bluuebunny/crossref_metadata_2025 huggingface dataset:
Smart Controlling system for Kitchen Fire Protection based Internet of Things
Authors: Haryanto  , Anifah L , Rahmawati D , Sahputra A K , Laksono D T
Published: May 2021

The use of IoT is urgently needed, its use makes life efficient both in terms of energy and time. In order to minimize the danger of fire in the kitchen, we proposed smart controlling system for kitchen fire protection based Internet of Things. The controlled part in this study are stove and LPG’s lid. Data received by the temperature sensor, smoke sensor and human sensor will be sent to the server, so the user can acces from yheir smartphone. If the condition is dangerous, a warning will be given to the user’s smartphone, and the user can control stove and LPG’s lid through the application on their smartphone. The design phase consists of designing hardware, software, servers, IoT, and applications to control the hardware. The implementation phase is implementing the design that has been made and then testing all elements. Testing phase by testing the harware, software, and system integration. The testing process aims to ensure that all elements work well according to the design. The results show that the system managed to anticipate early on from fires.
Analysis of the ambient air environment of the steam power plant industry
Authors: Rizal Reda
Published: May 2021

Steam power plants is one industry that produces electrical energy needed by the community, electrical energy is needed to improve the welfare of the wider community. The negative environmental impacts caused by this industrial activity include the impact of environmental pollution, both the physical-chemical, biological, economic-socio-cultural and public health environment living around the industrial activity site. The negative impact is mainly caused by the use of coal fuel which emits entropy which can affect the quality of the environment. In this research, we want to know the negative impact of the activities of the steam power industry on ambient air quality around the location of the activity. The experimental research method was conducted to determine the effect of coal use on the quality of the ambient air environment quantitatively. Methods of environmental quality analysis using laboratory tests and matching test results with national quality standards. Possible cause of the low levels of entropy in the steam power plant industry is the suitability of the type of electric power steam engine that is still classified as the latest technology with low rank coal used by the industry.
Interpretation of Food Crop Growth Progress Visualization and Prediction of Drone Based Production Estimates Based on Histogram Values in Government Areas-Case Study of Merauke Regency
Authors: Marsujitullah  , Manggau Fransiskus X. , Parenden Daniel
Published: May 2021

Farming is one of the pioneers of national development that plays an important role, especially Merauke Regency, which is planned to be the area for national food self-reliance in agribusiness (Indonesian). Government is currently very difficult. Will see the latest developments in the growth of food crops in the region, starting at the village level / kelurahan to the national level. These kindergartens growth in the crop until harvest time, and several obstacles to failure of crops from pests and environmental conditions such as flooding. Production estimates are easy if this information is available. The research aims to be able to show the status of the land in the form of different colors by the histogram method, plant information and the type of pest disease, while the retrieval of data is carried out using the photographic images. The long-term proficiency based on the coordinates through the GPS found on the Dji-Phantom Phantom device can also be used to calculate the area of land as the main parameters and requirements of the seed, the condition of the land and restrictions b. The failure of crop cultivation as a supporting parameter to determine the assessment of plant production by means of liver methods.
Physicochemical Properties of Black Soygurt Made from Black Soybeans (BS) and Black Sticky Rice (BR)
Authors: Winarti S , Sarofa U , Islami B Y
Published: May 2021

Back soygurt is a food product fermented by black soy milk using the bacteria Streptococcus thermophillus and Lactobacillus bulgaricus commonly used in the process of making yogurt. To improve the black color of the soyghurt produced, it was added black sticky rice extract. The objective of this study was to investigate the effect of the proportion of black soybean extract (BS) with black sticky rice extract (BR) and fermentation time, on physicochemical characteristics in black soygurt. This study uses a completely randomized factorial design consisting of two factors. The first factor was the proportion of black soybean extract and black sticky rice extract which consists of three levels (50:50, 60:40, and 70:30). Factor II was fermentation time which consists of 3 levels (10 hours, 12 hours and 14 hours). The data obtained were analyzed with ANOVA, and further tests with Duncan. The best treatment was the proportion of black soybean extract: black sticky rice extract (50:50) with 14 hours fermentation time. The characteristics of black soygurt from this treatment were total LAB 10.63 CFU/ml; acidity (pH) 4.23; intensity of color L* 58.28; soluble protein 1.58%; total anthocyanin 1.61 mg/100g; antioxidant activity 19.55%.
Particle Swarm Optimization to Solve Unrelated Parallel Machine Scheduling Problems
Authors: Pulansari F , Triyono M D R
Published: May 2021

The problem of unrelated parallel machines scheduling is very important in this industry. Scheduling is useful to save company resources, one of which is in terms of time. With minimization of completion time, companies can fulfill it quickly and precisely. Focuses on unrelated parallel machine scheduling problems that depend on sequences aimed at minimizing total turnaround time by considering setup time. This paper presents how unrelated parallel machine scheduling using the particle swarm optimization algorithm approach. The experimental results obtained indicate the optimum value.
Gating System Measuring of Sandcasting
Authors: Muzakki H , Millaily I , Winandar H
Published: May 2021

Sandcasting is the oldest casting method and valuable however it has still some problems. This study discussed a mathematical approach in the gating system design. A gating system of a Connecting Road from cast iron was used as an object this study. This study measured fluid flow, a gating position in a mold, pouring, spur basin, pouring time, and riser. Solidification time affect volume and surface area, so in this study we adjusted the height of riser based of 1.2 up to 2 as riser diameter. Results of mathematic analysis show that pouring time was 3 sec, dimension of runner as 1.2 cm as High, 1.2 cm of Large, 2.06 of Pressure. The other dimensions were 2.9 cm of High spur, 5.5 cm of Pouring basin, 3.15 cm2 of large of spur with 7.56 cm3 as volume total, and weight total of gating system and riser 0.285 kg. The metal fluid was poured in a molding at 2.83 sec. Dimensions of gating were gotten the 0.42 cm2 from the first in gate and 0.63 cm2 for second in gate.
Security and Privacy Issues in Location Dependent Services for Mobile Communication: A Synergistic Review
Authors: Chaubey Chitrangada , Raj Swapnil , Kaswan Suresh
Published: May 2021

With a growing rate of mobile usage in the current networking era, mobile devices have been adopted widely. With mobile proliferation, location awareness is gaining huge insights in mobile and communication technologies for which, information subsystem has to be maintained on geo-located systems. Location Dependent Services (LDS) fetch relevant information from the geo-located information subsystems and deliver it to the user based on their location preferences and choices. Despite having the desirable features and services, LDS does not provide satisfactory protection to the user’s geographic location. Preservation of location has become one of the utmost concerns in mobile network communication. In this paper, we will go through the security & privacy challenges for LDS in mobile networks. Precisely, this paper covers the cryptographic approaches and technologies to enhance privacy to promote location privacy in mobile network communication. The different approaches covered in the review are first compared and then the further research areas have been identified as well as concluded.
Optimization of Fused Deposition Modelling process parameters using Teaching Learning Based Optimization (TLBO) algorithm
Authors: Alam Nadeem , Alam Mahfuj , Ahmad Shafi
Published: May 2021

Fused Deposition Modelling (FDM) is one of the most commonly used Additive Manufacturing (AM) techniques with a wide range of applications in various modern manufacturing industries. It is widely employed to fabricate prototypes where immense surface finish is required. Furthermore, the literature suggests that process parameters such as nozzle temperature (NT), nozzle diameter (ND), and feed rate (FR) have a significant influence on the surface finish achieved in an FDM process. Hence, this work intends to examine the effect of process parameters viz. NT, ND, and FR on the side and top surface roughness of poly-lactic acid (PLA) sample fabricated through FDM process. Experiments are designed as per Taguchi’s L18 orthogonal array and a population-based algorithm identified as Teaching Learning Based Optimization (TLBO) algorithm is used to determine the optimal process parameter settings for optimum side and top surface roughness simultaneously. The results of the study reveal that NT of 493 K, ND of 0.4 mm and FR of 60 mm/s results in optimum side and top surface roughness simultaneously.
Effect of varying road profile amplitude on the behavior of a nonlinear quarter car model
Authors: Paliwal Vipul , Dobriyal Ritvik , Kumar Pushpendra , Manral Avi Raj
Published: May 2021

Vehicle suspensions are one of the most important equipment in an automobile which impart comfortable ride to the passengers. As the passive suspensions are most widely used in the automobiles, therefore this paper deals with the investigations of the suspension behavior at the different values of the road profile amplitude. The effects on the frequency plots are studied by using fast Fourier transform functions. The phase plots are also drawn to understand the periodic and quasi periodic transformations at the different values of road profile amplitude. It is seen that the natural frequency and its harmonics in the spectrum dies out with the rise in the values of the road profile amplitude and also the increase in the strength of forcing is observed. The in harmonics obtained is seen to be withdrawn with the increase in the road profile amplitude.
Implication of Renewable Energy in Sustainable Development in India: Future Strategy
Authors: Pachar Sunita , Singh Rubee , Wahid Mohd Atif
Published: May 2021

Renewable energy (RE) can play an important role in Sustainable Development in India. India is a growing economy, and it would need an assured supply of 3–4 times than the whole energy consumed today. This research paper discussed about RE sources, drivers, challenges and policies. It can be concluded from review of literature and other information provided in paper that RE have a huge potential in India and with latest technologies use it can fulfill India’s energy demand in future. Quality of life can be improved with the help of RE. It is predictable that large number of domestic jobs can be created in future in green energy and RE. The study found that RE can reduce environment pollution issues, carbon emission and scarcity of nonrenewable energy sources .RE has a positive relation with economic growth, job creation and welfare. This paper recommends some suggestions for strategic policy in sustainable energy sources.
3D FEM simulation on Deformation and Strain analysis for grain refinement of Mg Alloy passed through ECAP
Authors: Kapoor Arshit , Wahid Mohd Atif , Goel Pankul , Agarwal Krishna Mohan , Mohan Utkarsh
Published: May 2021

Equal Channel Angular Pressing (ECAP) is a cutting-edge Severe Plastic Deformation (SPD) process for grain refining of materials up to ultra-fine or nanostructured standards, resulting in superior mechanical properties. To consider the effect of each processing parameter on the end results, computer simulation is one of the better alternatives to real ECAP deformation. The alloys used in this study are AZ61 magnesium alloy, which is a difficult material to work with in automotive applications. The ECAP process is subjected to 3D FEM simulation using ANSYS software in order to better understand the process/die design parameters. 90° channel angles and corner angles 20° i.e the best combination suggested by experimental studies were used in the simulation. For a single ECAP pass, the ECAP phase was simulated. Extrusion load, established stresses, effective strain, and temperature variation on the processed material were all noted in the results. The minimum channel angle produces the highest temperature profile on the material, developing maximum stress and strain at the deformation zone, according to the observed results. Furthermore, the results obtained using such computational techniques show that the shear strain decreases as the channel and corner angle increase.
Optimization of turning process variables for surface integrity using taguchi technique
Authors: Kumar Gaurav , Tomer Ankit , Kumar Mukesh , Goel Pankul , Singh Om Prakash
Published: May 2021

The selection of proper machining parameters is crucial for the production of a product of desired quality. The Taguchi method will accomplish this. For this work, using tin coated tungsten carbide method, SS-321 work parts are placed onto CNC lathe machine. Stainless steel machining (SS-321) has issues such as worn-out tool and high roughness to the surface. The key reasons for choosing SS-321 grade as workpiece material is the issue of the machining process related with super finishing of Stainless Steel. For this work twenty-seven experiments were carried out on stainless steel (SS-321), as per Taguchi’s L27 orthogonal array. Data analysis was carried out using Taguchi response table method and ANOVA. Following this method, a confirmation experiment was performed to assess the surface integrity change. Turning machining parameter levels to reduce surface roughness were A1B3C1 i.e., depth of cut 0.5 mm, cutting speed of 120 m / min and feed of 0.2 mm / rev. ANOVA table represented the parameters which mostly affected the surface roughness with 76.27% contribution of depth of cut which is maximum followed by feed (7.72%), and effect of speed (3.48%) is insignificant. The research also shows that this approach can efficiently boost the surface finish of the turning process.
Real-time monitoring of volatiles and particles emitted from thermoplastic filaments during 3D printing
Authors: Wojnowski Wojciech , Marcinkowska Renata , Zabiegała Bożena
Published: May 2021

The proliferation of consumer-grade three-dimensional (3D) printers using fused deposition, also known as fused filament fabrication, has given rise to concerns over the exposure of users to potentially harmful substances. Thermoplastic filaments made of different polymers are extruded through a heated printer nozzle and deposited layer by layer on a build platform to form the printed object. This process leads to the emission of both particles and gases, in particular volatile organic compounds (VOCs). While the emission of airborne particulate matter during 3D-printing has been relatively well researched [1], this is not the case with the monitoring of the associated emission of VOCs, and so we are far from understanding the emission profile of 3D-printers as a whole. The main reason for that is the difficulty with sampling the emitted volatiles with sufficient time resolution to investigate e.g. the effect of rapid heating of the nozzle, and so the available data mostly describes either the total emission of particular VOCs during printing, or the time-resolved emission of total VOCs, without the determination of particular compounds [2,3]. In order to bridge this gap, we have previously demonstrated that proton transfer reaction mass spectrometry (PTR-MS) can be used to monitor the emission of volatiles during 3D-printing in real-time, both qualitatively and quantitatively [4]. Here, we propose to combine this approach with the concurrent real-time measurement of the corresponding emission of particles to obtain a more detailed understanding of the profile of pollutants generated during 3D-printing and the factors which determine this process.
Influence of Compacting Pressure on the Dielectric Properties of La-modified Bismuth Ferrite Multiferroics Prepared by Rapid Liquid-phase Sintering Method
Authors: Song Chunrui , Liedienov N.A. , Pashchenko A.V. , Tatarchuk D.D. , Didenko Y.V. , Levchenko G.G.
Published: May 2021

Structure, perovskite phase formation, chemical and phase composition, microstructure, morphology and dielectric properties of the single-phase lanthanum-modified bismuth ferrite multiferroic ceramics obtained by the rapid liquid-phase sintering method under different compacting pressures have been investigated using X-ray diffraction, scanning electron microscopy, energy-dispersive X-ray spectroscopy, thermogravimetry/differential thermal analysis and dielectric spectroscopy methods. The temperature and time for an express preparation of the single-phase Bi0.9La0.1FeO3 ceramics with formation of a perovskite structure have been found out. With an increase in the compacting pressure P from 100 to 1100 MPa, the dielectric constant ε′ changes by ∼25% and ∼80% in the low-frequency and ultra-high frequency ranges, respectively. In the low-frequency range, all samples depending on the pressure P demonstrate excellent dielectric behavior with a stable dielectric constant and quite low dielectric loss that make these samples perspective for their possible practical application in microelectronic and spintronic.
A Bayesian Inference Driven Computational Framework Applied for the Improvement of the Eurocode 2 creep model
Authors: Daou H , Raphael W , Geara F
Published: May 2021

Concrete creep, defined as the deformation of concrete under sustained load, can cause cracks in tensile members, redistribution of stresses over time in composite structures, loss of prestressing force in prestressed concrete elements, and excessive long-term deflection of structural members. The concrete creep coefficient is an important input in many calculations and analyses of reinforced concrete structures. Currently, the concrete creep coefficient has been predicted by many models such as the Eurocode 2 model. This study aims to improve the prediction of the Eurocode 2 creep coefficient model at long-term by implementing a correction coefficient into the model. The Northwestern University database is used and the correction coefficient is calculated using Bayesian inference. The accuracy and efficient of the proposed improvement and modification are demonstrated through statistical indicators.
Development of a model for predicting dynamic response of a sphere at viscoelastic interface: A dynamic Hertz model
Authors: Koruk H
Published: May 2021

A model for predicting the dynamic response of a sphere at viscoelastic interface is presented. The model is based on Hertz contact model and the model for a sphere in a medium. In addition to the elastic properties of medium and the size of sphere, the model considers the density of sphere, the density and viscosity of medium, and damping of oscillations of sphere due to radiation of shear waves. The model can predict not only the effects of the mechanical properties of medium, the physical properties of sphere, and the amplitude of excitation force on sphere displacement, but also the effects of these parameters on shift of resonance frequency. The proposed model can be used to identify the elastic and damping properties of materials, and to understand the dynamic responses of spherical objects at viscoelastic interfaces in practical applications.
Assessment of the models for predicting the responses of spherical objects in viscoelastic mediums and at viscoelastic interfaces
Authors: Koruk H
Published: May 2021

Spherical objects, such as bubbles and spheres, embedded in mediums and at viscoelastic interfaces are encountered in many applications, including the determination of material properties. This paper assesses the models for predicting the responses of spherical objects in viscoelastic mediums and at viscoelastic interfaces used in various applications. The models are presented very compactly, and evaluations are performed based on the analyses of the models for the spherical objects in viscoelastic mediums and at viscoelastic interfaces. First, the models for predicting the static displacements of spherical objects are presented and assessed. After that, the models for predicting the dynamic responses of spherical objects are presented and their dynamic behaviours are compared. Then, the models for the deformation of the medium around spherical objects and stress distribution are presented and evaluated. The models and evaluations presented in this study can be exploited in various applications, including biomedical applications.
Accuracy of Google Translate in translating the directions and counseling points for top-selling drugs from English to Arabic, Chinese, and Spanish
Authors: Cornelison Bernadette R , Al-Mohaish Sulaiman , Sun Yizhou , Edwards Christopher J
Published: May 2021

Purpose

A study was conducted to evaluate the accuracy of Google Translate (Google LLC, Mountain View, CA) when used to translate directions for use and counseling points for the top 100 drugs used in the United States into Arabic, Chinese (simplified), and Spanish.

Methods

Directions for use and common counseling points for the top 100 drugs were identified by 2 clinicians. This information was translated from English to Arabic, Chinese (simplified), and Spanish using Google Translate. Two nonclinician, bilingual native speakers of each language back-translated the Google Translate translation into English and determined if the sentence made sense in their native language. Two clinicians reviewed the back-translations to determine the clinical significance of each inaccurate translation.

Results

For the top 100 drugs, 38 unique directions for use and 170 unique counseling points were identified for translation. For the 38 directions for use, 29 (76.3%) of the Arabic translations were accurate, 34 (89.5%) of the Chinese (simplified) translations were accurate, and 27 (71%) of the Spanish translations were accurate. For the 170 counseling points, 92 (54.1%) of the Arabic translations were accurate, 130 (76.5%) of the Chinese (simplified) translations were accurate, and 65 (38.2%) of the Spanish translations were accurate. Of the 247 inaccurate translations, 72 (29.1%) were classified as highly clinically significant or potentially life-threatening.

Conclusion

Certified translators should be used to translate directions for use and common counseling points for prescription medications into Arabic, Chinese (simplified), and Spanish. Clinicians should be aware of the risk of inaccurate translation when Google Translate is used.
Inflammatory Status and Cardio-metabolic Risk Stratification of Rotational Shift Work
Authors: Collins Blake E G , Hartmann Tegan E , Marino Frank E , Skein Melissa
Published: May 2021

Objectives

To investigate the physiological effects of rotational shift work on measures of cardio-metabolic function.

Methods

Sedentary, healthy men (n = 87; age 37 ± 9 years; body mass index: 30.7 ± 5.1 kg m2) were recruited and categorized via occupation. SHIFT group: currently employed in rotational shift work defined by 8–12 h morning, afternoon, and night rotations; or NSHIFT: working fixed daytime hours. Testing procedures included baseline objective sleep assessment and laboratory testing, conducted between 0600 and 0900 h to assess body composition, cardiorespiratory fitness (VO2peak), inflammatory status [C-reactive protein, interleukin (IL)-6, and tumour necrosis factor-alpha (TNF-α)], glucose metabolism, heart rate variability (HRV), and self-reported leisure time physical activity (PA).

Results

SHIFT reported significantly less leisure time PA (P = 0.019), reduced VO2peak (P = 0.007), higher body fat percentage (BF%) (P = 0.021), increase response time to oral glucose tolerance test (P = 0.016), and higher IL-6 values (P = 0.008) compared with NSHIFT. A significant difference was observed in actigraphy measured total sleep time, with SHIFT recording reduced sleep following a night shift (P = 0.001). No group difference was observed in HRV or average sleep parameters (P > 0.05). Linear regression identified a significant association between occupation and inflammatory status (P = 0.006).

Conclusions

Rotational shift work is associated with increased risk factors for cardio-metabolic disorders, despite no differences in sleep quality and quantity. The results suggest rotational shift work has a detrimental effect on the health and wellbeing of employees; with homeostatic desynchronization identified as potential pathogenic mechanisms.
Understanding structural malleability of the SARS-CoV-2 proteins and relation to the comorbidities
Authors: Sen Sagnik , Dey Ashmita , Bandhyopadhyay Sanghamitra , Uversky Vladimir N , Maulik Ujjwal
Published: May 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a causative agent of the coronavirus disease (COVID-19), is a part of the $\beta $-Coronaviridae family. The virus contains five major protein classes viz., four structural proteins [nucleocapsid (N), membrane (M), envelop (E) and spike glycoprotein (S)] and replicase polyproteins (R), synthesized as two polyproteins (ORF1a and ORF1ab). Due to the severity of the pandemic, most of the SARS-CoV-2-related research are focused on finding therapeutic solutions. However, studies on the sequences and structure space throughout the evolutionary time frame of viral proteins are limited. Besides, the structural malleability of viral proteins can be directly or indirectly associated with the dysfunctionality of the host cell proteins. This dysfunctionality may lead to comorbidities during the infection and may continue at the post-infection stage. In this regard, we conduct the evolutionary sequence-structure analysis of the viral proteins to evaluate their malleability. Subsequently, intrinsic disorder propensities of these viral proteins have been studied to confirm that the short intrinsically disordered regions play an important role in enhancing the likelihood of the host proteins interacting with the viral proteins. These interactions may result in molecular dysfunctionality, finally leading to different diseases. Based on the host cell proteins, the diseases are divided in two distinct classes: (i) proteins, directly associated with the set of diseases while showing similar activities, and (ii) cytokine storm-mediated pro-inflammation (e.g. acute respiratory distress syndrome, malignancies) and neuroinflammation (e.g. neurodegenerative and neuropsychiatric diseases). Finally, the study unveils that males and postmenopausal females can be more vulnerable to SARS-CoV-2 infection due to the androgen-mediated protein transmembrane serine protease 2.
Identifying complex motifs in massive omics data with a variable-convolutional layer in deep neural network
Authors: Li Jing-Yi , Jin Shen , Tu Xin-Ming , Ding Yang , Gao Ge
Published: May 2021

Motif identification is among the most common and essential computational tasks for bioinformatics and genomics. Here we proposed a novel convolutional layer for deep neural network, named variable convolutional (vConv) layer, for effective motif identification in high-throughput omics data by learning kernel length from data adaptively. Empirical evaluations on DNA-protein binding and DNase footprinting cases well demonstrated that vConv-based networks have superior performance to their convolutional counterparts regardless of model complexity. Meanwhile, vConv could be readily integrated into multi-layer neural networks as an ‘in-place replacement’ of canonical convolutional layer. All source codes are freely available on GitHub for academic usage.
Preoperative hiatal hernia in oesophageal adenocarcinoma: An impact on patient outcomes?
Authors: St-Amour P , Mantziari S , Dromain C , Winiker M , Godat S , Schöpfer A , Demartines N , Schäfer M
Published: May 2021

Objective

Uncontrolled gastroesophageal reflux and the often-associated hiatal hernia (HH) are frequently encountered in oesophageal adenocarcinoma patients. Previous data suggest unfavourable long-term oncologic outcomes in the presence of a HH, but the evidence remains scarce. The aim of this study was to assess the potential impact of preoperative HH on histologic response after neoadjuvant treatment (NAT), as well as on overall and disease-free survival.

Methods

All patients operated for an adenocarcinoma of the oesophagus or gastro-oesophageal junction (GOJ) between 2012-2018 were assessed. Baseline endoscopy and CT-scan images were retrospectively reviewed to identify the presence of a clinically significant HH (≥3cm). Response to neoadjuvant treatment (Mandard TRG grade), postoperative outcomes and survival were compared between HH and non-HH patients. Categorical variables were compared with the x2 or Fisher’s test, whereas continuous ones with the Mann-Whitney-U test. Survival analyses were performed with the Kaplan-Meier method and log-rank test.

Results

Overall, 101 patients were included (84.1% male, median age 63 years); among them, 33 (32.7%) had a HH ≥ 3cm at diagnosis of oesophageal cancer. There were no significant baseline differences in demographics and tumour stages between the two groups. NAT was used in 80.9% of non-HH versus 81.8% HH patients (P = 0.910), most often chemoradiation (57.3% in non-HH versus 63.6% in HH patients, P = 0.423). Surgical approach and postoperative complication rates were similar in all patients. Good response to NAT (TRG 1-2) was observed in 32.3% of non-HH, versus 33.3% of HH patients (P = 0.297), whereas R0 resection was achieved in 94.1% vs 90.9% of patients respectively (P = 0.551). Overall survival was comparable between HH (median 28 mo, 95%CI 22-NA) and non-HH patients (median 41mo, 95% CI 29-NA) (P = 0.605). Disease-free survival was also similar (median 18 mo, 95%CI 12-NA for HH, vs 34mo, 95%CI 14-NA for non-HH patients, P = 0.283), although HH patients experienced higher rates of distant (51.6% vs 29.2% for non-HH, P = 0.033), but not locoregional recurrence.

Conclusion

A clinically significant HH is encountered in almost a third of patients with oesophageal adenocarcinoma. However, in our study, it was not associated with a worse response to NAT, nor did it lead to a worse overall and disease-free survival.
Opioid free pain management in ambulatory hemorrhoidectomy reduces pain
Authors: Haak F , Merlo L , Dursunoglu B , von Flüe M , Steinemann D
Published: May 2021

Objective

Outpatient hemorrhoid surgery is a topic of growing importance with a need of modifications to pain management to enable early discharge. Opioid free anesthesia and analgesia (OFAA) has the goal to reduce postoperative pain as well as to improve discharge circumstances. The impact of OFAA on patients receiving ambulatory hemorrhoidectomy is investigated.

Methods

A retrospective cohort study on ambulatory hemorrhoidectomy between 2018 and 2020 was performed and patients that did and did not receive OFAA were compared. In the OFAA group patients received spinal anesthesia with Takipril and hyperbaric technique. Additionally Metamizole 500mg i.v. and Paracetamol 1g i.v. was used. In the non-OFAA group opioids were administered intravenously (fentanyl or remifentanyl) and sublingual (buprenorphin). Primary endpoint was pain measured according to a numeric rating scale (NRS) one hour postoperatively. Secondary endpoints were pain 24 hours postoperative, duration of hospital stay, urinary retention, postoperative nausea and vomiting (PONV), overall morbidity, and re-admission. Wilcoxon Rank-Sum test was performed to search for differences between the outcomes.

Results

117 patients were included in the analysis. 41 percent of the patients were female. The mean age was 54±14 years. 40 patients did not receive opioids perioperatively (OFAA group) and 77 did (non-OFAA group). The non-OFAA group received a mean dose of 23.3±17.9 mg morphine equivalent. Median NRS score one hour postoperatively was 0 (interquartile range 0-1) for OFAA and 2 (0-4) for non-OFAA (p = 0.01). The median NRS score 24 hours postoperatively was 1 (0-2) for OFAA and 1 (0-3) for non-OFAA (p = 0.40). There were 3 patients (7.5%) with urinary retention in OFAA and 5 patients (6.5%) in non-OFAA(p = 0.84).No patient had PONV in OFAA and 5 (6.5%) in non-OFAA (p = 0.10). The overall morbidity was 5 (12.5%) in OFAA and 16 (20.8%) in non-OFAA (p = 0.27). There were two readmissions (5%) in OFAA and 6 (7.8%) in non-OFAA (p = 0.58).

Conclusion

There is a significant difference in pain one hour postoperatively between OFAA and non-OFAA with a clear benefit of not administering opioids. Opioids may trigger pelvic floor spasms and disimprove postoperative pain. In the context of outpatient surgery, we recommend an opioid free operation to reduce postoperative pain and improve discharge prerequisites.
Pre-operative iron allows correction of anaemia before abdominal surgery: A systematic review and meta-analysis of randomized controlled trials
Authors: Meyer J , Cirocchi R , Di Saverio S , Ris F , Wheeler J , Davies R J
Published: May 2021

Objective

Professional surgical societies recommend the identification and treatment of pre-operative anaemia in patients scheduled for abdominal surgery. However, the evidence supporting this recommendation has been of poor quality until the recent release of several randomized controlled trials (RCT) addressing the question. Our aim was to determine if pre-operative iron allows correction of haemoglobin concentration and decreased incidence of peri-operative blood transfusion in patients undergoing major abdominal surgery.

Methods

MEDLINE, Embase and CENTRAL were searched for RCTs written in English and assessing the effect of pre-operative iron on the incidence of peri-operative allogeneic blood transfusion in patients undergoing major abdominal surgery. Pooled relative risk (RR), risk difference (RD) and mean difference (MD) were obtained using models with random effects. Heterogeneity was assessed using the Q-test and quantified using the I2 value.

Results

Four RCTs were retained for analysis out of 285 eligible articles. MD in haemoglobin concentration between patients with pre-operative iron and patients without pre-operative iron was of 0.81 g/dl (3 RCTs, 95% CI: 0.30 to 1.33, I2: 60%, p = 0.002). Pre-operative iron did not lead to reduction in the incidence of peri-operative blood transfusion in terms of RD (4 RCTs, RD: -0.13, 95% CI: -0.27 to 0.01, I2: 65%, p = 0.07) or RR (4 RCTs, RR: 0.57, 95% CI: 0.30 to 1.09, I2: 64%, p = 0.09).

Conclusion

Pre-operative iron significantly increases haemoglobin concentration by 0.81 g/dl before abdominal surgery but does not reduce the need for peri-operative blood transfusion. Important heterogeneity exists between existing RCTs in terms of populations and interventions. Future trials should target patients suffering from iron-deficiency anaemia and assess the effect of intervention on anaemia-related complications.
Quantification of residual pneumoperitoneum after robotic-assisted laparoscopic surgery
Authors: Hefermehl L , Slieker J , Lehmann K , Niemann T , Maletzki P , Bujaroska T , Labulo O , Li Z , Guenther E , Ramakrishnan V , Kubik-Huch R , Nocito A
Published: May 2021

Objective

Laparoscopic surgery improves the postoperative recovery process and relies on CO2 insufflation to establish the operative field. Most residual CO2 is expelled prior to port and incision closure. Computed tomography (CT) is often used to assess an acute abdomen and is highly sensitive in detecting free intra-abdominal air – the hallmark sign of a bowel injury. Yet, the clinical significance of free air in the early postoperative period is confounded by residual CO2 and is not usually due to a visceral injury. The aim of this prospective study was to systematically quantify the residual pneumoperitoneum (RPP) at varying timepoints after robotic-assisted laparoscopic surgery.

Methods

Patients undergoing robot-assisted laparoscopic intervention, both radical prostatectomies and left hemicolectomies, were prospectively enrolled in the study. At the conclusion of each operation, manual abdominal pressure was applied to aid in exsufflation of residual CO2. Very-low-dose CT scans were performed on postoperative days (POD) 3, 5, and 7, with subsequent volumetric quantification of RPP. To investigate potential factors influencing the quantity of RPP, correlation plots were made against BMI, age, operative time, total insufflation volume, intra-abdominal pressure, time to flatus and first bowel movement, pain score, and postoperative analgesic requirement.

Results

Thirty-one patients undergoing robotic assisted laparoscopic prostatectomy were untill now enrolled in the study, of which only one experienced a Clavien-Dindo 2 complication; all others were free of any complications during post-operative assessment period. On POD3, 5, and 7, 97%, 94%, and 68% of patients, respectively, demonstrated RPP. The RPP volumes were noted to be 9.6 mL (IQR = 3.9-31.8; maximum = 247 mL) on POD3, 1.0 mL (0.1-5.1; maximum = 221 mL) on POD5, and 0.08 mL (1-1.2; maximum = 112 mL) on POD7. A significant correlation was only appreciated between RPP volume and BMI; those with higher BMIs had lower initial volumes of RPP on POD3 and exhibited a more rapid decrease in RPP over one week.

Conclusion

One week after robot-assisted laparoscopic operations, a majority of patients will exhibit clinically insignificant RPP, even with volumes as high as 250 mL. Larger patients tend to have smaller residuals of CO2. Our data provide new basic knowledge regarding RPP and may help to interpret postoperative CT-scans.
The effect of mesenteric defect closure on internal hernias and small bowel obstruction in patients undergoing colorectal surgery: A systematic review and meta-analysis
Authors: Haltmeier T , Destefani T , Holzgang M , Kohler A , Candinas D , Brügger L
Published: May 2021

Objective

Internal hernias (IH) are potentially severe complications after colorectal surgery and may lead to small bowel obstruction (SBO). However, the impact of mesenteric defect closure (MDC) on IH and SBO is currently unclear. The aim of this systematic review and meta-analysis was, therefore, to investigate the effect of MDC on IH and SBO in patients undergoing laparoscopic and open colorectal surgery.

Methods

Ovid Medline, PubMed, and Embase databases were searched. Studies reporting MDC in colorectal surgery were enclosed in the systematic review. Meta-analysis included studies that assessed the effect of MDC vs. non-closure (non-MDC) on IH and SBO. Meta-analysis was performed using a random effect model. Results of individual studies were summarized as ranges. Effect sizes were described as odds ratios (OR) with 95% confidence intervals (CI).

Results

Literature search revealed a total of 344 abstracts. Of these, 16 studies met the inclusion criteria. Included studies comprised a total of 10,068 patients and were published between 2009 and 2019. The incidence of IH and SBO as a composite outcome ranged from 0.0 to 3.5%, whereas the incidence of IH and SBO as single outcomes ranged from 0.0 to 2.7% and 0.0 to 1.7%, respectively. If IH occurred, reoperation was required in 66-100% with additional bowel resections in 20-100% and stoma-formation in 17-50%. The complication rate after reoperations was 25-100% and mortality 0-25%. Meta-analysis including four studies revealed no statistically significant effect of MDC on the composite outcome of IH and SBO (OR 0.25, 95% CI 0.04-1.77) and SBO as a single outcome (three studies, OR 0.48, 95% CI 0.04-5.49). The risk for IH as a single outcome was significantly lower in the MDC group (three studies, OR 0.15, 95% CI 0.02-0.92). Heterogeneity of the studies included was low to moderate for the composite outcome, as well as for IH and SBO as single outcomes (I2 40.3%, 0.0%, and 45.7%, respectively).

Conclusion

In current meta-analysis, MDC was not significantly associated with the composite outcome of IH and SBO in patients undergoing colorectal surgery. However, MDC significantly reduced the risk for IH. Based on these results, the benefit of MDC in colorectal surgery remains unclear and needs to be addressed in further studies.
External validation of three nomograms predicting survival using an international cohort of patients with resected pancreatic head ductal adenocarcinoma
Authors: Schneider M , Labgaa I , Vrochides D , Zerbi A , Nappo G , Perinel J , Adham M , van Roessel S , Besselink M , Mieog J S D , Groen J V , Demartines N , Schäfer M , Joliat G -R
Published: May 2021

Objective

Lymph node ratio (LNR, positive lymph nodes/collected lymph nodes during surgery) was identified as an important prognostic factor of survival in resected pancreatic cancer. Several nomograms based on LNR were recently proposed to predict survival after pancreatoduodenectomy (PD). The present study aimed to externally validate 3 published nomograms using an international cohort.

Methods

Consecutive patients with ductal adenocarcinoma of the pancreatic head who underwent PD without neoadjuvant treatment from 6 tertiary centers in Europe and the USA were retrospectively collected from 2000 to 2017. Patients with metastases at diagnosis, R2 resection, missing data regarding LNR, and who died within 90 postoperative days were excluded. The 3 selected nomograms were the updated Amsterdam nomogram (including LNR, adjuvant therapy, margin status, and tumor grade), the nomogram by Pu et al. (including LNR, age, tumor grade, and T stage) and the nomogram by Li et al. (including LNR, age, tumor location, grade, size, and TNM stage). Overall survivals (OS) were calculated using Kaplan-Meier method. For the validation, calibration (Hosmer-Lemeshow test), discrimination capacity (ROC curves for 3-year OS), and clinical utility (sensitivity and specificity at the value of Youden index) were assessed.

Results

After exclusion of 95 patients with metastases, R2 resection, and who died within 90 postoperative days, 1167 patients were included. Median OS of the entire cohort was 23 months (95% confidence interval: 21-24).

For the 3 nomograms, Kaplan-Meier curves showed significant diminution of OS with increasing scores (p < 0.01 for the 3 nomograms). All nomograms showed good calibration (non significant Hosmer-Lemeshow goodness-of-fit tests). For the updated Amsterdam nomogram, the area under the ROC curve (AUROC) for 3-year OS was 0.66. Sensitivity and specificity were 73% and 50%. Regarding the nomogram by Pu et al., the AUROC was 0.67. Sensitivity and specificity were 65% and 60%. For the nomogram by Li et al., the AUROC was 0.67, while sensitivity and specificity were 56% and 71%.

Conclusion

The 3 selected nomograms were validated using an external international cohort and displayed interesting and comparable predictive values. Those nomograms may be used in clinical practice to estimate survival after PD for ductal adenocarcinoma.
Recurrent internal hernias after Roux-en-Y gastric bypass: An observational study in 1219 patients over 20 years
Authors: Fringeli Y , Steffen R , Kessler U , Zehetner J
Published: May 2021

Objective

Internal hernia (IH) represents a well-known complication and the major cause of bowel obstruction after Roux-en-Y gastric bypass (RYGB) for morbid obesity. With the worldwide rise of performed RYGB, IH will become more frequent in the coming years. Lots of studies already addressed this issue to prevent its occurrence and improve its management. The aim of this study is to assess incidence and patterns of recurrence of IH.

Methods

A retrospective single-centre analysis was performed of prospectively collected follow-up data from patients who underwent a RYGB between January 2000 and December 2017 and who developed IH thereafter. Follow-up data were reviewed until December 2020. Both open (51) and laparoscopic procedures (1168) were included. All RYGB were performed using the antecolic technique with routine closure of the Petersen’s space (PS) and the mesenteric defect beneath the jejunojejunostomy (JJ). Only open mesenteric defects with incarcerated small bowel at the time of operation were considered as IH.

Results

One hundred thirty four patients presented with IH and all events occurred in the laparoscopic group (11.5%). Among the 134 patients with IH, a recurrence was observed in 35 patients (26.1%) after a median time of 13 months (range, 0-124) since the first IH. Seven patients presented more than 2 episodes of IH, among them one patient with 7 episodes. The median weight loss between the first and the second episode of IH was 0.0kg (range, -11.5-19.0) and the median percentage of excess weight loss achieved since the RYGB at the occurrence of the second IH was 97.2% (range, 55.3-111.2). Location of IH was PS in 70 patients (52.2%) at the time of the first IH and in 23 patients (65.7%) at the time of the second IH. Recurrence of IH at the same location was more frequent at the PS (22.9%) than at the JJ (10.9%). Overall, 185 operations for IH were performed, among them 132 (71.4%) laparoscopically. Only once, a small bowel resection was mandatory (0.5%).

Conclusion

For patients with laparoscopic RYGB, internal hernias represent a potential complication over a lifetime and have to be suspected even years after the index operation. One quarter of patients will develop a recurrence of IH and Petersen’s space is mostly involved.
Long-term effects of laparoscopic sleeve gastrectomy: What are the results beyond 10 years?
Authors: Kraljević M , Cordasco V , Schneider R , Peters T , Slawik M , Wölnerhanssen B , Peterli R
Published: May 2021

Objective

Sleeve gastrectomy (SG) has become the most commonly performed bariatric procedure worldwide. Newer studies providing long-term follow-up are showing high incidence of weight regain and high incidence of de novo reflux or worsening of preexisting GERD leading to conversion to different bariatric procedure. The objective of our study was to present 5 to 15-year follow-up results in terms of weight loss, remission of comorbidities and reoperation rate.

Methods

This is a retrospective analysis of prospectively collected data. The minimal follow-up time was 5 years. Patients who underwent SG between August 2004 and December 2014 were included. In case of reoperation patients were converted to Roux-en-Y gastric bypass or biliopancreatic diversion type duodenal-switch with or without hiatal hernia repair.

Results

A total of 307 patients underwent SG either as primary bariatric procedure (n = 262) or as redo operation after failed laparoscopic gastric banding (n = 45). Mean body mass index at time of primary SG was 46.4 ± 8.0 kg/m2. Mean age at operation was 43.7 ± 12.4 years with 68% females. Follow-up was 84% and 70% at 5 and 10 years respectively. The mean EBMIL for primary SG was 62.8 ± 23.1% after 5 years, 53.6 ± 24.6% after 10 years and 51.2 ± 20.3% after 13 years. Reoperation after SG was necessary in almost every fifth SG patient: 24 patients (7.8%) were reoperated due to insufficient weight loss, 12 patients (3.9 %) due to reflux, while 23 patients (7.5%) needed conversion due to both, insufficient weight loss and reflux. Comorbidities improved considerably while the incidence of new onset reflux was 29.7%.

Conclusion

SG provides a long-term EBMIL from 51 to 54% beyond 10 years and a significant improvement of comorbidities. On the other hand, a high incidence of both weight loss failure and de novo reflux was observed leading to conversion.