Five-year Experience Research Articles

Experience Teaching Mathematics at the University of Defence in the Study Field of Cybersecurity

The teaching of mathematics at the Faculty of Military Technology of the University of Defence in the first two years of the five-year Military master’s degree is divided into the teaching of students in four specializations: Military Technologies – Mechanical, Military Technologies – Electrical, Military Geography and Cartography, and Cybersecurity. The article discusses the previous five-year experience in teaching the subjects Mathematics I, Mathematics II, Mathematics III, and Graph theory for the specialization in Cybersecurity, that the author of the paper gained while teaching, as a guarantor of these four subjects. The article provides an overview of the topics that are covered, typical exam assignments, and an evaluation of the results of the semester exams in the five years since the accreditation of the Cybersecurity specialization was granted.

Predicting and managing intra-abdominal collections by image guided percutaneous drainage after cytoreductive surgery and hyperthermic intra peritoneal chemotherapy: A five-year experience with 1313 patients

IntroductionIntraabdominal collections (IACs) are common following cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). Inflammatory biomarkers and nutritional index (NI) may predict IACs. Management of IACs with image guided percutaneous drainage (IGPD) is an alternative to laparotomy. AimTo identify factors that predict IACs following CRS and HIPEC and to review outcomes following IGPD. MethodA retrospective review of prospectively collected data from a national referral centre including patients undergoing CRS and HIPEC who developed IACs treated with IGPD, between January 2018 and March 2022. Propensity score matched cases were compared to evaluate the prediction of IACs. The outcomes of IGPD were reviewed. ResultsIntraabdominal collections developed in 106 (8.0 %) of 1313 patients and 101/106 underwent IGPD, under Ultrasound or CT guidance. Laparotomy was required in 5/106.In those undergoing IGPD, pre- and postoperative CRP and neutrophils were significantly elevated while pre- and postoperative albumin and NI were significantly lower than propensity score matched controls. The postoperative CRP and neutrophil count, and pre and postoperative albumin and mGPS were identified as independent predictors in multivariable analysis.IGPD improved clinical condition in 94 %. In 15/106(14.8 %) the aetiology of the IAC was anastomotic leak with left subphrenic collections the most common (24/101, 24 %). There were 4 major complications, 2 perforations of bladder during IGPD insertion and 2 post drain removal bleeds. ConclusionIntraabdominal collections following CRS and HIPEC can be predicted by inflammatory markers and nutritional index. Prompt use of IGPD results in good outcomes avoiding the need for laparotomy.

Efficacy and Safety of Sacral Neuromodulation in Patients with Lower Urinary Tract Dysfunction: A Five-Year Experience in North Cyprus

Efficacy and Safety of Sacral Neuromodulation in Patients with Lower Urinary Tract Dysfunction: A Five-Year Experience in North Cyprus

254 Emergency Department-Based Medication for Opioid Use Disorder: A Five-Year Experience

254 Emergency Department-Based Medication for Opioid Use Disorder: A Five-Year Experience

A five-year, multi-institutional mentorship program in radiation oncology: the Society for Women in Radiation Oncology experience: Short running title: SWRO Mentorship Program

BackgroundMentorship in the field of radiation oncology (RO) promotes career development and satisfaction. Many individuals, however, do not have access to mentorship or are unsatisfied with their mentorship experience, potentially due to insufficient gender-concordant mentorship opportunities. To address this, the Society for Women in Radiation Oncology (SWRO) created the SWRO Mentorship Program for women, gender minorities, and those with intersecting marginalized identities at all stages of training for physicians and medical physicists. We present the five-year experience of the largest multi-institutional mentorship program, to our knowledge, in RO. MethodsPublicly available information and the SWRO mentorship sign-up form were used. Descriptive statistics and binomial tests compared to reference points were conducted. ResultsBetween January 2018 and June 2023, 296 individuals from 19 countries participated in the mentorship program, generating 225 mentee-mentor pairs. The majority were female (89.2%), based in the United States (US; 84.8%), and on the physician-track (96.6%). The remainder of the analysis focused on US-based, physician-track participants (n = 244), the majority of whom were female (96.7%) and trainees (58.2%). Among those who have completed RO residency, most accepted a first job in academia (82.1%) and remained in academia at the time of the analysis (76.3%). A significantly higher proportion of SWRO mentorship participants compared to the reference point took a first job in academia (82.1% vs 58.3%; p<0.0001). The most common disease sites of focus for the physician-track trainees who finished residency are breast (50.4%), central nervous system (32.7%), and gynecologic malignancies (30.1%), with 54% listing more than one. The most common expressed goals of mentorship are research (35.8%), leadership (24.5%), and building connections within a specific geography or institution (19.2%). ConclusionsThe SWRO experience demonstrates the feasibility of a large-scale, multi-institutional mentorship program in RO.

Modified stapled hemorrhoidopexy for lower postoperative stenosis: A five-year experience.

Stapled hemorrhoidopexy (SH) is currently a widely accepted method for treating the prolapse of internal hemorrhoids. Postoperative anal stenosis is a critical complication of SH. A remedy for this involves the removal of the circumferential staples of the anastomosis, followed by the creation of a hand-sewn anastomosis. Numerous studies have reported modified SH procedures to improve outcomes. We hypothesized that our modified SH technique may help reduce complications of anal stenosis after SH. To compare outcomes of staple removal at the 3- and 9-o'clock positions during modified SH in patients with mixed hemorrhoids. This was a single-center, retrospective, observational study. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015, and January 1, 2020, were included. The operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. Patients with grade III or IV hemorrhoids who underwent standard or modified SH at our colorectal center between January 1, 2015 and January 1, 2020, were included. Operation time, blood loss, length of hospital stay, and incidence of minor or major complications were recorded. We investigated 187 patients (mean age, 50.9 years) who had undergone our modified SH and 313 patients (mean age, 53.0 years) who had undergone standard SH. In the modified SH group, 54% of patients had previously undergone surgical intervention for hemorrhoids, compared with the 40.3% of patients in the standard SH group. The modified SH group included five (2.7%) patients with anal stenosis, while 21 (6.7%) patients in the standard SH group had complications of anal stenosis. There was a significant relationship between the rate of postoperative anal stenosis and the modified SH: 0.251 (0.085-0.741) and 0.211 (0.069-0.641) in multiple regression analysis. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH. The modified SH technique is a safe surgical method for advanced grade hemorrhoids and might result in a lower rate of postoperative anal stenosis than standard SH.

Five-year experience with titanium mesh for rigid chest wall reconstruction

ObjectiveTo characterize the performance of titanium mesh (TM) (off-label) for rigid chest wall reconstruction at a single institution over a 5-year period. MethodsBetween January 1, 2019, and May 15, 2023, 22 patients (median age, 61 years) underwent chest wall resection with TM reconstruction at Cleveland Clinic. Indications for resection included sarcoma (n = 15), breast cancer (n = 2), lung cancer (n = 2), chondroblastoma (n = 1), and benign neoplasm (n = 2). Patients were followed every 6 months with computed tomography scans for cancer recurrence. Continuous variables are summarized as median (interquartile range [IQR]); categorical variables, as frequency and percentage. Time to mesh fracture was assessed nonparametrically using Kaplan-Meier analysis. ResultsAmong the 22 patients over 21,870 patient-days of TM implantation, 21 (95%) had an R0 resection. The mean area of mesh coverage was 108 cm2 (IQR, 97-180 cm2). No patient experienced respiratory complications or mesh failure postoperatively. Of the 3 reoperations (13.6%), 2 were for delayed regional infection (at 7 and 12 months postoperatively), necessitating localized mesh removal, and the third was for local cancer recurrence. Fifteen implants developed visible fractures on imaging at a median time of 9 months after implantation. There were no adverse sequelae, including migration/erosion or clinical decline in respiratory function. ConclusionsChest wall resections, particularly those for sarcomas, require large margins for optimal oncologic outcomes. Rigid reconstruction of large defects is desirable, yet options are limited. TM reconstruction provides a promising alternative because of its biocompatibility, rigidity, robust incorporation into surrounding structures, and resistance to infection.

Commentator Discussion: Five-year experience with titanium mesh for rigid chest wall reconstruction

Commentator Discussion: Five-year experience with titanium mesh for rigid chest wall reconstruction

Esophagectomy due to esophagus cancer. Five-year experience at the Hospital Nacional de Itauguá. 2015-2020 period

Objetivo: Reportar la experiencia con las esofagectomías en pacientes con cáncer de esófago, en el Servicio de Cirugía General del Hospital Nacional de Itauguá, periodo 2015-2020. Metodología: Estudio descriptivo, retrospectivo, transversal, donde se revisaron los expedientes clínicos de pacientes con diagnóstico de neoplasia en el esófago sometidos a esofagectomía en el Hospital Nacional de Itauguá, período 2015-2020. Resultados: El estudio incluyó 18 expedientes clínicos. El 78% fueron del sexo masculino, la edad media fue de 62,6 años. El IMC promedio fue de 19. La frecuencia de los síntomas fueron la disfagia en un 86%, pérdida de peso en un 83% y epigastralgia en un 28%. El carcinoma escamoso predominó en un 67% sobre el adenocarcinoma. La ubicación de los tumores se distribuyó con más frecuencia en tercio medio. El 78% de los pacientes fueron sometidos a una esofagectomía total transhiatal por técnica de Orringer y el restante por vía transtorácica por técnica de Mc Keown. Las complicaciones de la anastomosis esofagogástrica correspondieron al 34% y las respiratorias a un 28%. La tasa de mortalidad perioperatoria fue de 17%. Conclusión: La esofagectomía sigue siendo el único tratamiento curativo para el cáncer de esófago a pesar de su alta tasa de morbimortalidad. Es importante el diagnóstico precoz para poder ofrecer un tratamiento curativo. Es infortunado que los pacientes estudiados no tuvieran un seguimiento, de manera que resulta imposible la evaluación objetiva de los resultados a mediano y largo plazo.

Use of crystallized phenol in pilonidal sinus, in the pediatric age group, 5-year single surgeon experience

Abstract Objective: The Pilonidal Sinus (PS) is a pathology of the gluteal cleft that occurs with acute or chronic infection. This study aimed to report the evaluation of five-year experience with 50 patients’ data outcomes of crystallized phenol in pilonidal sinus treatment (CP) pediatric age group. Methods: This retrospective study included 50 patients who underwent CP between 2017 and 2023 years. Patient demographics, operative data, follow-up findings, complications, and recurrence data were also evaluated. Results: Fifty patients (female:31, male:19), mean of age 15,4 years. Hirsutism was diagnosed in 10 female patients (20%). Sixteen (32 %) patients had a family history of PS. Five patients had a smoking habit history (%10). The form of anesthesia was local anesthesia in eight patients (16%), sedation and local anesthesia in 27 patients (54%), and spinal anesthesia in 15 patients (30%). The average duration of the procedure was 13,8 min (10–22 minutes). The mean postoperative leakage time were 6,6 days. Complications were observed in five patients. (10%). Recurrence was observed in three patients (6%). The overall cure rate is 94%. Conclusion: The CP procedure should be used as the first choice, especially in adolescents, compared to the primary method in PS, such as total sinus excision, due to its minimally invasive, painless, low risk of recurrence, and very short postoperative recovery time.

Five-Year Experience in Performing MRIs on Paediatric Patients with CIEDs (Cardiac Implantable Electronic Devices)

Five-Year Experience in Performing MRIs on Paediatric Patients with CIEDs (Cardiac Implantable Electronic Devices)

Analysis of Various Laparoscopic Pediatric Urology Surgeries: Five-Year Experience of a Single Institution.

Background In this study, we aim to report our single-center experience with laparoscopic pediatric urological surgeries. We aim to determine the feasibility of various urological and urogenital laparoscopic procedures and the tricks that increase surgical success. Methodology Data from 98 patients who underwent laparoscopic urological and/or urogenital procedures for diagnostic and therapeutic purposes in our clinic between June 2018 and February 2023 were retrospectively analyzed. All surgeries were performed by the same surgical team. Laparoscopic procedures included orchidopexy, gonadectomy, vaginoplasty, hysterectomy, pyeloplasty, nephrectomy/partial nephrectomy, ureteroneocystostomy, bladder diverticulum excision, renal cyst excision, proximal ureter stone removal, oophorectomy, ovarian detorsion, oophoropexy, and lymph node excision for diagnostic purposes. The surgical planning of the patients was based on the decisions of the pediatric nephrology, pediatric endocrinology, and pediatric oncology departments and the multidisciplinary council. Demographic characteristics of the patients, surgical indications, and intraoperative data, as well as postoperative pathological diagnoses and complications, were recorded. All patients underwent a transperitoneal approach. The duration of the operation was obtained from anesthesia records and defined as the time from the beginning of the surgical incision to the closure of the skin incision. Results Of the patients, 54 were males and 44 were females. The median age was 7.8 years. No complications other than grade 1 according to the Clavien-Dindo classification were observed in our patients. As different types of surgeries were analyzed, the mean operative duration was estimated. Conclusions The laparoscopic method should be performed by surgeons experienced in advanced surgeries in pediatric urology. It is critical to consider the difference in the size of pediatric patients in preparation for laparoscopic surgery to minimize technical and ergonomic problems. We believe that each surgery has its specific tricks and that these should be a part of laparoscopy training. Moreover, developing and sharing this information would be very useful for pediatric urologists.

A Diagnostic Stewardship Intervention to Improve Utilization of 1,3 β-D-Glucan Testing at a Single Academic Center: Five-Year Experience.

(1,3)- β-D-glucan (BDG) testing is one of the noninvasive tests to aid diagnosis of invasive fungal infections (IFIs). The study results have been heterogenous, and diagnostic performance varies depending on the risks for IFI. Thus, it is important to select appropriate patients for BDG testing to prevent false-positive results. An algorithmic diagnostic stewardship intervention was instituted at a single academic medical center to improve BDG test utilization. The BDG test order in the electronic health record was replaced with the BDG test request order, which required approval to process the actual test order. The approval criteria were (1) immunocompromised or intensive care unit patient and (2) on empiric antifungal therapy, or inability to undergo invasive diagnostic procedures. A retrospective observational study was conducted to evaluate the efficacy of the intervention by comparing the number of BDG tests performed between 1 year pre- and post-intervention. Safety was assessed by chart review of the patients for whom BDG test requests were deemed inappropriate and rejected. The number of BDG tests performed per year decreased by 85% from 156 in the pre-intervention period to 24 in the post-intervention period. The average monthly number of BDG tests performed was significantly lower between those periods (P = .002). There was no delay in IFI diagnosis or IFI-related deaths in the patients whose BDG test requests were rejected. The sustained effectiveness of the intervention was observed for 5 years. Institution of the diagnostic stewardship intervention successfully and safely improved BDG test utilization.

Comprehensive analysis of occupational radiation exposure and radiation safety practices in cardiac catheterization laboratories: A five-year experience

AimThe objective is to analyze the occupational radiation dose experienced by medical workers in the Cardiac catheterization Lab in Bahrain and evaluate their adherence to established radiation safety protocols. Material and methodsRetrospective analysis for the Hp(10) and Hp(0.07) doses over a five-year (2017–2021). Descriptive analyses conducted for both annual dose and cumulative data across all years for all healthcare workers. A questionnaire was administered to evaluate their adherence to radiation safety protocols. Descriptive statistics were conducted for all responses and ANOVA was conducted to discern differences in best practices across various demographics groups. ResultsNo single dose exceeded the dose limits and 89.4% of the workers received Hp(10) and Hp(0.07) radiation doses of less than 2 mSv. The overall mean and range of the annual Hp(10) and Hp(0.07) radiation dose over the 5-year study period for all workers were 1.07 (9.50-0.01) and 0.64 (11.30-0.02), respectively. The overall mean and range of the annual Hp(10) and Hp(0.07) (mSv) for cardiologists were 1.79 (9.50-0.04) and 1.42 (11.30-0.07), respectively. The survey showed inconsistent practices and gaps. In best practice scoring, physicians had highest score and cardiovascular technologists scored the lowest. ConclusionIt is important to emphasize proper radiation safety practices for healthcare professionals to reduce the risk of long-term repeated exposure. Commitment to radiation safety is shows the dedication to providing high-quality care and adhering to radiation safety practices is an ethical obligation towards patient. There is a need for tailored training on radiation safety and enforcement of safety measures.

Surgical retrieval of displaced mandibular third molars: A five-year experience with 16 cases

BACKGROUNDThis study aimed to report the surgical retrieval of iatrogenic displaced mandibular third molars using Computed Tomography CT and Cone Beam Computed Tomography CBCT as pre-surgical diagnostic imaging. MethodsSixteen patients were referred to the Oral and Maxillofacial Department, Faculty of Dentistry, XXXXX University for surgical retrieval of displaced third molars. Patients consented and thorough clinical assessment and radiographic examinations were done using either CT or CBCT scans before the standard surgical procedure to retrieve the displaced teeth. It was intended for all patients to have their displaced teeth or root fragments retrieved using an intra-oral approach while under general anesthesia. Results7 (43.75%) third mandibular left molars/root fragments and 9 (56.25 %) third mandibular right molars/root fragments were retrieved. There was no statistically significant difference regarding swelling between the two CT and CBCT groups (P> 0.05). One patient in the CT group and three patients in the CBCT group experienced lingual nerve paresthesia which was resolved after three months. ConclusionsCT and CBCT scans are crucial diagnostic tools for pre-surgical evaluation and planning for the displaced mandibular third molars. CT provides clearer images and enables easy pre-surgical assessment.

Kidney Transplantation in Elderly Recipients: Five-Year Experience

Kidney Transplantation in Elderly Recipients: Five-Year Experience

Benign acute myositis: Aetiology, treatment and evolution. Five-year experience at a tertiary hospital.

Benign acute myositis: Aetiology, treatment and evolution. Five-year experience at a tertiary hospital.

Gadoxetic Acid in MRI: A Five-Year Experience at a High-Complexity Hospital in Colombia.

Objective The objective of the study was to evaluate the use of the hepatospecific contrast agent, gadoxetic acid, for MRI in patients at a high-complexity hospital in Medellin, Colombia, from 2016 to 2022. Materials and methods This was an observational, descriptive, and retrospective cross-sectional study involving patients who had undergone MRI with gadoxetic acid from February 2016 to January 2022. The MRI studies were interpreted by two radiologists specializing in body imaging, each with at least 10 years of experience. The medical records of the identified patients were reviewed. Quantitative variables were presented using either means and standard deviations or medians and interquartile ranges, depending on the distribution of the variables. Qualitative variables were represented through absolute and relative frequencies. Results A total of 100 pharmacy records were collected, leading to a final sample of 75 patients aged between three and 91 years. The primary reason for imaging was to assess focal liver lesions in 58 patients (77.3%), with bile duct injury being the second most common indication in 16 patients (21.3%). A diagnostic alteration was noted in 69.3% of cases (52 patients). Among the 58 focal liver lesions analyzed using a hepatospecific agent, 31 cases (53.4%) were diagnosed as focal nodular hyperplasia. Conclusion Our study reinforces the clinical value of gadoxetic acid-enhanced MRI in refining diagnostic assessments, particularly in cases involving bile duct and focal hepatic lesions.

Socio-Economic and Demographic Factors that Influence Contraceptive Use by Men in Afikpo North Local Government Area of Ebonyi State

This study examines the Socio-Economic and Demographic Factors that influence Contraceptive use by Married Men in Afikpo North Local Government Area of Ebonyi State. It is aimed at identifying the determinants of contraceptive use among married men in Afikpo North Local Government Area of Ebonyi State. A sample of four hundred and sixty one (461) married men were selected for the study through Multi-Stage sampling design. Cross tabulation results revealed that there is a significant relationship between the independent variables and contraceptive use. Logistic regression results showed that the significant socio-economic and demographic determinants of contraceptives use among the study sample are marriage duration of at least five years, religion, education, occupation, parity, number of children living and age. The Hosmer Lemeshow test for goodness of fit of the logistic regression model is 87.9 percent and is highly significant (p-value &gt; 0.05). This indicates that the model fitted is adequate. The study recommends among others that it is necessary for young couples with less than five-year experience, Muslims, the no education group and farmers, to be targeted and carried along in the campaign for the use of contraceptive methods.

Contrast-enhanced Susceptibility Weighted Imaging (CE-SWI) for the Characterization of Musculoskeletal Oncologic Pathology: A Pictorial Essay on the Initial Five-year Experience at a Cancer Institution

Susceptibility-weighted imaging (SWI) is based on a 3D high-spatial-resolution, velocity-corrected gradient-echo MRI sequence that uses magnitude and filtered-phase information to create images. It SWI uses tissue magnetic susceptibility differences to generate signal contrast that may arise from paramagnetic (hemosiderin), diamagnetic (minerals and calcifications) and ferromagnetic (metal) molecules. Distinguishing between calcification and blood products is possible through the filtered phase images, helping to visualize osteoblastic and osteolytic bone metastases or demonstrating calcifications and osteoid production in liposarcoma and osteosarcoma. When acquired in combination with the injection of an exogenous contrast agent, contrast-enhanced SWI (CE-SWI) can simultaneously detect the T2* susceptibility effect, T2 signal difference, contrast-induced T1 shortening, and out-of-phase fat and water chemical shift effect. Bone and soft tissue lesion SWI features have been described, including giant cell tumors in bone and synovial sarcomas in soft tissues. We expand on the appearance of benign soft-tissue lesions such as hemangioma, neurofibroma, pigmented villonodular synovitis, abscess, and hematoma. Most myxoid sarcomas demonstrate absent or just low-grade intra-tumoral hemorrhage at the baseline. CE-SWI shows superior differentiation between mature fibrotic T2* dark components and active enhancing T1 shortening components in desmoid fibromatosis. SWI has gained popularity in oncologic MSK imaging because of its sensitivity for displaying hemorrhage in soft tissue lesions, thereby helping to differentiate benign versus malignant soft tissue tumors. The ability to show the viable, enhancing portions of a soft tissue sarcoma separately from hemorrhagic/necrotic components also suggests its utility as a biomarker of tumor treatment response. It is essential to understand and appreciate the differences between spontaneous hemorrhage patterns in high-grade sarcomas and those occurring in the therapy-induced necrosis process in responding tumors. Ring-like hemosiderin SWI pattern is observed in successfully treated sarcomas. CE-SWI also demonstrates early promising results in separating the T2* blooming of healthy iron-loaded bone marrow from the T1-shortened enhancement in bone marrow that is displaced by the tumor. SWI and CE-SWI in MSK oncology learning objectives: SWI and CE-SWI can be used to identify calcifications on MRI. Certain SWI and CE-SWI patterns can correlate with tumor histologic type. CE-SWI can discriminate mature from immature components of desmoid tumors. CE-SWI patterns can help to assess treatment response in soft tissue sarcomas. Understanding CE-SWI patterns in post-surgical changes can also be useful in discriminating between residual and recurrent tumors with overlapping imaging features.