Minimal Approach Research Articles

A multicomponent intervention program to Prevent and Reduce AgItation and phySical rEstraint use in the ICU (PRAISE): study protocol for a multicenter, stepped-wedge, cluster randomized controlled trial

BackgroundPhysical restraints remain to be commonly used in agitated intensive care unit (ICU) patients worldwide, despite a lack of evidence on efficacy and safety and reports of detrimental short and long-term consequences, such as prolonged delirium and a longer ICU length of stay. Physical restraint minimization approaches have focused mainly on educational strategies and other non-pharmacological interventions. Combining these interventions with goal-directed light sedation therapy if needed may play an important contributory role in further reducing the use of physical restraints. The aim of the study is to determine the effectiveness of a multicomponent intervention (MCI) program, combining person-centered non-pharmacological interventions with goal-directed light sedation, compared to physical restraints.MethodsA multicenter stepped-wedge cluster randomized controlled trial will be conducted in six Dutch ICUs. A power calculation based total of 480 (expected to become) agitated adult patients will be included in 26 months with a subsequent 2-year follow-up. Patients included in the control period will receive standard care with the current agitation management protocol including physical restraints. Patients included in the intervention period will be treated with the MCI program, consisting of four components, without physical restraints: education of ICU professionals, identification of patients at risk for agitation, formulation of a multidisciplinary person-centered care plan including non-pharmacological and medical interventions, and protocolized goal-directed light sedation using dexmedetomidine. Primary outcome is the number of days alive and outside of the ICU within 28 days after ICU admission. Secondary outcomes include length of hospital stay; 3-, 12-, and 24-month post-ICU quality of life; physical (fatigue, frailty, new physical problems), mental (anxiety, depression, and post-traumatic stress disorder), and cognitive health; and 1-year cost-effectiveness. A process evaluation will be conducted.DiscussionThis will be the first multicenter randomized controlled trial determining the effect of a combination of non-pharmacological interventions and light sedation using dexmedetomidine compared to physical restraints in agitated ICU patients. The results of this study, including long-term patient-centered outcomes, will provide relevant insights to aid ICU professionals in the management of agitated patients.Trial registrationNCT05783505, registration date 23 March 2023.

Improving long-term outcomes with intensive induction chemotherapy for patients with AML.

Intensive chemotherapy in combination with allogeneic hematopoietic cell transplantation and supportive care can induce long-term remissions in around 50% of acute myeloid leukemia patients eligible for intensive treatment. Several treatment optimization trials helped to refine schedule and dosing of the historic "7 + 3" combination. Together with the addition of novel agents, increased efficacy and tolerability led to improved long-term outcomes. Unsatisfactory outcomes in fit elderly patients and unfavorable genetic subgroups have raised the question of whether less-intensive venetoclax-based approaches may be beneficial as an alternative. Although tempting and worth exploring, this issue will remain controversial until the results of randomized comparisons appear. To date, intensive chemotherapy remains the only evident curative treatment option for long-term disease eradication in a fixed treatment time. With the advent of more novel agents and advances in minimal residual disease (MRD) detection and maintenance approaches, the face of intensive treatment could change in many ways. Several are being explored in clinical trials, such as (1) combinations of more than 1 novel agent with the intensive backbone, (2) head-to-head comparisons of novel agents, (3) replacement or dose reduction of cytotoxic components such as anthracyclines, and (4) MRD-guided escalation and de-escalation strategies. The combination of intensive treatment with individualized tailored innovative strategies will most certainly reduce treatment-related toxicities and increase the chances for long-term remission in the future.

ACCURACY OF A ROBOTIC DENTAL IMPLANT NAVIGATION SYSTEM IN DENTAL IMPLANT PRACTICE

Objective: To evaluate the implant positioning accuracy using a robotic implant navigation system in dental implant practice. Methods: The analysis of the treatment of 16 patients using a robotic implant navigation system in stages implant surgery and dental implant prosthetic rehabilitation performed for the period 2022-2023.All patients underwent a complex clinical, laboratory study, computed tomography (CT). A total of 46 implants were installed using the Navident (ClaroNav) navigation system a flapless or minimal flap approach. 25 implants were completely edentulous and 21 implants were installed in a partially edentulous area. To assess the accuracy of dental implant placement using preoperative plan cone beam computed tomography (CBCT),deviations between the planned and installed implant positions were analyzed. The coronal deviation was measured as the distance between the centers of the implant coronal platform. Apical deviation was measured as the distance between the centers of the implant apical. Angular deviation was measured as the angle of the axis of the implant center. Success of implantation and success of prosthetics of implant- supported reconstructions were evaluated. Data were statistically analyzed with. Results: No intra-operative or immediate post-operative complications were noted after procedure. The postoperative of the patients was favorable. For all implants, the mean deviations were: 0.21 mm at the entry point (lateral) and 0.27 mm at the apex. The average angle deviation from the actual and planned implant position was 1.32 degrees. Patients were satisfied with the functional and aesthetic results of implantation. Conclusion: Robotic implant navigation system allows for precise implant placement, the level of experience of the surgeon and the location of the implant do not affect the accuracy of placement and the timing of the procedure.

A Hybrid MIP-CBO Approach for Loss Minimization of the PMSM-fed Electric Vehicle Drive System

This paper presents an efficient operation method suitable for Permanent Magnet Synchronous Motors (PMSMs). The proposed algorithm provides control of copper and iron losses across the range of operations. The machine operating concept was initially reviewed to establish the control method, and a model was created for control purposes. The efficient operation boundary of the machine was then established based on PMSM voltage and current constraints. A rapid search for the optimal operating point was made possible by a hybrid COOT optimization with Mixed Integer Programming. This expands the high-efficiency area of the motor drive in an electric vehicle, leading to longer Km between charges.

P178: Scope of post-diagnostic dementia care by Japanese primary care clinics using team-based care models

Objective:Primary care clinics (PCCs) in Japan have acquired the capacity for screening and diagnosing dementia in its early stage. They face challenges in accommodating the complex care needs of people with early-stage dementia in collaboration with other healthcare providers in the community. The study aims were; 1) to classify team-based care models of PCCs for post-diagnostic care for people with early-stage dementia in Japan’s Community-based Integrative Care System and 2) to compare the scope of care in each model.Methods:We conducted a cross-sectional postal survey to certified Dementia Support Doctors working in PCCs in Tokyo. To classify team-based care models, the questionnaire asked about the members, roles, and collaboration of the community-wide care team for early-stage dementia in which participants’ PCCs were involved. We gathered information on care provision across seven domains that PCCs offered for people with early-stage dementia. Three-step latent class analysis was performed to classify models and analyze differences in the proportions of care provision in each domain. The Tokyo Metropolitan Institute for Geriatrics and Gerontology institutional review board approved the study.Results:From the 188 responses, PCCs’ team practices were categorized into three classes, which we named “co-managed,” carved-out,” and “stand-alone” models. While the first two ran an extended care team through in-person communication across facilities in the community, the last applied a minimal team approach with limited and indirect external interaction. The “co-managed” and “carved-out” models were distinguished by how team members shared decision-making responsibilities for patient care. Maximum likelihood estimation grouped 46.6%, 32.8%, and 20.6% of the PCCs into each model in the above order. The three models significantly differed in the proportions of care provision in five of seven domains. The proportions in each domain were the highest for the “co-managed” model (60.7-100%), followed by the “carved-out” (46.2- 98.2%) and “stand-alone” (25.7-88.6%) models.Conclusion:PCCs in Japan’s Community-based Integrative Care System formed three models of post- diagnostic support for people with early-stage dementia. Considering the application of the team approach and the breadth of care provision, either “co-managed” or “carved-out” models are recommended with available community resources in mind.

A propensity matched comparison of robotic vs. traditional minimal access approach for mitral valve repair with concomitant cryoablation.

Atrial fibrillation (AF) occurs frequently in patients with mitral valve disease. Results of cryoablation concomitant with either minimally invasive video-assisted [minimally invasive mitral valve surgery (MIMVS)] or with robotic-assisted (RMV) mitral valve surgery have previously been separately reported. However, there are up-to-date no studies comparing the two procedures in terms of safety, efficacy, and mid-term follow-up. Between January 2017 and March 2022, 294 patients underwent MIMVS, and 187 patients underwent RMV at our institution. After 1:1 propensity score matching using 22 preoperative variables, the study included 104 patients. Group 1 (MIMVS) included 52 patients operated on between 2017-2022 using a minimally invasive video-assisted right-sided mini-thoracotomy. Group 2 (RMV) included 52 patients operated on between 2019-2021 using a robotic-assisted approach. Early and mid-term outcomes were assessed, including maintenance of sinus rhythm. Follow-up was 100% complete at a median follow-up of 2 years. For the entire propensity matched cohort, the median EuroSCORE II was 3.14 [interquartile range (IQR), 1.93-4.99], the median age was 68 (IQR, 61-74) years, and two thirds of the patients were male. Most (72.1%) underwent mitral valve surgery, and 26.9% had an additional tricuspid procedure. Only four patients underwent mitral valve replacement (3.8%). The majority (87.5%) received a left-sided atrial Maze and 12.5% a bi-atrial Maze. The left atrial appendage was occluded in 72.1% cases. Overall, there were no significant differences between the two propensity matched groups in baseline demographics or intra-operative characteristics. Similarly, there were no significant differences in the post-operative short and mid-term outcomes between the two groups. There were no in-hospital or 30-day deaths. At the mid-term survival was similar between groups, log-rank test P=0.056. Maintenance of sinus rhythm at follow-up was 76%. Mitral or double valve repair with concomitant cryoablation can be safely performed with either a MIMVS or RMV approach. Both methods demonstrated outstanding early and mid-term outcomes.

A minimization principle for incompressible fluid mechanics

Most variational principles in classical mechanics are based on the principle of least action, which is only a stationary principle. In contrast, Gauss' principle of least constraint is a true minimum principle. In this paper, we apply Gauss' principle to the mechanics of incompressible flows, thereby discovering the fundamental quantity that Nature minimizes in most flows encountered in everyday life. We show that the magnitude of the pressure gradient over the domain is minimum at every instant of time. We call it the principle of minimum pressure gradient (PMPG). It turns a fluid mechanics problem into a minimization one. We demonstrate this intriguing property by solving four classical problems in fluid mechanics using the PMPG without resorting to Navier–Stokes' equation. In some cases, the PMPG minimization approach is not any more efficient than solving Navier–Stokes'. However, in other cases, it is more insightful and efficient. In fact, the inviscid version of the PMPG allowed solving the long-standing problem of the aerohydrodynamic lift over smooth cylindrical shapes where Euler's equation fails to provide a unique answer. The PMPG transcends Navier–Stokes' equations in its applicability to non-Newtonian fluids with arbitrary constitutive relations and fluids subject to arbitrary forcing (e.g., electromagnetic).

An automated approach for human-animal conflict minimisation in Assam and protection of wildlife around the Kaziranga National Park using YOLO and SENet Attention Framework

Human-animal conflict in Assam, India's north-eastern state, is rising continuously. Because it occurs year-round, it damages agricultural productivity and kills people and animals, including elephants. When a herd of wild elephants emerges from a deep forest and enters human-inhabited territory around the Kaziranga National Park (KNP) in Assam, an alert must be sounded for the neighbourhood residents and forest workers to prevent conflicts. Another concern is that many wild animals die near the KNP while crossing the national highway NH-37 which traverses the area. During floods, animals flee to the highlands for food and shelter. An automated animal identification and warning system near the KNP may reduce human-animal confrontations. This paper reports the design of a system that attempts to address the above concerns. Artificial Intelligence (AI)-based strategies are utilized to recognize wild animals from live video sequences, provide warnings to avoid encounters, and protect humans and animals. Deep learning models and YoloV5 with the SENet attention layer are used to recognize wild animals in real-time. This model is trained using a public and customized dataset of animal species. Cameras attached to the cloud-based AI system take photographs from several KNP locations to confirm the model. The model's 96% accuracy in animal photographs and videos taken day and night and in feed from contemporaneous location has shown its utility. The model also improves reliability by 1–13% over previous methods.

Comparative Analysis of Discrete Choice Approaches for Modeling Destination Choices of Urban Home-Based Trips to Work

Discrete choice models based on the Random Utility Maximization (RUM) approach are alternatives to traditional aggregated trip distribution models. However, the Random Regret Minimization (RRM) approach has emerged as an alternative to RUM for analyzing behavioral phenomena. This study compares the RUM and RRM approaches to model the destination choice of urban home-based trips to work, with a case study in the city of São Paulo, Brazil. The attributes of distance between traffic analysis zones (TAZs), total number of jobs, and number of jobs per type (industry and services) were considered, and the attributes referring to TAZs in commercial areas were tested in different models. We combined a method to estimate the optimal choice set size and a stratified sampling method to choose alternatives from available choices for a destination-choice problem with many alternatives. The RUM and RRM models produced similar results with respect to the final log-likelihood, [Formula: see text], Akaike information criterion, and Bayesian information criterion for the studied case. However, the RRM models required 52 min to be estimated on average, whereas estimation of the RUM models took only 31 s on average. Models derived from the RUM approach including the total number of jobs and distance produced higher accuracy, requiring less computational time to estimate the parameters.

Computationally efficient approach for risk-informed decision making

Probabilistic risk assessment (PRA) is used as an essential tool for risk-informed decision-making in the nuclear industry. The fault and event trees play a crucial role in PRA to estimate the probability of system failure based on the failure probabilities of components. The fault trees or event trees for an actual power plant unit can be fairly large in size with several different types of logic gates, interconnected events, dependent events, etc. A large fault tree can include hundreds of gates, basic events (BEs), multiple occurring events (MOEs), and dependent events. Complex connectivities can give rise to excessive computational demand and storage requirements for the analysis. Fault and event trees can be solved using the minimal cut-set approaches, or advanced quantification techniques such as Binary decision diagrams or Bayesian networks. However, these techniques can be computationally inefficient for larger fault trees and can run out of memory/storage space. This study focuses on developing and proposing a new approach for accurate estimation of the system-level risk while improving the computational efficiency significantly. More specifically, an attempt is made to reduce the complexity of the analysis of MOEs and dependent events in fault trees. The proposed algorithms in this study present a significant improvement over traditional approaches which makes it highly promising for additional development. The computational efficiency of the proposed approach over the traditional approach is illustrated for fault trees with a varying number of events and different types of logic gate connections.

Phase field-based cohesive zone approach to model delamination in fiber-reinforced polymer composites

In the present work, a unified phase field-based cohesive zone model (PF-CZM) has been utilized to predict bulk fracture and most importantly interfacial delamination in carbon fiber-reinforced polymer composites (CFRP). The formulation is based on the classical phase-field approach of energy minimization, with a rational degradation function and a polynomial-type crack geometric function. Incorporation of those provides the PF theory to integrate various traction–separation behaviors by choosing optimal constitutive functions and makes the theory capable of predicting the quasi-brittle type of fracture. Since the interfacial delamination in composites occurs either due to adhesive failure or decohesion between stacked lamina, the PF-CZM model is used to predict such failure by exploiting the cohesive zone flavor of the model. Further, the model inherently incorporates the strength of the material without any additional calibration. Various standard simulations are performed considering CFRP geometry where delaminations due to adhesive failure or interface decohesion occur in a mode-I and mode-II fashion. The model is observed to predict mode-I and mode-II separation accurately. To test the accuracy of the model an experimental validation is also performed. In addition to the delamination, open hole tension (OHT) simulations of CFRP lamina for different fiber orientations are considered to validate the anisotropic crack growth predictions, and the results are compared with experiments.

Simultaneous Detection of CO and NO2 Gases using Interaction Analysis of SnS2 Sensor Array Response

Developing a multi-analyte gas sensing system that simultaneously detects trace levels of CO and NO2 at low temperatures is necessary for the Internet of Things (IoT) based air quality monitoring applications. Nevertheless, gas sensors operating at low temperatures are nonspecific and rarely detect target gases at lower ppb levels in the air. Herein, an array of two SnS2 sensors with different bias voltages has been developed and characterized upon exposure to individual and binary mixtures of CO and NO2 gases at different concentrations. The developed gas sensors array achieved the lower detection limit of 45 ppb for NO2 and 150 ppb for CO. Further, co-adsorption-induced interaction analysis was carried out to predict the target gas concentration in the binary mixture using the mixed gas response. The mean absolute percentage error of 7.86% is observed in predicting the target gas concentrations in the binary mixture, which indicates the high prediction accuracy of proposed method. As a minimal resource intensive approach, the proposed method can be used in air quality monitoring applications that require low-power and low-cost sensors.

Minimization of eddy power loss in the cryostat for a z-gradient array coil driven by an arbitrary pulse sequence: An electromagnetic approach.

This paper presents a novel computational approach to optimize gradient array performance for a given pulse sequence. Specifically, we propose an electromagnetic (EM) approach that minimizes eddy losses within the cryostat while maintaining key performance parameters such as field linearity, gradient strength, and imaging region's dimension and position. High-resolution EM simulations on the cryostat's surface are deployed to compute the net EM fields generated by each element of a gradient array coil at different frequencies. The computed fields are stored and combined for each frequency to form a quadratic vector-matrix-vector computation. The overall time-average eddy power loss within the cryostat assembly for arbitrary pulse sequences is computed using frequency domain superposition. The proposed approach estimates and regulates eddy power losses within the cryostat assembly. When compared to the stray field minimization approach, it can achieve over twice the reduction in eddy power loss. The proposed approach eliminates the need to sample the stray fields on the cryostat surface, which the number and position of the samples would be challenging when designing tunable array coils with capabilities that disrupt field symmetries. Additionally, the loss calculation considers the entire cryostat assembly rather than just the inner cylindrical surface of the warm shield. Our findings highlight the efficacy of an on-the-fly tuning method for the development of high-performance whole-body gradient array coils, effectively mitigating eddy losses within the cryostat and minimizing stray fields outside the coil assembly. This approach proves particularly advantageous for array coils with variable feeding currents.

Heat release rate prediction for high-altitude gasoline pool fires based on field tests of combustion characteristics

The heat release rate is of great significance for fire protection design, whether in highway tunnel, building, oil depot and aircraft. Simply, the heat release rate can be estimated by multiplying the mass loss rate by the effective heat of combustion, which can be investigated via pool fire test, because of its wide applicability in various fire scenarios. In fact, both mass loss rate and effective heat of combustion are affected by the high-altitude environment, including the low atmospheric pressure and low ambient temperature. Thus, to obtain the mass loss rate and effective heat of combustion, field tests of gasoline pool fire were conducted at 4 altitudes. The test environments of 4 altitudes were consistent with that of real fires at high altitudes, especially the atmospheric pressure and ambient temperature, to ensure that the measuring data were correct. The heat release rate at high altitudes were calculated by using the fitting formulas of mass loss rate and effective heat of combustion, which were presented in this paper. The results revealed the following: (1) Both the atmospheric pressure and ambient temperature were important factors for the mass loss rate and effective heat of combustion. (2) Based on a global model and flame temperature correlation, a mass loss rate estimation method was established. After analysis, a linear relationship between lnm˙ and lnP∞ was identified for temperature greater than 0 °C, otherwise, there was a logarithmic relationship between lnm˙ and lnP∞. In addition, the fitting formula of mass loss rate was obtained. (3) A theoretical method of effective heat of combustion based on the Gibbs energy minimization approach was established. For simplification, the effects of atmospheric pressure and ambient temperature were approximately independent. The effective heat of combustion increased linearly with both atmospheric pressure and ambient temperature, and the fitting formula was gained by considering above two factors. (4) The heat release rates of gasoline pool fire at high altitudes were calculated, which varied with ambient temperature as the Gaussian function. And the relationship between heat release rate and atmospheric pressure was power function. The atmospheric pressure effect on heat release rate was more significant at temperatures lower than 10 °C. The results in this work could provide a basis for heat release rate prediction studies and subsequent research on smoke diffusion, whether in aircraft, highway tunnel, building and oil depot at high altitudes.

Prospective evaluation of clinical and radiographic 10-year results of Fitmore short-stem total hip arthroplasty

BackgroundShort stems were introduced into total hip arthroplasty (THA) to preserve bone stock, to transmit more load to the proximal femur, and to enable minimal invasive approaches. This study is the first long-term study (with a follow-up of 10 years) of the survival as well as the clinical and radiographic outcomes of the Fitmore hip stem, a short curved uncemented stem.MethodsIn total, 123 Fitmore hip stems were prospectively evaluated. At the final 10-year follow-up, 80 Fitmore stems (78 patients: 30 female, 48 male) were eligible for evaluation. Clinical parameters were thigh pain, EQ-5D, Harris Hip Score (HHS) and Oxford Hip Score. Radiographic parameters were cortical hypertrophy (CH), bone condensation, cortical thinning, radiolucency, reactive lines, calcar rounding, calcar resorption, subsidence and varus/valgus position.ResultsAfter 10 years, there was a survival rate of 99% (1 revision because of aseptic stem loosening). HHS had improved from 59 to 94 and Oxford Hip Score from 22 to 43. CH rate after 1 year was 69% and after 10 years 74%. In the first year, radiolucency was found in 58% and in 17.5% after 10 years. Subsidence after 1 year was 1.6 ± 1.6 mm and 5.0 ± 3.1 mm after 10 years.ConclusionsThe Fitmore hip stem showed a survival rate of 99% as well as good clinical and radiographic outcomes in the long-term follow-up of 10 years.

OGBN O09V Multi-modal Approach with Fluorescence Imaging, Intraoperative Ultrasound and Laser Lithotripsy in the Laparoscopic Management of Complex Large Bile Duct Stones

Abstract Background Choledocholithiasis is a common condition with various presentations. There are several approaches through which this can be managed. This presentation aims to explain novel techniques and various modalities in managing complex bile duct stones successfully with minimal invasive approach. Methods This video presentation depicts the procedure performed for large CBD stones with the use of indocyanine green (ICG) and intraoperative ultrasound (IOUS). The patient is a 61 year old gentleman presented with abdominal discomfort and deranged liver functions. Cross sectional imaging showed 2 large CBD calculi and attempt at endoscopic retrograde cholangio-pancreatigoraphy (ERCP) failed due to large impacted stones. Decision was made to proceed to single stage laparoscopic cholecystectomy and common bile duct exploration with use of ICG, IOUS and laser lithotripsy to achieve successful clearance of CBD. Results At laparoscopy, the CBD and common hepatic artery were identified with ICG and IOUS. A vertical choledochotomy was performed and choledochoscopy undertaken. Attempts to retrieve the stone with extraction basket were not successful. Laser lithotripsy was used to break the stones into smaller fragments which were subsequently retrieved using atraumatic graspers and extraction wire. Post operative period was uneventful and the patient was discharged home on day 2. Face to face follow-up at 6 weeks confirmed good recovery. Conclusions Laparoscopic management of complex CBD stones is challenging. Despite advances in endoscopy intervention, the role of surgery is irrefutable. Advanced laparoscopic skills and experience in bile duct exploration with advanced minimally invasive instruments and equipment are critical to achieve optimal patient outcomes, and mitigated the chances of conversion to open surgery which its associated morbidity. This presentation demonstrates a safe technique while working in the hostile area of the inflamed hepatocystic triangle and an alternative method in the retrieval of large common bile duct stones following failed ERCP.

A novel subject-wise dictionary learning approach using multi-subject fMRI spatial and temporal components

The conventional dictionary learning (DL) algorithms aim to adapt the dictionary/sparse code to individual functional magnetic resonance imaging (fMRI) data. Thus, lacking the capability to consolidate the spatiotemporal diversities offered by other subjects. Considering that subject-wise (sw) data matrix can be decomposed into the sparse linear combination of multi-subject (MS) time courses and MS spatial maps, two new algorithms, sw sequential DL (swsDL) and sw block DL (swbDL), have been proposed. They are based on the novel framework, defined by the mixing model, where base matrices prepared by operating a computationally fast sparse spatiotemporal blind source separation method over multiple subjects are employed to adapt the mixing matrices to sw training data. They solve the optimization models formulated using l_0/l_1-norm penalization/constraints through dictionary/sparse code pair update and alternating minimization approach. They are unique because no existing sparse DL method can incorporate MS spatiotemporal components while updating sw atoms/sparse codes, which can eventually be assembled using neuroscience knowledge to extract group-level dynamics. Various fMRI datasets are used to evaluate and compare the performance of the proposed algorithms with existing state-of-the-art algorithms. Specifically, overall, a 14% increase in the mean correlation value and 39% reduction in the mean computation time exhibited by swsDL and swbDL, respectively, over the adaptive consistent sequential dictionary algorithm.

An iteratively doubling binary search for the two-dimensional irregular multiple-size bin packing problem raised in the steel industry

This paper examines the two-dimensional irregular multiple-size bin packing problem, where the goal is to pack all the given irregular pieces into bins of various sizes such that the total area of the used bins is minimized. Meanwhile, the irregular pieces include holes, and the bins can be irregular, also. This problem is raised in the steel industry considering the reuse of leftover material. An iteratively doubling binary search is proposed to solve this problem. Moreover, a binary search strategy is introduced to search the bin combination with minimum area, and an iteratively doubling strategy is utilized to control the search effort on each bin combination. Once the bins are identified, a first-fit bottom-left method is utilized to generate the initial position for each piece. An overlap minimization approach, which includes a local search by exchanging the positions of two pieces, is adapted to minimize the overlap in the initial solution. Experiment results on existing instances show that our approach could find a better solution than existing methods. Several instances representing different application scenarios are generated, and the results show our approach’s effectiveness and generality.

Crown Fragment Reattachment by the Minimal Intervention Approach for Coronal Tooth Fractures: A Case Series

Crown Fragment Reattachment by the Minimal Intervention Approach for Coronal Tooth Fractures: A Case Series

Minimally Invasive Approach to Access Vessels for Microvascular Anastomosis in Head and Neck Reconstruction.

To describe our technique, review indications, and evaluate the outcomes of the minimal access approach for recipient vessel identification in microvascular tissue transfer. Retrospective chart review of all patients who underwent microvascular reconstruction using the minimal access technique between 2015 and 2021. We report 236 cases, comprising 214 patients with a mean age of 60.2 years (3-88). The most common primary defect sites were the mandible (22.6%), cranium (14%), maxilla (13.2%), skull base (12.8%), and nose/nasal cavity (10.6%). Indications for free flap reconstruction included head and neck cancer extirpation (32.2%), osteoradionecrosis (29.7%), acquired deformity (14.0%), chronic wound (11.9%) and oral motor dysfunction (7.2%). Free flap donor sites used were the anterolateral thigh (84.3%), fibula (7.2%), and radial forearm (6.4%). Vessels utilized include superficial temporal (49.8%), facial (38.3%), angular (11.1%), and transverse cervical (0.4%). The overall complication rate was 14% (n = 33), with surgical complications at the recipient site accounting for 67.6% (n = 25). Flap failure occurred in 3.4% of procedures. Prior head and neck surgery and free flaps were associated with an increased risk of major recipient site complications (n = 20, p = 0.0257 and n = 14, p = 0.0117, respectively). Minimal access techniques allow consistent recipient vessel identification for microvascular-free tissue transfer. These approaches may be utilized in reconstructing a broad range of head and neck defects, are low morbidity, and contribute to an overall shorter length of stay. 2 Laryngoscope, 134:2177-2181, 2024.