His post-operative recovery was uneventful. He is free from symptoms, and abdominal tomography shows complete disappearance of the cystic cavity. We believe that this is the first clinical paper that reports on the stapled cystogastrostomy. This instrument is very useful for creating a stapled cystogastrostomy, similar to one created in the standard open approach.

A Randomized Trial Comparing Stapled Rectal Mucosectomy Versus Open and Semiclosed Hemorrhoidectomy.

PubMed

Ripetti, Valter; La Vaccara, Vincenzo; Greco, Santi; Arullani, Augusto

2015-11-01

Different results have been reported concerning the postoperative outcomes of different surgical approaches for hemorrhoids. We aimed to determine the postoperative outcome following 3 main surgical techniques. A prospective, randomized trial was designed with 180 patients in 3 arms of 60 patients each. The study was conducted from April 1999 to January 2007 at the University Hospital "Campus Bio-Medico di Roma." All of the patients who were referred for hemorrhoid surgery were enrolled according to inclusion and exclusion criteria (ISRCTN12040297). Treatments according to the open, semiclosed, and stapled techniques were compared. Sample size was calculated to determine a difference in terms of the intensity of postoperative pain at the first week and the days required for return to work activity. After 1 week, patients who underwent semiclosed hemorrhoidectomy reported significantly less pain (p < 0.01) and a significant decrease in analgesic intake from the third postoperative day (p < 0.01) than after the other 2 techniques. The patients resumed work ≈11 days after semiclosed and stapled techniques (11.8 and 11.6 days), which was earlier compared with 21.3 days in the open group (p < 0.05). The high number of patients excluded might be considered a limitation of the study, but our selection criteria including patients living within 50 km of the hospital allowed for a low rate (9.4%) of patients lost to follow-up. This study found an earlier resumption of work and less pain in patients who underwent the stapled and semiclosed procedures rather than open, which was associated with more complications, particularly because of a higher rate of stenosis (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A196).

Advancing Stability and Reconciliation in Guinea-Bissau: Lessons from Africa’s First Narco-State

DTIC Science & Technology

2013-06-01

for failing to comply with a collection of information if it does not display a currently valid OMB control number. 1. REPORT DATE JUN 2013 2. REPORT...simultaneously led to a near doubling in the price of rice, the country’s staple grain, two-thirds of which must be imported. Forced to spend more of...half, the military’s troop-to-population ratio remains double the West African average. According to a 2008 study (see Table 1), more than half the

TRREMS procedure (transanal repair of rectocele and rectal mucosectomy with one circular stapler): a prospective multicenter trial.

PubMed

Cruz, José Vinicius; Regadas, Francisco Sergio P; Murad-Regadas, Sthela Maria; Rodrigues, Lusmar Veras; Benicio, Fernando; Leal, Rogério; Carvalho, César G; Fernandes, Margarete; Roche, Lucimar M C; Miranda, Antônio Carlos; Câmara, Lucia; Pereira, Joaquim Costa; Parra, Antonio Mallén; Leal, Vilmar Moura

2011-01-01

Since anorectocele is usually associated with mucosa prolapse and/or rectal intussusceptions, it was developed a stapled surgical technique using one circular stapler. To report the results of Transanal Repair of Rectocele and Rectal Mucosectomy with one Circular Stapler (TRREMS procedure) in the treatment of anorectocele with mucosa prolapse in a prospective multicenter trial. It was conducted by 14 surgeons and included 75 female patients, mean aged 49.6 years, with symptoms of obstructed defecation due to grade 2 (26.7%) and grade 3 (73.3%) anorectocele associated with mucosa prolapse and/or rectal intussusception (52.0%) and an average validated Wexner constipation score of 16. All patients were evaluated by a proctological examination, cinedefecography, anal manometry and colonic transit time. The TRREMS procedure consists of the manual removal of the rectocele wall with circumferential rectal mucosectomy performed with a circular stapler. The mean follow-up time was 21 months. All patients presented obstructed defecation and they persisted with symptoms despite conservative treatment. The mean operative time was 42 minutes. In 13 (17.3%) patients, bleeding from the stapled line required hemostatic suture. Stapling was incomplete in 2 (2.6%). Forty-nine patients (65.3%) required 1 hospitalization day, the remainder (34.7%) 2 days. Postoperatively, 3 (4.0%) patients complained of persistent rectal pain and 7 (9.3%) developed stricture on the stapled suture subsequently treated by stricturectomy under anesthesia (n = 1), endoscopic stricturectomy with hot biopsy forceps (n = 3) and digital dilatation (n = 3). Postoperative cinedefecography showed residual grade I anorectoceles in 8 (10.6%). The mean Wexner constipation score decreased significantly from 16 to 4 (0-4: n = 68) (6: n = 6) (7: n = 1) (P<0.0001). Current trial results suggest that TRREMS procedure is a safe and effective technique for the treatment of anorectocele associated with mucosa prolapse. The stapling technique is low-cost as requires the use of a single circular stapler.

Retrograde stapling of a free cervical jejunal interposition graft: a technical innovation and case report

PubMed Central

2014-01-01

Background Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining thoracic esophagus or a gastric conduit can be technically challenging when located very low in the thoracic aperture. We here describe a modified technique for retrograde stapling of a jejunal graft to a failed gastric conduit using a circular stapler on a delivery system. Case presentation A 56 year-old patient had been referred for esophageal squamous cell carcinoma at 20 cm from the incisors. On day 8 after thoracoabdominal esophagectomy with gastric pull-up, an anastomotic leakage was diagnosed. A proximal-release stent was successfully placed by gastroscopy and the patient was discharged. Two weeks later, an esophagotracheal fistula occurred proximal to the esophageal stent. Cervical esophagostomy was performed with cranial closure of the gastric conduit, which was left in situ within the right hemithorax. Three months later, reconstruction was performed using a free jejunal interposition. The anvil of a circular stapler (Orvil®, Covidien) was placed transabdominally through an endoscopic rendez-vous procedure into the gastric conduit. A free jejunal graft was retrogradely stapled to the proximal end of the conduit. Microvascular anastomoses were performed subsequently. The proximal anastomosis of the conduit was completed manually after reperfusion. Conclusions This modified technique allows stapling of a jejunal interposition graft located deep in the thoracic aperture and is therefore a useful method that may help to avoid reconstruction by colonic pull-up and thoracotomy. PMID:25319372

"How I do it"--radical right colectomy with side-to-side stapled ileo-colonic anastomosis.

PubMed

Hübner, M; Larson, D W; Wolff, B G

2012-08-01

Standardization of surgical technique helps to reproduce excellent clinical outcomes, especially in teaching institutions. We aim to describe in detail our established approach for oncological right colectomy. The right colon is mobilized in a five-step latero-inferior approach starting off with the terminal ileum, visualizing the duodenum and the head of pancreas. The ascending colon is dissected from the retroperitoneum, and takedown of the hepatic flexure is completed coming retrograde from the transverse colon. Transection of the remaining retroperitoneal attachments completes exposure of the duodenum and mobilization of the right colon. Ileocolic vessels are dissected out and divided close to their origin, and the mesocolon is divided. We then establish intestinal continuity by use of a side-to-side stapled technique. The arms of a linear cutting stapler are inserted via transverse incisions at the anti-mesenteric sides of the terminal ileum and the transverse colon (tenia) and fired. The enterotomy site is closed by removal of the specimen using a second transverse firing of the linear cutting stapler. An important final step is the reinforcement of the anastomotic ends and the crossing of the staple lines; an omental patch and closure of the mesenteric window are optional. The suggested standardized five-step lateral-to-medial dissection of the right colon and the three-step side-to-side stapled technique for ileo-colonic anastomosis are easy to learn and to reproduce. Careful adherence to pivotal technical details will help to obtain an optimal oncological outcome and a consistently low leak rate around 2%.

The stapled hemorrhoidopexy syndrome: a new clinical entity?

PubMed

Efthimiadis, Chr; Kosmidis, Chr; Grigoriou, M; Anthimidis, G; Vasiliadou, K; Baka, S; Gerasimidou, D; Basdanis, G

2011-10-01

Haemorrhoidal disease is a rather common disease of unknown cause. A new technique for treating prolapsing haemorrhoids known as the stapled hemorrhoidopexy (SH) or the "Longo procedure" is widely used. Serious adverse events were reported in 2000 and some discussion over the syndrome but nothing since. Two hundred and five patients underwent SH by our surgical team at the Interbalkan European Medical Center. Modified SH was performed. Despite the low incidence of postoperative complications (11/205), 36.58% of patients developed syndrome comprised of urgency to defecate, sensation of anal foreign body and incomplete defecation and mild cramp like anal discomfort, immediately after surgery or in the following 48 h. There is not statistically significant relationship between the presence of the syndrome and the gender, the presence of muscle fibres in the resected "ring" the degree of haemorrhoidal disease, age and ring length. Observations led us to conclude that the stapled hemorrhoidopexy syndrome (SHS) is probably caused by the irritating presence of the titanium staples in the rectal mucosa and by the resection itself.

Long-term prospective evaluation of intestinal anastomosis using stainless steel staples in 14 dogs

PubMed Central

Benlloch-Gonzalez, Manuel; Gomes, Eymeric; Bouvy, Bernard; Poncet, Cyrill

2015-01-01

This prospective clinical study evaluated the use, complications, and clinical and ultrasonographic follow-ups of end-to-end intestinal anastomoses with skin staples in naturally occurring diseases in canine small and large intestines. Intestinal anastomoses were performed in 14 dogs and pre-, peri-, and postoperative data were recorded. Postoperative clinical and ultrasound evaluations were performed at regular intervals for 1 year. The mean time taken to construct the anastomosis was 5 min. There were no intraoperative complications. Hemorrhage and colonic stricture were the main postoperative complications. Staple loss occurred in 2 cases. Absence of wall layering and focal wall thickening were observed in all cases at each ultrasonographic follow-up. Hyperechoic fat was observed in all but 1 of the cases at month 1. Nine dogs were alive with normal digestive function at the end of the study. The skin stapler technique enabled rapid construction of consistent anastomoses with inexpensive stapling material. PMID:26130833

Comparative study of Contour Transtar and STARR procedure for the treatment of obstructed defecation syndrome (ODS)--feasibility, morbidity and early functional results.

PubMed

Isbert, C; Reibetanz, J; Jayne, D G; Kim, M; Germer, C-T; Boenicke, L

2010-09-01

Stapled transanal rectal resection (STARR) is a promising new treatment for obstructed defecation syndrome (ODS). It may be performed using either a double-stapling technique (PPH-STARR) or with the new Contour Transtar (CT) device. The aim of this study was to evaluate the two techniques with respect to morbidity and functional outcomes. Patients presenting with ODS were evaluated using standardized clinical and radiological investigations and prospectively entered into a database. A total of 150 Patients were treated with either PPH-STARR (n = 68) or CT (n = 82) and further evaluated at 12 month postoperatively. The mean size of the resected specimen was 27 cm(2) (SD +/-4.86 cm(2)) in the PPH-STARR group and 46 cm(2) (SD +/-10.6 cm(2)) in the CT group [P < 0.001]. Morbidity was 7.3% (n = 5) in the PPH-STARR group and 7.5% (n = 6) in the CT group. The most common complication was minor postoperative bleeding in both groups (PPH-STARR: n = 2, 2.9%; CT: n = 2, 2.4%) Overall there were no septic complications and no surgical re-interventions. There was a tendency for more postoperative pain following CT (n = 3, 3.6%) as compared with PPH-STARR (n = 1, 1.4%). Constipation Scores (CCS) were 15.50 +/- 5.71 in the PPH-STARR group and 15.70 +/- 5.84 in the CT group preoperatively and decreased significantly to 8.25 (SD +/-1.45) and 8.01 (SD +/-2.31) 12-months after surgery. Values did not differ significantly between the two groups. Contour Transtar is as safe and effective as PPH-STARR and provides a true circumferential resection of rectal intussusception. This may benefit selected patients and result in improved long-term durability of the technique.

[Results of Longo's stapled hemorrhoidectomy in ambulatory surgery for grade III-IV hemorrhoids].

PubMed

Zaragozá, Cristóbal; García Fadrique, Alfonso; Castaño, Sergio; Villalba, Raúl; Bruna Esteban, Marcos; Redondo Cano, Carlos

2007-03-01

We prospectively evaluated the results of stapled hemorrhoidectomy for grade III-IV hemorrhoids in the ambulatory setting. Eighty-five consecutive patients with grade III-IV hemorrhoids, treated with the stapled technique with PPH01 in the Ambulatory Surgery Service of the General Hospital of Valencia were studied. Symptomatic, ASA I-II patients who agreed to undergo ambulatory surgery (vehicle, an accompanying adult, address with telephone, elevator, and basic hygiene conditions) were included. Thirty-nine percent were women and 61% were men, with a mean age of 47.6 years. A total of 85.9% had grade IV hemorrhoids and 14.1% had grade III. The average surgical time was 29.81+/- 12 minutes with a mean length of hospital stay of 168.88 +/- 88 minutes. Surgical complications consisted of 16 hemorrhages of the staple line (18.8%) and five hemorrhages due to mucous tear (5.9%). During the first 8 days the most frequent complication was pain (45.9%); only 7.1% of the patients required analgesia with opiates, and one patient required admission for 24 hours for analgesic purposes. Bleeding occurred in 10 patients, five of whom reported slight bleeding on defecation that stopped spontaneously; the remaining five required admission for 24 hours after surgical revision. Nine patients (10.6%) were admitted to the hospital for 24 hours, three due to intraoperative hemorrhage, five due to postoperative hemorrhage and one due to pain. A second intervention was required in 8.2%. Stapled hemorrhoidectomy can be applied in an ambulatory regime. Although technically simple with a short learning curve, this technique is not free of complications. Suitable patient selection and adequate perioperative information are indispensable for the ambulatory management of this disorder.

Reverse Transrectal Stapling Technique Using the EEA Stapler: An Alternative Approach in Difficult Reversal of Hartmann’s Procedure

PubMed Central

Zachariah, Sanoop K.

2010-01-01

The introduction of circular end-to-end stapling devices (CEEA OR EEA stapler) into colorectal surgery have revolutionised anastomotic techniques. The EEA stapler is generally regarded as an instrument that is safe, reliable, and simple to operate. Despite it’s popularity, very little information is available regarding the technical difficulties encountered during surgery. The routine technique to perform an end-to-end circular colonic anastomosis is to introduce the instrument distally through the anus (transrectal/transanal approach) and attach it to the anvil which is purse stringed at the distal end of the proximal bowel to be anastomosed. Two cases of reversal of Hartmann’s procedure for perforated diverticulitis are described in the present study, where difficulty was experienced while using the EEA stapler in the routine method. Hence, an alternative reverse technique which was used is presented. PMID:22091338

Cullin3 - BTB Interface: A Novel Target for Stapled Peptides

PubMed Central

Palmieri, Maddalena; Balasco, Nicole; Esposito, Luciana; Russo, Luigi; Mazzà, Daniela; Di Marcotullio, Lucia; Di Gaetano, Sonia; Malgieri, Gaetano; Vitagliano, Luigi; Pedone, Emilia; Zaccaro, Laura

2015-01-01

Cullin3 (Cul3), a key factor of protein ubiquitination, is able to interact with dozens of different proteins containing a BTB (Bric-a-brac, Tramtrack and Broad Complex) domain. We here targeted the Cul3–BTB interface by using the intriguing approach of stabilizing the α-helical conformation of Cul3-based peptides through the “stapling” with a hydrocarbon cross-linker. In particular, by combining theoretical and experimental techniques, we designed and characterized stapled Cul3-based peptides embedding the helix 2 of the protein (residues 49–68). Intriguingly, CD and NMR experiments demonstrate that these stapled peptides were able to adopt the helical structure that the fragment assumes in the parent protein. We also show that some of these peptides were able to bind to the BTB of the tetrameric KCTD11, a substrate adaptor involved in HDAC1 degradation, with high affinity (~ 300–600 nM). Cul3-derived staple peptides are also able to bind the BTB of the pentameric KCTD5. Interestingly, the affinity of these peptides is of the same order of magnitude of that reported for the interaction of full-length Cul3 with some BTB containing proteins. Moreover, present data indicate that stapling endows these peptides with an increased serum stability. Altogether, these findings indicate that the designed stapled peptides can efficiently mimic protein-protein interactions and are potentially able to modulate fundamental biological processes involving Cul3. PMID:25848797

A Safe and Reproducible Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy: The Circular Stapled Anastomosis with the Transoral Anvil

PubMed Central

Campos, Guilherme M; Jablons, David; Brown, Lisa M; Ramirez, René M; Rabl, Charlotte; Theodore, Pierre

2010-01-01

Objectives In expert hands, the intra-thoracic esophago-gastric anastamosis usually provides a low rate of strictures and leaks. However, anastomoses can be technically challenging and time consuming when minimally invasive techniques are used. We present our preliminary results of a standardized 25mm/4.8mm circular stapled anastomosis using a trans-orally placed anvil. Materials and Methods We evaluated a prospective cohort of 37 consecutive patients offered minimally invasive Ivor Lewis Esophagectomy at a tertiary referral center. The esophagogastric anastomosis was created using a 25mm anvil (Orvil, Autosuture, Norwalk, CT) passed trans-orally, in a tilted position, and connected to a 90cm long PVC delivery tube through an opening in the esophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (EEA XL 25mm with 4.8mm Staples, Autosuture, Norwalk, CT) inserted into the gastric conduit. Primary outcomes were leak and stricture rates. Results Thirty-seven patients (mean age 65 yrs) with distal esophageal adenocarcinoma (n=29), squamous cell cancer (n=5), or high-grade dysplasia in Barrett's Esophagus (n=3) underwent an Ivor Lewis Esophagectomy between October 2007 and August 2009. The abdominal portion of the operation was completed laparoscopically in 30 patients (81.1%). The thoracic portion was done using a muscle sparing mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 patients (37.8%). There were no intra-operative technical failures of the anastomosis or deaths. Five patients had strictures (13.5%) and all were successfully treated with endoscopic dilations. One patient had an anastomotic leak (2.7%) that was successfully treated by re-operation and endoscopic stenting of the anastomosis. Discussion The circular stapled anastomosis with the transoral anvil allows for an efficient, safe and reproducible anastomosis. This straightforward technique is particularly suited to the completely minimally invasive Ivor Lewis Esophagectomy. PMID:20153660

Comparative Study of Hand-Sutured versus Circular Stapled Anastomosis for Gastrojejunostomy in Laparoscopy Assisted Distal Gastrectomy.

PubMed

Seo, Su Hyun; Kim, Ki Han; Kim, Min Chan; Choi, Hong Jo; Jung, Ghap Joong

2012-06-01

Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer.

Technique-associated outcomes in horses following large colon resection.

PubMed

Pezzanite, Lynn M; Hackett, Eileen S

2017-11-01

To compare survival and complications in horses undergoing large colon resection with either sutured end-to-end or stapled functional end-to-end anastomoses. Retrospective cohort study. Twenty-six client-owned horses with gastrointestinal disease. Retrospective data were retrieved from the medical records of 26 horses undergoing colectomy, including 14 horses with sutured end-to-end and 12 horses with stapled functional end-to-end anastomoses, between 2003 and 2016. Records were evaluated for signalment, medical and surgical treatments, and survival to hospital discharge. Long-term follow-up was obtained through owner contact. Continuous variables were compared with Mann-Whitney tests. Fisher's exact testing was used to compare survival to hospital discharge. Survival time was compared by constructing Kaplan-Meier survival curves and performing log-rank curve comparison testing. Mean age of horses undergoing colectomy was 13 years. Reason for colectomy was prophylaxis (12) or salvage (14). Mean surgical time was 169 minutes. Mean hospitalization time was 9 days, which did not differ with anastomosis type (P = .62). Nine of 12 horses undergoing stapled functional end-to-end anastomosis and 12 of 14 horses undergoing sutured end-to-end anastomosis survived to hospital discharge (P = .63). Survival time did not differ with anastomosis technique (P = .35). Short- and long-term survival outcomes are not different between sutured end-to-end or stapled functional end-to-end anastomoses in horses undergoing colectomy. © 2017 The American College of Veterinary Surgeons.

Bronchial closure methods and risks for bronchopleural fistula in pulmonary resections: how a surgeon may choose the optimum method?

PubMed

Uçvet, Ahmet; Gursoy, Soner; Sirzai, Serdar; Erbaycu, Ahmet E; Ozturk, Ali A; Ceylan, Kenan C; Kaya, Seyda O

2011-04-01

There is debate about which bronchial closure technique is the best to prevent bronchopleural fistulas (BPFs). We aim to assess the effect of bronchial closure procedures and patients' characteristics on BPF occurrence in pulmonary resections. Bronchial closures in 625 consecutive patients were assessed. Stumps were closed by manual suturing in 204 and by mechanical stapling in 421 cases. In the mechanical stapling group, stapling supported by manual suture was performed in 170 cases. BPFs occurred in 3.8%. Of these, stapling was used in 5.0%, whereas manual suturing was used in 1.5% (P=0.04). BPFs were more prevalent among patients who had undergone pneumonectomy (P<0.01), right pneumonectomy (P<0.01), stapler closure (P<0.01), patients with co-factors (P<0.01), and patients who had undergone preoperative neo-adjuvant (P=0.01) or postoperative adjuvant therapy (P=0.03). There was no difference in the frequency of BPF between patients with and without adjuvant support in the stapling group. The optimum bronchial closure method has to be chosen by considering the patient and bronchus based characteristics. This has to be assessed carefully, especially in pneumonectomy and co-factors. The manual closure seems to be the more preferable method in risky patients. An additive support suture on the bronchial stump does not decrease the risk of BPF.

JPRS Report, China.

DTIC Science & Technology

1989-03-23

economic reform, the price hikes of some major consumer goods over the past 2 years have reached double digits.) There is another example regarding a...of this staple to eat. For urban residents, rationing now ensures a guar- anteed supply of grain at stable prices , so the greatest impact on...States was bogged down in the quagmire of the Vietnam war, faced both domestic and external diffi- culty, and was forced into strategic withdrawal. Mean

The efficacy and integrity of shape memory alloy staples and bone anchors with ligament tethers in the fusionless treatment of experimental scoliosis.

PubMed

Braun, John T; Akyuz, Ephraim; Ogilvie, James W; Bachus, Kent N

2005-09-01

Scoliosis is a complex three-dimensional deformity with limited treatment options. Current treatments present potential problems that may be addressed with use of fusionless techniques for the correction of scoliosis. However, there are few data comparing the efficacy of different fusionless implant strategies in controlling scoliosis or on the integrity of rigid compared with flexible devices in an in vivo setting over time. The objective of this study was to compare the efficacy and integrity of rigid and flexible anterior thoracic tethers used to treat experimental scoliosis. Experimental scoliosis was created in twenty-four Spanish Cross-X female goats and was subsequently treated with either anterior shape memory alloy staples or anterior ligament tethers attached to bone anchors. Serial radiographs were analyzed to determine the efficacy of the implants in controlling scoliosis progression as well as the integrity of the implants at study completion. After the goats were killed, the implants were analyzed with use of three quantitative indices of implant integrity and implant pullout testing. Over the treatment period, scoliosis progressed from 77.3 degrees to 94.3 degrees in the goats treated with staples and was corrected from 73.4 degrees to 69.9 degrees in the goats treated with bone anchors, with loosening of eighteen of forty-two staples (two of the eighteen dislodged) and evidence of drift in two of forty-nine anchors. Histologic sections revealed a consistent halo of fibrous tissue around the staple tines but well-fixed bone anchors at all sites. Pullout testing demonstrated that bone anchors had greater strength than staples initially and at the study completion, with an increase in bone anchor fixation over the course of the study. In this scoliosis model, the flexible ligament tethers attached to bone anchors demonstrated greater efficacy and integrity than the more rigid shape memory alloy staples.

Stapled technique for acute thrombosed hemorrhoids: a randomized, controlled trial with long-term results.

PubMed

Wong, J C H; Chung, C C; Yau, K K; Cheung, H Y S; Wong, D C T; Chan, O C Y; Li, M K W

2008-04-01

This study was designed to compare stapled vs. conventional hemorrhoidectomy for patients with acute thrombosed hemorrhoids. Forty-one patients with acute thrombosed hemorrhoids were randomized into: 1) stapled hemorrhoidectomy (PPH group; n = 21), and 2) open hemorrhoidectomy (open group; n = 20). Emergency surgery was performed with perioperative data and complications were recorded. Patients were followed up by independent assessors to evaluate pain, recurrence, continence function, and satisfaction at regular intervals. The median follow-up for the PPH group and open group were 59 and 56 weeks, respectively. There was no significant difference in terms of the hospital stay, complication rate, and continence function; however, the mean pain intensity in the first postoperative week was significantly less in the PPH group (4.1 vs. 5.7, P = 0.02). Patients in the PPH group recovered significantly faster in terms of the time to become analgesic-free (4 vs. 8.5 days, P < 0.01), time to become pain-free (9 vs. 20.5 days, P = 0.01), resumption of work (7 vs. 12.5 days, P = 0.01), and time for complete wound healing (2 vs. 4 weeks, P < 0.01). On long-term follow-up, significantly fewer patients in the PPH group complained of recurrent symptoms (0 vs. 5, P = 0.02). The overall symptom improvement and patients' satisfaction were significantly better in the PPH group (90 vs. 80 percent, P = 0.03 and +3 vs. +2, P < 0.01 respectively). Stapled hemorrhoidectomy is safe and effective for acute thrombosed hemorrhoids. Similar to elective stapled procedure, emergency stapled excision has greater short-term benefits compared with conventional excision: diminished pain, faster recovery, and earlier return to work. Long-term results and satisfaction were excellent.

Comparative Study of Hand-Sutured versus Circular Stapled Anastomosis for Gastrojejunostomy in Laparoscopy Assisted Distal Gastrectomy

PubMed Central

Seo, Su Hyun; Kim, Min Chan; Choi, Hong Jo; Jung, Ghap Joong

2012-01-01

Purpose Mechanical stapler is regarded as a good alternative to the hand sewing technique, when used in gastric reconstruction. The circular stapling method has been widely applied to gastrectomy (open orlaparoscopic), for gastric cancer. We illustrated and compared the hand-sutured method to the circular stapling method, for Billroth-II, in patients who underwent laparoscopy assisted distal gastrectomy for gastric cancer. Materials and Methods Between April 2009 and May 2011, 60 patients who underwent laparoscopy assisted distal gastrectomy, with Billroth-II, were enrolled. Hand-sutured Billroth-II was performed in 40 patients (manual group) and circular stapler Billroth-II was performed in 20 patients (stapler group). Clinicopathological features and post-operative outcomes were evaluated and compared between the two groups. Results Nosignificant differences were observed in clinicopathologic parameters and post-operative outcomes, except in the operation times. Operation times and anastomosis times were significantly shorter in the stapler group (P=0.004 and P<0.001). Conclusions Compared to the hand-sutured method, the circular stapling method can be applied safely and more efficiently, when performing Billroth-II anastomosis, after laparoscopy assisted distal gastrectomy in patients with gastric cancer. PMID:22792525

Use of the stapler in anterior resection for cancer of the rectosigmoid.

PubMed

Resnick, S D; Burstein, A E; Viner, Y L

1983-02-01

The circular stapling device was used for anterior resection in 61 of 88 patients who underwent curative surgery for rectosigmoid cancer. Use of the autosuture increased the success rate to 68.5% for this radical sphincter-saving procedure. In three-quarters of the patients the stapling end-to-end inverting colorectal anastomosis was created within 3 to 8 cm from the dentate line, where it is difficult or even impossible to perform anastamoses by the conventional manual technique. Anastomotic leakage (3.3%) and hemorrhage (4.9%), mild anastomotic stenosis (1.6%) and transitory anal incontinence (4.9%) were the main complications. There were no deaths in our series. The great safety of the stapling anastomosis and the low rate of anal incontinence may be explained by the preservation of an adequate blood supply and innervation of the rectal stump and its sphincter apparatus, as the stapling device needs only minimal mobilization of the bowel involved in the anastomosis. Restoring colorectal continuity after Hartmann's resection is a speedy, safe and simple procedure with the EEA (enteroenterostomy) stapler. Hartmann's operation may thus be considered the procedure of choice in emergency surgery for obstructed rectosigmoid cancer.

Non-Heme Iron Absorption and Utilization from Typical Whole Chinese Diets in Young Chinese Urban Men Measured by a Double-Labeled Stable Isotope Technique

PubMed Central

Yang, Lichen; Zhang, Yuhui; Wang, Jun; Huang, Zhengwu; Gou, Lingyan; Wang, Zhilin; Ren, Tongxiang; Piao, Jianhua; Yang, Xiaoguang

2016-01-01

Background This study was to observe the non-heme iron absorption and biological utilization from typical whole Chinese diets in young Chinese healthy urban men, and to observe if the iron absorption and utilization could be affected by the staple food patterns of Southern and Northern China. Materials and Methods Twenty-two young urban men aged 18–24 years were recruited and randomly assigned to two groups in which the staple food was rice and steamed buns, respectively. Each subject received 3 meals containing approximately 3.25 mg stable 57FeSO4 (the ratio of 57Fe content in breakfast, lunch and dinner was 1:2:2) daily for 2 consecutive days. In addition, approximately 2.4 mg 58FeSO4 was administered intravenously to each subject at 30–60 min after dinner each day. Blood samples were collected from each subject to measure the enrichment of the 57Fe and 58Fe. Fourteen days after the experimental diet, non-heme iron absorption was assessed by measuring 57Fe incorporation into red blood cells, and absorbed iron utilization was determined according to the red blood cell incorporation of intravenously infused 58Fe SO4. Results Non-heme iron intake values overall, and in the rice and steamed buns groups were 12.8 ±2.1, 11.3±1.3 and 14.3±1.5 mg, respectively; the mean 57Fe absorption rates were 11±7%, 13±7%, and 8±4%, respectively; and the mean infused 58Fe utilization rates were 85±8%, 84±6%, and 85±10%, respectively. There was no significantly difference in the iron intakes, and 57Fe absorption and infused 58Fe utilization rates between rice and steamed buns groups (all P>0.05). Conclusion We present the non-heme iron absorption and utilization rates from typical whole Chinese diets among young Chinese healthy urban men, which was not affected by the representative staple food patterns of Southern and Northern China. This study will provide a basis for the setting of Chinese iron DRIs. PMID:27099954

A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy: the circular-stapled anastomosis with the trans-oral anvil.

PubMed

Campos, Guilherme M; Jablons, David; Brown, Lisa M; Ramirez, René M; Rabl, Charlotte; Theodore, Pierre

2010-06-01

In expert hands, the intrathoracic oesophago-gastric anastamosis usually provides a low rate of strictures and leaks. However, anastomoses can be technically challenging and time consuming when minimally invasive techniques are used. We present our preliminary results of a standardised 25 mm/4.8mm circular-stapled anastomosis using a trans-orally placed anvil. We evaluated a prospective cohort of 37 consecutive patients offered minimally invasive Ivor Lewis oesophagectomy at a tertiary referral centre. The oesophago-gastric anastomosis was created using a 25-mm anvil (Orvil, Autosuture, Norwalk, CT, USA) passed trans-orally, in a tilted position, and connected to a 90-cm long polyvinyl chloride delivery tube through an opening in the oesophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (end-to-end anastomosis stapler (EEA XL) 25 mm with 4.8-mm staples, Autosuture, Norwalk, CT, USA) inserted into the gastric conduit. Primary outcomes were leak and stricture rates. Thirty-seven patients (mean age 65 years) with distal oesophageal adenocarcinoma (n=29), squamous cell cancer (n=5) or high-grade dysplasia in Barrett's oesophagus (n=3) underwent an Ivor Lewis oesophagectomy between October 2007 and August 2009. The abdominal portion was operated laparoscopically in 30 patients (81.1%). The thoracic portion was done using a muscle-sparing mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 patients (37.8%). There were no intra-operative technical failures of the anastomosis or deaths. Five patients had strictures (13.5%) and all were successfully treated with endoscopic dilations. One patient had an anastomotic leak (2.7%) that was successfully treated by re-operation and endoscopic stenting of the anastomosis. The circular-stapled anastomosis with the trans-oral anvil allows for an efficient, safe and reproducible anastomosis. This straightforward technique is particularly suited to the completely minimally invasive Ivor Lewis oesophagectomy. Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

[Practical and theoretical aspects of cost-benefit relations in viscerosynthesis].

PubMed

Fuchs, K H; Heimbucher, J; Geiger, D; Thiede, A

1997-01-01

The necessity of limiting health care costs requires adequate service recording and quality control even in visceral surgery. In this field, the safety of the anastomoses is of greatest importance. Anastomoses at risk are esophageal connections to jejunum or colon and deep rectal anastomoses. At these locations expensive suture devices, such as stapling instruments, can be used in a cost saving aspect, if they help to increase anastomotic safety, time saving and expansion of surgical indication. Manual sutures thus represent the cheapest anastomotic technique as continuous sutures would cost between DM 10.- to 20.- and single stitch sutures between DM 60.- and 100.-. A surgical school should prevalently aim at training manual anastomoses, while special anastomotic techniques should only complete the skill for selected indications. The overall staff expenditure for extended operations amounts around DM 600.- per hour respectively DM 10.- per minute. Time for surgery might be shortened by auxiliary tools as much as to perform an additional operation. However, a circular stapler anastomosis that costs between DM 650.- to 850.- is twice as expensive as manual sutures notwithstanding the double time needed. In the past years, the necessity for a rational use of different anastomotic techniques has shown to be mandatory since, increasingly, financial aspects of health economy require cost benefit calculations in visceral surgery.

Blind-Side, High-Temperature Fastener Lock

NASA Technical Reports Server (NTRS)

Matza, E. C.; While, D. M.

1985-01-01

Formed-in-place staple provides positive mechanical lock. Post-supported, advanced carbon/carbon standoff panels, currently under consideration as alternate thermal protection system for Shuttle orbiter, locking feature applicable to temperatures of 1,600 degrees F (870 degrees C) and higher and employable after panel installed, resulting in blind application. Blind-side locking technique employs wire staple inserted into grooves in post, formed in place by ramped portion of post grooves. This splays out wire ends that move into castellated end of grommet, mechanically locking post and grommet against relative rotation. Splayed ends provide mechanical lock to prevent wire from falling out.

Ovarian cryopreservation after laparoscopic ovariectomy using the Endo-GIA stapling device and LAPRO-clip absorbable ligating clip in a woman: a case report

PubMed Central

2011-01-01

Introduction Several options are available for preserving fertility before cytotoxic treatment, including ovarian tissue cryopreservation. Most reported surgical techniques include electrocoagulation. Our hypothesis is that avoidance of electrocoagulation may decrease ovarian cortex injury during cryopreservation procedures. Case presentation We report a laparoscopic technique of whole-ovary removal without coagulation using Endo-GIA forceps and clips. Laparoscopic ovariectomy was performed for cryopreservation in a 37-year-old Caucasian woman with breast cancer and for whom chemotherapy was planned. The procedure was completed quickly and without complication. This Endo-GIA procedure was of short duration with a short period of ischemia before freezing. Conclusion Laparoscopic ovariectomy using the Endo-GIA stapling device procedure without coagulation may diminish ovary injury before ovarian cryopreservation. PMID:21291518

Application of Six Sigma towards improving surgical outcomes.

PubMed

Shukla, P J; Barreto, S G; Nadkarni, M S

2008-01-01

Six Sigma is a 'process excellence' tool targeting continuous improvement achieved by providing a methodology for improving key steps of a process. It is ripe for application into health care since almost all health care processes require a near-zero tolerance for mistakes. The aim of this study is to apply the Six Sigma methodology into a clinical surgical process and to assess the improvement (if any) in the outcomes and patient care. The guiding principles of Six Sigma, namely DMAIC (Define, Measure, Analyze, Improve, Control), were used to analyze the impact of double stapling technique (DST) towards improving sphincter preservation rates for rectal cancer. The analysis using the Six Sigma methodology revealed a Sigma score of 2.10 in relation to successful sphincter preservation. This score demonstrates an improvement over the previous technique (73% over previous 54%). This study represents one of the first clinical applications of Six Sigma in the surgical field. By understanding, accepting, and applying the principles of Six Sigma, we have an opportunity to transfer a very successful management philosophy to facilitate the identification of key steps that can improve outcomes and ultimately patient safety and the quality of surgical care provided.

Needlescopic sleeve gastrectomy: pushing the boundaries of the standard technique.

PubMed

Loureiro, Marcelo; Sultan, Abdulah; Alhaddad, Mohannad; Mostafa, Hatem; Nocca, David; Nedelcu, Marius; Buhaimed, Walled

2017-10-01

Laparoscopic sleeve gastrectomy (LSG) is the most common bariatric surgery performed worldwide. Improvements in LSG have been suggested to achieve better weight loss or to lessen the complications rates. We propose a change in the standard technique to privilege the use of thinner instruments, the needlescopic sleeve gastrectomy (NSG). A 40-year-old female, BMI 40, with no previous abdominal surgery was selected for a NSG. She was placed in a semi-sitting position with the surgeon standing between the legs. Pneumoperitoneum was created through open laparoscopy; 5 trocars were inserted in standard position for laparoscopic gastric surgery. We have used one 12 mm trocar in the navel for a 5 mm scope and for stapling the stomach; one 5 mm trocar for impedance coagulator and also for the scope during the stapling process, and three 3 mm trocars for liver retraction, left hand manipulation, and greater curve exposition. Surgical techniques are basically the same as for a standard LSG until the moment of stapling the stomach, when the 5 mm scope is changed to the right hand trocar. Stapling can be done trough the umbilical port, parallel to the lesser curvature, in contact with the calibration tube. After stapling, hemostasis was achieved by bipolar coagulation, application of titanium clips, and absorbable suture. The 12 mm umbilical orifice is closed after extraction of the resected stomach. Operative time was 76 min. There was no per-operative complication. Recovery was uneventful and patient was discharged at post operative day 2. Pain was considered minor by the patient. One month after surgery, cosmetic results were very convincing. There are several proposed technical modifications in LSG. They can influence complication rates or weight loss like the length of antrum resection, the size of Fouchet tube, or the reinforcement of staple line [1-4]. Besides that other concepts regarding reduction of size or number of trocars have also been applied. LSG has been performed with fewer trocars, using for example special designed internal retractors or even the posterior part of the dissected stomach to replace the liver retractor and its trocar [5, 6]. Single port is another well-known possibility [7, 8], but mini-laparoscopy or needlescopic SG is still not well explored in our opinion. We believe that this technical alternative proposed in this video keeps the standards of care and safety of conventional LSG. There is no change in the position of the surgeon, not even the trocars. Specially designed needlescopic instruments show enough strength to be used in bariatrics and allow the surgeon to perform all the routine maneuvers from dissection to suturing. LSG can be done by mini-laparoscopy with a short adaptation period, previewing a short learning curve with no increase in the complications rate. NSG is feasible in selected patients and with few modifications in the standard technique. There might be a benefit in terms of pain. Further studies with large series are necessary to observe these potential benefits.

Stapled peptides as a new technology to investigate protein-protein interactions in human platelets.

PubMed

Iegre, Jessica; Ahmed, Niaz S; Gaynord, Josephine S; Wu, Yuteng; Herlihy, Kara M; Tan, Yaw Sing; Lopes-Pires, Maria E; Jha, Rupam; Lau, Yu Heng; Sore, Hannah F; Verma, Chandra; O' Donovan, Daniel H; Pugh, Nicholas; Spring, David R

2018-05-28

Platelets are blood cells with numerous crucial pathophysiological roles in hemostasis, cardiovascular thrombotic events and cancer metastasis. Platelet activation requires the engagement of intracellular signalling pathways that involve protein-protein interactions (PPIs). A better understanding of these pathways is therefore crucial for the development of selective anti-platelet drugs. New strategies for studying PPIs in human platelets are required to overcome limitations associated with conventional platelet research methods. For example, small molecule inhibitors can lack selectivity and are often difficult to design and synthesise. Additionally, development of transgenic animal models is costly and time-consuming and conventional recombinant techniques are ineffective due to the lack of a nucleus in platelets. Herein, we describe the generation of a library of novel, functionalised stapled peptides and their first application in the investigation of platelet PPIs. Moreover, the use of platelet-permeable stapled Bim BH3 peptides confirms the part of Bim in phosphatidyl-serine (PS) exposure and reveals a role for the Bim protein in platelet activatory processes. Our work demonstrates that functionalised stapled peptides are a complementary alternative to conventional platelet research methods, and could make a significant contribution to the understanding of platelet signalling pathways and hence to the development of anti-platelet drugs.

Investigation of the best suture pattern to close a stuffed Christmas turkey.

PubMed

Verwilghen, D; Busoni, V; van Galen, G; Wilke, M

Instructions on how to debone and stuff a turkey are available, but what is the best way to close it up? A randomised trial involving 15 turkeys was performed in order to evaluate skin disruption scores and cosmetic outcomes following the use of different suture patterns. Turkeys were deboned, stuffed and cooked according to guidelines of the US Department of Agriculture Food Safety and Inspection Services. After stuffing, they were randomly assigned to one of five closure groups: simple continuous Lembert; simple continuous Cushing; simple continuous Utrecht; simple continuous; or staples. Turkeys were cooked at 180 °C for two hours ensuring core temperature reached 75 °C. Suture line integrity was evaluated after removal of the sutures and the cosmetic aspect was graded. Before cooking, the Utrecht pattern and skin staples offered the best cosmetic result. After removal of the sutures, the skin remained intact only in the stapled group. All other suture patterns disrupted the skin after removal of the sutures, rendering the turkey less cosmetically appealing for serving. Closure of a stuffed turkey was best performed using skin staples to achieve the best cosmetic results. Using this technique you will be able to impress family and friends at a Christmas dinner, and finally show them your surgical skills.

[Resistance to pressure of bronchial closures. Comparison of pressure resistance of manual and stapler bronchial closures depending on the angle to the cartilaginous rings].

PubMed

Ludwig, C; Behrend, M; Hoffarth, U; Schüttler, W; Stoelben, E

2004-09-01

This study was aimed to determine the resistance to pressure of manual and stapled bronchial closures under ideal conditions (90 degrees to the bronchial tree) and parallel to the trachea (45 degrees). An experimental study was done on 60 explanted pig tracheae which were alternatively closed with either double-layer, running sutures angled 90 degrees to the cartilaginous rings or an automatic stapling device. The closure line was placed exactly 90 degrees to the bronchial tree in 30 cases and parallel to the trachea (45 degrees) in 30. The sutures were placed under pressure until air leakage was observed. The leakage pressure was digitally recorded. A statistically significant difference existed between the two groups. Mechanical sutures proved more resistant to pressure (P=0.011). Under ideal conditions, the resistance to pressure of mechanical sutures is equal to if not better than that of manual sutures.

Laparoscopic liver resection: when to use the laparoscopic stapler device

PubMed Central

Gumbs, Andrew A.; Gayet, Brice

2008-01-01

Minimally invasive hepatic resection was first described by Gagner et al. in the early 1990s and since then has become increasingly adopted by hepatobiliary and liver transplant surgeons. Several techniques exist to transect the hepatic parenchyma laparoscopically and include transection with stapler and/or energy devices, such as ultrasonic shears, radiofrequency ablation and bipolar devices. We believe that coagulative techniques allow for superior anatomic resections and ultimately permit for the performance of more complex hepatic resections. In the stapling technique, Glisson's capsule is usually incised with an energy device until the parenchyma is thinned out and multiple firings of the staplers are then used to transect the remaining parenchyma and larger bridging segmental vessels and ducts. Besides the economic constraints of using multiple stapler firings, the remaining staples have the disadvantage of hindering and even preventing additional hemostasis of the raw liver surface with monopolar and bipolar electrocautery. The laparoscopic stapler device is, however, useful for transection of the main portal branches and hepatic veins during minimally invasive major hepatic resections. Techniques to safely perform major hepatic resection with the above techniques will be described with an emphasis on when and how laparoscopic vascular staplers should be used. PMID:18773113

Cost-revenue analysis in the surgical treatment of the obstructed defecation syndrome.

PubMed

Schiano di Visconte, Michele; Piccin, Alessandra; Di Bella, Raimondo; Giomo, Priscilla; Pederiva, Vania; Cina, Livio Dal; Munegato, Gabriele

2006-01-01

The obstructed defecation syndrome is a frequent condition in the female population. Rectocele and rectal intussusception may cause symptoms of obstructed defecation. The aim of this study is to carry out an economic cost-revenue analysis comparing the rectocele and the rectal intussusception surgical techniques using a double-transanal, circular stapler (Stapled Trans-Anal Rectal Resection - STARR) with other techniques used to repair the same defects. The analysis involved the systematic calculation of the costs incurred during hospitalisation. The revenue estimate was obtained according to the rate quantification of the Diagnosis Related Group (DRG) associated with each hospitalisation. Our analysis confirmed that the global expenditure for the STARR technique amounts to 3,579.09 Euro as against 5,401.15 Euro for rectocele abdominal repair and 3,469.32 Euro for perineal repair. The intussusception repair cost according to Delorme's procedure amounts to 5,877.41Euro as against 3,579.09 Euro for the STARR technique. The revenue analysis revealed a substantial gain for the Health Authority as regards the treatment of rectocele and rectal intussusception for obstructed defecation syndrome. The highest revenue, 6,168. 52 Euro, was obtained with intussusception repair with STARR as compared to Delorme's procedure which presented revenue amounting to 2,359.04. Lower revenues are recorded if the STARR technique is intended for rectocele repair; in this case the revenue amounts to 1,778.12 Euro as against 869.67 Euro and 1,887.89 Euro for abdominal and perineal repair, respectively.

[Closing the resection surface in left pancreatic resection with the surgical stapler].

PubMed

Fuchs, M; Köhler, H; Schafmayer, A; Peiper, H J

1992-01-01

In the present paper a technique is demonstrated wherein the closure of the pancreatic remnant following left pancreatectomy with absorbable staples was performed. The good results with minimal complications recommend this method.

Transanal repair of rectocele and full rectal mucosectomy with one circular stapler: a novel surgical technique.

PubMed

Regadas, F S P; Regadas, S M M; Rodrigues, L V; Misici, R; Silva, F R; Regadas Filho, F S P

2005-04-01

We present a new surgical stapling technique for treatment of rectocele when associated with internal mucosal prolapse or haemorrhoids using only one circular mechanical stapler. Eight female patients, mean age 53 years (range, 42-70), complaining of obstructed defecation with vaginal digitation because of rectocele associated with internal mucosal prolapse underwent transanal repair of rectocele and rectal mucosectomy using one circular stapler between April and July 2004. A running horizontal mattress suture was placed through the base of the rectocele including mucosa, submucosa and the muscle layer of the whole anterior anorectal junction wall. The prolapsed mucosa and the muscular layer were then excised with an electrical scapel. A continuous pursestring rectal mucosa suture was placed 0.5 cm before the previous anterior mucosa and muscle layers resected wound, including the anorectal junction wall which was kept separate from the posterior vaginal wall by a Babcock forceps. Posteriorly, the pursestring suture included only mucosal and submucosal layers. The stapled suture was positioned between normal anterior rectal wall and the anal canal, 0.5 cm above the pectinate line. The stapler was then closed, fired and withdrawn. One patient complained of a perianal hematoma on the seventh postoperative day, requiring surgical excision. Postoperative defecography showed correction of the rectocele and outlet obstruction disappeared in all patients. This novel combined manual-stapled technique for rectocele and rectal internal mucosal prolapse seems to be a safe procedure and the preliminary results are encouraging. Further investigations have to be performed to assess long-term outcome in a larger number of patients.

21 CFR 878.4760 - Removable skin staple.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Removable skin staple. 878.4760 Section 878.4760...) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4760 Removable skin staple. (a) Identification. A removable skin staple is a staple-like device intended to connect external tissues temporarily...

Serosal Laceration During Firing of Powered Linear Stapler Is a Predictor of Staple Malformation.

PubMed

Matsuzawa, Fumihiko; Homma, Shigenori; Yoshida, Tadashi; Konishi, Yuji; Shibasaki, Susumu; Ishikawa, Takahisa; Kawamura, Hideki; Takahashi, Norihiko; Iijima, Hiroaki; Taketomi, Akinobu

2017-12-01

Although several types of staplers have been developed, staple-line leaks have been a great problem in gastrointestinal surgery. Powered linear staplers were recently developed to further reduce the risk of tissue trauma during laparoscopic surgery. The aim of this study was to identify the factors that predict staple malformation and determine the effect of precompression and slow firing on the staple formation of this novel powered stapling method. Porcine stomachs were divided using an endoscopic powered linear stapler with gold reloads. We divided the specimens into 9 groups according to the precompression time (0/60/180 seconds) and firing time (0/60/180 seconds). The occurrence and length of laceration and the shape of the staples were evaluated. We examined the factors influencing successful stapling and investigated the key factors for staple malformation. Precompression significantly decreased the occurrence and length of serosal laceration. Precompression and slow firing significantly improved the optimal stapling formation rate. Univariate analysis showed that the precompression time (0 seconds), firing time (0 seconds), and presence of serosal laceration were significantly associated with a low optimal formation rate. Multivariate analysis showed that these three factors were associated independently with low optimal formation rate and that the presence of serosal laceration was the only factor that could be detected during the stapling procedure. We have shown that serosal laceration is a predictor of staple malformation and demonstrated the importance of precompression and slow stapling when using the powered stapling method.

75 FR 43921 - Certain Polyester Staple Fiber From Taiwan: Final Results of Antidumping Duty Administrative Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-27

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Certain Polyester Staple... certain polyester staple fiber from Taiwan. The period of review is May 1, 2008, through April 30, 2009... polyester staple fiber (PSF) from Taiwan. See Certain Polyester Staple Fiber From Taiwan: Preliminary...

Finite element modelling of stapled colorectal end-to-end anastomosis: advantages of variable height stapler design.

PubMed

Nováček, V; Tran, T N; Klinge, U; Tolba, R H; Staat, M; Bronson, D G; Miesse, A M; Whiffen, J; Turquier, F

2012-10-11

The impact of surgical staplers on tissues has been studied mostly in an empirical manner. In this paper, finite element method was used to clarify the mechanics of tissue stapling and associated phenomena. Various stapling modalities and several designs of circular staplers were investigated to evaluate the impact of the device on tissues and mechanical performance of the end-to-end colorectal anastomosis. Numerical simulations demonstrated that a single row of staples is not adequate to resist leakage due to non-linear buckling and opening of the tissue layers between two adjacent staples. Compared to the single staple row configuration, significant increase in stress experienced by the tissue at the inner staple rows was observed in two and three rows designs. On the other hand, adding second and/or third staple row had no effect on strain in the tissue inside the staples. Variable height design with higher staples in outer rows significantly reduced the stresses and strains in outer rows when compared to the same configuration with flat cartridge. Copyright © 2012 Elsevier Ltd. All rights reserved.

Long-term outcome of a multicentre randomized clinical trial of stapled haemorrhoidopexy versus Milligan-Morgan haemorrhoidectomy.

PubMed

Ganio, E; Altomare, D F; Milito, G; Gabrielli, F; Canuti, S

2007-08-01

Stapled haemorrhoidopexy is less painful than Milligan-Morgan haemorrhoidectomy, allowing an earlier return to working activities, but its long-term efficacy is not fully established. This study reports the long-term follow-up of a randomized clinical trial comparing the two techniques in 100 patients affected by third- and fourth-degree haemorrhoids. All patients were contacted and invited to attend the clinic to assess long-term functional outcome. The degree of continence and satisfaction were assessed by questionnaire. Anal manometry and anoscopy were performed. Eighty patients were available after a median follow-up of 87 months. No statistically significant differences were found between the two groups in terms of incontinence, stenosis, pain, bleeding, residual skin tags or recurrent prolapse. A tendency towards a higher recurrence rate was reported in patients with fourth-degree haemorrhoids, irrespective of the technique used. No significant changes in anal manometric values were found after surgery in either group. Both techniques are effective in the long term. Copyright (c) 2007 British Journal of Surgery Society Ltd.

A new internal fixation technique for fractures of the proximal humerus--the Bilboquet device: a report on 26 cases.

PubMed

Doursounian, L; Grimberg, J; Cazeau, C; Jos, E; Touzard, R C

2000-01-01

We describe a novel internal fixation device and report on 26 patients (mean age, 70 years) whose proximal humeral fractures were managed with this technique. The 2-part titanium implant consists of a circular staple impacted into the humeral head cancellous bone and a spigoted diaphyseal stem that inserts into the staple "cup." Of the 26 cases reviewed, 16 had 3-part fractures and 10 had 4-part fractures. Mean follow-up was 25.9 months. In the 16 3-part fractures, the mean active forward elevation was 114 degrees and the results were as follows: excellent, 7; good, 5; fair, 3; poor, 1. In the 10 4-part fracture patients, the mean active forward elevation was 101 degrees and the results were as follows: excellent, 2; good, 4; fair, 3; poor, 1. There were 5 cases of avascular necrosis and 1 case of tuberosity nonunion. Only 2 cases needed conversion to hemiarthroplasty. The new technique should simplify the surgery of these fractures and reduce the need for arthroplasty.

Water and Land Limitations to Future Agricultural Production in the Middle East

NASA Astrophysics Data System (ADS)

Koch, J. A. M.; Wimmer, F.; Schaldach, R.

2015-12-01

Countries in the Middle East use a large fraction of their scarce water resources to produce cash crops, such as fruit and vegetables, for international markets. At the same time, these countries import large amounts of staple crops, such as cereals, required to meet the nutritional demand of their populations. This makes food security in the Middle East heavily dependent on world market prices for staple crops. Under these preconditions, increasing food demand due to population growth, urban expansion on fertile farmlands, and detrimental effects of a changing climate on the production of agricultural commodities present major challenges to countries in the Middle East that try to improve food security by increasing their self-sufficiency rate of staple crops.We applied the spatio-temporal land-use change model LandSHIFT.JR to simulate how an expansion of urban areas may affect the production of agricultural commodities in Jordan. We furthermore evaluated how climate change and changes in socio-economic conditions may influence crop production. The focus of our analysis was on potential future irrigated and rainfed production (crop yield and area demand) of fruit, vegetables, and cereals. Our simulation results show that the expansion of urban areas and the resulting displacement of agricultural areas does result in a slight decrease in crop yields. This leads to almost no additional irrigation water requirements due to the relocation of agricultural areas, i.e. there is the same amount of "crop per drop". However, taking into account projected changes in socio-economic conditions and climate conditions, a large volume of water would be required for cereal production in order to safeguard current self-sufficiency rates for staple crops. Irrigation water requirements are expected to double until 2025 and to triple until 2050. Irrigated crop yields are projected to decrease by about 25%, whereas there is no decrease in rainfed crop yields to be expected.

Comparative morphology, biology and histology of reproductive development in three lines of Manihot esculenta Crantz (Euphorbiaceae: Crotonoideae).

PubMed

Perera, P I P; Quintero, M; Dedicova, B; Kularatne, J D J S; Ceballos, H

2013-01-01

Cassava (Manihot esculenta), a major food staple in the tropics and subtropics, thrives even in environments undergoing threatening climate change. To satisfy the increasing demand for crop improvement and overcome the limitations of conventional breeding, the introduction of inbreeding techniques such as the production of doubled haploid lines via androgenesis or gynogenesis offers advantages. However, comprehensive studies on cassava flower bud biology or structural development are lacking and precise structural and biological information is a prerequisite to enhance the efficiency of these techniques. The floral biology of three selected cassava lines was studied, focusing on morphology, phenology and pollen biology (quantity, viability and dimorphism). Histological studies were also conducted on microsporogenesis/microgametogenesis and megasporogenesis/megagameto-genesis to generate precise developmental data for these lines. Male and female cyathia have distinct developmental phases. Pollen viability was high during immature stages of plant development; however, pollen mortality was common at later stages. Pollen trimorphism in male gametophytes towards the larger or smaller pollen size, as compared with normal size, was observed. Ten characteristic events were identified in male gametogenesis and six in female gametogenesis that were correlated with flower bud diameter. Male gametophyte diameter at different developmental stages was also determined. Results indicate that the three lines did not differ significantly, except regarding a few morphological aspects such as plant height, flower colour and number of male cyathia. Pollen grains were initially viable, but viability decreased drastically at later stages of growth. Abnormal meiosis or mitosis triggered pollen trimorphism. The demonstrated sequential events of reproductive development generated valuable information at the cellular level, which will help close the current information gap for cassava improvement via breeding programmes and doubled haploid plant production.

Technical innovation: Intragastric Single Port Sleeve Gastrectomy (IGSG). A feasibility survival study on porcine model.

PubMed

Estupinam, Oscar; Oliveira, André Lacerda de Abreu; Antunes, Fernanda; Galvão, Manoel; Phillips, Henrique; Scheffer, Jussara Peters; Rios, Marcelo; Zorron, Ricardo

2018-01-01

To perform technically the laparoscopic sleeve gastrectomy (LSG) using a unique Intragastric Single Port (IGSG) in animal swine model, evidencing an effective and safe procedure, optimizing the conventional technique. IGSG was performed in 4 minipigs, using a percutaneous intragastric single port located in the pre-pyloric region. The gastric stapling of the greater curvature started from the pre-pyloric region towards the angle of His by Endo GIA™ system and the specimen was removed through the single port. In the postoperative day 30, the animals were sacrificed and submitted to autopsy. All procedures were performed without conversion, and all survived 30 days. The mean operative time was 42 min. During the perioperative period no complications were observed during invagination and stapling. No postoperative complications occurred. Post-mortem examination showed no leaks or infectious complications. Intragastric Single Port is a feasible procedure that may be a suitable alternative technique of sleeve gastrectomy for the treatment of morbid obesity.

Stapled haemorrhoidopexy: a consensus position paper by an international working party - indications, contra-indications and technique.

PubMed

Corman, M L; Gravié, J-F; Hager, T; Loudon, M A; Mascagni, D; Nyström, P-O; Seow-Choen, F; Abcarian, H; Marcello, P; Weiss, E; Longo, A

2003-07-01

An international working party with experience in the performance of an alternative haemorrhoid operation through the use of the circular stapler was convened for the purpose of developing a consensus as to the criteria for undertaking this procedure. The agenda consisted of first, naming the operation; second, the indications and contra-indications for its performance; and third, the preferred surgical technique. Among the recommendations for individuals who plan to embark on this surgery are that experience with anorectal surgery and an understanding of anorectal anatomy are requisites; experience with circular stapling devices is essential; and the surgeon must attend a formal course which should include lectures, videos, the application of the instrument in models, and observation of the operation as performed by a surgeon recognized by his or her peers-leading ultimately to undertaking the procedure while being observed by an experienced surgeon. Following satisfactory completion of the above, independent responsibility should be determined by an individual's department of surgery.

Laparoscopic anterior resection and total mesorectal excision for rectal cancer: a prospective nonrandomized study.

PubMed

Palanivelu, C; Sendhilkumar, K; Jani, Kalpesh; Rajan, P S; Maheshkumar, G S; Shetty, Roshan; Parthasarthi, R

2007-04-01

The purpose of this study was to present our experience of laparoscopic total mesorectal resection, including ultralow resection and coloanal anastomosis. Between 1993 and 2005, patients fit for general anesthesia, with resectable cancers, and with lower edge of tumor beyond 5 cm of the anal verge were subjected to laparoscopic anterior resection with sphincter preservation. Double stapling technique is used to establish bowel continuity. A total of 170 patients, 88 males and 82 females, were subjected to successful laparoscopic anterior resection, which included high anterior resection (n=90), low anterior resection (n=52), ultralow anterior resection (n=20), and coloanal anastomosis (n=8). The average age of patients was 58.4 years (12-90 years). Mean operating time was 130 min and mean hospital stay was 7 days. The morbidity was 13.5% with nil mortality. With an average follow-up of 49 months (range 9 years to 3 months), 9 patients developed local recurrence and 45 patients developed distant metastasis. In selected cases, laparoscopic anterior resection is possible for all levels of rectal tumors, allowing sphincter preservation and maintaining oncological safety.

Comparison of endostapler performance in challenging tissue applications.

PubMed

Contini, Elizabeth; Whiffen, Jennifer; Bronson, Dwight

2013-01-01

Surgical staplers are frequently used in a variety of applications, demanding exacting instrument performance over a huge range of tissue compositions and disease states. The shape of a staple that is formed by a stapling device is one industry-accepted indicator of device performance; typically a B-shaped staple is considered the gold standard for staple formation. This B shape allows blood flow through the tissue, which is one important factor in the healing events that take place clinically after stapling. With the use of an animal model, this ex vivo study investigated staple formation when thick tissue endoscopic staplers were used on challenging and variable tissue. The setting was a corporate institution in the United States. Two 60-mm linear endoscopic thick tissue reloads, a varied-height stapler (VHS), and a single-height stapler (SHS) were fired on 7 different regions of porcine stomach. Resultant staple formation was assessed per region of the stomach and evaluated for proper B-shaped staple formation and staple malformation. The VHS reload had significantly better B-shaped formation (P<.001) for all regions of the stomach and reduced occurrence of malformed staples in 5 of the 7 regions compared with the SHS reload, wherein the remaining 2 regions exhibited comparable malform occurrence. This study compared 2 thick tissue reloads and found that the VHS reload had superior outcomes, with respect to staple formation, compared with the SHS reload. Copyright © 2012 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Partial stapled hemorrhoidopexy: a minimally invasive technique for hemorrhoids.

PubMed

Lin, Hong-Cheng; He, Qiu-Lan; Ren, Dong-Lin; Peng, Hui; Xie, Shang-Kui; Su, Dan; Wang, Xiao-Xue

2012-09-01

This study was designed to assess the safety, efficacy, and postoperative outcomes of partial stapled hemorrhoidopexy (PSH). A prospective study was conducted between February and March 2010. PSH was performed with single-window anoscopes for single isolated hemorrhoids, bi-window anoscopes for two isolated hemorrhoids, and tri-window anoscopes for three isolated hemorrhoids or circumferential hemorrhoids. The data pertaining to demographics, preoperative characteristics and postoperative outcomes were collected and analyzed. Forty-four eligible patients underwent PSH. Single-window anoscopes were used in 2 patients, and bi- and tri-window anoscopes in 6 and 36 patients. The blood loss in patients with single-window, bi-window, and tri-window anoscopes was 6.0 ml (range 5.0-7.0 ml), 5.0 ml (range 5.0-6.5 ml), and 5.0 ml (4.5-14.5 ml) (P = 0.332). The mean postoperative visual analog scale score for pain was 3 (range, 1-4), 2 (range 1-4), 3 (range 2-6), 1 (range 0-3), 1 (range 0-2) and 2 (range 2-4) at 12 h, days 1, 2, 3, and 7, and at first defecation. The rate of urgency was 9.1%. No patients developed anal incontinence or stenosis. The 1-year recurrence rate of prolapsing hemorrhoids was 2.3%. Partial stapled hemorrhoidopexy appears to be a safe and effective technique for grade III-IV hemorrhoids. Encouragingly, PSH is associated with mild postoperative pain, few urgency episodes, and no stenosis or anal incontinence.

Improving the side-to-side stapled anastomosis: comparison of staplers for robust crotch formation.

PubMed

Kimura, Masahiro; Kuwabara, Yoshiyuki; Taniwaki, Satoshi; Mitsui, Akira; Shibata, Yasuyuki; Ueno, Shuhei

2018-01-01

Few studies have investigated the burst pressure of side-to-side anastomoses comparing different stapling devices that are commercially available. We conducted side-to-side anastomoses with a variety of staplers and compared burst pressure in the crotch of the anastomoses. Nagoya City East Medical Center. We conducted side-to-side anastomoses with 9 staplers with different shapes and forms. Fresh pig small intestines were used. A side-to-side anastomosis was performed between 2 intestine specimens using a linear stapler. The burst pressure of the anastomosis was recorded. In total, 45 staplers were used for this experiment. The site of leakage in all cases was the crotch. Regarding the influence of the number of staple rows, the burst pressure in 3-row staplers was significantly higher than in 2-row staplers. With regard to the relationship between staple height and burst pressure, staples with a height slightly shorter than the intestinal thickness showed the highest burst pressure. In a comparison of staplers with uniform staple heights and stamplers with staples of 3 different heights, the latter had significantly lower burst pressures. Neoveil significantly increased the burst pressure in the crotch and contributed to the highest burst pressure of all the staplers used in this experiment. In this experiment, we defined the important factors that influence burst pressure at the crotch of a stapled, side-to-side anastomosis. These factors include the number of staple rows, the height of the staple compared with the thickness of the tissue, uniformity of staple height, and reinforcement of the staple line. In any surgical case requiring intestinal anastomosis, selection of a stapler is a critical step. Copyright © 2017 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

The use of bioabsorbable staple line reinforcement for circular stapler (BSG "Seamguard") in colorectal surgery: initial experience.

PubMed

Franklin, Morris E; Ramila, Guillermo Portillo; Treviño, Jorge M; González, John J; Russek, Karla; Glass, Jeffrey L; Kim, Greg

2006-12-01

Of all the complications associated with colorectal surgery, the most devastating and constant, despite all techniques being performed properly is anastomotic leakage, especially in left colon and rectal resections with rates as high as 50% when the rectum is involved. In 2005, our center published the preliminary experience with the use of linear staple line reinforcement for colon surgery. The purpose of this paper is to present a series of cases using a new conformation of bioabsorbable reinforcement for circular staplers in 5 patients, 2 patients with rectal cancer, 2 patients with diverticular disease, and 1 patient with sigmoid cancer. These initial data are very promising and has encouraged us to continue using this device on further patients.

Completely staple-free hand-sewn laparoscopic anastomosis in colorectal surgery.

PubMed

Lipski, David; Dapri, Giovanni; Himpens, Jacques

2008-04-01

Colonic continuity following a laparoscopic left hemicolectomy is usually performed by using a circular stapler to achieve end-to-end colorectal anastomosis. However, not much consideration is given to the costs of this technique and the long-term risk of stenosis. In this paper, we report the first case of a completely staple-free hand-sewn laparoscopic colonic anastomosis (CSHLCA) following a laparoscopic left hemicolectomy for cancer. Total operative time was 170 minutes, and the time to perform the anastomosis was 38 minutes. The postoperative stay was uneventful, with a total hospital stay of 6 days. CSHLCA is feasible and can lower the cost of the laparoscopic procedure. It may be considered in countries with limited access to mechanical staplers.

Early Experience With a Partial Stapled Hemorrhoidopexy for Treating Patients With Grades III–IV Prolapsing Hemorrhoids

PubMed Central

Jeong, Hyeonseok; Ryu, Kil O; Lim, Jiyong; Kim, Hyun Tae; Yu, Hye Mi; Yoon, Jihoon; Lee, Ju-Young; Kim, Hyoung Rae; Choi, Young Gil

2017-01-01

Purpose Circular stapled hemorrhoidopexy (CSH) is widely used to treat patients with grades III–IV hemorrhoids because of less pain and short hospital stay. However, this procedure is associated with some complications, such as urge to defecate, anal stenosis, staple line dehiscence, abscess and sepsis. To avoid these complications, surgeons perform a partial stapled hemorrhoidopexy (PSH). The aim of this study is to present our early experience with the PSH. Methods We retrospectively reviewed the medical records of 58 patients with hemorrhoids who were treated with a PSH at Busan Hang-Un Hospital from January 2016 to June 2016. A specially designed tri-window anoscope was used, and a purse string suture was made at the mucosae of the protruding hemorrhoids through the window of the anoscope. The hemorrhoidopexy was done by using a circular stapler. Results Of the 58 patients included in this study, 34 were male and 24 were female patients (mean age, 50.4 years). The mean operation time was 12.4 minutes, and the mean postoperative hospital stay was 3.8 days. Three patients experienced bleeding (5.1%) 5 urinary retention (8.6%) and 5 skin tags (8.6%). Urge to defecate, tenesmus, abscess, rectovaginal fistula, anal stricture, incontinence, and recurrence did not occur. Conclusion PSH is a minimally invasive, feasible, and safe technique for treating patients with grades III–IV hemorrhoids. A PSH, instead of a CSH, can be used to treat certain patients with hemorrhoids. PMID:28289661

7 CFR 457.105 - Extra long staple cotton crop insurance provisions.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 6 2014-01-01 2014-01-01 false Extra long staple cotton crop insurance provisions... long staple cotton crop insurance provisions. The extra long staple cotton crop insurance provisions... Crop Insurance Corporation ELS Cotton Crop Provisions 1. Definitions Cotton. Varieties identified as...

7 CFR 457.105 - Extra long staple cotton crop insurance provisions.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 6 2012-01-01 2012-01-01 false Extra long staple cotton crop insurance provisions... long staple cotton crop insurance provisions. The extra long staple cotton crop insurance provisions... Crop Insurance Corporation ELS Cotton Crop Provisions 1. Definitions Cotton. Varieties identified as...

7 CFR 457.105 - Extra long staple cotton crop insurance provisions.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 6 2013-01-01 2013-01-01 false Extra long staple cotton crop insurance provisions... long staple cotton crop insurance provisions. The extra long staple cotton crop insurance provisions... Crop Insurance Corporation ELS Cotton Crop Provisions 1. Definitions Cotton. Varieties identified as...

The effect of three different surgical techniques for colon anastomosis on regional postoperative microperfusion: Laser Doppler Flowmetry study in pigs.

PubMed

Kaska, Milan; Blazej, Slavomir; Turek, Zdenek; Ryska, Ales; Jegorov, Boris; Radochova, Vera; Bezouska, Jan; Paral, Jiri

2018-01-01

The optimal surgical approach to reconnecting bowel ends safely after resection is of great importance. This project is focused on assessment of the perianastomotic microcirculation quality in the short postoperative period when using three different anastomosis techniques in experimental animal. The experimental study involved 27 young female domestic pigs divided into three subgroups of 9 animals according to each surgical method of anastomosis construction in the sigmoid colon region: by manual suture, by stapler, or by gluing. Blood microcirculation in the anastomosis region was monitored using Laser Doppler Flowmetry (LDF). Anastomosis healing was evaluated by macroscopic and histological examination. Evaluation of the microcirculation in the anastomosis region showed the smallest decrease in perfusion values in animals reconstructed by suturing (Δ= -38.01%). A significantly more profound drop was observed postoperatively after stapling or gluing (Δ= -52.42% and Δ= -59.53%, respectively). All performed anastomoses healed without any signs of tissue and function pathology. Sewing, stapling, and gluing techniques for bowel anastomosis each have a different effect on regional microcirculation during 120 min. postoperatively. Nevertheless, the final results of anastomosis healing were found without of any pathology in all experimental animals managed by above mentioned anastomotic techniques.

76 FR 2886 - Certain Polyester Staple Fiber From the People's Republic of China: Final Results and Partial...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-18

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... duty order on certain polyester staple fiber (``PSF'') from the People's Republic of China (``PRC''). See Certain Polyester Staple Fiber From the People's Republic of China: Notice of Preliminary Results...

78 FR 51707 - Certain Polyester Staple Fiber From the Republic of Korea: Rescission of Antidumping Duty...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-21

... DEPARTMENT OF COMMERCE International Trade Administration [A-580-839] Certain Polyester Staple... certain polyester staple fiber (polyester staple fiber) from the Republic of Korea (Korea) for the period..., 2013, the Department initiated an administrative review of the antidumping duty order on polyester...

75 FR 34097 - Certain Polyester Staple Fiber From Taiwan: Extension of the Final Results of Antidumping Duty...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-16

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Certain Polyester Staple... administrative review of the antidumping duty order on certain polyester staple fiber from Taiwan. See Certain Polyester Staple Fiber from Taiwan: Preliminary Results of Antidumping Duty Administrative Review, 75 FR...

77 FR 6783 - Certain Polyester Staple Fiber From the People's Republic of China: Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-09

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... results of the administrative review of certain polyester staple fiber from the People's Republic of China... polyester staple fiber from the PRC. See Initiation of Antidumping and Countervailing Duty Administrative...

The interrupted serosubmucosal anastomosis - still the gold standard.

PubMed

Leslie, A; Steele, R J C

2003-07-01

The single-layer appositional serosubmucosal anastomosis is a well established technique and appears to have a favourable record. Over a 15-year period the senior author of this paper has performed or directly supervised 553 anastomoses using this technique. This report describes the results of these operations, the results of stapled anastomoses carried out during the same period and discusses the utility of the handsewn technique. From August 1986 to July 2001, 553 intestinal anastomoses in 550 patients were fashioned using single-layer, interrupted serosubmucosal 3/0 braided polyamide and 131 anastomoses in 131 patients were performed using a circular anastomosing stapler. One anastomotic leakage occurred in the group of patients whose anastomosis was handsewn (0.2%) and 11 leaks occurred in those who had a stapled anastomoses (8.4%). The mortality rate in each group was similar (2% and 2.3%, respectively). There were no deaths attributable to anastomotic dehiscence in either group. In this prospectively audited series of 553 handsewn anastomoses the leakage rate was 0.2%. These results compare favourably with other published series and continue to support a single layer of interrupted serosubmucosal sutures as the gold standard for anastomoses involving the large or small bowel.

What matters after sleeve gastrectomy: patient characteristics or surgical technique?

PubMed

Dhar, Vikrom K; Hanseman, Dennis J; Watkins, Brad M; Paquette, Ian M; Shah, Shimul A; Thompson, Jonathan R

2018-03-01

The impact of operative technique on outcomes in laparoscopic sleeve gastrectomy has been explored previously; however, the relative importance of patient characteristics remains unknown. Our aim was to characterize national variability in operative technique for laparoscopic sleeve gastrectomy and determine whether patient-specific factors are more critical to predicting outcomes. We queried the database of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program for laparoscopic sleeve gastrostomies performed in 2015 (n = 88,845). Logistic regression models were used to determine predictors of postoperative outcomes. In 2015, >460 variations of laparoscopic sleeve gastrectomy were performed based on combinations of bougie size, distance from the pylorus, use of staple line reinforcement, and oversewing of the staple line. Despite such substantial variability, technique variants were not predictive of outcomes, including perioperative morbidity, leak, or bleeding (all P ≥ .05). Instead, preoperative patient characteristics were found to be more predictive of these outcomes after laparoscopic sleeve gastrectomy. Only history of gastroesophageal disease (odds ratio 1.44, 95% confidence interval 1.08-1.91, P < .01) was associated with leak. Considerable variability exists in technique among surgeons nationally, but patient characteristics are more predictive of adverse outcomes after laparoscopic sleeve gastrectomy. Bundled payments and reimbursement policies should account for patient-specific factors in addition to current accreditation and volume thresholds when deciding risk-adjustment strategies. Copyright © 2018 Elsevier Inc. All rights reserved.

26 CFR 301.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 18 2012-04-01 2012-04-01 false Stapled foreign corporations. 301.269B-1....269B-1 Stapled foreign corporations. In accordance with section 269B(a)(1), a stapled foreign corporation is subject to the same taxes that apply to a domestic corporation under Title 26 of the Internal...

26 CFR 301.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 18 2010-04-01 2010-04-01 false Stapled foreign corporations. 301.269B-1....269B-1 Stapled foreign corporations. In accordance with section 269B(a)(1), a stapled foreign corporation is subject to the same taxes that apply to a domestic corporation under Title 26 of the Internal...

26 CFR 301.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 18 2013-04-01 2013-04-01 false Stapled foreign corporations. 301.269B-1....269B-1 Stapled foreign corporations. In accordance with section 269B(a)(1), a stapled foreign corporation is subject to the same taxes that apply to a domestic corporation under title 26 of the Internal...

26 CFR 301.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 18 2014-04-01 2014-04-01 false Stapled foreign corporations. 301.269B-1....269B-1 Stapled foreign corporations. In accordance with section 269B(a)(1), a stapled foreign corporation is subject to the same taxes that apply to a domestic corporation under title 26 of the Internal...

26 CFR 1.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 26 Internal Revenue 3 2010-04-01 2010-04-01 false Stapled foreign corporations. 1.269B-1 Section 1... (CONTINUED) INCOME TAXES Items Not Deductible § 1.269B-1 Stapled foreign corporations. (a) Treatment as a domestic corporation—(1) General rule. Except as otherwise provided, if a foreign corporation is a stapled...

26 CFR 301.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 18 2011-04-01 2011-04-01 false Stapled foreign corporations. 301.269B-1....269B-1 Stapled foreign corporations. In accordance with section 269B(a)(1), a stapled foreign corporation is subject to the same taxes that apply to a domestic corporation under Title 26 of the Internal...

75 FR 30373 - Certain Polyester Staple Fiber From the People's Republic of China: Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-01

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... results of the administrative review of certain polyester staple fiber from the People's Republic of China... administrative review of the antidumping duty order on certain polyester staple fiber from the PRC. See...

75 FR 47795 - Certain Polyester Staple Fiber from Korea: Rescission of Antidumping Duty Administrative Review

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-09

... DEPARTMENT OF COMMERCE International Trade Administration [A-580-839] Certain Polyester Staple... Polyester staple fiber (``PSF'') covered by the scope of the order is defined as synthetic staple fibers, not carded, combed or otherwise processed for spinning, of polyesters measuring 3.3 decitex (3 denier...

77 FR 21733 - Certain Polyester Staple Fiber From Taiwan: Extension of Time Limit for Preliminary Results of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-11

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Certain Polyester Staple... Department) initiated an administrative review of the antidumping duty order on certain polyester staple fiber from Taiwan for the period May 1, 2010, through April 30, 2011.\\1\\ In Certain Polyester Staple...

75 FR 39208 - Polyester Staple Fiber from Taiwan: Final Results of Changed-Circumstances Antidumping Duty...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-08

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Polyester Staple Fiber from... Eastern Textile Limited with regard to the antidumping duty order on polyester staple fiber from Taiwan... on polyester staple fiber from Taiwan to determine whether FENC was the successor-in-interest to FET...

75 FR 51442 - Polyester Staple Fiber from Taiwan: Rescission of Antidumping Duty Administrative Review in Part

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-20

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Polyester Staple Fiber from... antidumping duty order on polyester staple fiber from Taiwan. The period of review is May 1, 2009, through... duty order on polyester staple fiber from Taiwan with respect to respondents Nan Ya Plastics...

78 FR 38938 - Polyester Staple Fiber From Taiwan: Final Results of Antidumping Duty Administrative Review; 2011...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-28

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Polyester Staple Fiber From... duty order on polyester staple fiber (PSF) from Taiwan. The period of review is May 1, 2011, through... Results. None were received. \\1\\ See Polyester Staple Fiber From Taiwan: Preliminary Results of...

76 FR 58040 - Certain Polyester Staple Fiber From Korea and Taiwan

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-19

... Polyester Staple Fiber From Korea and Taiwan Determination On the basis of the record \\1\\ developed in the... antidumping duty orders on certain polyester staple fiber from Korea and Taiwan would be likely to lead to...), entitled Certain Polyester Staple Fiber From Korea and Taiwan: Investigation Nos. 731-TA-825 and 826...

75 FR 6352 - Certain Polyester Staple Fiber from the People's Republic of China: Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-09

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... results of the administrative review of certain polyester staple fiber from the People's Republic of China... administrative review of the antidumping duty order on certain polyester staple fiber from the PRC. See...

76 FR 7532 - Certain Polyester Staple Fiber From the People's Republic of China: Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-02-10

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... results of the administrative review of certain polyester staple fiber from the People's Republic of China... initiation of the administrative review of the antidumping duty order on certain polyester staple fiber from...

77 FR 19619 - Certain Polyester Staple Fiber from the People's Republic of China: Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-04-02

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... results of the administrative review of certain polyester staple fiber from the People's Republic of China... polyester staple fiber from the PRC.\\1\\ On February 9, 2012 the Department partially extended the deadline...

76 FR 28420 - Certain Polyester Staple Fiber From the People's Republic of China: Full Extension of Preliminary...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-17

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... results of the administrative review of certain polyester staple fiber from the People's Republic of China... administrative review of the antidumping duty order on certain polyester staple fiber from the PRC. See...

75 FR 76954 - Certain Polyester Staple Fiber From the People's Republic of China: Extension of Time Limit for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-10

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... administrative review of certain polyester staple fiber (``PSF'') from the People's Republic of China (``PRC''), covering the period June 1, 2008--May 31, 2009. See Certain Polyester Staple Fiber From the People's...

76 FR 52935 - Certain Polyester Staple Fiber From Korea: Rescission of Antidumping Duty Administrative Review

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-24

... DEPARTMENT OF COMMERCE International Trade Administration [A-580-839] Certain Polyester Staple... on polyester staple fiber from Korea. See Antidumping or Countervailing Duty Order, Finding, or..., 76 FR 37781 (June 28, 2011). Scope of the Order Polyester staple fiber covered by the scope of the...

Surgical Ablation Assay for Studying Eye Regeneration in Planarians.

PubMed

Morton, Jacob M; Saad, Marwa A; Beane, Wendy S

2017-04-14

In the study of adult stem cells and regenerative mechanisms, planarian flatworms are a staple in vivo model system. This is due in large part to their abundant pluripotent stem cell population and ability to regenerate all cell and tissue types after injuries that would be catastrophic for most animals. Recently, planarians have gained popularity as a model for eye regeneration. Their ability to regenerate the entire eye (comprised of two tissue types: pigment cells and photoreceptors) allows for the dissection of the mechanisms regulating visual system regeneration. Eye ablation has several advantages over other techniques (such as decapitation or hole punch) for examining eye-specific pathways and mechanisms, the most important of which is that regeneration is largely restricted to eye tissues alone. The purpose of this video article is to demonstrate how to reliably remove the planarian optic cup without disturbing the brain or surrounding tissues. The handling of worms and maintenance of an established colony is also described. This technique uses a 31 G, 5/16-inch insulin needle to surgically scoop out the optic cup of planarians immobilized on a cold plate. This method encompasses both single and double eye ablation, with eyes regenerating within 1-2 weeks, allowing for a wide range of applications. In particular, this ablation technique can be easily combined with pharmacological and genetic (RNA interference) screens for a better understanding of regenerative mechanisms and their evolution, eye stem cells and their maintenance, and phototaxic behavioral responses and their neurological basis.

Totally intracorporeal delta-shaped B-I anastomosis following laparoscopic distal gastrectomy using the Tri-Staple™ reloads on the manual Ultra handle: a prospective cohort study with historical controls.

PubMed

Man-I, Mariko; Suda, Koichi; Kikuchi, Kenji; Tanaka, Tsuyoshi; Furuta, Shimpei; Nakauchi, Masaya; Ishikawa, Ken; Ishida, Yoshinori; Uyama, Ichiro

2015-11-01

A delta-shaped anastomosis in totally laparoscopic Billroth I gastrectomy could be performed easily and sufficiently using only laparoscopic linear staplers. However, the restricted maneuverability and severe blurring of these staplers along with their limited hemostability induced strain. In this study, we determined the feasibility and safety of performing delta-shaped anastomosis using the Endo GIA™ Reloads with Tri-Staple™ Technology combined with Endo GIA™ Ultra Universal stapler (Tri-Staple) with a particular focus on short-term surgical outcomes. We performed a single-institutional prospective interventional study (UMIN 000008014). The Tri-Staple was prospectively used on 23 consecutive patients who underwent a curative totally laparoscopic Billroth I gastrectomy with delta-shaped anastomosis. These patients were matched with the 19 patients previously treated using the ENDOPATH(®) ETS Articulating Linear Cutters (ETS) on clinical and demographic characteristics. There were no differences between the groups in anastomosis-related local complications, morbidity, non-anastomosis-related local complications, total systemic complications, and short-term outcomes with the exception of significantly reduced blood loss in the Tri-Staple group (ETS vs. Tri-Staple: 37 [10-306] vs. 15 [5-210] mL, p = 0.02). Intraoperative bleeding from the staple line was significantly reduced in the Tri-Staple group. The postoperative drain indwelling period (ETS vs. Tri-Staple, 6 [4-10] vs. 4 [2-43] days, p = 0.032), fasting period (5 [3-7] vs. 3 [3-24] days, p = 0.022), and hospital stay (14 [10-47] vs. 11 [6-58] days, p = 0.025) were significantly shorter in the Tri-Staple group. There was no mortality in this series. Acceleration assessed as indices of blurring of stapler tip might have a significant adverse influence on staple-line bleeding at stapling sites. Totally laparoscopic Billroth I distal gastrectomy using Tri-Staple was feasible and safe with favorable short-term surgical outcomes. Reduced blurring while stapling may be a novel endpoint which newly developed stapling devices should target.

Stapled versus handsewn methods for colorectal anastomosis surgery.

PubMed

Lustosa, S A; Matos, D; Atallah, A N; Castro, A A

2001-01-01

Randomized controlled trials comparing stapled with handsewn colorectal anastomosis have not shown either technique to be superior, perhaps because individual studies lacked statistical power. A systematic review, with pooled analysis of results, might provide a more definitive answer. To compare the safety and effectiveness of stapled and handsewn colorectal anastomosis. The following primary hypothesis was tested: the stapled technique is more effective because it decreases the level of complications. The RCT register of the Cochrane Review Group was searched for any trial or reference to a relevant trial (published, in-press, or in progress). All publications were sought through computerised searches of EMBASE, LILACS, MEDLINE, the Cochrane Controlled Clinical Trials Database, and through letters to industrial companies and authors. There were no limits upon language, date, or other criteria. All randomized clinical trials (RCTs) in which stapled and handsewn colorectal anastomosis were compared. Adult patients submitted electively to colorectal anastomosis. Endoluminal circular stapler and handsewn colorectal anastomosis. a) Mortality b) Overall Anastomotic Dehiscence c) Clinical Anastomotic Dehiscence d) Radiological Anastomotic Dehiscence e) Stricture f) Anastomotic Haemorrhage g) Reoperation h) Wound Infection i) Anastomosis Duration j) Hospital Stay. Data were independently extracted by the two reviewers (SASL, DM) and cross-checked. The methodological quality of each trial was assessed by the same two reviewers. Details of the randomization (generation and concealment), blinding, whether an intention-to-treat analysis was done, and the number of patients lost to follow-up were recorded. The results of each RCT were summarised on an intention-to-treat basis in 2 x 2 tables for each outcome. External validity was defined by characteristics of the participants, the interventions and the outcomes. The RCTs were stratified according to the level of colorectal anastomosis. The Risk Difference method (random effects model) and NNT for dichotomous outcomes measures and weighted mean difference for continuous outcomes measures, with the corresponding 95% confidence interval, were presented in this review. Statistical heterogeneity was evaluated by using funnel plot and chi-square testing. Of the 1233 patients enrolled ( in 9 trials), 622 were treated with stapled, and 611 with manual, suture. The following main results were obtained: a) Mortality: result based on 901 patients; Risk Difference - 0.6% Confidence Interval -2.8% to +1.6%. b) Overall Dehiscence: result based on 1233 patients; Risk Difference 0.2%, 95% Confidence Interval -5.0% to +5.3%. c) Clinical Anastomotic Dehiscence : result based on 1233 patients; Risk Difference -1.4%, 95% Confidence Interval -5.2 to +2.3%. d) Radiological Anastomotic Dehiscence : result based on 825 patients; Risk Difference 1.2%, 95% Confidence Interval -4.8% to +7.3%. e) Stricture: result based on 1042 patients; Risk Difference 4.6%, 95% Confidence Interval 1.2% to 8.1%. Number needed to treat 17, 95% confidence interval 12 to 31. f) Anastomotic Hemorrhage: result based on 662 patients; Risk Difference 2.7%, 95% Confidence Interval - 0.1% to +5.5%. g) Reoperation: result based on 544 patients; Risk Difference 3.9%, 95% Confidence Interval 0.3% to 7.4%. h) Wound Infection: result based on 567 patients; Risk Difference 1.0%, 95% Confidence Interval -2.2% to +4.3%. i) Anastomosis duration: result based on one study (159 patients); Weighted Mean Difference -7.6 minutes, 95% Confidence Interval -12.9 to -2.2 minutes. j) Hospital Stay: result based on one study (159 patients), Weighted Mean Difference 2.0 days, 95% Confidence Interval -3.27 to +7.2 days. The evidence found was insufficient to demonstrate any superiority of stapled over handsewn techniques in colorectal anastomosis, regardless of the level of anastomosis.

Gastrointestinal surgery in gynecologic oncology: evaluation of surgical techniques.

PubMed

Penalver, M; Averette, H; Sevin, B U; Lichtinger, M; Girtanner, R

1987-09-01

In recent years, the use of surgical staples has become popular in all subspecialties of surgery. The advantages proposed have been a decrease in operative time and morbidity. This paper reviews the University of Miami/Jackson Memorial Medical Center, Division of Gynecologic Oncology experience with the use of surgical staples in gastrointestinal surgery on patients with a diagnosis of a gynecologic malignancy. Between January 1, 1979 and July 1, 1985, a total of 152 procedures were done, 81 by stapler and 71 by suture anastomosis. Ninety-one patients had received previous radiation or chemotherapy. The average age of the patients was 52 years. The results show a decrease in operating time, blood loss, and postoperative hospital stay in those patients where the stapler anastomosis was used. The postoperative morbidity and mortality were not increased. Twenty-seven total pelvic exenterations were performed during the period of study and they were evaluated separately. The hospital stay and blood loss as well as the operative time were significantly less using staplers. This report includes a detailed evaluation of the results. From this study, we concluded that surgical staples are a safe alternative in gastrointestinal surgery in patients with a gynecologic malignancy.

Stapled versus handsewn methods for colorectal anastomosis surgery.

PubMed

Neutzling, Cristiane B; Lustosa, Suzana A S; Proenca, Igor M; da Silva, Edina M K; Matos, Delcio

2012-02-15

Previous systematic reviews comparing stapled and handsewn colorectal anastomosis that are available in the medical literature have not shown either technique to be superior. An update of this systematic review was performed to find out if there are any data that properly answer this question. To compare the safety and effectiveness of stapled and handsewn colorectal anastomosis surgery. The following primary hypothesis was tested: the stapled technique is more effective because it decreases the level of complications. A computerized search was performed in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE according to the strategies of the Colorectal Cancer Group of The Cochrane Collaboration. There were no limits upon language, date or other criteria. A revised search strategy was performed for this updated version of the review May 2011. All randomised controlled trials (RCTs) in which stapled and handsewn colorectal anastomosis techniques were compared. Participants were adult patients undergoing elective colorectal anastomosis surgery. The interventions were endoluminal circular stapler and handsewn colorectal anastomosis surgery. Outcomes considered were a) mortality; b) overall anastomotic dehiscence; c) clinical anastomotic dehiscence; d) radiological anastomotic dehiscence; e) stricture; f) anastomotic haemorrhage; g) reoperation; h) wound infection; i) anastomosis duration; and j) hospital stay. Data were independently analysed by the two review authors (CBN, SASL) and cross-checked. The methodological quality of each trial was assessed by the same two authors. After searching the literature for this update, no study was added to those in the previous version of this review. Details of randomizations (generation and concealment), blinding, whether an intention-to-treat analysis was done or not, and the number of patients lost to follow-up were recorded. The analysis of the risk of bias was updated according to the software Review Manager 5.1. The results of each RCT were summarized on an intention-to-treat basis in 2 x 2 tables for each outcome. External validity was defined by the characteristics of the participants, interventions and the outcomes. The RCTs were stratified according to the level of colorectal anastomosis. The risk difference (RD) method (random-effects model) and number needed to treat (NNT) for dichotomous outcome measures and weighted mean differences (WMD) for continuous outcomes measures, with the corresponding 95% confidence intervals (CI), were presented in this review. Statistical heterogeneity was evaluated using a funnel plot and the Chi(2) test. Of the 1233 patients enrolled in nine identified trials, 622 were treated with staples and 611 with manual suture. The following main results were obtained. a) Mortality, result based on 901 patients: RD -0.6%, 95% CI -2.8% to +1.6%. b) Overall dehiscence, result based on 1233 patients: RD 0.2%, 95% CI -5.0% to +5.3%. c) Clinical anastomotic dehiscence, result based on 1233 patients: RD -1.4%, 95% CI -5.2 to +2.3%. d) Radiological anastomotic dehiscence, result based on 825 patients: RD 1.2%, 95% CI -4.8% to +7.3%. e) Stricture, result based on 1042 patients: RD 4.6%, 95% CI 1.2% to 8.1%; NNT 17, 95% CI 12 to 31. f) Anastomotic haemorrhage, result based on 662 patients: RD 2.7%, 95% CI -0.1% to +5.5%. g) Reoperation, result based on 544 patients: RD 3.9%, 95% CI 0.3% to 7.4%. h) Wound infection, result based on 567 patients: RD 1.0%, 95% CI -2.2% to +4.3%. i) Anastomosis duration, result based on one study (159 patients): WMD -7.6 minutes, 95% CI -12.9 to -2.2 minutes. j) Hospital stay, result based on one study (159 patients): WMD 2.0 days, 95% CI -3.27 to +7.2 days. The evidence found was insufficient to demonstrate any superiority of stapled over handsewn techniques in colorectal anastomosis surgery, regardless of the level of anastomosis. There were no randomised clinical trials comparing these two types of anastomosis in elective conditions in the last decade. The relevance of this research question has possibly lost its strength where elective surgery is concerned. However, in risk situations, such as emergency surgery, trauma and inflammatory bowel disease, new clinical trials are needed.

Circumferentially oversewn inverted stapled anastomosis.

PubMed

Karam, Charbel; Lord, Sally; Gett, Rohan; Meagher, Alan P

2018-04-01

Leak rates of over 5% following anastomoses between the ileum and colon continue to be reported in large series and are associated with substantial morbidity and with mortality rates of 10-20%. In 1994, we began performing circumferentially oversewn inverted stapled anastomoses in patients undergoing ileo-colic anastomoses or ileostomy closure. It has become increasingly apparent that this method is associated with a low risk of leakage, which we should report. The anastomotic technique described was used in all patients undergoing ileo-colic anastomosis or closure of ileostomy by surgeon 1 (1994-2015) and in all ileo-colic anastomoses by surgeon 2 (2007-2015). All patients had a widely patent anastomosis constructed by two firings of a linear cutting stapler, as previously described. Additionally, the entire staple line was carefully oversewn with interrupted, inverting 4/0 polydioxanone sutures. Anastomotic leak was defined as a patient requiring re-operation or radiological drainage. One thousand and twelve patients underwent ileo-colic anastomosis and 685 patients underwent closure of ileostomy by surgeon 1, and 165 patients underwent ileo-colic anastomosis by surgeon 2. None of the 1862 patients required re-operation or radiological drainage for a leak (event rate 0%, 95% confidence interval 0-0.2%). However, there were three possible contained leaks treated successfully conservatively. The time taken to perform the actual anastomosis was measured in the last 30 ileo-colic resections. The median time was 42 min. While this method may well be too slow to gain widespread adoption, we hope this report encourages increased research into finding techniques with similar low leak rates. © 2016 Royal Australasian College of Surgeons.

Diagnosing Internal Herniation After Roux-en-Y Gastric Bypass Surgery: Literature Overview, Cadaver Study and the Added Value of 3D CT Angiography.

PubMed

Klop, Cornelis; Deden, Laura N; Aarts, Edo O; Janssen, Ignace M C; Pijl, Milan E J; van den Ende, Anneline; Witteman, Bart P L; de Jong, Gabie M; Aufenacker, Theo J; Slump, Cornelis H; Berends, Frits J

2018-02-05

The purposes of the study are to outline the complexity of diagnosing internal herniation after Roux-en-Y gastric bypass (RYGB) surgery and to investigate the added value of computed tomography angiography (CTA) for diagnosing internal herniation. A cadaver study was performed to investigate the manifestations of internal hernias and mesenteric vascularization. Furthermore, a prospective, ethics approved study with retrospective interpretation was conducted. Ten patients, clinically suspected for internal herniation, were prospectively included. After informed consent was obtained, these subjects underwent abdominal CT examination, including additional arterial phase CTA. All subjects underwent diagnostic laparoscopy for suspected internal herniation. The CTA was used to create a 3D reconstruction of the mesenteric arteries and surgical staples (3D CTA). The 3D CTA was interpreted, taking into account the presence and type of internal hernia that was found upon laparoscopy. Cadaveric analysis demonstrated the complexity of internal herniation. It also confirmed the expected changes in vascular structure and surgical staple arrangement in the presence of internal herniation. 3D CTA studies of the subjects with active internal hernias demonstrated remarkable differences when compared to control 3D CTA studies. The blood supply of herniated intestinal limbs in particular showed abnormal trajectories. Additionally, enteroenterostomy staple lines had migrated or altered orientation. 3D CTA is a promising technique for diagnosing active internal hernias. Our findings suggest that for diagnosing internal hernias, focus should probably shift from routine abdominal CT examination towards the 3D assessment of the mesenteric vasculature and surgical staples.

Committing Canadian sociology: developing a Canadian sociology and a sociology of Canada.

PubMed

Matthews, Ralph

2014-05-01

This paper is a slightly revised version of the author's "Outstanding Career Award Lecture" presented at the Annual Meeting of the Canadian Sociological Association in Victoria, British Columbia on June 6, 2013. The paper distinguishes between Canadian Sociology and the Sociology of Canada. The former involves the explanatory stance that one takes to understanding Canada. The latter addresses the significant social dimensions that underlie Canadian social organization, culture, and behavior. I make a case for a Canadian Sociology that focuses on the unique features of Canadian society rather than adopting a comparative perspective. I also argue that there is a continuing need within the Sociology of Canada to address the issues of staples development. However, I argue that "new" staples analysis must have a directional change from that of the past, in that social processes now largely determine the pattern of staples development. Moreover, new staples analysis must include issues that were never part of earlier staples analysis, such as issues of environmental impacts and of staples depletion under conditions, such as climate change. The paper concludes by analyzing four factors that provide the dominant social contexts for analyzing modern staples development: (1) the rise of neoliberal government, (2) the implementation of globalization and its social consequences, (3) the assumption of aboriginal rights and entitlement, and (4) the rise of environmentalism. These factors were generally not considered in earlier staples approaches. They are critical to understanding the role of staples development and its impact on Canada in the present time.

Supraperitoneal colorectal anastomosis: hand-sewn versus circular staples--a controlled clinical trial. French Associations for Surgical Research.

PubMed

Fingerhut, A; Hay, J M; Elhadad, A; Lacaine, F; Flamant, Y

1995-09-01

Although used widely for supraperitoneal anastomoses, circular stapled anastomoses have never been proved better than hand-sewn anastomoses. In the one prospective controlled trial that studied these anastomoses specifically, the only significant difference found was that there were more clinically obvious leakages with the circular stapled variety, but not in the overall clinical and roentgenologic leakage rates. One hundred fifty-nine consecutive patients (88 men and 71 women, mean age 65.8 +/- 12.1 years) were randomized to undergo hand-sewn (n = 74) or circular stapled (n = 85) supraperitoneal colorectal anastomosis after left colectomy. Patient demographics were similar in both groups. Overall mortality was 1.3% (2 of 159; one in each group). No statistically significant difference (NS) was found in the rate of early complications, including anastomotic leakage (4 of 74 versus 6 of 85) in the hand-sewn and stapled anastomoses, respectively). Mishaps (n = 10) and hemorrhage (n = 5) occurred in the stapled group only. Stapled anastomoses took an average of 8 minutes less to perform (p < 0.001), but this time gain did not significantly influence the overall duration of operation (identical median times). The median duration of hospitalization was 13 and 14 days, respectively (NS). At 8 months there were 2 of 74 strictures in the hand-sewn group and 4 of 85 strictures in the stapled group (NS). According to these results, there seems to be no advantage of routine or regular use of stapling instruments for supraperitoneal colorectal anastomosis.

Assessing the evolving fragility of the global food system

NASA Astrophysics Data System (ADS)

Puma, Michael J.; Bose, Satyajit; Chon, So Young; Cook, Benjamin I.

2015-02-01

The world food crisis in 2008 highlighted the susceptibility of the global food system to price shocks. Here we use annual staple food production and trade data from 1992-2009 to analyse the changing properties of the global food system. Over the 18 year study period, we show that the global food system is relatively homogeneous (85% of countries have low or marginal food self-sufficiency) and increases in complexity, with the number of global wheat and rice trade connections doubling and trade flows increasing by 42 and 90%, respectively. The increased connectivity and flows within these global trade networks suggest that the global food system is vulnerable to systemic disruptions, especially considering the tendency for exporting countries to switch to non-exporting states during times of food scarcity in the global markets. To test this hypothesis, we superimpose continental-scale disruptions on the wheat and rice trade networks. We find greater absolute reductions in global wheat and rice exports along with larger losses in network connectivity as the networks evolve due to disruptions in European wheat and Asian rice production. Importantly, our findings indicate that least developed countries suffer greater import losses in more connected networks through their increased dependence on imports for staple foods (due to these large-scale disturbances): mean (median) wheat losses as percentages of staple food supply are 8.9% (3.8%) for 1992-1996, increasing to 11% (5.7%) for 2005-2009. Over the same intervals, rice losses increase from 8.2% (2.2%) to 14% (5.2%). Our work indicates that policy efforts should focus on balancing the efficiency of international trade (and its associated specialization) with increased resilience of domestic production and global demand diversity.

Assessing the Evolving Fragility of the Global Food System

NASA Technical Reports Server (NTRS)

Puma, Michael Joseph; Bose, Satyajit; Chon, So Young; Cook, Benjamin I.

2015-01-01

The world food crisis in 2008 highlighted the susceptibility of the global food system to price shocks. Here we use annual staple food production and trade data from 1992-2009 to analyse the changing properties of the global food system. Over the 18-year study period, we show that the global food system is relatively homogeneous (85 of countries have low or marginal food self-sufficiency) and increases in complexity, with the number of global wheat and rice trade connections doubling and trade flows increasing by 42 and 90, respectively. The increased connectivity and flows within these global trade networks suggest that the global food system is vulnerable to systemic disruptions, especially considering the tendency for exporting countries to switch to non-exporting states during times of food scarcity in the global markets. To test this hypothesis, we superimpose continental-scale disruptions on the wheat and rice trade networks. We find greater absolute reductions in global wheat and rice exports along with larger losses in network connectivity as the networks evolve due to disruptions in European wheat and Asian rice production. Importantly, our findings indicate that least developed countries suffer greater import losses in more connected networks through their increased dependence on imports for staple foods (due to these large-scale disturbances): mean (median) wheat losses as percentages of staple food supply are 8.9 (3.8) for 1992-1996, increasing to 11 (5.7) for 20052009. Over the same intervals, rice losses increase from 8.2 (2.2) to 14 (5.2). Our work indicates that policy efforts should focus on balancing the efficiency of international trade (and its associated specialization) with increased resilience of domestic production and global demand diversity.

Applying the algorithm "assessing quality using image registration circuits" (AQUIRC) to multi-atlas segmentation

NASA Astrophysics Data System (ADS)

Datteri, Ryan; Asman, Andrew J.; Landman, Bennett A.; Dawant, Benoit M.

2014-03-01

Multi-atlas registration-based segmentation is a popular technique in the medical imaging community, used to transform anatomical and functional information from a set of atlases onto a new patient that lacks this information. The accuracy of the projected information on the target image is dependent on the quality of the registrations between the atlas images and the target image. Recently, we have developed a technique called AQUIRC that aims at estimating the error of a non-rigid registration at the local level and was shown to correlate to error in a simulated case. Herein, we extend upon this work by applying AQUIRC to atlas selection at the local level across multiple structures in cases in which non-rigid registration is difficult. AQUIRC is applied to 6 structures, the brainstem, optic chiasm, left and right optic nerves, and the left and right eyes. We compare the results of AQUIRC to that of popular techniques, including Majority Vote, STAPLE, Non-Local STAPLE, and Locally-Weighted Vote. We show that AQUIRC can be used as a method to combine multiple segmentations and increase the accuracy of the projected information on a target image, and is comparable to cutting edge methods in the multi-atlas segmentation field.

The C-Port Distal Coronary Anastomotic Device Is Comparable With a Hand-Sewn Anastomosis: Human Histological Case Study.

PubMed

Balkhy, Husam H; Nisivaco, Sarah M; Husain, Aliya N; Jeevanandam, Valluvan; Arif, Quidsia

Coronary artery bypass surgery is most commonly performed using a hand-sewn technique with a continuous monofilament suture. The C-Port distal anastomotic device is a miniature stapler designed to create an arteriotomy and attach the graft to the coronary artery all in one step. It is the only distal coronary anastomotic device currently approved for clinical use and can be useful in facilitating less invasive coronary surgery. This report examines the histological attributes of such an anastomosis in a patient who underwent heart transplantation approximately 1 year after robotic totally endoscopic stapled coronary bypass using the C-Port anastomotic device. There have been no previous reports of histological examination of this type of bypass graft in humans in the literature. We found that the C-Port single-shot stapled coronary anastomotic device had a similar histological appearance to a traditional hand-sewn technique using monofilament suture. The amount of inflammation around the anastomosis using the two techniques was found to be comparable in this histological case study in an explanted human heart. There was no evidence of increased neointimal hyperplasia. These findings add to the already known equivalent clinical patency rates of the C-Port device in coronary bypass procedures.

A Discussion with Suzanne Fisher Staples: The Author as Writer and Cultural Observer.

ERIC Educational Resources Information Center

Sawyer, Walter E.; Sawyer, Jean C.

1993-01-01

Presents an interview with Suzanne Fisher Staples, author of the children's novel, "Shabanu, Daughter of the Wind." Discusses Staples' creative writing process, background, and the writer's role as cultural observer. (HB)

Effect of Stapling Architecture on Physiochemical Properties and Cell Permeability of Stapled α-Helical Peptides: A Comparative Study.

PubMed

Tian, Yuan; Jiang, Yanhong; Li, Jingxu; Wang, Dongyuan; Zhao, Hui; Li, Zigang

2017-11-02

Stapled peptides have emerged as a new class of targeting molecules with high binding affinity and specificity for intracellular undruggable targets. Their ability to penetrate cell membranes is exceptionally intriguing but remains elusively and controversially discussed. To understand the effect of stapling architectures on their physiochemical properties and to aid in promoting their cell permeability, we report herein a comparative study on the physiochemical properties and cell permeability of stapled α-helical peptides with different types of crosslinks. We highlight the decisive impact of the intrinsic properties of the crosslinks on cell permeability rather than the helical contents of the peptides in model amphipathic sequences targeting estrogen receptor-coactivator interaction. We envision this finding to shed further light on the chemical optimization of stapled α-helical peptides or macrocyclic cell-penetrating peptides for enhanced cell penetration. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

Competitive annealing of multiple DNA origami: formation of chimeric origami

NASA Astrophysics Data System (ADS)

Majikes, Jacob M.; Nash, Jessica A.; LaBean, Thomas H.

2016-11-01

Scaffolded DNA origami are a robust tool for building discrete nanoscale objects at high yield. This strategy ensures, in the design process, that the desired nanostructure is the minimum free energy state for the designed set of DNA sequences. Despite aiming for the minimum free energy structure, the folding process which leads to that conformation is difficult to characterize, although it has been the subject of much research. In order to shed light on the molecular folding pathways, this study intentionally frustrates the folding process of these systems by simultaneously annealing the staple pools for multiple target or parent origami structures, forcing competition. A surprising result of these competitive, simultaneous anneals is the formation of chimeric DNA origami which inherit structural regions from both parent origami. By comparing the regions inherited from the parent origami, relative stability of substructures were compared. This allowed examination of the folding process with typical characterization techniques and materials. Anneal curves were then used as a means to rapidly generate a phase diagram of anticipated behavior as a function of staple excess and parent staple ratio. This initial study shows that competitive anneals provide an exciting way to create diverse new nanostructures and may be used to examine the relative stability of various structural motifs.

Pod mesocarp flour of North and South American species of Leguminous tree (mesquite): Composition and food applications

USDA-ARS?s Scientific Manuscript database

Flour from the mesocarp of pods of the tree legume known as mesquite (Prosopis spp.) in North America or algarrobo in South America was one of the most important food staples for desert people. Contemporary milling techniques produces a similar flour that is about 40% sucrose, 25% dietary fiber, and...

Teaching Note--Theatre of the Oppressed and Social Work Education: Radicalizing the Practice Classroom

ERIC Educational Resources Information Center

Giesler, Mark A.

2017-01-01

Augusto Boal's Theatre of the Oppressed has been the basis for radical performance techniques practiced around the world. Widely a staple for theatre performance syllabi, it also has an innovative application for the social work classroom. This article designates Boal's four stages of his poetics of the oppressed and concomitant theatrical…

Will Transition of Staple Food Strategy in China Really Mitigate Global Climate Change?

NASA Astrophysics Data System (ADS)

Liu, B.; Zhao, D.

2017-12-01

With the increase in agricultural demand, reducing greenhouse gas (GHG) emissions is a vital challenge in mitigating climate change. Potato staple food strategy in China introduced by Ministry of Agriculture in 2015 is to gradually adjust staple food structure, which provides an opportunity to meet with the challenge. Apart from staple food structure, difference on energy, material input, geography, and crop management are essential to determine agriculture's contribution to climate change. In this study, we conduct a life cycle analysis of four staple foods in China, namely rice, wheat, maize, and potato, to develop crop-specific estimates of GHG emissions and GHG intensity by using `Production intensity' (carbon dioxide equivalent emissions per kilocalorie produced), to help us understand potential synergies and frictions between food producing and climate mitigation. Data used in this study is on city / province levels if city level is unavailable in 2015. First, we evaluate GHG reductions due to transition of staple food structure in China. Staple food GHG emissions in China are 546.90 Tg CO2e yr-1 in 2015, with 47.6%, 21.9%, 27.3% and 3.2% from rice, wheat, maize and potato. Mean production intensity of staple food is 0.45 Mg CO2e M kcal-1 in 2015. Maize leads the intensity with 0.77 Mg CO2e M kcal-1, followed by rice (0.49 Mg CO2e M kcal-1), wheat (0.28 Mg CO2e M kcal-1) and potato (0.24 Mg CO2e M kcal-1). After staple food structure adjustment, 25 Tg CO2e yr-1 (4.2%) reduction will be accomplished in 2020 without any crop management improvement. Further reduction (33.3% - 40.4%) could be achieved with crop management improvement. In addition, because of staple food structure switching, native rice production will decline, which might lead to more export from countries with higher production intensity. Estimated emission leakage from rice import is 30.10 Tg CO2e yr-1, exceeds emission reduction in native China. Therefore, potato staple food strategy could meet the demand for food in China, but it increases risk of global climate change.

Surgical stapling device-tissue interactions: what surgeons need to know to improve patient outcomes.

PubMed

Chekan, Edward; Whelan, Richard L

2014-01-01

The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a "knowledge gap" that is potentially dangerous. The goal of this review is to present a framework for the study of device- tissue interactions and to initiate the process of "filling in" the knowledge gap via the available literature. Surgical staplers, which are continually being developed, are the focus of this piece. The integrity of the staple line, which depends on adequate tissue compression, is the primary factor in creating a stable anastomosis. This review focuses on published studies that evaluated the creation of stable anastomoses in bariatric, thoracic, and colorectal procedures. Understanding how staplers interact with target tissues is key to improving patient outcomes. It is clear from this review that each tissue type presents unique challenges. The thickness of each tissue varies as do the intrinsic biomechanical properties that determine the ideal compressive force and prefiring compression time for each tissue type. The correct staple height will vary depending on these tissue-specific properties and the tissue pathology. These studies reinforce the universal theme that compression, staple height, tissue thickness, tissue compressibility, and tissue type must all be considered by the surgeon prior to choosing a stapler and cartridge. The surgeon's experience, therefore, is a critical factor. Educational programs need to be established to inform and update surgeons on the characteristics of each stapler. It is hoped that the framework presented in this review will facilitate this process.

Partial stapled hemorrhoidopexy versus circular stapled hemorrhoidopexy for grade III-IV prolapsing hemorrhoids: a two-year prospective controlled study.

PubMed

Lin, H-C; Ren, D-L; He, Q-L; Peng, H; Xie, S-K; Su, D; Wang, X-X

2012-10-01

Circular stapled hemorrhoidopexy (CSH) is an effective technique for treating prolapsing hemorrhoids; but urgency and anal stenosis are common postoperative complications. The aim of this study was to assess the efficacy and postoperative outcomes of partial stapled hemorrhoidopexy (PSH), compared with CSH. Seventy-two consecutive patients with grade III and IV hemorrhoids who met the inclusion/exclusion criteria were divided in a non-randomized manner to undergo either PSH (n = 34) or CSH (n = 38). Intraoperative and postoperative parameters in both groups were collected and compared. The postoperative visual analog score for pain at first defecation was significantly lower in the PSH group than that in the CSH group (P = 0.001). Fewer patients in the PSH group experienced postoperative urgency, compared with those in the CSH group at 12 h, 1 day, and 7 days after surgery (P = 0.025, P = 0.019, and P = 0.043, respectively). Gas incontinence occurred in 3 patients (7.9%) in the CSH group, but in none of patients in the PSH group (P = 0.242). Postoperative anal stenosis developed in one patient (2.6%) in the CSH group, but in none of the patients in the PSH group (P = 1.0). The 2-year recurrence rate was 2.9 and 5.3%, respectively, in the PSH and CSH groups (P = 1.0). The 2-year recurrence rate is similar in patients with grade III-IV hemorrhoids treated with PSH or CSH. However, PSH is associated with less postoperative pain, fewer episodes of urgency, and no anal incontinence or anal stenosis.

Assessment of MRI issues at 3-Tesla for metallic surgical implants: findings applied to 61 additional skin closure staples and vessel ligation clips.

PubMed

Gill, Amreeta; Shellock, Frank G

2012-01-09

Metallic skin closure staples and vessel ligation clips should be tested at 3-Tesla to characterize MRI issues in order to ensure patient safety. Therefore, metallic surgical implants were assessed at 3-Tesla for magnetic field interactions, MRI-related heating, and artifacts. A skin closure staple (Visistat Skin Stapler, staple, Polytetrafluoroethylene, PTFE, coated 316L/316LVM stainless steel; Teleflex Medical, Durham, NC) and a vessel ligation clip (Hemoclip Traditional, stainless steel; Teleflex Medical, Durham, NC) that represented the largest metallic sizes made from materials with the highest magnetic susceptibilities (i.e., based on material information) among 61 other surgical implants (52 metallic implants, 9 nonmetallic implants) underwent evaluation for magnetic field interactions, MRI-related heating, and artifacts using standardized techniques. MRI-related heating was assessed by placing each implant in a gelled-saline-filled phantom with MRI performed using a transmit/receive RF body coil at an MR system reported, whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were characterized using T1-weighted, SE and GRE pulse sequences. Each surgical implant showed minor magnetic field interactions (20- and 27-degrees, which is acceptable from a safety consideration). Heating was not substantial (highest temperature change, ≤ 1.6°C). Artifacts may create issues if the area of interest is in the same area or close to the respective surgical implant. The results demonstrated that it would be acceptable for patients with these metallic surgical implants to undergo MRI at 3-Tesla or less. Because of the materials and dimensions of the surgical implants that underwent testing, these findings pertain to 61 additional similar implants.

Assessment of MRI issues at 3-Tesla for metallic surgical implants: findings applied to 61 additional skin closure staples and vessel ligation clips

PubMed Central

2012-01-01

Purpose Metallic skin closure staples and vessel ligation clips should be tested at 3-Tesla to characterize MRI issues in order to ensure patient safety. Therefore, metallic surgical implants were assessed at 3-Tesla for magnetic field interactions, MRI-related heating, and artifacts. Methods A skin closure staple (Visistat Skin Stapler, staple, Polytetrafluoroethylene, PTFE, coated 316L/316LVM stainless steel; Teleflex Medical, Durham, NC) and a vessel ligation clip (Hemoclip Traditional, stainless steel; Teleflex Medical, Durham, NC) that represented the largest metallic sizes made from materials with the highest magnetic susceptibilities (i.e., based on material information) among 61 other surgical implants (52 metallic implants, 9 nonmetallic implants) underwent evaluation for magnetic field interactions, MRI-related heating, and artifacts using standardized techniques. MRI-related heating was assessed by placing each implant in a gelled-saline-filled phantom with MRI performed using a transmit/receive RF body coil at an MR system reported, whole body averaged SAR of 2.9-W/kg for 15-min. Artifacts were characterized using T1-weighted, SE and GRE pulse sequences. Results Each surgical implant showed minor magnetic field interactions (20- and 27-degrees, which is acceptable from a safety consideration). Heating was not substantial (highest temperature change, ≤ 1.6°C). Artifacts may create issues if the area of interest is in the same area or close to the respective surgical implant. Conclusions The results demonstrated that it would be acceptable for patients with these metallic surgical implants to undergo MRI at 3-Tesla or less. Because of the materials and dimensions of the surgical implants that underwent testing, these findings pertain to 61 additional similar implants. PMID:22230200

Radical cystectomy with W-shaped orthotopic ileal neobladder constructed with non-absorbable titanium staples-long term follow-up.

PubMed

Kravchick, Sergey; Lobik, Leonid; Paz, Adrian; Stepnov, Eugeny; Ben-Dor, David; Cytron, Shmuel

2013-01-01

We retrospectively assessed our experience with the W-shaped orthotopic ileal pouch, which was constructed with non-absorbable titanium staples. For these purpose, we discuss the results of bladder capacity, urinary continence and early and long-term postoperative complications. We included in the study 17 patients who underwent radical cystoprostatectomy followed by construction of an orthotopic W-shaped ileal pouch between October 2000 and November 2009. A 65-70 cm segment of ileum was isolated and prearranged into a W-configuration, leaving two 10 cm intact segments on both sides of the ileal fragment. In our technique we entirely anatomized all adjacent limbs in order to create a sphere-shaped pouch. The ureters were directly anastomized to both intact segments of the ileal division. All our patients underwent pouchscopy 6 months after operation and annually. Mean operative time for neobladder reconstruction and ureteral anastomoses was 87 ± 7.67 minutes. In one patient a leak from the ileo-ileal anastomosis was confirmed on the 3rd day after operation. In 2 cases unilateral stricture of the ureteral-neobladder anastomosis was documented. Staple lines were mostly covered with ileal mucosa after 6 months. The mean functional bladder capacity was 340 ± 27.6 mL and 375 ± 43.4 mL at 6 and 12 months, respectively. First-year daytime and nighttime continence was good and acceptable in 90% and 78% of patients, while it increased to 95% during the 2nd year. The long term follow-up shows that non-absorbable titanium staples can be safely used for creation of an orthotopic ileal neobladder. However, these data should be further validated in a larger series of patients.

Outcomes after aortic graft-to-graft anastomosis with an automated circular stapler: A novel approach.

PubMed

Idrees, Jay J; Yazdchi, Farhang; Soltesz, Edward G; Vekstein, Andrew M; Rodriguez, Christopher; Roselli, Eric E

2016-10-01

Patients with complex aortic disease often require multistaged repairs with numerous anastomoses. Manual suturing can be time consuming. To reduce ischemic time, a circular stapling device has been used to facilitate prosthetic graft-to-graft anastomoses. Objectives are to describe this technique and assess outcomes. From February 2009 to May 2014, 44 patients underwent complex aortic repair with a circular end-to-end anastomosis (EEA) stapler at Cleveland Clinic. All patients had extensive aneurysms: 17 after ascending dissection repair, 10 chronic type B dissections, and 17 degenerative aneurysms. Stapler was used during total arch repair as an end-to-side anastomosis (n = 36; including first stage elephant trunk [ET] in 32, frozen ET in 3) and an end-to-end anastomosis during redo thoracoabdominal repair (n = 11). Three patients had the stapler used during both stages of repair. Patients underwent early and annual follow-ups with computed tomography analysis. There were no bleeds, ruptures, or leaks at the stapled site, but 2 patients died. Complications included 7 reoperations not related to the site of stapled anastomosis and 6 tracheostomies, but there was no paralysis or renal failure. Mean circulatory arrest time was 16 ± 5 minutes. Mean follow-up was 26 ± 17 months and consisted of imaging before discharge, at 3 to 6 months, and at 1 year. Planned reinterventions included 21 second-stage ET completion: Endovascular (n = 18) and open (n = 3). There were 4 late deaths. Use of an end-to-end anastomotic automated circular stapler is safe, effective, and durable in performing graft-to-graft anastomoses during complex thoracic aortic surgery. Further evaluation and refinement of this technique are warranted. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Thoracoscopic Lobectomy in Infants and Children Utilizing a 5 mm Stapling Device.

PubMed

Rothenberg, Steven

2016-12-01

Thoracoscopic lobectomy for congenital cystic lung disease has become an accepted and in many institutions the preferred technique. However, the technical challenges are many. Previous endoscopic staplers (12 mm) used commonly in adults are too large for use in infants This study evaluates the safety and efficacy of using a 5 mm stapling device to seal and divide major pulmonary structures. From July 2014 to March 2016, 26 patients of age 6 weeks to 13 months underwent thoracoscopic lobectomy for CPAM or sequestration. Weights ranged from 3.2 to 11.4 kg. There were 7 upper lobectomies, 2 middle, and 17 lower lobectomies. In each case, the 5 mm stapler (Justright Surgical; Louisville, Colorado) was the primary device for vessel and bronchial sealing and division. It is 4.8 mm in diameter with an anvil length of 25 mm and lays down four rows of staples and divides between them. A 3 mm sealing device was used for dissection and to take smaller segmental vessels as necessary. Stump lines were evaluated for bleeding or air leak in all cases. All procedures were accomplished successfully thoracoscopically. The stapler was used on the main lobar artery cases and vein in 24 cases, a large systemic sequestration vessel in 5 cases, and the bronchus in all 26. The stapler was also used to complete the minor fissure in 1 case and the major fissure in 1 case. A total of 96 staple loads were fired. Operative times ranged from 35 to 135 minutes. There was no significant bleeding of any vascular stump. In 1 case, the edge of the bronchial stump had to be reinforced, this was thought to be secondary to too much tissue being enclosed in the jaws. There were no postoperative complications. The use of a 5 mm stapling device appears to be safe and effective in thoracoscopic lobectomy in infants. It allows for safe management of major pulmonary vessels and bronchi in the confined chest of an infant through a single 5 mm port.

[Is the stapled suture in visceral surgery still justified? A prospective controlled, randomized study of cost effectiveness of manual and stapler suture].

PubMed

Izbicki, J R; Gawad, K A; Quirrenbach, S; Hosch, S B; Breid, V; Knoefel, W T; Küpper, H U; Broelsch, C E

1998-07-01

Hospitals are facing increasing economic pressure. It therefore seems necessary to evaluate the efficiency and effectiveness of medical or surgical interventions. In this study 324 anastomoses (167 stapled and 157 hand-sewn) were performed after randomization during 200 elective operations [20.5% gastrectomies, 14% gastric resections (Billroth II), 15% Whipple's procedures, 4% segmental colonic resections, 18% right-sided hemicolectomies, 4% left-sided hemicolectomies, 22% sigmoid- or anterior rectal resections, 2.5% total colectomies with pouch-anal anastomoses] in 200 patients. Postoperative motility (time to full oral diet, time with naso-gastric tube) and hospitalization were comparable in both groups. Anastomotic insufficiency was observed in 2.1% of all patients, five after stapled and two after hand-sewn anastomoses. Hospital mortality was 1.5%. All stapled anastomoses were performed significantly (P < 0.001) faster. However, the cost of material for these anastomoses was significantly (P < 0.001) higher, resulting in significantly higher total costs for reconstruction. The time saving for the reconstruction did not influence the total operative time (except for stapled gastrectomy). Therefore, all operations with stapled reconstruction were more expensive than those with sutured reconstruction. The difference was significant for the gastrectomy (P < 0.01), colonic resection (P < 0.01) and sigmoid and rectal resection (P < 0.001) groups. Stapled and sutured anastomoses are equally effective. Stapled anastomoses are not efficient, however, and should be reserved for individual indications.

21 CFR 878.4750 - Implantable staple.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Implantable staple. 878.4750 Section 878.4750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4750 Implantable staple. (a...

21 CFR 878.4750 - Implantable staple.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Implantable staple. 878.4750 Section 878.4750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4750 Implantable staple. (a...

21 CFR 878.4750 - Implantable staple.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Implantable staple. 878.4750 Section 878.4750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4750 Implantable staple. (a...

21 CFR 878.4750 - Implantable staple.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Implantable staple. 878.4750 Section 878.4750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4750 Implantable staple. (a...

21 CFR 878.4750 - Implantable staple.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Implantable staple. 878.4750 Section 878.4750 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4750 Implantable staple. (a...

Comparison of stapled haemorrhoidopexy with traditional excisional surgery for haemorrhoidal disease (eTHoS): a pragmatic, multicentre, randomised controlled trial.

PubMed

Watson, Angus J M; Hudson, Jemma; Wood, Jessica; Kilonzo, Mary; Brown, Steven R; McDonald, Alison; Norrie, John; Bruhn, Hanne; Cook, Jonathan A

2016-11-12

Two commonly performed surgical interventions are available for severe (grade II-IV) haemorrhoids; traditional excisional surgery and stapled haemorrhoidopexy. Uncertainty exists as to which is most effective. The eTHoS trial was designed to establish the clinical effectiveness and cost-effectiveness of stapled haemorrhoidopexy compared with traditional excisional surgery. The eTHoS trial was a large, open-label, multicentre, parallel-group, pragmatic randomised controlled trial done in adult participants (aged 18 years or older) referred to hospital for surgical treatment for grade II-IV haemorrhoids. Participants were randomly assigned (1:1) to receive either traditional excisional surgery or stapled haemorrhoidopexy. Randomisation was minimised according to baseline EuroQol 5 dimensions 3 level score (EQ-5D-3L), haemorrhoid grade, sex, and centre with an automated system to stapled haemorrhoidopexy or traditional excisional surgery. The primary outcome was area under the quality of life curve (AUC) measured with the EQ-5D-3L descriptive system over 24 months, assessed according to the randomised groups. The primary outcome measure was analysed using linear regression with adjustment for the minimisation variables. This trial is registered with the ISRCTN registry, number ISRCTN80061723. Between Jan 13, 2011, and Aug 1, 2014, 777 patients were randomised (389 to receive stapled haemorrhoidopexy and 388 to receive traditional excisional surgery). Stapled haemorrhoidopexy was less painful than traditional excisional surgery in the short term and surgical complication rates were similar between groups. The EQ-5D-3L AUC score was higher in the traditional excisional surgery group than the stapled haemorrhoidopexy group over 24 months; mean difference -0·073 (95% CI -0·140 to -0·006; p=0·0342). EQ-5D-3L was higher for stapled haemorrhoidopexy in the first 6 weeks after surgery, the traditional excisional surgery group had significantly better quality of life scores than the stapled haemorrhoidopexy group. 24 (7%) of 338 participants who received stapled haemorrhoidopexy and 33 (9%) of 352 participants who received traditional excisional surgery had serious adverse events. As part of a tailored management plan for haemorrhoids, traditional excisional surgery should be considered over stapled haemorrhoidopexy as the surgical treatment of choice. National Institute for Health Research Health Technology Assessment programme. Copyright © 2016 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY license. Published by Elsevier Ltd.. All rights reserved.

[Closure of pancreas stump after distal and segmental resection : Suture, stapler, coverage or anastomosis?

PubMed

Michalski, C W; Tramelli, P; Büchler, M W; Hackert, T

2017-01-01

Postoperative pancreatic fistulas represent the most frequent complication after distal and segmental pancreatectomy and occur with a frequency of up to 50 %. There are many technical variations of pancreatic stump treatment for reduction of fistula rates after distal resection. Most of these techniques have only been analyzed in retrospective studies and the evidence for or against a specific technique is low. Several retrospective trials have been conducted with good results to compare suturing with stapled closure of the remnant and to assess the effect of a vascularized falciform ligament patch in reducing postoperative pancreatic fistula; however, in a recently published randomized trial, which analyzed closure of the remnant with a pancreaticojejunostomy compared to standard closure, these results could not be confirmed. Because stapler resection and closure is the most commonly used technique in laparoscopic distal pancreatectomy, there are a large number of studies which assessed various novel methods of improving stapling. Extended stapler compression time and mesh augmentation of the stapler line can be valid methods to reduce fistula rates. Central pancreatectomy is a relatively rarely used procedure where the right-sided pancreatic remnant is closed in the same fashion as during distal pancreatectomy and the left-sided remnant is connected to the intestines with a pancreaticojejunostomy or pancreaticogastrostomy. In conclusion, postoperative pancreatic fistula rates are still a relevant clinical problem after distal pancreatectomy and further studies on potentially improved novel techniques are required.

75 FR 70906 - Certain Polyester Staple Fiber From the People's Republic of China: Partial Rescission of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-19

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple Fiber From the People's Republic of China: Partial Rescission of the Third Antidumping Duty... Request Administrative Review'' of the antidumping duty order on certain polyester staple fiber (``PSF...

76 FR 5331 - Certain Polyester Staple Fiber From Taiwan: Extension of Time Limit for Preliminary Results of...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-31

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Certain Polyester Staple Fiber From Taiwan: Extension of Time Limit for Preliminary Results of Antidumping Duty Administrative...) initiated an administrative review of the antidumping duty order on certain polyester staple fiber from...

77 FR 54562 - Certain Polyester Staple Fiber From the Republic of Korea: Rescission of Antidumping Duty...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-05

... DEPARTMENT OF COMMERCE International Trade Administration [A-580-839] Certain Polyester Staple Fiber From the Republic of Korea: Rescission of Antidumping Duty Administrative Review AGENCY: Import... antidumping duty order on certain polyester staple fiber from the Republic of Korea (``the Order''). The...

75 FR 4044 - Polyester Staple Fiber From Taiwan: Initiation and Preliminary Results of Changed-Circumstances...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-26

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Polyester Staple Fiber From... Commerce is initiating a changed- circumstances review of the antidumping duty order on polyester staple... previously accorded to Far Eastern Textile Limited with regard to the antidumping duty order on polyester...

77 FR 4543 - Certain Polyester Staple Fiber From Taiwan: Extension of Time Limit for Preliminary Results of...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-30

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Certain Polyester Staple Fiber From Taiwan: Extension of Time Limit for Preliminary Results of Antidumping Duty Administrative...) initiated an administrative review of the antidumping duty order on certain polyester staple fiber from...

77 FR 50530 - Polyester Staple Fiber From China; Scheduling of an Expedited Five-Year Review Concerning the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-21

... INTERNATIONAL TRADE COMMISSION [Investigation No. 731-TA-1104 (Review)] Polyester Staple Fiber... Polyester Staple Fiber From China AGENCY: United States International Trade Commission. ACTION: Notice... CONTACT: Joanna Lo (202-205-1888), Office of Investigations, U.S. International Trade Commission, 500 E...

77 FR 60720 - Certain Polyester Staple Fiber From China

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-04

... Fiber From China Determination On the basis of the record \\1\\ developed in the subject five-year review... certain polyester staple fiber from China would be likely to lead to continuation or recurrence of... (September 2012), entitled Certain Polyester Staple Fiber from China: Investigation No. 731-TA-1104 (Review...

7 CFR 28.303 - Standards for length of staple for American upland cotton.

Code of Federal Regulations, 2013 CFR

2013-01-01

... cotton. 28.303 Section 28.303 Agriculture Regulations of the Department of Agriculture AGRICULTURAL... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.303 Standards for length of staple for...

7 CFR 28.304 - Original representation of American Pima cotton staple lengths.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Original representation of American Pima cotton staple... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.304 Original representation of American...

7 CFR 28.304 - Original representation of American Pima cotton staple lengths.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Original representation of American Pima cotton staple... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.304 Original representation of American...

75 FR 70850 - Common Crop Insurance Regulations; Extra Long Staple Cotton Crop Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-19

... Crop Insurance Regulations; Extra Long Staple Cotton Crop Provisions AGENCY: Federal Crop Insurance... Corporation (FCIC) proposes to amend the Common Crop Insurance Regulations, Extra Long Staple Cotton Crop Insurance Provisions to remove all references to the Daily Spot Cotton Quotation and replace the reference...

76 FR 32067 - Common Crop Insurance Regulations; Extra Long Staple Cotton Crop Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-03

... 0563-AC27 Common Crop Insurance Regulations; Extra Long Staple Cotton Crop Provisions AGENCY: Federal... (FCIC) finalizes amendments made to the Common Crop Insurance Regulations, Extra Long Staple Cotton Crop Insurance Provisions to remove all references to the Daily Spot Cotton Quotation and replace the references...

7 CFR 28.303 - Standards for length of staple for American upland cotton.

Code of Federal Regulations, 2011 CFR

2011-01-01

... cotton. 28.303 Section 28.303 Agriculture Regulations of the Department of Agriculture AGRICULTURAL... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.303 Standards for length of staple for...

78 FR 47214 - Common Crop Insurance Regulations; Extra Long Staple Cotton Crop Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-05

... Long Staple Cotton Crop Provisions AGENCY: Federal Crop Insurance Corporation, USDA. ACTION: Proposed... Insurance Regulations, Extra Long Staple (ELS) Cotton Crop Insurance Provisions to make the ELS Cotton Crop Insurance Provisions consistent with the Upland Cotton Crop Insurance Provisions and to allow a late...

7 CFR 28.304 - Original representation of American Pima cotton staple lengths.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Original representation of American Pima cotton staple... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.304 Original representation of American...

7 CFR 28.303 - Standards for length of staple for American upland cotton.

Code of Federal Regulations, 2014 CFR

2014-01-01

... cotton. 28.303 Section 28.303 Agriculture Regulations of the Department of Agriculture AGRICULTURAL... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.303 Standards for length of staple for...

7 CFR 28.304 - Original representation of American Pima cotton staple lengths.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Original representation of American Pima cotton staple... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.304 Original representation of American...

7 CFR 28.304 - Original representation of American Pima cotton staple lengths.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Original representation of American Pima cotton staple... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.304 Original representation of American...

7 CFR 28.303 - Standards for length of staple for American upland cotton.

Code of Federal Regulations, 2012 CFR

2012-01-01

... cotton. 28.303 Section 28.303 Agriculture Regulations of the Department of Agriculture AGRICULTURAL... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.303 Standards for length of staple for...

7 CFR 28.303 - Standards for length of staple for American upland cotton.

Code of Federal Regulations, 2010 CFR

2010-01-01

... cotton. 28.303 Section 28.303 Agriculture Regulations of the Department of Agriculture AGRICULTURAL... STANDARDS AND STANDARD CONTAINER REGULATIONS COTTON CLASSING, TESTING, AND STANDARDS Standards Official Cotton Standards of the United States for Length of Staple § 28.303 Standards for length of staple for...

21 CFR 878.4760 - Removable skin staple.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Removable skin staple. 878.4760 Section 878.4760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4760 Removable skin staple. (a...

21 CFR 878.4760 - Removable skin staple.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Removable skin staple. 878.4760 Section 878.4760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4760 Removable skin staple. (a...

21 CFR 878.4760 - Removable skin staple.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Removable skin staple. 878.4760 Section 878.4760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4760 Removable skin staple. (a...

21 CFR 878.4760 - Removable skin staple.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Removable skin staple. 878.4760 Section 878.4760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4760 Removable skin staple. (a...

Circular stapled anopexy for haemorrhoidal disease: results.

PubMed

Lehur, P A; Gravié, J F; Meurette, G

2001-11-01

Stapled anopexy is a new approach for haemorrhoids requiring surgical treatment. This study reviews the available information concerning the present results of this procedure. Medline and hand search of the literature was conducted to identify available information on the procedure, with a special interest for the on-going or published randomized clinical trials. The advantages of the stapled approach of haemorrhoids were analyzed in the different areas of concern, including postoperative pain reduction, length of hospital stay and sick-leave, postoperative wound care and type and rate of complications. Continence status, symptom cure and patient satisfaction following stapled anopexy are also reported. Stapled anopexy is probably less painful than conventional haemorrhoidectomy. Other advantages in the short term result from this new approach. Long term efficacy of the procedure is still unknown.

Characterization of materials eliciting foreign body reaction in stapled human gastrointestinal anastomoses.

PubMed

Lim, C B B; Goldin, R D; Darzi, A; Hanna, G B

2008-08-01

Staples are made of titanium, which elicits minimal tissue reaction. The authors have encountered foreign body reaction associated with stapled human gastrointestinal anastomoses, although the literature has no reports of this. The aim of this study was to identify the refractile foreign materials causing this reaction. Histological sections were taken from 14 gastrointestinal specimens from patients with a history of a stapled anastomosis within the specimen excised. These were reviewed by light and polarization microscopy. Scanning electron microscopy and energy dispersive X-ray analysis were carried out on these sections, staples and stapler cartridges used for gastrointestinal surgery. Foreign bodies rich in fluorine were found in three patients, and those rich in carbon in 12. Other elements identified included oxygen, calcium, sodium, potassium, magnesium, aluminium and silicon. One specimen was found to contain titanium with no surrounding foreign body reaction. Stapler cartridges contained carbon, oxygen, fluorine, calcium, sodium, potassium, magnesium, aluminium, silicon and traces of titanium. Staples were composed of pure titanium with some fibrous material on the surface containing elements found in stapler cartridges. The presence of foreign body reaction was confirmed in stapled human gastrointestinal anastomoses. The source of refractile materials eliciting this reaction was the stapler cartridges. (c) 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Rectal distensibility and symptoms after stapled and Milligan-Morgan operation for hemorrhoids.

PubMed

Corsetti, Maura; De Nardi, Paola; Di Pietro, Salvatore; Passaretti, Sandro; Testoni, Pier Alberto; Staudacher, Carlo

2009-12-01

In a previous uncontrolled study, a reduction of rectal distensibility and volume thresholds for sensations have been related to the occurrence of fecal urgency and/or increased stool frequency after stapled hemorrhoidopexy. The aim of this study was to compare rectal symptoms and sensory-motor function after stapled hemorrhoidopexy and Milligan-Morgan hemorrhoidectomy. The clinical records of 12 (four women) and ten patients (four women) with third- and fourth-degree hemorrhoids, respectively, who underwent stapled hemorrhoidopexy or Milligan-Morgan's hemorrhoidectomy, were evaluated. One week before and 6 months after surgery, rectal motor and sensory response to distension was assessed by an electronic barostat, and bowel and rectal symptoms were recorded by means of a 7-day diary and Bristol Index scale and psychological symptoms with SCL-90 questionnaire. Rectal distensibility and volume thresholds for sensations were significantly lower after surgery (P < 0.02) in the stapled group. Increased stool frequency and/or fecal urgency arose in 41% of patients in the stapled group and associated with altered rectal distensibility. No difference within and between groups could be demonstrated in SCL-90 score. Rectal distensibility and volume thresholds for sensations decrease after stapled hemorrhoidopexy. Altered rectal distensibility was associated with rectal urgency and/or increased stool frequency.

Clips versus suture technique: is there a difference?

PubMed

Chughtai, T; Chen, L Q; Salasidis, G; Nguyen, D; Tchervenkov, C; Morin, J F

2000-11-01

Coronary artery bypass grafting (CABG) is one of the most common procedures performed today, and wound complications are a major source of morbidity and cost. To determine whether there is any difference in wound outcome (including cost in a Canadian context) between a subcuticular suture technique and skin stapling technique for closure of sternal and leg incisions in CABG patients. One hundred and sixty-two patients undergoing CABG were prospectively, randomly placed to have their sternal and leg incisions closed with either a subcuticular suture technique or with a skin clip. Data were obtained through chart review, in-hospital assessments and follow-up visits. Nonblinded assessments were made regarding wound leakage, inflammation, infection, necrosis, swelling, dehiscence and cosmesis. Each of the parameters was graded on a scale from 1 to 4. The cost was evaluated in Canadian dollars. There were trends toward increased rates of in-hospital sternal (P=0.09) and leg (P=0.17) incision inflammation when the wounds were closed with skin clips. There was a significantly greater (P=0.05) rate of sternal wound infection with clips, as well as a tendency (P=0.15) toward a greater rate of mediastinitis at follow-up assessment. Cosmetic outcome was similar for both groups. The cost incurred was significantly greater when skin clips were used for closure. There was a greater than threefold difference, which translates to a greater than $10,000 difference over one year. Closure with a subcuticular technique achieves better outcomes than the use of skin clips. When factoring in the increased cost incurred by using clips, as well as other intangible factors such as surgical skill acquisition, subcuticular suture closure appears to be a favourable method of wound closure in CABG patients compared with the use of skin stapling techniques.

Does Robotic Roux-en-Y Gastric Bypass Provide Outcome Advantages over Standard Laparoscopic Approaches?

PubMed

Rogula, Tomasz; Koprivanac, Marijan; Janik, Michał Robert; Petrosky, Jacob A; Nowacki, Amy S; Dombrowska, Agnieszka; Kroh, Matthew; Brethauer, Stacy; Aminian, Ali; Schauer, Philip

2018-04-10

The aim was to compare clinical outcomes of patients treated with totally robotic Roux-en-Y gastric bypass (TRRYGB) with those treated with the different laparoscopic Roux-en-Y gastric bypass (LRYGB) techniques. The clinical benefit of the robotic approach to bariatric surgery compared to the standard laparoscopic approach is unclear. There are no studies directly comparing outcomes of TRRYGB with different LRYGB techniques. Outcomes of 578 obese patients who underwent RYGB between 2011 and 2014 at an academic center were assessed. Multivariable analysis and propensity matching were used for comparing TRRYGB to different LRYGB techniques, including 21-mm EEA circular-stapled gastrojejunal anastomosis (GJA, LRYGB-21CS), linear-stapled GJA (LRYGB-LS), and hand-sewn GJA (LRYGB-HS). The TRRYGB technique required a longer mean operative time compared to the other groups, respectively 204 ± 46 vs. 139 ± 30 min (LRYGB-21CS), 206 ± 37 vs. 158 ± 30 min (LRYGB-LS), and 210 ± 36 vs. 167 ± 30 min (LRYGB-HS). TRRYGB experienced a lower stricture rate (2 vs. 17%, P = 0.003), shorter hospital stay (2.6 ± 1.2 vs. 4.3 ± 5.5 days, P = 0.008), and lower readmission rate (12 vs. 28%, P = 0.009). No significant differences in outcomes were observed when comparing RRYGB to LRYGB-LS or LRYGB-HS. TRRYGB increases operative time compared to all LRYGB techniques. TRRYGB was superior to LRYGB-21CS in terms of significantly shorter hospital stay, lower readmission rate, and less frequent GJA stricture formation. TRRYGB provides no clinical advantages over the LRYGB-LS and LRYGB-HS techniques.

26 CFR 1.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 26 Internal Revenue 3 2013-04-01 2013-04-01 false Stapled foreign corporations. 1.269B-1 Section 1... (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.269B-1 Stapled foreign corporations. (a) Treatment as a domestic corporation—(1) General rule. Except as otherwise provided, if a foreign corporation...

26 CFR 1.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 26 Internal Revenue 3 2011-04-01 2011-04-01 false Stapled foreign corporations. 1.269B-1 Section 1... (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.269B-1 Stapled foreign corporations. (a) Treatment as a domestic corporation—(1) General rule. Except as otherwise provided, if a foreign corporation...

26 CFR 1.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 26 Internal Revenue 3 2014-04-01 2014-04-01 false Stapled foreign corporations. 1.269B-1 Section 1... (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.269B-1 Stapled foreign corporations. (a) Treatment as a domestic corporation—(1) General rule. Except as otherwise provided, if a foreign corporation...

26 CFR 1.269B-1 - Stapled foreign corporations.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 26 Internal Revenue 3 2012-04-01 2012-04-01 false Stapled foreign corporations. 1.269B-1 Section 1... (CONTINUED) INCOME TAXES (CONTINUED) Items Not Deductible § 1.269B-1 Stapled foreign corporations. (a) Treatment as a domestic corporation—(1) General rule. Except as otherwise provided, if a foreign corporation...

76 FR 60802 - Certain Polyester Staple Fiber From the Republic of Korea and Taiwan: Continuation of Antidumping...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-30

... DEPARTMENT OF COMMERCE International Trade Administration [A-580-839, A-583-833] Certain Polyester... Commission (ITC) that revocation of the antidumping duty orders on certain polyester staple fiber from the... and the ITC instituted sunset reviews of the antidumping duty orders on polyester staple fiber from...

77 FR 62217 - Certain Polyester Staple Fiber From the People's Republic of China: Continuation of Antidumping...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-12

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... International Trade Commission (``ITC'') that revocation of the antidumping duty order on certain polyester... antidumping duty order on certain polyester staple fiber from the PRC pursuant to section 751(c)(2) of the...

76 FR 37830 - Polyester Staple Fiber From Korea and Taiwan; Scheduling of Expedited Five-Year Reviews...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-28

... INTERNATIONAL TRADE COMMISSION [Investigation Nos. 731-TA-825 and 826 (Second Review)] Polyester... Duty Orders on Polyester Staple Fiber From Korea and Taiwan AGENCY: United States International Trade... determine whether revocation of the antidumping duty orders on polyester staple fiber from Korea and Taiwan...

75 FR 5763 - Notice of Correction to the First Administrative Review of Certain Polyester Staple Fiber From...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-04

... First Administrative Review of Certain Polyester Staple Fiber From the People's Republic of China: Final... the People's Republic of China (``PRC''). See First Administrative Review of Certain Polyester Staple Fiber From the People's Republic of China: Final Results of Antidumping Duty Administrative Review, 75...

78 FR 70485 - Common Crop Insurance Regulations; Extra Long Staple Cotton Crop Provisions

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-26

...-0002] RIN 0563-AC41 Common Crop Insurance Regulations; Extra Long Staple Cotton Crop Provisions AGENCY... Cotton Crop Insurance Provisions to make the Extra Long Staple (ELS) Cotton Crop Insurance Provisions consistent with the Upland Cotton Crop Insurance Provisions and to allow a late planting period. The intended...

75 FR 1336 - First Administrative Review of Certain Polyester Staple Fiber From the People's Republic of China...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-11

... System. Jianxin Fuda Chemical Fibre Factory. Comment 6: Correction of Name in Federal Register Notice... of Certain Polyester Staple Fiber From the People's Republic of China: Final Results of Antidumping... duty order on certain polyester staple fiber (``PSF'') from the People's Republic of China (``PRC...

77 FR 39990 - Certain Polyester Staple Fiber From the People's Republic of China: Preliminary Results of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-06

... calls into question the reliability of this information. \\27\\ See Polyester Staple Fiber Final... Fiber From the People's Republic of China: Preliminary Results of the Antidumping Duty Administrative... duty order on certain polyester staple fiber from the People's Republic of China (``PRC'') for the...

78 FR 17637 - Polyester Staple Fiber From Taiwan: Preliminary Results of Antidumping Duty Administrative Review...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-22

... DEPARTMENT OF COMMERCE International Trade Administration [A-583-833] Polyester Staple Fiber From... staple fiber (PSF) from Taiwan. The period of review (POR) is May 1, 2011, through April 30, 2012. The.... DATES: Effective Date: March 22, 2013. FOR FURTHER INFORMATION CONTACT: Bryan Hansen or Minoo Hatten, AD...

A randomized, controlled trial of diathermy hemorrhoidectomy vs. stapled hemorrhoidectomy in an intended day-care setting with longer-term follow-up.

PubMed

Cheetham, M J; Cohen, C R G; Kamm, M A; Phillips, R K S

2003-04-01

Hemorrhoidectomy is the most effective long-term treatment for hemorrhoids. Although it is possible to perform hemorrhoidectomy as a day case with a high degree of patient satisfaction, patients take an average of 14 days off work after surgery. Stapled hemorrhoidectomy is believed to be less painful than conventional hemorrhoidectomy and should allow an earlier return to work. The aim of this study was to compare both the immediate and the long-term results of stapled hemorrhoidectomy with diathermy hemorrhoidectomy in patients with prolapsing internal hemorrhoids in an intended day-care setting. Thirty-one patients were randomly assigned to undergo diathermy hemorrhoidectomy (n = 16) or stapled hemorrhoidectomy performed with a purpose-designed endoluminal stapling device, PPH01T (n = 15). All operations were planned as day or short-stay cases. All patients received lactulose, commenced preoperatively, together with postoperative topical glyceryl trinitrate and oral metronidazole. Patients were assessed by structured interview to assess their symptoms before and after surgery, with an intended follow-up of six months. All patients completed a 10-cm visual analog pain scale daily for the first ten days after surgery. The total pain score (sum of all pain scores) was significantly higher in the diathermy group (50 (range, 9.8-79.9) vs. 19.6 (range, 1.3-89.5), P = 0.03). Patients took a median of 14 (range, 3-21) days off work after diathermy hemorrhoidectomy compared with 10 (range, 3-38) days for the patients undergoing stapled hemorrhoidectomy (P = 0.15). At long-term follow-up, three patients (all in the stapled group) developed new symptoms of fecal urgency and anal pain, and three patients required further surgery to remove symptomatic external hemorrhoids after stapled hemorrhoidectomy. Although stapled hemorrhoidectomy is less painful in the short term, this does not lead to a significantly earlier return to work, and some patients develop new symptoms at long-term follow-up.

Left Atrial Appendage Closure for Stroke Prevention: Devices, Techniques, and Efficacy.

PubMed

Iskandar, Sandia; Vacek, James; Lavu, Madhav; Lakkireddy, Dhanunjaya

2016-05-01

Left atrial appendage closure can be performed either surgically or percutaneously. Surgical approaches include direct suture, excision and suture, stapling, and clipping. Percutaneous approaches include endocardial, epicardial, and hybrid endocardial-epicardial techniques. Left atrial appendage anatomy is highly variable and complex; therefore, preprocedural imaging is crucial to determine device selection and sizing, which contribute to procedural success and reduction of complications. Currently, the WATCHMAN is the only device that is approved for left atrial appendage closure in the United States. Copyright © 2016 Elsevier Inc. All rights reserved.

77 FR 54898 - Certain Polyester Staple Fiber From the People's Republic of China: Final Results of Expedited...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-06

... Fiber From the People's Republic of China: Final Results of Expedited Sunset Review of the Antidumping... (``sunset'') review of the antidumping duty order on certain polyester staple fiber from the People's... Department finds that revocation of the antidumping duty order on certain polyester staple fiber from the PRC...

76 FR 53899 - Notice to All Interested Parties of the Termination of the Receivership of 10006-First Integrity...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-30

... Receivership of 10006--First Integrity Bank, Staples, MN Notice Is Hereby Given that the Federal Deposit Insurance Corporation (``FDIC'') as Receiver for First Integrity Bank, Staples, MN (``the Receiver... Integrity Bank, Staples, MN on May 30, 2008. The liquidation of the receivership assets has been completed...

Polymorphic design of DNA origami structures through mechanical control of modular components.

PubMed

Lee, Chanseok; Lee, Jae Young; Kim, Do-Nyun

2017-12-12

Scaffolded DNA origami enables the bottom-up fabrication of diverse DNA nanostructures by designing hundreds of staple strands, comprised of complementary sequences to the specific binding locations of a scaffold strand. Despite its exceptionally high design flexibility, poor reusability of staples has been one of the major hurdles to fabricate assorted DNA constructs in an effective way. Here we provide a rational module-based design approach to create distinct bent shapes with controllable geometries and flexibilities from a single, reference set of staples. By revising the staple connectivity within the desired module, we can control the location, stiffness, and included angle of hinges precisely, enabling the construction of dozens of single- or multiple-hinge structures with the replacement of staple strands up to 12.8% only. Our design approach, combined with computational shape prediction and analysis, can provide a versatile and cost-effective procedure in the design of DNA origami shapes with stiffness-tunable units.

Exploitation of the Ornithine Effect Enhances Characterization of Stapled and Cyclic Peptides

NASA Astrophysics Data System (ADS)

Crittenden, Christopher M.; Parker, W. Ryan; Jenner, Zachary B.; Bruns, Kerry A.; Akin, Lucas D.; McGee, William M.; Ciccimaro, Eugene; Brodbelt, Jennifer S.

2016-05-01

A method to facilitate the characterization of stapled or cyclic peptides is reported via an arginine-selective derivatization strategy coupled with MS/MS analysis. Arginine residues are converted to ornithine residues through a deguanidination reaction that installs a highly selectively cleavable site in peptides. Upon activation by CID or UVPD, the ornithine residue cyclizes to promote cleavage of the adjacent amide bond. This Arg-specific process offers a unique strategy for site-selective ring opening of stapled and cyclic peptides. Upon activation of each derivatized peptide, site-specific backbone cleavage at the ornithine residue results in two complementary products: the lactam ring-containing portion of the peptide and the amine-containing portion. The deguanidination process not only provides a specific marker site that initiates fragmentation of the peptide but also offers a means to unlock the staple and differentiate isobaric stapled peptides.

Skin closure using staples and nylon sutures: a comparison of results.

PubMed

Stockley, I; Elson, R A

1987-03-01

A disposable skin stapler (Elite: Auto Suture UK Ltd) and Nylon vertical mattress sutures have been used for skin closure. The complications related to each method were evaluated in 129 wounds. There was a higher incidence of inflammation, discomfort on removal and spreading of the healing scar associated with staples. The only advantage of staples was speed of wound closure.

75 FR 33783 - Certain Polyester Staple Fiber from the Republic of Korea: Preliminary Results of the 2008 - 2009...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-15

... Fiber from the Republic of Korea: Preliminary Results of the 2008 - 2009 Antidumping Duty Administrative... antidumping duty order on certain polyester staple fiber from the Republic of Korea. The period of review is May 1, 2008, through April 30, 2009. This review covers imports of certain polyester staple fiber from...

Is STAPLE algorithm confident to assess segmentation methods in PET imaging?

NASA Astrophysics Data System (ADS)

Dewalle-Vignion, Anne-Sophie; Betrouni, Nacim; Baillet, Clio; Vermandel, Maximilien

2015-12-01

Accurate tumor segmentation in [18F]-fluorodeoxyglucose positron emission tomography is crucial for tumor response assessment and target volume definition in radiation therapy. Evaluation of segmentation methods from clinical data without ground truth is usually based on physicians’ manual delineations. In this context, the simultaneous truth and performance level estimation (STAPLE) algorithm could be useful to manage the multi-observers variability. In this paper, we evaluated how this algorithm could accurately estimate the ground truth in PET imaging. Complete evaluation study using different criteria was performed on simulated data. The STAPLE algorithm was applied to manual and automatic segmentation results. A specific configuration of the implementation provided by the Computational Radiology Laboratory was used. Consensus obtained by the STAPLE algorithm from manual delineations appeared to be more accurate than manual delineations themselves (80% of overlap). An improvement of the accuracy was also observed when applying the STAPLE algorithm to automatic segmentations results. The STAPLE algorithm, with the configuration used in this paper, is more appropriate than manual delineations alone or automatic segmentations results alone to estimate the ground truth in PET imaging. Therefore, it might be preferred to assess the accuracy of tumor segmentation methods in PET imaging.

Is STAPLE algorithm confident to assess segmentation methods in PET imaging?

PubMed

Dewalle-Vignion, Anne-Sophie; Betrouni, Nacim; Baillet, Clio; Vermandel, Maximilien

2015-12-21

Accurate tumor segmentation in [18F]-fluorodeoxyglucose positron emission tomography is crucial for tumor response assessment and target volume definition in radiation therapy. Evaluation of segmentation methods from clinical data without ground truth is usually based on physicians' manual delineations. In this context, the simultaneous truth and performance level estimation (STAPLE) algorithm could be useful to manage the multi-observers variability. In this paper, we evaluated how this algorithm could accurately estimate the ground truth in PET imaging. Complete evaluation study using different criteria was performed on simulated data. The STAPLE algorithm was applied to manual and automatic segmentation results. A specific configuration of the implementation provided by the Computational Radiology Laboratory was used. Consensus obtained by the STAPLE algorithm from manual delineations appeared to be more accurate than manual delineations themselves (80% of overlap). An improvement of the accuracy was also observed when applying the STAPLE algorithm to automatic segmentations results. The STAPLE algorithm, with the configuration used in this paper, is more appropriate than manual delineations alone or automatic segmentations results alone to estimate the ground truth in PET imaging. Therefore, it might be preferred to assess the accuracy of tumor segmentation methods in PET imaging.

Modelling DNA origami self-assembly at the domain level.

PubMed

Dannenberg, Frits; Dunn, Katherine E; Bath, Jonathan; Kwiatkowska, Marta; Turberfield, Andrew J; Ouldridge, Thomas E

2015-10-28

We present a modelling framework, and basic model parameterization, for the study of DNA origami folding at the level of DNA domains. Our approach is explicitly kinetic and does not assume a specific folding pathway. The binding of each staple is associated with a free-energy change that depends on staple sequence, the possibility of coaxial stacking with neighbouring domains, and the entropic cost of constraining the scaffold by inserting staple crossovers. A rigorous thermodynamic model is difficult to implement as a result of the complex, multiply connected geometry of the scaffold: we present a solution to this problem for planar origami. Coaxial stacking of helices and entropic terms, particularly when loop closure exponents are taken to be larger than those for ideal chains, introduce interactions between staples. These cooperative interactions lead to the prediction of sharp assembly transitions with notable hysteresis that are consistent with experimental observations. We show that the model reproduces the experimentally observed consequences of reducing staple concentration, accelerated cooling, and absent staples. We also present a simpler methodology that gives consistent results and can be used to study a wider range of systems including non-planar origami.

Modelling DNA origami self-assembly at the domain level

NASA Astrophysics Data System (ADS)

Dannenberg, Frits; Dunn, Katherine E.; Bath, Jonathan; Kwiatkowska, Marta; Turberfield, Andrew J.; Ouldridge, Thomas E.

2015-10-01

We present a modelling framework, and basic model parameterization, for the study of DNA origami folding at the level of DNA domains. Our approach is explicitly kinetic and does not assume a specific folding pathway. The binding of each staple is associated with a free-energy change that depends on staple sequence, the possibility of coaxial stacking with neighbouring domains, and the entropic cost of constraining the scaffold by inserting staple crossovers. A rigorous thermodynamic model is difficult to implement as a result of the complex, multiply connected geometry of the scaffold: we present a solution to this problem for planar origami. Coaxial stacking of helices and entropic terms, particularly when loop closure exponents are taken to be larger than those for ideal chains, introduce interactions between staples. These cooperative interactions lead to the prediction of sharp assembly transitions with notable hysteresis that are consistent with experimental observations. We show that the model reproduces the experimentally observed consequences of reducing staple concentration, accelerated cooling, and absent staples. We also present a simpler methodology that gives consistent results and can be used to study a wider range of systems including non-planar origami.

Different surgical strategies in the treatment of familial adenomatous polyposis: what's the role of the ileal pouch-anal anastomosis?

PubMed

Leonard, D; Wolthuis, A; D'Hoore, A; Bruyninx, L; Van De Stadt, J; Van Cutsem, E; Kartheuser, A

2011-09-01

Restorative coloproctectomy (RCP) with ileal pouch-anal anastomosis (IPAA), is one of the surgical responses to the crucial question of prophylactic treatment in familial adenomatous polyposis (FAP). No consensus has been reached, until now, to choose between IPAA and ileo-rectal anastomosis (IRA), the rectal sparing prophylactic colectomy. This paper aims to review the latest issues related to IPAA and highlights its specificities compared to IRA. PubMed database was searched using the following search items: familial adenomatous polyposis, surgery, ileal pouch-anal anastomosis, ileo-rectal anastomosis. Papers published between 1978 and 2010 were selected. Absence of mortality, acceptable morbidity and good functional results combined to high quality of life have promoted the IPAA technique. New technical issues such as the double stapled technique, mesenteric lengthening, omission of temporary protective stoma can be addressed almost systematically for these patients. A laparoscopic approach, lessening the body image impact, has proven to be as effective and safe as the open approach to perform IPAA. Further advantages of laparoscopic IPAA rely on the lower adhesion formation resulting in less small bowel occlusion. Sexuality, fertility and childbirth are important functional issues often cited as threatened by the pelvic manoeuvres of the IPAA technique which can be prevented by close rectal wall dissection and a laparoscopic approach. IPAA offers the best available prophylaxis in FAP patients. Technical enhancements in IPAA will most probably decrease the functional risks. Thus IPAA remains the alternative to IRA for the prophylactic treatment of FAP.Nevertheless, based on the latest evidence, the choice between both procedures is still matter of debate.

A low glycemic index staple diet reduces postprandial glucose values in Asian women with gestational diabetes mellitus.

PubMed

Hu, Zhi-Geng; Tan, Rong-Shao; Jin, Di; Li, Wei; Zhou, Xiao-Yan

2014-12-01

A low glycemic index (GI) diet is beneficial for glucose control in patients with diabetes mellitus. This study aimed to investigate the influence of a low-GI diet on postprandial glucose levels in women with gestational diabetes mellitus (GDM). Pregnant women with GDM were randomized to receive a normal diabetic control diet or a low-GI staple diet for 5 days. A low-GI staple food was used to replace rice in lunch and dinner for the low-GI staple diet group, whereas the total energy and carbohydrate levels remained equal in both groups. Fasting and postprandial glucose levels were determined daily. A total of 140 pregnant women with GDM were included in the study, including 66 in the low-GI staple diet group and 74 in the normal diabetic diet control group. No differences existed in baseline characteristics between the 2 groups (all P > 0.05). After dietary intervention, glucose levels were significantly reduced in the low-GI staple diet group (all P < 0.01) and the control group (all P < 0.008). Postintervention glucose values after breakfast, lunch, and dinner were significantly reduced in the treatment group compared with those in the control group (all P < 0.05). The percentage changes from baseline of all glucose values were significantly greater in the treatment group than in the control group (all P < 0.05). A low-GI staple diet significantly reduces postprandial glucose levels in women with GDM.

The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks

PubMed Central

Terterov, Dimitry; Leung, Philemon Ho-Yan; Twells, Laurie K.; Gregory, Deborah M.; Smith, Chris; Boone, Darrell; Pace, David

2017-01-01

Background Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure’s morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs. Methods We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments. Results Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000. Conclusion The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead. PMID:28742012

The usefulness and costs of routine contrast studies after laparoscopic sleeve gastrectomy for detecting staple line leaks.

PubMed

Terterov, Dimitry; Leung, Philemon Ho-Yan; Twells, Laurie K; Gregory, Deborah M; Smith, Chris; Boone, Darrell; Pace, David

2017-09-01

Although laparoscopic sleeve gastrectomy (LSG) has been shown to be a safe and effective treatment for severe obesity (body mass index ≥ 35), staple line leaks remain a major complication and account for a substantial portion of the procedure's morbidity and mortality. Many centres performing LSG routinely obtain contrast studies on postoperative day 1 for early detection of staple line leaks. We examined the usefulness of Gastrografin swallow as an early detection test for staple line leaks on postoperative day 1 after LSG as well as the associated costs. We conducted a retrospective review of a prospectively collected database that included 200 patients who underwent LSG for severe obesity between 2011 and 2014. Primary outcome measures were the incidence of staple line leaks and the results of Gastrografin swallow tests. We obtained imaging costs from appropriate hospital departments. Gastrografin swallow was obtained on postoperative day 1 for all 200 patients who underwent LSG. Three patients (1.5%) were found to have staple line leaks. Gastrograffin swallows yielded 1 true positive result and 2 false negatives. The false negatives were subsequently diagnosed on computed tomography (CT) scan. The sensitivity of Gastrografin swallow in this study was 33%. For 200 patients, the total direct cost of the Gastrografin swallows was $35 000. The use of routine upper gastrointestinal contrast studies for early detection of staple line leaks has low sensitivity and is costly. We recommend selective use of CT instead.

Surgical stapling device–tissue interactions: what surgeons need to know to improve patient outcomes

PubMed Central

Chekan, Edward; Whelan, Richard L

2014-01-01

The introduction of both new surgical devices and reengineered existing devices leads to modifications in the way traditional tasks are carried out and allows for the development of new surgical techniques. Each new device has benefits and limitations in regards to tissue interactions that, if known, allow for optimal use. However, most surgeons are unaware of these attributes and, therefore, new device introduction creates a “knowledge gap” that is potentially dangerous. The goal of this review is to present a framework for the study of device– tissue interactions and to initiate the process of “filling in” the knowledge gap via the available literature. Surgical staplers, which are continually being developed, are the focus of this piece. The integrity of the staple line, which depends on adequate tissue compression, is the primary factor in creating a stable anastomosis. This review focuses on published studies that evaluated the creation of stable anastomoses in bariatric, thoracic, and colorectal procedures. Understanding how staplers interact with target tissues is key to improving patient outcomes. It is clear from this review that each tissue type presents unique challenges. The thickness of each tissue varies as do the intrinsic biomechanical properties that determine the ideal compressive force and prefiring compression time for each tissue type. The correct staple height will vary depending on these tissue-specific properties and the tissue pathology. These studies reinforce the universal theme that compression, staple height, tissue thickness, tissue compressibility, and tissue type must all be considered by the surgeon prior to choosing a stapler and cartridge. The surgeon’s experience, therefore, is a critical factor. Educational programs need to be established to inform and update surgeons on the characteristics of each stapler. It is hoped that the framework presented in this review will facilitate this process. PMID:25246812

Tailored prolapse surgery for the treatment of hemorrhoids with a new dedicated device: TST Starr plus.

PubMed

Naldini, G; Fabiani, B; Menconi, C; Giani, I; Toniolo, G; Martellucci, J

2015-12-01

The aim of the study was to assess the results of the stapled transanal procedure in the treatment of hemorrhoidal prolapse in terms of postoperative complications and recurrence rate using a new dedicated device, TST Starr plus. Patients affected by III-IV degree hemorrhoidal prolapsed that underwent stapled transanal resection with the TST Starr plus were included in the present study. Results of the procedure with perioperative complications, postoperative complications, and recurrence rate were reported. From November 2012 to October 2014, 52 patients (19 females) were enrolled in the study. The main symptoms were prolapse (100 %) and bleeding (28.8 %). Transanal rectal resection was performed with parachute technique in 24 patients (46.2 %) and purse string technique in 23 patients (53.8 %). A mild hematoma at the suture line occurred in one patient (1.9 %). Postoperative bleeding was reported in three patients (5.7 %), in one of which, reoperation was necessary (1.9 %). Tenesmus occurred in one patient (1.9 %), and it was resolved with medical therapy. Urgency was reported in nine patients (17.1 %) at 7 days after surgery. Of these, three patients (5.7 %) complained urgency at the median follow-up of 14.5 months. Reoperation was performed in one patient (1.9 %) for chronic anal pain for rigid suture fixed on the deep plans. Occasional bleeding was reported in four patients (7.7 %). No recurrence of prolapse was reported at a median of 14.5 months after surgery, even if one patient (1.9 %) had a partial recurrent prolapse of a downstaged single pile. TST Starr plus seems to be safe and effective for a tailored transanal stapled surgery for the treatment of III-IV degree hemorrhoidal prolapse. The new conformation and innovative technology of the stapler seems to reduce some postoperative complications and recurrence rate.

Management of a failed mandibular staple implant: a clinical report.

PubMed

Ettinger, Ronald L; Fakhry, Ali

2010-12-01

A 48-year-old woman sought treatment because her staple implant-retained overdenture was no longer retentive, and the denture was worn over the abutments. After unsuccessfully attempting to move the retentive nuts along the transosseous posts of the staple implant, the posts were cut off at the level of the bone. Two endosseous implants were placed around the staple implant, and a new implant-retained overdenture was fabricated and inserted using ball attachments for retention. This article describes the treatment for this patient, who has been wearing the new dentures successfully for the past 4 years. Copyright © 2010 The Editorial Council of the Journal of Prosthetic Dentistry. Published by Mosby, Inc. All rights reserved.

Semitransparent bandages based on chitosan and extracellular matrix for photochemical tissue bonding.

PubMed

Frost, Samuel J; Mawad, Damia; Wuhrer, Richard; Myers, Simon; Lauto, Antonio

2018-01-22

Extracellular matrices (ECMs) are often used in reconstructive surgery to enhance tissue regeneration and remodeling. Sutures and staples are currently used to fix ECMs to tissue although they can be invasive devices. Other sutureless and less invasive techniques, such as photochemical tissue bonding, cannot be coupled to ECMs because of their intrinsic opacity to light. We succeeded in fabricating a biocompatible and adhesive device that is based on ovine forestomach matrix (OFM) and a chitosan adhesive. The natural opacity of the OFM has been overcome by adding the adhesive into the matrix that allows for the light to effectively penetrate through it. The OFM-chitosan device is semitransparent (attenuation length ~ 106 µm) and can be photoactivated by green light to bond to tissue. This device does not require sutures or staples and guarantees a bonding strength of ~ 23 kPa. A new semitransparent and biocompatible bandage has been successfully fabricated and characterized for sutureless tissue bonding.

A case report of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device.

PubMed

Boo, Yoon Jung; Gödeke, Jan; Engel, Veronika; Muensterer, Oliver J

2017-01-01

Laparoscopic duodenal atresia repair is an advanced procedure performed in select pediatric surgical centers. Recently, sub-6mm endosurgical staplers have been introduced, facilitating and accelerating the creation of intracorporeal intestinal anastomoses. We performed a laparoscopic duodenojejunostomy in a one-day-old child with duodenal atresia due to annular pancreas using a novel 5.8mm articulating endostapler with excellent outcome. The technical details are reported. Laparoscopic duodenojejunostomy is a technically demanding procedure due to difficulty in hand-sewn anastomosis in a small and restricted space. With this novel 5.8mm articulating endostapler, we were able to perform a quicker and easier anastomosis. We report a case of laparoscopic duodenal atresia repair in a neonate using a novel miniature stapling device. This new technique is a safe, quick and easier way to perform laparoscopic duodenal atresia repair. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Pilot study on preventing anastomotic leakage in stapled gastroesophageal anastomosis

PubMed Central

Huang, Weiming; Liu, Xiangzheng; Li, Jian

2017-01-01

Background This study explored how to improve the surgical technique to reduce or avoid anastomotic leakage. Methods From January 2012 to December 2016, 101 consecutive patients with cancer of the esophagus or gastroesophageal junction underwent stapled gastroesophageal anastomosis. The procedure included creating a tube‐type stomach, fixing an inserted anvil, inspecting mucosa‐to‐mucosa alignment in the lumen under direct vision after firing the stapler, and, if found, manually repairing a rupture of the mucous membrane of the anastomosis. Results A rupture of the mucous membrane of the anastomosis was found in four out of the 101 patients and manually repaired. No postsurgical anastomotic leakage occurred. All patients recovered well and the average postoperative stay was 10.4 days. There was no mortality within 30 days after surgery. Conclusion It is critical to inspect the integrality of the luminal mucous membrane of the anastomosis under direct vision in order to prevent anastomotic leakage in surgical resection of esophageal and gastroesophageal junction malignancies. PMID:29130643

Projective analysis of staple food crop productivity in adaptation to future climate change in China

NASA Astrophysics Data System (ADS)

Zhang, Qing; Zhang, Wen; Li, Tingting; Sun, Wenjuan; Yu, Yongqiang; Wang, Guocheng

2017-08-01

Climate change continually affects our capabilities to feed the increasing population. Rising temperatures have the potential to shorten the crop growth duration and therefore reduce crop yields. In the past decades, China has successfully improved crop cultivars to stabilize, and even lengthen, the crop growth duration to make use of increasing heat resources. However, because of the complex cropping systems in the different regions of China, the possibility and the effectiveness of regulating crop growth duration to reduce the negative impacts of future climate change remain questionable. Here, we performed a projective analysis of the staple food crop productivity in double-rice, wheat-rice, wheat-maize, single-rice, and single-maize cropping systems in China using modeling approaches. The results indicated that from the present to the 2040s, the warming climate would shorten the growth duration of the current rice, wheat, and maize cultivars by 2-24, 11-13, and 9-29 days, respectively. The most significant shortening of the crop growth duration would be in Northeast China, where single-rice and single-maize cropping dominates the croplands. The shortened crop growth duration would consequently reduce crop productivity. The most significant decreases would be 27-31, 6-20, and 7-22% for the late crop in the double-rice rotation, wheat in the winter wheat-rice rotation, and single maize, respectively. However, our projection analysis also showed that the negative effects of the warming climate could be compensated for by stabilizing the growth duration of the crops via improvement in crop cultivars. In this case, the productivity of rice, wheat, and maize in the 2040s would increase by 4-16, 31-38, and 11-12%, respectively. Our modeling results implied that the possibility of securing future food production exists by adopting proper adaptation options in China.

Haploids: Constraints and opportunities in plant breeding.

PubMed

Dwivedi, Sangam L; Britt, Anne B; Tripathi, Leena; Sharma, Shivali; Upadhyaya, Hari D; Ortiz, Rodomiro

2015-11-01

The discovery of haploids in higher plants led to the use of doubled haploid (DH) technology in plant breeding. This article provides the state of the art on DH technology including the induction and identification of haploids, what factors influence haploid induction, molecular basis of microspore embryogenesis, the genetics underpinnings of haploid induction and its use in plant breeding, particularly to fix traits and unlock genetic variation. Both in vitro and in vivo methods have been used to induce haploids that are thereafter chromosome doubled to produce DH. Various heritable factors contribute to the successful induction of haploids, whose genetics is that of a quantitative trait. Genomic regions associated with in vitro and in vivo DH production were noted in various crops with the aid of DNA markers. It seems that F2 plants are the most suitable for the induction of DH lines than F1 plants. Identifying putative haploids is a key issue in haploid breeding. DH technology in Brassicas and cereals, such as barley, maize, rice, rye and wheat, has been improved and used routinely in cultivar development, while in other food staples such as pulses and root crops the technology has not reached to the stage leading to its application in plant breeding. The centromere-mediated haploid induction system has been used in Arabidopsis, but not yet in crops. Most food staples are derived from genomic resources-rich crops, including those with sequenced reference genomes. The integration of genomic resources with DH technology provides new opportunities for the improving selection methods, maximizing selection gains and accelerate cultivar development. Marker-aided breeding and DH technology have been used to improve host plant resistance in barley, rice, and wheat. Multinational seed companies are using DH technology in large-scale production of inbred lines for further development of hybrid cultivars, particularly in maize. The public sector provides support to national programs or small-medium private seed for the exploitation of DH technology in plant breeding. Copyright © 2015 Elsevier Inc. All rights reserved.

Projective analysis of staple food crop productivity in adaptation to future climate change in China.

PubMed

Zhang, Qing; Zhang, Wen; Li, Tingting; Sun, Wenjuan; Yu, Yongqiang; Wang, Guocheng

2017-08-01

Climate change continually affects our capabilities to feed the increasing population. Rising temperatures have the potential to shorten the crop growth duration and therefore reduce crop yields. In the past decades, China has successfully improved crop cultivars to stabilize, and even lengthen, the crop growth duration to make use of increasing heat resources. However, because of the complex cropping systems in the different regions of China, the possibility and the effectiveness of regulating crop growth duration to reduce the negative impacts of future climate change remain questionable. Here, we performed a projective analysis of the staple food crop productivity in double-rice, wheat-rice, wheat-maize, single-rice, and single-maize cropping systems in China using modeling approaches. The results indicated that from the present to the 2040s, the warming climate would shorten the growth duration of the current rice, wheat, and maize cultivars by 2-24, 11-13, and 9-29 days, respectively. The most significant shortening of the crop growth duration would be in Northeast China, where single-rice and single-maize cropping dominates the croplands. The shortened crop growth duration would consequently reduce crop productivity. The most significant decreases would be 27-31, 6-20, and 7-22% for the late crop in the double-rice rotation, wheat in the winter wheat-rice rotation, and single maize, respectively. However, our projection analysis also showed that the negative effects of the warming climate could be compensated for by stabilizing the growth duration of the crops via improvement in crop cultivars. In this case, the productivity of rice, wheat, and maize in the 2040s would increase by 4-16, 31-38, and 11-12%, respectively. Our modeling results implied that the possibility of securing future food production exists by adopting proper adaptation options in China.

Stapled Golgi cisternae remain in place as cargo passes through the stack

PubMed Central

Lavieu, Gregory; Zheng, Hong; Rothman, James E

2013-01-01

We have designed a membrane ‘staple’, which consists of membrane-anchored repeats of the trans-aggregating FM domain that face the lumen of the secretory pathway. In the presence of the disaggregating drug these proteins transit the secretory pathway. When the drug is removed these proteins form electron-dense plaques which we term staples. Unexpectedly, when initially positioned within the cis-Golgi, staples remained at the cis face of the Golgi even after many hours. By contrast, soluble FM-aggregates transited the Golgi. Staples and soluble aggregates placed in cis-Golgi cisternae therefore have different fates. Whereas the membrane staples are located in the flattened, stacked central regions of the cisternae, the soluble aggregates are in the dilated rims. This suggests that while the cisternae are static on the time scale of protein traffic, the dilated rims are mobile and progress in the cis → trans direction via a mechanism that we term ‘Rim Progression’. DOI: http://dx.doi.org/10.7554/eLife.00558.001 PMID:23755362

A randomized study comparing outcomes of stapled and hand-sutured anastomoses in patients undergoing open gastrointestinal surgery.

PubMed

Chandramohan, S M; Gajbhiye, Raj Narenda; Agwarwal, Anil; Creedon, Erin; Schwiers, Michael L; Waggoner, Jason R; Tatla, Daljit

2013-08-01

Although stapling is an alternative to hand-suturing in gastrointestinal surgery, recent trials specifically designed to evaluate differences between the two in surgery time, anastomosis time, and return to bowel activity are lacking. This trial compared the outcomes of the two in subjects undergoing open gastrointestinal surgery. Adult subjects undergoing emergency or elective surgery requiring a single gastric, small, or large bowel anastomosis were enrolled into this open-label, prospective, randomized, interventional, parallel, multicenter, controlled trial. Randomization was assigned in a 1:1 ratio between the hand-sutured group (n = 138) and the stapled group (n = 142). Anastomosis time, surgery time, and time to bowel activity were collected and compared as primary endpoints. A total of 280 subjects were enrolled from April 2009 to September 2010. Only the time of anastomosis was significantly different between the two arms: 17.6 ± 1.90 min (stapled) and 20.6 ± 1.90 min (hand-sutured). This difference was deemed not clinically or economically meaningful. Safety outcomes and other secondary endpoints were similar between the two arms. Mechanical stapling is faster than hand-suturing for the construction of gastrointestinal anastomoses. Apart from this, stapling and hand-suturing are similar with respect to the outcomes measured in this trial.

Meta-analysis of randomized controlled trials comparing outcomes for stapled hemorrhoidopexy versus LigaSure hemorrhoidectomy for symptomatic hemorrhoids in adults.

PubMed

Lee, Ko-Chao; Chen, Hong-Hwa; Chung, Kuan-Chih; Hu, Wan-Hsiang; Chang, Chia-Lo; Lin, Shung-Eing; Tsai, Kai-Lung; Lu, Chien-Chang

2013-01-01

This purpose of the meta-analysis was to compare treatment outcomes for adult patients with symptomatic hemorrhoids treated by stapled hemorrhoidopexy or LigaSure hemorrhoidectomy. A search of public medical databases was made to identify randomized controlled trials (RCTs) comparing stapled hemorrhoidopexy (SH) with LigaSure hemorrhoidectomy (LH) for the treatment of adult patients with symptomatic grade 3 and grade 4 hemorrhoids. Postoperative pain as measured using a visual analog scale was the primary outcome, and rate of recurrent prolapse and postoperative bleeding were secondary outcome measures. Four RCTs were identified that met the inclusion criteria. Data for the pooled outcomes were analyzed using odds ratio (OR) analysis. None of the studies in the analysis indicated a significant difference between SH and LH for the outcomes VAS pain score, recurrence rate, or postoperative bleeding. Pooled analysis revealed a significant OR in favor of the SH method for recurrent prolapse (OR = 5.529, P = 0.016) for up to 2 years after surgery. No significant differences between the two methods were identified for VAS pain scores (OR = -1.060, P = 0.149) or postoperative bleeding OR = 1.188, P = 0.871). Pooled analysis of RCT results comparing SH to LH for symptomatic hemorrhoids revealed a significantly greater incidence of recurrent prolapse for SH. The two techniques were associated with similar levels of postoperative pain and postoperative bleeding. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

Early and late complications of stapled haemorrhoidopexy: a 6-year experience from a single surgical clinic.

PubMed

Grigoropoulos, P; Kalles, V; Papapanagiotou, I; Mekras, A; Argyrou, A; Papageorgiou, K; Derian, A

2011-10-01

Introduction of stapled hemorrhoidopexy (SH) brought a radical change in the treatment of haemorrhoidal disease. The aim of this study is to evaluate the results and the complications (early and late) from the use of this technique. During the last 6 years (2005-2011), 123 patients underwent a SH in our ward. Our sample consists of 79 male and 44 female patients with an average age of 48.2 years (range 22-83 years). Of them, 83 had third-degree haemorrhoidal disease, 34 had fourth-degree and 6 had second-degree bleeding haemorrhoids. The follow-up period was 6-72 months. Pain was minimal or even not existent. Additional sutures or use of adrenaline 1:200.000 for haemostasis were required in 6 patients (4.8%). The bleeding has been diminished with the use of this new haemorrhoidectomy stapler PPH03. Urinary retention, which was observed in 3 patients (2.4%), was temporary and the use of catheter was not needed. As a late complication, 'faecal urgency' occurred in 8 patients (6.5%), and disappeared after some months. No recurrent haemorrhoidal disease occurred. No cases of chronic pain were reported. Average hospital stay was 1 day, except for 2 patients who remained for 2 days for bleeding observation. The correct application of SH reduces the possible complications. The advantages of the stapled procedure are reduced postoperative pain, the minimal hospital stay and early return to work.

Thoracoscopic stapler-based "bidirectional" segmentectomy for posterior basal segment (S10) and its variants.

PubMed

Sato, Masaaki; Murayama, Tomonori; Nakajima, Jun

2018-04-01

Thoracoscopic segmentectomy for the posterior basal segment (S10) and its variant (e.g., S9+10 and S10b+c combined subsegmentectomy) is one of the most challenging anatomical segmentectomies. Stapler-based segmentectomy is attractive to simplify the operation and to prevent post-operative air leakage. However, this approach makes thoracoscopic S10 segmentectomy even more tricky. The challenges are caused mostly from the following three reasons: first, similar to other basal segments, "three-dimensional" stapling is needed to fold a cuboidal segment; second, the belonging pulmonary artery is not directly facing the interlobar fissure or the hilum, making identification of target artery difficult; third, the anatomy of S10 and adjacent segments such as superior (S6) and medial basal (S7) is variable. To overcome these challenges, this article summarizes the "bidirectional approach" that allows for solid confirmation of anatomy while avoiding separation of S6 and the basal segment. To assist this approach under limited thoracoscopic view, we also show stapling techniques to fold the cuboidal segment with the aid of "standing stiches". Attention should also be paid to the anatomy of adjacent segments particularly that of S7, which tends to be congested after stapling. The use of virtual-assisted lung mapping (VAL-MAP) is also recommended to demark resection lines because it flexibly allows for complex procedures such as combined subsegmentectomy such as S10b+c, extended segmentectomy such as S10+S9b, and non-anatomically extended segmentectomy.

Functional abdominal pain syndrome in morbidly obese patients following laparoscopic gastric bypass surgery.

PubMed

Eidy, Mohammad; Pazouki, Abdolreza; Raygan, Fahimeh; Ariyazand, Yazdan; Pishgahroudsari, Mohadeseh; Jesmi, Fatemeh

2014-03-01

Roux-en-Y gastric bypass surgery (RYGBP) is one of the most common bariatric surgeries, which is being performed using various techniques like gastrojejunostomy by hand swen, linear or circular stapler. Abdominal pain is a common complaint following laparoscopic gastric bypass procedure (LGBP), which has different aetiologies, such as overeating, adhesion, internal herniation, bile reflux and many more. In this study LGBP was performed in an ante-colic ante-gastric pattern in a double loop manner and the prevalence and distribution of pain in morbidly obese patients undergoing LGBP was assessed. The aim of this study was to analyze the distribution and frequency of post LGBP pain in morbidly obese patients. This study was performed on 190 morbidly obese patients referred to Hazrat Rasoul Hospital in Tehran. After LGBP, pain was measured in the following intervals: 24 hours, one week and one month after the operation. Before the operation onset, 2 mg Keflin and 5000 IU subcutaneous heparin were administered as prophylaxis. LGBP was performed using five ports including: one 11 mm port was placed 15-20 cm far from the xiphoid, one 12-mm port in mid-clavicular line at the level of camera port, one 5-mm port in subcostal area in ante-axillary region in the left, another 5-mm port in the right mid-clavicular area and a 5-mm port in sub-xyphoid. All operations were done by the same team. Staple was used for all anastomoses and hand sewn technique to close the staple insertion site. The mesenteric defect was left open and no effort was made to repair it. The results of this study showed that 99.94 % of the patients had complains of pain in the first 24 hours of post operation, about 60% after one week and 29.5 % still had pain after one month. In addition, left upper quadrant (LUQ) was found to be the most prevalent site for the pain in 53.7% of the patients in the first 24 hours, 59.6% after one week and 16.8% after one month (except for obscure pain) with a significance of < 0.05. In this study, the authors analyzed the location and disturbance level of pain after LGBP, which could serve as a cornerstone for further researches. The authors suggest that long-term follow-up (for more than a year after operation) should be considered in future studies and also the relationship between the drainage site and pain should be investigated.

Skin closure using staples and nylon sutures: a comparison of results.

PubMed Central

Stockley, I.; Elson, R. A.

1987-01-01

A disposable skin stapler (Elite: Auto Suture UK Ltd) and Nylon vertical mattress sutures have been used for skin closure. The complications related to each method were evaluated in 129 wounds. There was a higher incidence of inflammation, discomfort on removal and spreading of the healing scar associated with staples. The only advantage of staples was speed of wound closure. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:3566131

Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids.

PubMed

Simillis, C; Thoukididou, S N; Slesser, A A P; Rasheed, S; Tan, E; Tekkis, P P

2015-12-01

The aim was to compare the clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Randomized clinical trials were identified by means of a systematic review. A Bayesian network meta-analysis was performed using the Markov chain Monte Carlo method in WinBUGS. Ninety-eight trials were included with 7827 participants and 11 surgical treatments for grade III and IV haemorrhoids. Open, closed and radiofrequency haemorrhoidectomies resulted in significantly more postoperative complications than transanal haemorrhoidal dearterialization (THD), LigaSure™ and Harmonic® haemorrhoidectomies. THD had significantly less postoperative bleeding than open and stapled procedures, and resulted in significantly fewer emergency reoperations than open, closed, stapled and LigaSure™ haemorrhoidectomies. Open and closed haemorrhoidectomies resulted in more pain on postoperative day 1 than stapled, THD, LigaSure™ and Harmonic® procedures. After stapled, LigaSure™ and Harmonic® haemorrhoidectomies patients resumed normal daily activities earlier than after open and closed procedures. THD provided the earliest time to first bowel movement. The stapled and THD groups had significantly higher haemorrhoid recurrence rates than the open, closed and LigaSure™ groups. Recurrence of haemorrhoidal symptoms was more common after stapled haemorrhoidectomy than after open and LigaSure™ operations. No significant difference was identified between treatments for anal stenosis, incontinence and perianal skin tags. Open and closed haemorrhoidectomies resulted in more postoperative complications and slower recovery, but fewer haemorrhoid recurrences. THD and stapled haemorrhoidectomies were associated with decreased postoperative pain and faster recovery, but higher recurrence rates. The advantages and disadvantages of each surgical treatment should be discussed with the patient before surgery to allow an informed decision to be made. © 2015 BJS Society Ltd Published by John Wiley & Sons Ltd.

A Circular Surgical Stapler Designed to Anastomose Aorta and Dacron Tube Graft

PubMed Central

2013-01-01

Background: A circular aortic stapler has been developed to anastomose the open end of the aorta to a size-matched Dacron tube graft in one quick motion and without having to pull sutures through the aortic wall. Methods: A prototype was developed, and its design and function were tested in bench experiments and compared with hand-sewn anastomosis. The basic design of the stapler is a central rod (anvil) surrounded by 10 stapling limbs, which can be closed over the anvil in a full circle, with staples extruded by turning a knob at the back. To test its function, a Dacron tube graft was inserted in the middle of a length of bovine aorta. One side was anastomosed with the stapler and the other hand-sewn in each of 10 experiments. Bovine blood was infused under increasing pressure. Results: It took considerably less time to complete the stapled anastomosis than the hand-sewn side (3 minutes, 46 seconds versus 15 minutes, 42 seconds). Initial leak occurred at low pressures on the hand-sewn side (mean pressure 40 mm Hg) compared with the stapled side (mean pressure 70 mm Hg). In 7 of 10 experiments, the leak became too brisk on the hand-sewn side to sustain pressure, compared with 3 of 10 with stapled anastomoses. The stapling device performed well in all cases except when the bovine aorta was too thick for the staples (two cases) or when there was a missed branch at the anastomotic site (one case). Conclusions: These experiments validate the concept and the design of this aortic stapler. There are some limitations in the current design, which will need to be modified before its use in live animals or clinically. PMID:26798678

Glycaemic responses of staple South Asian foods alone and combined with curried chicken as a mixed meal.

PubMed

George, R; Garcia, A L; Edwards, C A

2015-06-01

The glycaemic responses of staples differ when eaten as mixed meals. We determined the glycaemic responses and glycaemic index (GI) values for common South Asian carbohydrate rich foods and the effect of adding curried chicken to them as mixed meals. The GI and glycaemic response to staples (basmati rice, pilau rice and chapatti) and mixed meals (pilau rice with chicken curry and chapatti with chicken curry) were measured in healthy volunteers. Paired comparisons in each subject were carried out for staples and their equivalent mixed meals (n = 9). GI values for the mixed meals were significantly lower than the staples alone (41 and 60 for pilau rice with chicken curry and pilau rice alone, P = 0.001; 45 and 68 for chapatti with chicken curry and chapatti alone, P = 0.004). Both, pilau rice and chapatti with chicken curry had a significantly lower glycaemic response than their equivalent staples alone: incremental area under the blood glucose response curves (IAUC) 111.9 mmol min(-1 ) L(-1) for pilau rice with curry versus 162.4 mmol min(-1 ) L(-1) for pilau rice alone (P = 0.001) and IAUC 110.1 mmol min(-1 ) L(-1) for chapatti with chicken curry versus 183.6 mmol min(-1 ) L(-1) for chapatti alone (P = 0.002). Adding fat and protein-containing curries as part of a mixed meal to carbohydrate rich staple foods reduced glycaemic responses, and also changed the GI category. © 2014 The British Dietetic Association Ltd.

A Circular Surgical Stapler Designed to Anastomose Aorta and Dacron Tube Graft: Validation of the Concept and Comparison to Hand-Sewn Anastomosis in Bench Experiments.

PubMed

Raza, Syed T

2013-06-01

A circular aortic stapler has been developed to anastomose the open end of the aorta to a size-matched Dacron tube graft in one quick motion and without having to pull sutures through the aortic wall. A prototype was developed, and its design and function were tested in bench experiments and compared with hand-sewn anastomosis. The basic design of the stapler is a central rod (anvil) surrounded by 10 stapling limbs, which can be closed over the anvil in a full circle, with staples extruded by turning a knob at the back. To test its function, a Dacron tube graft was inserted in the middle of a length of bovine aorta. One side was anastomosed with the stapler and the other hand-sewn in each of 10 experiments. Bovine blood was infused under increasing pressure. It took considerably less time to complete the stapled anastomosis than the hand-sewn side (3 minutes, 46 seconds versus 15 minutes, 42 seconds). Initial leak occurred at low pressures on the hand-sewn side (mean pressure 40 mm Hg) compared with the stapled side (mean pressure 70 mm Hg). In 7 of 10 experiments, the leak became too brisk on the hand-sewn side to sustain pressure, compared with 3 of 10 with stapled anastomoses. The stapling device performed well in all cases except when the bovine aorta was too thick for the staples (two cases) or when there was a missed branch at the anastomotic site (one case). These experiments validate the concept and the design of this aortic stapler. There are some limitations in the current design, which will need to be modified before its use in live animals or clinically.

Patient and surgical factors influencing air leak after lung volume reduction surgery: lessons learned from the National Emphysema Treatment Trial.

PubMed

DeCamp, Malcolm M; Blackstone, Eugene H; Naunheim, Keith S; Krasna, Mark J; Wood, Douglas E; Meli, Yvonne M; McKenna, Robert J

2006-07-01

Although staple line buttressing is advocated to reduce air leak after lung volume reduction surgery (LVRS), its effectiveness is unknown. We sought to identify risk factors for air leak and its duration and to estimate its medical consequences for selecting optimal perioperative technique(s), such as buttressing technique, to preempt or treat post-LVRS air leak. Detailed air leak data were available for 552 of 580 patients receiving bilateral stapled LVRS in the National Emphysema Treatment Trial. Risk factors for prevalence and duration of air leak were identified by logistic and hazard function analyses. Medical consequences were estimated in propensity-matched pairs with and without air leak. Within 30 days of LVRS, 90% of patients developed air leak (median duration = 7 days). Its occurrence was more common and duration prolonged in patients with lower diffusing capacity (p = 0.06), upper lobe disease (p = 0.04), and important pleural adhesions (p = 0.007). Duration was also protracted in Caucasians (p < 0.0001), patients using inhaled steroids (p = 0.004), and those with lower 1-second forced expiratory volume (p = 0.0003). Surgical approach, buttressing, stapler brand, and intraoperative adjunctive procedures were not associated with fewer or less prolonged air leaks (p >/= 0.2). Postoperative complications occurred more often in matched patients experiencing air leak (57% vs 30%, p = 0.0004), and postoperative stay was longer (11.8 +/- 6.5 days vs 7.6 +/- 4.4 days, p = 0.0005). Air leak accompanies LVRS in 90% of patients, is often prolonged, and is associated with a more complicated and protracted hospital course. Its occurrence and duration are associated with characteristics of patients and their disease, not with a specific surgical technique.

Development of Flame Resistant Combat Uniform Fabrics Made from Long Staple Wool and Aramid Blend Yarn

DTIC Science & Technology

2013-04-15

Kentwool recombed the wool top ( wool is first combed during the production of wool top); a second combing process is an optional step sometimes used in...RESISTANT COMBAT UNIFORM FABRICS MADE FROM LONG STAPLE WOOL AND ARAMID BLEND YARN by Parvez Mehta* Mitchell Driggers* and Carole...SUBTITLE DEVELOPMENT OF FLAME RESISTANT COMBAT UNIFORM FABRICS MADE FROM LONG STAPLE WOOL AND ARAMID BLEND YARN 5a. CONTRACT NUMBER W911QY-11

Scraping and stapling of end-grafted DNA chains by a bioadhesive spreading vesicle to reveal chain internal friction and topological complexity.

PubMed

Nam, Gimoon; Hisette, Marie Laure; Sun, Yuting Liang; Gisler, Thomas; Johner, Albert; Thalmann, Fabrice; Schröder, André Pierre; Marques, Carlos Manuel; Lee, Nam-Kyung

2010-08-20

Stained end-grafted DNA molecules about 20 μm long are scraped away and stretched out by the spreading front of a bioadhesive vesicle. Tethered biotin ligands bind the vesicle bilayer to a streptavidin substrate, stapling the DNAs into frozen confinement paths. Image analysis of the stapled DNA gives access, within optical resolution, to the local stretching values of individual DNA molecules swept by the spreading front, and provides evidence of self-entanglements.

Wound Complication Rates After Staples or Suture for Midline Vertical Skin Closure in Obese Women: A Randomized Controlled Trial.

PubMed

Kuroki, Lindsay M; Mullen, Mary M; Massad, L Stewart; Wu, Ningying; Liu, Jingxia; Mutch, David G; Powell, Matthew A; Hagemann, Andrea R; Thaker, Premal H; McCourt, Carolyn K; Novetsky, Akiva P

2017-07-01

To compare wound complication rates after skin closure with staples and subcuticular suture in obese gynecology patients undergoing laparotomy through a midline vertical incision. In this randomized controlled trial, women with body mass indexes (BMIs) of 30 or greater undergoing surgery by a gynecologic oncologist through a midline vertical incision were randomized to skin closure with staples or subcuticular 4-0 monofilament suture. The primary outcome was the rate of wound complication, defined as the presence of a wound breakdown, or infection, within 8 weeks postoperatively. Secondary outcomes included operative time, Stony Brook scar cosmetic score, and patient satisfaction. A sample size of 162 was planned to detect a 50% reduction in wound complications. At planned interim review (n=82), there was no significant difference in primary outcome. Between 2013 and 2016, 163 women were analyzed, including 84 who received staples and 79 suture. Women who received staples were older (mean age 59 compared with 57 years), had lower mean BMI (37.3 compared with 38.9), and fewer benign indications for surgery (22 compared with 27). There were no differences in wound complication rates between staple compared with suture skin closure (28 [33%] compared with 25 [32%], relative risk 1.05, 95% confidence interval [CI] 0.68-1.64). Women with staples reported worse median cosmetic scores (four of five compared with five of five, P<.001), darker scar color (37 [49%] compared with 13 [18%], relative risk 2.69, 95% CI 1.57-4.63), and more skin marks (30 [40%] compared with three [4%], relative risk 9.47, 95% CI 3.02-29.65) compared with women with suture closure. There was no group difference regarding satisfaction with their scar. Stepwise multivariate analysis revealed BMI (odds ratio [OR] 1.13, 95% CI 1.07-1.20), maximum postoperative glucose (OR 1.01, 95% CI 1.00-1.01), and cigarette smoking (OR 4.96, 95% CI 1.32-18.71) were correlates of wound complication. Closure of midline vertical skin incisions with subcuticular suture does not reduce surgical site wound complications compared with staples in obese gynecology patients. ClinicalTrials.gov, NCT01977612.

Need and prospects for using tracer techniques in fruit breeding

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zagaja, S.W.

1975-01-01

Compared with staple food crops and fodder crops, the commercial value of fruits depends more on their quality than on their productivity. Modified screening techniques are therefore required for fruit crop improvement. The following are areas of fruit crop improvement in which tracer techniques could be used to speed up the progress: assessment of rootstocks and particularly their effect on vigour of growth and productivity of the trees; assessment of mutants productivity; assessment of adaptability to various habitats of fruit tree cultivars and rootstocks; and juvenility studies on fruit trees, aimed at shortening the juvenile stage. On each of thesemore » subjects background information is provided and suggestions are made concerning the scope of research. (auth)« less

Thoracoscopic stapler-based “bidirectional” segmentectomy for posterior basal segment (S10) and its variants

PubMed Central

Murayama, Tomonori; Nakajima, Jun

2018-01-01

Thoracoscopic segmentectomy for the posterior basal segment (S10) and its variant (e.g., S9+10 and S10b+c combined subsegmentectomy) is one of the most challenging anatomical segmentectomies. Stapler-based segmentectomy is attractive to simplify the operation and to prevent post-operative air leakage. However, this approach makes thoracoscopic S10 segmentectomy even more tricky. The challenges are caused mostly from the following three reasons: first, similar to other basal segments, “three-dimensional” stapling is needed to fold a cuboidal segment; second, the belonging pulmonary artery is not directly facing the interlobar fissure or the hilum, making identification of target artery difficult; third, the anatomy of S10 and adjacent segments such as superior (S6) and medial basal (S7) is variable. To overcome these challenges, this article summarizes the “bidirectional approach” that allows for solid confirmation of anatomy while avoiding separation of S6 and the basal segment. To assist this approach under limited thoracoscopic view, we also show stapling techniques to fold the cuboidal segment with the aid of “standing stiches”. Attention should also be paid to the anatomy of adjacent segments particularly that of S7, which tends to be congested after stapling. The use of virtual-assisted lung mapping (VAL-MAP) is also recommended to demark resection lines because it flexibly allows for complex procedures such as combined subsegmentectomy such as S10b+c, extended segmentectomy such as S10+S9b, and non-anatomically extended segmentectomy. PMID:29785292

Safety and short-term effectiveness of EEA stapler vs PPH stapler in the treatment of degree III haemorrhoids: prospective randomized controlled trial.

PubMed

Giuratrabocchetta, S; Pecorella, G; Stazi, A; Tegon, G; De Fazio, M; Altomare, D F

2013-03-01

Stapled haemorrhoidopexy has gained wide acceptance due to less postoperative pain although postoperative bleeding and prolapse recurrence are among the major drawbacks of this technique compared with the standard Milligan-Morgan hemorrhoidectomy. The aim was to investigate a new stapler device designed to overcome these side effects. In all, 135 patients (71 men, mean age 42 years) with degree III haemorrhoids were randomly allotted to stapled haemorrhoidopexy with PPH® staplers (Ethicon EndoSurgery) (63 patients) or with an EEA® stapler (Covidien) (72 patients) in four referral colorectal centres. The number of haemostatic overstitches apposed on the stapled suture, the area of the resected mucosa (in square centimetres) and any postoperative bleeding within 30 days were recorded. The mean area of the resected mucosa was significantly wider in EEA than PPH patients (35.75 ± 17.51 vs 28.05 ± 10.23 cm(2), P = 0.002). The median number of haemostatic stitches apposed in the EEA group was significantly lower than in the PPH groups (median value 1, vs 3, interquartile range 0-2, vs 2-5, P < 0.0001). Intraoperative haemostasis was better in the EEA group compared with the PPH01 and PPH03 groups. Postoperative bleeding occurred only in two PPH patients. Data suggest that the EEA stapler has better haemostatic properties than the PPH stapler and allows resection of a larger area of mucosal prolapse with potential benefits over the recurrence rate of haemorrhoid prolapse. © 2012 The Authors. Colorectal Disease © 2012 The Association of Coloproctology of Great Britain and Ireland.

Retention of Provitamin A Carotenoids in Staple Crops Targeted for Biofortification in Africa: Cassava, Maize and Sweet Potato

PubMed Central

De Moura, Fabiana F.; Miloff, Alexander; Boy, Erick

2015-01-01

HarvestPlus, part of the Consultative Group on Internation Agriculture research (CGIAR) Program on Agriculture for Nutrition and Health (A4NH) uses conventional plant breeding techniques to develop staple food crops that are rich in micronutrients, a food-based approach to reduce micronutrient malnutrition known as biofortification. The nutritional breeding targets are established based on the food intake of target populations, nutrient losses during storage and processing and bioavailability. This review collates the evidence on the retention of provitamin A carotenoid (pVAC) after processing, cooking, and storing of the staple crops targeted for pVAC biofortification: cassava, maize, and sweet potato. Sun drying was more detrimental to the pVAC levels (27–56% retention) in cassava than shade (59%) or oven (55–91%) drying, while the pVAC retention levels (66–96%) in sweet potato were not significantly different among the various drying methods. Overall, boiling and steaming had higher pVAC retention (80–98%) compared to baking (30–70%) and frying (18–54%). Gari, the most frequently consumed form of cassava in West Africa had the lowest pVAC retention (10–30%). The pVAC retention of maize grain and cassava and sweet potato flour reached levels as low as 20% after 1–4 months of storage and was highly dependent on genotype. Therefore, we recommend that an evaluation of the pVAC degradation rate among different genotypes be performed before a high pVAC crop is promoted. PMID:24915386

Strength of fixation constructs for basilar osteotomies of the first metatarsal.

PubMed

Lian, G J; Markolf, K; Cracchiolo, A

1992-01-01

Twenty-four pairs of fresh-frozen human feet had a proximal osteotomy of the first metatarsal that was fixed using either screws, staples, or K wires. Each metatarsal was excised and the specimen was loaded to failure in a cantilever beam configuration by applying a superiorly directed force to the metatarsal head using an MTS servohydraulic test machine. Specimens with a crescentic osteotomy that were fixed using a single screw demonstrated higher mean failure moments than pairs that were fixed with four staples or two K wires; staples were the weakest construct. All specimens fixed with staples failed by bending of the staples without bony fracture; all K wire constructs but one failed by wire bending. Chevron and crescentic osteotomies fixed with a single screw demonstrated equal bending strengths; the bending strength of an oblique osteotomy fixed with two screws was 82% greater than for a crescentic osteotomy fixed with a single screw. Basilar osteotomies of the first metatarsal are useful in correcting metatarsus primus varus often associated with hallux valgus pathology. Fixation strength is an important consideration since weightbearing forces on the head of the first metatarsal acting at a distance from the osteotomy site subject the construct to a dorsiflexion bending moment, as simulated in our tests. Our results show that screw fixation is the strongest method for stabilizing a basilar osteotomy. Based upon the relatively low bending strengths of the staple and K wire constructs, we would not recommend these forms of fixation.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical comparison of the double-push technique and the conventional skate skiing technique in cross-country sprint skiing.

PubMed

Stöggl, Thomas; Müller, Erich; Lindinger, Stefan

2008-09-01

The aims of the study were to: (1) adapt the "double-push" technique from inline skating to cross-country skiing; (2) compare this new skiing technique with the conventional skate skiing cross-country technique; and (3) test the hypothesis that the double-push technique improves skiing speed in a short sprint. 13 elite skiers performed maximum-speed sprints over 100 m using the double-push skate skiing technique and using the conventional "V2" skate skiing technique. Pole and plantar forces, knee angle, cycle characteristics, and electromyography of nine lower body muscles were analysed. We found that the double-push technique could be successfully transferred to cross-country skiing, and that this new technique is faster than the conventional skate skiing technique. The double-push technique was 2.9 +/- 2.2% faster (P < 0.001), which corresponds to a time advantage of 0.41 +/- 0.31 s over 100 m. The double-push technique had a longer cycle length and a lower cycle rate, and it was characterized by higher muscle activity, higher knee extension amplitudes and velocities, and higher peak foot forces, especially in the first phase of the push-off. Also, the foot was more loaded laterally in the double-push technique than in the conventional skate skiing technique.

DNA origami metallized site specifically to form electrically conductive nanowires.

PubMed

Pearson, Anthony C; Liu, Jianfei; Pound, Elisabeth; Uprety, Bibek; Woolley, Adam T; Davis, Robert C; Harb, John N

2012-09-06

DNA origami is a promising tool for use as a template in the design and fabrication of nanoscale structures. The ability to engineer selected staple strands on a DNA origami structure provides a high density of addressable locations across the structure. Here we report a method using site-specific attachment of gold nanoparticles to modified staple strands and subsequent metallization to fabricate conductive wires from DNA origami templates. We have modified DNA origami structures by lengthening each staple strand in select regions with a 10-base nucleotide sequence and have attached DNA-modified gold nanoparticles to the lengthened staple strands via complementary base-pairing. The high density of extended staple strands allowed the gold nanoparticles to pack tightly in the modified regions of the DNA origami, where the measured median gap size between neighboring particles was 4.1 nm. Gold metallization processes were optimized so that the attached gold nanoparticles grew until gaps between particles were filled and uniform continuous nanowires were formed. Finally, electron beam lithography was used to pattern electrodes in order to measure the electrical conductivity of metallized DNA origami, which showed an average resistance of 2.4 kΩ per metallized structure.

Double-push skating versus V2 and V1 skating on uphill terrain in cross-country skiing.

PubMed

Stöggl, Thomas; Kampel, Wolfgang; Müller, Erich; Lindinger, Stefan

2010-01-01

The aims of the study were a) to compare the double-push skating technique with the V2 and the V1 skating techniques on an uphill terrain by a kinematic and kinetic analysis, b) to provide kinetic and kinematic data of the V1 technique at maximal skiing speeds, and c) to test the hypotheses that the double-push skating technique is faster compared with the V2 and the V1 skating techniques. Six elite skiers performed maximum speed sprints over a 60-m uphill section (7 degrees -10 degrees) using the double-push, the V2, and the V1 techniques. Pole and plantar forces and cycle characteristics were analyzed. The double-push skating technique was approximately 4.3% faster (P < 0.05) compared with the V2 skating technique and equally fast compared with the V1 skating technique. The double-push and the V2 techniques demonstrated longer cycle lengths, lower cycle rates (both P < 0.05), and equal poling frequencies and pole forces compared with the V1 technique. Cycle length, peak foot force, and knee extension ranges of motion and velocities were higher in the double-push technique compared with the V2 technique (all P values <0.05). Center of pressure was located more laterally in the double-push technique compared with the other two techniques (P < 0.05). All measured skiing speeds were drastically higher compared with former studies. The higher skiing speeds of the V1 and the double-push techniques compared with the V2 technique stress the mechanical advantage of those techniques on uphill terrain. Because of larger cycle lengths, lower cycle rate, longer recovery times, and equal poling frequency, the double-push technique might be seen as more economic on steep uphills compared with the V1 technique. From a tactical point of view compared with the V1 technique, the double-push technique needs less space due to less lateral displacement, and no technique transitions are necessary when entering and leaving an uphill section.

Dual-acting stapled peptides target both HIV-1 entry and assembly

PubMed Central

2013-01-01

Background Previously, we reported the conversion of the 12-mer linear and cell-impermeable peptide CAI to a cell-penetrating peptide NYAD-1 by using an i,i + 4 hydrocarbon stapling technique and confirmed its binding to the C-terminal domain (CTD) of the HIV-1 capsid (CA) protein with an improved affinity (Kd ~ 1 μM) compared to CAI (Kd ~ 15 μM). NYAD-1 disrupts the formation of both immature- and mature-like virus particles in in vitro and cell-based assembly assays. In addition, it displays potent anti-HIV-1 activity in cell culture against a range of laboratory-adapted and primary HIV-1 isolates. Results In this report, we expanded the study to i,i + 7 hydrocarbon-stapled peptides to delineate their mechanism of action and antiviral activity. We identified three potent inhibitors, NYAD-36, -66 and -67, which showed strong binding to CA in NMR and isothermal titration calorimetry (ITC) studies and disrupted the formation of mature-like particles. They showed typical α-helical structures and penetrated cells; however, the cell penetration was not as efficient as observed with the i,i + 4 peptides. Unlike NYAD-1, the i,i + 7 peptides did not have any effect on virus release; however, they impaired Gag precursor processing. HIV-1 particles produced in the presence of these peptides displayed impaired infectivity. Consistent with an effect on virus entry, selection for viral resistance led to the emergence of two mutations in the gp120 subunit of the viral envelope (Env) glycoprotein, V120Q and A327P, located in the conserved region 1 (C1) and the base of the V3 loop, respectively. Conclusion The i,i + 7 stapled peptides derived from CAI unexpectedly target both CA and the V3 loop of gp120. This dual-targeted activity is dependent on their ability to penetrate cells as well as their net charge. This mechanistic revelation will be useful in further modifying these peptides as potent anti-HIV-1 agents. PMID:24237936

M1.3 - a small scaffold for DNA origami

NASA Astrophysics Data System (ADS)

Said, Hassan; Schüller, Verena J.; Eber, Fabian J.; Wege, Christina; Liedl, Tim; Richert, Clemens

2012-12-01

The DNA origami method produces programmable nanoscale objects that form when one long scaffold strand hybridizes to numerous oligonucleotide staple strands. One scaffold strand is dominating the field: M13mp18, a bacteriophage-derived vector 7249 nucleotides in length. The full-length M13 is typically folded by using over 200 staple oligonucleotides. Here we report the convenient preparation of a 704 nt fragment dubbed ``M1.3'' as a linear or cyclic scaffold and the assembly of small origami structures with just 15-24 staple strands. A typical M1.3 origami is large enough to be visualized by TEM, but small enough to show a cooperativity in its assembly and thermal denaturation that is reminiscent of oligonucleotide duplexes. Due to its medium size, M1.3 origami with globally modified staples is affordable. As a proof of principle, two origami structures with globally 5'-capped staples were prepared and were shown to give higher UV-melting points than the corresponding assembly with unmodified DNA. M1.3 has the size of a gene, not a genome, and may function as a model for gene-based nanostructures. Small origami with M1.3 as a scaffold may serve as a workbench for chemical, physical, and biological experiments.The DNA origami method produces programmable nanoscale objects that form when one long scaffold strand hybridizes to numerous oligonucleotide staple strands. One scaffold strand is dominating the field: M13mp18, a bacteriophage-derived vector 7249 nucleotides in length. The full-length M13 is typically folded by using over 200 staple oligonucleotides. Here we report the convenient preparation of a 704 nt fragment dubbed ``M1.3'' as a linear or cyclic scaffold and the assembly of small origami structures with just 15-24 staple strands. A typical M1.3 origami is large enough to be visualized by TEM, but small enough to show a cooperativity in its assembly and thermal denaturation that is reminiscent of oligonucleotide duplexes. Due to its medium size, M1.3 origami with globally modified staples is affordable. As a proof of principle, two origami structures with globally 5'-capped staples were prepared and were shown to give higher UV-melting points than the corresponding assembly with unmodified DNA. M1.3 has the size of a gene, not a genome, and may function as a model for gene-based nanostructures. Small origami with M1.3 as a scaffold may serve as a workbench for chemical, physical, and biological experiments. Electronic supplementary information (ESI) available: Materials, full sequence of M1.3, alternative restriction reactions, sequences and origami designs, ALEX data, estimated cost of producing M13, additional melting data for origami, and MALDI spectra of individual capped oligonucleotides. See DOI: 10.1039/c2nr32393a

Ultrastructural analysis of different-made staplers' staples.

PubMed

Gentilli, S; Portigliotti, L; Aronici, M; Ferrante, D; Surico, D; Milanesio, M; Gianotti, V; Gatti, G; Addante, A; Garavoglia, M

2012-10-01

Recently, Chinese-made mechanical staplers with lower price respect to American-made ones have been introduced in clinical practice. In literature, small case series compare the clinical outcomes of different staplers concluding that the new stapler devices perform as well as the American ones. The aim of this study is to compare with an ultrastructural analysis the staples of different staplers in order to verify the existence of differences that might explain significant price disparity and condition clinical outcomes. Each stapler was subjected to morphological analysis, energy dispersive X-Ray spectroscopy, metal release assessment followed by inductively coupled plasma mass spectroscopy. P-values were considered statistically significant when <0.05. Autosuture staples have square section whereas the other American one and Chinese made staples have round sections. Roughness index and chips presence before and after ageing tests were comparable for all samples except for Ethicon Endo-Surgery stapler. Energy dispersive X-Ray spectroscopy showed that all staplers are made of pure Titanium but Ethicon Endo-Surgery staples are made with an alloy. Metal release analysis release statistically significant differences between samples in simulated body fluid 20 days solution (P=0.002) and in Aquaregia at 14 days solution. Discussion. Stapling devices have became routinely used in gastrointestinal surgery mainly because of operative time reduction. Recently, new Chinese-made mechanical staplers, with significantly lower prices, have been introduced in clinical practice. In literature, there are some studies that compare clinical outcomes of American-made and Chinese-made staplers on small groups of patients but doesn't exist any work which consider structural differences between traditional and new devices. In our study, for the first time, we propose a comparison between two American-made staplers and three Chinese-made staplers which evaluate morphology, metal composition and chemical staples release. Our study suggest that there are some ultrastructural differences between commercially available staplers with no correlation to price disparity. More studies are needed to confirm our results and to verify if our findings could condition clinical outcomes.

Reducing the global burden of type 2 diabetes by improving the quality of staple foods: The Global Nutrition and Epidemiologic Transition Initiative.

PubMed

Mattei, Josiemer; Malik, Vasanti; Wedick, Nicole M; Hu, Frank B; Spiegelman, Donna; Willett, Walter C; Campos, Hannia

2015-06-04

The prevalence of type 2 diabetes has been reaching epidemic proportions across the globe, affecting low/middle-income and developed countries. Two main contributors to this burden are the reduction in mortality from infectious conditions and concomitant negative changes in lifestyles, including diet. We aimed to depict the current state of type 2 diabetes worldwide in light of the undergoing epidemiologic and nutrition transition, and to posit that a key factor in the nutrition transition has been the shift in the type and processing of staple foods, from less processed traditional foods to highly refined and processed carbohydrate sources. We showed data from 11 countries participating in the Global Nutrition and Epidemiologic Transition Initiative, a collaborative effort across countries at various stages of the nutrition-epidemiologic transition whose mission is to reduce diabetes by improving the quality of staple foods through culturally-appropriate interventions. We depicted the epidemiologic transition using demographic and mortality data from the World Health Organization, and the nutrition transition using data from the Food and Agriculture Organization food balance sheets. Main staple foods (maize, rice, wheat, pulses, and roots) differed by country, with most countries undergoing a shift in principal contributors to energy consumption from grains in the past 50 years. Notably, rice and wheat products accounted for over half of the contribution to energy consumption from staple grains, while the trends for contribution from roots and pulses generally decreased in most countries. Global Nutrition and Epidemiologic Transition Initiative countries with pilot data have documented key barriers and motivators to increase intake of high-quality staple foods. Global research efforts to identify and promote intake of culturally-acceptable high-quality staple foods could be crucial in preventing diabetes. These efforts may be valuable in shaping future research, community interventions, and public health and nutritional policies.

THREE PORT LAPAROSCOPIC APPENDECTOMY TECHNIQUE WITH LOW COST AND AESTHETIC ADVANTAGE

PubMed Central

DOMENE, Carlos Eduardo; VOLPE, Paula; HEITOR, Frederico Almeida

2014-01-01

Introduction Despite dating more than 30 years after the first laparoscopic appendectomy, ileocecal appendix resection is still performed by laparotomy in more than 90% of cases, in our country. Aim To describe a technique for laparoscopic removal of the ileocecal appendix with three portals, at low cost and very good aesthetic appearance. Technique Three incisions, one umbilical and two suprapubic are made; permanent material used comprises: grasping forceps, hook, scissors, needle holders, three metal trocars and four other usual instruments, and a single strand of cotton. There is no need to use of operative extractors bags, clips, endoloops, staples or bipolar or harmonic energy instruments. Allows triangulation and instrumentation in the conventional manner. Conclusion The proposed technique is safe and reproducible, easily teachable, at very low cost and can be applied in general hospitals with conventional laparoscopic equipment. PMID:25409972

Small intestinal volvulus caused by loose surgical staples.

PubMed

Page, Matthew P; Kim, Heung Bae; Fishman, Steven J

2009-09-01

Small intestinal volvulus beyond infancy is rare and usually has an iatrogenic cause. The authors describe an adolescent boy with small bowel volvulus secondary to the presence of free intraperitoneal surgical staples after a laparoscopic appendectomy.

78 FR 26791 - Government-Owned Inventions; Availability for Licensing

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-08

... 301-435-0103. Stapled Peptides for Treatment of Cardiovascular Diseases and Inflammation Description... inflammation and cardiovascular diseases, including hyperlipidemia, atherosclerosis, restenosis, and acute...-stapled Apolipoprotein Peptide Mimetics for the Treatment of Cardiovascular Diseases and Inflammation. For...

Complications and results after stapled haemorrhoidopexy as a day surgical procedure.

PubMed

Mlakar, B; Kosorok, P

2003-10-01

The aim of this report is to describe our experience with stapled haemorrhoidopexy as a day surgery procedure. From January 2000 to January 2003, a total of 214 patients with third- and fourth-degree haemorrhoids underwent stapled haemorrhoidopexy under spinal anaesthesia. We analysed early postoperative complications and long-term results. Patients were followed for 4-36 months (mean, 22 months). Only 3 patients (1%) were hospitalised. The long-term complications were analysed by means of a mailed questionnaire. Minor bleeding at wiping after defecation was observed by 9% of patients and minor haemorrhoidal prolapse by 8% of patients. Pain after defecation was reported by 6% of patients and anal stenosis occurred in 2% of them. Faecal urgency was reported by 3% of patients with previously unknown incontinence problems. According to our experience, stapled haemorrhoidopexy can be safely performed as a day surgery procedure.

Sivers and Boer-Mulders observables from lattice QCD

NASA Astrophysics Data System (ADS)

Musch, B. U.; Hägler, Ph.; Engelhardt, M.; Negele, J. W.; Schäfer, A.

2012-05-01

We present a first calculation of transverse momentum-dependent nucleon observables in dynamical lattice QCD employing nonlocal operators with staple-shaped, “process-dependent” Wilson lines. The use of staple-shaped Wilson lines allows us to link lattice simulations to TMD effects determined from experiment, and, in particular, to access nonuniversal, naively time-reversal odd TMD observables. We present and discuss results for the generalized Sivers and Boer-Mulders transverse momentum shifts for the SIDIS and DY cases. The effect of staple-shaped Wilson lines on T-even observables is studied for the generalized tensor charge and a generalized transverse shift related to the worm-gear function g1T. We emphasize the dependence of these observables on the staple extent and the Collins-Soper evolution parameter. Our numerical calculations use an nf=2+1 mixed action scheme with domain wall valence fermions on an Asqtad sea and pion masses 369 MeV as well as 518 MeV.

Hand-suture versus stapling for closure of loop ileostomy: HASTA-Trial: a study rationale and design for a randomized controlled trial

PubMed Central

2011-01-01

Background Colorectal cancer is the second most common tumor in developed countries, with a lifetime prevalence of 5%. About one third of these tumors are located in the rectum. Surgery in terms of low anterior resection with mesorectal excision is the central element in the treatment of rectal cancer being the only option for definite cure. Creating a protective diverting stoma prevents complications like anastomotic failure and meanwhile is the standard procedure. Bowel obstruction is one of the main and the clinically and economically most relevant complication following closure of loop ileostomy. The best surgical technique for closure of loop ileostomy has not been defined yet. Methods/Design A study protocol was developed on the basis of the only randomized controlled mono-center trial to solve clinical equipoise concerning the optimal surgical technique for closure of loop ileostomy after low anterior resection due to rectal cancer. The HASTA trial is a multi-center pragmatic randomized controlled surgical trial with two parallel groups to compare hand-suture versus stapling for closure of loop ileostomy. It will include 334 randomized patients undergoing closure of loop ileostomy after low anterior resection with protective ileostomy due to rectal cancer in approximately 20 centers consisting of German hospitals of all level of health care. The primary endpoint is the rate of bowel obstruction within 30 days after ileostomy closure. In addition, a set of surgical and general variables including quality of life will be analyzed with a follow-up of 12 months. An investigators meeting with a practical session will help to minimize performance bias and enforce protocol adherence. Centers are monitored centrally as well as on-site before and during recruitment phase to assure inclusion, treatment and follow up according to the protocol. Discussion Aim of the HASTA trial is to evaluate the efficacy of hand-suture versus stapling for closure of loop ileostomy in patients with rectal cancer. Trial registration German Clinical Trial Register Number: DRKS00000040 PMID:21303515

EEA stapler and omental graft in esophagogastrectomy: experience with 30 intrathoracic anastomoses for cancer.

PubMed Central

Fekete, F; Breil, P; Ronsse, H; Tossen, J C; Langonnet, F

1981-01-01

Experience with the EEA stapler device used in 30 esophagogastric resections for cancer with intrathoracic anastomosis, is reported. The mortality rate was 13.3%. The anastomotic failure rate was 3.3% (1/30) with only one death; three asymptomatic blind fistulas were found on a routine contrast examination of the anastomosis. It is felt that esophagogastric EEA stapled anastomosis associated with an omental graft is a very safe technique. Images Fig. 4. Fig. 5. Fig. 6. PMID:7247526

Concept design and simulation study on a "phantom" anvil for circular stapler.

PubMed

Rulli, Francesco; Kartheuser, Alex; Amirhassankhani, Sasan; Mourad, Michel; Stefani, Mario; de Ferrá Aureli, Andrés; Sileri, Pierpaolo; Valentini, Pier Paolo

2015-04-01

Complications and challenges arising from the intraoperative double-stapling technique are seldom reported in colorectal surgery literature. Partial or full-thickness rectal injuries can occur during the introduction and the advancement of the circular stapler along the upper rectum. The aim of this study is to address some of these issues by designing and optimizing a "phantom" anvil manufactured to overcome difficulties throughout the rectal introduction and advancement of the circular stapler for the treatment of benign and malignant colon disease. The design of the "phantom" anvil has been performed using computer-aided modeling techniques, finite element investigations, and 2 essential keynotes in mind. The first one is the internal shape of the anvil, which is used for the connection to the gun. The second is the shape of the cap, which makes possible the insertion of the gun through the rectum. The "phantom" anvil has 2 functional requirements, which have been taken into account. The design has been optimized to avoid colorectal injuries, neoplastic dissemination (ie, mechanical seeding) and to reduce the fecal contamination. Numerical simulations show that a right combination of both top and bottom fillet radii of the shape of the anvil can reduce the stress for the considered anatomic configuration of >90%. Both the fillet radii at the top and the bottom of the device influence the local stress of the colon rectum. A dismountable device, which is used only for the insertion and advancement of the stapler, allows a dedicated design of its shape, keeping the remainder of the stapler unmodified. Computer-aided simulations are useful to perform numerical investigations to optimize the design of this auxiliary part for both the safety of the patient and the ease of the stapler advancement through the rectum.

Hydrocarbon-stapled lipopeptides exhibit selective antimicrobial activity.

PubMed

Jenner, Zachary B; Crittenden, Christopher M; Gonzalez, Martín; Brodbelt, Jennifer S; Bruns, Kerry A

2017-05-01

Antimicrobial peptides (AMPs) occur widely in nature and have been studied for their therapeutic potential. AMPs are of interest due to the large number of possible chemical structural combinations using natural and unnatural amino acids, with varying effects on their biological activities. Using physicochemical properties from known naturally occurring amphipathic cationic AMPs, several hydrocarbon-stapled lipopeptides (HSLPs) were designed, synthesized, and tested for antimicrobial properties. Peptides were chemically modified by N-terminal acylation, C-terminal amidation, and some were hydrocarbon stapled by intramolecular olefin metathesis. The effects of peptide length, amphipathic character, and stapling on antimicrobial activity were tested against Escherichia coli, three species of Gram-positive bacteria (Staphylococcus aureus, Bacillus megaterium, and Enterococcus faecalis), and two strains of Candida albicans. Peptides were shown to disrupt liposomes of different phospholipid composition, as measured by leakage of a fluorescent compound from vesicles. Peptides with (S)-2-(4'-pentenyl)-alanine substituted for l-alanine in a reference peptide showed a marked increase in antimicrobial activity, hemolysis, and membrane disruption. Stapled peptides exhibited slightly higher antimicrobial potency; those with greatest hydrophobic character showed the greatest hemolysis and liposome leakage, but lower antimicrobial activity. The results support a model of HSLPs as membrane-disruptive AMPs with potent antimicrobial activity and relatively low hemolytic potential at biologically active peptide concentrations. © 2017 Wiley Periodicals, Inc.

30-Day Outcomes of Revisional Bariatric Stapling Procedures: First Report Based on MBSAQIP Data Registry.

PubMed

El Chaar, Maher; Stoltzfus, Jill; Melitics, Maureen; Claros, Leonardo; Zeido, Ahmad

2018-06-06

The number of bariatric revisional cases has nearly doubled since 2011, and now comprises 13.6% of the total number of cases. The objective of this study is to evaluate the outcomes and safety of the two most common stapling revisional procedures, namely, sleeve and gastric bypass in comparison to primary stapling procedures using the MBSAQIP data registry. We reviewed all the sleeve and gastric bypass cases entered between January 1, 2015, and December 31, 2015, in the MBSAQIP data registry. We, then, identified sleeve and bypass patients who have had a previous bariatric procedure. Demographics and 30 day outcomes of all sleeve and gastric bypass patients were analyzed. We conducted within group comparisons comparing primary sleeve gastrectomy (PS) and primary gastric bypass (PB) patients to revisional sleeve (RS) and revisional gastric bypass (RB) patients, respectively. We, then, conducted group comparisons comparing RS to RB patients. The total number of patients analyzed was 141,577 (98,292 or 69% sleeve patients and 43,285 or 31% gastric bypass patients). Among the sleeve patients, 92,666 (94%) had a PS and 5626 (6%) had RS. Among the bypass patients, 39,567 (91%) had a PB and 3718 patients (9%) had RB. 30-day readmission rate of RS was significantly higher as compared to PS (4.1 vs 0.4%, p < 0.05). The incidence of at least one complication requiring reoperation or reintervention within 30 days following RS was twice as high as compared to PS (1.9 and 2% for RS vs 0.9 and 1.1% for PS respectively, p < 0.05). Length of stay and 30 day mortality rates for PS and RS were the same. 30-day readmission rate of RB as compared to PB was 8.3 vs 6.3% (p < 0.05). Also, the incidence of at least one complication requiring reoperation or reintervention following RB was 3.9 and 4%, respectively vs 2.4 and 2.7% for PB (p < 0.05). In addition, readmission rates and unplanned admission rates to the ICU were significantly higher for RB compared to RS (8.3 and 2% for RB vs 4.1 and 0.9% for RS respectively, p < 0.05). The incidence of at least one reoperation or one intervention following RB were also significantly higher compared to RS (3.9 vs 1.9% and 4 vs 2% respectively, p < 0.05). Revisional stapling procedures are safe but the rates of complications following RS and RB are twice as high compared to PS and PB. Also, RB are more likely to develop complications compared to RS.

A simplified technique for a totally diverting transverse loop colostomy and distal irrigation.

PubMed

Rose, D; Koniges, F; Frazier, T G

1985-12-01

This technique of totally diverting loop colostomy may be performed as an independent procedure or with exploratory laparotomy and surgical treatment on the distal part of the colon. Either a transverse or sigmoid loop colostomy can be used for diversion without the risk of fecal contamination of the peritoneal cavity, particularly when working with unprepared intestine. When distal irrigation is desired to purge the intestine of fecal material, either intraoperatively or as part of a subsequent intestinal preparation, it can easily be accomplished by placing an irrigating catheter distal to the staple line. In addition, the use of a small rubber suspension bar facilitates application of standard colostomy appliances for the stoma.

Laser tissue welding in ophthalmic surgery.

PubMed

Rossi, Francesca; Matteini, Paolo; Ratto, Fulvio; Menabuoni, Luca; Lenzetti, Ivo; Pini, Roberto

2008-09-01

Laser welding of ocular tissues is an alternative technique or adjunct to conventional suturing in ophthalmic surgery. It is based on the photothermal interaction of laser light with the main components of the extracellular matrix of connective tissues. The advantages of the welding procedure with respect to standard suturing and stapling are reduced operation times, lesser inflammation, faster healing and increased ability to induce tissue regeneration. The procedure we set up is based on the use of an infrared diode laser in association with the topical application of the chromophore Indocyanine Green. Laser light may be delivered either continuously or in pulses, thus identifying two different techniques that have been applied clinically in various types of transplants of the cornea.

Food contamination as a pathway for lead exposure in children during the 2010-2013 lead poisoning epidemic in Zamfara, Nigeria.

PubMed

Tirima, Simba; Bartrem, Casey; von Lindern, Ian; von Braun, Margrit; Lind, Douglas; Anka, Shehu Mohamed; Abdullahi, Aishat

2018-05-01

In 2010, an estimated 400 to 500 children died of acute lead poisoning associated with artisanal gold mining in Zamfara, Nigeria. Processing of gold ores containing up to 10% lead within residential compounds put residents, especially children, at the highest risk. Principal routes of exposure were incidental ingestion and inhalation of contaminated soil and dusts. Several Nigerian and international health organizations collaborated to reduce lead exposures through environmental remediation and medical treatment. The contribution of contaminated food to total lead exposure was assessed during the environmental health response. Objectives of this investigation were to assess the influence of cultural/dietary habits on lead exposure pathways and estimate the contribution of contaminated food to children's blood lead levels (BLLs). A survey of village dietary practices and staple food lead content was conducted to determine dietary composition, caloric intakes, and lead intake. Potential blood lead increments were estimated using bio-kinetic modeling techniques. Most dietary lead exposure was associated with contamination of staple cereal grains and legumes during post-harvest processing and preparation in contaminated homes. Average post-harvest and processed cereal grain lead levels were 0.32mg/kg and 0.85mg/kg dry weight, respectively. Age-specific food lead intake ranged from 7 to 78μg/day. Lead ingestion and absorption were likely aggravated by the dusty environment, fasting between meals, and nutritional deficiencies. Contamination of staple cereal grains by highly bioavailable pulverized ores could account for as much as 11%-34% of children's BLLs during the epidemic, and were a continuing source after residential soil remediation until stored grain inventories were exhausted. Copyright © 2017. Published by Elsevier B.V.

Superiority of stapled side-to-side gastrojejunostomy over conventional hand-sewn end-to-side gastrojejunostomy for reducing the risk of primary delayed gastric emptying after subtotal stomach-preserving pancreaticoduodenectomy.

PubMed

Murata, Yasuhiro; Tanemura, Akihiro; Kato, Hiroyuki; Kuriyama, Naohisa; Azumi, Yoshinori; Kishiwada, Masashi; Mizuno, Shugo; Usui, Masanobu; Sakurai, Hiroyuki; Isaji, Shuji

2017-08-01

Delayed gastric emptying (DGE) is the most common complication following pancreaticoduodenectomy (PD). The clinical efficacy of stapled side-to-side anastomosis using a laparoscopic stapling device during alimentary reconstruction in PD is not well understood and its superiority over conventional hand-sewn end-to-side anastomosis remains controversial. The objective of this study was to evaluate the effectiveness of the stapled side-to-side anastomosis in preventing the development of DGE after PD. The subjects of this retrospective study were 137 patients who underwent pancreaticoduodenectomy, as subtotal stomach-preserving pancreaticoduodenectomy (SSPPD; n = 130), or conventional whipple procedure (n = 7) with Child reconstruction, between January 2010 and May 2014. The patients were divided into two groups according to whether they had had a stapled side-to-side anastomosis (SA group; n = 57) or a conventional hand-sewn end-to-side anastomosis (HA group; n = 80). SA reduced the operative time (SA vs. HA: 508 vs. 557 min, p = 0.028) and the incidence of delayed gastric emptying (SA vs. HA: 21.1 vs. 46.3%, p = 0.003) and was associated with shorter hospitalization (SA vs. HA: 33 vs. 39.5 days, p = 0.007). In this cohort, SA was the only significant factor contributing to a reduction in the incidence of DGE (p = 0.002). Stapled side-to-side gastrojejunostomy reduced the operative time and the incidence of DGE following PD with Child reconstruction, thereby also reducing the length of hospitalization.

Routine intraoperative leak testing for sleeve gastrectomy: is the leak test full of hot air?

PubMed

Bingham, Jason; Lallemand, Michael; Barron, Morgan; Kuckelman, John; Carter, Preston; Blair, Kelly; Martin, Matthew

2016-05-01

Staple line leak after sleeve gastrectomy (SG) is a rare but dreaded complication with a reported incidence of 0% to 8%. Many surgeons routinely test the staple line with an intraoperative leak test (IOLT), but there is little evidence to validate this practice. In fact, there is a theoretical concern that the leak test may weaken the staple line and increase the risk of a postop leak. Retrospective review of all SGs performed over a 7-year period was conducted. Cases were grouped by whether an IOLT was performed, and compared for the incidence of postop staple line leaks. The ability of the IOLT for identifying a staple line defect and for predicting a postoperative leak was analyzed. Five hundred forty-two SGs were performed between 2007 and 2014. Thirteen patients (2.4%) developed a postop staple line leak. The majority of patients (n = 494, 91%) received an IOLT, including all 13 patients (100%) who developed a subsequent clinical leak. There were no (0%) positive IOLTs and no additional interventions were performed based on the IOLT. The IOLT sensitivity and positive predictive value were both 0%. There was a trend, although not significant, to increase leak rates when a routine IOLT was performed vs no routine IOLT (2.6% vs 0%, P = .6). The performance of routine IOLT after SG provided no actionable information, and was negative in all patients who developed a postoperative leak. The routine use of an IOLT did not reduce the incidence of postop leak, and in fact was associated with a higher leak rate after SG. Published by Elsevier Inc.

Staple Line Reinforcement with Stitch in Laparoscopic Sleeve Gastrectomies. Is It Useful or Harmful?

PubMed

Albanopoulos, Konstantinos; Tsamis, Dimitrios; Arapaki, Aggeliki; Kleidi, Eleftheria; Zografos, Georgios; Leandros, Emmanouil

2015-07-01

Reinforcement of the staple line in laparoscopic sleeve gastrectomy (LSG) is a practice that leads to less morbidity, but equivocal results have been reported in the literature. This is a prospective randomized study comparing two groups of patients who underwent LSG. In one group LSG was performed with a running absorbable suture placement at the staple line. In the other group the running suture was not placed. General data of the patients, as well as intraoperative and postoperative data, were gathered and statistically analyzed. Overall, 146 patients were subjected to LSG. In 84 patients a running suture was placed, and in 62 patients no suture was placed. No significant differences were found between the two groups in demographic data. No significant differences were found also in the intraoperative data, such as number of trocars, number and type of cartridges, drain placement, and operative time (45±21 versus 40±20 minutes, respectively; P<.05). Intraoperative complications were significantly more in the group with the suture placement (33.3% versus 16.1%, respectively; P<.05). Hematomas developed intraoperatively in more patients after the placement of the running suture (9.5% versus 0.0%, respectively; P<.05). Postoperatively, there was no significant difference in morbidity between the two groups (8.3% versus 9.7%, respectively; P>.05). After this randomized study, final conclusions about the efficacy of this running suture to the staple line cannot be made. To the contrary, problems seem to exist after such reinforcement of the staple line, such as hematomas. Dealing with possible leaks and hemorrhage of the staple line is also problematic after placement of the running suture.

Staples.com: Focus on Usability.

ERIC Educational Resources Information Center

McCann, Tom; Hynes, Colin

2002-01-01

Describes the Staples.com electronic commerce Web site; discusses its steady growth rate; and details two case studies in which data from a variety of sources were used to identify and resolve site usability issues and which are supported by compelling ROI (return on investment) figures. (Author/LRW)

Hemorrhoids.

PubMed

Mounsey, Anne L; Halladay, Jacqueline; Sadiq, Timothy S

2011-07-15

Most patients with hemorrhoids experience only mild symptoms that can be treated with nonprescription topical preparations. Patients usually seek treatment when symptoms increase. Internal hemorrhoids typically present with prolapse or painless rectal bleeding. External hemorrhoids also bleed and can cause acute pain if thrombosed. Medical therapy should be initiated with stool softeners plus local therapy to relieve swelling and symptoms. If medical therapy is inadequate, surgical intervention is warranted. Rubber band ligation is the treatment of choice for grades 1 and 2 hemorrhoids. Rubber band ligation, excisional hemorrhoidectomy, or stapled hemorrhoidopexy can be performed in patients with grade 3 hemorrhoids. Rubber band ligation causes less postoperative pain and fewer complications than excisional hemorrhoidectomy and stapled hemorrhoidopexy, but has a higher recurrence rate. Excisional hemorrhoidectomy or stapled hemorrhoidopexy is recommended for treatment of grade 4 hemorrhoids. Stapled hemorrhoidopexy has a faster postoperative recovery, but a higher recurrence rate. Postoperative pain from excisional hemorrhoidectomy can be treated with nonsteroidal anti-inflammatory drugs, narcotics, fiber supplements, and topical antispasmodics. Thrombosed external hemorrhoids can be treated conservatively or excised.

Stapled or manual suturing in esophagojejunostomy after total gastrectomy: a comparison of outcome in 379 patients.

PubMed

Fujimoto, S; Takahashi, M; Endoh, F; Takai, M; Kobayashi, K; Kiuchi, S; Konno, C; Obata, G; Okui, K

1991-09-01

From January 1983 to December 1989, we performed esophagojejunostomy on 379 patients who underwent total gastrectomy for gastric cancer. A mechanical EEA stapler or conventional manual suturing was used. The clinical outcomes of 199 patients in whom stapling was used (stapler group) and 180 patients in whom manual suturing was done (manual group) were compared. Two of the 199 patients in the stapler group and 3 of the 180 patients in the manual group died of causes directly related to the anastomosis. In the stapler group, 16 stapled anastomoses were formed supradiaphragmatically, and manual suturing was done for 6 patients. The highly placed anastomosis was formed without left thoracotomy or with median sternotomy in 8 of the 16 patients in whom the stapling device was used and in 1 of the 6 patients in whom manual suturing was used. The incidence of anastomotic leakage and stenosis did not differ between the groups. Thus, the mechanical stapler facilitated the construction of a rapid, reliable esophagojejunostomic anastomosis.

Sivers and Boer-Mulders observables from lattice QCD.

DOE Office of Scientific and Technical Information (OSTI.GOV)

B.U. Musch, Ph. Hagler, M. Engelhardt, J.W. Negele, A. Schafer

We present a first calculation of transverse momentum dependent nucleon observables in dynamical lattice QCD employing non-local operators with staple-shaped, 'process-dependent' Wilson lines. The use of staple-shaped Wilson lines allows us to link lattice simulations to TMD effects determined from experiment, and in particular to access non-universal, naively time-reversal odd TMD observables. We present and discuss results for the generalized Sivers and Boer-Mulders transverse momentum shifts for the SIDIS and DY cases. The effect of staple-shaped Wilson lines on T-even observables is studied for the generalized tensor charge and a generalized transverse shift related to the worm gear function g{submore » 1}T. We emphasize the dependence of these observables on the staple extent and the Collins-Soper evolution parameter. Our numerical calculations use an n{sub f} = 2+1 mixed action scheme with domain wall valence fermions on an Asqtad sea and pion masses 369 MeV as well as 518 MeV.« less

Synthesis of all-hydrocarbon stapled α-helical peptides by ring-closing olefin metathesis.

PubMed

Kim, Young-Woo; Grossmann, Tom N; Verdine, Gregory L

2011-06-01

This protocol provides a detailed procedure for the preparation of stapled α-helical peptides, which have proven their potential as useful molecular probes and as next-generation therapeutics. Two crucial features of this protocol are (i) the construction of peptide substrates containing hindered α-methyl, α-alkenyl amino acids and (ii) the ring-closing olefin metathesis (RCM) of the resulting resin-bound peptide substrates. The stapling systems described in this protocol, namely bridging one or two turns of an α-helix, are highly adaptable to most peptide sequences, resulting in favorable RCM kinetics, helix stabilization and promotion of cellular uptake.

Circular stapled pyloroplasty: a fast and effective technique for pyloric disruption during esophagectomy with gastric pull-up.

PubMed

Oezcelik, A; DeMeester, S R; Hindoyan, K; Leers, J M; Ayazi, S; Abate, E; Zehetner, J; Hagen, J A; Lipham, J C; DeMeester, T R

2011-08-01

The necessity of pyloroplasty after esophagectomy and gastric pull-up is debated. Disadvantages of a standard pyloroplasty include the potential for leak, shortening of the length of the graft, and complexity when done during a minimally invasive procedure. The aim of this study is to report our experience with a novel internal pyloroplasty technique using a circular stapler (CS pyloroplasty), which is applicable for both laparoscopic and open esophagectomy. The records of all patients who underwent an esophagectomy with gastric pull-up and pyloroplasty between 2002 and 2007 were reviewed. The CS pyloroplasty was performed through a lesser curve gastrotomy with a 21-mm CS, while the standard pyloroplasty entailed a longitudinal full thickness incision through the pylorus with mucosal closure in the same direction and a Graham patch. A CS pyloroplasty was performed in 144 and a standard pyloroplasty in 133 patients. The median patient age was 66years, and the median follow-up was 17months, and was similar for both types of pyloroplasty. Routine postoperative videoesophagram was significantly more likely to show a delay in contrast transit through the pylorus after standard pyloroplasty (16% standard vs. 8% CS pyloroplasty, P= 0.03). Significantly more patients had postoperative endoscopy after standard pyloroplasty (40% standard vs. 24% CS pyloroplasty, P= 0.004), but the frequency of pyloric dilatation was similar. There were no leaks with either technique. A circular stapled pyloroplasty is as efficacious as a standard pyloroplasty after esophagectomy with gastric pull-up. Potential advantages include the ease and simplicity of the procedure along with virtually no risk of a leak and no graft shortening. The technique is amenable to both open and minimally invasive procedures. © 2011 Copyright the Authors. Journal compilation © 2011, Wiley Periodicals, Inc. and the International Society for Diseases of the Esophagus.

Single versus double-row repair of the rotator cuff: does double-row repair with improved anatomical and biomechanical characteristics lead to better clinical outcome?

PubMed

Pauly, Stephan; Gerhardt, Christian; Chen, Jianhai; Scheibel, Markus

2010-12-01

Several techniques for arthroscopic repair of rotator cuff defects have been introduced over the past years. Besides established techniques such as single-row repairs, new techniques such as double-row reconstructions have gained increasing interest. The present article therefore provides an overview of the currently available literature on both repair techniques with respect to several anatomical, biomechanical, clinical and structural endpoints. Systematic literature review of biomechanical, clinical and radiographic studies investigating or comparing single- and double-row techniques. These results were evaluated and compared to provide an overview on benefits and drawbacks of the respective repair type. Reconstructions of the tendon-to-bone unit for full-thickness tears in either single- or double-row technique differ with respect to several endpoints. Double-row repair techniques provide more anatomical reconstructions of the footprint and superior initial biomechanical characteristics when compared to single-row repair. With regard to clinical results, no significant differences were found while radiological data suggest a better structural tendon integrity following double-row fixation. Presently published clinical studies cannot emphasize a clearly superior technique at this time. Available biomechanical studies are in favour of double-row repair. Radiographic studies suggest a beneficial effect of double-row reconstruction on structural integrity of the reattached tendon or reduced recurrent defect rates, respectively.

Pricing of Staple Foods at Supermarkets versus Small Food Stores

PubMed Central

Caspi, Caitlin E.; Pelletier, Jennifer E.; Harnack, Lisa J.; Erickson, Darin J.; Laska, Melissa N.

2017-01-01

Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10–54% more expensive in smaller stores than in supermarkets (p < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces. PMID:28809795

Pricing of Staple Foods at Supermarkets versus Small Food Stores.

PubMed

Caspi, Caitlin E; Pelletier, Jennifer E; Harnack, Lisa J; Erickson, Darin J; Lenk, Kathleen; Laska, Melissa N

2017-08-15

Prices affect food purchase decisions, particularly in lower-income communities, where access to a range of food retailers (including supermarkets) is limited. The aim of this study was to examine differences in staple food pricing between small urban food stores and the closest supermarkets, as well as whether pricing differentials varied based on proximity between small stores and larger retailers. In 2014, prices were measured for 15 staple foods during store visits in 140 smaller stores (corner stores, gas-marts, dollar stores, and pharmacies) in Minneapolis/St. Paul, MN and their closest supermarket. Mixed models controlling for store type were used to estimate the average price differential between: (a) smaller stores and supermarkets; (b) isolated smaller stores (>1 mile to closest supermarket) and non-isolated smaller stores; and (c) isolated smaller stores inside versus outside USDA-identified food deserts. On average, all items except white bread were 10-54% more expensive in smaller stores than in supermarkets ( p < 0.001). Prices were generally not significantly different in isolated stores compared with non-isolated stores for most items. Among isolated stores, there were no price differences inside versus outside food deserts. We conclude that smaller food stores have higher prices for most staple foods compared to their closest supermarket, regardless of proximity. More research is needed to examine staple food prices in different retail spaces.

Chromosome doubling method

DOEpatents

Kato, Akio

2006-11-14

The invention provides methods for chromosome doubling in plants. The technique overcomes the low yields of doubled progeny associated with the use of prior techniques for doubling chromosomes in plants such as grasses. The technique can be used in large scale applications and has been demonstrated to be highly effective in maize. Following treatment in accordance with the invention, plants remain amenable to self fertilization, thereby allowing the efficient isolation of doubled progeny plants.

Suzanne Fisher Staples: From Journalist to Novelist.

ERIC Educational Resources Information Center

Greever, Ellen A.; Austin, Patricia

1997-01-01

Presents the story of Suzanne Fisher Staples, author of the Newbery Honor Book, "Shabanu: Daughter of the Wind." States that she was first a journalist who experienced different foreign cultures firsthand, which provided the background for the novel. Discusses the difference between writing for newspapers and writing fiction. (PA)

Rural Inservice Education: Staples Teacher Center Style.

ERIC Educational Resources Information Center

Krueger, Rick

In its two-year existence, the federally funded Staples Teacher Center (STC) in Minnesota has had a significant impact on improving classroom instruction and staff development activities in a rural setting, proving that teacher centers are a most effective delivery system for inservice education in sparsely populated areas. Services are rendered…

Genome-wide association mapping of provitamin A carotenoid content in cassava

USDA-ARS?s Scientific Manuscript database

Global efforts are underway to develop staple crops with improved levels of provitamin A carotenoids to help combat dietary vitamin A deficiency, which is widespread among resource-poor farmers in the developing world. As a staple crop for more than 500 million people in sub-Saharan Africa, cassava ...

Extra long staple upland cotton for the production of superior yarn

USDA-ARS?s Scientific Manuscript database

Cotton, Gossypium spp., fibers are produced primarily by two species, G. hirsutum L., upland, and G. barbadense L., pima, which also is referred to as Extra Long Staple (ELS). The Cotton Improvement Laboratory, Texas AgriLife Research, has developed ELS upland lines through intraspecific crosses and...

Irrigation Comes to Staples

ERIC Educational Resources Information Center

Lund, Duane R.

1977-01-01

Describes the case of Staples, Minnesota, where the vocational-technical school bought a 300-acre farm and with the help of a strong advisory committee was instrumental in changing the farming practices in an eight-county area. Emphasis is on the role and activities of the advisory committee; eleven specific contributions are listed. (HD)

7 CFR 1427.160 - Applicability.

Code of Federal Regulations, 2010 CFR

2010-01-01

.... (a) This subpart is applicable to the 2008 through 2012 crops of upland and extra long staple seed... for upland cotton and the national average loan rate for extra long staple cotton. (c) A producer must...) Loans shall not be available for seed cotton produced on land owned or otherwise in the possession of...

Stabilized helical peptides: overview of the technologies and its impact on drug discovery.

PubMed

Klein, Mark

2017-11-01

Protein-protein interactions are predominant in the workings of all cells. Until now, there have been a few successes in targeting protein-protein interactions with small molecules. Peptides may overcome some of the challenges of small molecules in disrupting protein-protein interactions. However, peptides present a new set of challenges in drug discovery. Thus, the study of the stabilization of helical peptides has been extensive. Areas covered: Several technological approaches to helical peptide stabilization have been studied. In this review, stapled peptides, foldamers, and hydrogen bond surrogates are discussed. Issues regarding design principles are also discussed. Furthermore, this review introduces select computational techniques used to aid peptide design and discusses clinical trials of peptides in a more advanced stage of development. Expert opinion: Stabilized helical peptides hold great promise in a wide array of diseases. However, the field is still relatively new and new design principles are emerging. The possibilities of peptide modification are quite extensive and expanding, so the design of stabilized peptides requires great attention to detail in order to avoid a large number of failed lead peptides. The start of clinical trials with stapled peptides is a promising sign for the future.

Hemorrhoids.

PubMed

Hulme-Moir, M; Bartolo, D C

2001-03-01

Understanding of hemorrhoidal pathology and treatment has come a long way. The theory of a sliding anal canal lining and the knowledge that hemorrhoidal cushions are a normal part of the anal anatomy should encourage symptom control rather than radical removal of tissue. Techniques that fix the cushions back in position can be performed in outpatients with reasonable success rates. When required, surgery should be aimed at symptomatic hemorrhoids. It is hoped that new developments such as circular stapling and better pain management will promote increased day surgery, better pain control, and less time off work for patients.

78 FR 38939 - Certain Polyester Staple Fiber From the People's Republic of China: Final Results of Antidumping...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-28

... DEPARTMENT OF COMMERCE International Trade Administration [A-570-905] Certain Polyester Staple... Preliminary Results of the 2011-2012 administrative review of the antidumping duty order on certain polyester... dumping margin is listed in the ``Final Results of Review'' section below. \\1\\ See Certain Polyester...

76 FR 45227 - Initiation of Antidumping and Countervailing Duty Administrative Reviews, Requests for...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-28

... antidumping duty orders on Certain Polyester Staple Fiber from the People's Republic of China with respect to... Certain Polyester Staple Fiber from the People's Republic of China with respect to two exporters and on... exporter. Period to be reviewed Antidumping Duty Proceedings Japan: Certain Large Diameter Carbon and Alloy...

7 CFR 28.301 - Measurement: humidity; temperature.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 7 Agriculture 2 2014-01-01 2014-01-01 false Measurement: humidity; temperature. 28.301 Section 28... for Length of Staple § 28.301 Measurement: humidity; temperature. The length of staple of any cotton... its fibers under a relative humidity of the atmosphere of 65 percent and a temperature of 70 °F. ...

7 CFR 28.301 - Measurement: humidity; temperature.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 7 Agriculture 2 2011-01-01 2011-01-01 false Measurement: humidity; temperature. 28.301 Section 28... for Length of Staple § 28.301 Measurement: humidity; temperature. The length of staple of any cotton... its fibers under a relative humidity of the atmosphere of 65 percent and a temperature of 70 °F. ...

7 CFR 28.301 - Measurement: humidity; temperature.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 7 Agriculture 2 2010-01-01 2010-01-01 false Measurement: humidity; temperature. 28.301 Section 28... for Length of Staple § 28.301 Measurement: humidity; temperature. The length of staple of any cotton... its fibers under a relative humidity of the atmosphere of 65 percent and a temperature of 70° F. ...

7 CFR 28.301 - Measurement: humidity; temperature.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 7 Agriculture 2 2012-01-01 2012-01-01 false Measurement: humidity; temperature. 28.301 Section 28... for Length of Staple § 28.301 Measurement: humidity; temperature. The length of staple of any cotton... its fibers under a relative humidity of the atmosphere of 65 percent and a temperature of 70 °F. ...

7 CFR 28.301 - Measurement: humidity; temperature.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 7 Agriculture 2 2013-01-01 2013-01-01 false Measurement: humidity; temperature. 28.301 Section 28... for Length of Staple § 28.301 Measurement: humidity; temperature. The length of staple of any cotton... its fibers under a relative humidity of the atmosphere of 65 percent and a temperature of 70 °F. ...

Double row equivalent for rotator cuff repair: A biomechanical analysis of a new technique.

PubMed

Robinson, Sean; Krigbaum, Henry; Kramer, Jon; Purviance, Connor; Parrish, Robin; Donahue, Joseph

2018-06-01

There are numerous configurations of double row fixation for rotator cuff tears however, there remains to be a consensus on the best method. In this study, we evaluated three different double-row configurations, including a new method. Our primary question is whether the new anchor and technique compares in biomechanical strength to standard double row techniques. Eighteen prepared fresh frozen bovine infraspinatus tendons were randomized to one of three groups including the New Double Row Equivalent, Arthrex Speedbridge and a transosseous equivalent using standard Stabilynx anchors. Biomechanical testing was performed on humeri sawbones and ultimate load, strain, yield strength, contact area, contact pressure, and a survival plots were evaluated. The new double row equivalent method demonstrated increased survival as well as ultimate strength at 415N compared to the remainder testing groups as well as equivalent contact area and pressure to standard double row techniques. This new anchor system and technique demonstrated higher survival rates and loads to failure than standard double row techniques. This data provides us with a new method of rotator cuff fixation which should be further evaluated in the clinical setting. Basic science biomechanical study.

Apex technique in the treatment of obstructed defecation syndrome associated with rectal intussusception and full rectal mucosa prolapse.

PubMed

Regadas, F Sergio P; Abedrapo, Mario; Cruz, Jose Vinicius; Murad Regadas, Sthela M; Regadas Filho, F Sergio P

2014-11-01

The aim of the current study was to demonstrate the use of a modified stapling technique, called the apex technique, to treat rectal intussusception and full rectal mucosal prolapse. It was conducted as a retrospective study at 3 centers (2 in Brazil and 1 in Chile). The apex technique is performed by using a HEM/EEA-33 stapler. A pursestring suture is placed at the apex of the prolapse, on the 4 quadrants, independent of the distance to the dentate line. A second pursestring is then placed to define the band of rectal mucosa to be symmetrically resected. Outcome measures included width of the resected full-thickness rectal wall; the intensity of postoperative pain on a visual analog scale from 1 to 10; full mucosal prolapse and rectal intussusception assessed by physical examination, cinedefecography, or echodefecography; and change in the constipation scale. Forty-five patients (30 women/15 men; mean age, 59.5 years) with rectal intussusception and full mucosal prolapse were included. The median operative time was 17 (range, 15-30) minutes. Bleeding after stapler fire requiring manual suture occurred in 3 patients (6.7%); 25 (55.6%) patients reported having no postoperative pain. Hospital stay was 24 hours. The mean width of the resected rectal wall was 5.9 (range, 5.0-7.5) cm. Stricture at the staple line was seen in 4 patients, of whom 1 required dilation under anesthesia. The median follow-up time was 120 (range, 90-120) days. A small residual prolapse was identified in 6 (13.3%) patients. Imaging demonstrated complete disappearance of rectal intussusception in all patients, and the mean postoperative constipation score decreased from 13 (range, 8-15) to 5 (range, 3-7). The apex technique appears to be a safe, quickly performed, and low-cost method for the treatment of rectal intussusception. In this series, imaging examinations showed the disappearance of rectal intussusception, and a significant decrease in constipation score suggested improvement in functional outcomes.

Management of staple line leaks after sleeve gastrectomy in a consecutive series of 378 patients.

PubMed

Vix, Michel; Diana, Michele; Marx, Ludovic; Callari, Cosimo; Wu, Hurng-Sheng; Perretta, Silvana; Mutter, Didier; Marescaux, Jacques

2015-02-01

Laparoscopic sleeve gastrectomy (LSG) is gaining acceptance as a stand-alone bariatric procedure with proven efficacy on weight loss and obesity-related comorbidities. A specific and potentially severe complication of LSG is the staple line leak (SLL). Our aim was to report the SLL rate and its management in a prospective cohort of 378 LSGs. A total of 378 patients underwent LSG from July 2005 to July 2011. The gastric transection was performed by an initial 60 mm firing of 4.5 mm staples at the antrum and successive 60 mm firings of 3.5 mm staples at the gastric body and fundus toward the left diaphragmatic crus. A 36 Fr bougie was used to calibrate the gastric tube. The staple line was systematically reinforced with a partial-thickness running suture. The overall complications and SLL rate were 20/378 (5.29%) and 9/378 (2.38%), respectively. SLLs were managed by laparoscopic (n=2) or open (n=1) exploration, drainage and endoscopic self-expandable covered stent, computed tomography-guided percutaneous drainage (n=2), or a self-expandable covered stent alone (n=4). Medical support including total parenteral nutrition and adapted antibiotics was started in all patients. The combined treatment modalities were successful in all cases. SLL was the most common complication of LSG accounting for half of the overall complications. Percutaneous drainage and self-covered stents combined with antibiotics and parenteral nutrition are effective for SLL and should be proposed as first-line treatment in stable patients.

[Staple fixation for the treatment of hamate metacarpal joint injury].

PubMed

Tang, Yang-Hua; Zeng, Lin-Ru; Huang, Zhong-Ming; Yue, Zhen-Shuang; Xin, Da-Wei; Xu, Can-Da

2014-03-01

To investigate the effcacy of the staple fixation for the treatment of hamate metacarpal joint injury. From May 2009 to November 2012,16 patients with hamate metacarpal joint injury were treated with staple fixation including 10 males and 6 females with an average age of 33.6 years old ranging from 21 to 57 years. Among them, 11 cases were on the fourth or fifth metacarpal base dislocation without fractures, 5 cases were the fourth or fifth metacarpal base dislocation with avulsion fractures of the back of hamatum. Regular X-ray review was used to observe the fracture healing, joint replacement and position of staple fixation. The function of carpometacarpal joint and metacarpophalangeal joint were evaluated according to ASIA (TAM) system evaluation method. All incision were healed well with no infection. All patients were followed up from 16 to 24 months with an average of (10.0 +/- 2.7) months. No dislocation recurred, the position of internal fixator was good,no broken nail and screw withdrawal were occurred. Five patients with avulsion fracture of the back of hamatum achieved bone healing. The function of carpometacarpal joint and metacarpophalangeal was excellent in 10 cases,good in 5 cases, moderate in 1 case. The application of the staple for the treatment of hamatometacarpal joint injury has the advantages of simple operation, small trauma, reliable fixation, early postoperative function exercise and other advantages, which is the ideal operation mode for hamatometacarpal joint injury.

The Importance of Animal Source Foods for Nutrient Sufficiency in the Developing World: The Zambia Scenario.

PubMed

Zhang, Zhiying; Goldsmith, Peter D; Winter-Nelson, Alex

2016-05-05

There have been successful interventions fortifying staple foods to mobilize micronutrients as well as agricultural efforts to raise yields of staple foods to increase food availability. Zambia serves as an interesting case study because since 1961 there has been a notable decline in the availability of animal source foods (ASFs) and pulses and a significant increase in the supply of cassava and vegetable oils. The shift in food availability was partly attributed to the agricultural success in high-yielding and drought-resistant varieties that made cassava and oil crops more affordable and readily available. In this research, we explore another policy strategy that involves ASF as a mechanism to help remedy micronutrient inadequacies in a population. A scenario modeling analysis compares the changes in the nutrient profile of the Zambian diet through adding either staple plant source foods (PSFs) or ASFs. The scenarios under study involve the addition of (1) 18 fl oz of whole cow's milk; (2) 60 g of beef, 30 g of chicken, and 5 g of beef liver; (3) milk plus meat; or (4) 83 g of maize flour, 123 g of cassava, and other staple PSF, that is, isocaloric to the "milk + meat" group. The findings alert program planners and policy makers to the value of increasing the availability, accessibility, and utilization of ASF to simultaneously address multiple nutrient deficiencies, as well as the nutrition challenges that remain when expanding the availability of plant-based staples. © The Author(s) 2016.

Double quick, double click reversible peptide “stapling”† †Electronic supplementary information (ESI) available: Synthesis and characterization, additional biophysical and biochemical analyses. See DOI: 10.1039/c7sc01342f Click here for additional data file. Click here for additional data file. Click here for additional data file.

PubMed Central

Grison, Claire M.; Burslem, George M.; Miles, Jennifer A.; Pilsl, Ludwig K. A.; Yeo, David J.; Imani, Zeynab; Warriner, Stuart L.; Webb, Michael E.

2017-01-01

The development of constrained peptides for inhibition of protein–protein interactions is an emerging strategy in chemical biology and drug discovery. This manuscript introduces a versatile, rapid and reversible approach to constrain peptides in a bioactive helical conformation using BID and RNase S peptides as models. Dibromomaleimide is used to constrain BID and RNase S peptide sequence variants bearing cysteine (Cys) or homocysteine (hCys) amino acids spaced at i and i + 4 positions by double substitution. The constraint can be readily removed by displacement of the maleimide using excess thiol. This new constraining methodology results in enhanced α-helical conformation (BID and RNase S peptide) as demonstrated by circular dichroism and molecular dynamics simulations, resistance to proteolysis (BID) as demonstrated by trypsin proteolysis experiments and retained or enhanced potency of inhibition for Bcl-2 family protein–protein interactions (BID), or greater capability to restore the hydrolytic activity of the RNAse S protein (RNase S peptide). Finally, use of a dibromomaleimide functionalized with an alkyne permits further divergent functionalization through alkyne–azide cycloaddition chemistry on the constrained peptide with fluorescein, oligoethylene glycol or biotin groups to facilitate biophysical and cellular analyses. Hence this methodology may extend the scope and accessibility of peptide stapling. PMID:28970902

[The advantages in using cyanoacrylate glue over skin staples as a method of skin graft fixation in the pediatric burns population].

PubMed

Curings, P; Vincent, P-L; Viard, R; Gir, P; Comparin, J-P; Voulliaume, D

2017-11-23

Local postoperative care and burn wound management can present with a certain degree of difficulty in the pediatric population. While the use of skin staples as a method of skin graft fixation is a well-known, rapid and simple method, their removal can be painful and may necessitate some sedation or even general anesthesia. We studied in this article the advantages and economic value of using the cyanoacrylate glue as a fixation method for skin grafts. A comparative study was carried out from 2012 to 2016. Hundred and eighteen infants with burns up to 5% of total body surface area were included in the study. Seventy-two infants had split thickness skin grafts fixed with skin staples. Forty-six infants had split thickness skin grafts fixed with cyanoacrylate glue. We compared the quality of graft, the sedation used during the first postoperative dressing, the length of hospital stay, the amount of glue used and the presence of complications. There is a difference between the two groups studied in terms of age and total burn surface area. The rate of graft take was 100% in both groups. The first postoperative dressing was carried out without the use of powerful analgesia in the cyanoacrylate group, while it was necessary to use general anesthesia in 64% of the skin staples group. The average length of stay in hospital after skin grafting was 4.9 days for the cyanoacrylate glue versus 6.5 days in the skin staples group. No complications were noted in the 2 groups. The use of cyanoacrylate glue allows rapid fixation of skin grafts and avoid general anesthesia for postoperative cares. Subsequently the length of hospital stay is reduced within 25%. The medico-economic value of glue protocol is highly significant compared to skin staples, while having similar good results and without significant problems. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

SU-E-J-101: Improved CT to CBCT Deformable Registration Accuracy by Incorporating Multiple CBCTs

DOE Office of Scientific and Technical Information (OSTI.GOV)

Godley, A; Stephans, K; Olsen, L Sheplan

2015-06-15

Purpose: Combining prior day CBCT contours with STAPLE was previously shown to improve automated prostate contouring. These accurate STAPLE contours are now used to guide the planning CT to pre-treatment CBCT deformable registration. Methods: Six IGRT prostate patients with daily kilovoltage CBCT had their original planning CT and 9 CBCTs contoured by the same physician. These physician contours for the planning CT and each prior CBCT are deformed to match the current CBCT anatomy, producing multiple contour sets. These sets are then combined using STAPLE into one optimal set (e.g. for day 3 CBCT, combine contours produced using the planmore » plus day 1 and 2 CBCTs). STAPLE computes a probabilistic estimate of the true contour from this collection of contours by maximizing sensitivity and specificity. The deformation field from planning CT to CBCT registration is then refined by matching its deformed contours to the STAPLE contours. ADMIRE (Elekta Inc.) was used for this. The refinement does not force perfect agreement of the contours, typically Dice’s Coefficient (DC) of > 0.9 is obtained, and the image difference metric remains in the optimization of the deformable registration. Results: The average DC between physician delineated CBCT contours and deformed planning CT contours for the bladder, rectum and prostate was 0.80, 0.79 and 0.75, respectively. The accuracy significantly improved to 0.89, 0.84 and 0.84 (P<0.001 for all) when using the refined deformation field. The average time to run STAPLE with five scans and refine the planning CT deformation was 66 seconds on a Telsa K20c GPU. Conclusion: Accurate contours generated from multiple CBCTs provided guidance for CT to CBCT deformable registration, significantly improving registration accuracy as measured by contour DC. A more accurate deformation field is now available for transferring dose or electron density to the CBCT for adaptive planning. Research grant from Elekta.« less

Economic and clinical comparison of 2-octyl cyanoacrylate/polymer mesh tape with skin staples in total knee replacement.

PubMed

Sutton, Nadia; Schmitz, Niels-Derrek; Johnston, Stephen S

2018-04-01

To compare economic and clinical outcomes between skin staples and 2-octyl cyanoacrylate plus polymer mesh tape, Dermabond Prineo skin closure system, (SCS) among patients undergoing total knee replacement (TKR). Retrospective, observational study using the Premier Healthcare Database, which comprises hospital administrative and billing data for over 700 hospitals in the US. Patients selected for study had an elective hospital admission, with discharge occurring between January 2012 and September 2015, carrying primary ICD-9-CM procedure and diagnosis codes for TKR and osteoarthritis. Patients were classified into two mutually-exclusive groups based on billing records during the index admission: those with billing record(s) for the skin closure system (SCS group); and those with billing record(s) for skin staples (staple group). Primary outcomes were index admission's length of stay (LOS), total hospital costs, and discharge status (skilled nursing facility (SNF)/other versus home/home health-care); exploratory outcomes included operating room time (ORT) during index admission and 30, 60, and 90-day readmissions. The SCS and staple groups were propensity score matched (1:1/nearest neighbour/caliper=0.10) on patient, hospital, and provider characteristics. Multivariable regressions accounting for hospital-level clustering after matching were used to compare outcomes between study groups. Each group comprised 971 patients (1942 total patients; mean age: 65.3 years; female: 63.5%). The groups were generally well-balanced on matching covariates: mean standardised difference calculated across 49 covariates=0.049. Compared with the staple group, the SCS group had statistically significant shorter LOS (2.8 days versus 3.2 days, p=0.002), lower rate of discharge to SNF/other versus home/home health-care (26.4% versus 38.5%, p=0.011), and lower rate of 30, 60, and 90-day readmissions (30-day, 1.8% versus 4.4%, p=0.006; 60-day, 3.0% versus 5.4%, p<0.001; 90-day, 5.4% versus 7.4%, p=0.016). Differences between the groups for other outcomes were not statistically significant. Among patients undergoing TKR, use of the SCS was associated with shorter LOS, less resource intensive discharge status, and lower rates of all-cause readmission as compared with skin staples.

[A new technic for esophago-enteral anastomosis with a mechanical stapler without purse-string sutures].

PubMed

Liboni, A; Mari, C; Zamboni, P; Uzzau, A; Noce, L; Bucoliero, F; Mele, M; Masala, C

1989-01-01

Staplers have improved the results of esophageal surgery, in our experience and in others experience, as esophago-enteric anastomoses have become safer and faster than when manual suturing is used. Probably one of the last problems in the stapler technique, especially in the thoracic area, is the performance of on adequate esophageal purse-string suture: an improper performance of this suture can cause a dangerous leak of the anastomosis. So, many surgeons, to reduce the risk of esophageal dehiscence connected with the esophageal purse-string, use either purse-string devices or alternative methods such as a second handsewn purse-string, U stitches of the esophagus, etc. We think that the risk of improper anastomoses after esophageal resection can be reduced if the need for the esophageal purse-string can be eliminated. This work shows our personal technique for performing esophagoenterostomy, especially in the thoracic area, using the new CEEA stapler (Autosuture) without esophageal purse-string sutures. According to the modified procedure the stapler anvil and the mini rod are introduced in the esophagectomy and a 2-0 thread is knotted around the CEEA mini rod. Then the esophageal mutilated part is closed by a linear stapler keeping a syringe needle, which contains the thread, through the linear suture. Then, using the thread as a pulling system, the surgeon makes the needle and the tip of the mini rod slide out of the esophageal suture. Now the surgeon can reassemble the CEEA and perform the anastomosis. There are many clinical reports that cite no leaks following circular stapled anastomoses across linear stapled closures.

Transabdominal preperitoneal herniorrhaphy using laser-assisted tissue soldering in a porcine model.

PubMed

Lanzafame, Raymond J; Soltz, Barbara A; Stadler, Istvan; Soltz, Robert

2009-01-01

Collagen solder is capable of fixation of surgical meshes during laparoscopic herniorrhaphy without compromising tissue integration, increasing adhesions or inflammation. This pilot study describes development of instrumentation and techniques for transabdominal preperitoneal (TAPP) herniorrhaphy using laser-assisted soldering technology. Anesthetized 20-kg to 25-kg female Yorkshire pigs underwent laparoscopy performed using a 3-trocar technique. Peritoneal incisions were made and pockets created in the preperitoneal space for mesh placement. Parietex TEC mesh segments embedded in 60% collagen-solder were soldered to the muscle surface by using a prototype laser (1.45micro, 4.5W CW, 5mm spot, and 55 degrees C set temperature) and custom laparoscopic handpiece. Parietex TEC mesh segments (Control) were affixed to the muscle with fibrin sealant (Tisseel). Peritoneal closure was with staples (Control) or by soldering collagen embedded Vicryl mesh segments over the peritoneal incision (Mesh/TAPP). Segments were inserted using a specially designed introducer. Animals were recovered and underwent second-look laparoscopy at 6 weeks postimplantation. Mesh sites were harvested after animals were euthanized. The mesh-solder constructs were easily inserted and affixed in the TAPP approach. Tisseel tended to drip during application, particularly in vertical and ventral locations. Postoperative healing was similar to Control segments in all cases. Mesh/TAPP closures healed without scarring or adhesion formation. Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce use of staples for laparoscopic mesh fixation and peritoneal closure. Laser-assisted mesh fixation and peritoneal closure is a promising alternative for laparoscopic herniorrhaphy. Further development of this strategy is warranted.

76 FR 38612 - Certain Polyester Staple Fiber From the Republic of Korea and Taiwan: Final Results of the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-01

... DEPARTMENT OF COMMERCE International Trade Administration [A-580-839, A-583-833] Certain Polyester... sunset reviews of the antidumping duty orders on polyester staple fiber (PSF) from the Republic of Korea... polyesters measuring 3.3 decitex (3 denier, inclusive) or more in diameter. This merchandise is cut to...

78 FR 2366 - Certain Polyester Staple Fiber From the People's Republic of China: Final Results of Antidumping...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-01-11

... Fiber From the People's Republic of China: Final Results of Antidumping Duty Administrative Review; 2010... staple fiber (``PSF'') from the People's Republic of China (``PRC'').\\1\\ We gave interested parties an opportunity to comment on the Preliminary Results. Based upon our analysis of the comments and information...

78 FR 14512 - Certain Polyester Staple Fiber From the People's Republic of China: Preliminary Results and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-06

... Fiber From the People's Republic of China: Preliminary Results and Rescission in Part of the 2011-2012... administrative review of the antidumping duty order on certain polyester staple fiber from the People's Republic... Industries (``Far Eastern'') and Huvis Sichuan Chemical Fiber Corp. and Huvis Sichuan Polyester Fiber Ltd...

Formulating Spatially Varying Performance in the Statistical Fusion Framework

PubMed Central

Landman, Bennett A.

2012-01-01

To date, label fusion methods have primarily relied either on global (e.g. STAPLE, globally weighted vote) or voxelwise (e.g. locally weighted vote) performance models. Optimality of the statistical fusion framework hinges upon the validity of the stochastic model of how a rater errs (i.e., the labeling process model). Hitherto, approaches have tended to focus on the extremes of potential models. Herein, we propose an extension to the STAPLE approach to seamlessly account for spatially varying performance by extending the performance level parameters to account for a smooth, voxelwise performance level field that is unique to each rater. This approach, Spatial STAPLE, provides significant improvements over state-of-the-art label fusion algorithms in both simulated and empirical data sets. PMID:22438513

[Stapler and manual bronchial anastomosis--results of a consecutive trial series].

PubMed

Junginger, T; Walgenbach, S; Pichlmaier, H

1989-01-01

After lobectomy and pneumonectomy in experimental evaluations stapled bronchial closures showed the lowest incidence of inflammatory reaction and the highest strength determined by leakage pressure compared with other suture material. A total of 233 lung resections-performed at Surgical University Clinic Köln-Lindenthal and the Clinic for General and Abdominal Surgery of the Johannes-Gutenberg-Universität Mainz--were reviewed. Mechanical stapling reduced the rate of bronchopleural fistulas to 2.0% compared with 7.1% after manual suturing. In parallel, mortality related to bronchial stump leakage decreased to 0.7%. Main advantages of bronchial closure with staplers are the simplicity of their use, the speed and the uniformity of the closure. Thereby stapling devices are valuable completions in pulmonary surgery.

Intensification of tropical agriculture as seen by satellite

NASA Astrophysics Data System (ADS)

Galford, G. L.; Michelson, H. C.; Spera, S. A.; Hadnott, B.

2013-12-01

We present case studies from Latin America and Africa on intensification of tropical agriculture. The Brazilian Amazon of the early 2000s experienced intensification and extensification. We use time series analysis of MODIS vegetation indices to track changes in cropping intensity and crop types over time. The state of Mato Grosso is Brazil's leading producer of soy, corn and cotton. Using 250 m MODIS EVI data and a new decision-tree algorithm tuned to phenological patterns characteristic of Mato Grosso's major natural vegetation and crop rotations, we mapped land-cover across the state over 11 growing seasons (2001-2011). Between 2000 and 2011, a majority of the cultivated land in Mato Grosso transitioned from the cultivation of one commercial crop per growing season (soy or cotton) to two commercial crops (a soy crop followed by a corn or cotton crop). Over our study period, the cultivated area of double cropped land in Mato Grosso steadily increased over 6-fold from .46 million hectares to 2.9 million hectares, 92% of which was in a soy-corn double cropping rotation. In the sub-Saharan country of Malawi, 70% of the land is dedicated to food production yet yields of the primary staple crop, maize, have stagnated around 1 ton ha-1 (developed nations' maize yields are 12-16 tons ha-1). Due to the limited land area, improving yields through intensification is a necessary objective of development. Poverty and food insecurity were widespread and persistent for smallholder farmers cultivating less than 1 hectare of land until the implementation of a government intervention, funded through foreign aid, subsidized allocations of fertilizer and improved seed to small farmers. Since implementation of the policy, the number of food insecure, or people in need of food aid, has decreased from 5 million to half a million people. We present indicators that levels of poverty have decreased since the subsidy. National yields have doubled. Applying modified methods from Brazil, we are able to detect cropland intensification through remote sensing. We present remote sensing analysis of social and economic correlates to changes in yields and build an empirical model of sustainable intensification. Together, these case studies demonstrate that remote sensing techniques can be easily adapted across very different crop types, field sizes and environments.

Rectovaginal fistula following colectomy with an end-to-end anastomosis stapler for a colorectal adenocarcinoma.

PubMed

Klein, A; Scotti, S; Hidalgo, A; Viateau, V; Fayolle, P; Moissonnier, P

2006-12-01

An 11-year-old, female neutered Labrador retriever was presented with a micro-invasive differentiated papillar adenocarcinoma at the colorectal junction. A colorectal end-to-end anastomosis stapler device was used to perform resection and anastomosis using a transanal technique. A rectovaginal fistula was diagnosed two days later. An exploratory laparotomy was conducted and the fistula was identified and closed. Early dehiscence of the colon was also suspected and another colorectal anastomosis was performed using a manual technique. Comparison to a conventional manual technique of intestinal surgery showed that the use of an automatic staple device was quicker and easier. To the authors' knowledge, this is the first report of a rectovaginal fistula occurring after end-to-end anastomosis stapler colorectal resection-anastomosis in the dog. To minimise the risk of this potential complication associated with the limited surgical visibility, adequate tissue retraction and inspection of the anastomosis site are essential.

Transgenic multivitamin corn through biofortification of endosperm with three vitamins representing three distinct metabolic pathways

PubMed Central

Naqvi, Shaista; Zhu, Changfu; Farre, Gemma; Ramessar, Koreen; Bassie, Ludovic; Breitenbach, Jürgen; Perez Conesa, Dario; Ros, Gaspar; Sandmann, Gerhard; Capell, Teresa; Christou, Paul

2009-01-01

Vitamin deficiency affects up to 50% of the world's population, disproportionately impacting on developing countries where populations endure monotonous, cereal-rich diets. Transgenic plants offer an effective way to increase the vitamin content of staple crops, but thus far it has only been possible to enhance individual vitamins. We created elite inbred South African transgenic corn plants in which the levels of 3 vitamins were increased specifically in the endosperm through the simultaneous modification of 3 separate metabolic pathways. The transgenic kernels contained 169-fold the normal amount of β-carotene, 6-fold the normal amount of ascorbate, and double the normal amount of folate. Levels of engineered vitamins remained stable at least through to the T3 homozygous generation. This achievement, which vastly exceeds any realized thus far by conventional breeding alone, opens the way for the development of nutritionally complete cereals to benefit the world's poorest people. PMID:19416835

Rational design of high-yield and superior-quality rice.

PubMed

Zeng, Dali; Tian, Zhixi; Rao, Yuchun; Dong, Guojun; Yang, Yaolong; Huang, Lichao; Leng, Yujia; Xu, Jie; Sun, Chuan; Zhang, Guangheng; Hu, Jiang; Zhu, Li; Gao, Zhenyu; Hu, Xingming; Guo, Longbiao; Xiong, Guosheng; Wang, Yonghong; Li, Jiayang; Qian, Qian

2017-03-20

Rice (Oryza sativa L.) is a staple food for more than half of the world's population. To meet the ever-increasing demand for food, because of population growth and improved living standards, world rice production needs to double by 2030 1 . The development of new elite rice varieties with high yield and superior quality is challenging for traditional breeding approaches, and new strategies need to be developed. Here, we report the successful development of new elite varieties by pyramiding major genes that significantly contribute to grain quality and yield from three parents over five years. The new varieties exhibit higher yield potential and better grain quality than their parental varieties and the China's leading super-hybrid rice, Liang-you-pai-jiu (LYP9 or Pei-ai 64S/93-11). Our results demonstrate that rational design is a powerful strategy for meeting the challenges of future crop breeding, particularly in pyramiding multiple complex traits.

Genomic prediction unifies animal and plant breeding programs to form platforms for biological discovery.

PubMed

Hickey, John M; Chiurugwi, Tinashe; Mackay, Ian; Powell, Wayne

2017-08-30

The rate of annual yield increases for major staple crops must more than double relative to current levels in order to feed a predicted global population of 9 billion by 2050. Controlled hybridization and selective breeding have been used for centuries to adapt plant and animal species for human use. However, achieving higher, sustainable rates of improvement in yields in various species will require renewed genetic interventions and dramatic improvement of agricultural practices. Genomic prediction of breeding values has the potential to improve selection, reduce costs and provide a platform that unifies breeding approaches, biological discovery, and tools and methods. Here we compare and contrast some animal and plant breeding approaches to make a case for bringing the two together through the application of genomic selection. We propose a strategy for the use of genomic selection as a unifying approach to deliver innovative 'step changes' in the rate of genetic gain at scale.

Single- and double-row repair for rotator cuff tears - biology and mechanics.

PubMed

Papalia, Rocco; Franceschi, Francesco; Vasta, Sebastiano; Zampogna, Biagio; Maffulli, Nicola; Denaro, Vincenzo

2012-01-01

We critically review the existing studies comparing the features of single- and double-row repair, and discuss suggestions about the surgical indications for the two repair techniques. All currently available studies comparing the biomechanical, clinical and the biological features of single and double row. Biomechanically, the double-row repair has greater performances in terms of higher initial fixation strength, greater footprint coverage, improved contact area and pressure, decreased gap formation, and higher load to failure. Results of clinical studies demonstrate no significantly better outcomes for double-row compared to single-row repair. Better results are achieved by double-row repair for larger lesions (tear size 2.5-3.5 cm). Considering the lack of statistically significant differences between the two techniques and that the double row is a high cost and a high surgical skill-dependent technique, we suggest using the double-row technique only in strictly selected patients. Copyright © 2012 S. Karger AG, Basel.

Overlapping double etch technique for evaluation of metallic alloys to stress corrosion cracking

DOEpatents

Steeves, Arthur F.; Stewart, James C.

1981-01-01

A double overlapping etch zone technique for evaluation of the resistance of metallic alloys to stress corrosion cracking. The technique involves evaluating the metallic alloy along the line of demarcation between an overlapping double etch zone and single etch zone formed on the metallic alloy surface.

Effect of shoulder abduction angle on biomechanical properties of the repaired rotator cuff tendons with 3 types of double-row technique.

PubMed

Mihata, Teruhisa; Fukuhara, Tetsutaro; Jun, Bong Jae; Watanabe, Chisato; Kinoshita, Mitsuo

2011-03-01

After rotator cuff repair, the shoulder is immobilized in various abduction positions. However, there is no consensus on the proper abduction angle. To assess the effect of shoulder abduction angle on the biomechanical properties of the repaired rotator cuff tendons among 3 types of double-row techniques. Controlled laboratory study. Thirty-two fresh-frozen porcine shoulders were used. A simulated rotator cuff tear was repaired by 1 of 3 double-row techniques: conventional double-row repair, transosseous-equivalent repair, and a combination of conventional double-row and bridging sutures (compression double-row repair). Each specimen underwent cyclic testing followed by tensile testing to failure at a simulated shoulder abduction angle of 0° or 40° on a material testing machine. Gap formation and failure loads were measured. Gap formation in conventional double-row repair at 0° (1.2 ± 0.5 mm) was significantly greater than that at 40° (0.5 ± 0.3mm, P = .01). The yield and ultimate failure loads for conventional double-row repair at 40° were significantly larger than those at 0° (P < .01), whereas those for transosseous-equivalent repair (P < .01) and compression double-row repair (P < .0001) at 0° were significantly larger than those at 40°. The failure load for compression double-row repair was the greatest among the 3 double-row techniques at both 0° and 40° of abduction. Bridging sutures have a greater effect on the biomechanical properties of the repaired rotator cuff tendon at a low abduction angle, and the conventional double-row technique has a greater effect at a high abduction angle. Proper abduction position after rotator cuff repair differs between conventional double-row repair and transosseous-equivalent repair. The authors recommend the use of the combined technique of conventional double-row and bridging sutures to obtain better biomechanical properties at both low and high abduction angles.

C-reactive protein, fibrinogen, and procalcitonin levels as early markers of staple line leak after laparoscopic sleeve gastrectomy in morbidly obese patients within an Enhanced Recovery After Surgery (ERAS) program.

PubMed

Ruiz-Tovar, Jaime; Muñoz, Jose Luis; Gonzalez, Juan; Garcia, Alejandro; Ferrigni, Carlos; Jimenez, Montiel; Duran, Manuel

2017-12-01

The performance of most bariatric procedures within an Enhanced Recovery After Surgery program has resulted in significant advantages, including a reduction in the length of hospital stay to 2-3 days. However, some postoperative complications may appear after the patient has been discharged. The aim of this study was to investigate the efficacy of various acute-phase parameters determined 24 h after a laparoscopic sleeve gastrectomy for predicting staple line leak in the postoperative course. A prospective study of 208 morbidly obese patients undergoing laparoscopic sleeve gastrectomy as bariatric procedure between 2012 and 2015 was performed. Blood analysis was performed 24 h after surgery. Acute-phase parameters (C-reactive protein, procalcitonin, fibrinogen, and White Blood Cell count) were investigated. Staple line leak appeared in eight patients (3.8%). Using receiver operating characteristic analysis at 24 h postoperatively, a cutoff level of CRP at 9 mg/dL achieved 85% sensitivity and 90% specificity for predicting staple line leak, a cutoff level of procalcitonin at 0.85 ng/mL achieved 70% sensitivity and 90% specificity, and a cutoff level of fibrinogen at 600 mg/dL achieved 80% sensitivity and 87.5% specificity. An elevation of CRP > 9 mg/dL, procalcitonin > 0.85 ng/mL and fibrinogen > 600 mg/dL should alert the surgeon the possibility of occurrence of postoperative staple line leak.

Evaluation of a Powered Stapler System with Gripping Surface Technology on Surgical Interventions Required During Laparoscopic Sleeve Gastrectomy.

PubMed

Fegelman, Elliott; Knippenberg, Susan; Schwiers, Michael; Stefanidis, Dimitrios; Gersin, Keith S; Scott, John D; Fernandez, Adolfo Z

2017-05-01

Transection of gastric tissue during laparoscopic sleeve gastrectomy (LSG) can be challenging. Reinforcing the staple line may decrease the incidence of issues requiring intervention. The objective of this study was to compare the number of intraoperative surgical interventions for a surgical stapler and reload system with Gripping Surface Technology (GST) to standard reloads in patients who underwent LSG. Patients who underwent elective LSG were enrolled. The study was conducted in two stages. For Stage 1, procedures were performed using a powered stapler and standard reloads. For Stage 2, a reload system with GST was used. The primary endpoint was surgical interventions for bleeding and/or staple line issues during transection of the greater curvature of the stomach. Propensity score matching was applied to create two groups similar in baseline characteristics and risk factors. A total of 111 subjects were enrolled across four centers. Propensity-matched procedures were completed with the standard (n = 38) or GST reloads (n = 38). The mean number of interventions in the standard group was 1.9 (1.29) versus 1.1 (1.45) in the GST group. Nonparametric comparisons were statistically significant, indicating a reduction in the distribution of interventions for GST subjects (P = .0036 for matched pair data). Tissue slippage during transection was low for both groups. Intraoperative leak testing was negative in all procedures, and no procedures were converted to open. Use of the GST stapling system reduces the need for staple line interventions in LSG. Both stapling systems had an acceptable safety profile.

Comparison between orogastric tube/bougie and a suction calibration system for effects on operative duration, staple-line corkscrewing, and esophageal perforation during laparoscopic sleeve gastrectomy.

PubMed

Gagner, Michel; Huang, Rose Y

2016-04-01

Placement of a bougie for sleeve sizing during laparoscopic sleeve gastrectomy (LSG) is recommended. We compared this standard with a suction calibration system (SCS) that performs all functions with one insertion, and measured each step's duration. Primary LSG was performed using a bougie and SCS in alternating order. Number of tube movements to achieve optimal placement, durations of decompression, leak testing, and overall operative time, and remnant linear measurements were obtained. LSG was performed in 26 patients (15 women, 11 men; mean age 36.8 years; mean BMI 45.3 kg/m(2)). The mean number of tube movements was significantly greater for the bougie than for the SCS (8.13 vs. 3.58; p < 0.0001). Percent reductions achieved using the SCS were: time to full decompression of the stomach, 62% (21 vs. 8 s; p < 0.138); tube placement, 51% (101 vs. 49 s; p < 0.0001); leak testing, 78% (119 vs. 26 s; p < 0.0003); and mean operative duration (from tube insertion to end of stapling), 21% (875 vs. 697 s; p < 0.019). Variance of the staple-line distance, measured from the greater curvature to the staple line, was 1.64 and 0.92 for the bougie and SCS, respectively, indicating a reduction in corkscrewing, for a 43.9% straighter sleeve. SCS maintained the gastric wall in place, thereby preventing corkscrewing, and reducing total operating time. Reducing the number of tube insertions may prevent esophageal damage and accidental tube stapling.

Incorporating priors on expert performance parameters for segmentation validation and label fusion: a maximum a posteriori STAPLE

PubMed Central

Commowick, Olivier; Warfield, Simon K

2010-01-01

In order to evaluate the quality of segmentations of an image and assess intra- and inter-expert variability in segmentation performance, an Expectation Maximization (EM) algorithm for Simultaneous Truth And Performance Level Estimation (STAPLE) was recently developed. This algorithm, originally presented for segmentation validation, has since been used for many applications, such as atlas construction and decision fusion. However, the manual delineation of structures of interest is a very time consuming and burdensome task. Further, as the time required and burden of manual delineation increase, the accuracy of the delineation is decreased. Therefore, it may be desirable to ask the experts to delineate only a reduced number of structures or the segmentation of all structures by all experts may simply not be achieved. Fusion from data with some structures not segmented by each expert should be carried out in a manner that accounts for the missing information. In other applications, locally inconsistent segmentations may drive the STAPLE algorithm into an undesirable local optimum, leading to misclassifications or misleading experts performance parameters. We present a new algorithm that allows fusion with partial delineation and which can avoid convergence to undesirable local optima in the presence of strongly inconsistent segmentations. The algorithm extends STAPLE by incorporating prior probabilities for the expert performance parameters. This is achieved through a Maximum A Posteriori formulation, where the prior probabilities for the performance parameters are modeled by a beta distribution. We demonstrate that this new algorithm enables dramatically improved fusion from data with partial delineation by each expert in comparison to fusion with STAPLE. PMID:20879379

Incorporating priors on expert performance parameters for segmentation validation and label fusion: a maximum a posteriori STAPLE.

PubMed

Commowick, Olivier; Warfield, Simon K

2010-01-01

In order to evaluate the quality of segmentations of an image and assess intra- and inter-expert variability in segmentation performance, an Expectation Maximization (EM) algorithm for Simultaneous Truth And Performance Level Estimation (STAPLE) was recently developed. This algorithm, originally presented for segmentation validation, has since been used for many applications, such as atlas construction and decision fusion. However, the manual delineation of structures of interest is a very time consuming and burdensome task. Further, as the time required and burden of manual delineation increase, the accuracy of the delineation is decreased. Therefore, it may be desirable to ask the experts to delineate only a reduced number of structures or the segmentation of all structures by all experts may simply not be achieved. Fusion from data with some structures not segmented by each expert should be carried out in a manner that accounts for the missing information. In other applications, locally inconsistent segmentations may drive the STAPLE algorithm into an undesirable local optimum, leading to misclassifications or misleading experts performance parameters. We present a new algorithm that allows fusion with partial delineation and which can avoid convergence to undesirable local optima in the presence of strongly inconsistent segmentations. The algorithm extends STAPLE by incorporating prior probabilities for the expert performance parameters. This is achieved through a Maximum A Posteriori formulation, where the prior probabilities for the performance parameters are modeled by a beta distribution. We demonstrate that this new algorithm enables dramatically improved fusion from data with partial delineation by each expert in comparison to fusion with STAPLE.

“Five on a dice” port placement for robot-assisted thoracoscopic right upper lobectomy using robotic stapler

PubMed Central

Chan, Edward Y.

2017-01-01

Early versions of the da Vinci robot system (S and Si) have been used to perform pulmonary lung resection with severe limitations. The lack of a vascular robot stapler required the presence of a trained bedside assistant whose role was to place, manipulate and fire the stapler around major vascular structures. Thus, the techniques developed for the Si robot required a skilled bedside assistant to perform stapling of the hilar structure and manipulation of the lung. With the advent of the da Vinci Xi system with a vascular robot stapler, we postulated that we could develop a new port placement and technique to provide total control for the surgeon during the pulmonary lung resection. We found that the “five on a dice” port placement and technique allows for minimal assistance during the lobectomy with full control by the surgeon. This technique uses the full capability of the Xi robot to make the robot-assisted lobectomy a safe and ergonomic operation. PMID:29312746

"Five on a dice" port placement for robot-assisted thoracoscopic right upper lobectomy using robotic stapler.

PubMed

Kim, Min P; Chan, Edward Y

2017-12-01

Early versions of the da Vinci robot system (S and Si) have been used to perform pulmonary lung resection with severe limitations. The lack of a vascular robot stapler required the presence of a trained bedside assistant whose role was to place, manipulate and fire the stapler around major vascular structures. Thus, the techniques developed for the Si robot required a skilled bedside assistant to perform stapling of the hilar structure and manipulation of the lung. With the advent of the da Vinci Xi system with a vascular robot stapler, we postulated that we could develop a new port placement and technique to provide total control for the surgeon during the pulmonary lung resection. We found that the "five on a dice" port placement and technique allows for minimal assistance during the lobectomy with full control by the surgeon. This technique uses the full capability of the Xi robot to make the robot-assisted lobectomy a safe and ergonomic operation.

75 FR 44224 - Initiation of Antidumping and Countervailing Duty Administrative Reviews and Requests for...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-07-28

... orders on Certain Polyester Staple Fiber from the People's Republic of China (``PRC'') with respect to... Diameter Carbon and Alloy Seamless, 6/1/09-5/31/10 Standard, Line, and Pressure Pipe, A-588-850.... JFE... Republic of China: Certain Polyester Staple Fiber, \\3\\ A-570-905.... 6/1/09-5/31/10 Far Eastern Industries...

Evaluation of the ViSiGiTM Calibration System

ClinicalTrials.gov

2013-12-10

Enhance Delineation of the Stomach Anatomy and the Surgeon's Appreciation of the Extent of Gastric Volume to be Removed;; Increase the Safety Profile of the Patient (i.e., Reduce the Likelihood of Accidental Stapling of the Orogastric Tube or Bougie);; Reduce the Incidence of OR Contamination/Infection Transmission;; Streamline OR Workflow, Resulting in Reduced OR Time; Ensure Consistent and Reproducible Staple Lines.

Statistical fusion of continuous labels: identification of cardiac landmarks

NASA Astrophysics Data System (ADS)

Xing, Fangxu; Soleimanifard, Sahar; Prince, Jerry L.; Landman, Bennett A.

2011-03-01

Image labeling is an essential task for evaluating and analyzing morphometric features in medical imaging data. Labels can be obtained by either human interaction or automated segmentation algorithms. However, both approaches for labeling suffer from inevitable error due to noise and artifact in the acquired data. The Simultaneous Truth And Performance Level Estimation (STAPLE) algorithm was developed to combine multiple rater decisions and simultaneously estimate unobserved true labels as well as each rater's level of performance (i.e., reliability). A generalization of STAPLE for the case of continuous-valued labels has also been proposed. In this paper, we first show that with the proposed Gaussian distribution assumption, this continuous STAPLE formulation yields equivalent likelihoods for the bias parameter, meaning that the bias parameter-one of the key performance indices-is actually indeterminate. We resolve this ambiguity by augmenting the STAPLE expectation maximization formulation to include a priori probabilities on the performance level parameters, which enables simultaneous, meaningful estimation of both the rater bias and variance performance measures. We evaluate and demonstrate the efficacy of this approach in simulations and also through a human rater experiment involving the identification the intersection points of the right ventricle to the left ventricle in CINE cardiac data.

Estimated Dietary Exposure to Mycotoxins after Taking into Account the Cooking of Staple Foods in Japan

PubMed Central

Sakuma, Hisako; Watanabe, Yasushi; Furusawa, Hiroko; Yoshinari, Tomoya; Akashi, Hajime; Kawakami, Hiroshi; Saito, Shiro; Sugita-Konishi, Yoshiko

2013-01-01

Mycotoxins are commonly present in cereal grains and are not completely destroyed during their cooking and processing. When mycotoxins contaminate staple foods, the risk for exposure becomes serious. In East Asia, including Japan, rice is consumed as a staple food, and with the increasingly Westernized lifestyle, the consumption of wheat has increased. The mycotoxins commonly associated with rice and wheat are total aflatoxin (AFL) and ochratoxin A (OTA), respectively. This study examined the retention of AFL and OTA during the cooking of rice and pasta. AFL was retained at 83%–89% the initial level after the cooking of steamed rice. In pasta noodles, more than 60% of the OTA was retained. These results show that AFL and OTA are relatively stable during the cooking process, suggesting that a major reduction in the exposure to these mycotoxins cannot be expected to occur by cooking rice and pasta. The estimated exposure assessment at the high consumer level (95th percentile) and the mycotoxin contamination level determined by taking into account these reductions in the present study should be useful for the establishment of practical regulations for mycotoxins in staple foods. PMID:23698358

Accidental entrapment of an endo-bronchial blocker tip by a surgical stapler during selective ventilation for lung lobectomy in a dog.

PubMed

Levionnois, Olivier L; Bergadano, Alessandra; Schatzmann, Urs

2006-01-01

To describe the use of an endobronchial blocker (EBB) and to perform selective ventilation during pulmonary lobe resection via thoracotomy in a dog and report its accidental stapling in the resection site. Clinical case report. One female dog with a suspected abscess or neoplasia of the right caudal pulmonary lobe. One-lung ventilation was performed using a wire-guided EBB to seal the contaminated parenchyma and facilitate surgical access. The affected lung parenchyma was resected and the resection site was closed with staples. Lobar resection was performed successfully, but the loop of the EBB guide wire was inadvertently entrapped in the staple line of the lobectomy. Staples were removed to release the wire loop, and the resulting air leak caused loss of ventilation control until the parenchyma was re-sealed. We recommend removing the wire guide associate with the EBB after successful lung separation to avoid accidents that could have life-threatening consequences if not recognized. One-lung ventilation is useful to isolate healthy parenchyma from diseased parenchyma during lobectomy. Anesthesiologists and surgeons need to be aware of the potential complications associated with use of EBB.

Statistical Fusion of Continuous Labels: Identification of Cardiac Landmarks.

PubMed

Xing, Fangxu; Soleimanifard, Sahar; Prince, Jerry L; Landman, Bennett A

2011-01-01

Image labeling is an essential task for evaluating and analyzing morphometric features in medical imaging data. Labels can be obtained by either human interaction or automated segmentation algorithms. However, both approaches for labeling suffer from inevitable error due to noise and artifact in the acquired data. The Simultaneous Truth And Performance Level Estimation (STAPLE) algorithm was developed to combine multiple rater decisions and simultaneously estimate unobserved true labels as well as each rater's level of performance (i.e., reliability). A generalization of STAPLE for the case of continuous-valued labels has also been proposed. In this paper, we first show that with the proposed Gaussian distribution assumption, this continuous STAPLE formulation yields equivalent likelihoods for the bias parameter, meaning that the bias parameter-one of the key performance indices-is actually indeterminate. We resolve this ambiguity by augmenting the STAPLE expectation maximization formulation to include a priori probabilities on the performance level parameters, which enables simultaneous, meaningful estimation of both the rater bias and variance performance measures. We evaluate and demonstrate the efficacy of this approach in simulations and also through a human rater experiment involving the identification the intersection points of the right ventricle to the left ventricle in CINE cardiac data.

Staple Food Self-Sufficiency of Farmers Household Level in The Great Solo

NASA Astrophysics Data System (ADS)

Darsono

2017-04-01

Analysis of food security level of household is a novelty of measurement standards which usually includes regional and national levels. With household approach is expected to provide the basis of sharp food policy formulation. The purpose of this study are to identify the condition of self-sufficiency in staple foods, and to find the main factors affecting the dynamics of self-sufficiency in staple foods on farm household level in Great Solo. Using primary data from 50 farmers in the sample and secondary data in Great Solo (Surakarta city, Boyolali, Sukoharjo, Karanganyar, Wonogiri, Sragen and Klaten). Compiled panel data were analyzed with linear probability regression models to produce a good model. The results showed that farm households in Great Solo has a surplus of staple food (rice) with an average consumption rate of 96.8 kg/capita/year. This number is lower than the national rate of 136.7 kg/capita/year. The main factors affecting the level of food self-sufficiency in the farmer household level are: rice production, rice consumption, land tenure, and number of family members. Key recommendations from this study are; improvement scale of the land cultivation for rice farming and non-rice diversification consumption.

Laparoscopy-assisted sigmoid resection.

PubMed

Fowler, D L; White, S A

1991-09-01

Laparoscopic cholecystectomy has been widely accepted, and because of its many benefits, other intra-abdominal operations are now being done laparoscopically. We felt the next step in the evolution of laparoscopic surgery could be bowel resection. This paper presents two cases of laparoscopic sigmoid resection and a detailed description of the technique. Included in the technique is the use of prototype endoscopic stapling devices to divide the mesentery and bowel. The two most difficult technical decisions involved the methods for specimen removal and for completing the anastomosis. The specimen was removed through a muscle splitting incision in the left lower quadrant, positioned as a mirror image of a standard appendectomy incision. The anvil of the CEEA (end-to-end) stapler was also position in the proximal colon through this incision; the anastomosis was completed with the CEEA stapler.

Comparison of gravimetric and a double-indicator dilution technique for assessment of extra-vascular lung water in endotoxaemia.

PubMed

Rossi, P; Oldner, A; Wanecek, M; Leksell, L G; Rudehill, A; Konrad, D; Weitzberg, E

2003-03-01

To compare a molecular double-indicator dilution technique with the gravimetrical reference method for measurement of extra-vascular lung water in porcine endotoxin shock. Open comparative experimental study. Animal research laboratory. In fourteen anaesthetised, mechanically ventilated landrace pigs, central and pulmonary haemodynamics as well as pulmonary gas exchange were measured. Extra-vascular lung water was quantitated gravimetrically as well as with a molecular double indicator dilution technique. Eight of these animals were subjected to endotoxaemia, the rest serving as sham controls. No difference in extra-vascular lung water was observed between the two methods in sham animals. Furthermore, extra-vascular lung water assessed with the molecular double-indicator dilution technique at the initiation of endotoxin infusion did not differ significantly from the corresponding values for sham animals. Endotoxaemia induced a hypodynamic shock with concurrent pulmonary hypertension and a pronounced deterioration in gas exchange. No increase in extra-vascular lung water was detected with the molecular double-indicator dilution technique in response to endotoxin, whereas this parameter was significantly higher when assessed with the gravimetric method. The molecular double-indicator dilution technique showed similar results as the gravimetrical method for assessment of extra-vascular lung water in non-endotoxaemic conditions. However, during endotoxin-induced lung injury the molecular double indicator dilution technique failed to detect the significant increase in extra-vascular lung water as measured by the gravimetric method. These data suggest that the molecular double indicator dilution technique may be of limited value during sepsis-induced lung injury.

Productivity of Rice Grown on Arsenic Contaminated Soil under a Changing Climate

NASA Astrophysics Data System (ADS)

Wang, T.; Plaganas, M.; Muehe, E. M.; Fendorf, S. E.

2016-12-01

Rice is the staple food for more than 50% of the global population. In South and Southeast Asia, native soil arsenic coupled with arsenic-laden irrigation water result in paddy soils having arsenic levels that decrease the quality and productivity of rice and thus compromise food security worldwide. However, it remains unknown how climate change will affect the accumulation of arsenic in rice plants, specifically grain, grown in arsenic-bearing paddy soils. We hypothesize that the bioavailability of arsenic in the paddy soil will increase with climate change leading to an even sharper decrease of rice productivity and quality than presently estimated. In order to shed light on this question, we performed greenhouse studies to simulate today's climate condition in Asian paddy soils and compare it to the conditions projected for the year 2100. We investigated climate conditions estimated in the 5th assessment report of the IPCC1, indicating up to a 5°C increase in temperature and doubled atmospheric CO2 concentrations. Under these current and future climate conditions, we examined rice physiology including plant height and biomass, leaf chlorophyll content, grain number and weight as well as contents of accumulated arsenic, and its species in the different rice tissues. We further correlate different geochemical parameters of the soil, including arsenic and other relevant metal dynamics in the soil, to plant response. In sum, our analyses will allow us to better predict the productivity of rice and its grain quality in a future climate condition, and may help to take precautions to avoid a global food crisis, particularly for South and Southeast Asia where rice is a daily staple. 1IPCC - Intergovernmental Panel on Climate Change, Climate Change 2013, The Physical Science Basis.

Occupational exposure to indoor air pollution among bakery workers in Ethiopia; A comparison of electric and biomass cookstoves.

PubMed

Downward, George S; van der Zwaag, Hugo P; Simons, Leon; Meliefste, Kees; Tefera, Yifokire; Carreon, J Rosales; Vermeulen, Roel; Smit, Lidwien A M

2018-02-01

The indoor air pollution (IAP) produced by the domestic combustion of solid fuels is responsible for up to 4 million deaths annually, especially among low and middle income countries. Occupational exposure within the food preparation industries of these nations remains underexplored. We investigated occupational exposure to the IAP produced during the commercial production of injera, a staple of the Ethiopian diet, from bakeries in Addis Ababa, Ethiopia. Measurements of PM 2.5 , black carbon (via the proxy measure PM 2.5 absorbance) and CO were collected from 30 bakeries and their employees for an average of 4-h per working day. Measurements were compared between bakeries using biomass and electric cookstoves. Further, the respiratory health data of 35 bakery employees were collected by interview-based questionnaire. Personal exposure to PM2.5 from biomass cookstoves was double that of electric cookstoves (430 μg/m3 vs. 216 μg/m3), black carbon exposure was four times higher among biomass users (67 × 10-5m-1 vs. 15 × 10-5m-1), and CO exposure was twenty times higher among biomass users (22 ppm vs. 1 ppm). Mixed effect models indicated that the number of stoves in use and additional solid fuel usage (e.g. coffee brewing) also contributed to exposure levels. These findings indicate that the use of biomass powered cookstoves during commercial injera production significantly contributes to IAP and self-reported respiratory symptoms. As injera is the staple foodstuff of Ethiopia, a widespread conversion to electric cookstoves is likely to have a significant impact. However, as high levels of IAP were also observed within the electric bakeries, further identification of pollution sources is required. Copyright © 2017 Elsevier Ltd. All rights reserved.

Overlapping double etch technique for evaluation of metallic alloys to stress corrosion cracking

DOEpatents

Not Available

1980-05-28

A double overlapping etch zone technique for evaluation of the resistance of metallic alloys to stress corrosion cracking is described. The technique involves evaluating the metallic alloy along the line of demarcation between an overlapping double etch zone and single etch zone formed on the metallic alloy surface.

The business case for transitioning to safer chemicals.

PubMed

McFadden, Roger D

2011-01-01

Emerging domestic and international chemical regulations and a heightened consumer awareness of chemicals of concern in products is challenging American businesses to reevaluate and reconsider their approaches to supply chain management and product design. Some of these companies recognize business opportunities and are responding proactively with innovative strategies and tactics. This article describes steps that Staples Inc., the world's largest office products provider, is taking to meet demand for products that are safer and more sustainable. In trying to meet the demand for safer products, Staples faces significant barriers, including the complexity of supply chains, data gaps, and confidential business information. New collaborations between companies, government, and advocates, and improved tools and criteria for defining safer products enhance the ability of businesses, like Staples, to meet new consumer demands.

Biomechanical evaluation of knotless anatomical double-layer double-row rotator cuff repair: a comparative ex vivo study.

PubMed

Hepp, Pierre; Osterhoff, Georg; Engel, Thomas; Marquass, Bastian; Klink, Thomas; Josten, Christoph

2009-07-01

The layered configuration of the rotator cuff tendon is not taken into account in classic rotator cuff tendon repair techniques. The mechanical properties of (1) the classic double-row technique, (2) a double-layer double-row (DLDR) technique in simple suture configuration, and (3) a DLDR technique in mattress suture configuration are significantly different. Controlled laboratory study. Twenty-four sheep shoulders were assigned to 3 repair groups of full-thickness infraspinatus tears: group 1, traditional double-row repair; group 2, DLDR anchor repair with simple suture configuration; and group 3, DLDR knotless repair with mattress suture configuration. After ultrasound evaluation of the repair, each specimen was cyclically loaded with 10 to 100 N for 50 cycles. Each specimen was then loaded to failure at a rate of 1 mm/s. There were no statistically significant differences among the 3 testing groups for the mean footprint area. The cyclic loading test revealed no significant difference among the 3 groups with regard to elongation. For the load-to-failure test, groups 2 and 3 showed no differences in ultimate tensile load when compared with group 1. However, when compared to group 2, group 3 was found to have significantly higher values regarding ultimate load, ultimate elongation, and energy absorbed. The DLDR fixation techniques may provide strength of initial repair comparable with that of commonly used double-row techniques. When compared with the knotless technique with mattress sutures, simple suture configuration of DLDR repair may be too weak. Knotless DLDR rotator cuff repair may (1) restore the footprint by the use of double-row principles and (2) enable restoration of the shape and profile. Double-layer double-row fixation in mattress suture configuration has initial fixation strength comparable with that of the classic double-row fixation and so may potentially improve functional results of rotator cuff repair.

No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection.

PubMed

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-04-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question as they included sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates and operation time were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. When looking at manual vs mechanical staples, it was noted that stapler failure can occur in around 4% of cases. The rate of bronchopleural fistula (BPF) development varied more in patients who underwent manual closure (1.5-12.5%) than in patients who underwent mechanical closure (1-5.7%). Although most of the studies reviewed showed no statistical differences between manual and mechanical closure in terms of BPF development, one study, however, showed that manual closure was significantly associated with lower numbers of postoperative BPF, while another study showed that mechanical closure is significantly associated with lower incidence of BPF. When looking at the role of the learning curve and training opportunities, it seems that the surgeon's inexperience when using mechanical staples can contribute to BPF development. A surgeon's experience can play a major role in the prevention of BPF development in patients having manual closure. Manual closure can provide a cheap and reliable technique when compared with costs incurred from using staplers, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk. However, there is a lack of evidence to suggest that manual closure is better than mechanical stapler closure following anatomical lung resection.

Meniscal repair using the Polysorb Meniscal Stapler XLS.

PubMed

Oberlander, Michael A; Chisar, Michael A

2005-09-01

We present our technique of repair of meniscal tears in 11 patients using a newly designed stapler, the Polysorb Meniscal Stapler XLS (USS Sports Medicine, Norwalk, CT), to increase the effectiveness and ease of repair of tears in the vascular zone while limiting potential complications. The low-profile stapler comes with a reloadable pistol grip device and a disposable straight or 15 degrees upcurved shaft with a single preloaded 10-mm staple. Standard anteromedial and anterolateral portals were used, along with a superomedial portal for inflow. The portal was enlarged slightly to facilitate introduction of the cannula or the stapler directly into the knee. The nose of the stapler was applied to the superior surface of the inner edge of the meniscal tear. The sharp points on the tip of the nose were used to manipulate the inner edge and coapt the tear site. Firm pressure was applied to the meniscal tissue, and the nose of the stapler was embedded in the inner edge of the meniscus no more than 2 to 3 mm from the tear (as measured along the meniscal surface). The handle was pulled slowly as the staple engaged the meniscal tissue. This step was repeated every 3 to 4 mm to ensure ideal tear stabilization.

[Stapled transanal rectal resection (STARR) in the treatment of rectocele: personal experience].

PubMed

Guarnieri, Alfredo; Cesaretti, Manuela; Tirone, Andrea; Vuolo, Giuseppe; Verre, Luigi; Savelli, Vinno; Piccolomini, Alessandro; Di Cosmo, Leonardo; Carli, Anton Ferdinando; Burroni, Mariagrazia; Pitzalis, Marcella

2008-01-01

Rectocele is an organic cause of chronic constipation, with a prevalence ranging from 8.95% to 12% in Europe and United States. Necessarily, the approach for rectocele repair is a surgical operation. Stapled transanal rectal resection (STARR) is safe and effective in the treatment of obstructed defecation syndrome. The authors' experience suggests that the surgical operation needs to be combined to rehabilitation exercises, before and after the surgical treatment, in order to strengthen the muscles of the pelvic pavement. From January 2005 to January 2007, 20 patients with outlet obstruction underwent STARR. Patients were selected for operation based on a strict diagnostic protocol: anamnesis, clinical examination, coloproctological and urogynaecological examinations, defecography, anorectal manometry, transrectal ultrasonography and peritoneal electromyography. The therapeutic protocol consists of 3 parts: phase I: rehabilitation of the pelvic pavement; phase II: surgical operation; III phase: post-surgical rehabilitation of the pelvic pavement; The clinical result was classified into: excellent (6 patients), when all constipation symptoms disappeared, good (11 patients), when patient has 1 or 2 obstructed defecation episodes treated with a laxative, fairly good (2 patients), more than 2 episodes, and poor (1 patient), when surgical operation doesn't improve any of the symptoms. Our results, confirmed by the literature, suggest that Longo's technique should be considered as gold standard for rectocele treatment.

The impact of surgeon choice on the cost of performing laparoscopic appendectomy.

PubMed

Chu, Thomas; Chandhoke, Ryan A; Smith, Paul C; Schwaitzberg, Steven D

2011-04-01

While laparoscopic appendectomy (LA) can be performed using a myriad of techniques, the cost of each method varies. The purpose of this study is to analyze the effects of surgeon choice of technique on the cost of key steps in LA. Surgeon operative notes, hospital invoice lists, and surgeon instrumentation preference sheets were obtained for all LA cases in 2008 at Cambridge Health Alliance (CHA). Only cases (N = 89) performed by fulltime staff general surgeons (N = 8) were analyzed. Disposable costs were calculated for the following components of LA: port access, mesoappendix division, and management of the appendiceal stump. The actual cost of each disposable was determined based on the hospital's materials management database. Actual hospital reimbursements for LA in 2008 were obtained for all payers and compared with the disposable cost per case. Disposable cost per case for the three portions analyzed for 126 theoretical models were calculated and found to range from US $81 to US $873. The surgeon with the most cost-effective preferred method (US $299) utilized one multi-use endoscopic clip applier for mesoappendix division, two commercially available pretied loops for management of the appendiceal stump, and three 5-mm trocars as their preferred technique. The surgeon with the least cost-effective preferred method (US $552) utilized two staple firings for mesoappendix division, one staple firing for management of the appendiceal stump, and 12/5/10-mm trocars for access. The two main payers for LA patients were Medicaid and Health Safety Net, whose total hospital reimbursements ranged from US $264 to US $504 and from US $0 to US $545 per case, respectively, for patients discharged on day 1. Disposable costs frequently exceeded hospital reimbursements. Currently, there is no scientific literature that clearly illustrates a superior surgical method for performing these portions of LA in routine cases. This study suggests that surgeons should review the cost implications of their practice and to find ways to provide the most cost-effective care without jeopardizing clinical outcome.

The growing importance of staple foods and condiments used as ingredients in the food industry and implications for large-scale food fortification programs in Southeast Asia.

PubMed

Spohrer, Rebecca; Larson, Melanie; Maurin, Clémence; Laillou, Arnaud; Capanzana, Mario; Garrett, Greg S

2013-06-01

Food fortification is a viable strategy to improve the nutritional status of populations. In Southeast Asia, recent growth and consolidation of the food industry provides an opportunity to explore whether certain widely consumed processed foods could contribute to micronutrient status if they are made with adequately fortified staples and condiments. To estimate the potential contribution certain processed foods can make to micronutrient intake in Southeast Asia if they are made with fortified staples and condiments; e.g., via the inclusion of iodized salt in various processed foods in the Philippines, fortified wheat flour in instant noodles in Indonesia, and fortified vegetable oil in biscuits in Vietnam. For Indonesia, the Philippines, and Vietnam, a review of consumption trends, relevant policies, and industry practices was conducted using publicly available sources,food industry market data and research reports, and oral communication. These informed the estimates of the proportion of the Recommended Nutrient Intake (RNI) that could be delivered via select processed foods. In the Philippines, Indonesia, and Vietnam, the processed food industry is not always required to use fortified staples and condiments. In the Philippines, dried salted fish with iodized salt would provide 64% to 85% of the iodine RNI for women of reproductive age and 107% to 141% of the iodine RNI for children 1 to 6 years of age. In Indonesia, a 75-g pack of instant noodles (a highly consumed product) with fortified wheat flour would provide 45% to 51% of the iron RNI for children 4 to 6 years of age and 10% to 11% of the iron RNI for women of reproductive age. In Vietnam, biscuits containing vegetable oil are increasingly popular. One 35-g biscuit serving with fortified vegetable oil would provide 13% to 18% of the vitamin A RNI for children 4 to 6 years of age and 12% to 17% of the vitamin A RNI for women of reproductive age. Ensuring that fortified staples and condiments such as flour, salt, and vegetable oil are used in widely consumed processed foods would ensure that these foods contribute to improvement in micronutrient intake among populations in Southeast Asia, particularly as the consumption of these foods is increasing. Policymakers and nutrition program managers should consider the contribution to nutritional intake that fortified staples and condiments can provide through processed foods, in addition to being used for cooking in the home, and ensure that the food industry is required to use these fortified staples and condiments rather than nonfortified foods.

Performance of Pallet Nails and Staples in 22 Southern Hardwoods

Treesearch

E.G. Stern

1976-01-01

The effectiveness of pointless, helically threaded, hardened-steel, 3 by O.120-inch, pallet nails with umbrella heads and 21/2-inch, 15-gauge, 7/16-inch crown, plastic-coated, pallet staples in 22 hardwoods grown on southern pine sites was determined on the basis of tests on 522 joints. Specific average performance values were derived from the test data for the tested...

Stapled haemorrhoidopexy transiently decreases rectal compliance and sensitivity.

PubMed

Filho, F L A; Macedo, G M; Dos Santos, A A; Rodrigues, L V; Oliveira, R B; Nobre E Souza, M A

2011-02-01

Stapled haemorrhoidopexy may damage the anorectal musculature and its sensorimotor function. Most studies have not used a barostat for the measurement of compliance. This study aimed to investigate the effect of stapled haemorrhoidopexy on rectal compliance and sensitivity. After Ethical Committee approval, we studied 10 male patients (mean age 33.8 years) with third- or fourth-degree haemorrhoids. Rectal compliance and sensitivity were measured with a 600-ml bag and an electronic barostat. Volunteers were submitted to two consecutive rectal distension protocols, including continuous distension at 2, 4 and 6 months after stapled haemorrhoidopexy. Intraluminal volume and pressure were recorded, including the first rectal sensation, desire to defecate and onset of rectal pain. Another group of 10 male control patients (mean age 24.9 years) with pilonidal sinus and no haemorrhoids was also included in the study. Two months after stapled haemorrhoidopexy, rectal compliance decreased (7.1 ± 0.2 vs 5.3 ± 0.1, 6.4 ± 0.1 vs 5.1 ± 0.1 and 5.6 ± 0.2 vs 4.7 ± 0.1 ml/mmHg for first rectal sensation, desire to defecate and rectal pain, respectively; P < 0.05). The sensitivity threshold volume did not change for the first sensation but decreased significantly for the desier to defecate and pain (p <0.05) (116.8 ± 13.8 vs 148.4 ± 14.61, 251.1 ± 8.9 vs 185.8 ± 8.6 and 293.3 ± 16.6 vs 221.2 ± 6.0 ml for first rectal sensation, desire to defecate and rectal pain, respectively). Four and 6 months after surgery, rectal compliance and sensitivity returned to levels similar to those in the basal period. Muscle tissue was found in only three of the 10 resected doughnuts. Controls remained without any change in rectal compliance and sensitivity. Stapled haemorrhoidopexy transiently decreases rectal compliance and sensitivity threshold in young male patients. © 2010 The Authors. Colorectal Disease © 2010 The Association of Coloproctology of Great Britain and Ireland.

J-tube technique for double-j stent insertion during laparoscopic upper urinary tract surgical procedures.

PubMed

Kim, Hyung Suk; Lee, Byung Ki; Jung, Jin-Woo; Lee, Jung Keun; Byun, Seok-Soo; Lee, Sang Eun; Jeong, Chang Wook

2014-11-01

Double-J stent insertion has been generally performed during laparoscopic upper urinary tract (UUT) surgical procedures to prevent transient urinary tract obstruction and postoperative flank pain from ureteral edema and blood clots. Several restrictive conditions that make this procedure difficult and time consuming, however, include the coiled distal ends of the flexible Double-J stent and the limited bending angle of the laparoscopic instruments. To overcome these limitations, we devised a Double-J stent insertion method using the new J-tube technique. Between July 2011 and May 2013, Double-J stents were inserted using the J-tube technique in 33 patients who underwent a laparoscopic UUT surgical procedure by a single surgeon. The mean stent placement time was 4.8±2.7 minutes, and there were no intraoperative complications. In conclusion, the J-tube technique is a safe and time-saving method for Double-J stent insertion during laparoscopic surgical procedures.

Part II: Biomechanical assessment for a footprint-restoring transosseous-equivalent rotator cuff repair technique compared with a double-row repair technique.

PubMed

Park, Maxwell C; Tibone, James E; ElAttrache, Neal S; Ahmad, Christopher S; Jun, Bong-Jae; Lee, Thay Q

2007-01-01

We hypothesized that a transosseous-equivalent repair would demonstrate improved tensile strength and gap formation between the tendon and tuberosity when compared with a double-row technique. In 6 fresh-frozen human shoulders, a transosseous-equivalent rotator cuff repair was performed: a suture limb from each of two medial anchors was bridged over the tendon and fixed laterally with an interference screw. In 6 contralateral matched-pair specimens, a double-row repair was performed. For all repairs, a materials testing machine was used to load each repair cyclically from 10 N to 180 N for 30 cycles; each repair underwent tensile testing to measure failure loads at a deformation rate of 1 mm/sec. Gap formation between the tendon edge and insertion was measured with a video digitizing system. The mean ultimate load to failure was significantly greater for the transosseous-equivalent technique (443.0 +/- 87.8 N) compared with the double-row technique (299.2 +/- 52.5 N) (P = .043). Gap formation during cyclic loading was not significantly different between the transosseous-equivalent and double-row techniques, with mean values of 3.74 +/- 1.51 mm and 3.79 +/- 0.68 mm, respectively (P = .95). Stiffness for all cycles was not statistically different between the two constructs (P > .40). The transosseous-equivalent rotator cuff repair technique improves ultimate failure loads when compared with a double-row technique. Gap formation is similar for both techniques. A transosseous-equivalent repair helps restore footprint dimensions and provides a stronger repair than the double-row technique, which may help optimize healing biology.

Multicenter prospective evaluation of a new articulating 5-mm endoscopic linear stapler.

PubMed

Kuthe, Andreas; Haemmerle, Alexander; Ludwig, Kaja; Falck, Stephan; Hiller, Wolfgang; Mainik, Frederick; Freys, Stephan; Dubovoy, Lev; Jaehne, Joachim; Oldhafer, Karl

2016-05-01

The objective of this study was to evaluate the safety and efficacy of a novel 5-mm laparoscopic linear stapler in clinical gastrointestinal surgical applications. A prospective, single-arm study with an open enrollment of subjects requiring stapling of the gastrointestinal (GI) tract was performed. The study endpoints were the number of complications and technical failures associated with the use of a novel stapler when compared to similar events with conventional staplers as described in the medical literature. Seven centers enrolled 160 subjects, 150 of which were followed up to at least 30 days postoperatively. Intraoperative success: In 423 deployments, there were two staple line leaks and five staple line bleeds, all of which were intraoperatively resolved. In addition, incomplete staple lines were noted as a result of user error (n = 15) or device-related issues (n = 22), all of which were immediately resolved and none of which resulted in a complication or a change of the surgical procedure. Late outcomes: A total of 13 surgical complications in 160 patients were related to a GI transection or anastomosis, 12 of which related to a hand-sewn anastomosis or use of other commercially available staplers. One event (1/153, 0.065 %) on POD 1, involving bleeding of the staple line, was felt to be related to the use of the new stapler. The study confirmed that the new device was user-friendly (9 % incidence of problems firing the device), reliable (3 % device failures) and safe (<1 % complication rate related to the stapler). Based on these results, it would seem that this new 5-mm stapler is a safe and effective alternative to standard 12-mm staplers.

A revolutionary design change to improve stapler safety.

PubMed

Arteaga-González, Iván J

2013-01-01

Postoperative staple line leaks and bleeding are the most common reasons for complications in surgical procedures that involve organ resection, such as sleeve gastrectomy. Increasing the safety of these operations requires improving the instruments (endostaplers or endocutters) used for stapling and sectioning the tissues. We present a new prototype stapler for marketing in resection surgery, especially designed for the sleeve gastrectomy. We suggest that the medical instrument industry creates devices in which the channel along which the knife blade runs is located asymmetrically. This would allow more staples to be placed on the side of the gastric remnant, thus improving the sealing and hemostasis of the suture line and reducing the number of complications for patients as a result. The application of new concepts in medical surgical devices can improve the safety of the procedures in our patients.

Transverse momentum-dependent parton distribution functions from lattice QCD

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michael Engelhardt, Philipp Haegler, Bernhard Musch, John Negele, Andreas Schaefer

Transverse momentum-dependent parton distributions (TMDs) relevant for semi-inclusive deep inelastic scattering (SIDIS) and the Drell-Yan process can be defined in terms of matrix elements of a quark bilocal operator containing a staple-shaped Wilson connection. Starting from such a definition, a scheme to determine TMDs in lattice QCD is developed and explored. Parametrizing the aforementioned matrix elements in terms of invariant amplitudes permits a simple transformation of the problem to a Lorentz frame suited for the lattice calculation. Results for the Sivers and Boer-Mulders transverse momentum shifts are obtained using ensembles at the pion masses 369MeV and 518MeV, focusing in particularmore » on the dependence of these shifts on the staple extent and a Collins-Soper-type evolution parameter quantifying proximity of the staples to the light cone.« less

Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients.

PubMed

Frasson, Matteo; Granero-Castro, Pablo; Ramos Rodríguez, José Luis; Flor-Lorente, Blas; Braithwaite, Mariela; Martí Martínez, Eva; Álvarez Pérez, Jose Antonio; Codina Cazador, Antonio; Espí, Alejandro; Garcia-Granero, Eduardo

2016-01-01

Studies focused on postoperative outcome after oncologic right colectomy are lacking. The main objective was to determine pre-/intraoperative risk factors for anastomotic leak after elective right colon resection for cancer. Secondary objectives were to determine risk factors for postoperative morbidity and mortality. Fifty-two hospitals participated in this prospective, observational study (September 2011-September 2012), including 1102 patients that underwent elective right colectomy. Forty-two pre-/intraoperative variables, related to patient, tumor, surgical procedure, and hospital, were analyzed as potential independent risk factors for anastomotic leak and postoperative morbidity and mortality. Anastomotic leak was diagnosed in 93 patients (8.4 %), and 72 (6.5 %) of them needed radiological or surgical intervention. Morbidity, mortality, and wound infection rates were 29.0, 2.6, and 13.4 %, respectively. Preoperative serum protein concentration was the only independent risk factor for anastomotic leak (p < 0.0001, OR 0.6 per g/dL). When considering only clinically relevant anastomotic leaks, stapled technique (p = 0.03, OR 2.1) and preoperative serum protein concentration (p = 0.004, OR 0.6 g/dL) were identified as the only two independent risk factors. Age and preoperative serum albumin concentration resulted to be risk factors for postoperative mortality. Male gender, pulmonary or hepatic disease, and open surgical approach were identified as risk factors for postoperative morbidity, while male gender, obesity, intraoperative complication, and end-to-end anastomosis were risk factors for wound infection. Preoperative nutritional status and the stapled anastomotic technique were the only independent risk factors for clinically relevant anastomotic leak after elective right colectomy for cancer. Age and preoperative nutritional status determined the mortality risk, while laparoscopic approach reduced postoperative morbidity.

Transabdominal Preperitoneal Herniorrhaphy using Laser-Assisted Tissue Soldering in a Porcine Model

PubMed Central

Soltz, Barbara A.; Stadler, Istvan; Soltz, Robert

2009-01-01

Background and Objectives: Collagen solder is capable of fixation of surgical meshes during laparoscopic herniorrhaphy without compromising tissue integration, increasing adhesions or inflammation. This pilot study describes development of instrumentation and techniques for transabdominal preperitoneal (TAPP) herniorrhaphy using laser-assisted soldering technology. Methods: Anesthetized 20-kg to 25-kg female Yorkshire pigs underwent laparoscopy performed using a 3-trocar technique. Peritoneal incisions were made and pockets created in the preperitoneal space for mesh placement. Parietex TEC mesh segments embedded in 60% collagen-solder were soldered to the muscle surface by using a prototype laser (1.45µ, 4.5W CW, 5mm spot, and 55°C set temperature) and custom laparoscopic handpiece. Parietex TEC mesh segments (Control) were affixed to the muscle with fibrin sealant (Tisseel). Peritoneal closure was with staples (Control) or by soldering collagen embedded Vicryl mesh segments over the peritoneal incision (Mesh/TAPP). Segments were inserted using a specially designed introducer. Animals were recovered and underwent second-look laparoscopy at 6 weeks postimplantation. Mesh sites were harvested after animals were euthanized. Results: The mesh-solder constructs were easily inserted and affixed in the TAPP approach. Tisseel tended to drip during application, particularly in vertical and ventral locations. Postoperative healing was similar to Control segments in all cases. Mesh/TAPP closures healed without scarring or adhesion formation. Discussion and Conclusion: Collagen-based tissue soldering permits normal wound healing and may mitigate or reduce use of staples for laparoscopic mesh fixation and peritoneal closure. Laser-assisted mesh fixation and peritoneal closure is a promising alternative for laparoscopic herniorrhaphy. Further development of this strategy is warranted. PMID:19660214

Finite element analysis and cadaveric cinematic analysis of fixation options for anteriorly implanted trabecular metal interbody cages.

PubMed

Berjano, Pedro; Blanco, Juan Francisco; Rendon, Diego; Villafañe, Jorge Hugo; Pescador, David; Atienza, Carlos Manuel

2015-11-01

To assess, with finite element analysis and an in vitro biomechanical study in cadaver, whether the implementation of an anterior interbody cage made of hedrocel with nitinol shape memory staples in compression increases the stiffness of the stand-alone interbody cage and to compare these constructs' stiffness to other constructs common in clinical practice. A biomechanical study with a finite element analysis and cadaveric testing assessed the stiffness of different fixation modes for the L4-L5 functional spinal unit: intact spine, destabilized spine with discectomy, posterior pedicle-screw fixation, anterior stand-alone interbody cage, anterior interbody cage with bilateral pedicle screws and anterior interbody cage with two shape memory staples in compression. These modalities of vertebral fixation were compared in four loading modes (flexion, extension, lateral bending, and axial rotation). The L4-L5 spinal unit with an anterior interbody cage and two staples was stiffer than the stand-alone cage. The construct stiffness was similar to that of a model of posterior pedicular stabilization. The stiffness was lower than that of the anterior cage plus bilateral pedicle-screw fixation. The use of an anterior interbody implant with shape memory staples in compression may be an alternative to isolated posterior fixation and to anterior isolated implants, with increased stiffness.

Stapled α−helical peptide drug development: A potent dual inhibitor of MDM2 and MDMX for p53-dependent cancer therapy

PubMed Central

Chang, Yong S.; Graves, Bradford; Guerlavais, Vincent; Tovar, Christian; Packman, Kathryn; To, Kwong-Him; Olson, Karen A.; Kesavan, Kamala; Gangurde, Pranoti; Mukherjee, Aditi; Baker, Theresa; Darlak, Krzysztof; Elkin, Carl; Filipovic, Zoran; Qureshi, Farooq Z.; Cai, Hongliang; Berry, Pamela; Feyfant, Eric; Shi, Xiangguo E.; Horstick, James; Annis, D. Allen; Manning, Anthony M.; Fotouhi, Nader; Nash, Huw; Vassilev, Lyubomir T.; Sawyer, Tomi K.

2013-01-01

Stapled α−helical peptides have emerged as a promising new modality for a wide range of therapeutic targets. Here, we report a potent and selective dual inhibitor of MDM2 and MDMX, ATSP-7041, which effectively activates the p53 pathway in tumors in vitro and in vivo. Specifically, ATSP-7041 binds both MDM2 and MDMX with nanomolar affinities, shows submicromolar cellular activities in cancer cell lines in the presence of serum, and demonstrates highly specific, on-target mechanism of action. A high resolution (1.7-Å) X-ray crystal structure reveals its molecular interactions with the target protein MDMX, including multiple contacts with key amino acids as well as a role for the hydrocarbon staple itself in target engagement. Most importantly, ATSP-7041 demonstrates robust p53-dependent tumor growth suppression in MDM2/MDMX-overexpressing xenograft cancer models, with a high correlation to on-target pharmacodynamic activity, and possesses favorable pharmacokinetic and tissue distribution properties. Overall, ATSP-7041 demonstrates in vitro and in vivo proof-of-concept that stapled peptides can be developed as therapeutically relevant inhibitors of protein–protein interaction and may offer a viable modality for cancer therapy. PMID:23946421

A Comparative Evaluation of the Effect of Double Casting Technique Using Functionally Generated Path and Conventional Single Casting with Respect to Functional Articulation, Patient Satisfaction and Chair Side Time, in Single Unit Molar Teeth: An In Vivo Study.

PubMed

Memon, Sarfaraz

2014-12-01

A stable centric occlusal position that shows no evidence of occlusal disease should not be altered. Confirmative restorative dentistry deals with making restorations that are in harmony with existing jaw relations. Conventional techniques for construction have been unsuccessful in producing a prosthesis that can be inserted without minor intraoral occlusal adjustment. This study was conducted to evaluate the benefits of the double casting technique with FGP over the conventional casting technique. Ten patients with root canal treated maxillary molar were selected for the fabrication of metal crown. Two techniques, one involving the conventional fabrication and other using functionally generated path with double casting were used to fabricate the prosthesis. A comparison based on various parameters which was done between the two techniques. The change in the height of castings for the double casting group was less compared to the conventional group and was highly statistically significant (P < 0.001). The time taken for occlusal correction was significantly lower in double casting group than the conventional group (P < 0.001). The patient satisfaction (before occlusal correction) indicated better satisfaction for double casting group compared to conventional (P < 0.01). The functionally generated path with double casting technique resulted in castings which had better dimensional accuracy, less occlusal correction and better patient satisfaction compared to the conventional castings.

Progression from laparoscopic-assisted to totally laparoscopic distal gastrectomy: comparison of circular stapler (i-DST) and linear stapler (BBT) for intracorporeal anastomosis.

PubMed

Ikeda, Tetsuo; Kawano, Hiroyuki; Hisamatsu, Yuichi; Ando, Koji; Saeki, Hiroshi; Oki, Eiji; Ohga, Takefumi; Kakeji, Yoshihiro; Tsujitani, Shunichi; Kohnoe, Shunji; Maehara, Yoshihiko

2013-01-01

Billroth I (B-I) gastroduodenostomy is an anastomotic procedure that is widely performed after gastric resection for distal gastric cancer. A circular stapler often is used for B-I gastroduodenostomy in open and laparoscopic-assisted distal gastrectomy. Recently, totally laparoscopic distal gastrectomy (TLDG) has been considered less invasive than laparoscopic-assisted gastrectomy, and many institutions performing laparoscopic-assisted distal gastrectomy are trying to progress to TLDG without markedly changing the anastomosis method. The purpose of this report is to introduce the technical details of new methods of intracorporeal gastroduodenostomy using either a circular or linear stapler and to evaluate their technical feasibility and safety. Seventeen patients who underwent TLDG with the intracorporeal double-stapling technique using a circular stapler (n = 7) or the book-binding technique (BBT) using a linear stapler (n = 10) between February 2010 and April 2011 were enrolled in the study. Clinicopathological data, surgical data, and postoperative outcomes were analyzed. There were no intraoperative complications or conversions to open surgery in any of the 17 patients. The usual postoperative complications following gastroduodenostomy, such as anastomotic leakage and stenosis, were not observed. Anastomosis took significantly longer to complete with DST (64 ± 24 min) than with BBT (34 ± 7 min), but more stapler cartridges were needed with BBT than with DST. TLDG using a circular or linear stapler is feasible and safe to perform. DST will enable institutions performing laparoscopic-assisted distal gastrectomy with circular staplers to progress to TLDG without problems, and this progression may be more economical because fewer stapler cartridges are used during surgery. However, if an institution has already been performing δ anastomosis in TLDG but has been experiencing certain issues with δ anastomosis, converting from δ anastomosis to BBT should be beneficial.

Neopterin, kynurenine and tryptophan as new biomarkers for early detection of rectal anastomotic leakage.

PubMed

Dusek, Tomas; Orhalmi, Julius; Sotona, Otakar; Krcmova, Lenka Kujovska; Javorska, Lenka; Dolejs, Josef; Paral, Jiri

2018-03-01

At present, there are no strong predictors, nor a useful scoring system, that clearly identifies patients at risk for anastomotic leakage. This study aimed to investigate a new method that assesses this risk by monitoring levels of neopterin, tryptophan, and kynurenine, in bodily fluids. This prospective study included patients who underwent elective rectal resection for carcinoma. The basic condition for inclusion was rectal anastomosis using the double-stapling technique. Preoperative levels of neopterin, tryptophan, kynurenine, and their ratios, were assessed with blood and urine samples. These levels were then monitored for 6 postoperative days in venous blood, urine, and abdominal drainage fluid. A total of 42 patients were enrolled in the study. Thirty-six patients underwent a laparoscopic resection and 6 patients had an open procedure. No differences were found among neopterin, tryptophan, and kynurenine serum levels. However, the groups were observed to have significant differences in the urinary neopterin/creatinine ratio: the preoperative neopterin/creatinine ratio was 139.5 μmol/mol in the group with leakage, vs 114.8 μmol/mol in the group without complications, p = 0.037. The same results were observed during the postoperative period, p = 0.012. Additionally, the group with complications had a higher mean value of neopterin in drainage fluid, p = 0.048. Our study demonstrated that high preoperative levels of urinary neopterin could be interpreted as a risk for anastomotic leakage. Moreover, pathological levels of neopterin in urine and abdominal drainage fluid could be useful for early identification of anastomotic leakage during the postoperative period prior to its clinical development.

Paraesthesia during the needle-through-needle and the double segment technique for combined spinal epidural anaesthesia.

PubMed

Ahn, H J; Choi, D H; Kim, C S

2006-07-01

Paraesthesia during regional anaesthesia is an unpleasant sensation for patients and, more importantly, in some cases it is related to neurological injury. Relatively few studies have been conducted on the frequency of paraesthesia during combined spinal epidural anaesthesia. We compared two combined spinal epidural anaesthesia techniques: the needle-through-needle technique and the double segment technique in this respect. We randomly allocated 116 parturients undergoing elective Caesarean section to receive anaesthesia using one of these techniques. Both techniques were performed using a 27G pencil point needle, an 18G Tuohy needle, and a 20G multiport epidural catheter from the same manufacturer. The overall frequency of paraesthesia was higher in the needle-through-needle technique group (56.9% vs. 31.6%, p = 0.011). The frequency of paraesthesia at spinal needle insertion was 20.7% in the needle-through-needle technique group and 8.8% in the double segment technique group; whereas the frequency of paraesthesia at epidural catheter insertion was 46.6% in the needle-through-needle technique group and 24.6% in the double segment technique group.

An Anatomic and Biomechanical Comparison of Bankart Repair Configurations.

PubMed

Judson, Christopher H; Voss, Andreas; Obopilwe, Elifho; Dyrna, Felix; Arciero, Robert A; Shea, Kevin P

2017-11-01

Suture anchor repair for anterior shoulder instability can be performed using a number of different repair techniques, but none has been proven superior in terms of anatomic and biomechanical properties. Purpose/Hypothesis: The purpose was to compare the anatomic footprint coverage and biomechanical characteristics of 4 different Bankart repair techniques: (1) single row with simple sutures, (2) single row with horizontal mattress sutures, (3) double row with sutures, and (4) double row with labral tape. The hypotheses were as follows: (1) double-row techniques would improve the footprint coverage and biomechanical properties compared with single-row techniques, (2) horizontal mattress sutures would increase the footprint coverage compared with simple sutures, and (3) repair techniques with labral tape and sutures would not show different biomechanical properties. Controlled laboratory study. Twenty-four fresh-frozen cadaveric specimens were dissected. The native labrum was removed and the footprint marked and measured. Repair for each of the 4 groups was performed, and the uncovered footprint was measured using a 3-dimensional digitizer. The strength of the repair sites was assessed using a servohydraulic testing machine and a digital video system to record load to failure, cyclic displacement, and stiffness. The double-row repair techniques with sutures and labral tape covered 73.4% and 77.0% of the footprint, respectively. These percentages were significantly higher than the footprint coverage achieved by single-row repair techniques using simple sutures (38.1%) and horizontal mattress sutures (32.8%) ( P < .001). The footprint coverage of the simple suture and horizontal mattress suture groups was not significantly different ( P = .44). There were no significant differences in load to failure, cyclic displacement, or stiffness between the single-row and double-row groups or between the simple suture and horizontal mattress suture techniques. Likewise, there was no difference in the biomechanical properties of the double-row repair techniques with sutures versus labral tape. Double-row repair techniques provided better coverage of the native footprint of the labrum but did not provide superior biomechanical properties compared with single-row repair techniques. There was no difference in footprint coverage or biomechanical strength between the simple suture and horizontal mattress suture repair techniques. Although the double-row repair techniques had no difference in initial strength, they may improve healing in high-risk patients by improving the footprint coverage.

Subcutaneous hemangiosarcoma induced by a foreign body (steel staple) in a cat.

PubMed

Tan, Rommel Max; Singh, Kuldeep; Sandman, Kristi

2013-04-01

An 8-year-old, female domestic shorthair cat was presented with a ventral abdominal subcutaneous mass. A radiograph showed that the center of the mass contained what appeared to be steel sutures, presumed to be from an ovariohysterectomy performed 7 years earlier. The excised mass was irregular and contained numerous pockets filled with friable necrotic material and hemorrhages that were dissected by fibrous connective tissue bands. Multiple tangled and fragmented pieces of steel staples were deeply embedded within the mass. Histologically, the mass was non-encapsulated, densely cellular, and infiltrative. Neoplastic cells lined caverns and channels and were factor VIII-positive by immunohistochemistry. The neoplastic cells were oval to round with granular cytoplasm and vesicular nucleus and exhibited moderate cellular and nuclear pleomorphism. A diagnosis of subcutaneous hemangiosarcoma was made. To our knowledge, this is the first report of foreign body associated hemangiosarcoma and the first case of steel staple associated neoplasm in domestic animals.

Hydrocarbon-Stapled Peptides: Principles, Practice, and Progress

PubMed Central

2015-01-01

Protein structure underlies essential biological processes and provides a blueprint for molecular mimicry that drives drug discovery. Although small molecules represent the lion’s share of agents that target proteins for therapeutic benefit, there remains no substitute for the natural properties of proteins and their peptide subunits in the majority of biological contexts. The peptide α-helix represents a common structural motif that mediates communication between signaling proteins. Because peptides can lose their shape when taken out of context, developing chemical interventions to stabilize their bioactive structure remains an active area of research. The all-hydrocarbon staple has emerged as one such solution, conferring α-helical structure, protease resistance, cellular penetrance, and biological activity upon successful incorporation of a series of design and application principles. Here, we describe our more than decade-long experience in developing stapled peptides as biomedical research tools and prototype therapeutics, highlighting lessons learned, pitfalls to avoid, and keys to success. PMID:24601557

Lung abscess mimicking lung cancer developed around staples in a patient with permanent tracheostoma.

PubMed

Watanabe, Yui; Aoki, Masaya; Suzuki, Soichi; Umehara, Tadashi; Harada, Aya; Wakida, Kazuhiro; Nagata, Toshiyuki; Kariatsumari, Kota; Nakamura, Yoshihiro; Sato, Masami

2015-11-01

A 68-year-old male with a tracheostoma due to hypopharyngeal cancer was admitted because his chest computed tomography (CT) showed a small nodule in the right middle lobe. Following a partial resection of the right middle lobe, histopathological diagnosis of the resected sample was that of organizing pneumonia. Eleven months later, chest CT showed a mass with pleural indentation and spiculation in the right middle lobe. 18-Fluorodeoxyglucose-positron emission tomography showed significant accumulation in the middle lobe tumor mass shadow. The abnormal chest shadow that had developed around surgical staples suggested inadequate resection and tumor recurrence. As the abnormal radiological shadow was enlarging, middle lobectomy was carried out. Histological examination revealed that the tumor was a lung abscess without malignant features. This is a unique case of lung abscess mimicking lung cancer which developed around staples used during partial resection of the lung.

A biomechanical comparison of 2 transosseous-equivalent double-row rotator cuff repair techniques using bioabsorbable anchors: cyclic loading and failure behavior.

PubMed

Spang, Jeffrey T; Buchmann, Stefan; Brucker, Peter U; Kouloumentas, Panos; Obst, Tobias; Schröder, Manuel; Burgkart, Rainer; Imhoff, Andreas B

2009-08-01

A novel double-row configuration was compared with a traditional double-row configuration for rotator cuff repair. In 10 matched-pair sheep shoulders in vitro repair was performed with either a double-row technique with corkscrew suture anchors for the medial row and insertion anchors for the lateral row (group A) or a double-row technique with a new tape-like suture material with insertion anchors for both the medial and lateral rows (group B). Each specimen underwent cyclic loading from 10 to 150 N for 100 cycles, followed by unidirectional failure testing. Gap formation and strain within the repair area for the first and last cycles were analyzed with a video digitizing system, and stiffness and failure load were determined from the load-elongation curve. The results were similar for the 2 repair types. There was no significant difference between the ultimate failure loads of the 2 techniques (421 +/- 150 N in group A and 408 +/- 66 N in group B, P = .31) or the stiffness of the 2 techniques (84 +/- 26 N/mm in group A and 99 +/- 20 N/mm in group B, P = .07). In addition, gap formation was not different between the repair types. Strain over the repair area was also not different between the repair types. Both tested rotator cuff repair techniques had high failure loads, limited gap formation, and acceptable strain patterns. No significant difference was found between the novel and conventional double-row repair types. Two double-row techniques-one with corkscrew suture anchors for the medial row and insertion anchors for the lateral row and one with insertion anchors for both the medial and lateral rows-provided excellent biomechanical profiles at time 0 for double-row repairs in a sheep model. Although the sheep model may not directly correspond to in vivo conditions, all-insertion anchor double-row constructs are worthy of further investigation.

A Comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs

PubMed Central

Dorweiler, Matthew A.; Van Dyke, Rufus O.; Siska, Robert C.; Boin, Michael A.; DiPaola, Mathew J.

2017-01-01

Background: Triceps tendon ruptures are rare orthopaedic injuries that almost always require surgical repair. This study tests the biomechanical properties of an original anchorless double-row triceps repair against a previously reported knotless double-row repair. Hypothesis: The anchorless double-row triceps repair technique will yield similar biomechanical properties when compared with the knotless double-row repair technique. Study Design: Controlled laboratory study. Methods: Eighteen cadaver arms were randomized into 2 groups. One group received the anchorless repair and the other received the knotless anchor repair. A materials testing system (MTS) machine was used to cycle the repaired arms from 0° to 90° with a 2.5-pound weight for 1500 cycles at 0.25 Hz. Real-time displacement of the tendon was measured during cycling using a probe. Load to failure was performed after completion of cyclic loading. Results: The mean displacement with the anchorless technique was 0.77 mm (SD, 0.25 mm) at 0° (full elbow extension) and 0.76 mm (SD, 0.38 mm) at 90° (elbow flexion). The mean displacement with the anchored technique was 0.83 mm (SD, 0.57 mm) at 0° and 1.01 mm (SD, 0.62 mm) at 90°. There was no statistically significant difference for tendon displacement at 0º (P = .75) or 90º (P = .31). The mean load to failure with the anchorless technique was 618.9 N (SD, 185.6 N), while it was 560.5 N (SD, 154.1 N) with the anchored technique, again with no statistically significant difference (P = .28). Conclusion: Our anchorless double-row triceps repair technique yields comparable biomechanical properties to previously described double-row triceps tendon repair techniques, with the added benefit of avoiding the cost of suture anchors. Clinical Relevance: This anchorless double-row triceps tendon repair can be considered as an acceptable alternative to a knotless anchor repair for triceps tendon ruptures. PMID:28607942

A Comparative Biomechanical Analysis of 2 Double-Row, Distal Triceps Tendon Repairs.

PubMed

Dorweiler, Matthew A; Van Dyke, Rufus O; Siska, Robert C; Boin, Michael A; DiPaola, Mathew J

2017-05-01

Triceps tendon ruptures are rare orthopaedic injuries that almost always require surgical repair. This study tests the biomechanical properties of an original anchorless double-row triceps repair against a previously reported knotless double-row repair. The anchorless double-row triceps repair technique will yield similar biomechanical properties when compared with the knotless double-row repair technique. Controlled laboratory study. Eighteen cadaver arms were randomized into 2 groups. One group received the anchorless repair and the other received the knotless anchor repair. A materials testing system (MTS) machine was used to cycle the repaired arms from 0° to 90° with a 2.5-pound weight for 1500 cycles at 0.25 Hz. Real-time displacement of the tendon was measured during cycling using a probe. Load to failure was performed after completion of cyclic loading. The mean displacement with the anchorless technique was 0.77 mm (SD, 0.25 mm) at 0° (full elbow extension) and 0.76 mm (SD, 0.38 mm) at 90° (elbow flexion). The mean displacement with the anchored technique was 0.83 mm (SD, 0.57 mm) at 0° and 1.01 mm (SD, 0.62 mm) at 90°. There was no statistically significant difference for tendon displacement at 0º ( P = .75) or 90º ( P = .31). The mean load to failure with the anchorless technique was 618.9 N (SD, 185.6 N), while it was 560.5 N (SD, 154.1 N) with the anchored technique, again with no statistically significant difference ( P = .28). Our anchorless double-row triceps repair technique yields comparable biomechanical properties to previously described double-row triceps tendon repair techniques, with the added benefit of avoiding the cost of suture anchors. This anchorless double-row triceps tendon repair can be considered as an acceptable alternative to a knotless anchor repair for triceps tendon ruptures.

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique.

PubMed

Mook, William R; Greenspoon, Joshua A; Millett, Peter J

2016-01-01

Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears.

Arthroscopic Double-Row Transosseous Equivalent Rotator Cuff Repair with a Knotless Self-Reinforcing Technique

PubMed Central

Mook, William R.; Greenspoon, Joshua A.; Millett, Peter J.

2016-01-01

Background: Rotator cuff tears are a significant cause of shoulder morbidity. Surgical techniques for repair have evolved to optimize the biologic and mechanical variables critical to tendon healing. Double-row repairs have demonstrated superior biomechanical advantages to a single-row. Methods: The preferred technique for rotator cuff repair of the senior author was reviewed and described in a step by step fashion. The final construct is a knotless double row transosseous equivalent construct. Results: The described technique includes the advantages of a double-row construct while also offering self reinforcement, decreased risk of suture cut through, decreased risk of medial row overtensioning and tissue strangulation, improved vascularity, the efficiency of a knotless system, and no increased risk for subacromial impingement from the burden of suture knots. Conclusion: Arthroscopic knotless double row rotator cuff repair is a safe and effective method to repair rotator cuff tears. PMID:27733881

A double sealing technique for increasing the precision of headspace-gas chromatographic analysis.

PubMed

Xie, Wei-Qi; Yu, Kong-Xian; Gong, Yi-Xian

2018-01-19

This paper investigates a new double sealing technique for increasing the precision of the headspace gas chromatographic method. The air leakage problem caused by the high pressure in the headspace vial during the headspace sampling process has a great impact to the measurement precision in the conventional headspace analysis (i.e., single sealing technique). The results (using ethanol solution as the model sample) show that the present technique is effective to minimize such a problem. The double sealing technique has an excellent measurement precision (RSD < 0.15%) and accuracy (recovery = 99.1%-100.6%) for the ethanol quantification. The detection precision of the present method was 10-20 times higher than that in earlier HS-GC work that use conventional single sealing technique. The present double sealing technique may open up a new avenue, and also serve as a general strategy for improving the performance (i.e., accuracy and precision) of headspace analysis of various volatile compounds. Copyright © 2017 Elsevier B.V. All rights reserved.

Double-row vs single-row rotator cuff repair: a review of the biomechanical evidence.

PubMed

Wall, Lindley B; Keener, Jay D; Brophy, Robert H

2009-01-01

A review of the current literature will show a difference between the biomechanical properties of double-row and single-row rotator cuff repairs. Rotator cuff tears commonly necessitate surgical repair; however, the optimal technique for repair continues to be investigated. Recently, double-row repairs have been considered an alternative to single-row repair, allowing a greater coverage area for healing and a possibly stronger repair. We reviewed the literature of all biomechanical studies comparing double-row vs single-row repair techniques. Inclusion criteria included studies using cadaveric, animal, or human models that directly compared double-row vs single-row repair techniques, written in the English language, and published in peer reviewed journals. Identified articles were reviewed to provide a comprehensive conclusion of the biomechanical strength and integrity of the repair techniques. Fifteen studies were identified and reviewed. Nine studies showed a statistically significant advantage to a double-row repair with regards to biomechanical strength, failure, and gap formation. Three studies produced results that did not show any statistical advantage. Five studies that directly compared footprint reconstruction all demonstrated that the double-row repair was superior to a single-row repair in restoring anatomy. The current literature reveals that the biomechanical properties of a double-row rotator cuff repair are superior to a single-row repair. Basic Science Study, SRH = Single vs. Double Row RCR.

Stapled Voltage-Gated Calcium Channel (CaV) α-Interaction Domain (AID) Peptides Act As Selective Protein-Protein Interaction Inhibitors of CaV Function.

PubMed

Findeisen, Felix; Campiglio, Marta; Jo, Hyunil; Abderemane-Ali, Fayal; Rumpf, Christine H; Pope, Lianne; Rossen, Nathan D; Flucher, Bernhard E; DeGrado, William F; Minor, Daniel L

2017-06-21

For many voltage-gated ion channels (VGICs), creation of a properly functioning ion channel requires the formation of specific protein-protein interactions between the transmembrane pore-forming subunits and cystoplasmic accessory subunits. Despite the importance of such protein-protein interactions in VGIC function and assembly, their potential as sites for VGIC modulator development has been largely overlooked. Here, we develop meta-xylyl (m-xylyl) stapled peptides that target a prototypic VGIC high affinity protein-protein interaction, the interaction between the voltage-gated calcium channel (Ca V ) pore-forming subunit α-interaction domain (AID) and cytoplasmic β-subunit (Ca V β). We show using circular dichroism spectroscopy, X-ray crystallography, and isothermal titration calorimetry that the m-xylyl staples enhance AID helix formation are structurally compatible with native-like AID:Ca V β interactions and reduce the entropic penalty associated with AID binding to Ca V β. Importantly, electrophysiological studies reveal that stapled AID peptides act as effective inhibitors of the Ca V α 1 :Ca V β interaction that modulate Ca V function in an Ca V β isoform-selective manner. Together, our studies provide a proof-of-concept demonstration of the use of protein-protein interaction inhibitors to control VGIC function and point to strategies for improved AID-based Ca V modulator design.

Expected increase in staple crop imports in water-scarce countries in 2050

NASA Astrophysics Data System (ADS)

Chouchane, Hatem; Krol, Maarten; Hoekstra, Arjen

2017-04-01

Water scarcity is a major challenge in the coming decades. The increasing population and the changing pattern of water availability that results from global warming reduce the potential of sufficient food production in many countries over the world. Today, two thirds of the global population are already living under conditions of severe water scarcity at least one month of the year. This rises the importance of addressing the present and future relationship between water availability and food import in water-scarce countries. The net import of staple crops (barley, cassava, maize, millet and products, oats, potatoes, rice, rye, sorghum, soybeans, sweet potatoes, wheat and yams) is analysed in relation to water availability per capita for the period 1961-2010, considering five decadal averages. The relation found is used together with the low, medium and high population growth scenarios from the United Nations to project the staple crops import in water-scarce countries for the year 2050. Additionally, we investigate the uncertainties related to the three population scenarios. Results will help countries to better understand the impact of population growth and limited water resources on their future food trade. This study will provide a valuable supporting tool for policy makers towards more sustainable and water-efficient food production as targeted with the Sustainable Development Goals. Keywords: Water Availability, Food Import, Staple Crops, Water Scarcity, Water-Use Efficiency, Sustainable Development Goals.

α/β-Peptide Foldamers Targeting Intracellular Protein-Protein Interactions with Activity in Living Cells.

PubMed

Checco, James W; Lee, Erinna F; Evangelista, Marco; Sleebs, Nerida J; Rogers, Kelly; Pettikiriarachchi, Anne; Kershaw, Nadia J; Eddinger, Geoffrey A; Belair, David G; Wilson, Julia L; Eller, Chelcie H; Raines, Ronald T; Murphy, William L; Smith, Brian J; Gellman, Samuel H; Fairlie, W Douglas

2015-09-09

Peptides can be developed as effective antagonists of protein-protein interactions, but conventional peptides (i.e., oligomers of l-α-amino acids) suffer from significant limitations in vivo. Short half-lives due to rapid proteolytic degradation and an inability to cross cell membranes often preclude biological applications of peptides. Oligomers that contain both α- and β-amino acid residues ("α/β-peptides") manifest decreased susceptibility to proteolytic degradation, and when properly designed these unnatural oligomers can mimic the protein-recognition properties of analogous "α-peptides". This report documents an extension of the α/β-peptide approach to target intracellular protein-protein interactions. Specifically, we have generated α/β-peptides based on a "stapled" Bim BH3 α-peptide, which contains a hydrocarbon cross-link to enhance α-helix stability. We show that a stapled α/β-peptide can structurally and functionally mimic the parent stapled α-peptide in its ability to enter certain types of cells and block protein-protein interactions associated with apoptotic signaling. However, the α/β-peptide is nearly 100-fold more resistant to proteolysis than is the parent stapled α-peptide. These results show that backbone modification, a strategy that has received relatively little attention in terms of peptide engineering for biomedical applications, can be combined with more commonly deployed peripheral modifications such as side chain cross-linking to produce synergistic benefits.

Gender Difference on the Association between Dietary Patterns and Obesity in Chinese Middle-Aged and Elderly Populations.

PubMed

Yuan, Ya-Qun; Li, Fan; Meng, Pai; You, Jie; Wu, Min; Li, Shu-Guang; Chen, Bo

2016-07-23

Dietary patterns are linked to obesity, but the gender difference in the association between dietary patterns and obesity remains unclear. We explored this gender difference in a middle-aged and elderly populations in Shanghai. Residents (n = 2046; aged ≥45 years; 968 men and 1078 women) who participated in the Shanghai Food Consumption Survey were studied. Factor analysis of data from four periods of 24-h dietary recalls (across 2012-2014) identified dietary patterns. Height, body weight, and waist circumference were measured to calculate the body mass index. A log binominal model examined the association between dietary patterns and obesity, stratified by gender. Four dietary patterns were identified for both genders: rice staple, wheat staple, snacks, and prudent patterns. The rice staple pattern was associated positively with abdominal obesity in men (prevalence ratio (PR) = 1.358; 95% confidence interval (CI) 1.132-1.639; p = 0.001), but was associated negatively with general obesity in women (PR = 0.745; 95% CI: 0.673-0.807; p = 0.031). Men in the highest quartile of the wheat staple pattern had significantly greater risk of central obesity (PR = 1.331; 95% CI: 1.094-1.627; p = 0.005). There may be gender differences in the association between dietary patterns and obesity in middle-aged and elderly populations in Shanghai, China.

Stapled Voltage-Gated Calcium Channel (CaV) α-Interaction Domain (AID) Peptides Act As Selective Protein–Protein Interaction Inhibitors of CaV Function

PubMed Central

2017-01-01

For many voltage-gated ion channels (VGICs), creation of a properly functioning ion channel requires the formation of specific protein–protein interactions between the transmembrane pore-forming subunits and cystoplasmic accessory subunits. Despite the importance of such protein–protein interactions in VGIC function and assembly, their potential as sites for VGIC modulator development has been largely overlooked. Here, we develop meta-xylyl (m-xylyl) stapled peptides that target a prototypic VGIC high affinity protein–protein interaction, the interaction between the voltage-gated calcium channel (CaV) pore-forming subunit α-interaction domain (AID) and cytoplasmic β-subunit (CaVβ). We show using circular dichroism spectroscopy, X-ray crystallography, and isothermal titration calorimetry that the m-xylyl staples enhance AID helix formation are structurally compatible with native-like AID:CaVβ interactions and reduce the entropic penalty associated with AID binding to CaVβ. Importantly, electrophysiological studies reveal that stapled AID peptides act as effective inhibitors of the CaVα1:CaVβ interaction that modulate CaV function in an CaVβ isoform-selective manner. Together, our studies provide a proof-of-concept demonstration of the use of protein–protein interaction inhibitors to control VGIC function and point to strategies for improved AID-based CaV modulator design. PMID:28278376

Gender Difference on the Association between Dietary Patterns and Obesity in Chinese Middle-Aged and Elderly Populations

PubMed Central

Yuan, Ya-Qun; Li, Fan; Meng, Pai; You, Jie; Wu, Min; Li, Shu-Guang; Chen, Bo

2016-01-01

Dietary patterns are linked to obesity, but the gender difference in the association between dietary patterns and obesity remains unclear. We explored this gender difference in a middle-aged and elderly populations in Shanghai. Residents (n = 2046; aged ≥45 years; 968 men and 1078 women) who participated in the Shanghai Food Consumption Survey were studied. Factor analysis of data from four periods of 24-h dietary recalls (across 2012–2014) identified dietary patterns. Height, body weight, and waist circumference were measured to calculate the body mass index. A log binominal model examined the association between dietary patterns and obesity, stratified by gender. Four dietary patterns were identified for both genders: rice staple, wheat staple, snacks, and prudent patterns. The rice staple pattern was associated positively with abdominal obesity in men (prevalence ratio (PR) = 1.358; 95% confidence interval (CI) 1.132–1.639; p = 0.001), but was associated negatively with general obesity in women (PR = 0.745; 95% CI: 0.673–0.807; p = 0.031). Men in the highest quartile of the wheat staple pattern had significantly greater risk of central obesity (PR = 1.331; 95% CI: 1.094–1.627; p = 0.005). There may be gender differences in the association between dietary patterns and obesity in middle-aged and elderly populations in Shanghai, China. PMID:27455322

Overlay metrology for double patterning processes

NASA Astrophysics Data System (ADS)

Leray, Philippe; Cheng, Shaunee; Laidler, David; Kandel, Daniel; Adel, Mike; Dinu, Berta; Polli, Marco; Vasconi, Mauro; Salski, Bartlomiej

2009-03-01

The double patterning (DPT) process is foreseen by the industry to be the main solution for the 32 nm technology node and even beyond. Meanwhile process compatibility has to be maintained and the performance of overlay metrology has to improve. To achieve this for Image Based Overlay (IBO), usually the optics of overlay tools are improved. It was also demonstrated that these requirements are achievable with a Diffraction Based Overlay (DBO) technique named SCOLTM [1]. In addition, we believe that overlay measurements with respect to a reference grid are required to achieve the required overlay control [2]. This induces at least a three-fold increase in the number of measurements (2 for double patterned layers to the reference grid and 1 between the double patterned layers). The requirements of process compatibility, enhanced performance and large number of measurements make the choice of overlay metrology for DPT very challenging. In this work we use different flavors of the standard overlay metrology technique (IBO) as well as the new technique (SCOL) to address these three requirements. The compatibility of the corresponding overlay targets with double patterning processes (Litho-Etch-Litho-Etch (LELE); Litho-Freeze-Litho-Etch (LFLE), Spacer defined) is tested. The process impact on different target types is discussed (CD bias LELE, Contrast for LFLE). We compare the standard imaging overlay metrology with non-standard imaging techniques dedicated to double patterning processes (multilayer imaging targets allowing one overlay target instead of three, very small imaging targets). In addition to standard designs already discussed [1], we investigate SCOL target designs specific to double patterning processes. The feedback to the scanner is determined using the different techniques. The final overlay results obtained are compared accordingly. We conclude with the pros and cons of each technique and suggest the optimal metrology strategy for overlay control in double patterning processes.

A tale of three Brownfields

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sweet, F.R.; Worthington, M.A.; Belli, E.

Contaminated site remediation and reuse, or Brownfield redevelopment, has become an increasingly important approach to site development in the northeast corridor, yet the scale of this activity is but a fraction of its full potential. The problem lies in the multi-jurisdictional quagmire that confronts a Brownfield project. Permitting such projects is an overly taxing dynamic process that has become a staple diet for adept multidisciplinary consulting firms. Limited government sanctions such as clean sites initiatives and economic revitalization zones are at best, when successful, interesting bench studies. The central hypothesis that, if regulations are streamlined then site reuse will occur,more » is sound. Yet streamlining brings concerns that the protection of public health and the environment will be compromised and that the result will be a lower standard of public protection for urban populations. The authors postulate that the permitting of Brownfield projects can be streamlined without creating a double standard of risk tolerance. The authors present evidence of this by comparing publicly and privately funded projects.« less

Single-row versus double-row rotator cuff repair: techniques and outcomes.

PubMed

Dines, Joshua S; Bedi, Asheesh; ElAttrache, Neal S; Dines, David M

2010-02-01

Double-row rotator cuff repair techniques incorporate a medial and lateral row of suture anchors in the repair configuration. Biomechanical studies of double-row repair have shown increased load to failure, improved contact areas and pressures, and decreased gap formation at the healing enthesis, findings that have provided impetus for clinical studies comparing single-row with double-row repair. Clinical studies, however, have not yet demonstrated a substantial improvement over single-row repair with regard to either the degree of structural healing or functional outcomes. Although double-row repair may provide an improved mechanical environment for the healing enthesis, several confounding variables have complicated attempts to establish a definitive relationship with improved rates of healing. Appropriately powered rigorous level I studies that directly compare single-row with double-row techniques in matched tear patterns are necessary to further address these questions. These studies are needed to justify the potentially increased implant costs and surgical times associated with double-row rotator cuff repair.

Effect of double-layer application on dentin bond durability of one-step self-etch adhesives.

PubMed

Taschner, M; Kümmerling, M; Lohbauer, U; Breschi, L; Petschelt, A; Frankenberger, R

2014-01-01

The aim of this in vitro study was 1) to analyze the influence of a double-layer application technique of four one-step self-etch adhesive systems on dentin and 2) to determine its effect on the stability of the adhesive interfaces stored under different conditions. Four different one-step self-etch adhesives were selected for the study (iBondSE, Clearfil S(3) Bond, XenoV(+), and Scotchbond Universal). Adhesives were applied according to manufacturers' instructions or with a double-layer application technique (without light curing of the first layer). After bonding, resin-dentin specimens were sectioned for microtensile bond strength testing in accordance with the nontrimming technique and divided into 3 subgroups of storage: a) 24 hours (immediate bond strength, T0), b) six months (T6) in artificial saliva at 37°C, or c) five hours in 10 % NaOCl at room temperature. After storage, specimens were stressed to failure. Fracture mode was assessed under a light microscope. At T0, iBond SE showed a significant increase in microtensile bond strength when the double-application technique was applied. All adhesive systems showed reduced bond strengths after six months of storage in artificial saliva and after storage in 10% NaOCl for five hours; however at T6, iBond SE, Clearfil S(3) Bond, and XenoV(+) showed significantly higher microtensile bond strength results for the double-application technique compared with the single-application technique. Scotchbond Universal showed no difference between single- or double-application, irrespective of the storage conditions. The results of this study show that improvements in bond strength of one-step self-etch adhesives by using the double-application technique are adhesive dependent.

A mechanical comparison of linear and double-looped hung supplemental heavy chain resistance to the back squat: a case study.

PubMed

Neelly, Kurt R; Terry, Joseph G; Morris, Martin J

2010-01-01

A relatively new and scarcely researched technique to increase strength is the use of supplemental heavy chain resistance (SHCR) in conjunction with plate weights to provide variable resistance to free weight exercises. The purpose of this case study was to determine the actual resistance being provided by a double-looped versus a linear hung SHCR to the back squat exercise. The linear technique simply hangs the chain directly from the bar, whereas the double-looped technique uses a smaller chain to adjust the height of the looped chain. In both techniques, as the squat descends, chain weight is unloaded onto the floor, and as the squat ascends, chain weight is progressively loaded back as resistance. One experienced and trained male weight lifter (age = 33 yr; height = 1.83 m; weight = 111.4 kg) served as the subject. Plate weight was set at 84.1 kg, approximately 50% of the subject's 1 repetition maximum. The SHCR was affixed to load cells, sampling at a frequency of 500 Hz, which were affixed to the Olympic bar. Data were collected as the subject completed the back squat under the following conditions: double-looped 1 chain (9.6 kg), double-looped 2 chains (19.2 kg), linear 1 chain, and linear 2 chains. The double-looped SHCR resulted in a 78-89% unloading of the chain weight at the bottom of the squat, whereas the linear hanging SHCR resulted in only a 36-42% unloading. The double-looped technique provided nearly 2 times the variable resistance at the top of the squat compared with the linear hanging technique, showing that attention must be given to the technique used to hang SHCR.

Interferometric Methods of Measuring Refractive Indices and Double-Refraction of Fibres.

ERIC Educational Resources Information Center

Hamza, A. A.; El-Kader, H. I. Abd

1986-01-01

Presents two methods used to measure the refractive indices and double-refraction of fibers. Experiments are described, with one involving the use of Pluta microscope in the double-beam interference technique, the other employing the multiple-beam technique. Immersion liquids are discussed that can be used in the experiments. (TW)

Functional and structural outcomes of single-row versus double-row versus combined double-row and suture-bridge repair for rotator cuff tears.

PubMed

Mihata, Teruhisa; Watanabe, Chisato; Fukunishi, Kunimoto; Ohue, Mutsumi; Tsujimura, Tomoyuki; Fujiwara, Kenta; Kinoshita, Mitsuo

2011-10-01

Although previous biomechanical research has demonstrated the superiority of the suture-bridge rotator cuff repair over double-row repair from a mechanical point of view, no articles have described the structural and functional outcomes of this type of procedure. The structural and functional outcomes after arthroscopic rotator cuff repair may be different between the single-row, double-row, and combined double-row and suture-bridge (compression double-row) techniques. Cohort study; Level of evidence, 3. There were 206 shoulders in 201 patients with full-thickness rotator cuff tears that underwent arthroscopic rotator cuff repair. Eleven patients were lost to follow-up. Sixty-five shoulders were repaired using the single-row, 23 shoulders using the double-row, and 107 shoulders using the compression double-row techniques. Clinical outcomes were evaluated at an average of 38.5 months (range, 24-74 months) after rotator cuff repair. Postoperative cuff integrity was determined using Sugaya's classification of magnetic resonance imaging (MRI). The retear rates after arthroscopic rotator cuff repair were 10.8%, 26.1%, and 4.7%, respectively, for the single-row, double-row, and compression double-row techniques. In the subcategory of large and massive rotator cuff tears, the retear rate in the compression double-row group (3 of 40 shoulders, 7.5%) was significantly less than those in the single-row group (5 of 8 shoulders, 62.5%, P < .001) and the double-row group (5 of 12 shoulders, 41.7%, P < .01). Postoperative clinical outcomes in patients with a retear were significantly lower than those in patients without a retear for all 3 techniques. The additional suture bridges decreased the retear rate for large and massive tears. The combination of the double-row and suture-bridge techniques, which had the lowest rate of postoperative retear, is an effective option for arthroscopic repair of the rotator cuff tendons because the postoperative functional outcome in patients with a retear is inferior to that without retear.

Stapled haemorrhoidopexy: extent of tissue excision and clinical implications in the early postoperative period.

PubMed

Behboo, R; Zanella, S; Ruffolo, C; Vafai, M; Marino, F; Scarpa, M

2011-06-01

This study quantified prospectively the amount of rectal wall removed during stapled haemorrhoidopexy and assessed its effect on ano-rectal function and health-related quality of life. Thirty-three consecutive patients who underwent stapled haemorrhoidopexy for second- or third- degree haemorrhoids, or for failed medical treatment, in the Department of Surgery and Gastroenterological Sciences at the University of Padova were included. All patients were assessed preoperatively and postoperatively using a structured questionnaire to determine the number of defecations per week, incomplete defecations, time taken to defecate any difficulty in defecating, soiling, the use of drugs and continence. All patients were reassessed at 1 and 2 weeks and at 30 days after the procedure using the Cleveland Global Quality of Life (CGQL) questionnaire. All patients underwent preoperative and postoperative ano-rectal manometry at least 30 days after stapled haemorrhoidopexy. The median surface area of the resected rectal wall was 10.5 (range, 9-15) mm(2) and the median thickness was 3 (range, 2-4) mm. Muscle tissue was included in all specimens. The median thickness of the resected rectal wall correlated inversely with the rectal volume when the recto-anal inhibitory reflex (RAIR) was initiated during postoperative manometry (ρ = -0.50, P = 0.07). A significant, direct correlation was found between the surface area of the resected rectal wall and the rectal volume during postoperative manometry (ρ = 0.53, P = 0.08) and the use of analgesic drugs after 2 weeks (ρ = 0.63, P = 0.04). Significant correlations were found between being female and postoperative resting pressure (ρ = -0.74, P < 0.01), squeeze pressure (ρ = -0.64, P = 0.01) and maximum tolerated volume (ρ = -0.78, P < 0.01). Stapled haemorrhoidopexy is safe and effective. The thicker the resected rectal wall, the lower the volume of initiation of the RAIR. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and Ireland.

In vitro biomechanical comparison of three different types of single- and double-row arthroscopic rotator cuff repairs: analysis of continuous bone-tendon contact pressure and surface during different simulated joint positions.

PubMed

Grimberg, Jean; Diop, Amadou; Kalra, Kunal; Charousset, Christophe; Duranthon, Louis-Denis; Maurel, Nathalie

2010-03-01

We assessed bone-tendon contact surface and pressure with a continuous and reversible measurement system comparing 3 different double- and single-row techniques of cuff repair with simulation of different joint positions. We reproduced a medium supraspinatus tear in 24 human cadaveric shoulders. For the 12 right shoulders, single-row suture (SRS) and then double-row bridge suture (DRBS) were used. For the 12 left shoulders, DRBS and then double-row cross suture (DRCS) were used. Measurements were performed before, during, and after knot tying and then with different joint positions. There was a significant increase in contact surface with the DRBS technique compared with the SRS technique and with the DRCS technique compared with the SRS or DRBS technique. There was a significant increase in contact pressure with the DRBS technique and DRCS technique compared with the SRS technique but no difference between the DRBS technique and DRCS technique. The DRCS technique seems to be superior to the DRBS and SRS techniques in terms of bone-tendon contact surface and pressure. Copyright 2010 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Laparoscopic subtotal colectomy with transrectal extraction of the colon and ileorectal anastomosis.

PubMed

Awad, Ziad T

2012-03-01

Despite the growing acceptance of laparoscopic colon surgery, an abdominal incision is needed to remove the specimen and perform an anastomosis. Five trocars (one 12 mm and four 5 mm) were used. The video describes the technique of performing laparoscopic subtotal colectomy, laparoscopic cholecystectomy, transrectal removal of the gallbladder and the entire colon, and intracorporeal stapled ileorectal anastomosis in a 27-year-old female with colonic inertia and biliary dyskinesia. There were no intraoperative complications. The operating time was 180 min. Blood loss was 10 cc. The patient was discharged home on postoperative day 4. Laparoscopic subtotal colectomy with transrectal removal of the colon is a safe and effective procedure that can be added to the armamentarium of surgeons performing laparoscopic colon surgery. This technique may provide both an attractive way to reduce abdominal wall morbidity and a bridge to NOTES colon surgery.

Photoreactive Stapled BH3 Peptides to Dissect the BCL-2 Family Interactome

PubMed Central

Braun, Craig R.; Mintseris, Julian; Gavathiotis, Evripidis; Bird, Gregory H.; Gygi, Steven P.; Walensky, Loren D.

2010-01-01

SUMMARY Defining protein interactions forms the basis for discovery of biological pathways, disease mechanisms, and opportunities for therapeutic intervention. To harness the robust binding affinity and selectivity of structured peptides for interactome discovery, we engineered photoreactive stapled BH3 peptide helices that covalently capture their physiologic BCL-2 family targets. The crosslinking α-helices covalently trap both static and dynamic protein interactors, and enable rapid identification of interaction sites, providing a critical link between interactome discovery and targeted drug design. PMID:21168768

Stapled peptide inhibitors of RAB25 target context-specific phenotypes in cancer | Office of Cancer Genomics

Cancer.gov

Recent evidence has established a role for the small GTPase RAB25, as well as related effector proteins, in enacting both pro-oncogenic and anti-oncogenic phenotypes in specific cellular contexts. Here we report the development of all-hydrocarbon stabilized peptides derived from the RAB-binding FIP-family of proteins to target RAB25. Relative to unmodified peptides, optimized stapled peptides exhibit increased structural stability, binding affinity, cell permeability, and inhibition of RAB25:FIP complex formation.

Noise Hazard Evaluation Sound Level Data on Noise Sources

DTIC Science & Technology

1975-01-01

Saw, Root Woodworking 43-20-J 102 16. Construction Saw, DeWalt Industrial 2185A 96 17. Cross-Cut Sw, Automatic 1-H 94 18, Cross-Cut Saw, DeWalt 3561...Saw, GM Diehr 750 92 53. Rip Saw, Wabach Industrial 750 97 59. Rip Saw, Yates American B. 102 60. Router: Black & Decker 118 61. Ruuter, Rockwell 150B...13. Sander, Disk, National-Detroit Dual Action 100 14. Stapler , Senco Mll 94* 15. Stapling Gun, Bostich II 105* 16. Stapling Gun, Bostich III 104* 17

The Boer-Mulders Transverse Momentum Distribution in the Pion and its Evolution in Lattice QCD

NASA Astrophysics Data System (ADS)

Engelhardt, M.; Musch, B.; Hägler, P.; Schäfer, A.; Negele, J.

2015-02-01

Starting from a definition of transverse momentum-dependent parton distributions (TMDs) in terms of hadronic matrix elements of a quark bilocal operator containing a staple-shaped gauge link, selected TMD observables can be evaluated within Lattice QCD. A TMD ratio describing the Boer-Mulders effect in the pion is investigated, with a particular emphasis on its evolution as a function of a Collins-Soper-type parameter which quantifies the proximity of the staple-shaped gauge links to the light cone.

Surgical treatment of haemorrhoids according to Longo and Milligan Morgan: an evaluation of postoperative tissue response.

PubMed

Krska, Z; Kvasnièka, J; Faltýn, J; Schmidt, D; Sváb, J; Kormanová, K; Hubík, J

2003-11-01

To compare by prospective randomised trial the postoperative tissue reaction of stapled vs. conventional haemorrhoidectomy. Fifty patients with stage III haemorrhoids underwent surgery for haemorrhoids. Group 1 (n = 25) had the Milligan-Morgan procedure; Group 2 (n = 25) had a stapled haemorrhoidectomy. All patients underwent measurements of endothelial dysfunction markers including E-selectin, P-selectin and intercellular adhesion molecule (ICAM). Acute-phase proteins including C-reactive protein, orosomucoid and fibrinogen were also measured. Estimations were made prior to surgery, immediately afterward surgery and on the first and fifth postoperative days. Assessment of clinical outcome was made one month after the surgery. There was a postoperative increase of acute-phase reactants in both groups. The patterns of the cures of the monitored parameters appeared similar in both groups. Lower values were found in Group 1, but the difference was not statistically significant except the level of fibrinogen on day 5, which was significantly higher in Group 2. E-selectin, P-selectin and ICAM showed similar time curves. Statistical analysis found the differences to be significant only when individual days were compared and not for the types of surgery. Raised ICAM and P-selectin on the fifth postoperative day was found in both groups. In Group 1, pain assessment by patients remained in the lower part of the pain rating scale, while in Group 2 it did not start declining until one week after surgery and became normal in the third to fourth weeks. In Group 1, the duration of hospitalization and the duration of incapacity for work were 50% of the values in Group 2. Patients having stapled haemorrhoidectomy have less pain and experience more rapid recovery when compared to classical haemorroidectomy. This was mirrored by the acute-phase protein CRP and fibrinogen levels postoperatively. There was no significant difference in other acute-phase reactants monitored, nor was there any difference in parameters of endothelial dysfunction. The techniques differ in extent of pain and duration of hospital stay and incapacity for work.

No evidence that manual closure of the bronchial stump has a lower failure rate than mechanical stapler closure following anatomical lung resection

PubMed Central

Zakkar, Mustafa; Kanagasabay, Robin; Hunt, Ian

2014-01-01

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether manual closure of the bronchial stump is safer with lower failure rates than mechanical closure using a stapling device following anatomical lung resection. One hundred and twenty-nine papers were identified using the search below. Eight papers presented the best evidence to answer the clinical question as they included sufficient number of patients to reach conclusions regarding the issues of interest for this review. Complications, complication rates and operation time were included in the assessment. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. When looking at manual vs mechanical staples, it was noted that stapler failure can occur in around 4% of cases. The rate of bronchopleural fistula (BPF) development varied more in patients who underwent manual closure (1.5–12.5%) than in patients who underwent mechanical closure (1–5.7%). Although most of the studies reviewed showed no statistical differences between manual and mechanical closure in terms of BPF development, one study, however, showed that manual closure was significantly associated with lower numbers of postoperative BPF, while another study showed that mechanical closure is significantly associated with lower incidence of BPF. When looking at the role of the learning curve and training opportunities, it seems that the surgeon's inexperience when using mechanical staples can contribute to BPF development. A surgeon's experience can play a major role in the prevention of BPF development in patients having manual closure. Manual closure can provide a cheap and reliable technique when compared with costs incurred from using staplers, it is applicable in all situations and can be taught to surgeons in training with an acceptable risk. However, there is a lack of evidence to suggest that manual closure is better than mechanical stapler closure following anatomical lung resection. PMID:24351508

Surgical technique of en bloc pelvic resection for advanced ovarian cancer.

PubMed

Chang, Suk Joon; Bristow, Robert E

2015-04-01

The aim of this paper was to describe the operative details for en bloc removal of the adnexal tumor, uterus, pelvic peritoneum, and rectosigmoid colon with colorectal anastomosis in advanced epithelial ovarian cancer patients with widespread pelvic involvement. The patient presented with good performance status and huge pelvic tumor extensively infiltrating into adjacent pelvic organs and obliterating the cul-de-sac. The patient underwent en bloc pelvic resection as primary cytoreductive surgery. En bloc pelvic resection procedure is initiated by carrying a circumscribing peritoneal incision to include all pan-pelvic disease within this incision. After retroperitoneal pelvic dissection, the round ligaments and infundibulopelvic ligaments are divided. The ureters are dissected and mobilized from the peritoneum. After dissecting off the anterior pelvic peritoneum overlying the bladder with its tumor nodules, the bladder is mobilized caudally and the vesicovaginal space is developed. The uterine vessels are divided at the level of the ureters, and the paracervical tissues (or parametria) are divided. The proximal sigmoid colon is divided above the most proximal extent of gross tumor using a ligating and dividing stapling device. The sigmoid mesentery is ligated and divided including the superior rectal vessels. The pararectal and retrorectal spaces are further developed and dissected down to the level of the pelvic floor. The posterior dissection is progressed and moves to the right and then to the left of the rectum. The rectal pillars including the middle rectal vessels are ligated and divided. Hysterectomy is completed in a retrograde fashion. The distal rectum is divided using a linear stapler. The specimen is removed en bloc with the uterus, adnexa, pelvic peritoneum, rectosigmoid colon, and tumor masses leaving a macroscopically tumor-free pelvis. Colorectal anastomosis was completed using stapling device. En bloc pelvic resection was performed by total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic peritonectomy, and rectosigmoid colectomy with colorectal anastomosis using a stapling device. Complete clearance of pelvic disease leaving no gross residual disease was possible using en bloc pelvic resection. En bloc pelvic resection is effective for achieving maximal cytoreduction with the elimination of the pelvic disease in advanced primary ovarian cancer patients with extensive pelvic organ involvement.

The Gut Microbiota, Food Science, and Human Nutrition: A Timely Marriage.

PubMed

Barratt, Michael J; Lebrilla, Carlito; Shapiro, Howard-Yana; Gordon, Jeffrey I

2017-08-09

Analytic advances are enabling more precise definitions of the molecular composition of key food staples incorporated into contemporary diets and how the nutrient landscapes of these staples vary as a function of cultivar and food processing methods. This knowledge, combined with insights about the interrelationship between consumer microbiota configurations and biotransformation of food ingredients, should have a number of effects on agriculture, food production, and strategies for improving the nutritional value of foods and health status. These effects include decision-making about which cultivars of current or future food staples to incorporate into existing and future food systems, and which components of waste streams from current or future food manufacturing processes have nutritional value that is worth capturing. They can also guide which technologies should be applied, or need to be developed, to produce foods that support efficient microbial biotransformation of their ingredients into metabolic products that sustain health. Copyright © 2017 Elsevier Inc. All rights reserved.

Anesthetic management of the SRS™ Endoscopic Stapling System for gastro-esophageal reflux disease.

PubMed

Topuz, Ufuk; Umutoglu, Tarik; Bakan, Mefkur; Ozturk, Erdogan

2013-01-14

The SRS(TM) Endoscopic Stapling System (Medigus, Tel Aviv, Israel) is a new tool capable of creating a totally endoscopic fundoplication, combined with an endoscope, endoscopic ultrasound and a surgical stapler. SRS(TM) endoscopic stapling for gastro-esophageal reflux disease is a minimally invasive, outpatient procedure, which requires general anesthesia with positive-pressure ventilation. Keeping the patient on positive end-expiratory pressure (PEEP) may minimize the pressure gradient between the esophagus and the mediastinum, as well as help to prevent air from leaking around the screws and causing pneumomediastinum. In addition, in patients with hiatal hernia, higher PEEP levels may be required to increase intra-thoracic pressure and to force the stomach to slide into the abdomen for ease of endoscopy. We advise smoother emergence from anesthesia, taking precautions for retching, postoperative nausea and vomiting (PONV), while coughing and gagging during extubation and PONV may affect the success of the procedure. Total intravenous anesthesia with propofol and remifentanil seems to be a good choice for these reasons.

Does double-row rotator cuff repair improve functional outcome of patients compared with single-row technique? A systematic review.

PubMed

DeHaan, Alexander M; Axelrad, Thomas W; Kaye, Elizabeth; Silvestri, Lorenzo; Puskas, Brian; Foster, Timothy E

2012-05-01

The advantage of single-row versus double-row arthroscopic rotator cuff repair techniques has been a controversial issue in sports medicine and shoulder surgery. There is biomechanical evidence that double-row techniques are superior to single-row techniques; however, there is no clinical evidence that the double-row technique provides an improved functional outcome. When compared with single-row rotator cuff repair, double-row fixation, although biomechanically superior, has no clinical benefit with respect to retear rate or improved functional outcome. Systematic review. The authors reviewed prospective studies of level I or II clinical evidence that compared the efficacy of single- and double-row rotator cuff repairs. Functional outcome scores included the American Shoulder and Elbow Surgeons (ASES) shoulder scale, the Constant shoulder score, and the University of California, Los Angeles (UCLA) shoulder rating scale. Radiographic failures and complications were also analyzed. A test of heterogeneity for patient demographics was also performed to determine if there were differences in the patient profiles across the included studies. Seven studies fulfilled our inclusion criteria. The test of heterogeneity across these studies showed no differences. The functional ASES, Constant, and UCLA outcome scores revealed no difference between single- and double-row rotator cuff repairs. The total retear rate, which included both complete and partial retears, was 43.1% for the single-row repair and 27.2% for the double-row repair (P = .057), representing a trend toward higher failures in the single-row group. Through a comprehensive literature search and meta-analysis of current arthroscopic rotator cuff repairs, we found that the single-row repairs did not differ from the double-row repairs in functional outcome scores. The double-row repairs revealed a trend toward a lower radiographic proven retear rate, although the data did not reach statistical significance. There may be a concerning trend toward higher retear rates in patients undergoing a single-row repair, but further studies are required.

Double Coaxial Microcatheter Technique for Glue Embolization of Renal Arteriovenous Malformations

DOE Office of Scientific and Technical Information (OSTI.GOV)

Uchikawa, Yoko, E-mail: jauchikawa@gmail.com; Mori, Kensaku, E-mail: moriken@md.tsukuba.ac.jp; Shiigai, Masanari, E-mail: m-41gai@yahoo.co.jp

PurposeTo demonstrate the technical benefit of the double coaxial microcatheter technique for embolization of renal arteriovenous malformations (AVMs) with n-butyl cyanoacrylate and iodized oil (glue).Materials and MethodsSix consecutive patients (1 man and 5 women; mean age 61 years; range 44–77 years) with renal AVMs were included. Five patients had hematuria, and one had a risk of heart failure due to a large intrarenal arteriovenous shunt. All patients underwent transarterial embolization using glue and the double coaxial microcatheter technique with outer 2.6F and inner 1.9F microcatheters. After glue injection, the inner microcatheter was retracted, while the outer microcatheter was retained. We assessed themore » complications and clinical outcomes of this technique.ResultsTechnical success was achieved in all patients. In 9 sessions, 34 feeding arteries were embolized with glue using the double coaxial microcatheter technique, 1 was embolized with glue using a single microcatheter, and 2 were embolized with coils. The double coaxial microcatheter technique was useful for selecting small tortuous feeding arteries, preventing glue reflux to the proximal arteries, and approaching multiple feeding arteries without complete retraction of the microcatheters. As a minor complication, glue migrated into the venous system in four patients without any sequelae. In all patients, favorable clinical outcomes, including hematuria cessation in five patients and improvement of the large intrarenal arteriovenous shunt in one patient, were obtained without deterioration of renal function.ConclusionGlue embolization with the double coaxial microcatheter technique was useful for treating renal AVMs with multiple tortuous feeding arteries.« less

Biomechanical evaluation of a single-row versus double-row repair for complete subscapularis tears.

PubMed

Wellmann, Mathias; Wiebringhaus, Philipp; Lodde, Ina; Waizy, Hazibullah; Becher, Christoph; Raschke, Michael J; Petersen, Wolf

2009-12-01

The purpose of the study was to compare a single-row repair and a double-row repair technique for the specific characteristics of a complete subscapularis lesion. Ten pairs of human cadaveric shoulder human shoulder specimens were tested for stiffness and ultimate tensile strength of the intact tendons in a load to failure protocol. After a complete subscapularis tear was provoked, the specimens were assigned to two treatment groups: single-row repair (1) and a double-row repair using a "suture bridge" technique (2). After repair cyclic loading a subsequent load to failure protocol was performed to determine the ultimate tensile load, the stiffness and the elongation behaviour of the reconstructions. The intact subscapularis tendons had a mean stiffness of 115 N/mm and a mean ultimate load of 720 N. The predominant failure mode of the intact tendons was a tear at the humeral insertion site (65%). The double-row technique restored 48% of the ultimate load of the intact tendons (332 N), while the single-row technique revealed a significantly lower ultimate load of 244 N (P = 0.001). In terms of the stiffness, the double-row technique showed a mean stiffness of 81 N/mm which is significantly higher compared to the stiffness of the single-row repairs of 55 N/mm (P = 0.001). The double-row technique has been shown to be stronger and stiffer when compared to a conventional single-row repair. Therefore, this technique is recommended from a biomechanical point of view irrespectively if performed by an open or arthroscopic approach.

Effective treatment of haemorrhoids: early complication and late results after 150 consecutive stapled haemorrhoidectomies.

PubMed

Bove, Aldo; Bongarzoni, Giuseppe; Palone, Gino; Chiarini, Stella; Calisesi, Enrico Maria; Corbellini, Luciano

2009-01-01

Haemorrhoidectomy according to Longo potentially reduces post-operative pain and allows an early return to work. The aim of this study was to evaluate the efficacy of the technique, the early and especially late complications, and recurrences, in 150 patients. Between January 2005 and December 2006, we performed 150 consecutive haemorrhoidectomies with the Longo technique: 82 for third degree haemorrhoids and 68 for fourth degree haemorrhoids. The mean age of patients was 42 years. Every patient had a pre-operative proctoscopy and endoscopy KIT PPH01 (Ethicon Endo Surgery) was used. We evaluated the length of the operation, the post-operative pain, the early and late complications, and the recurrence of the disease. The mean follow up was 52 months (range 36-72). There was no mortality. The mean length of the operation was 25 minutes with a range of 15 to 45 minutes. Pain, evaluated using the V.A.S. scale, was very light in 114 patients (V.A.S. 2,1) and light in 36 (V.A.S. 3.2). Only 11 (7.5%) patients took painkillers, on demand, for a week after discharge from hospital and 2 patients (1,3%) for more than one month. Early complications (6.6%) were: 5 bleeding (2 after seven days), 4 acute urinary retentions, 1 external haemorrhoid thrombosis and 1 haematoma of the rectus wall. Mean Hospital stay was 2.1 days. Late complications (10%) were: 5 "faecal urgency" which disappeared after six months, 6 moderate asymptomatic strictures, and 4 persistent skin tags. There were 8 recurrences (5.1%), 2 for haemorrhoids of grade 3 e 6 for haemorrhoids of grade 4. All the recurrences appeared within the first 24 months. The stapled procedure according to Longo is an effective treatment for haemorrhoids. The results for postoperative pain and early return to work are very good. However, special care for haemostasis is essential in order to avoid bleeding. An effective surgical technique prevents late complications, but results after long term follow up show a not insignificant percentage of recurrences that appeared especially in the fourth degree haemorrhoids. Therefore a careful pre-operative exclusion of those patients with a prominent prolax is necessary

An enhanced functional interrogation/manipulation of intracellular signaling pathways with the peptide 'stapling' technology.

PubMed

He, Y; Chen, D; Zheng, W

2015-11-12

Specific protein-protein interactions (PPIs) constitute a key underlying mechanism for the presence of a multitude of intracellular signaling pathways, which are essential for the survival of normal and cancer cells. Specific molecular blockers for a crucial PPI would therefore be invaluable tools for an enhanced functional interrogation of the signaling pathway harboring this particular PPI. On the other hand, if a particular PPI is essential for the survival of cancer cells but is absent in or dispensable for the survival of normal cells, its specific molecular blockers could potentially be developed into effective anticancer therapeutics. Due to the flat and extended PPI interface, it would be conceivably difficult for small molecules to achieve an effective blockade, a problem which could be potentially circumvented with peptides or proteins. However, the well-documented proteolytic instability and cellular impermeability of peptides and proteins in general would make their developing into effective intracellular PPI blockers quite a challenge. With the advent of the peptide 'stapling' technology which was demonstrated to be able to stabilize the α-helical conformation of a peptide via bridging two neighboring amino-acid side chains with a 'molecular staple', a linear parent peptide could be transformed into a stronger PPI blocker with enhanced proteolytic stability and cellular permeability. This review will furnish an account on the peptide 'stapling' technology and its exploitation in efforts to achieve an enhanced functional interrogation or manipulation of intracellular signaling pathways especially those that are cancer relevant.

Unexpected involvement of staple leads to redesign of selective bicyclic peptide inhibitor of Grb7

NASA Astrophysics Data System (ADS)

Gunzburg, Menachem J.; Kulkarni, Ketav; Watson, Gabrielle M.; Ambaye, Nigus D.; Del Borgo, Mark P.; Brandt, Rebecca; Pero, Stephanie C.; Perlmutter, Patrick; Wilce, Matthew C. J.; Wilce, Jacqueline A.

2016-06-01

The design of potent and specific peptide inhibitors to therapeutic targets is of enormous utility for both proof-of-concept studies and for the development of potential new therapeutics. Grb7 is a key signaling molecule in the progression of HER2 positive and triple negative breast cancers. Here we report the crystal structure of a stapled bicyclic peptide inhibitor G7-B1 in complex with the Grb7-SH2 domain. This revealed an unexpected binding mode of the peptide, in which the staple forms an alternative contact with the surface of the target protein. Based on this structural information, we designed a new series of bicyclic G7 peptides that progressively constrain the starting peptide, to arrive at the G7-B4 peptide that binds with an approximately 2-fold enhanced affinity to the Grb7-SH2 domain (KD = 0.83 μM) compared to G7-B1 and shows low affinity binding to Grb2-, Grb10- and Grb14-SH2 domains (KD > 100 μM). Furthermore, we determined the structure of the G7-B4 bicyclic peptide in complex with the Grb7-SH2 domain, both before and after ring closing metathesis to show that the closed staple is essential to the target interaction. The G7-B4 peptide represents an advance in the development of Grb7 inhibitors and is a classical example of structure aided inhibitor development.

Effect of public symphysiodesis on pelvic development in the skeletally immature greyhound.

PubMed

Swainson, S W; Conzemius, M G; Riedesel, E A; Smith, G K; Riley, C B

2000-01-01

To evaluate the effect of pubic symphysiodesis (PS) on pelvic development in skeletally immature dogs. Prospective randomized clinical trial. Eight 4 month-old, sexually intact female Greyhounds. Initial PS was performed at 4 months of age using a powered stapling device. Because of failure of the initial surgery, a second PS was performed 1 month later by resecting the pubic symphysis with a rongeur followed by placement of handmade bone staples in four dogs. Sham PS was performed in four control dogs at 4 months of age. Pubic growth rate and pelvic development were evaluated using standard plane radiography and computed tomography. Specific measurements included acetabular ventroversion, Norberg angle, lateral center-edge angle, and pelvic inlet dimensions. Hip distraction indices were determined as well. PS at 4 months of age using a stapling device failed. Pubic symphysiodesis using hand made staples was successful at 5 months of age and did not result in any clinically significant intraoperative or postoperative complications. Pubic symphysiodesis markedly decreased pubic symphysis growth in the treatment group. Hip distraction indices and pelvic inlet circumference, area, and width significantly decreased in treated dogs compared to those in the control group. Acetabular ventroversion was significantly increased in treated dogs compared to those in the control group. PS decreases pelvic canal size, increases acetabular ventroversion, and does not appear to have any clinically significant complications. PS performed in skeletally immature dogs with hip dysplasia may provide an effect similar to a triple pelvic osteotomy and warrants further investigation.

Is hand sewing comparable with stapling for anastomotic leakage after esophagectomy? A meta-analysis

PubMed Central

Liu, Quan-Xing; Min, Jia-Xin; Deng, Xu-Feng; Dai, Ji-Gang

2014-01-01

AIM: To compare the outcome of hand sewing and stapling for anastomotic leakage after esophagectomy. METHODS: A rigorous study protocol was established according to the recommendations of the Cochrane Collaboration. An electronic database search, hand search, and reference search were used to retrieve all randomized controlled trials that compared hand-sewn and mechanical esophagogastric anastomoses. RESULTS: This study included 15 randomized controlled trials with a total of 2337 patients. The results revealed that there was no significant difference in the incidence of anastomotic leakage between the methods [relative risk (RR) = 0.77, 95% confidence interval (CI): 0.57-1.04; P = 0.09], but a subgroup analysis yielded a significant difference for the sutured layer and year of publication (Ps < 0.05). There was also no significant difference in the incidence of postoperative mortality (RR = 1.52, 95%CI: 0.97-2.40; P = 0.07). However, the anastomotic strictures rate was increased in the stapler group compared with the hand-sewn group (RR = 1.45, 95%CI: 1.11-1.91; P < 0.01) in the end-to-side subgroup, while the incidence of anastomotic strictures was decreased (RR = 0.34, 95%CI: 0.16-0.76; P < 0.01) in the side-to-side subgroup. CONCLUSION: The stapler reduces the anastomotic leakage rate compared with hand sewing. End-to-side stapling increases the risk of anastomotic strictures, but side-to-side stapling decreases the risk. PMID:25493038

Results of More Than 11,800 Sleeve Gastrectomies: Data Analysis of the German Bariatric Surgery Registry.

PubMed

Stroh, Christine; Köckerling, Ferdinand; Volker, Lange; Frank, Benedix; Stefanie, Wolff; Christian, Knoll; Christiane, Bruns; Thomas, Manger

2016-05-01

Laparoscopic sleeve gastrectomy (SG) is an upcoming procedure in bariatric surgery and is currently performed worldwide. Staple line leakage, as the most frequent and most feared complication, is still a major concern. Since 2005 data from patients undergoing bariatric procedures in Germany have been prospectively registered in an online database and analyzed. All patients who had undergone primary SG within a 7-year period were considered for analysis. Using the German Bariatric Surgery Registry, data from more than 11,800 SGs were collected between January 1, 2005, and December 31, 2013. Staple line leak rate decreased from 6.5% to 1.4%. Male sex, higher body mass index, concomitant sleep apnea, conversion to laparotomy, longer operation time, a combination of buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate compared with when using either buttresses or oversewing alone. On multivariable analysis, operation time and year of procedure only had a significant impact on staple line leakage rate. Owing to the growing experience a constant decrease in the leakage rate after SG has been observed. Staple line disruption may still lead to sepsis, multiorgan dysfunction, and increased mortality. The results of the current study demonstrated that there are factors that increase the risk of leakage and which would enable surgeons to define risk groups, select patients more carefully, and offer closer follow-up during the postoperative course with early recognition and adequate treatment.

Advances in circular stapling technique for gastric bypass: transoral placement of the anvil.

PubMed

Nguyen, Ninh T; Hinojosa, Marcelo W; Smith, Brian R; Reavis, Kevin M; Wilson, Samuel E

2008-05-01

In Roux-en-Y gastric bypass, construction of the gastrojejunostomy is commonly performed using a circular stapler. The initial description for placement of the anvil was via the transoral approach. Although the concept was ingenious, technical difficulty was encountered during passage resulting in complications such as hypopharyngeal perforation and esophageal mucosal injury. As a result, most surgeons subsequently changed their route of anvil placement to the transabdominal approach. Advances in stapler technology now allow the head of the anvil to be pre-tilted, permitting transoral introduction with greater ease and safety. This paper describes this improved method for transoral placement of the anvil during laparoscopic gastric bypass and reoperative bariatric surgery.

Comparison of Single-Stick and Double-Stick Techniques for Percutaneous Nephrostomy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Funaki, Brian, E-mail: bfunaki@midway.uchicago.edu; Vatakencherry, Geogi

2004-01-15

We compared single- and double-stick techniques of percutaneous nephrostomy insertion by retrospectively reviewing 140 percutaneous nephrostomy procedures in 101 patients. All procedures were performed by residents or fellows with direct attending supervision. Either the single-stick or double-stick technique was used based solely on personal attending preference. There were no significant differences in groups in terms of age, sex, or degree of hydronephrosis. In the single-stick technique, the kidney was punctured with sonographic guidance and the tract was serially dilated to accept an 8.5 Fr. nephrostomy catheter. In the double-stick technique, the kidney was punctured with sonographic guidance and a mixturemore » of air and contrast were injected into the collecting system. The affected side was then elevated and a posterior calyx was punctured using fluoroscopic guidance. Both groups were compared in terms of complications and early tube dysfunction using the chi-squared test. All procedures were successful without immediate complications. Bleeding requiring transfusion occurred in 4.7% (4/86) procedures in the single stick group and 3.7% (2/54) in the double stick group (p-value not significant). None of these patients required further interventions for bleeding. Tube dysfunction leading to premature tube exchange occurred in 3.5% (3/86) of catheters in the single stick group and 3.7% (2/54) of catheters in the double- stick group (p-value not significant). We found no significant difference between the single and double- stick methods of percutaneous nephrostomy in terms of success rates, complications, or tube function. We believe that the single-stick method should be adopted as the insertion technique of choice.« less

Double emulsion solvent evaporation techniques used for drug encapsulation.

PubMed

Iqbal, Muhammad; Zafar, Nadiah; Fessi, Hatem; Elaissari, Abdelhamid

2015-12-30

Double emulsions are complex systems, also called "emulsions of emulsions", in which the droplets of the dispersed phase contain one or more types of smaller dispersed droplets themselves. Double emulsions have the potential for encapsulation of both hydrophobic as well as hydrophilic drugs, cosmetics, foods and other high value products. Techniques based on double emulsions are commonly used for the encapsulation of hydrophilic molecules, which suffer from low encapsulation efficiency because of rapid drug partitioning into the external aqueous phase when using single emulsions. The main issue when using double emulsions is their production in a well-controlled manner, with homogeneous droplet size by optimizing different process variables. In this review special attention has been paid to the application of double emulsion techniques for the encapsulation of various hydrophilic and hydrophobic anticancer drugs, anti-inflammatory drugs, antibiotic drugs, proteins and amino acids and their applications in theranostics. Moreover, the optimized ratio of the different phases and other process parameters of double emulsions are discussed. Finally, the results published regarding various types of solvents, stabilizers and polymers used for the encapsulation of several active substances via double emulsion processes are reported. Copyright © 2015 Elsevier B.V. All rights reserved.

A meta-analysis of the use of a transanal drainage tube to prevent anastomotic leakage after anterior resection by double-stapling technique for rectal cancer.

PubMed

Shigeta, Kohei; Okabayashi, Koji; Baba, Hideo; Hasegawa, Hirotoshi; Tsuruta, Masashi; Yamafuji, Kazuo; Kubochi, Kiyoshi; Kitagawa, Yuko

2016-02-01

The safety and efficacy of transanal drainage tube (TDT) placement to decrease the risk of postoperative anastomotic leakage after rectal cancer surgery has not been validated. The objective of this meta-analysis was to evaluate the usefulness of a TDT for the prevention of anastomotic leakage after an anterior resection for rectal cancer. The PubMed and Cochrane Library databases were searched for studies comparing TDT and non-TDT. The endpoint utilized in this study was defined as the rates of anastomotic leakage and re-operation. The relative effects of these variables were synthesized using Review Manager 5.1 software. Four trials including 909 participants (401 TDT cases and 508 non-TDT cases) met our inclusion criteria. The weighted mean anastomotic leakage rate was 4% [95% confidence interval (CI) 1-6%], and a significantly lower risk of anastomotic leakage was identified in the TDT group compared with the non-TDT group [odds ratio (OR) 0.30; 95% CI 0.16-0.55; p = 0.0001]. Furthermore, there were significant differences between the TDT and non-TDT groups in terms of the re-operation rate (OR 0.18; 95% CI 0.07-0.44; p = 0.0002). No significant covariates related to anastomotic leakage or re-operation were identified in meta-regression analysis. Both the anastomotic leakage and re-operation rates for all studies lay inside the 95% confidence interval boundaries. No visible publication bias was found by visual assessment of the funnel plot (Egger's test; anastomotic leakage: p = 0.056, re-operation: p = 0.681). Placement of a TDT is an effective and safe procedure that can decrease the rate of anastomotic leakage and re-operation after an anterior resection.

Genomic-based-breeding tools for tropical maize improvement.

PubMed

Chakradhar, Thammineni; Hindu, Vemuri; Reddy, Palakolanu Sudhakar

2017-12-01

Maize has traditionally been the main staple diet in the Southern Asia and Sub-Saharan Africa and widely grown by millions of resource poor small scale farmers. Approximately, 35.4 million hectares are sown to tropical maize, constituting around 59% of the developing worlds. Tropical maize encounters tremendous challenges besides poor agro-climatic situations with average yields recorded <3 tones/hectare that is far less than the average of developed countries. On the contrary to poor yields, the demand for maize as food, feed, and fuel is continuously increasing in these regions. Heterosis breeding introduced in early 90 s improved maize yields significantly, but genetic gains is still a mirage, particularly for crop growing under marginal environments. Application of molecular markers has accelerated the pace of maize breeding to some extent. The availability of array of sequencing and genotyping technologies offers unrivalled service to improve precision in maize-breeding programs through modern approaches such as genomic selection, genome-wide association studies, bulk segregant analysis-based sequencing approaches, etc. Superior alleles underlying complex traits can easily be identified and introgressed efficiently using these sequence-based approaches. Integration of genomic tools and techniques with advanced genetic resources such as nested association mapping and backcross nested association mapping could certainly address the genetic issues in maize improvement programs in developing countries. Huge diversity in tropical maize and its inherent capacity for doubled haploid technology offers advantage to apply the next generation genomic tools for accelerating production in marginal environments of tropical and subtropical world. Precision in phenotyping is the key for success of any molecular-breeding approach. This article reviews genomic technologies and their application to improve agronomic traits in tropical maize breeding has been reviewed in detail.

Stapled ileoanal anastomosis for ulcerative colitis and familial polyposis without a temporary diverting ileostomy.

PubMed Central

Sugerman, H J; Newsome, H H; Decosta, G; Zfass, A M

1991-01-01

Between March 1989 and August 1990, we performed 21 stapled J pouch ileonal procedures (20 ulcerative colitis [UC], 1 familial polyposis [FP]) without an ileostomy in 19, of whom 13 were taking prednisone and eight underwent semi-emergent surgery for uncontrollable bleeding. During the same time, an additional four patients required a standard ileonal procedure. The results of anal manometry and clinical function were compared to 25 patients who had previously undergone mucosal stripping and a sutured J pouch ileoanal anastomoses with a temporary diverting ileostomy between October 1982 and August 1990. During this same time period, an additional 19 patients underwent an anti-peristaltic reversed J pouch and 18 an S pouch, for a total of 83 ileoanal procedures. The reversed J pouch had a lower stool frequency than a standard J pouch but had an unacceptable incidence of complications and problems with pouch emptying. The S pouch had a stool frequency similar to the standard J pouch but provided greater length in patients with a short mesentery. Stapled J pouch ileoanal patients had a better (p less than 0.02) maximum and sphincter resting pressure (46 +/- 11 versus 34 +/- 12 mmHg), fewer (p less than 0.05) night-time accidents (22% versus 68%), daytime (17% versus 55%) or night-time (28 versus 61%) spotting, or use of a protective pad at night (11% versus 42%) than nonstapled J pouch ileoanal patients. Stool frequency was similar in the two groups. All but one UC patient had residual disease at the anastomosis. Anal mucosa between the dentate line and stapled anastomosis was 1.8 +/- 1.3 cm (range, 0 to 3.5 cm). Complications in the nonstapled J pouch group included 4 pouches excised (2 for complications, 2 for excessive stool frequency), 1 pelvic abscess, 2 stenosis requiring dilation under anesthesia, 1 enterocutaneous fistula after ileostomy closure, 1 ileostomy site hernia, and 2 small bowel obstructions. Of the 65 patients who underwent ileostomy closure in the entire series, 8 (12%) developed a complication requiring surgical intervention. Complications in the stapled group included 1 anastomotic leak, 1 pouch leak, and 1 pelvic abscess. Patients were managed successfully with drainage (all 3) and diverting ileostomy (1). One patient developed stenosis requiring dilation under anesthesia. The stapled J pouch ileoanal anastomosis is a simpler, safer procedure with less tension than a standard handsewn J pouch but leaves a very small cuff of residual disease. It provides significantly better stool control and may obviate the need for an ileostomy with its complications. PMID:2039292

Incidence of retear with double-row versus single-row rotator cuff repair.

PubMed

Shen, Chong; Tang, Zhi-Hong; Hu, Jun-Zu; Zou, Guo-Yao; Xiao, Rong-Chi

2014-11-01

Rotator cuff tears have a high recurrence rate, even after arthroscopic rotator cuff repair. Although some biomechanical evidence suggests the superiority of the double-row vs the single-row technique, clinical findings regarding these methods have been controversial. The purpose of this study was to determine whether the double-row repair method results in a lower incidence of recurrent tearing compared with the single-row method. Electronic databases were systematically searched to identify reports of randomized, controlled trials (RCTs) comparing single-row with double-row rotator cuff repair. The primary outcome assessed was retear of the repaired cuff. Secondary outcome measures were the American Shoulder and Elbow Surgeons (ASES) shoulder score, the Constant shoulder score, and the University of California, Los Angeles (UCLA) score. Heterogeneity between the included studies was assessed. Six studies involving 428 patients were included in the review. Compared with single-row repair, double-row repair demonstrated a lower retear incidence (risk ratio [RR]=1.71 [95% confidence interval (CI), 1.18-2.49]; P=.005; I(2)=0%) and a reduced incidence of partial-thickness retears (RR=2.16 [95% CI, 1.26-3.71]; P=.005; I(2)=26%). Functional ASES, Constant, and UCLA scores showed no difference between single- and double-row cuff repairs. Use of the double-row technique decreased the incidence of retears, especially partial-thickness retears, compared with the single-row technique. The functional outcome was not significantly different between the 2 techniques. To improve the structural outcome of the repaired rotator cuff, surgeons should use the double-row technique. However, further long-term RCTs on this topic are needed. Copyright 2014, SLACK Incorporated.

Single-row versus double-row capsulolabral repair: a comparative evaluation of contact pressure and surface area in the capsulolabral complex-glenoid bone interface.

PubMed

Kim, Doo-Sup; Yoon, Yeo-Seung; Chung, Hoi-Jeong

2011-07-01

Despite the attention that has been paid to restoration of the capsulolabral complex anatomic insertion onto the glenoid, studies comparing the pressurized contact area and mean interface pressure at the anatomic insertion site between a single-row repair and a double-row labral repair have been uncommon. The purpose of our study was to compare the mean interface pressure and pressurized contact area at the anatomic insertion site of the capsulolabral complex between a single-row repair and a double-row repair technique. Controlled laboratory study. Thirty fresh-frozen cadaveric shoulders (mean age, 61 ± 8 years; range, 48-71 years) were used for this study. Two types of repair were performed on each specimen: (1) a single-row repair and (2) a double-row repair. Using pressure-sensitive films, we examined the interface contact area and contact pressure. The mean interface pressure was greater for the double-row repair technique (0.29 ± 0.04 MPa) when compared with the single-row repair technique (0.21 ± 0.03 MPa) (P = .003). The mean pressurized contact area was also significantly greater for the double-row repair technique (211.8 ± 18.6 mm(2), 78.4% footprint) compared with the single-row repair technique (106.4 ± 16.8 mm(2), 39.4% footprint) (P = .001). The double-row repair has significantly greater mean interface pressure and pressurized contact area at the insertion site of the capsulolabral complex than the single-row repair. The double-row repair may be advantageous compared with the single-row repair in restoring the native footprint area of the capsulolabral complex.

Effective removal of equine arteritis virus from stallion semen.

PubMed

Morrell, J M; Geraghty, R M

2006-05-01

A method of removing equine arteritis virus (EAV) from equine semen used for artificial insemination is urgently needed. Recent medical studies suggest that a double semen processing technique of density gradient centrifugation followed by a 'swim-up' can provide virus-free sperm preparations for assisted reproduction. To investigate the use of the double semen processing technique to obtain virus-free sperm preparations from stallion semen containing EAV. Aliquots of an ejaculate from an uninfected stallion were spiked with virus and processed by the double processing technique. The sperm preparations were tested by PCR for the presence of EAV. The procedure was repeated using an ejaculate from a known shedding stallion, testing processed and unprocessed aliquots by PCR and virus isolation. Virus-free sperm preparations were obtained using the double sperm processing technique. The 'swim-up' step is apparently required to ensure complete virus removal. The double semen processing technique is potentially a useful and simple tool for the removal of EAV from the semen of shedding stallions. The inclusion of density gradient centrifugation and 'swim-up' in protocols for the processing of semen for artificial insemination could help prevent the transmission of viral diseases carried in semen, such as EAV.

Growth and nutritive value of cassava (Manihot esculenta Cranz.) are reduced when grown in elevated CO.

PubMed

Gleadow, Roslyn M; Evans, John R; McCaffery, Stephanie; Cavagnaro, Timothy R

2009-11-01

Global food security in a changing climate depends on both the nutritive value of staple crops as well as their yields. Here, we examined the direct effect of atmospheric CO(2) on cassava (Manihot esculenta Cranz., manioc), a staple for 750 million people worldwide. Cassava is poor in nutrients and contains high levels of cyanogenic glycosides that break down to release toxic hydrogen cyanide when damaged. We grew cassava at three concentrations of CO(2) (C(a): 360, 550 and 710 ppm) supplied together with nutrient solution containing either 1 mM or 12 mM nitrogen. We found that total plant biomass and tuber yield (number and mass) decreased linearly with increasing C(a). In the worst-case scenario, tuber mass was reduced by an order of magnitude in plants grown at 710 ppm compared with 360 ppm CO(2). Photosynthetic parameters were consistent with the whole plant biomass data. It is proposed that since cassava stomata are highly sensitive to other environmental variables, the decrease in assimilation observed here might, in part, be a direct effect of CO(2) on stomata. Total N (used here as a proxy for protein content) and cyanogenic glycoside concentrations of the tubers were not significantly different in the plants grown at elevated CO(2). By contrast, the concentration of cyanogenic glycosides in the edible leaves nearly doubled in the highest C(a). If leaves continue to be used as a protein supplement, they will need to be more thoroughly processed in the future. With increasing population density, declining soil fertility, expansion into marginal farmland, together with the predicted increase in extreme climatic events, reliance on robust crops such as cassava will increase. The responses to CO(2) shown here point to the possibility that there could be severe food shortages in the coming decades unless CO(2) emissions are dramatically reduced, or alternative cultivars or crops are developed.

Prevention of neural tube defects with folic acid: The Chinese experience.

PubMed

Ren, Ai-Guo

2015-08-08

Neural tube defects (NTDs) are a group of congenital malformations of the central nervous system that are caused by the closure failure of the embryonic neural tube by the 28(th) day of conception. Anencephaly and spina bifida are the two major subtypes. Fetuses with anencephaly are often stillborn or electively aborted due to prenatal diagnosis, or they die shortly after birth. Most infants with spina bifida are live-born and, with proper surgical treatment, can survive into adulthood. However, these children often have life-long physical disabilities. China has one of the highest prevalence of NTDs in the world. Inadequate dietary folate intake is believed to be the main cause of the cluster. Unlike many other countries that use staple fortification with folic acid as the public health strategy to prevent NTDs, the Chinese government provides all women who have a rural household registration and who plan to become pregnant with folic acid supplements, free of charge, through a nation-wide program started in 2009. Two to three years after the initiation of the program, the folic acid supplementation rate increased to 85% in the areas of the highest NTD prevalence. The mean plasma folate level of women during early and mid-pregnancy doubled the level before the program was introduced. However, most women began taking folic acid supplements when they knew that they were pregnant. This is too late for the protection of the embryonic neural tube. In a post-program survey of the women who reported folic acid supplementation, less than a quarter of the women began taking supplements prior to pregnancy, indicating that the remaining three quarters of the fetuses remained unprotected during the time of neural tube formation. Therefore, staple food fortification with folic acid should be considered as a priority in the prevention of NTDs.

Influence of multiple stapler firings used for rectal division on colorectal anastomotic leak rate.

PubMed

Braunschmid, Tamara; Hartig, Nikolaus; Baumann, Lukas; Dauser, Bernhard; Herbst, Friedrich

2017-12-01

Anastomotic leakage following colorectal resection remains one of the most significant complications with relevant morbidity and mortality. There is evidence that a higher number of stapler firings for rectal division can affect the leak rate in double stapling anastomosis. However, there are no data concerning compression anastomosis. We present our institutional experience addressing this issue. This is a retrospective review of a prospective institutional database of patients undergoing colonic and rectal resection for benign and malignant indications between January 2008 and December 2014 at the surgical department of the St. John of God Hospital, Vienna. Inclusion criteria were rectal division with linear stapling devices and construction of anastomosis to the rectal stump using a circular stapler or compression device. Three hundred eighty two (196 female; 51.3%) patients were included. Mean age was 65.8 years (range: 18-95) Indications for the operation included diverticular disease (44.8%), colorectal carcinoma (51.6%), inflammatory bowel disease (1.8%), and adenoma (1.8%). A laparoscopic approach was employed in 334 cases (87.4%); in 170 patients (44.9%), a compression anastomosis was created. One, two, and three or more stapler cartridges were used for rectal division in 58.4, 33.5, and 8.1%, respectively. Male gender, neoadjuvant therapy, rectal cancer as an underlying disease, laparoscopic surgical approach, and duration of operation longer than 200 min are leading causes for the usage of more than one stapler cartridge. Overall leak rate was 4.7% (18/382). The only factor associated with the occurrence of leakage was the use of three or more stapler cartridges for the closure of the rectal stump (p = 0.002). Our data support that multiple stapler firings for rectal division following colorectal resection has a major impact on anastomotic leak rate. Especially in laparoscopic surgery efforts should be made to minimize the number of stapler cartridges used.

Tomographie par coherence optique pour le guidage de chirurgies minimalement invasives du rachis

NASA Astrophysics Data System (ADS)

Beaudette, Kathy

Adolescent idiopathic scoliosis is a complex 3D deformity of the spine which requires surgical intervention in severe cases of the condition. The existing corrective procedure of scoliosis is very invasive; it involves a long incision and a large instrumentation, in addition to the fusion of a section of the spine. To improve postoperative conditions and to preserve patients' spinal flexibility, novel fusionless surgical approaches involving growth modulation are under investigation. With this objective in mind, a multidisciplinary team from École Polytechnique of Montreal and Sainte-Justine University Hospital Research Center is developing a surgical technique based on the insertion of micro-staples between vertebral growth plates and corresponding intervertebral disks. Each micro-staple passively modulates the vertebral growth on the convex side of the scoliotic curvature. This modulation modifies vertebral geometry which, for scoliotic patients, presents a wedging deformity. The modulation induced by these devices could lead to the correction of the curvature of the spine. This innovative procedure would preserve the flexibility of the spine as well as the health of intervertebral disks, in addition to being compatible with minimally invasive approaches. However, to be efficient, the micro-staples must be placed at the junction between the growth plate and the disk with a sub-millimeter precision. An intraoperative guiding system is therefore required to ensure the success of the intervention. Optical coherence tomography (OCT) is a promising candidate for this application. OCT is based on low-coherence interferometry and provides cross-sectional images with a resolution about 10 μm for a depth of 2 to 3 mm. This technique allows for the real-time acquisition of images and is compatible with endoscopy, thereby showing a potential for the intraoperative guidance of minimally invasive surgeries (MIS) of the spine. The main objective of this master's project is therefore to evaluate the possibility of using OCT to localize as well as identify spinal structures (such as growth plates, osseous tissue, intervertebral disks and connective tissue) and to guide the insertion of micro-staples. To attain this objective, an OCT handheld probe was designed and developed according to the surgical constraints of MIS performed by thoracoscopy (through the thorax). This probe has an external diameter of 17 mm and is 30 cm long. Coupled with a fibered interferometer, the axial and lateral resolutions of the probe are of 16 and 27 μm respectively. The OCT probe was used in vivo during an open surgery on a porcine model. Different tissues within the operative window (lung, muscles, osseous tissues and intervertebral disk) were imaged during the procedure. These preliminary in vivo tests demonstrated that the probe is capable of identifying different types of tissue with a good sensitivity and an adequate penetration depth. These results also showed that a visual inspection of the in vivo OCT images alone is not sufficient to localize the growth plates on the vertebrae. An ex vivo study using porcine vertebrae was therefore performed to identify quantitative markers in order to facilitate the interpretation of in vivo OCT images. OCT images were initially compared to corresponding histological sections. The ensuing results showed that the connective tissue layer presents a band pattern due to the birefringence properties of the collagen-rich tissue. The intervertebral disk was also shown to have a characteristic lamellar structure on OCT images. Lastly, within growth plate and osseous tissue locations, the OCT signal decay is monotonic, but with different attenuation coefficients (different slopes). Relative attenuation coefficients were therefore measured for each tissue (growth plate, osseous tissue, connective tissue and intervertebral disk) on several specimens and were compared. These results showed that growth plates present an average relative attenuation coefficient statistically different from the other tissues. An automatic growth plate segmentation algorithm was then developed and tested. The algorithm was applied to images from an ex vivo specimen of a porcine vertebra and successfully identified most of the growth plate (> 75%) amidst the osseous tissue of the vertebral body and the intervertebral disk. This master's project shows that OCT presents contrast, resolution and penetration depth that are sufficient for the identification of musculoskeletal structures of the spine. It is thus reasonable to believe that, ultimately, OCT could be used for the intraoperative guiding of the insertion of micro-staples during corrective surgeries of scoliosis.

Biomechanical Comparison of Arthroscopic Single- and Double-Row Repair Techniques for Acute Bony Bankart Lesions.

PubMed

Spiegl, Ulrich J; Smith, Sean D; Todd, Jocelyn N; Coatney, Garrett A; Wijdicks, Coen A; Millett, Peter J

2014-08-01

Single- and double-row arthroscopic reconstruction techniques for acute bony Bankart lesions have been described in the literature. The double-row fixation technique would provide superior reduction and stability of a simulated bony Bankart lesion at time zero in a cadaveric model compared with the single-row technique. Controlled laboratory study. Testing was performed on 14 matched pairs of glenoids with simulated bony Bankart fractures with a defect width of 25% of the glenoid diameter. Half of the fractures were repaired with a double-row technique, while the contralateral glenoids were repaired with a single-row technique. The quality of fracture reduction was measured with a coordinate measuring machine. To determine the biomechanical stability of the repairs, specimens were preconditioned with 10 sinusoidal cycles between 5 and 25 N at 0.1 Hz and then pulled to failure in the anteromedial direction at a rate of 5 mm/min. Loads at 1 mm and 2 mm of fracture displacement were determined. The double-row technique required significantly higher forces to achieve fracture displacements of 1 mm (mean, 60.6 N; range, 39.0-93.3 N; P = .001) and 2 mm (mean, 94.4 N; range, 43.4-151.2 N; P = .004) than the single-row technique (1 mm: mean, 30.2 N; range, 14.0-54.1 N and 2 mm: mean, 63.7 N; range, 26.6-118.8 N). Significantly reduced fracture displacement was seen after double-row repair for both the unloaded condition (mean, 1.1 mm; range, 0.3-2.4 mm; P = .005) and in response to a 10-N anterior force applied to the defect (mean, 1.6 mm; range, 0.5-2.7 mm; P = .001) compared with single-row repair (unloaded: mean, 2.1 mm; range, 1.3-3.4 mm and loaded: mean, 3.4 mm; range, 1.9-4.7 mm). The double-row fixation technique resulted in improved fracture reduction and superior stability at time zero in this cadaveric model. This information may influence the surgical technique used to treat large osseous Bankart fractures and the postoperative rehabilitation protocols implemented when such repair techniques are used. © 2014 The Author(s).

Double Density Dual Tree Discrete Wavelet Transform implementation for Degraded Image Enhancement

NASA Astrophysics Data System (ADS)

Vimala, C.; Aruna Priya, P.

2018-04-01

Wavelet transform is a main tool for image processing applications in modern existence. A Double Density Dual Tree Discrete Wavelet Transform is used and investigated for image denoising. Images are considered for the analysis and the performance is compared with discrete wavelet transform and the Double Density DWT. Peak Signal to Noise Ratio values and Root Means Square error are calculated in all the three wavelet techniques for denoised images and the performance has evaluated. The proposed techniques give the better performance when comparing other two wavelet techniques.

Diagnosis and treatment of haemorrhoids.

PubMed

Buntzen, Steen; Christensen, Peter; Khalid, Ali; Ljungmann, Ken; Lindholt, Jan; Lundby, Lilli; Walker, Line Rossell; Raahave, Dennis; Qvist, Niels

2013-12-01

These guidelines provide a review of diagnosis, conservative and surgical treatment of haemorrhoids with primary focus on the surgical treatment. In symptomatic hemorrhoids it is recommended, that conservative treatment is used as basic treatment regardless of grading. The vast majority of grade II haemorrhoids are treated conservatively, but surgery may be considered in a few cases with pronounced symptoms. In these cases chirurgia minor, Doppler guided dearterilization procedures or stapled haemorrhoidopexy are recommended. In grade III and IV Doppler guided dearterilization procedures, stapled haemorrhoidopexy (Grade III) or conventional Milligan Morgan haemorrhoidectomy are recommended.

Biomechanical Comparison of Single- Versus Double-Row Capsulolabral Repair for Shoulder Instability: A Review.

PubMed

Yousif, Matthew John; Bicos, James

2017-12-01

The glenohumeral joint is the most commonly dislocated joint in the body. Failure rates of capsulolabral repair have been reported to be approximately 8%. Recent focus has been on restoration of the capsulolabral complex by a double-row capsulolabral repair technique in an effort to decrease redislocation rates after arthroscopic capsulolabral repair. To present a review of the biomechanical literature comparing single- versus double-row capsulolabral repairs and discuss the previous case series of double-row fixation. Narrative review. A simple review of the literature was performed by PubMed search. Only biomechanical studies comparing single- versus double-row capsulolabral repair were included for review. Only those case series and descriptive techniques with clinical results for double-row repair were included in the discussion. Biomechanical comparisons evaluating the native footprint of the labrum demonstrated significantly superior restoration of the footprint through double-row capsulolabral repair compared with single-row repair. Biomechanical comparisons of contact pressure at the repair interface, fracture displacement in bony Bankart lesion, load to failure, and decreased external rotation (suggestive of increased load to failure) were also significantly in favor of double- versus single-row repair. Recent descriptive techniques and case series of double-row fixation have demonstrated good clinical outcomes; however, no comparative clinical studies between single- and double-row repair have assessed functional outcomes. The superiority of double-row capsulolabral repair versus single-row repair remains uncertain because comparative studies assessing clinical outcomes have yet to be performed.

DOUBLE ENDOR with a linearly and a circularly polarized radiofrequency field

NASA Astrophysics Data System (ADS)

Schweiger, A.; Rudin, M.; Forrer, J.; Günthard, Hs. H.

The combination of the two spectroscopical techniques, DOUBLE ENDOR and ENDOR with a circularly polarized radiofrequency field (CP-ENDOR), is described. with this new method, termed by the acronym CP-DOUBLE ENDOR, the selective induction of transitions of different types of nuclei and of different paramagnetic species allows a drastic reduction of the number of observed ENDOR lines. With this technique, analysis of hitherto not interpretable ENDOR spectra is often made possible. The experimental setup of the CP-DOUBLE ENDOR spectrometer is described. The advantage of using circularly polarized rf fields in DOUBLE ENDOR spectroscopy is illustrated by two applications on transition metal complexes in single crystals.

Tendoscopic Double-Row Suture Bridge Peroneal Retinaculum Repair for Recurrent Dislocation of Peroneal Tendons in the Ankle.

PubMed

Nishimura, Akinobu; Nakazora, Shigeto; Ito, Naoya; Fukuda, Aki; Kato, Ko; Sudo, Akihiro

2016-06-01

Traumatic dislocation of peroneal tendons in the ankle is an uncommon lesion that mainly affects young adults. Unfortunately, most cases lead to recurrent dislocation of the peroneal tendons of the ankle (RPTD). Therefore, most cases need operative treatment. One of the most common operative procedures is superior peroneal retinaculum (SPR) repair. Recently, surgery for RPTD has been achieved with less invasive arthroscopic procedures. In this article, tendoscopic surgery for RPTD using a double-row suture bridge technique is introduced. This technique consists of debridement of the lateral aspect of the fibula under an intrasheath pseudo-cavity, suture anchor insertion into the fibular ridge, and reattachment of the SPR to the fibula using a knotless anchor screwed into the lateral aspect of the fibula. This technique mimics the double-row suture bridge technique for rotator cuff tear repair. The double-row suture bridge technique requires more surgical steps than the single-row technique, but it provides a wider bone-SPR contact surface and tighter fixation than the single-row technique. This procedure is an attractive option because it is less invasive and has achieved results similar to open procedures.

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE DOUBLE-BUNDLE TECHNIQUE - EVALUATION IN THE BIOMECHANICS LABORATORY.

PubMed

D'Elia, Caio Oliveira; Bitar, Alexandre Carneiro; Castropil, Wagner; Garofo, Antônio Guilherme Padovani; Cantuária, Anita Lopes; Orselli, Maria Isabel Veras; Luques, Isabela Ugo; Duarte, Marcos

2011-01-01

The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group.

Synthesis and energetics of gold nanoclusters tailored by interfacial bonding structure

NASA Astrophysics Data System (ADS)

Tang, Zhenghua

In addition to the well known quantum confinement effects resulted from size and shape, interfacial bond structure is another factor, affecting the properties of the nanomaterial that is rarely studied. Inspired by the "Au-S-Au" staple motif discovered from the crystal structure of monothiol protected Au102 nanocluster (Science, 2007, 318, 430), dithiol molecules (e.g. 1, 2-dithiol, 1, 4-dithiol, etc.) with molecular structural constraint have been employed to create dithiolate protected clusters or mixed monothiolate and dithiolate protected clusters. The structure and properties of the Au clusters are expected to change due to two effects: The entropy gain of dithiol over monothiol protection and the constraint to the formation of the thiol bridging motif. DMPS (1, 2-dithiol molecule) stabilized clusters with characteristic absorption bands have been obtained, and characterized by multiple techniques. Monolayer reaction on gold core surface between the monothiol tiopronin and dithiol DMPS has been performed, and the mechanism has been probed. Mixed phenylethanethiolate and durene-dithiolate (1, 4-dithiol molecule) protected Au130 clusters with rich electrochemical features have been created, and the optical and electrochemical energetics have been successfully correlated based on core and core-ligand energy states. Furthermore, the impact of 1, 4-dithiolate-Au bonding on the near infrared luminescence has been studied. INDEX WORDS: Au MPCs, Staple motif, DMPS, Au DTCs, Au4, Tiopronin, Monolayer reaction, Durene-DT, Au MTCs, Au130, Optical energetic, Electrochemistry, Near infrared luminescence, 1, 4-Dithiolate-Au bonding.

Recent applications of multivariate data analysis methods in the authentication of rice and the most analyzed parameters: A review.

PubMed

Maione, Camila; Barbosa, Rommel Melgaço

2018-01-24

Rice is one of the most important staple foods around the world. Authentication of rice is one of the most addressed concerns in the present literature, which includes recognition of its geographical origin and variety, certification of organic rice and many other issues. Good results have been achieved by multivariate data analysis and data mining techniques when combined with specific parameters for ascertaining authenticity and many other useful characteristics of rice, such as quality, yield and others. This paper brings a review of the recent research projects on discrimination and authentication of rice using multivariate data analysis and data mining techniques. We found that data obtained from image processing, molecular and atomic spectroscopy, elemental fingerprinting, genetic markers, molecular content and others are promising sources of information regarding geographical origin, variety and other aspects of rice, being widely used combined with multivariate data analysis techniques. Principal component analysis and linear discriminant analysis are the preferred methods, but several other data classification techniques such as support vector machines, artificial neural networks and others are also frequently present in some studies and show high performance for discrimination of rice.

Use of Gastrointestinal Anastomosis Stapler for Harvest of Gracilis Muscle and Securing It in the Face for Facial Reanimation: A Novel Technique

PubMed Central

Shridharani, Sachin M.; Stapleton, Sahael M.; Redett, Richard J.; Magarakis, Michael; Rosson, Gedge D.

2010-01-01

Background: The primary objective of this study is to report a novel technique that uses the gastrointestinal anastomosis (GIA) stapler for harvesting and securing the gracilis muscle in facial reanimation surgery. Methods: We conducted a retrospective chart review with 18 consecutive patients who underwent gracilis muscle flap transfer with or without the use of a GIA stapler. Results: Of 11 operations with the GIA stapler, one patient developed a hematoma (donor site) and another required drainage of an abscess (recipient site). Of 8 operations without the use of the stapler, one patient had total flap failure and three required drainage of an abscess (2 recipient sites and 1 donor site). These differences trended toward improvement but were not statistically different. Conclusions: The use of the GIA stapler is a fast, safe technique. Larger studies are, however, warranted to further examine this novel approach in order to test precisely what factors of increased efficiency occur, the amount of suture pull-through, and overall tension capable of being applied to the secured staple line. PMID:20396379

[Early onset scoliosis. What are the options?].

PubMed

Farrington, D M; Tatay-Díaz, A

2013-01-01

The prognosis of children with progressive early onset scoliosis has improved considerably due to recent advances in surgical and non-surgical techniques and the understanding of the importance of preserving the thoracic space. Improvements in existing techniques and development of new methods have considerably improved the management of this condition. Derotational casting can be considered in children with documented progression of a <60° curve without previous surgical treatment. Both single and dual growing rods are effective, but the latter seem to offer better results. Hybrid constructs may be a better option in children who require a low-profile proximal anchor. The vertical expandable prosthetic titanium rib (VEPTR(®)) appears to be beneficial for patients with congenital scoliosis and fused ribs, and thoracic Insufficiency Syndrome. Children with medical comorbidities who may not tolerate repeated lengthenings should be considered for Shilla or Luque Trolley technique. Growth modulation using shape memory alloy staples or other tethers seem promising for mild curves, although more research is required to define their precise indications. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

A review of recent developments in the speciation and location of arsenic and selenium in rice grain

PubMed Central

Carey, Anne-Marie; Lombi, Enzo; Donner, Erica; de Jonge, Martin D.; Punshon, Tracy; Jackson, Brian P.; Guerinot, Mary Lou; Price, Adam H.; Meharg, Andrew A.

2014-01-01

Rice is a staple food yet is a significant dietary source of inorganic arsenic, a class 1, nonthreshold carcinogen. Establishing the location and speciation of arsenic within the edible rice grain is essential for understanding the risk and for developing effective strategies to reduce grain arsenic concentrations. Conversely, selenium is an essential micronutrient and up to 1 billion people worldwide are selenium-deficient. Several studies have suggested that selenium supplementation can reduce the risk of some cancers, generating substantial interest in biofortifying rice. Knowledge of selenium location and speciation is important, because the anti-cancer effects of selenium depend on its speciation. Germanic acid is an arsenite/silicic acid analogue, and location of germanium may help elucidate the mechanisms of arsenite transport into grain. This review summarises recent discoveries in the location and speciation of arsenic, germanium, and selenium in rice grain using state-of-the-art mass spectrometry and synchrotron techniques, and illustrates both the importance of high-sensitivity and high-resolution techniques and the advantages of combining techniques in an integrated quantitative and spatial approach. PMID:22159463

Do Clinical Results and Return-to-Sport Rates After Ulnar Collateral Ligament Reconstruction Differ Based on Graft Choice and Surgical Technique?

PubMed

Erickson, Brandon J; Cvetanovich, Gregory L; Frank, Rachel M; Bach, Bernard R; Cohen, Mark S; Bush-Joseph, Charles A; Cole, Brian J; Romeo, Anthony A

2016-11-01

Ulnar collateral ligament reconstruction (UCLR) has become a common procedure performed in overhead-throwing athletes of many athletic levels. The purpose of this study was to determine whether clinical outcomes and return-to-sport (RTS) rates differ among patients undergoing UCLR based on graft choice, surgical technique, athletic competition level, handedness, and treatment of the ulnar nerve. We hypothesized that no differences would exist in clinical outcomes or RTS rates between technique, graft choice, or other variables. Cohort study; Level of evidence, 3. All patients who underwent UCLR from January 1, 2004 through December 31, 2014 at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, handedness, athletic level, surgical technique, graft type, and complications. Patients were contacted via telephone to obtain the RTS rate, Conway-Jobe score, Timmerman-Andrews score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Eighty-five patients (mean age at surgery, 19.3 ± 4.7 years; 92% male; 78% right hand-dominant) underwent UCLR between 2004 and 2014 and were available for follow-up. Overall, 87% were baseball pitchers, 49.4% were college athletes, and 41.2% were high school athletes. No significant difference existed between the docking and double-docking techniques, graft choice, handedness, sex, activity level, and treatment of the ulnar nerve with regard to clinical outcomes, RTS, or subsequent surgeries (all P > .05). More complications were seen in the docking technique compared with the double-docking technique ( P = .036). Hamstring autograft was used more commonly with the docking technique ( P = .023) while allograft was used more commonly with the double-docking technique ( P = .0006). Both the docking and double-docking techniques produce excellent clinical outcomes in patients undergoing UCLR. No difference in outcome scores was seen between surgical technique or graft type. The double-docking technique had fewer complications than the docking technique.

Long-term outcome of stapled transanal rectal resection (STARR) versus stapled hemorrhoidopexys (STH) for grade III-IV hemorrhoids: preliminary results.

PubMed

Zanella, Simone; Spirch, Saverio; Scarpa, Marco; Ricci, Francesco; Lumachi, Franco

2014-01-01

Circular stapled transanal hemorrhoidopexy (STH) was first introduced by A. Longo for the correction of internal mucosal prolapse and obstructed defecation and in 1998, was proposed as alternative to conventional excisional hemorrhoidectomy. More recently, stapled transanal rectal resection (STARR) has gradually gained popularity, as the Longo procedure, in the treatment of hemorrhoids. The aim of our study was to evaluate the usefulness of STARR as alternative to STH in patients with grade III (n=218, 68.1%) and IV (n=102, 31.9%) hemorrhoids. A group of 320 consecutive patients (median age=51 years; range=16-85) underwent STH (n=281) or STARR (n=39) procedure. The rate of postoperative bleeding (53.8% vs. 74.4%, p<0.01) was significantly reduced in patients who underwent STARR procedure, which required a longer (45 ± 22 vs. 26 ± 11 min, p<0.01) operative time. There were no differences between groups with regard to use of painkillers, postoperative pain intensity, short- (three months) and long-term (one and three years) residual pain, soiling, incontinence and urgency. Patients treated with the STARR procedure had lower recurrence rate of hemorrhoids and a lower incidence of prolapse, both at one year (none vs. 1.4%, p=0.593 and 2.6% vs. 5.3%, p=0.396, respectively) and at two years (none vs. 6.8%, p=0.078 and none vs. 13.2%, p=0.012, respectively). The one-year (9.0 ± 1.8 vs. 9.4 ± 0.7, p=0.171) and two-year (9.6 ± 0.8 vs. 9.1 ± 1.7, p=0.072) general satisfaction was similar but higher in STARR patients than in the STH group. In conclusion, according to our preliminary results, the STARR procedure leads to a lower incidence of complications and recurrences and should be considered for patients with grade III or IV hemorrhoids previously selected for stapled hemorrhoidectomy, as a promising alternative to STH. Copyright © 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

An open, prospective, randomized pilot investigation evaluating pain with the use of a soft silicone wound contact layer vs bridal veil and staples on split thickness skin grafts as a primary dressing.

PubMed

Patton, Mary Lou; Mullins, Robert Fred; Smith, David; Korentager, Richard

2013-01-01

An open, prospective, randomized, pilot investigation was implemented to evaluate the pain, cost-effectiveness, ease of use, tolerance, efficacy, and safety of a soft silicone wound contact layer (Mepitel One) vs Bridal Veil and staples used on split thickness skin grafts in the treatment of deep partial or full-thickness thermal burns. Individuals aged between 18 and 70 years with deep partial or full-thickness thermal burns (1-25% TBSA) were randomized into two groups and treated for 14 days or until greater than 95% graft take was achieved, whichever occurred first. Data were obtained and analyzed on pain experienced before, during, and after dressing removal. Secondary considerations included the overall cost (direct), graft take and healing, the ease of product use, overall experience of the dressing, and adverse events. A total of 43 subjects were recruited. There were no significant differences in burn area profiles within the groups. The pain level during dressing removal was significant between the groups (P = .0118) with the removal of Mepitel One being less painful. The staff costs were lower in the group of patients treated with Mepitel One (P = .0064) as reflected in the shorter time required for dressing removal (P = .0005), with Mepitel One taking on average less than a quarter of the time to remove. There was no significant difference in healing between the two groups, with 99.0% of the Mepitel One group and 93.1% of the Bridal Veil and staples group showing greater than 95% graft take at post-op day 7 (+/-1) (P = .2373). Clinicians reported that the soft silicone dressing was easier to use, more conformable, and demonstrated better ability to stay in place, compared with the Bridal Veil and staples regime. Both treatments were well tolerated, with no serious adverse events in either treatment group. Mepitel One was at least as effective in the treatment of patients as the standard care (Bridal Veil and staples). In addition, the group of patients treated with the soft silicone dressing demonstrated decreased pain and lower costs associated with treatment.

Modified Longo's stapled hemorrhoidopexy with additional traction sutures for the treatment of residual prolapsed piles.

PubMed

Chen, Chuang-Wei; Kang, Jung-Cheng; Wu, Chang-Chieh; Hsiao, Cheng-Wen; Jao, Shu-Wen

2008-03-01

Residual prolapsed piles is a problem after the stapled hemorrhoidopexy, especially in large third- or fourth-degree hemorrhoids. We have developed a method using additional traction sutures along with modified Longo's procedure to manage this problem. From January 2005 to October 2005, 30 consecutive patients with symptomatic third- or fourth-degree hemorrhoids who underwent the modified Longo's stapled hemorrhoidopexy with additional traction sutures in a single institution were collected. The demographics, postoperative pain score, surgical features, outcomes, and early and late complications were recorded. All patients were followed for a mean duration of 8.8 (range, 4-15) months. Thirty patients (17 males) with a mean age of 45 (range, 27-63) years were identified. The mean postoperative pain score on the morning of the first postoperative day was 2.8 (range, 1-4). The mean duration of operation was 30.7 (range, 25-37) min. The mean duration of hospital stay was 2 (range, 1-3) days. The mean days for patients to resume normal work was 6.7 (range, 4-9) days. No other procedure-related complications occurred in all patients. There was no early complication except for fecal urgency found in one patient during the first postoperative days. Regarding the late complications, no residual prolapsed piles, persistent anal pain, incontinence, anal stenosis, or recurrent symptoms were found. Our preliminary experiences indicated that this modified procedures truly contributed to reduce the residual internal hemorrhoids and maintained the benefits of stapled hemorrhoidopexy. Randomized trial and long-term follow-up warrant to determine possible surgical and functional outcome.

Dietary acculturation among the South-Asian Surinamese population in the Netherlands: the HELIUS study.

PubMed

Raza, Qaisar; Nicolaou, Mary; Snijder, Marieke B; Stronks, Karien; Seidell, Jacob C

2017-08-01

To test Koctürk's model of dietary change among South-Asian Surinamese in the Netherlands. The model categorizes foods into staple, complementary and accessory foods and postulates that dietary change after migration begins with accessory foods while foods associated with ethnic identity (staple foods) change at a slower rate. Cross-sectional data from the HELIUS study. Dietary intake was assessed with an FFQ. Acculturation was based on social contacts and sense of belonging and was translated into four strategies of acculturation: assimilation, integration, separation and marginalization. Other indicators of acculturation included residence duration, age at migration and migration generation status. Amsterdam, the Netherlands. Participants of Dutch (n 1456) and South-Asian Surinamese origin (n 968). Across all acculturation strategies, South-Asian Surinamese participants reported significantly higher intakes of rice (staple food) and chicken (complementary food) and significantly lower intakes of red meat and vegetables (complementary foods) and cookies and sweets (accessory food) than Dutch participants. Men, second-generation and assimilated South-Asian Surinamese were inclined towards Dutch foods such as potato, pasta and red meat. Accessory foods like fruits showed variation across acculturation strategies. Consistent with the Koctürk model, the intake of staple foods was stable among South-Asian Surinamese irrespective of acculturation strategy while the intake of accessory foods like fruit varied. Contrary to expectations, South-Asian Surinamese showed consistently high intakes of complementary foods like chicken and fish irrespective of acculturation strategy. Public health practitioners should take into consideration the complex and dynamic nature of dietary acculturation.

Are there risk factors that increase the rate of staple line leakage in patients undergoing primary sleeve gastrectomy for morbid obesity?

PubMed

Benedix, Frank; Benedix, Diana D; Knoll, Christian; Weiner, Rudolf; Bruns, Christiane; Manger, Thomas; Stroh, Christine

2014-10-01

Laparoscopic sleeve gastrectomy (LSG) is currently being performed with increasing frequency worldwide. It offers an excellent weight loss and resolution of comorbidities in the short term with a very low incidence of complications. However, the ever present risk of a staple line leak is still a major concern. Since 2005, data from obese patients that undergo bariatric procedures in Germany are prospectively registered in an online database and analyzed at the Institute of Quality Assurance in Surgical Medicine. For the current analysis, all patients that had undergone primary sleeve gastrectomy for morbid obesity within a 7-year period were considered. Using the GBSR, data from 5.400 LSGs were considered for analysis. Staple line leak rate decreased during the study period from 6.5 to 1.4 %. Male gender, higher BMI, concomitant sleep apnea, conversion to laparotomy, longer operation time, use of both buttresses and oversewing, and the occurrence of intraoperative complications were associated with a significantly higher leakage rate. On multivariate analysis, operation time and year of procedure only had a significant impact on staple line leak rate. The results of the current study demonstrated that there are factors that increase the risk of a leakage which would enable surgeons to define risk groups, to more carefully select patients, and to offer a closer follow-up during the postoperative course with early recognition and adequate treatment. All future efforts should be focused on a further reduction of serious complications to make the LSG a widely accepted and safer procedure.

Breakfast staple types affect brain gray matter volume and cognitive function in healthy children.

PubMed

Taki, Yasuyuki; Hashizume, Hiroshi; Sassa, Yuko; Takeuchi, Hikaru; Asano, Michiko; Asano, Kohei; Kawashima, Ryuta

2010-12-08

Childhood diet is important for brain development. Furthermore, the quality of breakfast is thought to affect the cognitive functioning of well-nourished children. To analyze the relationship among breakfast staple type, gray matter volume, and intelligence quotient (IQ) in 290 healthy children, we used magnetic resonance images and applied voxel-based morphometry. We divided subjects into rice, bread, and both groups according to their breakfast staple. We showed that the rice group had a significantly larger gray matter ratio (gray matter volume percentage divided by intracranial volume) and significantly larger regional gray matter volumes of several regions, including the left superior temporal gyrus. The bread group had significantly larger regional gray and white matter volumes of several regions, including the right frontoparietal region. The perceptual organization index (POI; IQ subcomponent) of the rice group was significantly higher than that of the bread group. All analyses were adjusted for age, gender, intracranial volume, socioeconomic status, average weekly frequency of having breakfast, and number of side dishes eaten for breakfast. Although several factors may have affected the results, one possible mechanism underlying the difference between the bread and the rice groups may be the difference in the glycemic index (GI) of these two substances; foods with a low GI are associated with less blood-glucose fluctuation than are those with a high GI. Our study suggests that breakfast staple type affects brain gray and white matter volumes and cognitive function in healthy children; therefore, a diet of optimal nutrition is important for brain maturation during childhood and adolescence.

Load to Failure and Stiffness

PubMed Central

Esquivel, Amanda O.; Duncan, Douglas D.; Dobrasevic, Nikola; Marsh, Stephanie M.; Lemos, Stephen E.

2015-01-01

Background: Rotator cuff tendinopathy is a frequent cause of shoulder pain that can lead to decreased strength and range of motion. Failures after using the single-row technique of rotator cuff repair have led to the development of the double-row technique, which is said to allow for more anatomical restoration of the footprint. Purpose: To compare 5 different types of suture patterns while maintaining equality in number of anchors. The hypothesis was that the Mason-Allen–crossed cruciform transosseous-equivalent technique is superior to other suture configurations while maintaining equality in suture limbs and anchors. Study Design: Controlled laboratory study. Methods: A total of 25 fresh-frozen cadaveric shoulders were randomized into 5 suture configuration groups: single-row repair with simple stitch technique; single-row repair with modified Mason-Allen technique; double-row Mason-Allen technique; double-row cross-bridge technique; and double-row suture bridge technique. Load and displacement were recorded at 100 Hz until failure. Stiffness and bone mineral density were also measured. Results: There was no significant difference in peak load at failure, stiffness, maximum displacement at failure, or mean bone mineral density among the 5 suture configuration groups (P < .05). Conclusion: According to study results, when choosing a repair technique, other factors such as number of sutures in the repair should be considered to judge the strength of the repair. Clinical Relevance: Previous in vitro studies have shown the double-row rotator cuff repair to be superior to the single-row repair; however, clinical research does not necessarily support this. This study found no difference when comparing 5 different repair methods, supporting research that suggests the number of sutures and not the pattern can affect biomechanical properties. PMID:26665053

Biomechanical comparison of four double-row speed-bridging rotator cuff repair techniques with or without medial or lateral row enhancement.

PubMed

Pauly, Stephan; Fiebig, David; Kieser, Bettina; Albrecht, Bjoern; Schill, Alexander; Scheibel, Markus

2011-12-01

Biomechanical comparison of four different Speed-Bridge configurations with or without medial or lateral row reinforcement. Reinforcement of the knotless Speed-Bridge double-row repair technique with additional medial mattress- or lateral single-stitches was hypothesized to improve biomechanical repair stability at time zero. Controlled laboratory study: In 36 porcine fresh-frozen shoulders, the infraspinatus tendons were dissected and shoulders were randomized to four groups: (1) Speed-Bridge technique with single tendon perforation per anchor (STP); (2) Speed-Bridge technique with double tendon perforation per anchor (DTP); (3) Speed-Bridge technique with medial mattress-stitch reinforcement (MMS); (4) Speed-Bridge technique with lateral single-stitch reinforcement (LSS). All repairs were cyclically loaded from 10-60 N up to 10-200 N (20 N stepwise increase) using a material testing device. Forces at 3 and 5 mm gap formation, mode of failure and maximum load to failure were recorded. The MMS-technique with double tendon perforation showed significantly higher ultimate tensile strength (338.9 ± 90.0 N) than DTP (228.3 ± 99.9 N), LSS (188.9 ± 62.5 N) and STP-technique (122.2 ± 33.8 N). Furthermore, the MMS-technique provided increased maximal force resistance until 3 and 5 mm gap formation (3 mm: 77.8 ± 18.6 N; 5 mm: 113.3 ± 36.1 N) compared with LSS, DTP and STP (P < 0.05 for each 3 and 5 mm gap formation). Failure mode was medial row defect by tendon sawing first, then laterally. No anchor pullout occurred. Double tendon perforation per anchor and additional medial mattress stitches significantly enhance biomechanical construct stability at time zero in this ex vivo model when compared with the all-knotless Speed-Bridge rotator cuff repair.

Stapled haemorrhoidectomy in the operative treatment of grade III and IV haemorrhoids.

PubMed

Shrestha, S; Pradhan, G B N; Shrestha, R; Poudel, P; Bhattachan, C L

2014-09-01

Stapled haemorrhoidectomy (SH) is a minimally invasive intervention that uses a stapling device which avoids the need for wounds in the sensitive anal area and reduces the pain after surgery. This study was undertaken in Nepal Medical College Teaching Hospital from January 2010 to December 2012 to evaluate the efficacy of this modality of treatment among patients (32) who presented in the Surgery OPD with grade III and grade IV haemorrhoids. The results of SH were evaluated by the relief of symptoms, severity of post operative pain, and complications of SH. Twenty five (78.1%) patients had grade III and 7 (21.9%) presented with grade IV hemorrhoids. The most frequent presentation reported in our study was bleeding per rectum with perianal prolapse. Mean operating time was 40-60 minutes whereas mean hospital stay was 1.9 days. Urinary retention was the most common complication found in 12 (37.5%) patients in the immediate post operative period. SH is a safe, rapid, and convenient surgical remedy for grade III and grade IV hemorrhoids with low rate of complications, minimal postoperative pain, and shorter hospital stay.

Transgenic Biofortification of the Starchy Staple Cassava (Manihot esculenta) Generates a Novel Sink for Protein

PubMed Central

Abhary, Mohammad; Siritunga, Dimuth; Stevens, Gene; Taylor, Nigel J.; Fauquet, Claude M.

2011-01-01

Although calorie dense, the starchy, tuberous roots of cassava provide the lowest sources of dietary protein within the major staple food crops (Manihot esculenta Crantz). (Montagnac JA, Davis CR, Tanumihardjo SA. (2009) Compr Rev Food Sci Food Saf 8:181–194). Cassava was genetically modified to express zeolin, a nutritionally balanced storage protein under control of the patatin promoter. Transgenic plants accumulated zeolin within de novo protein bodies localized within the root storage tissues, resulting in total protein levels of 12.5% dry weight within this tissue, a fourfold increase compared to non-transgenic controls. No significant differences were seen for morphological or agronomic characteristics of transgenic and wild type plants in the greenhouse and field trials, but relative to controls, levels of cyanogenic compounds were reduced by up to 55% in both leaf and root tissues of transgenic plants. Data described here represent a proof of concept towards the potential transformation of cassava from a starchy staple, devoid of storage protein, to one capable of supplying inexpensive, plant-based proteins for food, feed and industrial applications. PMID:21283593

Transgenic biofortification of the starchy staple cassava (Manihot esculenta) generates a novel sink for protein.

PubMed

Abhary, Mohammad; Siritunga, Dimuth; Stevens, Gene; Taylor, Nigel J; Fauquet, Claude M

2011-01-25

Although calorie dense, the starchy, tuberous roots of cassava provide the lowest sources of dietary protein within the major staple food crops (Manihot esculenta Crantz). (Montagnac JA, Davis CR, Tanumihardjo SA. (2009) Compr Rev Food Sci Food Saf 8:181-194). Cassava was genetically modified to express zeolin, a nutritionally balanced storage protein under control of the patatin promoter. Transgenic plants accumulated zeolin within de novo protein bodies localized within the root storage tissues, resulting in total protein levels of 12.5% dry weight within this tissue, a fourfold increase compared to non-transgenic controls. No significant differences were seen for morphological or agronomic characteristics of transgenic and wild type plants in the greenhouse and field trials, but relative to controls, levels of cyanogenic compounds were reduced by up to 55% in both leaf and root tissues of transgenic plants. Data described here represent a proof of concept towards the potential transformation of cassava from a starchy staple, devoid of storage protein, to one capable of supplying inexpensive, plant-based proteins for food, feed and industrial applications.

Endoscopic hemostasis using endoclip in early gastrointestinal hemorrhage after gastric bypass surgery.

PubMed

Tang, Shou-Jiang; Rivas, Homero; Tang, Linda; Lara, Luis F; Sreenarasimhaiah, Jayaprakash; Rockey, Don C

2007-09-01

Roux-en-Y gastric bypass (RYGBP) is the most commonly performed bariatric operation in the USA. In the early postoperative stage, gastrointestinal (GI) bleeding is an infrequent but potentially serious complication that usually results from bleeding at the gastrojejunostomy staple-line. Observant management with transfusion for stable patients and surgical exploration for unstable patients is typically recommended for early GI bleeding. We hypothesized that use of endoclips, which do not cause thermal injury to the surrounding tissues (or anastomosis), may be preferable to thermal approaches which could cause tissue injury. We report 2 cases of early GI bleeding after RYGBP that were successfully managed with endoclip application to bleeding lesions. Emergent endoscopy was performed, and major stigmata such as active spurting vessel and adherent clot were noted at the gastrojejunostomy staple-lines. Endoscopic hemostasis using endoclips was readily applied to bleeding lesions at staple-lines. Primary hemostasis was achieved, and there was no recurrent bleeding or complication. We conclude that therapeutic endoscopy can be performed safely for early bleeding after RYGBP. In patients with early bleeding after RYGBP, use of endoclips is mechanistically preferable to other options.

Antioxidant capacity, total phenolics and nutritional content in selected ethiopian staple food ingredients.

PubMed

Forsido, Sirawdink Fikreyesus; Rupasinghe, H P Vasantha; Astatkie, Tess

2013-12-01

The total antioxidant capacity, total phenolics content (TPC) and nutritional content of five types of enset (Enset ventricosum) flour in comparison with four staples (teff [Eragrostis tef], wheat, corn and tapioca) were evaluated. Teff, corn and "amicho" (corm of enset) had the highest ferric reducing antioxidant power (FRAP). The FRAP and TPC of teff (1.8 mmol Trolox equivalence/100 g dry matter (DM) and 123.6 mg gallic acid equivalent/100 g DM, respectively) were over 4-fold larger than the lowest obtained from "bulla" (dehydrated juice of pseudostem of enset). Corn had the lowest IC(50) value of 1,1-diphenyl-2-picrylhydrazyl radical scavenging (10.27 mg DM mL(-1)). Teff had the highest crude fat content (3.71%) and some mineral profile (P, Mg, Mn and Cu). Enset products had higher fiber, Ca, K, Mg and Mn content as compared to wheat and corn. Ethiopian staple teff has a potential for developing value-added food products with nutritional and health benefits.

[Prevention of post-operative pain and haemorrhage in PPH (Procedure for Prolapse and Hemorrhoids) and STARR (Stapled Trans-Anal Rectal Resection). Preliminary results in 261 cases].

PubMed

Mongardini, M; Custureri, F; Schillaci, F; Cola, A; Maturo, A; Fanello, G; Corelli, S; Pappalardo, G

2005-04-01

Intra- and early (first week) post-operative haemorrhages are the most common complications in stapled hemorrhoidectomy PPH (Procedure for Prolapse and Hemorrhoids) and in circumferential resection of the rectal prolapse STARR (Stapled Trans Anal Rectal Resection). Performing PPH and STARR we employed a gelatin based haemostatic sealant with thrombin component (FloSeal) to control intra-operative bleeding and to reduce post-operative bleeding avoiding haemostatic stitches on suture line. We report the preliminary results on 197 PPH and 64 STARR; 44 PPH (22.4%) and 27 STARR (42.2%) were treated by FloSeal. No major post-operative bleeding was observed in all patients treated by FloSeal, compared to 1.3% and 2.7% of hemorrhage respectively in PPH and STARR patients treated without sealant. Post-operative pain was less severe in patients treated by FloSeal, without a difference statistically significant. The data are preliminary and must be confirmed in prospective randomized trials in larger series.

Biomechanical Comparison of Single- Versus Double-Row Capsulolabral Repair for Shoulder Instability: A Review

PubMed Central

Yousif, Matthew John; Bicos, James

2017-01-01

Background: The glenohumeral joint is the most commonly dislocated joint in the body. Failure rates of capsulolabral repair have been reported to be approximately 8%. Recent focus has been on restoration of the capsulolabral complex by a double-row capsulolabral repair technique in an effort to decrease redislocation rates after arthroscopic capsulolabral repair. Purpose: To present a review of the biomechanical literature comparing single- versus double-row capsulolabral repairs and discuss the previous case series of double-row fixation. Study Design: Narrative review. Methods: A simple review of the literature was performed by PubMed search. Only biomechanical studies comparing single- versus double-row capsulolabral repair were included for review. Only those case series and descriptive techniques with clinical results for double-row repair were included in the discussion. Results: Biomechanical comparisons evaluating the native footprint of the labrum demonstrated significantly superior restoration of the footprint through double-row capsulolabral repair compared with single-row repair. Biomechanical comparisons of contact pressure at the repair interface, fracture displacement in bony Bankart lesion, load to failure, and decreased external rotation (suggestive of increased load to failure) were also significantly in favor of double- versus single-row repair. Recent descriptive techniques and case series of double-row fixation have demonstrated good clinical outcomes; however, no comparative clinical studies between single- and double-row repair have assessed functional outcomes. Conclusion: The superiority of double-row capsulolabral repair versus single-row repair remains uncertain because comparative studies assessing clinical outcomes have yet to be performed. PMID:29230427

Evaluation of footprint contact area and pressure using a triple-row modification of the suture-bridge technique for rotator cuff repair.

PubMed

Ostrander, Roger V; McKinney, Bart I

2012-10-01

Studies suggest that arthroscopic repair techniques may have high recurrence rates for larger rotator cuff tears. A more anatomic repair may improve the success rate when performing arthroscopic rotator cuff repair. We hypothesized that a triple-row modification of the suture-bridge technique for rotator cuff repair would result in significantly more footprint contact area and pressure between the rotator cuff and the humeral tuberosity. Eighteen ovine infraspinatus tendons were repaired using 1 of 3 simulated arthroscopic techniques: a double-row repair, the suture-bridge technique, and a triple-row repair. The triple-row repair technique is a modification of the suture-bridge technique that uses an additional reducing anchor between the medial and lateral rows. Six samples were tested per group. Pressure-indicating film was used to measure the footprint contact area and pressure after each repair. The triple-row repair resulted in significantly more rotator cuff footprint contact area and contact pressure compared with the double-row technique and the standard suture-bridge technique. No statistical difference in contact area or contact pressure was found between the double-row technique and the suture-bridge technique. The triple-row technique for rotator cuff repair results in significantly more footprint contact area and contact pressure compared with the double-row and standard suture-bridge techniques. This more anatomic repair may improve the healing rate when performing arthroscopic rotator cuff repair. Copyright © 2012 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Faster Double-Size Bipartite Multiplication out of Montgomery Multipliers

NASA Astrophysics Data System (ADS)

Yoshino, Masayuki; Okeya, Katsuyuki; Vuillaume, Camille

This paper proposes novel algorithms for computing double-size modular multiplications with few modulus-dependent precomputations. Low-end devices such as smartcards are usually equipped with hardware Montgomery multipliers. However, due to progresses of mathematical attacks, security institutions such as NIST have steadily demanded longer bit-lengths for public-key cryptography, making the multipliers quickly obsolete. In an attempt to extend the lifespan of such multipliers, double-size techniques compute modular multiplications with twice the bit-length of the multipliers. Techniques are known for extending the bit-length of classical Euclidean multipliers, of Montgomery multipliers and the combination thereof, namely bipartite multipliers. However, unlike classical and bipartite multiplications, Montgomery multiplications involve modulus-dependent precomputations, which amount to a large part of an RSA encryption or signature verification. The proposed double-size technique simulates double-size multiplications based on single-size Montgomery multipliers, and yet precomputations are essentially free: in an 2048-bit RSA encryption or signature verification with public exponent e=216+1, the proposal with a 1024-bit Montgomery multiplier is at least 1.5 times faster than previous double-size Montgomery multiplications.

Single, double or multiple-injection techniques for non-ultrasound guided axillary brachial plexus block in adults undergoing surgery of the lower arm.

PubMed

Chin, Ki Jinn; Alakkad, Husni; Cubillos, Javier E

2013-08-08

Regional anaesthesia comprising axillary block of the brachial plexus is a common anaesthetic technique for distal upper limb surgery. This is an update of a review first published in 2006 and updated in 2011. To compare the relative effects (benefits and harms) of three injection techniques (single, double and multiple) of axillary block of the brachial plexus for distal upper extremity surgery. We considered these effects primarily in terms of anaesthetic effectiveness; the complication rate (neurological and vascular); and pain and discomfort caused by performance of the block. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE and reference lists of trials. We contacted trial authors. The date of the last search was March 2013 (updated from March 2011). We included randomized controlled trials that compared double with single-injection techniques, multiple with single-injection techniques, or multiple with double-injection techniques for axillary block in adults undergoing surgery of the distal upper limb. We excluded trials using ultrasound-guided techniques. Independent study selection, risk of bias assessment and data extraction were performed by at least two investigators. We undertook meta-analysis. The 21 included trials involved a total of 2148 participants who received regional anaesthesia for hand, wrist, forearm or elbow surgery. Risk of bias assessment indicated that trial design and conduct were generally adequate; the most common areas of weakness were in blinding and allocation concealment.Eight trials comparing double versus single injections showed a statistically significant decrease in primary anaesthesia failure (risk ratio (RR 0.51), 95% confidence interval (CI) 0.30 to 0.85). Subgroup analysis by method of nerve location showed that the effect size was greater when neurostimulation was used rather than the transarterial technique.Eight trials comparing multiple with single injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.25, 95% CI 0.14 to 0.44) and of incomplete motor block (RR 0.61, 95% CI 0.39 to 0.96) in the multiple injection group.Eleven trials comparing multiple with double injections showed a statistically significant decrease in primary anaesthesia failure (RR 0.28, 95% CI 0.20 to 0.40) and of incomplete motor block (RR 0.55, 95% CI 0.36 to 0.85) in the multiple injection group.Tourniquet pain was significantly reduced with multiple injections compared with double injections (RR 0.53, 95% CI 0.33 to 0.84). Otherwise there were no statistically significant differences between groups in any of the three comparisons on secondary analgesia failure, complications and patient discomfort. The time for block performance was significantly shorter for single and double injections compared with multiple injections. This review provides evidence that multiple-injection techniques using nerve stimulation for axillary plexus block produce more effective anaesthesia than either double or single-injection techniques. However, there was insufficient evidence for a significant difference in other outcomes, including safety.

Laser-assisted skin closure at 1.32 microns: the use of a software-driven medical laser system

NASA Astrophysics Data System (ADS)

Dew, Douglas K.; Hsu, Tung M.; Hsu, Long S.; Halpern, Steven J.; Michaels, Charles E.

1991-06-01

This study investigated the use of a computerized 1 .3 micron Nd:YAG laser to seal approximated wound edges in pig skin. The medical laser system used was the DLS Type 1 , 1 .32 micron Nd:YAG laser (Laser Surgery Software, Inc.). The purpose of this study was to evaluate the effectiveness of laser assisted skin closure using the DLS YAG laser in a large animal model. Effectiveness was judged on the basis of wound dehiscence, infection, unusual healing result and consistency of results. Comparative cosmetic result was also evaluated. In this study, the DLS YAG laser was used to close scalpel-induced, full-thickness wounds. The pig model was chosen for its many integumentary similarities to man. Controls included scalpel-induced wounds closed using suture, staple and some with norepair. After adequate anesthesia was achieved, the dorsum of Yucutan pigs (approximately 75- 100 pounds) each was clipped with animal hair clippers from the shoulder area to the hind legs. The area was then shaved with a razor blade, avoiding any inadvertent cuts or abrasions of the skin. The dorsum was divided into four rows of four parallel incisions made by a #15 scalpel blade. Full-thickness incisions, 9 cm long, were placed over the dorsum of the pigs and then closed either with one loosely approximating Prolene" suture (the "no repair' group), multiple interrupted 6-0 nylon sutures, staples or laser. The experimental tissue sealing group consisted of 1 69 laser assisted closures on 1 3 pigs. Sutured control wounds were closed with 6-0 nylon, full thickness, simple, interrupted sutures. Eight sutures were placed 1 cm apart along the 9 cm incision. Stapled control wounds were approximated using two evenly spaced 3-0 VicryP' sub-dermal sutures and the dermis closed using Proximate' skin staples. Eight staples were placed 1 cm apart along the 9 cm incision. The no-repair incisions were grossly approximated using a single 2-0 Prolene full thickness, simple, interrupted suture located at the center of the 9 cm incision. Experimental wounds were approximated using two evenly spaced subdermal 3.0 Vicryl' sutures and the dermis closed by laser sealing using the DLS YAG laser. Wounds were examined daily for the first seven days and followed for up to 20 months postoperatively. To facilitate wound edge approximation, surgical tape that is relatively transparent to 1.3 micron irradiation was used to hold the wound edges approximated while laser application occurred. Surgical tape was also applied to the "no-repair" suture and staple closures at the end of each procedure.

Geometric pre-patterning based tuning of the period doubling onset strain during thin film wrinkling

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saha, Sourabh K.

Wrinkling of supported thin films is an easy-to-implement and low-cost fabrication technique for generation of stretch-tunable periodic micro and nano-scale structures. However, the tunability of such structures is often limited by the emergence of an undesirable period doubled mode at high strains. Predictively tuning the onset strain for period doubling via existing techniques requires one to have extensive knowledge about the nonlinear pattern formation behavior. Herein, a geometric pre-patterning based technique is introduced to delay the onset of period doubling that can be implemented to predictively tune the onset strain even with limited system knowledge. The technique comprises pre-patterning themore » film/base bilayer with a sinusoidal pattern that has the same period as the natural wrinkle period of the system. The effectiveness of this technique has been verified via physical and computational experiments on the polydimethylsiloxane/glass bilayer system. It is observed that the period doubling onset strain can be increased from the typical value of 20% for flat films to greater than 30% with a modest pre-pattern aspect ratio (2∙amplitude/period) of 0.15. In addition, finite element simulations reveal that (i) the onset strain can be increased up to a limit by increasing the amplitude of the pre-patterns and (ii) the delaying effect can be captured entirely by the pre-pattern geometry. As a result, one can implement this technique even with limited system knowledge, such as material properties or film thickness, by simply replicating pre-existing wrinkled patterns to generate prepatterned bilayers. Thus, geometric pre-patterning is a practical scheme to suppress period doubling that can increase the operating range of stretch-tunable wrinkle-based devices by at least 50%.« less

Double hashing technique in closed hashing search process

NASA Astrophysics Data System (ADS)

Rahim, Robbi; Zulkarnain, Iskandar; Jaya, Hendra

2017-09-01

The search process is used in various activities performed both online and offline, many algorithms that can be used to perform the search process one of which is a hash search algorithm, search process with hash search algorithm used in this study using double hashing technique where the data will be formed into the table with same length and then search, the results of this study indicate that the search process with double hashing technique allows faster searching than the usual search techniques, this research allows to search the solution by dividing the value into the main table and overflow table so that the search process is expected faster than the data stacked in the form of one table and collision data could avoided.

A biomechanical comparison of single and double-row fixation in arthroscopic rotator cuff repair.

PubMed

Smith, Christopher D; Alexander, Susan; Hill, Adam M; Huijsmans, Pol E; Bull, Anthony M J; Amis, Andrew A; De Beer, Joe F; Wallace, Andrew L

2006-11-01

The optimal method for arthroscopic rotator cuff repair is not yet known. The hypothesis of the present study was that a double-row repair would demonstrate superior static and cyclic mechanical behavior when compared with a single-row repair. The specific aims were to measure gap formation at the bone-tendon interface under static creep loading and the ultimate strength and mode of failure of both methods of repair under cyclic loading. A standardized tear of the supraspinatus tendon was created in sixteen fresh cadaveric shoulders. Arthroscopic rotator cuff repairs were performed with use of either a double-row technique (eight specimens) or a single-row technique (eight specimens) with nonabsorbable sutures that were double-loaded on a titanium suture anchor. The repairs were loaded statically for one hour, and the gap formation was measured. Cyclic loading to failure was then performed. Gap formation during static loading was significantly greater in the single-row group than in the double-row group (mean and standard deviation, 5.0 +/- 1.2 mm compared with 3.8 +/- 1.4 mm; p < 0.05). Under cyclic loading, the double-row repairs failed at a mean of 320 +/- 96.9 N whereas the single-row repairs failed at a mean of 224 +/- 147.9 N (p = 0.058). Three single-row repairs and three double-row repairs failed as a result of suture cut-through. Four single-row repairs and one double-row repair failed as a result of anchor or suture failure. The remaining five repairs did not fail, and a midsubstance tear of the tendon occurred. Although more technically demanding, the double-row technique demonstrates superior resistance to gap formation under static loading as compared with the single-row technique. A double-row reconstruction of the supraspinatus tendon insertion may provide a more reliable construct than a single-row repair and could be used as an alternative to open reconstruction for the treatment of isolated tears.

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE DOUBLE-BUNDLE TECHNIQUE – EVALUATION IN THE BIOMECHANICS LABORATORY

PubMed Central

D'Elia, Caio Oliveira; Bitar, Alexandre Carneiro; Castropil, Wagner; Garofo, Antônio Guilherme Padovani; Cantuária, Anita Lopes; Orselli, Maria Isabel Veras; Luques, Isabela Ugo; Duarte, Marcos

2015-01-01

Objective: The objective of this study was to describe the methodology of knee rotation analysis using biomechanics laboratory instruments and to present the preliminary results from a comparative study on patients who underwent anterior cruciate ligament (ACL) reconstruction using the double-bundle technique. Methods: The protocol currently used in our laboratory was described. Three-dimensional kinematic analysis was performed and knee rotation amplitude was measured on eight normal patients (control group) and 12 patients who were operated using the double-bundle technique, by means of three tasks in the biomechanics laboratory. Results: No significant differences between operated and non-operated sides were shown in relation to the mean amplitudes of gait, gait with change in direction or gait with change in direction when going down stairs (p > 0.13). Conclusion: The preliminary results did not show any difference in the double-bundle ACL reconstruction technique in relation to the contralateral side and the control group. PMID:27027003

New technique of skin embedded wire double-sided laser beam welding

NASA Astrophysics Data System (ADS)

Han, Bing; Tao, Wang; Chen, Yanbin

2017-06-01

In the aircraft industry, double-sided laser beam welding is an approved method for producing skin-stringer T-joints on aircraft fuselage panels. As for the welding of new generation aluminum-lithium alloys, however, this technique is limited because of high hot cracking susceptibility and strengthening elements' uneven distributions within weld. In the present study, a new technique of skin embedded wire double-sided laser beam welding (LBW) has been developed to fabricate T-joints consisting of 2.0 mm thick 2060-T8/2099-T83 aluminum-lithium alloys using eutectic alloy AA4047 filler wire. Necessary dimension parameters of the novel groove were reasonably designed for achieving crack-free welds. Comparisons were made between the new technique welded T-joint and conventional T-joint mainly on microstructure, hot crack, elements distribution features and mechanical properties within weld. Excellent crack-free microstructure, uniform distribution of silicon and superior tensile properties within weld were found in the new skin embedded wire double-sided LBW T-joints.

Clinical Results of Flexor Tendon Repair in Zone II Using a six Strand Double Loop Technique.

PubMed

Savvidou, Christiana; Tsai, Tsu-Min

2015-06-01

The purpose of this study is to report the clinical results after repair of flexor tendon zone II injuries utilizing a 6-strand double-loop technique and early post-operative active rehabilitation. We retrospectively reviewed 22 patients involving 51 cases with zone II flexor tendon repair using a six strand double loop technique from September 1996 to December 2012. Most common mechanism of injuries was sharp lacerations (86.5 %). Tendon injuries occurred equally in manual and non-manual workers and were work-related in 33 % of the cases. The Strickland score for active range of motion (ROM) postoperatively was excellent and good in the majority of the cases (81 %). The rupture rate was 1.9 %. The six strand double loop technique for Zone II flexor tendon repair leads to good and excellent motion in the majority of patients and low re- rupture rate. It is clinically effective and allows for early postoperative active rehabilitation.

Hand and nickel-titanium root canal instrumentation performed by dental students: a micro-computed tomographic study.

PubMed

Peru, M; Peru, C; Mannocci, F; Sherriff, M; Buchanan, L S; Pitt Ford, T R

2006-02-01

The aim of this study was to evaluate root canals instrumented by dental students using the modified double-flared technique, nickel-titanium (NiTi) rotary System GT files and NiTi rotary ProTaper files by micro-computed tomography (MCT). A total of 36 root canals from 18 mesial roots of mandibular molar teeth were prepared; 12 canals were prepared with the modified double-flared technique, using K-flexofiles and Gates-Glidden burs; 12 canals were prepared using System GT and 12 using ProTaper rotary files. Each root was scanned using MCT preoperatively and postoperatively. At the coronal and mid-root sections, System GT and ProTaper files produced significantly less enlarged canal cross-sectional area, volume and perimeter than the modified double-flared technique (P < 0.05). In the mid-root sections there was significantly less thinning of the root structure towards the furcation with System GT and ProTaper (P < 0.05). The rotary techniques were both three times faster than the modified double-flared technique (P < 0.05). Qualitative evaluation of the preparations showed that both ProTaper and System GT were able to prepare root canals with little or no procedural error compared with the modified double-flared technique. Under the conditions of this study, inexperienced dental students were able to prepare curved root canals with rotary files with greater preservation of tooth structure, low risk of procedural errors and much quicker than with hand instruments.

Nuclease-mediated genome editing: At the front-line of functional genomics technology.

PubMed

Sakuma, Tetsushi; Woltjen, Knut

2014-01-01

Genome editing with engineered endonucleases is rapidly becoming a staple method in developmental biology studies. Engineered nucleases permit random or designed genomic modification at precise loci through the stimulation of endogenous double-strand break repair. Homology-directed repair following targeted DNA damage is mediated by co-introduction of a custom repair template, allowing the derivation of knock-out and knock-in alleles in animal models previously refractory to classic gene targeting procedures. Currently there are three main types of customizable site-specific nucleases delineated by the source mechanism of DNA binding that guides nuclease activity to a genomic target: zinc-finger nucleases (ZFNs), transcription activator-like effector nucleases (TALENs), and clustered regularly interspaced short palindromic repeats (CRISPR). Among these genome engineering tools, characteristics such as the ease of design and construction, mechanism of inducing DNA damage, and DNA sequence specificity all differ, making their application complementary. By understanding the advantages and disadvantages of each method, one may make the best choice for their particular purpose. © 2014 The Authors Development, Growth & Differentiation © 2014 Japanese Society of Developmental Biologists.

Essentials of skin laceration repair.

PubMed

Forsch, Randall T

2008-10-15

Skin laceration repair is an important skill in family medicine. Sutures, tissue adhesives, staples, and skin-closure tapes are options in the outpatient setting. Physicians should be familiar with various suturing techniques, including simple, running, and half-buried mattress (corner) sutures. Although suturing is the preferred method for laceration repair, tissue adhesives are similar in patient satisfaction, infection rates, and scarring risk in low skin-tension areas and may be more cost-effective. The tissue adhesive hair apposition technique also is effective in repairing scalp lacerations. The sting of local anesthesia injections can be lessened by using smaller gauge needles, administering the injection slowly, and warming or buffering the solution. Studies have shown that tap water is safe to use for irrigation, that white petrolatum ointment is as effective as antibiotic ointment in postprocedure care, and that wetting the wound as early as 12 hours after repair does not increase the risk of infection. Patient education and appropriate procedural coding are important after the repair.

Surgical management of penetrating pulmonary injuries

PubMed Central

Petrone, Patrizio; Asensio, Juan A

2009-01-01

Chest injuries were reported as early as 3000 BC in the Edwin Smith Surgical Papyrus. Ancient Greek chronicles reveal that they had anatomic knowledge of the thoracic structures. Even in the ancient world, most of the therapeutic modalities for chest wounds and traumatic pulmonary injuries were developed during wartime. The majority of lung injuries can be managed non-operatively, but pulmonary injuries that require operative surgical intervention can be quite challenging. Recent progress in treating severe pulmonary injuries has relied on finding shorter and simpler lung-sparing techniques. The applicability of stapled pulmonary tractotomy was confirmed as a safe and valuable procedure. Advancement in technology have revolutionized thoracic surgery and ushered in the era of video-assisted thoracoscopic surgery (VATS), providing an alternative method for accurate and direct evaluation of the lung parenchyma, mediastinum, and diaphragmatic injuries. The aim of this article is to describe the incidence of the penetrating pulmonary injuries, the ultimate techniques used in its operative management, as well as the diagnosis, complications, and morbidity and mortality. PMID:19236703

Laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis for middle or lower esophageal carcinoma

PubMed Central

Ai, Bo; Zhang, Zheng

2014-01-01

Thoracoscopic mobilization of esophagus and laparoscopic mobilization of stomach with cervical anastomosis is employed widely in minimally invasive esophagectomy (MIE) for esophageal carcinoma. However, it is associated with high incidence of complications, including recurrent laryngeal nerve injury and anastomotic leak. This paper summarizes the key techniques in total laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis for MIE in 62 patients of middle or lower esophageal cancer between March 2012 and August 2013. Total laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis was performed to treat the middle or lower esophageal cancer. Laparoscopic and thoracoscopic Ivor-Lewis esophagectomy was performed using a circular stapler (Johnson and Johnson) intrathoracically to staple esophagogastric anastomosis and reconstruct the digestive tract. In addition, we performed tension-relieving anastomotic suture and embedded with pedicled omental flap. Compared with the trans-orally inserted anvil (OrVil) approach, the technique reported here is safe, feasible and user-friendly. Total thoracoscopic intrathoracic anastomosis can be performed with a circular stapler (Johnson and Johnson). PMID:25276383

Laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis for middle or lower esophageal carcinoma.

PubMed

Ai, Bo; Zhang, Zheng; Liao, Yongde

2014-09-01

Thoracoscopic mobilization of esophagus and laparoscopic mobilization of stomach with cervical anastomosis is employed widely in minimally invasive esophagectomy (MIE) for esophageal carcinoma. However, it is associated with high incidence of complications, including recurrent laryngeal nerve injury and anastomotic leak. This paper summarizes the key techniques in total laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis for MIE in 62 patients of middle or lower esophageal cancer between March 2012 and August 2013. Total laparoscopic and thoracoscopic esophagectomy with intrathoracic anastomosis was performed to treat the middle or lower esophageal cancer. Laparoscopic and thoracoscopic Ivor-Lewis esophagectomy was performed using a circular stapler (Johnson and Johnson) intrathoracically to staple esophagogastric anastomosis and reconstruct the digestive tract. In addition, we performed tension-relieving anastomotic suture and embedded with pedicled omental flap. Compared with the trans-orally inserted anvil (OrVil) approach, the technique reported here is safe, feasible and user-friendly. Total thoracoscopic intrathoracic anastomosis can be performed with a circular stapler (Johnson and Johnson).

Double-bundle anterior cruciate ligament reconstruction is superior to single-bundle reconstruction in terms of revision frequency: a study of 22,460 patients from the Swedish National Knee Ligament Register.

PubMed

Svantesson, Eleonor; Sundemo, David; Hamrin Senorski, Eric; Alentorn-Geli, Eduard; Musahl, Volker; Fu, Freddie H; Desai, Neel; Stålman, Anders; Samuelsson, Kristian

2017-12-01

Studies comparing single- and double-bundle anterior cruciate ligament (ACL) reconstructions often include a combined analysis of anatomic and non-anatomic techniques. The purpose of this study was to compare the revision rates between single- and double-bundle ACL reconstructions in the Swedish National Knee Ligament Register with regard to surgical variables as determined by the anatomic ACL reconstruction scoring checklist (AARSC). Patients from the Swedish National Knee Ligament Register who underwent either single- or double-bundle ACL reconstruction with hamstring tendon autograft during the period 2007-2014 were included. The follow-up period started with primary ACL reconstruction, and the outcome measure was set as revision surgery. An online questionnaire based on the items of the AARSC was used to determine the surgical technique implemented in the single-bundle procedures. These were organized into subgroups based on surgical variables, and the revision rates were compared with the double-bundle ACL reconstruction. Hazard ratios (HR) with 95% confidence interval (CI) was calculated and adjusted for confounders by Cox regression. A total of 22,460 patients were included in the study, of which 21,846 were single-bundle and 614 were double-bundle ACL reconstruction. Double-bundle ACL reconstruction had a revision frequency of 2.0% (n = 12) and single-bundle 3.2% (n = 689). Single-bundle reconstruction had an increased risk of revision surgery compared with double-bundle [adjusted HR 1.98 (95% CI 1.12-3.51), p = 0.019]. The subgroup analysis showed a significantly increased risk of revision surgery in patients undergoing single-bundle with anatomic technique using transportal drilling [adjusted HR 2.51 (95% CI 1.39-4.54), p = 0.002] compared with double-bundle ACL reconstruction. Utilizing a more complete anatomic technique according to the AARSC lowered the hazard rate considerably when transportal drilling was performed but still resulted in significantly increased risk of revision surgery compared with double-bundle ACL reconstruction [adjusted HR 1.87 (95% CI 1.04-3.38), p = 0.037]. Double-bundle ACL reconstruction is associated with a lower risk of revision surgery than single-bundle ACL reconstruction. Single-bundle procedures performed using transportal femoral drilling technique had significantly higher risk of revision surgery compared with double-bundle. However, a reference reconstruction with transportal drilling defined as a more complete anatomic reconstruction reduces the risk of revision surgery considerably. III.

Comparison of hemostatic properties between collagen and synthetic buttress materials used in staple line reinforcement in a swine splenic hemorrhage model.

PubMed

Spector, David; Perry, Zvi; Konobeck, Tracy; Mooradian, Daniel; Shikora, Scott

2011-04-01

The use of staplers in gastrointestinal surgery is widespread, especially in advanced laparoscopic procedures. Staple line reinforcement with a buttress reduces bleeding and associated complications through a combination of factors. The intrinsic hemostatic properties of buttress materials have not been examined. This study examined the intrinsic hemostatic properties of two different types of material used in buttressing in an accepted hemostasis model that does not involve stapling or its effects by compression. An acellular collagen buttress (Veritas) and a synthetic polymer buttress (Duet) were compared to two commonly used hemostatic agents, Syvek and Surgicel, with gauze as control. In a swine capsular stripping hemostasis model, a 1 × 1 cm section of spleen capsule was removed and used as a source of bleeding, with one patch of material tested per bleeding site. A total of 51 wounds were created in five pigs (each patch n = 10, control n = 11). Hemostatic efficacy was assessed by quantitating the number of applications and total time needed for bleeding to stop. The mean time needed for hemostasis for Syvek and Veritas patches was significantly less than gauze, Duet and Surgicel (4.02, 4.51 vs. 8.97, 9.22, and 10.30 min respectively; p < 0.05). The Syvek and Veritas patches required significantly fewer applications than gauze, Duet™ and Surgicel (1.7, 2.2 vs. 4.1, 4.6, and 4.9 respectively; p < 0.01). The intrinsic hemostatic properties of different buttressing materials vary widely. In this study, a collagen buttress was significantly better at promoting hemostasis than the synthetic buttress material in a nonstapling model. This could be another factor to consider when choosing a buttress for staple line reinforcement.

Do Clinical Results and Return-to-Sport Rates After Ulnar Collateral Ligament Reconstruction Differ Based on Graft Choice and Surgical Technique?

PubMed Central

Erickson, Brandon J.; Cvetanovich, Gregory L.; Frank, Rachel M.; Bach, Bernard R.; Cohen, Mark S.; Bush-Joseph, Charles A.; Cole, Brian J.; Romeo, Anthony A.

2016-01-01

Background: Ulnar collateral ligament reconstruction (UCLR) has become a common procedure performed in overhead-throwing athletes of many athletic levels. Purpose/Hypothesis: The purpose of this study was to determine whether clinical outcomes and return-to-sport (RTS) rates differ among patients undergoing UCLR based on graft choice, surgical technique, athletic competition level, handedness, and treatment of the ulnar nerve. We hypothesized that no differences would exist in clinical outcomes or RTS rates between technique, graft choice, or other variables. Study Design: Cohort study; Level of evidence, 3. Methods: All patients who underwent UCLR from January 1, 2004 through December 31, 2014 at a single institution were identified. Charts were reviewed to determine patient age, sex, date of surgery, sport played, handedness, athletic level, surgical technique, graft type, and complications. Patients were contacted via telephone to obtain the RTS rate, Conway-Jobe score, Timmerman-Andrews score, and Kerlan-Jobe Orthopaedic Clinic (KJOC) Shoulder and Elbow score. Results: Eighty-five patients (mean age at surgery, 19.3 ± 4.7 years; 92% male; 78% right hand–dominant) underwent UCLR between 2004 and 2014 and were available for follow-up. Overall, 87% were baseball pitchers, 49.4% were college athletes, and 41.2% were high school athletes. No significant difference existed between the docking and double-docking techniques, graft choice, handedness, sex, activity level, and treatment of the ulnar nerve with regard to clinical outcomes, RTS, or subsequent surgeries (all P > .05). More complications were seen in the docking technique compared with the double-docking technique (P = .036). Hamstring autograft was used more commonly with the docking technique (P = .023) while allograft was used more commonly with the double-docking technique (P = .0006). Conclusion: Both the docking and double-docking techniques produce excellent clinical outcomes in patients undergoing UCLR. No difference in outcome scores was seen between surgical technique or graft type. The double-docking technique had fewer complications than the docking technique. PMID:27896290

Double-Row Capsulolabral Repair Increases Load to Failure and Decreases Excessive Motion.

PubMed

McDonald, Lucas S; Thompson, Matthew; Altchek, David W; McGarry, Michelle H; Lee, Thay Q; Rocchi, Vanna J; Dines, Joshua S

2016-11-01

Using a cadaver shoulder instability model and load-testing device, we compared biomechanical characteristics of double-row and single-row capsulolabral repairs. We hypothesized a greater reduction in glenohumeral motion and translation and a higher load to failure in a mattress double-row capsulolabral repair than in a single-row repair. In 6 matched pairs of cadaveric shoulders, a capsulolabral injury was created. One shoulder was repaired with a single-row technique, and the other with a double-row mattress technique. Rotational range of motion, anterior-inferior translation, and humeral head kinematics were measured. Load-to-failure testing measured stiffness, yield load, deformation at yield load, energy absorbed at yield load, load to failure, deformation at ultimate load, and energy absorbed at ultimate load. Double-row repair significantly decreased external rotation and total range of motion compared with single-row repair. Both repairs decreased anterior-inferior translation compared with the capsulolabral-injured condition, however, no differences existed between repair types. Yield load in the single-row group was 171.3 ± 110.1 N, and in the double-row group it was 216.1 ± 83.1 N (P = .02). Ultimate load to failure in the single-row group was 224.5 ± 121.0 N, and in the double-row group it was 373.9 ± 172.0 N (P = .05). Energy absorbed at ultimate load in the single-row group was 1,745.4 ± 1,462.9 N-mm, and in the double-row group it was 4,649.8 ± 1,930.8 N-mm (P = .02). In cases of capsulolabral disruption, double-row repair techniques may result in decreased shoulder rotational range of motion and improved load-to-failure characteristics. In cases of capsulolabral disruption, repair techniques with double-row mattress repair may provide more secure fixation. Double-row capsulolabral repair decreases shoulder motion and increases load to failure, yield load, and energy absorbed at yield load more than single-row repair. Published by Elsevier Inc.

Functional Outcomes Following Laparoscopic Ileal Pouch-Anal Anastomosis in Patients with Chronic Ulcerative Colitis: Long-Term Follow-up of a Case-Matched Study.

PubMed

Baek, Se-Jin; Lightner, Amy L; Boostrom, Sarah Y; Mathis, Kellie L; Cima, Robert R; Pemberton, John H; Larson, David W; Dozois, Eric J

2017-08-01

Laparoscopic ileal pouch-anal anastomosis (L-IPAA) has been increasingly adopted over the last decade due to short-term patient-related benefits. Several studies have shown L-IPAA to be equivalent to open IPAA in terms of safety and short-term outcomes. However, few L-IPAA studies have examined long-term functional outcomes. We aimed to evaluate the long-term functional outcomes of L-IPAA as compared to open IPAA. A previous case-matched cohort study at our institution compared short-term outcomes between L-IPAA and open IPAA from 1998 to 2004. For this study, we selected all patients from this case-matched cohort study with chronic ulcerative colitis (CUC) who had follow-up functional data of greater than 1 year. Functional data was obtained through prospective surveys, which were sent annually to all IPAA patients postoperatively. One hundred and forty-nine patients (58 L-IPAA, 91 open IPAA) with a median 8-year duration of follow-up were identified. There were no differences in demographics and long-term surgical outcomes between groups. Stapled anastomosis was more common in the laparoscopic group (91.4 versus 54.9%, p < 0.001). Stool frequency during daytime (>6 stools, L-IPAA 32.8%, open 49.4%, p = 0.048) and nighttime (>2 stools, L-IPAA 13.8%, open 30.6%; p = 0.024) was significantly lower in the L-IPAA group. Ability to differentiate gas from stool was not different (p = 0.13). Rate of complete continence was similar in L-IPAA and open groups (L-IPAA 36.2%, open 21.8%, p = 0.060). There was no difference in use of medication to control stools, perianal skin irritation, voiding difficulty, sexual problems, and occupational change between groups. Subgroup analysis to evaluate for any group differences attributable to anastomotic technique demonstrated only that stapled anastomoses lead to more perianal skin irritation in the L-IPAA group (L-IPAA = 60.4% versus open IPAA = 38.8%; p = 0.031). Overall, L-IPAA has comparable functional results to the open approach with slightly lower daytime and nighttime stool frequency. This difference may be attributed to a greater number of stapled anastomoses performed in the laparoscopic cohort.

Biomechanical characteristics and speed adaptation during kick double poling on roller skis in elite cross-country skiers.

PubMed

Göpfert, Caroline; Holmberg, Hans-Christer; Stöggl, Thomas; Müller, Erich; Lindinger, Stefan Josef

2013-06-01

Recent developments in cross-country ski racing should promote the use of kick double poling. This technique, however, has not been the focus in athletes' training and has barely been investigated. The aims of the present study were to develop a function-based phase definition and to analyse speed adaptation mechanisms for kick double poling in elite cross-country skiers. Joint kinematics and pole/plantar forces were recorded in 10 athletes while performing kick double poling at three submaximal roller skiing speeds. A speed increase was associated with increases in cycle length and rate, while absolute poling and leg push-off durations shortened. Despite maintained impulses of force, the peak and average pole/leg forces increased. During double poling and leg push-off, ranges of motion of elbow flexion and extension increased (p < 0.05) and were maintained for hip/knee flexion and extension. Cycle length increase was correlated to increases in average poling force (r = 0.71) and arm swing time (r = 0.88; both p < 0.05). The main speed adaptation was achieved by changes in double poling technique; however, leg push-off showed high variability among elite skiers, thus illustrating important aspects for technique training.

Bridging suture makes consistent and secure fixation in double-row rotator cuff repair.

PubMed

Fukuhara, Tetsutaro; Mihata, Teruhisa; Jun, Bong Jae; Neo, Masashi

2017-09-01

Inconsistent tension distribution may decrease the biomechanical properties of the rotator cuff tendon after double-row repair, resulting in repair failure. The purpose of this study was to compare the tension distribution along the repaired rotator cuff tendon among three double-row repair techniques. In each of 42 fresh-frozen porcine shoulders, a simulated infraspinatus tendon tear was repaired by using 1 of 3 double-row techniques: (1) conventional double-row repair (no bridging suture); (2) transosseous-equivalent repair (bridging suture alone); and (3) compression double-row repair (which combined conventional double-row and bridging sutures). Each specimen underwent cyclic testing at a simulated shoulder abduction angle of 0° or 40° on a material-testing machine. Gap formation and tendon strain were measured during the 1st and 30th cycles. To evaluate tension distribution after cuff repair, difference in gap and tendon strain between the superior and inferior fixations was compared among three double-row techniques. At an abduction angle of 0°, gap formation after either transosseous-equivalent or compression double-row repair was significantly less than that after conventional double-row repair (p < 0.01). During the 30th cycle, both transosseous-equivalent repair (p = 0.02) and compression double-row repair (p = 0.01) at 0° abduction had significantly less difference in gap formation between the superior and inferior fixations than did conventional double-row repair. After the 30th cycle, the difference in longitudinal strain between the superior and inferior fixations at 0° abduction was significantly less with compression double-row repair (2.7% ± 2.4%) than with conventional double-row repair (8.6% ± 5.5%, p = 0.03). Bridging sutures facilitate consistent and secure fixation in double-row rotator cuff repairs, suggesting that bridging sutures may be beneficial for distributing tension equally among all sutures during double-row repair of rotator cuff tears. Copyright © 2017 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

Prospects of pharmaceuticals and biopharmaceuticals loaded microparticles prepared by double emulsion technique for controlled delivery

PubMed Central

Giri, Tapan Kumar; Choudhary, Chhatrapal; Ajazuddin; Alexander, Amit; Badwaik, Hemant; Tripathi, Dulal Krishna

2012-01-01

Several methods and techniques are potentially useful for the preparation of microparticles in the field of controlled drug delivery. The type and the size of the microparticles, the entrapment, release characteristics and stability of drug in microparticles in the formulations are dependent on the method used. One of the most common methods of preparing microparticles is the single emulsion technique. Poorly soluble, lipophilic drugs are successfully retained within the microparticles prepared by this method. However, the encapsulation of highly water soluble compounds including protein and peptides presents formidable challenges to the researchers. The successful encapsulation of such compounds requires high drug loading in the microparticles, prevention of protein and peptide degradation by the encapsulation method involved and predictable release, both rate and extent, of the drug compound from the microparticles. The above mentioned problems can be overcome by using the double emulsion technique, alternatively called as multiple emulsion technique. Aiming to achieve this various techniques have been examined to prepare stable formulations utilizing w/o/w, s/o/w, w/o/o, and s/o/o type double emulsion methods. This article reviews the current state of the art in double emulsion based technologies for the preparation of microparticles including the investigation of various classes of substances that are pharmaceutically and biopharmaceutically active. PMID:23960828

Double transosseous pull out suture technique for transection of posterior horn of medial meniscus.

PubMed

Ahn, Jin Hwan; Wang, Joon Ho; Lim, Hong Chul; Bae, Ji Hoon; Park, Joon Soo; Yoo, Jae Chul; Shyam, Ashok Kumar

2009-03-01

Transection injury (complete radial tear, root tear) in the posterior horn of medial meniscus will lead to loss of hoop strain, extrusion of the meniscus and early degenerative changes. The posterior horn of medial meniscus is amenable to repair due to its good blood supply and repair is the procedure of choice for these injuries. In cases of transection of the medial meniscus posterior horn, the meniscus can be repaired by a pull out suture technique using trans-septal portal. The single transosseous pull out suturing technique is a point fixation technique with limited contact area having low and inhomogeneous contact pressure. This article describes a double transosseous pull out suture technique using trans-septal portal for the repair of transection of posterior horn of medial meniscus. Use of double transosseous technique provides more secure fixation, more homogeneous and wider contact pressure area between meniscus and the bone, improving the healing potential of the repair.

Conventional (CH) vs. stapled hemorrhoidectomy (SH) in surgical treatment of hemorrhoids. Ten years experience.

PubMed

Manfredelli, Simone; Montalto, Gioacchino; Leonetti, Giovanni; Covotta, Marco; Amatucci, Chiara; Covotta, Alfredo; Forte, Angelo

2012-01-01

Interest about hemorrhoids is related to its high incidence and elevated social costs that derive from its treatment. Several comparative studies are reported in Literature to define a standard for ideal treatment of hemorrhoidal disease. Radical surgery is the only therapeutic option in case of III and IV stage haemorrhoids. Hemorrhoids surgical techniques are classified as Open, Closed and Stapled ones. We report our decennial experience on surgical treatment focusing on early, middle and late complications, indications and contraindications, satisfaction level of each surgical procedure for hemorrhoids. Four hundred forty-eight patients have been hospitalized in our department fom 1st January to 31st December 2008. Of these 241 underwent surgery with traditional open or closed technique and 207 with the SH technique according to Longo. This retrospective study includes only patients with symptomatic hemorrhoids at III or IV stage. There were no differences between CH and SH about both pre and post surgery hospitalization and intraoperative length. Pain is the most frequently observed early complication with a statistically significant difference in favour of SH. We obtain good results in CH group using anoderma sparing and perianal anaesthetic infiltration at the end of the surgery. In all cases, pain relief was obtained only with standard analgesic drugs (NSAIDs). We also observed that pain level influences the outcome after surgical treatment. No chronic pain cases were observed in both groups. Bleeding is another relevant early complication in particular after SH: we reported 2 cases of immediate surgical reintenvention and 2 cases treated with blood transfusion. Only in SH group we report also 5 cases of thrombosis of external haemorrhoids and 7 perianal hematoma both solved with medical therapy There were no statistical significant differences between two groups about fever, incontinence to flatus, urinary retention, fecal incontinence, substenosis and anal burning. No cases of anal stenosis were observed. About late complications, most frequently observed were rectal prolapse and hemorrhoidal recurrence, especially after SH. Our experience confirms the validity of both CH and SH. Failure may be related to wrong surgical indication or technical execution. Certainly CH procedure is more invasive and slightly more painfull in immediate postoperative period than SH surgery, which is slightly more expensive and has more complications. In our opinion the high risk of possible early and immediate complications after surgery requires at least a 24 hours hospitalization length. SH is the gold standard for III grade haemorrhoids with mucous prolapse while CH is suggested in IV grade cases. Hemorrhoidal arterial ligation operation (HALO) technique in III and IV degree needs further validations.

Fluoride exposure and its health risk assessment in drinking water and staple food in the population of Dayyer, Iran, in 2013

PubMed Central

Keshavarz, Somayye; Ebrahimi, Afshin; Nikaeen, Mahnaz

2015-01-01

Aims: The aims of this study were to determine fluoride concentration in drinking water and staple foods consumed by residents of Dayyer port (Bushehr province, south of Iran) and to assess its health risk via human intake in 2013. Materials and Methods: Health risk assessment due to fluoride exposure via consumption of drinking water, date, vegetables and fish was conducted in spring and summer of 2013 using the US-EPA (United States—Environmental Protection Agency) method, which considers hazard quotient (HQ) as a ratio of the estimated dose of a contaminant to the reference dose. A fluoride ion-selective electrode (ISE) measured the fluoride contents of food samples. The sodium-2-(parasulfophenyl largo)-1,8-dihydroxy-3,6-naphtnalene disulfonate colorimetric method (SPADNS) was used to determine fluoride concentration in water samples. Results: The total estimated oral intake of fluoride for children in summer and spring were 120.6 and 145.6 µg/kg/day, respectively. These values for adults were 99.2 and 112 µg/kg/day. This survey demonstrated that drinking water was the most important contributor of dietary fluoride intake in the study area. Conclusion: HQ values for adults and children were >1 which approves that a potential health risk of fluorosis can exist. The recommendations for the study area are supplying drinking water from alternative sources and defluoridation of drinking water by an adsorption technique and membrane filtration, respectively. Furthermore, people are suggested to have a good nutrition (especially rich of vitamin C) to reduce the risk of fluorosis. PMID:27462614

Fluoride exposure and its health risk assessment in drinking water and staple food in the population of Dayyer, Iran, in 2013.

PubMed

Keshavarz, Somayye; Ebrahimi, Afshin; Nikaeen, Mahnaz

2015-01-01

The aims of this study were to determine fluoride concentration in drinking water and staple foods consumed by residents of Dayyer port (Bushehr province, south of Iran) and to assess its health risk via human intake in 2013. Health risk assessment due to fluoride exposure via consumption of drinking water, date, vegetables and fish was conducted in spring and summer of 2013 using the US-EPA (United States-Environmental Protection Agency) method, which considers hazard quotient (HQ) as a ratio of the estimated dose of a contaminant to the reference dose. A fluoride ion-selective electrode (ISE) measured the fluoride contents of food samples. The sodium-2-(parasulfophenyl largo)-1,8-dihydroxy-3,6-naphtnalene disulfonate colorimetric method (SPADNS) was used to determine fluoride concentration in water samples. The total estimated oral intake of fluoride for children in summer and spring were 120.6 and 145.6 µg/kg/day, respectively. These values for adults were 99.2 and 112 µg/kg/day. This survey demonstrated that drinking water was the most important contributor of dietary fluoride intake in the study area. HQ values for adults and children were >1 which approves that a potential health risk of fluorosis can exist. The recommendations for the study area are supplying drinking water from alternative sources and defluoridation of drinking water by an adsorption technique and membrane filtration, respectively. Furthermore, people are suggested to have a good nutrition (especially rich of vitamin C) to reduce the risk of fluorosis.

Minimizing blood loss at cesarean-hysterectomy for placenta previa percreta.

PubMed

Belfort, Michael A; Shamshiraz, Alireza A; Fox, Karin

2017-01-01

Preventing blood loss at the time of a cesarean delivery during a scheduled, nonemergent cesarean hysterectomy for placenta percreta may reduce the need for crystalloid and blood product transfusion. Commonly a classical hysterotomy is created and this can result in as much as a 500-800 mL blood loss before the hysterotomy is closed. Our technique involves placement of 4 full-thickness interrupted sutures in a box pattern to create an unperfused area of upper uterine segment. Diathermy is used to open the uterus to the membranes in the center of the "box" without blood loss. A finger is then inserted between the membranes and uterus to create a space into which 1 side of an 80-mm linear cutting stapler is introduced. The other side of the stapler is then attached and clamped closed, and the stapler is activated. Forward motion of the lever lays down 2 rows of staples, and backward movement of the lever divides the uterine muscle between the 2 staple lines. The stapler is removed and reloaded and reintroduced 1 or 2 times as needed to create an avascular hysterotomy large enough to atraumatically deliver the baby. The membranes are then opened and the baby is delivered. Following this the umbilical cord is clamped and cut without any attempt to remove the placenta, replaced in the uterine cavity, and the hysterotomy is closed with a running locked suture that incorporates the membrane edges. The hysterectomy then proceeds. In most cases there is minimal blood loss (usually <20 mL) from the cesarean delivery. Copyright © 2016 Elsevier Inc. All rights reserved.

NASA/UH signing of memorandum of understanding

NASA Image and Video Library

1996-10-02

NASA/University of Houston (UH) signing of memorandum of understanding. Johnson Space Center (JSC) Director George Abbey signs a memorandum of understanding with University of Houston's President Glenn Goerke and University of Houston Clear Lake President Williams Staples. UH will supply post-doctoral researchers to JSC for more than 15 projects of scientific interest to both JSC and the university. Seated from left are, Abbey, Goerke and Staples. Standing from left are David Criswell, director of the Institute of Space Systems Operations; Texas State Representatives Michael Jackson, Robert Talton and Talmadge Heflin. View appears in Space News Roundup v35 n41 p4, 10-18-96.

Lattice QCD Studies of Transverse Momentum-Dependent Parton Distribution Functions

NASA Astrophysics Data System (ADS)

Engelhardt, M.; Musch, B.; Hägler, P.; Negele, J.; Schäfer, A.

2015-09-01

Transverse momentum-dependent parton distributions (TMDs) relevant for semi-inclusive deep inelastic scattering and the Drell-Yan process can be defined in terms of matrix elements of a quark bilocal operator containing a staple-shaped gauge link. Such a definition opens the possibility of evaluating TMDs within lattice QCD. By parametrizing the aforementioned matrix elements in terms of invariant amplitudes, the problem can be cast in a Lorentz frame suited for the lattice calculation. Results for selected TMD observables are presented, including a particular focus on their dependence on a Collins-Soper-type evolution parameter, which quantifies proximity of the staple-shaped gauge links to the light cone.

Transverse Momentum-Dependent Parton Distributions from Lattice QCD

NASA Astrophysics Data System (ADS)

Engelhardt, M.; Musch, B.; Hägler, P.; Negele, J.; Schäfer, A.

Starting from a definition of transverse momentum-dependent parton distributions for semi-inclusive deep inelastic scattering and the Drell-Yan process, given in terms of matrix elements of a quark bilocal operator containing a staple-shaped Wilson connection, a scheme to determine such observables in lattice QCD is developed and explored. Parametrizing the aforementioned matrix elements in terms of invariant amplitudes permits a simple transformation of the problem to a Lorentz frame suited for the lattice calculation. Results for the Sivers and Boer-Mulders transverse momentum shifts are presented, focusing in particular on their dependence on the staple extent and the Collins-Soper evolution parameter.

Transverse Momentum-Dependent Parton Distributions From Lattice QCD

DOE Office of Scientific and Technical Information (OSTI.GOV)

Michael Engelhardt, Bernhard Musch, Philipp Haegler, Andreas Schaefer

Starting from a definition of transverse momentum-dependent parton distributions for semi-inclusive deep inelastic scattering and the Drell-Yan process, given in terms of matrix elements of a quark bilocal operator containing a staple-shaped Wilson connection, a scheme to determine such observables in lattice QCD is developed and explored. Parametrizing the aforementioned matrix elements in terms of invariant amplitudes permits a simple transformation of the problem to a Lorentz frame suited for the lattice calculation. Results for the Sivers and Boer-Mulders transverse momentum shifts are presented, focusing in particular on their dependence on the staple extent and the Collins-Soper evolution parameter.

Why Clothes Don't Fall Apart: Tension Transmission in Staple Yarns

NASA Astrophysics Data System (ADS)

Warren, Patrick B.; Ball, Robin C.; Goldstein, Raymond E.

2018-04-01

The problem of how staple yarns transmit tension is addressed within abstract models in which the Amontons-Coulomb friction laws yield a linear programing (LP) problem for the tensions in the fiber elements. We find there is a percolation transition such that above the percolation threshold the transmitted tension is in principle unbounded. We determine that the mean slack in the LP constraints is a suitable order parameter to characterize this supercritical state. We argue the mechanism is generic, and in practical terms, it corresponds to a switch from a ductile to a brittle failure mode accompanied by a significant increase in mechanical strength.

Improved Estimation of Cardiac Function Parameters Using a Combination of Independent Automated Segmentation Results in Cardiovascular Magnetic Resonance Imaging.

PubMed

Lebenberg, Jessica; Lalande, Alain; Clarysse, Patrick; Buvat, Irene; Casta, Christopher; Cochet, Alexandre; Constantinidès, Constantin; Cousty, Jean; de Cesare, Alain; Jehan-Besson, Stephanie; Lefort, Muriel; Najman, Laurent; Roullot, Elodie; Sarry, Laurent; Tilmant, Christophe; Frouin, Frederique; Garreau, Mireille

2015-01-01

This work aimed at combining different segmentation approaches to produce a robust and accurate segmentation result. Three to five segmentation results of the left ventricle were combined using the STAPLE algorithm and the reliability of the resulting segmentation was evaluated in comparison with the result of each individual segmentation method. This comparison was performed using a supervised approach based on a reference method. Then, we used an unsupervised statistical evaluation, the extended Regression Without Truth (eRWT) that ranks different methods according to their accuracy in estimating a specific biomarker in a population. The segmentation accuracy was evaluated by estimating six cardiac function parameters resulting from the left ventricle contour delineation using a public cardiac cine MRI database. Eight different segmentation methods, including three expert delineations and five automated methods, were considered, and sixteen combinations of the automated methods using STAPLE were investigated. The supervised and unsupervised evaluations demonstrated that in most cases, STAPLE results provided better estimates than individual automated segmentation methods. Overall, combining different automated segmentation methods improved the reliability of the segmentation result compared to that obtained using an individual method and could achieve the accuracy of an expert.