Average Loss Research Articles

Clinical observation of 7 cases of functional pituitary neuroendocrine tumor treated by endoscopic transnasal selective resection of the cavernous sinus medial wall

The clinical data of 7 patients (3 males and 4 females) with functional pituitary neuroendocrine tumor treated by endoscopic transnasal resection of the cavernous sinus medial wall from May to October 2023 in the Department of Neurosurgery of the First Affiliated Hospital of University of Science and Technology of China were retrospectively analyzed. They ranged in age from 29 to 60, with an average age of 45. The clinical diagnosis was acromegaly in 5 cases and Cushing's disease in 2 cases. There were 1 cases of microadenoma and 6 cases of macroadenoma. Knosp grade: Grade 1 adenoma in 3 cases, grade 2 adenoma in 3 cases and grade 3A adenoma in 1 case. Intraoperative resection of cavernous sinus medial wall was performed on the side of tumor. Five cases were determined to be invaded by tumor, and 2 cases were uncertain. No internal carotid artery injury occurred in all patients. The average intraoperative blood loss was 156 ml, and no patient was transfused. Postoperative endocrine remission was found in 6 cases, and tumor cells were found in 6 cases by pathological examination of the medial wall of cavernous sinus. No serious complications occurred in all patients. For Knosp grade 1-3 functional pituitary neuroendocrine tumor surgery, if there is no clear false envelope or normal pituitary between the tumor and the cavernous sinus medial wall during the operation, the cavernous sinus medial wall should be actively removed to improve the postoperative endocrine remission rate.

Household Economic Losses and Community Knowledge Determine Control Strategies: A Case of Cerebral Coenurosis in Small Ruminants in Northern Tanzania

Cerebral coenurosis affects sheep and goats worldwide and has zoonotic implications. Information on the financial burden and understanding of the disease and control practices may inform control strategies. A cross-sectional study was conducted in Babati and Ngorongoro Districts, Tanzania, to determine economic losses, farmers’ knowledge, and attitudes and practices on the control of coenurosis in small ruminants. A structured questionnaire was administered to 558 households for data collection. The total annual loss was TZS 122.8 M (USD 52.9 K) for Babati and TZS 656.5 M (USD 282.9 K) for Ngorongoro District. The average annual household financial loss was TZS 356.8 K (USD 153.83) for Babati and TZS 3.1 M (USD 1.3 K) for Ngorongoro District. Almost 90% of respondents were aware of coenurosis while less than 1% of the respondents had no knowledge of it at all. The average knowledge score was 5.85 out of 16 (36.6%), which implies a low level of knowledge on coenurosis. About 94% of respondents showed a willingness to participate and pay the control costs. Given the economic loss and favorable attitudes toward control participation, delivery of an educational package on epidemiology and control of coenurosis to livestock keepers may trigger collaborative and sustainable intervention.

Periods of weed interference in garlic crop

Garlic cultivation holds significant importance in Brazil. However, research on garlic crops is currently limited and outdated, highlighting the necessity for new studies, particularly focused on enhancing weed management and optimizing the use of agricultural inputs. This study aimed to assess the extent of yield losses attributed to weed interference and the specific periods during which weed interference impacts garlic crop yields in the state of Santa Catarina, Brazil. The experiments were conducted in Curitibanos, Santa Catarina State, Brazil, during 2019 and 2020, using the garlic cultivars Chonan and Ito, respectively. A randomized block experimental design was employed, consisting of 16 treatment groups with four replications. The design incorporated a 2×8 factorial arrangement, involving two weed management strategies (coexistence and control) and eight crop-weed coexistence periods (0, 15, 30, 45, 60, 90, 120, and 130 days after crop emergence – DAE). The study evaluated the weed community and recorded data on the number of bulbs, bulb diameter, as well as total and commercial bulb yields of garlic crops. The results indicated average losses of 24.3% in total bulb yield and 28.9% in commercial bulb yield. Critical periods for effective weed control were identified as 6 to 126 DAE in 2019, 5 to 126 DAE in 2020 for total yield, 3 to 126 DAE in 2019, and 5 to 126 DAE in 2020 for commercial bulb yield. Consequently, it is imperative to maintain garlic crops weed-free throughout most of their growth cycle.

Monolithically integrated mode converter from terahertz substrateless silicon guide to conductive slotline

Although substrateless micro-scale silicon waveguides are a useful and versatile platform for terahertz waves, the fact that modal fields occupy the volume of the core limits the potential to dynamically manipulate guided waves. To address this, we introduce an aperiodic lattice structure to enable the monolithic co-integration of a Vivaldi antenna-like mode converter with a substrateless silicon waveguide. This broadband transition is experimentally confirmed to exhibit ∼2.5 dB average loss for two couplers, from 220 GHz to 330 GHz, and enables a photoexcited variable attenuator as proof-of-concept demonstration. This is an important enabling step to incorporate general-purpose dynamic reconfigurability, sensing, and modulation functionality into terahertz-range silicon-based integrated circuits, which are currently limited to primarily all-passive structures.

Severe Intraocular Inflammation After Intravitreal Injection of Faricimab: A Single-Site Case Series of Six Patients

To describe the patient characteristics and clinical course of severe intraocular inflammation (IOI) following intravitreal injection (IVT) of faricimab. Retrospective case series. Case series at a single French academic center (Dijon University Hospital) where 263 patients were treated with faricimab IVT between January 9, 2024 and May 7, 2024. Over the 4-month period, a total of 1659 eyes (1338 patients) received anti-vascular endothelial growth factor (anti-VEGF) IVTs for a total of 3510 IVTs, of which 343 eyes (263 patients) received faricimab IVTs for a total of 971 IVTs. Overall, 6 pretreated eyes with neovascular age-related macular degeneration that were switched to faricimab developed severe unilateral IOI following faricimab IVT (1/162 injections [0.62%]), including 5 eyes presenting with a severe anterior and intermediate uveitis mimicking infectious endophthalmitis. All eyes were normotensive and presented with mild to moderate pain and predominantly moderate vitritis, associated with granulomatous keratic precipitates in 2 eyes and nonocclusive vasculitis in one eye. The clinical presentation, sterile vitreous sample culture, and rapid improvement with treatment made the diagnosis of infectious endophthalmitis unlikely. Four patients out of 6 did not recover their pre-IOI visual acuity, with an average visual loss of +0.2 logMAR. Two patients had positive antinuclear antibodies, including one with a history of cutaneous lupus. In this case series, we reported 6 cases of severe IOI after intravitreal faricimab over 4 months in a single French center with an estimated incidence rate of 0.6% per injection. Future real-world data will contribute to a better evaluation of the epidemiology of this rare inflammatory adverse event related to intravitreal faricimab.

Spatial analysis and assessment of soil erosion in the southern Western Ghats region in India.

Soil erosion is expected to worsen in the future as a result of climate change, growing population demands, improper land use, and excessive exploitation of natural resources in India. Due to the growing population and changes in land use, it has become increasingly crucial to map and quantitatively assess soil for the purpose of sustainable agricultural usage and planning conservation efforts. The problem of soil erosion is mainly on steeper slopes with intense rainfall in parts of Western Ghats. The 20.17% of geographical area have been converted into wasteland due to soil erosion. The Revised Universal Soil Loss Equation (RUSLE) is a highly prevalent and effective technique utilized for estimating soil loss in order to facilitate the planning of erosion control measures. Despite the fact that RUSLE is accurately estimate sediment yields from gully erosion, it is an effective tool in estimating sheet and rill erosions losses from diverse land uses like agricultural to construction sites. The current study is mainly about combining the RUSLE model with GIS (Geographic Information System) to find out how much soil is being lost, particularly in Noyyal and Sanganur watersheds which is located in Coimbatore district of Tamil Nadu, India. This analysis is based on the soil order, with a significant proportion of alfisols and inceptisols being considered. The obtained outcome is contrasted with the established soil loss tolerance threshold, leading to the identification of the areas with the highest susceptibility to erosion. Within the narrower and more inclined section of the watershed, yearly soil loss scales from 0 to 5455 tonnes/ha/year, with an average annual loss of soil of 2.44 tonnes/ha. The severe soil erosion of 100 to 5455 tonnes/ha/year is found along the steep and greater slope length. The generated soil map was classified into six categories: very slight, slight, moderate, high, severe, and very severe. These classifications, respectively, occupied 6.23%, 14.88%, 10.56%, 15.70%, 7.73%, and 6.63% of the basin area. Based on the results of cross-validation, the estimated result of the present study was found to be very high compared to past studies conducted 0 to 368.12 tonnes/ha/year especially in very severe erosion zones. But very slight to severe erosion zones nearly matched with same level of soil loss. To protect the soil in the study area from erosion, more specific actions should be taken. These include micro-catchment, broad bed furrows, up-and-down farming, soil amendment with coconut coir pith composition, streambank stabilization with vegetation, and micro-water harvesting with abandoned well recharge. These actions should be carried out over time to make sure to work.

Joint Time-Frequency Signal Analysis of Li-Ion Batteries

Measurements acquired from batteries, such as voltage-time and capacity-time signals, offer valuable insights into their cyclability performance. While analyzing these signals in the time domain provides an understanding of global characteristics, scrutinizing local behavior is crucial for detecting issues like battery fading. In this context, we delve into the application of short-time Fourier transform for time-frequency deconstruction of galvanostatic charge/discharge signals, using lithium-sulfur batteries as an illustrative example. Spectrograms resulting from this analysis unveil the evolving frequency content of signals throughout the battery's lifespan, facilitating the identification of critical changes in the response and early detection of issues leading to fading and potential default. Simultaneously, the stability analysis of the dynamic response of red phosphorus and sulfide polyacrylonitrile (RP-SPAN) composite, a promising anode material for lithium batteries, can also be studied using Fourier transform analysis. Our study employs transfer function stability analysis, Kramers-Kronig integral relations, and differential capacity analysis to assess the cell's behavior in both frequency and time domains. Parameters such as stationarity, stability, linearity, dissipation, and degradation are scrutinized over extended charge/discharge cycles. Results reveal a highly nonlinear and time-variant system at low frequencies, aligning with the observed 0.21% average capacity loss per cycle. Our results indicate that short-time Fourier transform could provide insightful information for analyzing battery health.

Design and experimental demonstration of a high-performance all-silicon transverse magnetic polarizer using tilted-elliptical-hole arrays

This study presents the design and experimental demonstration of a high-performance all-silicon transverse magnetic (TM) polarizer. The tilted-elliptical-hole arrays are designed to effectively reflect transverse electric (TE) modes while propagating TM modes with low loss. The device bandwidth (BW) is controlled by changing the tilting angle of the elliptical hole or by combining it with changes in other parameters. The device operates beyond 326 nm (1385–1711 nm) in BW, achieving an average insertion loss (IL) below 1.0 dB and a polarization extinction ratio (PER) over 20 dB. A 20 nm shift in BW can be obtained with a 30° deflection, and an 80 nm shift can be achieved with multiple parameter changes. The experimental results confirm the theoretical analysis. The present device with the advantages of simple structure, flexible design, and broad BW has great potential applications in silicon photonics.

Shallow groundwater table fluctuations weaken nitrogen accumulation in the thin layer vadose zone of cropland around plateau lakes, Southwest China

Excessive accumulation of nitrogen (N) in the soil profile in the intensive agricultural region will seriously threaten groundwater quality and safety. However, the impact of shallow groundwater table (SGWT) fluctuations driven by seasonal variations on the N accumulation characterizations in the soil profiles has not been well quantified, particularly in the regions with thin layer vadose zone. Through in-situ monitoring and simulation experiments, the changes in the SGWT and N accumulation of soil profile in intensive cropland around 7 plateau lakes in Yunnan were studied during the rainy season (RS) and dry season (DS), and the N loss in soil profile of cropland driven by SGWT fluctuations was estimated. The results showed that the SGWT and N accumulation in soil profile of cropland around the plateau lakes had obvious seasonal variation characteristics. The proportion of N storage in different forms in 60–100 cm soil layer in the RS was greater than that in the DS, particularly the proportion of NH4+-N storage was as high as 55 %, while N accumulation in surface soil was obvious in the DS. Compared with the DS, due to the rising SGWT in the RS, the maximum storages of TN and NO3−-N in the 0–100 cm soil layer decreased by17% and 36 %, respectively. The TN loss intensities from the 0–100 cm soil profiles of cropland around Fuxian Lake, Yilong Lake, Qilu Lake, Dianchi Lake, Yangzong Lake, Erhai Lake, and Xingyun Lake were 74, 54, 127, 105, 93, 72 and 207 kg/ha, respectively. Moreover, if the SGWT was <30 cm, the average TN loss intensity and amount could reach 177 kg/ha and 1250 t, respectively. Therefore, the SGWT regulation was one of the key measures to reducing soil N loss from the thin layer vadose zone of cropland around plateau lakes and improving groundwater quality.

Influence of a traditional flea market on property prices in its surroundings – a case study in Porto Alegre, Brazil

Flea markets are important as economic and cultural phenomenon in several cities around the world. There is little attention to their influence on real estate prices. The “Brique da Redenção” occur every weekend since 1978 in Porto Alegre, Brazil. There could be positive effects on surrounding properties. However, the positioning of this flea market implies on reduce the accessibility on weekends to properties placed in the same street and it could reduce property prices. The aim of this paper is to evaluate the influence of this flea market in residential prices. It was developed hedonic models to explore these effects, with a sample of more than 5.3 thousand apartment sales. The analysis shows a satisfactory statistical performance of the hedonic model. The study indicates that Brique’ effect is capitalized in the market prices, with an average loss on value around to 7.8% to properties placed in front to the Brique.

Failure assessment of deteriorated steel light poles

Steel poles are extensively used as street light posts and various other applications within the power distribution network. For partially buried pole, the effect of corrosion below and at the ground level significantly controls the overall load capacity. In this study, number of in-service steel pole specimens extracted from field were assessed for the corrosion damage. The level of corrosion was estimated by remaining wall thickness measured using ultrasonic testing and the surface corrosion was estimated using 3D laser scanning to adopt an appropriate existing model for buried steel structures. A relationship between maximum and average corrosion pit depth and loss of embedment depth was then developed. Finally, the corrosion parameters, combined with uncertainty in loading and soil properties were employed to perform time-dependent reliability assessment for steel light poles which can be used to assist the asset maintenance team in planning the replacement or strengthening works for steel pole.

An eight-year analysis of robotic surgery in morbidly obese women with endometrial cancer in a tertiary center in Singapore

IntroductionSurgical management of endometrial cancer is a total hysterectomy, bilateral salphingo-oophorectomy and pelvic lymph node dissection (THBSO-PLND), which is a challenging surgery in the morbidly obese. Data on morbidly obese women undergoing robotic surgery is limited in Asia. We share our experience in Singapore and aim to demonstrate that robotic surgery is safe and effective in morbidly obese women with endometrial cancer. Materials and MethodsWe performed a retrospective analysis of patients with BMI > 40 kg/m2, who underwent robotic surgery from January 2016 to September 2023 at the Singapore General Hospital. We recruited a total of 33 patients who underwent robotic surgery for endometrial malignancy and analysed surgical outcomes, operative complications, and survival rates. ResultsThe average age of patients was 53 years and mean BMI 45.7. The average operative time was 232 min and average blood loss 184 ml. 3 patients had THBSO while 27 underwent THBSO-PLND. None required conversion to laparotomy. 4 patients required a mini-laparotomy for the retrieval of bulky uterus. 12 required adhesiolysis. 6 patients had additional omentectomy done. The average inpatient stay was 4.8 days. The 1-year mortality rate is 0. However, 1 patient passed away 13 months after surgery due to complications from bowel obstruction and another passed away 39 months later due to disease recurrence. 1 patient readmitted on POD6 due to post-op ileus and another for port-site hematoma. Both were managed conservatively. ConclusionRobotic surgery is a safe and effective alternative surgical tool for women who are morbidly obese with endometrial cancer.

Compressive Failure Characteristics of 3D Four-Directional Braided Composites with Prefabricated Holes.

The low delamination tendency and high damage tolerance of three-dimensional (3D) braided composites highlight their significant potential in handling defects. To enhance the engineering potential of three-dimensional four-directional (3D4d) braided composites and assess the failure mode of hole defects, this study introduces a series of 3D4d braided composites with prefabricated holes, studying their compressive properties and failure mechanisms through experimental and finite element methods. Digital image correlation (DIC) was used to monitor the compressive strain on the surface of materials. Scanning acoustic microscope (SAM) and scanning electron microscopy (SEM) were used to characterize the longitudinal compression failure mode inside the material. A macroscopic model is established, and the porous materials are predicted by using the general braided composite material prediction theory. While reducing the forecast cost, the error is also controlled within 21%. The analysis of failure mechanisms elucidates the damage extension mode, and the porous damage tolerance ability aligns closely with the bearing mode of braided material structure. Different braiding angles will lead to different bearing modes of materials. Under longitudinal compression, the average strength loss of 15° specimens is 38.21%, and that of 30° specimens is 8.1%. The larger the braided angle, the stronger the porous damage tolerance. Different types of prefabricated holes will also affect their mechanical properties and damage tolerance.

Investigation of the Usefulness of Implants With Locking Mechanisms for Diffuse Idiopathic Skeletal Hyperostosis (DISH)-Induced Thoracic and Lumbar Fractures in Patients Operated in the Prone Position.

Background Diffuse idiopathic skeletal hyperostosis (DISH) is a disease that causes bone growth in the spine and musculoskeletal system, and even minor trauma can cause fractures that often require surgery. DISH-induced fractures show a tendency for bone loss when operated in the prone position, which can lead to poor fusion and implant failure; therefore, surgery in the lateral recumbent position is often recommended. However, inserting a pedicle screw (PS) in the lateral recumbent position is technically difficult. This study examined the effectiveness of the repair and fixation of thoracic and lumbar spine fractures using implants with locking mechanisms in the prone position in patients with DISH. Methods We retrospectively analyzed the data from 11 patients (six males and five females; mean age: 87 years) who underwent surgery for thoracic and lumbar fractures caused by DISH between December 2023 and June 2024. Surgery was performed in the prone position using PSs or transdiscal screws (TSDs) for DISH. Ennovate® implants manufactured by B-BRAUN were used. The fixed range was three above-three below for PSs and two above-two below for TSDs. The evaluation parameters were the height/level of injury, operative time, blood loss, local kyphosis angle, anterior wall height ratio, and complications. The local kyphosis angle was measured as the angle between the upper and lower endplates of the fractured vertebrae. The ratio of the anterior wall height was evaluated. Results The average operative time was 87 min (52-172 min), and the average blood loss was 40ml (10-140 ml). The preoperative and postoperative local kyphosis angle was -8.7° and -2.4°, respectively, and the average local kyphosis angle improvement was 6.3° (0.1-14°). The preoperative and postoperative anterior wall height ratio was 132% and 110%, respectively, and the average anterior wall height ratio improvement was 22% (2-82%). No complications, such as screw deviation, implant loosening, loss of correction, or skin problems, were observed. Conclusion This study demonstrated that DISH-induced thoracic and lumbar spine fractures could be repaired and fixed using implants with locking mechanisms in the prone position. The prone position is familiar to spine surgeons and is considered safe. Additionally, screw migration may occur due to decreased bone density in the vertebral bodies with DISH; in such cases, it would be better to fix the screw without forcing it to be repositioned.

Predicting soil erosion risk using the revised universal soil loss equation (RUSLE) model and geo‐spatial methods

AbstractAnthropogenic activities like overgrazing, deforestation and mismanaged land use accelerate soil erosion (SE), causing nutritional and organic matter loss. In this study, we predicted the annual rate of soil loss in the Salt Range, extending south from the Pothohar plateau, Pakistan, using the Revised Universal Soil Loss Equation (RUSLE). The RUSLE model parameters and erosion probability zones were estimated using remote sensing and Geo‐Spatial methods. The annual average soil loss rates were calculated by considering five geo‐environmental factors, that is, slope length and steepness (LS), rainfall erosivity (R), cover management (C), soil erodibility (K), and conservation practice (P) range from 0–559 527, 1404–4431, 0–1, −0.14 to 1.64, and 0.2–122 respectively. This research determined that the yearly average rate of SE in the Salt Range varies from over 50 to above 350 . The distribution of land area across different SE probability zones reveals that a small portion (2.11%) is classified as High, a moderate portion (7.13%) falls under the category of Moderate, while the majority (90.7%) is classified as Low in terms of proneness towards erosion. The land devoid of vegetation and characterized by steep slopes is especially prone to SE. The Salt Range is highly vulnerable to SE risk due to climatic variations and improper land use practices. The result provides a spatial distribution of SE across the salt range, utilized for management planning processes and conservation at the policy level among decision‐makers and land‐use planners.

Pyrolysis kinetics of waste ryegrass under nitrogen and air atmosphere

To investigate the pyrolysis reaction of ryegrass, we conducted a simultaneous thermal analysis using thermogravimetric(TG) analyzers. This involved obtaining data through Thermogravimetry (TG), Derivative Thermogravimetry (DTG), and Differential thermal analysis (DTA) techniques. The experiments were conducted under dynamic nitrogen and air atmospheres at different heating rates. The kinetic parameters of ryegrass pyrolysis were determined using the Kissinger method, the Flynn-Wall-Ozawa (FWO) peak conversion rate approximate equivalence method, the Flynn-Wall-Ozawa (FWO) equal conversion rate method, and the Škvára-Šesták (S–S) method. It provides a theoretical basis for the reuse of ryegrass resources. The findings indicated that the pyrolysis temperature of ryegrass increased with the accelerated rate of temperature increase in both atmospheres. The average weight loss rate of pyrolysis of ryegrass in the air atmosphere (92.27 %) is higher than that compared to that in a nitrogen atmosphere (86.11 %). Additionally, the temperature required for complete decomposition is lower in the former case. The FWO peak conversion rate approximation equivalence approach and the FWO equal conversion rate method do not apply to the solution of the pyrolysis activation energy of ryegrass. The pyrolysis activation energy for the two decomposition stages, as calculated by the Kissinger method, is 165.73 and 185.86 kJ/mol−1 in the air atmosphere, and 219.99 and 277.02 kJ/mol−1 in a nitrogen atmosphere, respectively. The activation energy and mechanism function of ryegrass pyrolysis calculated by using the S–S method are as follows: [−ln(1−α)]2, 119.79, 104.31, 95.75, and 91.93 kJ/mol−1 in air atmosphere, (1−α)−1, 176.64, 67.89, 61.15, and 54.25 kJ/mol−1 in nitrogen atmosphere, respectively. The activation energy of ryegrass pyrolysis, as determined by both the Kissinger method and S–S method, was found to be higher under an air atmosphere compared to a nitrogen atmosphere.

Advancing the understanding of earthquake risk in Portugal

The assessment of earthquake risk at the national scale is crucial for the design and implementation of risk reduction measures. Due to its location in the southwest of the Eurasian plate, Portugal is exposed to moderate to strong seismic events, such as the well-known 1755 Lisbon earthquake. We reviewed existing studies covering exposure, seismic hazard, vulnerability, and risk assessment for Portugal, and performed probabilistic seismic hazard and risk analyses for the country using new model components. These include a new exposure model developed for the residential building stock using the 2021 national Building Census Survey, a recent exposure model for commercial and industrial buildings, updated vulnerability functions for 116 building classes, and the recently released European Probabilistic Seismic Hazard model. The seismic risk results include average annual economic losses, fatalities, buildings with complete damage, and population left homeless. These results allowed the identification of the regions in Portugal with the highest earthquake risk, as well as which building classes contribute the most to the overall impact.

Outcome of bariatric surgery in patients with unexpected liver cirrhosis: A multicenter study from China

Background and aimsLiver cirrhosis is a complex disease that may result in increased morbidity and mortality following bariatric surgery (BS). This study aimed to explore the outcome of BS in patients with unexpected cirrhosis, focusing on postoperative complications and the progression of liver disease. MethodsA retrospective study of bariatric patients with cirrhosis from four centers in China between 2016 and 2023 was conducted, with follow-up for one year after BS. The primary outcome was the safety of BS in patients with unexpected cirrhosis, while the secondary outcome was the metabolic efficacy of BS in this group postoperatively. ResultsA total of 47 patients met the study criteria, including 46 cases of Child-Pugh class A cirrhosis and 1 case of Child-Pugh B. Pathological examination confirmed nodular cirrhosis in 21 patients (44.68%), pseudolobule formation in 1 patient (2.13%), lipedema degeneration with inflammatory cell infiltration in 3 patients (6.38%), and chronic hepatitis in 1 patient (2.13%). The average percentage of total weight loss was 29.73 ± 6.53% at one year postoperatively. During the 30-day postoperative period, the complication rate was 6.38%, which included portal vein thrombosis, gastrointestinal bleeding, and intra-abdominal infection. Moreover, no cases of liver decompensation or mortality were reported during the follow-up period. The remission rates of comorbidities among 41 patients one year after surgery were as follows: dyslipidemia 100%, type 2 diabetes 82.61%, hypertension 84.62%, and obstructive sleep apnea syndrome 85.71%. ConclusionsBS can be safely performed in patients with unexpected cirrhosis in the compensated stage of liver disease, with low postoperative morbidity and no mortality observed during one-year follow-up.

‘The treatable triad’ long-term functional results of surgically treated acute isolated terrible triad injuries: an 18-year follow-up

BackgroundSurgical techniques for Terrible Triad injuries developed 20 years ago. Good and excellent short- and medium-term functional results have been reported. No long-term (over 10 years) functional outcomes have previously been reported. This case-series is the longest follow-up of patients treated for acute, isolated terrible triad injuries using a standard treatment protocol. Methods20 Patients with acute, isolated, surgically managed terrible triad injuries were treated between October 2001 and May 2008. 10 of these patients were seen face-to face for a clinical follow-up and if required a radiological assessment. Mayo Elbow Performance Scores (MEPS) and Disability of the Arm, Shoulder and Hand (DASH) scores, requirement for further surgery and elbow instability were recorded. ResultsThe average length of follow-up was 18.8 years. The mean MEPS was 88 and the mean DASH score was 12.3. The average loss of pronation was 8 degrees. The average loss of supination was 13 degrees. The re-operation rate was 40%, only one of these was a functionally limiting operation. A trend towards osteoarthritis was observed but there were no conversions to total elbow replacement. DiscussionThis is the longest-term follow-up study of these injuries and demonstrates the functional performance that the majority of patients achieve. The low follow-up rate can be expected with such a long interval between treatment and assessment. A relatively high re-operation rate is largely made up of minor procedures (removal of metalwork and cubital tunnel release) which did not impact the patients’ functional status. ConclusionThis study adds to the evidence that the terrible triad of the elbow is surgically treatable to allow a high functional standard not only in the short-term but also in the long-term. As such this is a useful adjunct to have both when informing patients of what can be expected in their long-term recovery from this injury.

The Discrepancy Between Visual Acuity Decline and Foveal Involvement in Geographic Atrophy

To investigate the discrepancy between visual acuity (VA) decline and foveal involvement in geographic atrophy (GA) secondary to non-exudative age-related macular degeneration (AMD), and to explore how early retinal changes impact the progression of visual impairment. Retrospective, longitudinal cohort study. This study evaluated 80 eyes from 60 patients (mean age 74.2±10 years) with progressing non-neovascular AMD using blue-light fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT). The study monitored the onset of foveal involvement and analyzed VA changes over an average follow-up of 60±26.4 months, encompassing 785 observations. Mixed-effects models with natural splines assessed the effects of demographic and ocular characteristics on baseline VA and its rate of decline. Survival analyses compared the timing of anatomical changes with the most rapid functional declines, indicated by the highest first derivative of VA trajectories. Discrepancies between visual and anatomical changes were explored using generalized linear mixed-effects models. VA declined consistently by an average of 0.010 LogMAR per month (SE: 0.0003, p<0.001). The onset of foveal involvement significantly exacerbated this decline, adding an average loss of 0.15 LogMAR (SE: 0.02, p<0.001). Stabilization of VA typically occurred around 41 months post-foveal involvement. Significant factors associated with worse baseline VA were older age, female gender, unifocal GA morphology, and drusen-associated forms of GA (p<0.05). The most rapid declines in VA typically occurred about 9 months (IQR 0-27 months) prior to detectable subfoveal changes. The reticular FAF pattern (27/46 [59%] vs. 2/13 [15%], p=0.02) and smaller baseline GA lesions (p=0.01) were associated with faster deterioration preceding visible foveal damage. This study demonstrates that significant VA loss in GA can precede detectable foveal involvement, suggesting a window for early interventions to slow the progression of visual impairment. Identifying specific GA characteristics and FAF patterns as predictors of rapid VA decline supports the need for personalized treatment strategies to optimize outcomes for patients with non-exudative AMD.