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(1) Background: Distal pancreatectomy is a standard treatment for tumours of the pancreatic body and tail. Minimally invasive techniques for all types of pancreatic tumours (benign and malignant) are being established, while concerns regarding oncological safety, cost effectiveness and learning curves are being explored with prospective studies. This paper presents our unit's data in the context of the above concerns and provides a relevant narrative review of the current literature. (2) Methods: Data were collected retrospectively between 2014 and 2021 for all adult patients who underwent elective distal pancreatectomy in our tertiary care referral HPB Unit. Data on demographics, underlying pathology, perioperative variables and post-operative complications were collected and reported using descriptive statistics. On review of the Miami guidelines, four important but less validated areas regarding distal pancreatectomy are presented in light of the current evidence; these are recent randomised controlled trials, oncological safety, cost effectiveness and learning curves in minimally invasive distal pancreatectomy (MIDP). (3) Results: 207 patients underwent distal pancreatectomy in total from 2014–2021, with 114 and 93 patients undergoing open and minimally invasive techniques, respectively. 44 patients were operated on for PDAC in the open vs. 17 in the minimally invasive group. The operative time was 212 min for the open and 248 min for the minimally invasive group. The incidence of pancreatic fistula was higher in the minimally invasive group vs. the open group (16% vs. 4%). (4) Conclusions: Our unit's data conform with the published literature, including three randomised control trials. These published studies will not only pave the way for establishing minimally invasive techniques for suitable patients, but also define their limitations and indications. Future studies will inform us about the oncological safety, cost effectiveness, overall survival and learning curves regarding patients undergoing minimally invasive distal pancreatectomy. [ABSTRACT FROM AUTHOR]

Colorectal liver metastases (CRLM) afflict a significant proportion of patients with colorectal cancer (CRC), ranging from 25% to 30% of patients throughout the course of the disease. In recent years, there has been a surge of interest in the application of near-infrared fluorescence (NIRF) imaging as an intraoperative imaging technique for liver surgery. The utilisation of NIRF-guided liver surgery, facilitated by the administration of fluorescent dye indocyanine green (ICG), has gained traction in numerous medical institutions worldwide. This innovative approach aims to enhance lesion differentiation and provide valuable guidance for surgical margins. The use of ICG, particularly in minimally invasive surgery, has the potential to improve lesion detection rates, increase the likelihood of achieving R0 resection, and enable anatomically guided resections. However, it is important to acknowledge the limitations of ICG, such as its low specificity. Consequently, there has been a growing demand for the development of tumour-specific fluorescent probes and the advancement of camera systems, which are expected to address these concerns and further refine the accuracy and reliability of intraoperative fluorescence imaging in liver surgery. While NIRF imaging has been extensively studied in patients with CRLM, it is worth noting that a significant proportion of published research has predominantly focused on the detection of hepatocellular carcinoma (HCC). In this study, we present a comprehensive literature review of the existing literature pertaining to intraoperative fluorescence imaging in minimally invasive surgery for CRLM. Moreover, our analysis places specific emphasis on the techniques employed in liver resection using ICG, with a focus on tumour detection in minimal invasive surgery (MIS). Additionally, we delve into recent developments in this field and offer insights into future perspectives for further advancements. [ABSTRACT FROM AUTHOR]

Emerging technologies such as network function virtualization and software-defined networking (SDN) have made a phenomenal breakthrough in network management by introducing softwarization. The provision of assets to each virtualized network functions autonomously as well as efficiently and searching for an optimal pattern for traffic routing challenges are still under consideration. Unfortunately, the traditional methods for estimating the desired performance indicators are insufficient for a self-driven SDN. In the last decade, a combination of machine learning and cognitive techniques construct a knowledge plane (KP) for the Internet which introduces numerous benefits to networking, like automation and recommendation. Furthermore, the inclusion of KP to the conventional three planes SDN architectures recently has added another knowledge defined networking (KDN) architecture to drive an SDN autonomously. In this article, a self-driving system has been proposed based on KDN to achieve the selection of an optimal path for the deployment of service function chaining (SFC) and reactive traffic routing among the edge clouds. Considering the limited resource of edge clouds, the proposed system also maintains a balance among edge cloud resources while orchestrating SFC resources. The graph neural network has been also applied in the proposed system to recognize the composite relationship concerning topology, traffic features, and routing patterns for accurate estimation of key performance indicators. The proposed system improves resource utilization efficiency for SFC deployment by 20%, maximum network throughput by 5%, and CPU load by 13%. [ABSTRACT FROM AUTHOR]

Spontaneous occurrence of Tumor Lysis Syndrome (TLS) is very rare. Only 3 pediatric case reports were reported in literature. All 3 patients presented with therapy-sensitive disease. Unfortunately, only one patient survived. It is preventable in 100% of patients, but TLS is a hard nut to crack. We present three distinct cases of spontaneous tumor lysis syndrome within the pediatric population, each associated with different types of tumors. A 3-year-old boy with mediastinal germ cell tumor of stage III, had hyperuricemia and hyperphosphatemia on presentation, tumor lysis syndrome improved but later died with sepsis, another patient of 4-year-old girl with precursor B cell acute lymphoblastic lymphoma had hyperkalemia, hyperuricemia and hyperphosphatemia on presentation and third patient was 6-year-old boy with abdominal Burkitt lymphoma stage III presented with hyperkalemia, hyperuricemia, hyperphosphatemia and Acute Kidney Injury (AKI) before initiation of chemotherapy. Later both these patients improved and survived. Spontaneous tumor lysis syndrome has high mortality, so it is of utmost importance to diagnose it timely. Swift and effective responses to spontaneous TLS can significantly reduce the risk of mortality linked to this critical emergency condition. [ABSTRACT FROM AUTHOR]

Left sided superior vena cava (SVC) is a rare anatomic variant of the normal anatomy of the heart and the venous system that has clinical implications. The presence of this variant is relevant to central venous catheter placement, cardioverter defibrillator placement, coronary artery bypass grafting, and numerous other medical procedures. In this report, we describe a rare case of left sided SVC, which was diagnosed during central venous catheter insertion. We also discuss the vascular and anesthetic considerations for individuals with this uncommon variant. [ABSTRACT FROM AUTHOR]

An experiment was conducted at the Research Farm of the Muhammad Nawaz Shareef University of Agriculture, Multan during the winter season of 2018-19 with the objective to evaluate weed dynamics, growth, and productivity of wheat crop under stale seedbed. This experiment was held under RCBD with three replications. The study consisted of eight treatments viz: T1: stale seedbed + no herbicide, T2: stale seedbed + glyphosate @ 711 a.i mL ha-1, T3: stale seedbed + paraquat-dichloride @ 494 a.i mL ha-1, T4: stale seedbed + atlantis (mesosulfuron-methyl and iodosulfuron-methyl-sodium) @ 15 a.i g ha-1, T5: stale seedbed + glyphosate @ 356 a.i mL ha-1 + paraquat @ 247 a.i mL ha-1, T6: stale seedbed + glyphosate @ 356 a.i mL ha-1 + atlantis @ 7.5 a.i g ha-1, T7: stale seedbed + paraquat @ 247 a.i mL ha-1 + atlantis @ 7.5 a.i g ha-1, T8: stale seedbed + glyphosate @ 237 a.i mL ha-1 + paraquat @ 165 a.i mL ha-1+ atlantis @ 5 a.i g ha-1. The highest WCE (84%), HEI (13.01), Pn (13.83 µmol CO2 m-2 s-1) and gs (234.33 mmol m-2 s-1) was recorded in plots treated with glyphosate + paraquat + atlantis. The highest NAR (3.60 gm-2day-1), LAI (4.82), GCR (7.87 gm-2day-1), LAD (186.43 days) was recorded in the treatment Stale seedbed + glyphosate + paraquat + atlantis. This treatment depicted the highest productive tillers m-2 (246.33), grains spike-1 (53.67), 100-grains weight (31.88 g), and grain yield 40% (4.65 Tons ha-1) in comparison with the no herbicide treated plots. From this study, it is concluded that using the stale seedbed, pre- and post-emergence herbicides in reduced doses can restrict weeds growth till 40 DAS to maximize wheat productivity. [ABSTRACT FROM AUTHOR]

This article, published in the Qatar Medical Journal, discusses the incidence of right ventricular (RV) strain in pulmonary embolism (PE) in patients with Covid-19 pneumonia. The study analyzed 63 cases of PE in Covid-19 patients and found an RV strain incidence of 22.2% and a mortality rate of 25.4%. However, there was no significant association between RV strain and clot burden or mortality. The authors suggest that further research with a larger sample size is needed to fully understand the relationship between RV strain and PE in Covid-19 pneumonia. [Extracted from the article]

Background: Portomesenteric Vein Thrombosis (PMVT) following Laparoscopic Sleeve Gastrectomy (LSG) is an uncommon but potentially debilitating complication. Catheter-Directed Thrombolysis (CDT) has an evolving role in recanalizing the venous flow and preventing thrombus propagation. Therefore, it can be used as an alternative or in combination with systemic anticoagulants in selected patients. We report two trans-hepatic and trans-splenic CDT. The patient's clinical details, radiological findings, safety, and efficacy are reported. Cases presentation: Two patients presented to the Emergency Department (ED) within 14 days of surgery. The presenting complaints were generally nonspecific. The diagnosis of PMVT was established in both patients based on abdominal Contrast-Enhanced Computed Tomography (CECT). The two patients received a combined therapy of subcutaneous (SC) heparinization and CDT using a trans-hepatic approach in case 1 and a trans-splenic approach in case 2. Subsequent post-procedure venograms and CECT were performed and showed significant thrombus resolution. Both patients received oral anticoagulant therapy upon discharge with a successful overall recovery. Conclusion: PMVT is an infrequent and severe post LSG complication. Various approaches for re-establishing the portal venous flow have been described according to the severity of venous thrombosis. This article describes CDT therapy as a safe and effective option for treating PMVT in symptomatic patients. [ABSTRACT FROM AUTHOR]

Background: The learning curve of new surgical procedures has implications for the education, evaluation and subsequent adoption. There is currently no standardised surgical training for those willing to make their first attempts at minimally invasive pancreatic surgery. This study aims to ascertain the learning curve in minimally invasive pancreatic surgery. Methods: A systematic search of PubMed, Embase and Web of Science was performed up to March 2021. Studies investigating the number of cases needed to achieve author-declared competency in minimally invasive pancreatic surgery were included. Results: In total, 31 original studies fulfilled the inclusion criteria with 2682 patient outcomes being analysed. From these studies, the median learning curve for distal pancreatectomy was reported to have been achieved in 17 cases (10–30) and 23.5 cases (7–40) for laparoscopic and robotic approach respectively. The median learning curve for pancreaticoduodenectomy was reported to have been achieved at 30 cases (4–60) and 36.5 cases (20–80) for a laparoscopic and robotic approach respectively. Mean operative times and estimated blood loss improved in all four surgical procedural groups. Heterogeneity was demonstrated when factoring in the level of surgeon's experience and patient's demographic. Conclusions: There is currently no gold standard in the evaluation of a learning curve. As a result, derivations are difficult to utilise clinically. Existing literature can serve as a guide for current trainees. More work needs to be done to standardise learning curve assessment in a patient-centred manner. [ABSTRACT FROM AUTHOR]

Objective: to evaluate outcomes of vascularized fibula flap used for Avascular necrosis of femoral head. Outcomes were recorded by post-operative Harris hip and radiological improvement of the femoral head. Study Design: Retrospective longitudinal study. Place and Duration of Study: Department of Plastic Surgery, Shifa International Hospital, Islamabad Pakistan, from Jan 2019 to Jan 2020. Methodology: Cases were recruited from 2005-2018 (SIH) performed by the same Orthopaedic and Plastic Surgeon. Data from 30 patients was reviewed. Ethical approval and consent of the patient were taken before the utilization of their data. Results: A total of 30 patients were included, comprising 27(90%) males and 3(10%) females. The mean age was 28.3± years. Pre-operative Harris Hip scores were fair in 17(56.7%) and poor in 13(43.3%) patients. Post operatively these scores improved and were noted to be excellent in 10(33.3%), good in 18(60%) and fair in 2(6,7%) patients. Radiological improvement was seen in 20(80%) patients, 8(23.3%) showed no change and 2(6.7%) went into progression. The radiological improvement was significantly associated with aetiology (p=0.004) and Avascular necrosis of HIP (p=0.007). Conclusion: A vascularized fibular graft is an effective treatment option for avascular necrosis of the femoral head in terms of improved radiological outcomes and post-operative Harris Hip scores. [ABSTRACT FROM AUTHOR]

The early prediction of Alzheimer's disease (AD) can be vital for the endurance of patients and establishes as an accommodating and facilitative factor for specialists. The proposed work presents a robotized predictive structure, dependent on machine learning (ML) methods for the forecast of AD. Neuropsychological measures (NM) and magnetic resonance imaging (MRI) biomarkers are deduced and passed on to a recurrent neural network (RNN). In the RNN, we have used long short-term memory (LSTM), and the proposed model will predict the biomarkers (feature vectors) of patients after 6, 12, 21 18, 24, and 36 months. These predicted biomarkers will go through fully connected neural network layers. The NN layers will then predict whether these RNN-predicted biomarkers belong to an AD patient or a patient with a mild cognitive impairment (MCI). The developed methodology has been tried on an openly available informational dataset (ADNI) and accomplished an accuracy of 88.24%, which is superior to the next-best available algorithms. [ABSTRACT FROM AUTHOR]