| 1. |
- Bass, Gary Alan, 1979-, et al.
(författare)
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Techniques for mesoappendix transection and appendix resection: insights from the ESTES SnapAppy study
- 2023
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 17-32
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Surgically managed appendicitis exhibits great heterogeneity in techniques for mesoappendix transection and appendix amputation from its base. It is unclear whether a particular surgical technique provides outcome benefit or reduces complications. Material and methods: We undertook a pre-specified subgroup analysis of all patients who underwent laparoscopic appendectomy at index admission during SnapAppy (ClinicalTrials.gov Registration: NCT04365491). We collected routine, anonymized observational data regarding surgical technique, patient demographics and indices of disease severity, without change to clinical care pathway or usual surgeon preference. Outcome measures of interest were the incidence of complications, unplanned reoperation, readmission, admission to the ICU, death, hospital length of stay, and procedure duration. We used Poisson regression models with robust standard errors to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). Results: Three-thousand seven hundred sixty-eight consecutive adult patients, included from 71 centers in 14 countries, were followed up from date of admission for 90days. The mesoappendix was divided hemostatically using electrocautery in 1564(69.4%) and an energy device in 688(30.5%). The appendix was amputated by division of its base between looped ligatures in 1379(37.0%), with a stapler in 1421(38.1%) and between clips in 929(24.9%). The technique for securely dividing the appendix at its base in acutely inflamed (AAST Grade 1) appendicitis was equally divided between division between looped ligatures, clips and stapled transection. However, the technique used differed in complicated appendicitis (AAST Grade 2 +) compared with uncomplicated (Grade 1), with a shift toward transection of the appendix base by stapler (58% vs. 38%; p < 0.001). While no statistical difference in outcomes could be detected between different techniques for division of appendix base, decreased risk of any [adjusted IRR (95% CI): 0.58 (0.41–0.82), p = 0.002] and severe [adjusted IRR (95% CI): 0.33 (0.11–0.96), p = 0.045] complications could be detected when using energy devices. Conclusions: Safe mesoappendix transection and appendix resection are accomplished using heterogeneous techniques. Technique selection for both mesoappendix transection and appendix resection correlates with AAST grade. Higher grade led to more ultrasonic tissue transection and stapled appendix resection. Higher AAST appendicitis grade also correlated with infection-related complication occurrence. Despite the overall well-tolerated heterogeneity of approaches to acute appendicitis, increasing disease acuity or complexity appears to encourage homogeneity of intraoperative surgical technique toward advanced adjuncts.
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| 2. |
- Forssten, Maximilian Peter, 1996-, et al.
(författare)
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Surgical management of acute appendicitis during the European COVID-19 second wave: safe and effective
- 2023
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1615-3146 .- 1863-9941. ; 49, s. 57-67
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The COVID-19 (SARS-CoV-2) pandemic drove acute care surgeons to pivot from long established practice patterns. Early safety concerns regarding increased postoperative complication risk in those with active COVID infection promoted antibiotic-driven non-operative therapy for select conditions ahead of an evidence-base. Our study assesses whether active or recent SARS-CoV-2 positivity increases hospital length of stay (LOS) or postoperative complications following appendectomy. Methods: Data were derived from the prospective multi-institutional observational SnapAppy cohort study. This preplanned data analysis assessed consecutive patients aged ≥ 15years who underwent appendectomy for appendicitis (November 2020–May 2021). Patients were categorized based on SARS-CoV-2 seropositivity: no infection, active infection, and prior infection. Appendectomy method, LOS, and complications were abstracted. The association between SARS-CoV-2 seropositivity and complications was determined using Poisson regression, while the association with LOS was calculated using a quantile regression model. Results: Appendectomy for acute appendicitis was performed in 4047 patients during the second and third European COVID waves. The majority were SARS-CoV-2 uninfected (3861, 95.4%), while 70 (1.7%) were acutely SARS-CoV-2 positive, and 116 (2.8%) reported prior SARS-CoV-2 infection. After confounder adjustment, there was no statistically significant association between SARS-CoV-2 seropositivity and LOS, any complication, or severe complications. Conclusion: During sequential SARS-CoV-2 infection waves, neither active nor prior SARS-CoV-2 infection was associated with prolonged hospital LOS or postoperative complication. Despite early concerns regarding postoperative safety and outcome during active SARS-CoV-2 infection, no such association was noted for those with appendicitis who underwent operative management.
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| 3. |
- Bagni, T., et al.
(författare)
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Modeling Results of the Quench Behavior of a Nb-Ti Canted-Cosine-Theta Corrector Magnet for LHC
- 2024
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Ingår i: IEEE transactions on applied superconductivity (Print). - : IEEE. - 1051-8223 .- 1558-2515. ; 34:5
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Tidskriftsartikel (refereegranskat)abstract
- A newly designed superconducting magnet of the Canted-Cosine-Theta (CCT) type was developed as a result of a collaboration between Swedish universities (Uppsala and Linneaus) and Swedish industries. This magnet was designed to function as a replacement of the present LHC orbit corrector magnets, which are approaching their end of life due to the radiation load. As a result, the new CCT magnet was developed to be more radiation tolerant and to constitute a one-to-one replacement to the currently installed version, which is a 1 m long 70 mm double aperture dipole magnet. The final magnet, which is currently under construction, will be tested at FREIA laboratory at Uppsala University and generate a magnetic field of 3.3 T and an integrated field of 2.8 Tm at about 85 A. To examine the magnet quench behavior and to identify a suitable quench protection system, the 3D electro-magnetic and thermal behavior of the coil was modeled using the RAT-Raccoon software. Based on the simulation results, a Metrosil varistor was selected to protect the magnet during the test. In this article, we report the results of the numerical analysis. The magnet model is equipped with a spot heater to initialize the quench and the temperature and voltages are monitored during the avalanche effect. The simulated current decay and the hot-spot temperature are analyzed with a focus on the impact of quench-back on the magnet protection.
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| 4. |
- Bagni, Tommaso, et al.
(författare)
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Modeling Results of the Quench Behavior of a Nb-Ti Canted-Cosine-Theta Corrector Magnet for LHC
- 2024
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Ingår i: IEEE transactions on applied superconductivity (Print). - : Institute of Electrical and Electronics Engineers (IEEE). - 1051-8223 .- 1558-2515. ; 34:5, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- A newly designed superconducting magnet of the Canted-Cosine-Theta (CCT) type was developed as a result of a collaboration between Swedish universities (Uppsala and Linneaus) and Swedish industries. This magnet was designed to function as a replacement of the present LHC orbit corrector magnets, which are approaching their end of life due to the radiation load. As a result, the new CCT magnet was developed to be more radiation tolerant and to constitute a one-to-one replacement to the currently installed version, which is a 1 m long 70 mm double aperture dipole magnet. The final magnet, which is currently under construction, will be tested at FREIA laboratory at Uppsala University and generate a magnetic field of 3.3 T and an integrated field of 2.8 Tm at about 85 A. To examine the magnet quench behavior and to identify a suitable quench protection system, the 3D electro-magnetic and thermal behavior of the coil was modeled using the RAT-Raccoon software. Based on the simulation results, a Metrosil varistor was selected to protect the magnet during the test. In this article, we report the results of the numerical analysis. The magnet model is equipped with a spot heater to initialize the quench and the temperature and voltages are monitored during the avalanche effect. The simulated current decay and the hot-spot temperature are analyzed with a focus on the impact of quench-back on the magnet protection.
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| 5. |
- Pepitone, K., et al.
(författare)
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Design and Fabrication of a Canted-Cosine-Theta Double Aperture Orbit Corrector Dipole for the LHC
- 2023
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Ingår i: IEEE transactions on applied superconductivity (Print). - : IEEE. - 1051-8223 .- 1558-2515 .- 2378-7074. ; 33:5
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Tidskriftsartikel (refereegranskat)abstract
- A prototype CCT dipole magnet developed by a collaboration between Swedish universities, Swedish industry and CERN will be tested at Uppsala University. This 1 m long double-aperture magnet can provide a field strength of 3.3 T at 85 A in a 70 mm aperture with an integrated field of 2.8 Tm. It is intended to replace the current LHC orbit corrector magnets which are reaching the end of their expected life due to the radiation load. The new magnet is designed to handle the radiation dose of the upgrade to the high-luminosity LHC, which will deliver about ten times the current radiation dose. It must therefore be more resistant to radiation and meet strict requirements in terms of electrical insulation while matching the original field quality and self-protective capability, mechanical volume, and maximum excitation current. This paper will present the latest of the design and manufacturing work, including the results of simulations of the mechanical field and the mechanical stress. Details of the various tests performed before machining the parts are also presented.
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| 6. |
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| 7. |
- Pepitone, Kevin, Dr, 1988-, et al.
(författare)
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Design and Fabrication of a Canted-Cosine-Theta Double Aperture Orbit Corrector Dipole for the LHC
- 2023
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Ingår i: IEEE transactions on applied superconductivity (Print). - : IEEE. - 1051-8223 .- 1558-2515. ; 33:5
-
Tidskriftsartikel (refereegranskat)abstract
- A prototype CCT dipole magnet developed by a collaboration between Swedish universities, Swedish industry and CERN will be tested at Uppsala University. This 1 m long double-aperture magnet can provide a field strength of 3.3 T at 85 A in a 70 mm aperture with an integrated field of 2.8 Tm. It is intended to replace the current LHC orbit corrector magnets which are reaching the end of their expected life due to the radiation load. The new magnet is designed to handle the radiation dose of the upgrade to the high-luminosity LHC, which will deliver about ten times the current radiation dose. It must therefore be more resistant to radiation and meet strict requirements in terms of electrical insulation while matching the original field quality and self-protective capability, mechanical volume, and maximum excitation current. This paper will present the latest of the design and manufacturing work, including the results of simulations of the mechanical field and the mechanical stress. Details of the various tests performed before machining the parts are also presented.
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| 8. |
- Pepitone, Kevin, Dr, 1988-, et al.
(författare)
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Design of a Canted-Cosine-Theta Orbit Corrector for the High Luminosity LHC
- 2022
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Ingår i: IEEE transactions on applied superconductivity (Print). - : IEEE. - 1051-8223 .- 1558-2515. ; 32:6
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Tidskriftsartikel (refereegranskat)abstract
- The High Luminosity LHC requires dipole orbit correctors grouped in double aperture magnet assemblies. They provide a field of 3.1 T at 100 A in an aperture of 70 mm. The current standard design is a classical cosine-theta layout made with ribbon cable. However, the electric insulation of this cable is not radiation-resistant enough to withstand the radiation load expected in the coming years of LHC operation. A new design, based on a cable with polyimide insulator, that can replace the existing orbit correctors, is needed. The challenge is to design a magnet that fits directly into the existing positions and that can operate with the same busbars, passive quench protection, and power supplies. The new orbit corrector design meets high requirements on the field quality while keeping within the same mechanical volume and maximum excitation current. A collaboration of Swedish universities and Swedish industry has been formed for the development and production of a prototype magnet following a concurrent engineering methodology to reduce the time needed to produce a CCT magnet. The magnet has a 1 m long CCT dipole layout consisting of two coils. The superconductor is a commercially available 0.33 mm wire with polyimide insulation in a 6-around-1 cable. The channels in the coil formers, that determine the CCT layout, allow for 2 x 5 cable layers. A total of 70 windings makes that the coil current can be kept below 100 A. We will present the detailed design and preliminary quench simulations.
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