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Background: Laparoscopic surgery has become the preferred management for paraesophageal hernias (PEH); however surgical management versus watchful waiting remains controversial in older patients.Methods: This retrospective study analyzed the outcomes of PEH repair in elderly patients surgically managed at The Ottawa Hospital over a 10-year period. Patients older than 60 years who underwent PEH repair were examined with respect to presentation, technique and associated complications.Results: Despite similar demographics, our study groups showed significantly different characteristics of surgical techniques. Most surgeries were performed laparoscopically; however, patients aged 70 years or older underwent more open and emergency surgeries than the younger group. Despite a 30-day postoperative complication rate of 45 % and 13 % in the older (≥ 70 yr) and younger (60-69 yr) groups, respectively, the rates during elective repair were similar. There were no deaths in the younger group, whereas the 30-day mortality rate was 5 % in patients aged 70 years and older, including a 2-fold increase with emergency repair (4 v. 2 patients).Conclusion: Management of PEH in older adults remains controversial in relation to a surgical versus watchful waiting approach. We found that in patients aged 70 years and older who undergo surgical management of PEH experience more open and emergency procedures, which are associated with higher complication rates. However, in the elective setting older patients had increased laparoscopic repairs and comparable complication rates to younger patients. We found the greatest outcomes with early, elective laparoscopic repair, irrespective of age. [ABSTRACT FROM AUTHOR]

Abstract Volume conduction in the brain may influence the synchronization between EEG signals considerably, as it may lead to detection of spurious functional couplings among the recording channels. It has been shown that the volume conduction effect can be approximated as a linear mixing of the electrical fields of the brain regions. In this paper, we investigate the reliability of various synchronization measures in the presence of the linear superposition in EEG time series. For this purpose, we applied linear mixing to artificially generated EEG times series using the Kuramoto model of coupled phase oscillators, which represents the behavior of coupled systems with local interactions at the fundamental level. Our simulation results showed that the phase-lag index and the synchronization measures based on the visibility graph algorithms were less sensitive to the linear mixing effect and could predict the coupling degree correctly even with strongly overlapping signals. The results of our further data analyses demonstrated the effect of linear superposition in time series on the behavior of various complex network measures. For each case, we provide recommendations for proper choices of synchronization measures to obtain complex network characteristics that are minimally sensitive to linear mixing. Highlights • Investigating the effect of volume conduction on synchronization between EEG signals. • Comparing the sensitivity of common synchronization measures to the presence of the volume conduction effect. • Investigating the effect of volume conduction on various complex networks measures. [ABSTRACT FROM AUTHOR]

Background: Surgical resection remains a critical component of esophageal cancer treatment with curative-intent. The aim of this study was to compare open (OE) to minimally invasive Ivor Lewis esophagectomy (MIE) with respect to perioperative and oncologic outcomes.Methods: Retrospective single-institution review of MIE and OE patients operated between 2001 and 2015 was conducted. Univariable and multivariable models were created using Cox regression. The Kaplan-Meier method was used to compare oncologic outcomes. Propensity score matching was used to compare oncological outcomes in MIE and OE patients.Results: Of 210 esophageal resection patients, 47% had OE (137/291) and 25% had MIE (73/291). The MIE and OE groups were comparable with respect to patient factors and operative details. Fewer OE patients received neoadjuvant chemoradiation. MIE was associated with improved lymph node yield, (MIE = 30 [IQR:22-39]; OE = 14 [IQR:7-19], p < 0.001), less intraoperative blood loss (MIE = 312 mL [100-400]; OE = 657 mL [350-700], p < 0.001), and shorter median length of stay (MIE = 10 days [IQR = 8-14]; OE = 14 days [IQR = 11-22] p < 0.01). The OE group had significantly more adverse events resulting in reoperation or intensive care unit admission (MIE = 21%; OE = 34%; p < 0.01). On multivariable analysis, age and positive resection margins were associated with decreased odds of survival. The number of lymph nodes retrieved, positive resection margins, and pathologic stage were significant predictors of disease-free survival. Analysis of 69 matched pairs showed equivalent median overall survival (MIE = 49 months [18-67]; OE = 29 months [17-69]; p = 0.26) and disease-free survival (MIE = 9 [6-22]; OE = 13 [6-22]; p = 0.45) between the two groups.Conclusions: Although long-term oncologic outcomes appear to be similar, MIE is associated with significantly less intraoperative blood loss, improved lymph node yield, less risk of severe postoperative adverse events, and shorter length of stay. [ABSTRACT FROM AUTHOR]

The efficiency ofTrichoderma harzianum(MIAU 145 C) in promoting kidney bean (cv. Goli) growth in different soil texture (sandy loam, loam and clay loam) and organic matter content (0.5 and 2% of leaf litter) was assessed in a factorial experiment in the absence ofMeloidogyne javanica. In another factorial experiment, the effect of soil texture, soil organic content and control measure (no control, 10 ml ofT. harzianumcontaining 106spore ml−1and 2 mg ai cadusafos kg−1soil) was determined on nematode-infected kidney bean’s growth, fungus controlling activity andM. javanicareproduction. Except for the shoot length, the fungus improved plant growth. Clay loam was not a proper soil type for the cultivation of kidney bean plants (even in the soil without nematode), but the plant grew better in sandy loam and loam soil. The presence of leaf litter in the soil enhanced plant growth, increased fungal efficiency and increased nematode reproduction. It seems thatT. harzianumcan activate the plant defence system in sandy loam soil.T. harzianumwas more effective in sandy loam or loam soil containing 2% organic matter (leaf litter) and reduced the reproduction factor of the nematode in the tested soil textures equally to the chemical nematicide treatment. [ABSTRACT FROM PUBLISHER]

The severe problem of the most lattice Boltzmann methods (LBM) is the instability within the solution. This paper presents the implementation and applicability of a stable finite volume (FV) formulation of LBM for simulating steady separating and reattaching flow pasts backward-facing step geometry. For simulation purpose, a cell-centered scheme is implemented to discretize the convection operator and new weighting factors are used as flux correctors. Compared with previous FV formulations, a remarkable stability improvement is achieved and the secondary recirculation region is clearly captured for Reynolds numbers higher than 400. The simulation results show good agreement with benchmark data, which demonstrate the trustworthiness of the scheme. [ABSTRACT FROM AUTHOR]

Background: Evidence-Based Reviews in Surgery (EBRS) is a program developed to teach critical appraisal skills to general surgeons and residents. The purpose of this study was to assess the use of EBRS by general surgery residents across Canada and to assess residents' opinions regarding EBRS and journal clubs. Methods:We surveyed postgraduate year 2-5 residents from 15 general surgery programs. Data are presented as percentages and means. Results: A total of 231 residents (58%, mean 56% per program, range 0%-100%) responded: 172 (75%) residents indicated that they know about EBRS and that it is used in their programs. More than 75% of residents who use EBRS agreed or strongly agreed that the EBRS clinical and methodological articles and reviews are relevant. Only 55 residents (24%) indicated that they used EBRS online. Most residents (198 [86%]) attend journal clubs. The most common format is a mandatory meeting held at a special time every month with faculty members with epidemiologic - al and clinical expertise. Residents stated that EBRS articles were used exclusively (13%) or in conjunction with other articles (57%) in their journal clubs. Most re - spond ents (176 of 193 [91%]) stated that journal clubs are very or somewhat valuable to their education. Conclusion: The EBRS program is widely used among general surgery residents across Canada. Although most residents who use EBRS rate it highly, a large proportion are unaware of EBRS online features. Thus, future efforts to increase awareness of EBRS online features and increase its accessibility are required. [ABSTRACT FROM AUTHOR]

Abstract: The automatic recognition of the modulation format of a detected signal, the intermediate step between signal detection and demodulation, is a major task of an intelligent receiver, with various civilian and military applications. Obviously, with no knowledge of the transmitted data and many unknown parameters at the receiver, such as the signal power, carrier frequency and phase offsets, timing information, etc., blind identification of the modulation is a difficult task. This becomes even more challenging in real world. In this paper I develop a novel algorithm using Two Threshold Sequential Algorithmic Scheme (TTSAS) algorithm and pattern recognition to identify the modulation types of the communication signals automatically. I have proposed and implemented a technique that casts modulation recognition into shape recognition. Constellation diagram is a traditional and powerful tool for design and evaluation of digital modulations. In this paper, modulation classification is performed using constellation of the received signal by fuzzy clustering and consequently hierarchical clustering algorithms are used for classification of Quadrature–Amplitude Modulation (QAM) and Phase Shift Keying (PSK) modulations and also modulated signal symbols constellation utilizing TTSAS clustering algorithm, and matching with standard templates, is used for classification of QAM modulation. TTSAS algorithm used here is implemented by the Hamming neural network. The simulation results show the capability of this method for modulation classification with high accuracy and appropriate convergence in the presence of noise. [Copyright &y& Elsevier]

Background: Templating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients' demographics, implant brand, and the assessors' grade of education. Methods: We retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes. Result: After excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period. Conclusion: Our study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor's experience and expertise in THA preoperative templating. Level of evidence: Level III (retrospective observational study). [ABSTRACT FROM AUTHOR]