Alternative Procedure Research Articles

Survival prognostic in different age groups of patients undergoing local versus radical excision for rectal cancer: a study based on the SEER database.

Age significantly affects the prognosis of patients with rectal cancer after radical excision (RE), and local excision (LE) is an alternative surgical procedure to RE. To compare the survival prognosis in different age groups of LE versus RE for rectal cancer. Patients diagnosed with rectal adenocarcinoma treated by LE or RE from 2010 to 2017 were obtained from the SEER database. The primary outcomes are 5-year OS and CSS. A total of 11,170 patients were eventually included, and there were 490 patients in LE and RE groups, respectively, after 1:1 propensity score matching. The 5-year OS and CSS after LE were significantly better in < 50years and 50-66years groups than in > 66years group (5-year OS: 95.70% vs 88.40% vs 67.00%, P < 0.001; 5-year CSS: 95.70% vs 96.30% vs 82.60%, P < 0.001). No statistical significance was found for the differences in 5-year OS and CSS between LE and RE in < 50, 50-66, and > 66years group (P > 0.05). Multivariate analysis showed age > 66years, poorly differentiated or undifferentiated (Grade III/IV), and tumor size 3 to 5cm was independent risk factors for 5-year OS after LE; age > 66years, perineural invasion, and tumor size 3 to 5cm were the 5-year CSS independent risk factors for after LE. We found that the survival prognosis of younger rectal cancer patients treated with LE was significantly better than older (> 66years) patients, and the survival prognosis of rectal cancer patients in the three age groups was similar between LE and RE.

Functional results after hiatal repair and gastropexy without fundoplication in patients with paraoesophageal hernia

PurposeParaoesophageal hernias (PEH) are associated with a high complication rate and often occur in elderly and fragile patients. Surgical gastropexy without fundoplication is an accepted alternative procedure; however, outcomes and functional results are rarely described. Our study aims to evaluate short-term outcomes and the long-term quality of life after gastropexy as treatment for PEH.MethodsSingle center cohort analysis of all consecutive patients who underwent gastropexy for PEH without fundoplication. Postoperative outcomes and functional results were retrospectively collected. Reflux symptoms developed postoperatively were reported using the validated quality of life questionnaire: GERD-Health Related Quality of Life Qestionnaire (GERD-HRQL).ResultsThirty patients (median age: 72 years (65–80)) were included, 40% classified as ASA III. Main PEH symptoms were reflux (63%), abdominal/thoracic pain (47%), pyrosis (33%), anorexia (30%), and food blockage (26%). Twenty-six laparoscopies were performed (86%). Major complications (III-IVb) occurred in 9 patients (30%). Seven patients (23%) had PEH recurrence, all re-operated, performing a new gastropexy. Median follow-up was 38 (17–50) months. Twenty-two patients (75%) reported symptoms resolution with median GERD-HRQL scale of 4 (1–6). 72% (n = 21) reported operation satisfaction. GERD-HRQL was comparable between patients who were re-operated for recurrence and others: 5 (2–19) versus 3 (0–6), p = 0.100.ConclusionGastropexy without fundoplication was performed by laparoscopy in most cases with acceptable complications rates. Two-thirds of patients reported symptoms resolution, and long-term quality-of-live associated to reflux symptoms is good. Although the rate of PEH recurrence requiring a new re-intervention remained increased (23%), it does not seem to affect long-term functional results.

Ozone Strong Water Dosing as Optimized Ozonation Process for Micropollutants Reduction in Wastewater Treatment Plants

ABSTRACT Growing concern over potential ecotoxicological problems caused by micropollutants (MPs) in water has led to the application of adsorptive and oxidative advanced treatment technologies at European wastewater treatment plants (WWTPs). Direct dosage of gaseous ozone via diffusers or pump-injection systems is the most common large-scale process applied in water and wastewater treatment. Studies point out that MP removal may take place via the direct, very selective reaction with the ozone molecule as well as the indirect reaction with the very reactive but nonselective hydroxyl radicals. Several process parameters and set-ups may affect the MPs elimination and inhibit or even cause the formation of transformation products (TPs) such as bromate. This work compares an alternative ozone application procedure (the so-called ‘ozone strong water’ dosing – OSW) with standard systems regarding MP elimination, ozone consumption, reaction time, and required plant space. A full-scale OSW system was installed and operated at the WWTP Duisburg-Vierlinden. A significant reduction in the time required to achieve the maximum possible elimination was observed for all six MPs investigated, with a hydraulic reaction time of 8 min. According to a theoretical calculation, the reactor volume could be reduced by two-thirds of the installed volume.

Restorative Justice Under the Legislation of The Republic of Kosovo

Objectives: Restorative justice is also recognized and applied in Kosovo legislation and practice. As a process of involvement in the agreement of the perpetrator and the victim, always with the commitment and support of the mediator, its goal results in the achievement of compensation in relation to the victim. Therefore, its main goal remains the restoration of justice and the elimination of the damage caused as much as possible.   Methods: To achive the state objective in this scientific paper, I will use a legal-normative method, statistical method.    Result: In addition, we must emphasize that mediation as an alternative procedure for resolving disputes between subjects, namely as an extrajudicial activity, offers the possibility not only of solving the presented problem quickly, but at the same time is a direct contributor of creating a relaxing relationship between the parties involved in this whole process.   Conclusion: In a conclusion restorative justice has a wide application in the legislation in force in the Republic of Kosovo in the criminal field and the application of restorative justice is being implemented more and more, because it is showing a legal effect for many reasons; the parties are not taking much time in solving their cases, the parties are free to choose the mediator and the they are free to decide where the meetings will be held, and the other advantage is that the mediation agreement has the legal force of a judicial decision and produces legal effect and is enforceable

[Intraosseous vascular access - step by step].

Probably everyone who works in emergency medicine has been in the situation of having to insert a peripheral vein under time pressure in difficult venous conditions. So what do I do if I don't succeed? Establish a peripheral venous catheter? In recent years, the intraosseous approach has become increasingly popular as an alternative procedure. In this article, you will be guided step by step through the creation of an intraosseous access.

Machine learning as alternative strategy for the numerical prediction of the shear response in reinforced and prestressed concrete beams

Some materials, such as reinforced and prestressed concrete, involve non-linear constitutive relationships in elasticity problems defined on them. In particular, the shear strength of a reinforced concrete beam may be calculated by considering a diagonal struts field in the context of the so-called “Compression Field Theories” (CFTs). This work presents an efficient Machine Learning method alternative to numerical methods for obtaining the full shear response of reinforced and prestressed concrete beams based on CFT regarding stresses, strains, and crack angles. For that, a regression task is developed using state-of-the-art Machine Learning (ML) models. A ML model per output variable is trained with the existing Newton-Raphson solutions database. The solvability region of the embedded steel constitutive model is also considered, demonstrating the comprehensive character of the proposed method. The model is validated on two real beam responses, where the results obtained demonstrate that this alternative method based on ML algorithms effectively addresses the problem of prediction of the shear response in reinforced and prestressed concrete beams. The proposed ML approximation performs reasonably well without requiring any initial approximations. Moreover, the ML regressor here developed shows a low dependence on the concrete tension stiffening area surrounding the steel reinforcement, which significantly improves the performance of this methodology in a higher number of design cases. Thus, in the practical context of structural engineering, this last approach establishes an efficient alternative procedure for obtaining numerical solutions of mechanical models based on the CFTs framework.

Determination of resistance at zero and infinite frequencies in bioimpedance spectroscopy for assessment of body composition in babies.

&#xD;Bioimpedance spectroscopy (BIS) is a popular technique for the assessment of body composition in children and adults but has not found extensive use in babies and infants. This due primarily to technical difficulties of measurement in these groups. Although improvements in data modelling have, in part, mitigated this issue, the problem continues to yield unacceptably high rates of poor quality data. This study investigated an alternative data modelling procedure obviating issues associated with BIS measurements in babies and infants.&#xD;Approach&#xD;BIS data are conventionally analysed according to the Cole model describing the impedance response of body tissues to an applied AC current. This approach is susceptible to errors due to capacitive leakage errors of measurement at high frequency. The alternative is to model BIS data based on the resistance-frequency spectrum rather than the reactance-resistance Cole model thereby avoiding capacitive error impacts upon reactance measurements.&#xD;Main results&#xD;The resistance-frequency approach allowed analysis of 100% of data files obtained from BIS measurements in 72 babies compared to 87% successful analyses with the Cole model. Resistance-frequency modelling error (percentage standard error of the estimate) was half that of the Cole method. Estimated resistances at zero and infinite frequency were used to predict body composition. Resistance-based prediction of fat-free mass (FFM) exhibited a 30% improvement in the two-standard deviation limits of agreement with reference FFM measured by air displacement plethysmography when compared to Cole model-based predictions.&#xD;Significance&#xD;This study has demonstrated improvement in the analysis of BIS data based on the resistance frequency response rather than conventional Cole modelling. This approach is recommended for use where BIS data are compromised by high frequency capacitive leakage errors such as those obtained in babies and infants.&#xD.

Fluorine contamination, mobility, and risks in soils at a phosphate-gypsum waste landfill: a new analytical method and comparison with previous methods.

This study used a new X-ray fluorescence (XRF)-based analytical method with better precision and sensitivity to evaluate the fluorine concentrations in soil. It was hypothesized that the XRF method with a pellet-synthesizing procedure may effectively analyze the fluorine concentrations in soil with ease and reliability. The total fluorine concentrations determined using XRF were compared with those determined using three different types of analytical protocols-incineration/distillation, alkaline fusion, and aqua regia extraction procedures. Among the three procedures, the incineration/distillation procedure did not show reliable precision and reproducibility. In contrast, the total fluorine concentrations determined using the XRF analysis were linearly correlated with those determined using the alkaline fusion and aqua regia extraction procedures. Based on the results of the Korean waste leaching procedure and toxicity characteristics leaching procedure, the leachability of fluorine from soil and waste was not directly related to total fluorine concentrations in soil. Risk assessment also revealed that the fluorine-rich soils did not show non-carcinogenic toxic effects, despite exceeding the regulation level (800mg/kg) in South Korea for total fluorine concentrations in soil. Our results suggest that XRF analysis in combination with the newly developed pretreatment method may be a promising alternative procedure for easily and rapidly determining the total fluorine concentration in soil. However, further efforts are needed to evaluate fluorine leachability and its associated risks in fluorine-contaminated soils.

Matters related to key features of the by-law contestation administrative proceedings

The article points out that in cases concerning appeals against normative acts in the presence of obvious signs of its unlawfulness and violation of the rights or legitimate interests of a person who has filed a lawsuit against such an act, this lawsuit can be accompanied by an interim remedy stopping the effect of the respective normative act. This is allowed in exceptional cases when, on the basis of the evidence available in the case, the court is convinced that the contested act clearly contradicts the criteria of its lawfulness established by law on administrative proceedings. At the same time, one cannot claim that an exceptional case for stopping the effect of a normative legal act, when the norms of substantive law establish an alternative procedure for the exercise of rights affected by the contested normative legal act (in particular, if it is possible to act on the basis of normative acts having higher legal force). In addition, when deciding the issue of suspending the effect of a normative legal act, the court must observe the limits of judicial intervention in the activities of their issuers and respect their discretionary powers, primarily those that lie in the domain of their exclusive executive functions, especially those that are characterized by political and narrowly-specialized character.&#x0D; The author, moreover, maintains that in order to encourage plaintiffs to use their right to claim and procedural rights in good faith, it is proposed to establish the date when the plaintiff learned or should have learned about the violation of his rights and legitimate interests. It is also clarified that termination of a person’s participation in social relations, the participants of which are assigned rights and duties by the relevant normative act, as well as the termination of the normative legal act itself, is the starting point for calculating the timeframe for its appeal to court.&#x0D; The article also indicates that there are critical gaps in the legislative provisions, which give rise to uncertainty regarding the impact of the published announcement on the appeal of a normative act on timeframes of appeal to the administrative court for other addressees of the relevant normative legal act, as well as regarding the procedural status of those who expressed their intention to join before consideration of the case on its unlawfulness.

Combined spectroscopic and chromatographic techniques augmented with chemometrics for the authentication of black cumin (Nigella sativa L.) seed oil

Edible oils adulteration has a great concern because of its health and economical effects. Black cumin seed oils (BCSOs) are one of the most adulterated edible oils. In this case, the purpose of this research was to investigate authenticity of commercial BCSOs by spectroscopic and chromatographic techniques combined with orthogonal partial least square-discriminant analysis (OPLS-DA) and hierarchical cluster analysis (HCA). Sixteen commercial BCSO samples (100 % pure-certified and other BCSOs), potential blending oils (sunflower, corn, and soybean oils), and twenty-one synthetically adulterated BCSO samples blended with sunflower (SFO), corn (CO), and soybean (SBO) oils at levels of 5 %, 10 %, 15 %, 20 %, 30 %, 40 %, and 50 % (v/v) were analysed. Screening of potential fingerprinting markers such as thymohydroquinone (THQ), thymoquinone (TQ), carvacrol (CRV), tocopherol isomers (α-, γ-, and δ-), as well as total antioxidant capacity and phenolic content analysis were carried out utilizing spectrophotometric CUPRAC, ABTS, and Folin Ciocalteu’s assays. Commercial pure and fraudulent BCSOs and synthetically adulterated samples were successfully classified in OPLS-DA graphs with 95 % confidence level. Even to five percent detection limit for SFO, CO and SBO adulteration were prominently monitored. In consequence, the proposed spectroscopic and chromatographic methods seem to be a practically applicable, sensitive and versatile protocol that can be used as an alternative fingerprinting procedure to determine adulteration of commercial BCSOs.

Cholangioscopy with Spyglass DS using percutaneous transhepatic cholangiography access: a retrospective cohort study.

Conventional peroral methods to visualize biliary strictures are not feasible in some patients with altered anatomy or biliary obstruction, and percutaneous transhepatic cholangioscopy can be used as an alternative procedure. This study aimed to retrospectively review the use of percutaneous transhepatic cholangiography using the SpyGlass DS technology (S-PTCS) during a 5-year period at a Danish tertiary referral centre. All patients who underwent S-PTCS at a single Danish tertiary referral centre between 2016 and 2021 were retrospectively analyzed. The visual, technical, and overall success rates of S-PTCS were analyzed, as well as the complication rate. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of S-PTCS were calculated. Twenty-two patients were included in the study. Visual, technical, and overall success of S-PTCS was achieved in 17/22, 22/22, and 21/22 patients, respectively. S-PTCS yielded a sensitivity of 83.3%, a specificity of 100%, a PPV of 100%, a NPV of 94.1%, and an accuracy of 95.4%. Complications occurred in 1/22 patients. S-PTCS is a safe modality, with high success rates, high predictive values, and a low rate of complications. This study suggests that S-PTCS is an alternative to conventional methods in patients with indeterminate biliary strictures where conventional methods were unfeasible.

Outcomes after fertility-sparing surgery of early-stage ovarian cancer: A nationwide population-based study.

Fertility-sparing surgery (FSS) is an alternative choice of young patients who have not completed their family planning and still have fertility needs. The aims of this study were to compare the outcomes of early-stage epithelial ovarian cancer (EOC) patients undergoing FSS and radical comprehensive staging surgery (RCS), and the suitability of FSS. A total of 1297 patients aged between 20 and 44 years with newly diagnosed early-stage EOC were recruited from the Taiwan Cancer Registry database between 2009 and 2017. Site-specific surgery codes were used to distinguish patients in FSS group or RCS group. Cancer-specific survival (CSS) was evaluated using Kaplan-Meier method with log-rank test and Cox regression model. There were 401 and 896 patients in FSS and RCS group. Patients in FSS group were with younger age and mostly had Stage I disease. In contrast, patients in RCS group were older. There were more Stage II, high-grade (Grade 3) disease, and adjuvant chemotherapy in RCS group. Stage and tumor grade were two independent factors correlating with CSS and the type of surgery showed no effect on CSS (HR: 1.09, 95% CI: 0.66-1.77, p = 0.73) in multivariable analysis. In multivariable analysis, the clear cell carcinoma group who underwent FSS demonstrated better CSS compared to those in the RCS group (HR: 0.28, 95% CI: 0.06-0.82, p = 0.04). A total of 17 women who underwent FSS developed second malignancies of the uterine corpus or contralateral ovary. FSS can be a safe alternative procedure in selected young patients of Stage I EOC who have fertility desire. Endometrial biopsy before or during FSS and regular surveillance to detect recurrence are mandatory for ovarian cancer patients undergoing FSS.

Safety of cricotracheostomy with skin and tracheal membrane flaps for severe COVID-19 patients

ObjectiveAirway surgery is performed for COVID-19 patients who require long-term tracheal intubation and mechanical ventilation. Tracheostomy sometimes causes postoperative complications represented by bleeding at a relatively high rate in COVID-19 patients. As an alternative surgical procedure to tracheostomy, cricotracheostomy may reduce these complications, but few studies have examined its safety. MethodsData were retrospectively collected for sixteen COVID-19 patients (11 underwent tracheostomy, 5 underwent modified cricotracheostomy). In addition to patients’ backgrounds and blood test data, the frequency of complications and additional care required for postoperative complications were collected. Statistical analysis was conducted by the univariate analysis of Fischer analysis and Mann–Whitney U test. ResultsFive cases experienced postoperative bleeding, four cases experienced peristomal infection, and one case experienced subcutaneous emphysema in the tracheostomy patients. These complications were not observed in the cricotracheostomy patients. The number of additional cares for postoperative complications was significantly lower in cricotracheostomy than in tracheostomy patients (p < 0.05). ConclusionsModified cricotracheostomy could be a safe procedure in airway surgery for patients with COVID-19 from the point of fewer postoperative complications and additional care. It might be necessary to select the cricotracheostomy depending on patients’ background to reduce postoperative complications.

An Alternative Procedure for a Win-win African-Swiss Cooperation in Gold Production in Africa.

The growth of Africa as a major gold (Au) exporter can not only strengthen economic ties with other parts of the world, but also lead to solutions to global industrial challenges, and the only way to stop gold smuggling out of gold-producing African countries seems to be having multiple refineries in Africa, for which developing gold-producing African countries might need technological assistance provided by a more developed country, especially Switzerland. In this Note, the chemistry of gold mining was discussed, and the idea is conveyed that if aqua regia is used as a main reagent in both gold mining and the electrolytic refinement of gold, then the two systems of gold mining and gold refining can be coupled industrially and geographically, and such a coupling can facilitate the growth of home-grown gold refineries in gold-producing African countries. It is also discussed that with Swiss companies finding it economical to properly use aqua regia in Africa as described, a win-win African-Swiss cooperation will be established that will benefit both the Swiss companies and gold-producing African countries. Further, it is concluded that the addressed cooperation will be accompanied by four of the seventeen goals called 'Sustainable Development Goals' by the United Nations.

Tendon ball arthroplasty and proximal carpal stabilization with tendon graft for advanced Kienbock's disease.

This study reports the surgical technique and outcomes of tendon ball arthroplasty combined with proximal carpal stabilization using the extensor carpi radialis longus tendon for treating advanced Kienbock's disease. The collapsed lunate is excised and a tendon ball inserted as a spacer. A distally based extensor carpi radials longus graft is passed through the scaphoid, tendon ball and triquetrum, reconstructing the proximal carpal row. In total, 16 patients were included and the mean follow-up was 25 months. Pain improved from 5.6 preoperatively to 1.3 postoperatively on a 10-point visual analogue scale. Mean wrist motion improved by 17.8° and grip strength compared with the non-operative side increased by 22.1% on average. Radiographic outcomes demonstrated correction of scaphoid flexion and carpal height ratio. The modified tendon ball arthroplasty may be an alternative wrist salvage procedure for the treatment of advanced Kienbock's disease.Level of evidence: IV.

Carbocationoids, a concept for controlling highly reactive cationic species

Carbocations, which are positively charged highly electrophilic intermediates, are efficacious for the direct alkylation of low-reactive nucleophiles. The utilization of carbocations in SN1 reactions relies on the activation of their precursors in the presence of a nucleophile. However, undesirable interactions between the nucleophile and the leaving group activator limit the scope of acceptable nucleophiles. Here we report a strategy to conduct SN1 reactions involving unstable carbocations in an alternative stepwise procedure, which was demonstrated by the benzylation of various neutral nucleophiles. In the first step, carbocations were accumulated in a nucleophile-free solution in the form of carbocationoids utilizing the coordinative stabilization of triazinediones. Subsequently, the addition of these solutions in the second step enabled room-temperature alkylation without the need for acidic additives. This methodology overcomes the inherent challenges of carbocations in SN1 reactions.

Robotic kidney transplantation.

Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patientswith obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach.

Vulnerability of a developing stock market to openness: One-way return and volatility transmissions

Drawing from two independent literature sources on vulnerability and stock price volatility, we show that the high magnitude and persistence of stock return volatility evident in the Nigerian Exchange Group (NGX) are, at least in part, indications of vulnerability to openness, which paves the way for the transmission of external shocks. Using a uniquely modified set of bivariate asymmetric GARCH models, we investigate one-way return and volatility transmissions from the international Brent oil market, natural gas markets, carbon markets, and naira-dollar exchange market to the NGX. Firstly, we document direct and asymmetric return and volatility transmissions from the Brent oil market to the NGX, denoting the fragile sensitivity of the NGX to international oil price turbulence. Secondly, we find a direct volatility transmission from natural gas markets to the NGX, implying an increasing reliance on natural gas exports by the Nigerian government. Thirdly, we document an inverse volatility transmission from carbon markets to the NGX, indicating Nigeria's negative reaction, as a major oil and gas producer, to increasing global sustainable production activities. Fourthly, the insignificant effect of the naira-dollar official exchange rate on volatility in the NGX demonstrates the spurious impression that Nigeria's exertion of control over the exchange rate is shielding the economy. In sum, our results confirm that the openness of the NGX makes it vulnerable to external shock transmissions from related external markets subsisting outside Nigeria. Our results are robust to an alternative estimation procedure that employs a different measure of price volatility from the three external markets.

Safety and efficacy of pelvic arterial embolization for primary postpartum hemorrhage in hemodynamically stable and hemodynamically unstable patients: Is it “time” for a paradigm change?

BackgroundPelvic artery embolization (PAE) is an effective and safe technique for treating postpartum hemorrhage (PPH) with hemodynamic stability. However, its use in hemodynamically unstable patients remains controversial. PurposeTo determine the safety and efficacy of pelvic arterial embolization (PAE) according to the hemodynamic state of primary postpartum hemorrhage (PPH) patients. MethodsThis cohort study was conducted retrospectively, using data from January 2004 to December 2021, in a resource-rich setting at a tertiary Level 1 trauma academic center. A total of 437 patients were diagnosed with PPH during the study period. Of these 437 patients, 161 with primary PPH who underwent PAE were enrolled in the study. The outcomes assessed included the clinical success rate, mortality, the overall success rate, predictive factors for failed PAE, and time-dependent changes in hemodynamic parameters, such as systolic blood pressure (SBP), heart rate (HR), and shock index (SI). Propensity score (PS) matching analysis was performed to assess the influence of specific variables or conditions on the outcomes. ResultsOf the 161 patients who underwent PAE for primary PPH (mean age, 32.9 ± 4.3 [SD]), 85 were retrospectively categorized as having hemodynamic stability (mean age, 32.6 ± 4.1 [SD]), while 76 were categorized as having hemodynamic instability (mean age, 33.3 ± 4.4 [SD]). This study showed PAE for primary PPH had a success rate of 91.9 %, with no significant difference in mortality rates between the groups. The clinical success rate was 98.8 % for patients with hemodynamic stability and 84.2 % for those with hemodynamic instability (p < .001). The overall success rate was 98.8 % for hemodynamic stability and 89.5 % for hemodynamic instability (p = .014). After propensity score matching, the clinical success rate was higher in hemodynamically stable patients than in unstable ones (100 % vs. 86.3 %, p = .013). However, there was no significant difference in the overall success rate (100 % vs. 90.2 %, p = .056). Among the PS-matched population, predictive factors for the failed PAE in primary PPH were hemodynamic instability (adjusted odds ratio [aOR] 21.22, 95 % CI 1.27-355.76; p = .034) and emergency Cesarean delivery with accompanying hemorrhag (aOR 54.00, 95 % CI 11.93-244.56; p = .008). In three groups within a PS-matched population — hemodynamically stable, unstable with successful outcomes, and unstable with unsuccessful outcomes, a generalized linear mixed model (GLMM) analysis for time-dependent changes in hemodynamic parameters revealed a statistically significant difference in SBP, HR, and SI at various time points. ConclusionPelvic arterial embolization of primary postpartum bleeding in hemodynamic instability has been identified as an alternative, safe, and effective life-saving procedure for multidisciplinary treatment in resource-rich environments even after the baseline characteristics are balanced by the PS matching, suggesting it is a primary care option.

De novo regeneration of dentin pulp complex mediated by Adipose derived stem cells in an immunodeficient albino rat model (Histological, histochemical and scanning electron microscopic Study)

BackgroundDental tissue engineering is an alternative procedure for restoring damaged dental tissues. Adipose-derived stem cells are a new source of cells for regenerative endodontics in combination with scaffold materials. The descriptive data about this regenerative process is still insufficient. ObjectiveTo evaluate the regenerative potential of Adipose-derived stem cells using a self-assembling polypeptide scaffold for the dentin-pulp complex in an emptied root canal space. Material and Methods40 root segments of human single-rooted teeth were transplanted into the albino rats’ dorsal subcutaneous tissue. Root segments were divided into two groups: group I contained only a self-assembling polypeptide scaffold, and group II contained fluorescent-labeled Adipose-derived stem cells embedded in a self-assembling polypeptide scaffold. The newly formed tissues were assessed on the 60th and 90th days post-transplantation using routine histological examination, Masson trichrome staining, and scanning electron microscopy. ResultsGroup I showed granulation tissue without any signs of predentin formation or odontoblast-like cells. Group II revealed the presence of predentin tissue along the dentin margin, with arranged odontoblast-like cells. An organized connective tissue with abundant vasculature and calcific masses was observed in the pulp space. ConclusionAdipose-derived stem cells can be considered as alternative stem cells for regenerating the dentin-pulp complex. Dentin pulp complex regeneration utilizing a self-assembling polypeptide scaffold alone would not yield successful results.