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Introduction: The perforation of gloves during surgical procedures is quite common. A cheap and quite effective method of reducing the risk of blood-borne infections is wearing two pairs of gloves. Unfortunately, some surgeons are reluctant to it, and they report decreased dexterity and sensation. The aim of the study was to evaluate surgeons' double-gloving practices to determine the factors related to compliance. Material and methods: An anonymous, 21-question survey in Polish was sent by post to 41 surgical departments. The questions concerned: demographic data, type of surgical gloves used, allergy to latex, number of surgeries performed, frequency of using double gloves and negative impressions from using them and finally, the frequency of needlestick injuries during surgical procedures. Results: We received 179 questionnaires back. More than 62% of the surgeons believe that double gloves provide better protection than a single pair, 24% do not believe in this, and 14% have no opinion. Only 0.6% of respondents always use double gloves during surgery, 19% double glove in at least 25% of cases and 68% do it occasionally. 13% of the surgeons declared that they had never worn double gloves. During high-risk procedures, 86% of respondents wear double gloves. About half of respondents (50.3%) report discomfort while wearing double gloves; 45% - decreased dexterity; about 30% complain of numbness and tingling; and 64% - decreased sensation. Conclusion: Due to the high number of surgical glove perforations and relatively high prevalence of needlestick injuries, it is necessary to use methods that reduce the risk of transmission of pathogens. The habit of using a double pair of gloves should be implemented especially among young surgeons starting to train in their specialities. Consequently, the period of initial discomfort will be combined with the acquisition of surgical skills, which will allow for gradual acclimatization. [ABSTRACT FROM AUTHOR]

Three groups of furanoses with restricted freedom of rotation on the C3–C4, C2–C3, and C1–C2 bonds, respectively, are presented. Conformational analysis of these furanoses is conducted based on the proton nuclear magnetic resonance (1H NMR) spectroscopy, density functional theory (DFT) calculations, and X-ray analysis. It is shown that the particular group of the presented furanoses is locked in the specific conformation. These are the 1 T 2 -like, the 0 E -like, and the 3 T 4 -like conformation, respectively. Characteristic 1H NMR spectra of these three conformations are presented and the factors influencing the conformational preferences of the analyzed furanoses are discussed. [Display omitted] • Specific furanose ring conformation can be recognize based on 1H NMR spectra. • The zero coupling constant is characteristic of the trans -oriented pseudoequatorial protons. • The vicinal coupling constant for the pseudodiaxially oriented protons amounts to 8–9 Hz. • Ecliptical and 1,3-pseudodiaxial orientations of the ring substituents adversely affect conformation. • Favorable anomeric effect acts in some conformations of a furanose ring. [ABSTRACT FROM AUTHOR]

N -(α- d -Glucofuranurono-6,3-lactone)- p -nitroaniline and N -(methyl β- d -glucopyranuronate)- p -nitroaniline were obtained as crystalline solids. The single-crystal X-ray diffraction, NMR data and DFT calculations for N -(α- d -glucofuranurono-6,3-lactone)- p -nitroaniline indicate that this N -furanoside adopts a 3 T 2 / 3 E -like conformation in the crystal lattice, solution and gas phase. Thus, the structure of recorded for N -furanoside 1 H NMR spectrum is indicative of the 3 T 2 / 3 E region of the pseudorotational itinerary for furanose derivatives with α- d -gluco, β-L-ido and α- d -xylo configurations. Moreover, it is concluded that the 1 T 2 / E 2 / 3 T 2 / 3 E region of the pseudorotational itinerary for furanose derivatives with d -gluco, L-ido and d -xylo configurations should be characterised by the lack of coupling between H2 and H3 protons, irrespective of the anomeric configuration. Such a lack of vicinal coupling is characteristic for some of the trans- oriented furanose ring protons. The single-crystal X-ray diffraction and NMR data for N -(methyl β- d -glucopyranuronate)- p -nitroaniline indicate that this N -glucuronide adopts the 4 C 1 conformation, both in the crystal lattice and solution. The occurrence of anomeric effects in the presented N -glycosides is discussed. The crystal structure analysis of both N -glycosides gives evidence that the amine group in p -nitroaniline is planar due to the nitrogen sp 2 hybridisation. [ABSTRACT FROM AUTHOR]

An enteric fistula that occurs in an open abdomen is called an enteroatmospheric fistula (EAF) and is the most challenging complication for a surgical team to deal with. The treatment of EAF requires a multidisciplinary approach. First of all, sepsis has to be managed. Any fluid, electrolyte and metabolic disorders need to be corrected. Oral intake must be stopped and total parenteral nutrition introduced. The control and drainage of the effluent from the fistula is a separate issue. Since there are no fixed algorithms for the treatment of EAF, surgeons need to develop their own, often highly unconventional solutions. We present the case of a 24-year-old man who developed enteroatmospheric fistula after laparotomy and relaparotomy due to acute necrotic pancreatitis. Both the laparostomy and the fistula were successfully managed using modified negative pressure wound therapy. The literature regarding this issue was also reviewed. [ABSTRACT FROM AUTHOR]

Introduction: During laparoscopy, the monitor is usually placed near the operating table, at eye level, which significantly affects hand-eye coordination. First, it is impossible for the surgeon to simultaneously observe the operative field and hand movement. Second, the axis of view of the endoscope rarely matches the natural axis of the surgeon's sight: it resembles a direct view into the operative field. Finally, as the arms of the tools act as levers with a fulcrum at the site of the skin incision, the action of the tool handles is a mirror image of the movement of the tool tips seen on the monitor. Studies have shown that a neutral position with the head flexed at 15-45° is the most ergonomically suitable. Aim: To evaluate whether the level of monitor placement exerts an influence on laparoscopic performance. Material and methods: A group of 52 students of medicine were asked to pass a thread through 9 holes of different sizes, placed at different levels and angles, using a self-made laparoscopic simulator. Each student performed the task four times in two monitor positions: at eye level, and placed on a simulator. The order of monitor placement was randomized. Results: The task was performed more quickly when the monitor was placed on the simulator and the sight was forced downwards. Lower placement was also found to be more beneficial for students with experience in laparoscopy. Conclusions: New technologies which place the display on the patient, thus improving the ergonomics of the operation, should be developed. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of acute appendicitis (AA) is still a problem and is not always easy, even for experienced surgeons. Studies have shown that 20 to 30% of the appendices removedwere normal. Therefore, various scoring systems have been developed to aid in the diagnosis of doubtful cases and reduce the number of unnecessary appendectomies. The aim of this study was to assess the diagnostic value of different scoring systems in acute appendicitis. Material and methods. The study involved 94 patients who underwent laparotomy due to suspected acute appendicitis. Medical examination at hospital admission was performed by a resident and a general surgery specialist. The probability of AA was evaluated using six different scoring systems: Alvarado, Fenyo, Eskelinen, Ohman, Tzankis, and RIPASA. The resident calculated the results in individual systems. The decision to perform the operation was taken by a specialist surgeon who did not know the results. Results. Normal appendix was removed in 26% of cases. Eskelinen, RIPASA and Alvarado systems showed highest sensitivity (99%, 88% and 85%, respectively). Tzankis and Fenyo systems showed highest specificity (62% and 50%, respectively). Conclusions. Our study has shown limited value of scoring systems for the diagnosis of acute appendicitis. The systems may improve diagnostic accuracy as they require obtaining a more detailed medical history, and making a more thorough and organized data analysis. However, the scoring systems should be treated only as an aid to diagnosis [ABSTRACT FROM AUTHOR]

Introduction: Laparoscopic trainers have gained recognition for improving laparoscopic surgery skills and preparing for operations on humans. Unfortunately, due to their high price, commercial simulators are hard to obtain, especially for young surgeons in small medical centers. The solution might be for them to construct a device by themselves. Aim: To make a relatively cheap and easy to construct laparoscopic trainer for residents who wish to develop their skills at home. Material and methods: Two laparoscopic simulators were designed and constructed: 1) a box model with an optical system based on two parallel mirrors, 2) a box model with an HD webcam, a light source consisting of LED diodes placed on a camera casing, and a modeling servo between the webcam and aluminum pipe to allow electronic adjustment of the optical axis. Results: The two self-constructed simulators were found to be effective training devices, the total cost of parts for each not exceeding $100. Advice is also given for future constructors. Conclusions: Home made trainers are accessible to any personal budget and can be constructed with a minimum of practical skill. They allow more frequent practice at home, outside the venue and hours of surgical departments. What is more, home made trainers have been shown to be comparable to commercial trainers in facilitating the acquisition of basic laparoscopic skills. [ABSTRACT FROM AUTHOR]

The article discusses the history of the use of surgical gloves in medicine. Topics covered include the role of German physician Johann Walbaum in the gloves' history dates back to 1758 and the milestone made in February 1839, the first study concerning the use of surgical rubber gloves in 1897, and the role of surgical gloves in protecting against hematogenous pathogens such as HIV and hepatitis type B and C viruses. Also mentioned is the cause of damage to the surgical gloves.

B3LYP/6-31+G** level computations were performed for the formation of four trimethylammonium salts in the reaction of methyl chloride ( 1a), ( S)-1,4-andydro-5-chloro-2,3,5-trideoxypentitol ( 2a), (2 S,5 S)-2,5-andydro-6-chloro-1,3,4,6-tetradeoxyhexitol ( 3a) and methyl 5-chloro-2,3,5-trideoxy-β-D-pentofuranoside ( 4a) with trimethylamine. All the structures were fully optimized in the gas phase, in chloroform and water. In addition, B3LYP/6-311++G** and MPW1K/6-31+G** level calculations were carried out to estimate activation barrier heights in the gas phase. A detailed description of all stationary points is presented, and the conformational behavior of the THF ring is discussed. B3LYP and MPW1K activation barriers indicate the reaction between methyl chloride and trimethylamine to be the fastest, whereas reaction 4 is the slowest one, both in the gas phase and in solvents. THF ring conformation changes were observed for reactions 2 and 3 along the reaction pathway, whereas it was almost unchanged for reaction 4, in the gas phase. In the case of reactions 2 and 3, different shapes of the THF ring were found for the transition state geometry in the gas phase and in water. The E→ E and E→ E conformational changes were observed for reactions 2 and 3, respectively. [Figure not available: see fulltext.] [ABSTRACT FROM AUTHOR]

Abstract: Geometry optimizations at the B3LYP level of density functional theory (DFT) are reported for the 4 H 5 and 5 H 4 conformations of four glycals: 3,4-di-O-acetyl-1,5-anhydro-2-deoxy-d-erythro-pent-1-enitol (3,4-di-O-acetyl-d-arabinal), its d-threo isomer (3,4-di-O-acetyl-d-xylal), 3,4-di-O-acetyl-1,5-anhydro-2,6-dideoxy-d-arabino-hex-1-enitol (3,4-di-O-acetyl-d-rhamnal), and its d-lyxo isomer (3,4-di-O-acetyl-d-fucal). The Gibbs free energies, relative Gibbs free energies and geometry parameters are presented for all the optimized structures. Conformational analysis of both the acetoxy groups and 1,2-unsaturated pyranoid ring is performed. It is demonstrated that the acetoxy group is planar and adopts two conformations with regard to the Ac-O bond rotations, one of which is strongly preferred. One of the hydrogen atoms of the methyl group is always oriented synperiplanarly whereas the remaining two anticlinally with respect to the carbonyl oxygen. With regard to the AcO–R bond rotations some of the orientations are forbidden. The calculations indicate that 3,4-di-O-acetyl-d-arabinal adopts mainly the 4 H 5 conformation, whereas 3,4-di-O-acetyl-d-xylal prefers the 5 H 4 form, owing to the vinylogous anomeric effect (VAE). Competition between the VAE and quasi 1,3-diaxial interactions means that both 3,4-di-O-acetyl-d-rhamnal and 3,4-di-O-acetyl-d-fucal remain in the 4 H 5 5 H 4 conformational equilibrium, shifted in the 4 H 5 direction. It seems that the orientation of the 4-OAc group influences the quasi 1,3-diaxial interactions between 3-OAc and 5-CH3 groups. Theoretical results are compared with assignments based on 1H NMR studies. [Copyright &y& Elsevier]

Volvulus of transverse colon is a rare cause of large bowel obstruction. Diagnosis can be challenging and the effective management remains controversial. We report a case of volvulus of the transverse colon in a 76-year-old woman. The literature regarding diagnosis and treatment of such pathology was also reviewed. [ABSTRACT FROM AUTHOR]

Background: Entero-atmospheric fistula (EAF) is an enteric fistula occurring in the setting of an open abdomen, thus creating a communication between the GI tract and the external atmosphere. Management and nursing of patients suffering EAF carries several challenges, and prevention of EAF should be the first and best treatment option. Purpose: Here, we present a novel modified classification of EAF and review the current state of the art in its prevention and management including nutritional issues and feeding strategies. We also provide an overview on surgical management principles, highlighting several surgical techniques for dealing with EAF that have been reported in the literature throughout the years. Conclusions: The treatment strategy for EAF should be multidisciplinary and multifaceted. Surgical treatment is most often multistep and should be tailored to the single patient, based on the type and characteristics of the EAF, following its correct identification and classification. The specific experience of surgeons and nursing staff in the management of EAF could be enhanced, applying distinct simulation-based ex vivo training models. [ABSTRACT FROM AUTHOR]

Background: Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN + M0 patients. The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN + M0 patients after radical rectal anterior resection.Methods: 112 patients with ypN + M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan-Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.Results: In the multiple factor Cox analysis, adverse factors affecting disease-free survival (DFS) were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (hazard ratio HR: 3.11, 95% CI 1.01-9.56, p = 0.047), presence of perineural invasion (HR: 7.27, 95% CI 2.74-19.3, p < 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI 2.09-22.11, p = 0.001), while a positive factor was the negative lymph node (NLN) count > 7 (HR: 0.33, 95% CI 0.12-0.88, p = 0.026). In the disease-specific survival (DSS) analysis, an adverse factor was the use of ACEIs (HR: 4.275, 95% CI 1.44-12.694, p = 0.009), while a positive effect was caused by NLN > 5 (HR: 0.22, 95% CI 0.082-0.586, p = 0.002).Conclusions: The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN + M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well. [ABSTRACT FROM AUTHOR]

The formation of pyridinium salts in the transformation of three O-isopropylidene-protected mesylates of furanoid sugar derivatives under pyridine action is considered at the B3LYP/6-31+G** computation level. All the structures were optimized in the gas phase, in chloroform and water. Activation barrier heights in the gas phase were also estimated at the B3LYP/6-311++G**, MPW1K/6-31+G** and MPW1K/6-311++G** levels. The conducted calculations, both in the gas phase (regardless of the computation level) and in solvents, revealed the barrier height increasing order as follows: 1>2>3 for the three reactions studied. The conformational behavior of the five-membered ring is discussed in the gas phase and in solvents. The fused dioxolane ring makes the furanoid ring less likely to undergo conformational changes. In the case of reaction 3, the furanoid ring shape does not change either in the gas phase or in solvents. All conformers are close to E0 or 0E. [ABSTRACT FROM AUTHOR]

Introduction: The stoma reversal (SR) procedure is associated with a relatively high risk of perioperative complications with surgical site infection (SSI) as the most common. Recently closed incision negative pressure wound therapy (ciNPWT) was applied widely to prevent SSI. Aim: To investigate the efficiency of ciNPWT in terms of the incidence rate of SSI after SR surgery. Material and methods: As an exploratory observational cohort study patients were treated either with ciNPWT (n = 15) or standard sterile dressing (SSD) (n = 15). CiNPWT was applied every 3 days whereas SSD was changed every day. Clinical evaluation for SSI signs, C-reactive protein level and pain assessment using the visual analogue scale (VAS) were analyzed. Results: The incidence rate of SSI was in 13% (2/15) in the ciNPWT group and 26% (4/15) in the SSD group (p = 0.651, OR = 0.44, 95% CI: 0.03-3.73). All patients in the SSD group who developed SSI presented both local and generalized signs of infection. Pain-VAS levels assessed on the 1st (MdnciNPWT = 4, MdnSSD = 5, p = 0.027, W = 51.5) and 3rd postoperative day (MdnciNPWT = 2, MdnSSD = 4, p = 0.014, W = 45.5) were significantly lower in the ciNPWT group than in the SSD group. Conclusions: CiNPWT seems not to have a benefit to reduce SSI after the SR procedure. Further investigation is needed to establish firmly the benefit of using ciNPWT in this group of patients. [ABSTRACT FROM AUTHOR]

Scalp amputation is a rare but serious trauma that is challenging from the surgeons perspective. Injuries usually occur in the avulsion mechanism, which creates difficulties during reconstruction. These problems include: determining the correct position of damaged head tissues, shortening and contraction of crushed vessels, as well as problems with the patency of the vessels following anastomosis due to damage to their inner layer. Many surgical methods are described to restore a lost organ with replantation still being the method of choice. The following article describes a failed attempt of scalp replantation in a 7-year-old girl. [ABSTRACT FROM AUTHOR]

This mini review is focused on the emerging nexus between the medical device and pharmaceutical industries toward the treatment of damaged articular cartilage. The physical rationale of hyaluronic acid and phospholipid preparations as tribological surgical adjuvants for repaired articular cartilage surfaces is explored, with directions for possible new research which have arisen due to the therapeutic advance of the physiochemical scalpel. Because synovial joint lubrication regimes become dysfunctional at articular cartilage lesion sites as a result of the regional absence of the surface active phospholipid layer and its inability to reform without surgical repair, hyaluronic acid and phospholipid intra-articular injections have yielded inconsistent efficacy outcomes and only short-term therapeutic benefits mostly due to non-tribological effects. Parameters for hydrophobic-polar type interactions as applied to the lubricating properties of normal and osteoarthritic synovial fluid useful for repaired articular cartilage surfaces are discussed. [ABSTRACT FROM AUTHOR]

Wound dehiscence is a surgical complication in which the wound ruptures along the surgical suture with abdominal cavity bowel displacement. It is observed in 0.2-6% of operated patients. The extensive wound is a gateway for infection. Moreover, increased secretion of serous fluid induces a hygienic problem and may lead to secondary skin infections or bedsores. The negative pressure wound therapy (NPWT) system is an innovative therapeutic method. It perfectly executes the TIME strategy, receiving more and more recognition. The study presented a case of a 62-year old male patient after several consecutive wound dehiscence episodes who was primarily treated for rectal cancer by means of low anterior resection of the rectum. Due to acute respiratory insufficiency after several operations, wound necrosis with dehiscence was observed. Considering the high risk of perioperative death we abandoned surgical treatment and introduced conservative management using negative pressure wound therapy until the patient's health improved. Literature regarding the above-mentioned issue was also reviewed. [ABSTRACT FROM AUTHOR]

A better understanding of material deformation behaviours with changes in size is crucial to the design and operation of metal microforming processes. In order to facilitate the investigation of size effects, material deformation behaviours needed to be determined directly from material characterizations. This study was aimed at the design and manufacture of a compact universal testing machine (UTM) compatible with a 3D laser-confocal microscope to observe the deformation behaviour of materials in real-time. In this study, uniaxial micro tensile testing was conducted on three different thin (0.05 mm, 0.1 mm, and 0.3 mm) copper specimens with characteristic dimensions at micro scales. Micro tensile experimental runs were carried out on copper specimens with varying grain sizes on the newly developed apparatus under a 3D laser-confocal microscope. Microscale experiments under 3D laser-confocal microscope provided not only a method to observe the microstructure of materials, but also a novel way to observe the early stages of fracture mechanisms. From real-time examination using the newly developed compact testing apparatus, we discovered that fracture behaviour was mostly brought about by the concave surface formed by free surface roughening. Findings with high stability were discovered while moving with the sample grasped along the drive screw in the graphical plot of a crosshead's displacement against time. Our results also showed very low mechanical noise (detected during the displacement of the crosshead), which indicated that there were no additional effects on the machine, such as vibrations or shifts in speed that could influence performance. The engineering stress-strain plots of the pure copper-tests with various thicknesses or samples depicted a level of stress necessary to initiate plastic flowing inside the material. From these results, we observed that strength and ductility declined with decreasing thickness. The influence of thickness on fracture-strain, observed during tensile testing, made it clear that the elongation-at-break of the pure-copper foils intensely decreased with decreases in thickness. The relative average surface-roughness Ra was evaluated, which showed us that the surface-roughness escalated with the increasing trend of plasticity deformation (plastic strain) ε. For better understanding of the effects of plastic strain on surface roughness prior to material fractures, micro tensile tests were performed on the newly developed machine under a 3D laser-confocal-microscope. We observed that homogeneous surface roughness was caused by plastic strain, which further formed the concave surface that led to the fracture points. Finally, we concluded that surface roughness was one of the crucial factors influencing the fracture behaviour of metallic sheet-strips in metal microforming. We found that this type of testing apparatus could be designed and manufactured within a manageable budget. [ABSTRACT FROM AUTHOR]

Pure TiO2 nanoparticles (TiO2NPs) were produced via the sol–gel method and then coated with silver nanoparticles (AgNPs) to reduce their optical band gap. The concurrent synthesis and immobilization of AgNPs over TiO2NPs was achieved through the interaction of an open-air argon plasma jet with a solution of silver nitrate/stabilizer/TiO2NPs. The one-pot plasma synthesis and coating of AgNPs over TiO2NPs is a more straightforward and environmentally friendly method than others. The plasma-produced Ag/TiO2 nanocomposites were characterized and tested for their photocatalytic potential by degrading different concentrations of methyl blue (MB) in water. The dye concentration, oxidant dose, catalyst dose, and reaction time were also optimized for MB degradation. XRD results revealed the formation of pure AgNPs, pure TiO2NPs, and Ag/TiO2 nanocomposites with an average grain size of 12.36 nm, 18.09 nm, and 15.66 nm, respectively. The immobilization of AgNPs over TiO2NPs was also checked by producing SEM and TEM images. The band gap of AgNPs, TiO2NPs, and Ag/TiO2 nanoparticles was measured about 2.58 eV, 3.36 eV, and 2.86 eV, respectively. The ultraviolet (UV) results of the nanocomposites were supportive of the degradation of synthetic dyes in the visible light spectrum. The AgNPs in the composite not only lowered the band gap but also obstructed the electron–hole recombinations. The Ag/TiO2 composite catalyst showed 90.9% degradation efficiency with a 5 ppm dye concentration after 120 min of light exposure. [ABSTRACT FROM AUTHOR]