Evaluation of denitrification performance and bacterial community of a sequencing batch reactor under intermittent aeration.

Effects of operational parameters (initial nitrite concentration, initial nitrate concentration, carbon source, and COD/N ratio) on denitrification performance was evaluated using a sequencing batch reactor (SBR) under intermittent aeration. Complete denitrification was observed without N2O accumulation when the initial nitrite concentration was 100-500 mg-N·L-1. When the initial nitrate concentration was 75-300 mg-N·L-1, 95-96% of NO3--N was completely reduced to N2 gas. Acetate was the most effective sole carbon source for the complete denitrification of the SBR under intermittent aeration, and 99% of NO3--N was reduced to N2 gas. The optimum COD/N ratio was 8-12 for the complete denitrification, while NO2- accumulation was observed at low COD/N ratios of 1 and 2. In this study, N2O accumulation was not observed during the denitrification process regardless of operational condition. Paracoccus (15-68%), a representative aerobic denitrifying bacterium, was dominant in the SBR during the denitrification process, and the intermittent aeration condition could affect the abundance of Paracoccus in this study.

Characterization of nitrous oxide reduction by Azospira sp. HJ23 isolated from advanced wastewater treatment sludge.

A new nitrous oxide (N2O)-reducing bacterium was isolated from a consortium that was enriched using advanced wastewater treatment sludge as an inoculum and N2O as the sole nitrogen source. The isolated facultative anaerobe was identified as Azospira sp. HJ23. Azospira sp. HJ23 exhibited optimum N2O-reducing activity with a C/N ratio of 62 at pH 6 in the temperature range of 37 °C to 40 °C. The optimum carbon source for N2O reduction was a mixture of glucose and acetate. The maximum rate of N2O reduction by Azospira sp. HJ23 was 4.8 mmol·g-dry cell-1·h-1, and its N2O-reducing activity was higher than other known N2O reducers. Azospira sp. HJ23 possessed several functional genes for denitrification. These included narG (NO3- reductase), nirK (NO2- reductase), norB (NO reductase), and nosZ (N2O reductase) genes. These results suggest that Azospira sp. HJ23 can be applied in the denitrification process to minimalize N2O emission.

Removal of particulate matter from pork belly grilling gas using an orifice wet scrubber.

Grilling restaurants are a major contributor to airborne particulate matter (PM) in metropolitan areas. In this study, the removal of PM during the grilling of pork belly using an orifice scrubber, which is a form of gas-induced spray scrubber, was assessed. During grilling, the particle mass concentration was the highest for 1.0 < PM ≤ 2.5 µm (55.5% of total PM emissions), followed by 0.5 < PM ≤ 1.0 (27.1%), PM ≤ 0.5 (10.7%), and PM > 2.5 µm (7.0%). The PM removal efficiency of the orifice scrubber at a gas flow of 4.5 m3 min-1 was > 99.7% for PM ≥ 2.5 µm, 89.4% for 1.0 < PM ≤ 2.5 µm, 62.1% for 0.5 < PM ≤ 1.0, and 36.5% for PM ≤ 0.5 µm. Although further research is necessary to optimize its use, the orifice scrubber offers a user-friendly technology for the control of PM in small grilling restaurants because of its simple design, uncomplicated operation, and satisfactory PM removal performance.

Prognostic Value of the Maximum Standardized Uptake Value on Positron Emission Tomography for Esophageal Squamous Cell Carcinoma.

BACKGROUND: Esophageal cancer is a malignant tumor with one of the worst prognosis. Positron emission tomography (PET) reveals the degree of metabolic activity of tumor cells. We hypothesized that a high maximum standardized uptake value (SUVmax) on PET would predict a poor clinical outcome. METHODS: From November 2004 to August 2011, we reviewed 88 patients with esophageal squamous cell carcinoma who underwent preoperative PET followed by surgery. SUVmax values of primary sites were measured. The patients were divided into two groups with median SUVmax as a cutoff value and outcomes were compared. RESULTS: The median SUVmax was 6.35. Cervical and upper thoracic cancer, large tumor size, stage ≥ T2, and lymph node metastasis were significantly associated with the high SUVmax group. Cervical and upper thoracic cancer (p = 0.038), SUVmax (p = 0.038), number of lymph nodes dissected (p = 0.009), stage ≥ T2 (p = 0.003), lymph node metastasis (p < 0.001), and incomplete resection (p = 0.031) were significant predictors for the disease-free survival. A high SUVmax ( ≥ 6.35, p = 0.023) and stage ≥ T2 (p = 0.025) were significantly associated with overall survival by multivariate analysis. CONCLUSION: High preoperative SUVmax on PET predicts advanced T stage and worse prognosis. SUVmax on PET may provide useful information combined with current stage for determining optimal treatment in esophageal cancer.

Lymphatic vessel invasion in pathologic stage I and II non-small cell lung tumors.

PURPOSE: Tumor node-metastasis staging is essential for predicting the prognosis of patients with non-small cell lung cancer (NSCLC); however, its accuracy remains limited. The aim of this study was to establish the significant predictors of outcome for patients with pathologic stage I or II NSCLC. METHODS: We reviewed the records of patients with pathologic stage I and II NSCLC retrospectively. After the exclusion of those who underwent sublobar resection, received neoadjuvant treatment, or died within 30 days of surgery, 271 patients treated between January, 2004 and December, 2010 were analyzed. We investigated whether lymphatic vessel invasion (LVI) grade was associated with prognosis in stage I or II NSCLC. RESULTS: The median age of the patients was 64 years. Of the 198 and 73 patients with pathologic stage I and stage II disease, respectively, 73 (26.9%) had LVI. Thirteen patients had a high degree of LVI. Although LVI was not associated with overall survival (p = 0.13), a high degree of LVI was associated with poor survival (p < 0.001). Multivariate analysis revealed that diabetes mellitus (p = 0.001), tumor size (p < 0.001), LVI grade (p < 0.001), and pathologic stage II (p = 0.040) were all associated with overall survival. CONCLUSIONS: A higher grade of LVI was predictive of a worse prognosis. Further study is required to establish the prognostic role of moderate and marked LVI in NSCLC.

Predictive procedure for compensatory hyperhidrosis before sympathectomy: preliminary findings.

OBJECTIVE: Compensatory hyperhidrosis is one of the most common and serious adverse effects following sympathectomy. We performed a local anesthetic procedure that predicts the occurrence and severity of compensatory hyperhidrosis, and evaluated the feasibility, safety, and efficacy of the procedure. METHODS AND METHODS: From July 2009 to July 2010, 20 patients with severe primary palmar hyperhidrosis underwent predictive procedures. A sympathetic nerve block was obtained via thoracoscopic approach under local anesthesia. The patients were evaluated for compensatory hyperhidrosis 1 week after the procedure before deciding whether to proceed with sympathectomy. RESULTS: Of the 20 patients, 17 patients proceeded with sympathectomy and 3 refused the final procedure. Following sympathectomy, the occurrence and severity of compensatory hyperhidrosis in the remaining 17 patients were statistically analyzed with two tailed paired t test, and there is no significant difference between the predictive and final procedures (t = 1.69, df = 16, p > 0.1). CONCLUSION: Predictive procedure using local anesthesia to detect compensatory hyperhidrosis before sympathectomy may be useful for helping patients to decide whether to undergo the operation.

Extent of removal for mediastinal nodal stations for patients with clinical stage I non-small cell lung cancer: effect on outcome.

BACKGROUND: Lobectomy and mediastinal lymph node dissection comprise the standard surgical treatment for non-small cell lung cancer (NSCLC). Although complete mediastinal lymph node dissection has been recommended as part of the procedure for achieving complete resection, the benefits for early lung cancer are unclear. The purpose of this study was to determine the effects of different degrees of mediastinal lymph node dissection on the clinical outcomes of patients with clinical stage I NSCLC. MATERIALS AND METHODS: The records of patients with clinical stage I NSCLC treated between January 2000 and September 2010 were reviewed retrospectively. This study consisted of 211 patients who underwent lobectomy plus mediastinal lymph node dissection and sampling. Patients were divided into a group who underwent lymphadenectomy (LA) including complete mediastinal node dissection or lobe-specific lymph node dissection and a group who underwent selective lymph node sampling (LS). Clinical outcomes, including survival, and prognostic factors were determined. RESULTS: The mean (±) number of extracted lymph nodes for the LS and LA patients was 7.50 ± 5.44 and 14.09 ± 7.57, respectively (p < 0.001). Male and diabetes mellitus patients were more associated with LS. Survival of the LA patients was significantly longer (p = 0.029). By multivariate analysis, extent of mediastinal nodal sampling (p = 0.029) and positive for mediastinal nodal (N2-positive) disease (p = 0.046) were significant predictors for survival. CONCLUSIONS: The extent of dissection of mediastinal lymph nodes affected the clinical outcomes of our study patients with clinical stage I NSCLC. At least evaluation of lobe-specific lymph node dissection is required.

Sublobar resection versus lobectomy in solid-type, clinical stage IA, non-small cell lung cancer.

BACKGROUND: Recent studies have demonstrated that sublobar resection is not inferior to lobectomy for peripheral early lung cancer with ground-glass opacification. However, the effect of sublobar resection on solid-type early lung cancer is controversial. The aim of this study was to compare clinical outcomes of patients who have undergone sublobar resection or lobectomy for solid-type, early-stage, non-small cell lung cancer (NSCLC). METHODS: This study was a retrospective review of the records of patients who underwent lobectomy or sublobar resection between March 2000 and September 2010 for clinical stage IA NSCL. Patients with pure ground-glass opacities or death within 30 days after surgery were excluded. Disease-free interval, survival, and prognostic factors were analyzed. RESULTS: Thirty-one patients and 133 patients underwent sublobar resection and lobectomy, respectively. There were significant differences in age (P < 0.001), cardiovascular disease (P = 0.001), and diffusing capacity of the lung for carbon monoxide (DLCO) (P < 0.001). The patients with lobectomy had a significantly longer disease-free interval (P < 0.001) and survival (P = 0.001). By multivariate analysis, sublobar resection (P = 0.011), lymphatic vessel invasion (P = 0.006), and number of positive lymph nodes (P = 0.028) were predictors for survival. Sublobar resection (P < 0.001), visceral pleural invasion (P = 0.002), and lymphatic vessel invasion (P < 0.001) were predictors for disease-free interval. CONCLUSIONS: Lobectomy should remain the standard surgical procedure for solid-type, clinical stage IA, NSCLC.

Correction of pectus excavatum with breast hypoplasia using simultaneous pectus bar procedure and augmentation mammoplasty.

Most women with asymmetric pectus excavatum suffer from hypoplastic breasts. Hence, aesthetic correction of pectus excavatum has to address thoracic wall deformity, breast hypoplasia, and asymmetry.In retrospective series, 21 patients with a diagnosis of pectus excavatum with hypoplastic breasts were corrected using the pectus bar procedure and subpectoral augmentation mammoplasty. Results were assessed by analyzing prospectively collected data and calculating pectus indices from computed tomographic scans. At 12 months postoperatively, cosmetic evaluations were performed by the patients and by an independent, board-certified plastic surgeon using score from 0 (very poor) to 4 (very good).Cosmetic results evaluated by plastic surgeon were good (3.33 ± 0.03) and patient satisfaction was high (3.52 ± 0.03). Furthermore, indices of pectus excavatum were corrected to near normal.The authors consider that the pectus bar procedure with subpectoral augmentation mammoplasty is useful for the aesthetic correction of pectus excavatum with hypoplastic breasts.

Recent Advancements in Pectus Surgery: Crane Lifting, Multiple-Bar Approach, Bridge Stabilization, and Sandwich Technique.

PURPOSE: The most recent procedure for pectus excavatum repair involves crane-powered entire chest wall remodeling, which employs crane lifting, multiple-bar approach, bridge stabilization, and sandwich techniques. This resulted in a paradigm shift in pectus deformity repair from merely lifting the sunken bone to remodeling the chest wall into normal anatomy. METHODS: We analyzed 649 patients who underwent surgery for pectus excavatum or complex combined deformities between March 2018 and January 2022. A crane with sternal wiring or screwing was used to lift the chest wall without using the pectus bar turning power. Multiple bars with bridge connections were placed to eliminate bar displacement. Modified sandwich techniques were applied to relieve the lower coastal flare (flare-buster) and focal protuberance (magic string). RESULTS: The mean age of the patients included in the study was 12.2 years (range: 3-45 years). A single bar was used for 202 patients until 2021. For the multiple-bar technique, parallel bars (n = 142), crossbars (n = 166), and crossbars plus upper horizontal bars (XI pattern; n = 139) were used. The overall complication rate was 6.2 %. There was no cases of bar displacement were observed, but other minor complications such as pneumothorax (n = 20, 3.1 %), pleural effusion (n = 7, 1.1 %), and wound infection (n = 5, 0.8 %) were detected. Three patients required reoperation (infection, two: hemorrhage, one). CONCLUSIONS: The crane-powered entire chest wall remodeling technique improved the safety and comprehensiveness of the repair procedure. By incorporating bridge stabilization and the use of multiple bars, we effectively resolved the issues related to bar displacement and incomplete repair. TYPE OF STUDY: Retrospective Cohort Study.

Effect of Preoperative Clear Liquid Consumption on Postoperative Recovery in Pediatric Patients Undergoing Minimally Invasive Repair of Pectus Excavatum: A Prospective Randomized Controlled Study.

Background/Objectives: Preoperative fasting guidelines traditionally aim to reduce pulmonary aspiration risk. However, concerns over the adverse effects of prolonged fasting have led to exploring alternatives. This study aimed to investigate the impact of preoperative clear liquid intake on postoperative outcomes in children undergoing minimally invasive repair of pectus excavatum (MIRPE). Methods: A prospective randomized controlled study was conducted on children aged 3-6 years scheduled for elective MIRPE. Patients were randomized into either a routine overnight fasting group (NPO) or a clear liquid group. The incidence and severity of emergence delirium (ED) were assessed using Pediatric Anesthesia Emergence Delirium (PAED) and Watcha scales at recovery room. Postoperative pain scores and opioid requirements were evaluated at intervals of 1-6 h, 6-12 h, and 12-24 h after surgery. Results: Fasting time was 178.6 ± 149.5 min and 608.9 ± 148.4 min in the clear liquid group compared and NPO group, respectively. The incidence of ED, measured by PAED and Watcha scales, was lower in the clear liquid group (PAED score ≥ 12: 55.6% vs. 85.2%, p = 0.037; Watcha score ≥ 3: 51.9% vs. 85.2%, p = 0.019). The highest PAED score recorded in the recovery room was significantly lower in the clear liquid group (11.4 ± 2.8 vs. 14.6 ± 2.8, p < 0.001). Clear liquid group showed significantly lower pain scores at 1-6, 6-12, and 12-24 h postoperatively. Additionally, clear liquid group had lower opioid requirement at 1-6 and 6-12 h postoperatively. Conclusions: Preoperative clear liquid consumption was associated with a lower incidence of ED in pediatric patients undergoing MIRPE.

Serratus Anterior Plane Block: A Better Modality of Pain Control after Pectus Excavatum Repair.

Background: Postoperative pain management following minimally invasive repair of pectus excavatum (MIRPE) remains a critical concern due to severe post-procedural pain. Promising results have been reported for cryoanalgesia following MIRPE; however, its invasiveness, single-lung ventilation, and additional instrumentation requirements remain obstacles. Serratus anterior plane block (SAPB) is a regional block technique capable of covering the anterior chest wall at the T2-9 levels, which are affected by MIRPE. We hypothesized that SAPB would be a superior alternative pain control modality that reduces postoperative pain more effectively than conventional methods. Methods: We conducted a retrospective study of patients who underwent MIRPE between March 2022 and August 2023. The efficacy of pain control was compared between group N (conventional pain management, n=24) and group S (SAPB, n=26). Group N received intravenous patient-controlled analgesia (IV-PCA) and subcutaneous local anesthetic infusion. Group S received bilateral continuous SAPB with 0.3% ropivacaine after a bilateral bolus injection of 30 mL of 0.25% ropivacaine with baseline IV-PCA. Pain levels were evaluated using a Visual Analog Scale (VAS) at 1, 3, 6, 12, 24, 48, and 72 hours postoperatively and total intravenous rescue analgesic consumption by morphine milligram equivalents (MME). Results: Mean VAS scores were significantly lower in group S than in group N throughout the 72-hour postoperative period (p<0.01). Group S showed significantly lower MME at postoperative 72 hours (group N: 108.53, group S: 16.61; p<0.01). Conclusion: SAPB improved immediate postoperative pain control in both the resting and dynamic states and reduced opioid consumption compared to conventional management.

Toward unsupervised single-shot diffractive imaging of heterogeneous particles using X-ray free-electron lasers.

Single shot diffraction imaging experiments via X-ray free-electron lasers can generate as many as hundreds of thousands of diffraction patterns of scattering objects. Recovering the real space contrast of a scattering object from these patterns currently requires a reconstruction process with user guidance in a number of steps, introducing severe bottlenecks in data processing. We present a series of measures that replace user guidance with algorithms that reconstruct contrasts in an unsupervised fashion. We demonstrate the feasibility of automating the reconstruction process by generating hundreds of contrasts obtained from soot particle diffraction experiments.

New computerized indices for quantitative evaluation of depression and asymmetry in patients with chest wall deformities.

An evaluation index that can quantitatively assess the severity of chest wall deformities is essential to prepare and assess corrective surgical operations for patients with these deformities, including funnel chest patients. In previous studies, our group proposed several automatically calculated indices that represent the severity of depression and asymmetry in the chest wall. These indices showed sufficient performance in most cases of deformities, including those involving asymmetric and symmetric depression; however, their linearity declined when assessing complex deformities. The purpose of this study is to propose two automated indices that provide linear evaluation output for all types of chest wall deformities, including complex deformities, and to evaluate their performance and clinical feasibility. Six reference chest wall boundary curves were obtained from 60 computed tomography (CT) images of a normal chest. Next, an active contour model-based image processing technique was used to extract boundary curves from images of patients with real chest wall deformities. Third, the required parameters were extracted from the boundary curves and the targeted indices were calculated. Finally, the performance of the proposed indices was evaluated using 33 synthetic images and 60 real chest CT images of patients with chest wall deformities. The newly proposed indices can be automatically calculated from the original CT images and showed sufficient performance for all types of chest wall deformities. We believe that the newly proposed indices can facilitate pre- and postoperative evaluation of chest wall deformities in clinical practice.

Comparison of respiratory mechanics in adult patients undergoing minimally invasive repair of the pectus excavatum and removal of a pectus bar.

OBJECTIVE: The objective of this study was to compare the respiratory mechanics and gas exchange in adult patients undergoing minimally invasive repair of the pectus excavatum (MIRPE group) and removal of a pectus bar (bar removal group). DESIGN: A prospective observational study. SETTING: A tertiary university hospital. PARTICIPANTS: Thirty-two patients scheduled for elective MIRPE or removal of a pectus bar. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Spirometry was used to measure the peak inspiratory airway pressure (PIP), static compliance, and respiratory resistance. The measurements were recorded at 1 minute after beginning mechanical ventilation (T0), 15 minutes after beginning sevoflurane inhalation (T1), and after the insertion (or removal) of a pectus bar through the chest wall (T2). Pulmonary gas exchange was assessed by calculating the alveolar arterial oxygen tension difference (AaDO2) before surgical incision and after insertion (or removal) of the pectus bar. In the MIRPE group, static compliance was decreased significantly (p < 0.001), and PIP was increased significantly (p < 0.001) after insertion of the pectus bar (T2) compared with baseline. In contrast, the bar removal group showed the opposite results. There were significant differences in static compliance and PIP at T2 between the groups (p = 0.002 and 0.026, respectively). AaDO2 was increased significantly in the MIRPE group compared with the bar removal group (p = 0.012). CONCLUSIONS: Insertion of the pectus bar through the chest wall results in significant changes in respiratory mechanics and gas exchange. Therefore, close attention to pulmonary function is required during and after these surgical procedures.

The Cross-Bar Technique for Pectus Excavatum Repair: A Key Element for Remodeling of the Entire Chest Wall.

INTRODUCTION: The multiple bar approach was developed to cover broader and heavier teenager/adult chest wall deformities. We designed the cross-bar technique to achieve remodeling of the entire chest wall. This study aimed to demonstrate the role of cross-bar and its benefits over the parallel bar. MATERIALS AND METHODS: The cross-bar technique involves placing two bars diagonally and then cross on the target. The primary purposes are to double the lifting forces by making two bars converge on a single target to lift inflexible heavy chest wall depressions or cover lower lateral areas. The results of the cross-bar and parallel bar are compared for the indications, postrepair outcomes, and complications. RESULTS: From 2016 to 2019, 247 patients who underwent multiple bar pectus excavatum (PE) repair were enrolled in the study: 157 with cross-bar and 90 with parallel bar. In the cross-bar group, 33% (51/157) received three bars in XI fashion to cover the upper depression. The cross-bar group was older (18.0 ± 6.1 vs. 15.7 ± 5.0), had higher depression index (1.9 ± 0.7 vs. 1.8 ± 0.3), and was less asymmetric (45% vs. 71%) than those in the parallel bar group. The overall complication rates were not different between the two groups (9.6% vs. 10%, p = 1.0), although the cross-bar group was more rigid and complex. There was no bar displacement or reoperation in both groups. CONCLUSION: The cross-bar technique is as safe and effective as the parallel-bar technique, even though it was selected to correct more complexities. The cross-bar technique could be a method for complex PE deformities for remodeling of the entire chest wall.

Factors Influencing Suicidal Ideation According to the Deprivation Indices of Different Regions in Korea.

OBJECTIVES: This study examined how deprivation differed by region and the effect those differences had on suicidal ideation among the local population. METHODS: Data collected over 10 years (2012-2021) in the Korea Welfare Panel Study were organized into 3 categories: metropolitan, city, and rural. A panel analysis was conducted on the impact of deprivation indices, socio-demographic characteristics, and life satisfaction on suicidal ideation in each category. RESULTS: Income, divorce status, family relationship satisfaction, and medical deprivation had a significant impact on suicidal ideation in metropolitan areas, whereas these variables did not have significant effects in rural areas. In other words, income, family, and medical support were more impactful in city areas. CONCLUSIONS: Although the deprivation index was higher in rural areas than in city areas due to an aging population and reduced income levels, the mental health of rural residents was found to be generally better than that of city residents. The possibility that this is related to the strength of relationships within the respective communities should be considered in light of recent discussions on relational welfare.

Technical Advances in Pectus Bar Stabilization in Chest Wall Deformity Surgery: 10-Year Trends and an Appraisal with 1,500 Patients.

Background: We aimed to demonstrate the advances we have achieved in pectus excavatum surgery over the last 10 years, with a particular focus on the refinement of pectus bar stabilization techniques and devices. Methods: In total, 1,526 patients who underwent minimally invasive repair of pectus excavatum surgery from 2013 to 2022 were enrolled and analyzed. We have pursued a new paradigm of crane-powered remodeling of the entire chest wall. The method of bar stabilization has changed from claw fixators to hinge plates and, finally, to bridge plate connections. We also evaluated the effectiveness of the hinge plate (group H) and the bridge plate (group B). Results: The bar displacement rates were 0.1% (n=2) for the claw fixator, 0% for the hinge plate (n=0), and 0% for the bridge plate (n=0). We stopped using the claw fixator in 2022 and the hinge plate in 2019. Since 2022, when we shifted to a multiple-bar technique for all patients, the bridge plate has replaced both the claw fixator and the hinge plate. No bar displacement occurred in either group. Group H had more pleural effusion, wound problems (p<0.05), and longer stays (5.5 vs. 6.2 days, p=0.034) than group B. Conclusion: We have made significant progress in pectus repair surgery over the last decade, particularly in stabilizing the pectus bar and reducing perioperative complications. Our current strategy is the multiple-bar approach with bridge stabilization. Since the bridge-only technique resulted in no bar displacement, we could eliminate the invasive claw fixator or hinge plate.

Relationship Between Community Resilience and Quality of Life of Disaster-Affected People: Reinforcement Effects of the Perception of Government Relief Services in South Korea.

OBJECTIVE: The occurrence of various forms of disasters has increased worldwide. In South Korea, community resilience is particularly emphasized, especially in response to large-scale disasters in regional and group units. This study investigated the association between community resilience and the quality of life of disaster-affected people, and identified the moderating effects of perception of government relief services. METHODS: Data from the third long-term survey on the change of life of disaster-affected people conducted in 2018 by the National Disaster Management Research Institute were used. The study selected 1046 participants ages ≥ 19 years from among the disaster-affected people. Statistical analyses were performed using Model 1 of the PROCESS Macro 4.0 in the SPSS program. RESULTS: Community resilience positively affected disaster-affected people's quality of life. The perception of government relief services significantly strengthened the association between community resilience and quality of life. CONCLUSIONS: The study highlights the importance of enhancing community resilience to improve disaster-affected people's quality of life and emphasizes the role of perception of government relief services in reinforcing this relationship. Several practical and political measures that focus on improving community resilience and perception of government relief services are suggested to enhance disaster-affected people's quality of life.

Crane-powered pectus excavatum repair: the NeoPectus surgery.

Introduction: The conventional technique for pectus excavatum repair was pushing up the depressed chest wall by turning over the convexity of the bent pectus bar. We developed a new concept in which a total crane lift was used as the source of power to elevate the depressed sternum without using pectus bar leverage. This study aims to verify the efficacy of exclusively crane-powered pectus excavatum repair in recent years. Methods: Among the 3622 pectus deformity repairs since 1999, 691 cases repaired with the total crane power between 2017 and 2022 were enrolled. The mean age was 12.0 years (3-45). The operative technique involved wire/screw crane elevation of the sternum, the entire chest wall remodeling with the cross or parallel bars, the bridge/claw bar fixations, and other adjunctive techniques. Outcome analysis included morphological variations, patterns of pectus bar placement, and complication rates. Results: The crane technique and pectoscopy (100%) were used. The bar placements were parallel (22.0%) and cross-bar (47.5%). The bar fixations were the claw fixators for a single bar (30.5%) and the bridge plates for multiple bars (69.5%). The flare-buster and magic strings were liberally used. No serious complications or catastrophic events occurred, but minor complications occurred in 16.9%: pneumothorax in 7.4% (51), pleural effusion in 1.6% (11), and wound problems in 0.4% (3). There was no case of bar displacement. Discussion: The crane-powered pectus excavatum repair showed excellent results with minimal complications and no bar displacement. This innovative approach, part of the NeoPectus surgery, represents a significant advancement in correcting pectus excavatum deformities by utilizing a crane machine to elevate the chest wall.