Additional Complications Research Articles

Cortiva versus AlloDerm in Prepectoral and Partial Submuscular Implant-Based Breast Reconstruction: A Randomized Clinical Trial.

Several acellular dermal matrices (ADMs) are used for soft-tissue support in prosthetic breast reconstruction. Little high-level evidence supports the use of one ADM over another. The authors sought to compare Cortiva 1-mm Allograft Dermis with AlloDerm RTU (ready to use), the most studied ADM in the literature. A single-blinded randomized controlled trial comparing Cortiva with AlloDerm in prepectoral and subpectoral immediate prosthetic breast reconstruction was performed at 2 academic hospitals from March of 2017 to December of 2021. Reconstructions were direct to implant (DTI) or tissue expander (TE). Primary outcome was reconstructive failure, defined as TE explantation before planned further reconstruction, or explantation of DTI reconstructions before 3 months postoperatively. Secondary outcomes were additional complications, patient-reported outcomes (PROs), and cost. There were 302 patients included: 151 AlloDerm (280 breasts), 151 Cortiva (277 breasts). The majority of reconstructions in both cohorts consisted of TE (62% versus 38% DTI), smooth device (68% versus 32% textured), and prepectoral (80% versus 20% subpectoral). Reconstructive failure was no different between ADMs (AlloDerm 9.3% versus Cortiva 8.3%; P = 0.68). There were no additional differences in any complications or PROs between ADMs. Seromas occurred in 7.6% of Cortiva but 12% of AlloDerm cases, in which the odds of seroma formation were two-fold higher (odds ratio, 1.93 [95% CI, 1.01 to 3.67]; P = 0.047). AlloDerm variable cost was 10% to 15% more than Cortiva, and there were no additional cost differences. When assessing safety, clinical performance, PROs, and cost, Cortiva is noninferior to AlloDerm in immediate prosthetic breast reconstruction, and may be less expensive, with lower risk of seroma formation. Therapeutic, I.

Evaluation of the Effects of Incorporating Long-Acting Subcutaneous Insulin Into the Standard Treatment Protocol for Diabetic Ketoacidosis in Children

Background: Despite the progress made in the treatment of type 1 diabetes, the incidence of diabetic ketoacidosis (DKA) in children is still increasing, and its management requires hospitalization in the pediatric intensive care unit (PICU). It is important to find a new and low-risk treatment method to shorten the recovery time from DKA. Objectives: This study aimed to evaluate the effectiveness and safety of integrating two different types of long-acting subcutaneous insulin into the standard treatment for DKA in children. Methods: The study was conducted in the PICU, and comprehensive monitoring was performed throughout the process. Patients aged between 2 and 15 years were divided into three groups: Two intervention groups receiving the addition of two types of long-acting insulin, Detemir and Glargine, to the standard treatment, and a control group. Each group consisted of 36 individuals. The impact of the intervention on the recovery time from DKA and the potential complications were investigated in all three groups. Results: The analysis of the results revealed a significant difference in the duration of exiting the acute phase among the groups. Additionally, the post-hoc test demonstrated that the recovery time for ketoacidosis in the Detemir arm was significantly shorter than in the standard arm (P = 0.008). However, it is important to note that there were no significant differences in the occurrence of common complications among the three study groups. Conclusions: Based on the findings, it appears that incorporating specific types of long-acting subcutaneous insulin into the standard treatment of DKA in children leads to a reduction in the resolution time of the acute phase of ketoacidosis. Importantly, this approach does not introduce additional complications. Consequently, it has the potential to optimize resource allocation and enhance patient care by freeing up beds in the PICU.

An Enigmatic Discovery - Accidental Insertion of Internal Jugular Haemodialysis Catheter into the Vertebral Vein

A 40-year-old male was admitted to the medical ward with chronic kidney disease with uremic symptoms and a decision was made to initiate the patient on haemodialysis. It was decided to catheterize the right internal jugular vein directly as the patient would require an A-V fistula in the near future which would be created in the left arm subsequently.
 Procedure
 During the time of right internal jugular vein catheterization using the anterior landmark technique, the right carotid artery was punctured leading to hematoma formation on the right side of the neck, despite adequate haemostatic measures.
 It was decided to catheterize the left internal jugular vein subsequently. Using the anterior landmark technique again, venipuncture was performed on the left side of the neck and in the first attempt itself the guide wire was inserted without any difficulty or resistance.
 Safe back-flow of venous blood was achieved through all ports of the catheter; that is, the catheter tip was presumed to be well positioned in the left internal jugular vein (IJV), as seen on the chest X-ray taken following the procedure.
 Clinical Course
 The patient complained of numbness over the left shoulder and weakness of the left upper limb following the procedure and was evaluated for the same. Under the clinical suspicion of left vertebral artery catheterization, a vascular surgeon opinion was sought and a CT angiogram of the neck was advised.
 The CT angiogram revealed the catheter entering the left vertebral vein at the level of C6 vertebra, coursing anteroinferiorly reaching the left brachiocephalic vein with its tip noted at the confluence of subclavian vein with internal jugular vein.
 After the CT angiogram, the misplaced catheter was promptly extracted to prevent the onset of additional complications.
 No excessive resistance was encountered during the catheter removal, and there were no signs of hematoma formation.
 Over the next few days, the patient’s symptoms of numbness and weakness resolved spontaneously.
 The patient had no neurological complaints and deficits on examination during follow-up in the outpatient department.

Urogenital Complications that Decrease Quality of Life in Transgender Surgery

Gender reassignment surgeries are performed not to treat a congenital or anatomical anomaly, but to treat the psychological problems of transsexuals. In fact, there is no definitive evidence showing that psychological problems in transsexuals are cured by hormonal and/or surgical treatments for gender reassignment. On the contrary, there is evidence that these psychological problems persist after medical and surgical interventions, and even increase in some transsexuals, and a new form of body dysphoria occurs in a quarter of cases. Psychological problems in transgender people are not cured by surgery, and additional surgery-related complications develop in three-quarters of the cases. The vast majority of these are urogenital complications, and more than half require reoperations. However, in a significant proportion of cases, the outcome is unsuccessful and these urogenital complications significantly reduce the quality of life of transsexuals. Data also show that the life expectancy of transsexuals who undergo surgery is shortened by an average of 25-28 years due to psychological problems, suicides, surgical complications, reoperations and diseases related to hormone use. These results have led to an increase in the number of detransitioners who regret their medical and surgical transition and want to return in recent years, and have increased ethical debates on this issue. In this article, urogenital complications that develop after transgender surgery, which reduce the quality of life and possibly play a role in regrets are summarized.

Microvascular decompression for hemifacial spasm after Bell's palsy: a retrospective clinical study.

This study aimed to investigate the clinical characteristics of hemifacial spasm (HFS) after Bell's palsy and to evaluate the therapeutic efficacy of microvascular decompression (MVD). A retrospective analysis was conducted on 18 patients who underwent MVD for HFS after Bell's palsy at our institution between January 1, 2017, and December 31, 2021. Clinical presentations, intraoperative findings, postoperative outcomes, and complications were comprehensively assessed. Neurovascular compression (NVC) was identified in all the 18 patients. The offending vessels included anterior inferior cerebellar artery (AICA) in 6 patients (33.3%), posterior inferior cerebellar artery (PICA) in 7 patients (38.9%), vertebral artery (VA) combined with AICA in 3 patients (16.7%), and VA alongside PICA in 2 patients (11.1%). Notably, marked arachnoid membrane adhesion was evident in 11 patients (61.1%). 15(83.3%) patients were cured immediately after MVD, delayed relief was found in 3 (16.7%) patients. During the follow-up period, recurrence was not documented. Surgical complications were limited to facial paralysis in 3 patients and auditory impairment in 1 patient. No additional surgical complications were recorded. In patients manifesting HFS after Bell's palsy, NVC predominantly underlies the etiology. MVD is a reliably safe and efficacious therapeutic intervention.

Demographic, Etiological, and Clinical Characteristics of Eyelid Lacerations.

To evaluate the demographic, etiological, and accompanying clinical factors in eyelid lacerations (EL). The records of patients who presented to our clinic between 2018 and 2022 with eyelid trauma were retrospectively reviewed. Age, gender, cause of injury, clinical findings, accompanying ocular findings, and additional complications were analyzed. The study included 135 patients (106 male, 29 female) with a mean age of 37.0±18.6 years. Among the patients, 29 (21.4%) were 18 years old or younger, 93 (68.8%) were between 19 and 64 years old, and 13 (9.6%) were 65 years old or older. EL were most caused by various sharp objects in 44 patients (33%), blunt trauma in 40 patients (30%), falls in 30 patients (22%), and traffic accidents in 21 patients (15%). Fifteen eyes (11.1%) had foreign bodies at the wound site. Thirty patients (22.2%) (20 lower eyelid, 10 upper eyelid) had accompanying canalicular lacerations. Twenty-three (17%) patients had accompanying conjunctival lacerations, 14 (10.3%) had open-globe injury, 10 (7.4%) had corneal epithelial defects, 9 (6.6%) had intravitreal hemorrhage, 6 (4.4%) had hyphema, and 5 (3.7%) had retinal detachment. Four patients had lid notching and 1 patient (0.7%) had ectropion. Five patients (3.7%) required suturing. No additional complications were observed. EL are more commonly seen in young adulthood and in males. The most common mechanism of injury is impact by various objects. Eyelash margin and canalicular lacerations frequently accompany these injuries. Serious ocular pathologies such as hyphema and open-globe injury can accompany eyelid trauma.

What can they expect? Decreased quality of life and increased postoperative complication rate in patients with a fracture-related infection

BackgroundBy gaining insight into the Quality of Life (QoL) status and occurrence of complications, critical facets in the care for patients with Fracture-Related Infection (FRI) can be mitigated and measures can be taken to improve their outcome. Therefore, the aims of this study were to 1) determine the QoL in FRI patients in comparison to non-FRI patients and 2) describe the occurrence of other complications in both FRI and non-FRI patients. MethodsAn ambidirectional cohort study was conducted in a level 1 trauma centre between January 1st 2016 and November 1st 2021. All patients who underwent surgical stabilisation of an isolated long bone fracture were eligible for inclusion. To avoid confounding, only patients with an Injury Severity Score (ISS) <16 were included. Data regarding patient demographics, fracture characteristics, treatment, follow-up and complications were collected of both non-FRI and FRI patients. QoL was assessed through the use of five-level EuroQol five-dimension (EQ-5D-5L) questionnaires twelve months post-injury. ResultsA total of 134 patients were included in this study, of whom 38 (28%) FRI patients and 96 (72%) non-FRI patients. In comparison to non-FRI patients, FRI patients scored significantly worse on the QoL assessment regarding the index value (p = 0.012) and the domains mobility (p<0.001), usual activities (p = 0.010) and pain/discomfort (p = 0.009). Other postoperative complications were more often reported (p<0.001) in FRI patients (66%, n = 25/38) compared to non-FRI patients (27%, n = 26/96). During the median follow-up of 14.5 months (interquartile range (IQR) 9.5–26.5), 25 FRI patients developed a total of 49 distinctive complications besides FRI. The complications nonunion (18%, n = 9/49), infection other than FRI (e.g. line infection, urinary tract infection, pneumonia) (18%, n = 9/49) and implant failure (14%, n = 7/49) were the most frequently described in the FRI group. ConclusionPatients who suffered from an FRI have a decreased QoL in comparison to those without an FRI. Moreover, patients with an FRI have a higher rate of additional complications. These findings can help in patient counselling regarding the potential physical and mental consequences of having a complicated course of recovery due to an infection.

Construction and validation of a risk-prediction model for anastomotic leakage after radical gastrectomy: A cohort study in China

ObjectivesAnastomotic leakage (AL) stands out as a prevalent and severe complication following gastric cancer surgery. It frequently precipitates additional serious complications, significantly influencing the overall survival time of patients. This study aims to enhance the risk-assessment strategy for AL following gastrectomy for gastric cancer. MethodsThis study included a derivation cohort and validation cohort. The derivation cohort included patients who underwent radical gastrectomy at Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, from January 1, 2015 to December 31, 2020. An evidence-based predictor questionnaire was crafted through extensive literature review and panel discussions. Based on the questionnaire, inpatient data were collected to form a model-derivation cohort. This cohort underwent both univariate and multivariate analyses to identify factors associated with AL events, and a logistic regression model with stepwise regression was developed. A 5-fold cross-validation ensured model reliability. The validation cohort included patients from August 1, 2021 to December 31, 2021 at the same hospital. Using the same imputation method, we organized the validation-queue data. We then employed the risk-prediction model constructed in the earlier phase of the study to predict the risk of AL in the subjects included in the validation queue. We compared the predictions with the actual occurrence, and evaluated the external validation performance of the model using model-evaluation indicators such as the area under the receiver operating characteristic curve (AUROC), Brier score, and calibration curve. ResultsThe derivation cohort included 1377 patients, and the validation cohort included 131 patients. The independent predictors of AL after radical gastrectomy included age ≥65 y, preoperative albumin <35 g/L, resection extent, operative time ≥240 min, and intraoperative blood loss ≥90 mL. The predictive model exhibited a solid AUROC of 0.750 (95% CI: 0.694–0.806; p < 0.001) with a Brier score of 0.049. The 5-fold cross-validation confirmed these findings with a calibrated C-index of 0.749 and an average Brier score of 0.052. External validation showed an AUROC of 0.723 (95% CI: 0.564–0.882; p = 0.006) and a Brier score of 0.055, confirming reliability in different clinical settings. ConclusionsWe successfully developed a risk-prediction model for AL following radical gastrectomy. This tool will aid healthcare professionals in anticipating AL, potentially reducing unnecessary interventions.

Endogenous cAMP elevation in Brassica napus causes changes in phytohormone levels

ABSTRACT In higher plants, the regulatory roles of cAMP (cyclic adenosine 3′,5′-monophosphate) signaling remain elusive until now. Cellular cAMP levels are generally much lower in higher plants than in animals and transiently elevated for triggering downstream signaling events. Moreover, plant adenylate cyclase (AC) activities are found in different moonlighting multifunctional proteins, which may pose additional complications in distinguishing a specific signaling role for cAMP. Here, we have developed rapeseed (Brassica napus L.) transgenic plants that overexpress an inducible plant-origin AC activity for generating high AC levels much like that in animal cells, which served the genetic model disturbing native cAMP signaling as a whole in plants. We found that overexpression of the soluble AC activity had significant impacts on the contents of indole-3-acetic acid (IAA) and stress phytohormones, i.e. jasmonic acid (JA), abscisic acid (ABA), and salicylic acid (SA) in the transgenic plants. Acute induction of the AC activity caused IAA overaccumulation, and upregulation of TAA1 and CYP83B1 in the IAA biosynthesis pathways, but also simultaneously the hyper-induction of PR4 and KIN2 expression indicating activation of JA and ABA signaling pathways. We observed typical overgrowth phenotypes related to IAA excess in the transgenic plants, including significant increases in plant height, internode length, width of leaf blade, petiole length, root length, and fresh shoot biomass, as well as the precocious seed development, as compared to wild-type plants. In addition, we identified a set of 1465 cAMP-responsive genes (CRGs), which are most significantly enriched in plant hormone signal transduction pathway, and function mainly in relevance to hormonal, abiotic and biotic stress responses, as well as growth and development. Collectively, our results support that cAMP elevation impacts phytohormone homeostasis and signaling, and modulates plant growth and development. We proposed that cAMP signaling may be critical in configuring the coordinated regulation of growth and development in higher plants.

Comparative Complications Associated With BMP Use In Patients Undergoing ACDF for Degenerative Spinal Conditions: Systematic Review and Meta-Analysis.

Systematic Review and Meta-Analysis. To compare complication incidence in patients with or without the use of recombinant human Bone Morphogenic Protein-2 (BMP2) undergoing anterior cervical discectomy and fusion (ACDF) for degenerative conditions. A systematic search of eight online databases was conducted using PRISMA guidelines. Inclusion criteria included English language studies with a minimum of 10 adult patients undergoing instrumented ACDF surgery for a degenerative spinal condition in which BMP2 was used in all patients or one of the treatment arms. Studies with patients undergoing circumferential fusions, with non-degenerative indications, or which did not report post-operative complication data were excluded. Patients with and without BMP2 were compared in terms of the incidence of dysphagia/dysphonia, anterior soft tissue complications (hematoma, seroma, infection, dysphagia/dysphonia), nonunion, medical complications, and new neurologic deficits. Of 1832 preliminary search results, 27 manuscripts were included. Meta-analysis revealed the relative risk of dysphagia or dysphonia (RR = 1.39, CI 95% 1.18 - 1.64, P = <.001), anterior soft tissue complications (RR = 1.43, CI 95% 1.25-1.64, P = <.001), and medical complications (RR = 1.32, CI 95% 1.06-1.66, P = .013) were statistically significant in the BMP2 group while the relative risk of non-union (RR = .5, CI 95% .23 - 1.13, P = .09) trended lower in the BMP2 group. Neurological deficit (RR = 1.06, CI 95% .82-1.37, P = .66), and additional medical complications (RR = 1.53, CI 95% .98-2.38, P = .06) were not found to be statistically different between the groups. This meta-analysis identified a high rate of arthrodesis when BMP2 was used in ACDF, but confirmed increased rates of dysphagia and anterior soft tissue complications. Surgeons may consider reserving BMP2 implementation for cases with a high risk of non-union, and should be aware of the risk of airway compromise.

Benchtop Nickel Catalysis Invigorated by Electron-Deficient Diene Ligands.

ConspectusDue to the rarity of precious metals like palladium, nickel catalysis is becoming an increasingly important player in organic synthesis, especially for the formation of bonds with sp3-hybridized carbon centers. Traditionally, catalytic processes involving active Ni(0) species have relied on Ni(COD)2 or in situ reduction of Ni(II) salts. However, Ni(COD)2 is an air- and temperature-sensitive material that requires use in an inert-atmosphere glovebox, and in situ reduction protocols of Ni(II) salts using metallic or organometallic reductants add additional complications to reaction development.This Account chronicles the development of air-stable Ni(0) precursors as replacements for Ni(COD)2 or in situ reduction. Based on Schrauzer's seminal discovery of Ni(COD)(DQ) as an air-stable zerovalent organonickel complex, our research laboratories at Scripps Research and Bristol Myers Squibb have developed a class of precatalysts based on the Ni(COD)(EDD) (EDD = electron-deficient diene) framework, relying on the steric and electronic properties of the supporting diene to render the metal center stable to air, moisture, and even silica gel but reactive to ligand substitution and redox changes.The stable Ni(0) complexes can be accessed through ligand exchange with Ni(COD)2, through reduction of Ni(acac)2 using DIBAL-H, or electrochemically via cathodic reduction of Ni(acac)2 to Ni(COD)2, followed by addition of an EDD ligand in one pot. As a toolkit, the complexes demonstrate reactivity that is equivalent or enhanced compared to Ni(COD)2, catalyzing C-C and C-N cross-couplings, Miyaura borylations, C-H activations, and other transformations. Since the initial report on Ni(COD)(DQ), its reactivity in C(sp2)-CN activation, metallophotoredox, and electric field-induced cross-coupling have also been demonstrated.By incorporating the precatalyst toolkit into reaction discovery campaigns, our laboratories have been able to perform C(sp3)-S(alkyl) couplings and metallonitrenoid carboamination, both of which represent challenging transformations that were inaccessible with traditional phosphine, nitrogen, or electron-deficient olefin ligands. Computational and experimental studies demonstrate how the quinone ligands are hemilabile, adopting η1(O)-bound geometries to relieve steric strain or stabilize transition states and intermediates; redox-active, able to transiently oxidize the metal center; and electron-withdrawing or -donating, depending on metal oxidation state and coordination geometry. These studies show how the ligands enable key steps in catalysis beyond imparting air-stability.Since our report documenting the catalytic activity of Ni(COD)(DQ), many other laboratories have also observed unique reactivity with this precatalyst. Ni(COD)(DQ) was found to offer superior reactivity to Ni(COD)2 in C-N cross coupling to form N,N-diaryl sulfonamides and in preparation of biaryls from aryl halides and benzene through a Ni-mediated, base-assisted homolytic aromatic substitution.

A Self-Designed Endobutton Installation Device for Coracoclavicular Stabilization in Acute Rockwood Type III Acromioclavicular Joint Dislocation.

Endobutton technique could provide flexible coracoclavicular (CC) stabilization for acromioclavicular joint (ACJ) dislocation and achieved good clinical outcomes. However, the difficult part of this technique was placement of the Endobutton to the coracoid base. In this study, we designed an Endobutton installation device to place the Endobutton at the coracoid base. And we examined the clinical and radiographic outcomes of patients with acute Rockwood type III ACJ dislocation repaired with Endobutton using this device. We designed an Endobutton installation device to place the Endobutton at the coracoid base to achieve CC stabilization. We retrospectively reviewed 42 patients with acute Rockwood type III ACJ dislocation who underwent CC stabilization with Endobuttons placed either using this novel device (group I, n = 19) or the traditional technique (CC stabilization without using special device, group II, n = 23) from January 2015 to April 2020. The two groups were compared regarding the operative time, intraoperative blood loss, and clinical and radiologic outcomes at final follow-up. The operation-related complications were also evaluated. The Student's t test and the Mann-Whitney U-test were used to compare differences in continuous variables. Differences in categorical variables were assessed with either the Pearson's chi-squared test or Fisher's exact test. Forty-two patients were clinically followed up for a minimum of 12 months. Compared with group II, group I had a significantly shorter mean operative time (56.05 ± 7.82 min vs. 65.87 ± 7.43 min, p < 0.01) and significantly lesser mean intraoperative blood loss (67.89 ± 14.75 mL vs. 94.78 ± 25.01 mL, p < 0.01). At final follow-up, there were no significant differences between the two groups in the visual analog scale score for pain, Oxford Shoulder Score, Disabilities of the Arm, Shoulder, and Hand score, and postoperative CC distance of the affected side. Loss of reduction occurred in four patients in group I and three patients in group II (p = 0.68); there were no other operation-related complications in either group. The Endobutton installation device makes placement of the Endobutton at the coracoid base easier and achieves satisfactory clinical and radiologic outcomes without additional complications in acute Rockwood type III ACJ dislocation.

Risk factors for postoperative delirium in orthopaedic hip surgery patients: a database review

BackgroundPostoperative delirium is a common problem affecting admitted patients that decreases patient satisfaction and increases the cost and complexity of care. The purpose of this study was to use the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database to compare rates and risk factors of postoperative delirium for total hip arthroplasty (THA) and hemiarthroplasty patients indicated for osteoarthritis or proximal femur fracture.MethodsThe 2021 NSQIP database was queried for patients using Current Procedural Terminology (CPT) codes for THA and hemiarthroplasty and ICD-10 codes for osteoarthritis or proximal femur fracture. Demographic, past medical history, preoperative labs, and functional status data were recorded. Procedural data were also collected. Finally, postoperative outcomes and complications were reviewed.ResultsOverall, 16% of patients had postoperative delirium. Delirium patients were older on average (82.4 years vs. 80.7 years, p < 0.001), had a lower BMI (19.5 vs. 24.8, p < 0.001), were more likely to have a history of dementia (54.6% vs. 13.6%, p < 0.001), were less likely to have an independent functional status (p < 0.001) or live alone (p < 0.001), and were more likely to have sustained a recent fall (p < 0.001). Delirium patients were more likely to be hyponatremic or hypernatremic (p = 0.002), anemic (p < 0.001), and severely dehydrated (p < 0.001), among other lab abnormalities. Delirium patients were also more likely to experience additional postoperative complications, including pneumonia, pulmonary embolism, urinary tract infection, stroke, cardiac arrest, sepsis, and unplanned reoperation and readmission after discharge (all p < 0.05).ConclusionsIn this study, factors associated with postoperative delirium in patients undergoing hemiarthroplasty and THA were identified, including older age, lower BMI, certain medical conditions, decreased functional status, certain lab abnormalities, and postoperative complications. These findings can be used by clinicians to better inform care and to determine when orthopaedic joint replacement patients may be at an increased risk for postoperative delirium.

Creating a 3D-printed pelvic phantom to explore the impact of Magnetic Resonance (MR) scanner noise in radiomics analysis, a technical note.

Reproducibility of radiomics features necessitates that scanner noise be considered prior to feature extraction. Phantom research provides the opportunity for such ‘ground truth’ measurements, without the additional complication of patient-related factors. The aim of this technical note was to create a 3D printed Magnetic Resonance Imaging (MRI)-compatible pelvic phantom that can be used for subsequent analysis of the impact of scanner noise on the reproducibility of radiomics features.A 3D printed phantom of a male pelvis was created using fused deposition modelling technology. It was 3D printed using the high density MRI-compatible acrylonitrile butadiene styrene (ABS). The ‘negative’ mould created was then filled with silicone, and the prostate gland and femoral heads were also simulated.We successfully created an MRI-compatible 3D printed pelvic phantom, with a test scan. The phantom will subsequently be utilised to determine the impact of MRI scanner noise on radiomics feature reproducibility.

Study of the Interaction of a Hydraulic Fracture with a Natural Fracture in a Laboratory Experiment Based on Ultrasonic Transmission Monitoring

This paper presents the results of experiments on the study of a hydraulic fracture’s interaction with a preexisting fracture. A distinctive feature of the conducted experiments is the ability to use ultrasonic transmitting monitoring to measure the fracture propagation and opening simultaneously with the pore pressure measurements at several points of the porous saturated sample. It allows us to obtain the pressure distributions at various experiment stages and to establish a relation between the pore pressure distribution and hydraulic fracture propagation and its interaction with macroscopic natural fractures. The possibilities of active ultrasonic monitoring have been expanded due to preliminary calibration experiments, which make it possible to estimate the fracture opening via attenuation of ultrasonic pulses. The experiment demonstrated the most complex scenario of fracture interactions when a hydraulic fracture intersected with a natural fracture and the natural fracture in the vicinity of the intersection was also opened. The additional complications arise from fracture arrangement: the hydrofracture was normal with respect to the base plane, while the natural fracture was slanted. This led to gradual growth of the intersection zone as the hydrofracture propagated. The experiments show that the natural fracture limited the fracture’s propagation. This was caused by the hydraulic fracturing fluid leaking into the natural fracture; thus, both the hydraulic fracture and natural fracture compose a united hydraulic system.

Reference suture of gluteus minimus muscle: a modification of the lateral approach in total hip arthroplasty

The lateral approach is one of the most frequently used surgical procedures in total hip arthroplasty, being its main disadvantage the postsurgical abductor muscle weakness that many patients present, which may lead to Trendelenburg gait in a high percent of cases. For this reason we propose a surgical variation which consists in using a suture reference for the gluteus minimus just before its tenotomy, that allows a better repair of the abductor musculature during the closure. It also facilities muscles mobilization during the dissection, reducing the risk of neurovascular damage if we place an additional retractor, and also protects the gluteus minimus and gluteus medium during the insertion of the prosthetic components. With these advantages, we aim to reduce the most frequent complication of the lateral approach as it is the abductor muscle weakness. This modification only consists in a new suture, so it does not implies additional complications in contrast with the classical approach. However, in some patients can be difficult to place the suture if they have a tendinous deterioration of the gluteus minimus or a chronic break.

TRAUMATIC LENS SUBLUXATION FROM PICKLEBALL INJURY: A CASE SERIES

Purpose: The purpose of this study was to describe two cases of traumatic lens subluxation resulting from pickleball injury. Methods: This is a case series. Results: A 77-year-old man presented with worsening vision and was noted to have subluxation of his intraocular lens 10 days after being struck in the eye with a pickleball. The patient underwent a lens exchange with scleral fixation. A 76-year-old woman presented with blurry vision on the same day as her injury and was noted to have subluxation of her crystalline lens. She also underwent a lens insertion with scleral fixation. However, she experienced additional complications of postoperative cystoid macular edema and traumatic glaucoma. Conclusion: We recommend increased use of eye protection in pickleball.

Удосконалення процесу прийняття управлінських рішень в Україні шляхом забезпечення їх публічності в умовах війни

Problem statement. The requirement to make timely and correct administrative decisions is relevant for public management at any level, in all countries and in all historical periods. Therefore, many managers wonder how to develop a mechanism for making such a decision. There are conditions in which the administrative decision-making process acquires additional complications. In the conditions of martial law, the improvement of such a process acquires certain specific features. It is affected mainly by the safety and value components of social life, as well as the change in the algorithms of interaction between society and authorities in the specific conditions of war. An additional factor that provokes the need to revise the administrative decision-making process in Ukraine is the implementation of systemic reforms in the context of fulfilling the requirements for our country’s accession to the EU and NATO. Therefore, improving the administrative decision-making process in Ukraine, ensuring their publicity, is becoming particularly acute. Presentation of basic material. The article analyses the administrative decision- making process under martial law in Ukraine through the principle of publicity, specific requirements for the publicity of information management and administration via the prism of security requirements, and interaction with the Armed Forces. It substantiates that the publicity principle ensuring the formation and implementation of administrative decisions at management levels is a European integration requirement. Based on the analysis of normative and legal instruments it establishes that organisational, institutional, and legal requirements for the authorities’ activity provide for and oblige them to follow the publicity principle while adopting administrative decisions under martial law. Possible restrictions on public information disclosure are analysed and defined. It is revealed that restrictions relate to the issues of defence means and forces of Ukraine, but not to the processes of making administrative decisions, the public information holder is responsible for the information content in the decision-making process, and it is stipulated by the legislation. It is shown that the administrative decision-making process improvement in Ukraine by ensuring its publicity under martial law is achievable through several strategies (digitalisation, financing control, electronic reporting development, revision and improvement of crisis communication algorithms between the population and authorities, civil society institutions development, in particular, motivation of people to participate in making managerial decisions, enhancing officials’ skills in communicating with the population based on the publicity and compliance balance with the requirements of the martial law on access to information, etc.). Conclusions and suggestions. A conclusion is made that Ukraine is developing during wartime in line with European managerial approaches, among which is publicity in making managerial decisions by the authorities. Among the promising directions of research, we see the issue of cooperation with international organizations and partners to strengthen efforts to ensure publicity during the administrative decision-making process at various levels; exchange of publicity practices with democratic countries that have experience in decision-making during military conflicts.

Evaluation of Hemodialysis Complications among Children with Chronic Kidney Disease at District Head Quarter Hospital, Nankana Sahib

A patient with chronic kidney disease depends on hemodialysis to mechanically remove fluid, electrolytes, and waste products from the blood. Chronic kidney disease (CKD) is a universal matter of concern that affects around 15% of the population globally. Objective: To evaluate hemodialysis complications among children with chronic kidney disease. Methods: A cross-sectional descriptive study was carried out at the renal department of DHQ hospital. The duration of study was six months from April to September, 2023. The sample size was 45 children on hemodialysis with kidney disease. A purposive sampling technique was used. Data were gathered through self-administrated questionnaire. Data were analyzed through SPSS-25.0 and results were presented in the form of frequencies tables. Results: Majority of the participants suggested that initiation of hemodialysis lead to cardiovascular problems (72%), anemia (83%), and metallic taste (79%) in children. Moreover, majority of them complained about skin problem and itching as an adverse effect (78%). Other complications as indicated by participants are headache, restlessness, vertigo, nausea and vomiting (86%). Conversely, some subjects did not considered the hypertriglyceridemia (27%), gastric problems (31%), sleep problems (24%) and muscular pain (34%) as the result of initiation of hemodialysis procedure. Conclusions: Findings of present study suggested the most common complications of hemodialysis are hemodynamic instability, anemia and hypertension/hypotension, skin problems and itching. Other complications of hemodialysis as indicated by participants are headache, restlessness, vertigo, nausea, vomiting and decease concentration in children. However, most of the participants have limited understanding about additional complications of hemodialysis.

Risk Analysis of Diabetic Leg Amputation : A Systematic Study

Diabetic Foot Ulcer is considered a critical complication of diabetes, characterized by injuries and frequent exposure of the diabetic patient's foot. Approximately 20 % of diabetic patients may develop foot ulcers, with around 10 % requiring hospitalization due to additional complications. Typically, these ulcers affect individuals who have had diabetes for more than ten years. Neglecting or leaving Diabetic Foot Ulcers untreated can result in severe damage, leading to worsened infections and potentially necessitating amputation, often accompanied by multiple complications that may even result in mortality. Therefore, early prediction of foot-threatening risks is crucial to prevent worsening situations. In this work visualization methods are applied for a better understanding of the dataset to draw meaningful insights and to observe the behavior of amputation risks in diabetic patients. The feature values fluctuate, so selecting the best feature from a combination of statistical and graphical data analysis is not trivial. Data visualization techniques (data-driven approach), and statistical analysis were used to select important features, that lead to leg amputation. The Machine learning models were implemented to forecast foot ulcers depending on clinical outcomes. A predicted accuracy of 85 % is observed using Ensemble Methods