Major Wound Research Articles

Wind disasters adaptation in cities in a changing climate: A systematic review.

Wind-related disasters will bring more devastating consequences to cities in the future with a changing climate, but relevant studies have so far provided insufficient information to guide adaptation actions. This study aims to provide an in-depth elaboration of the contents discussed in open access literature regarding wind disaster adaptation in cities. We used the Latent Dirichlet Allocation (LDA) to refine topics and main contents based on 232 publications (1900 to 2019) extracted from Web of Science and Scopus. We conducted a full-text analysis to filter out focal cities along with their adaptation measures. The results show that wind disaster adaptation research in cities has formed a systematic framework in four aspects: 1) vulnerability and resilience of cities, 2) damage evaluation, 3) response and recovery, and 4) health impacts of wind disaster. Climate change is the background for many articles discussing vulnerability and adaptation in coastal areas. It is also embedded in damage evaluation since it has the potential to exacerbate disaster consequences. The literature is strongly inclined towards more developed cities such as New York City and New Orleans, among which New York City associated with Hurricane Sandy ranks first (38/232). Studies on New York City cover all the aspects, including the health impacts of wind disasters which are significantly less studied now. Distinct differences do exist in the number of measures regarding the adaptation categories and their subcategories. We also find that hard adaptation measures (i.e., structural and physical measures) are far more popular than soft adaptation measures (i.e., social and institutional measures). Our findings suggest that policymakers should pay more attention to cities that have experienced major wind disasters other than New York. They should embrace the up-to-date climate change study to defend short-term disasters and take precautions against long-term changes. They should also develop hard-soft hybrid adaptation measures, with special attention on the soft side, and enhance the health impact study of wind-related disasters.

Hospital variability in modifiable factors driving coronary artery bypass charges

ObjectiveCoronary artery bypass grafting is associated with significant interhospital variability in charges. Drivers of hospital charge variability remain elusive. We identified modifiable factors associated with statewide interhospital variability in hospital charges for coronary artery bypass grafting. MethodsCharge data were used as a surrogate for cost. Society of Thoracic Surgeons data from Maryland institutions and charge data from the Maryland Health Care Commission were linked to characterize interhospital charge variability for coronary artery bypass grafting. Multivariable linear regression was used to identify perioperative factors independently related to coronary artery bypass grafting charges. Of the factors independently associated with charges, we analyzed which factors varied between hospitals. ResultsA total of 10,337 patients underwent isolated coronary artery bypass grafting at 9 Maryland hospitals from 2012 to 2016, of whom 7532 patients were available for analyses. Mean normalized charges for isolated coronary artery bypass grafting varied significantly among hospitals, ranging from $30,000 to $57,000 (P < .001). Longer preoperative length of stay, operating room time, and major postoperative morbidity including stroke, renal failure, prolonged ventilation, reoperation, and deep sternal wound infection were associated with greater hospital charges. Incidence of major postoperative events, except stroke and deep sternal wound infection, was variable between hospitals. In a univariate linear regression model, patient risk profile only accounted for approximately 10% of statistical variance in charges. ConclusionsThere is significant charge variability for coronary artery bypass grafting among hospitals within the same state. By targeting variation in preoperative length of stay, operating room time, postoperative renal failure, prolonged ventilation, and reoperation, cardiac surgery programs can realize cost savings while improving quality of care for this resource-intense patient population.

Outcomes of stab wounds presenting to Kamuzu Central Hospital in Malawi

Injuries are a leading cause of morbidity and mortality worldwide, necessitating that we understand the local burden of injury to improve injury-related trauma care and patient outcomes. The characteristics, outcomes, and risk factors for mortality following stab wounds in Malawi are poorly delineated. This is a retrospective, descriptive analysis of patients presenting to Kamuzu Central Hospital in Lilongwe, Malawi, with stab wounds from February 2008 to May 2018. Univariate and bivariate analyses were performed to compare patient and injury characteristics based on mortality. We performed Poisson multivariate regression to predict the factors that increase the relative risk of mortality. During the study, 32,297 patients presented with assault. Of those patients, 2,352 (7.3%) presented with stab wounds resulting in a 3.2% (n=74) overall mortality. The majority of wounds were to the head or cervical spine (n=1,043, 44.6%), while injuries to the chest (n=319, 13.7%) were less frequent. We found an increased relative risk of mortality in patients who presented with an injury to the chest (RR 3.95, 95% CI 1.79-8.72, p=0.001) and who were brought in by the police (RR 33.24, 95% CI 11.23-98.35, p<0.001). In this study, stab wounds accounted for 7.3% of all assault cases, with a 3.2% mortality. Though the commonest site of stab was the head, wounds to the chest conferred the highest relative risk of mortality. A multifaceted approach to reducing mortality is needed. Incorporating training of first responders in basic life support, including the police, may reduce stab-related mortality.

Shape memory alloy as an internal splint in a rat model of excisional wound healing

The purpose of an animal wound model is to replicate the wound healing process of humans as accurately as possible. Although rodents are attractive candidates for animal wound models, the drawback is that their major wound healing occurs by contraction, which is fundamentally different from that seen in humans, where healing is achieved mainly by re-epithelialization and granulation tissue growth. There has been an attempt to overcome such drawbacks by applying an external splint on wounded mice. This model, however, has a few problems concerning the assimilating ability of external splints with the dynamic soft tissue movements and robustness issues. The authors hereby describe a new animal wound model using an internal splint made of nitinol, one of the shape memory alloys (SMAs). SMA wire was inserted intradermally around the full-thickness excisional wound to act as the internal splint, and its ability to impede wound contraction was analyzed. In experiment 1, three different sizes of SMAs (0.18 mm, 0.24 mm, and 0.30 mm diameters of thickness) were inserted as the internal splint and their ability to impede the wound contraction was compared. The most effective size of SMA as the internal splint was selected among them. In experiment 2, contraction of the wound with the selected size of SMA inserted as the internal splint was compared with that of the unsplinted wound. SMA as an internal splint effectively impeded wound contraction without affecting the re-epithelialization rate, thereby successfully mimicking the human wound healing mechanism. In this study, the authors introduce a novel animal wound model that replicates the human wound healing mechanism. This model is robust, reliable, and easily reproducible.

Bigger Is Not Always Better: Review of Small Wind in Brazil

This century registers a significant expansion in the wind power market. However, the vast majority of these investments are concentrated in large wind turbines. The century begins with an installed capacity of about 20 GW, which reaches 650 GW in 2019. On the other hand, it is important to highlight that small wind turbines have not followed this virtuous path, a fact that is evident in Brazil’s reality. In this context, the article aims at evaluating the current situation of the wind energy market for Small Wind Turbines in Brazil (SWT) and its future perspectives, identifying the main characteristics of the sector, its challenges, and opportunities. It is an exploratory–explanatory research study that investigates the theme, generating knowledge that turns to practical application, as it seeks answers to solve local interests. This methodological approach provides objective evidence that the production of knowledge about the use of SWT in Brazil still remains embryonic, shaded by the impressive progress registered by the major wind farms in the country, despite all the potential and socioeconomic and environmental attractions. This fact credits the revision research with an innovative role in the apprehension of knowledge related to the development of SWT in Brazil.

Perineal Wound Closure Following Abdominoperineal Resection and Pelvic Exenteration for Cancer: A Systematic Review and Meta-Analysis.

Simple SummaryAbdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer (mainly anal and rectal cancers) require extensive pelvic resection with a high rate of postoperative complications. The objective of this work was to systematically review and meta-analyze the effects of vertical rectus abdominis myocutaneous flap (VRAMf) and mesh closure on perineal morbidity following APR and PE. The studies were distributed as follows: Group A comparing primary closure (PC) and VRAMf, Group B comparing PC and mesh closure, Group C comparing PC and VRAMf in PE. The meta-analysis of Groups A and B showed PC to be associated with an increase in the rate of total and major perineal wound complications. PC was associated with a decrease in total and major perineal complications in Group C.Background. Abdominoperineal resection (APR) and pelvic exenteration (PE) for the treatment of cancer require extensive pelvic resection with a high rate of postoperative complications. The objective of this work was to systematically review and meta-analyze the effects of vertical rectus abdominis myocutaneous flap (VRAMf) and mesh closure on perineal morbidity following APR and PE (mainly for anal and rectal cancers). Methods. We searched PubMed, Cochrane, and EMBASE for eligible studies as of the year 2000. After data extraction, a meta-analysis was performed to compare perineal wound morbidity. The studies were distributed as follows: Group A comparing primary closure (PC) and VRAMf, Group B comparing PC and mesh closure, and Group C comparing PC and VRAMf in PE. Results. Our systematic review yielded 18 eligible studies involving 2180 patients (1206 primary closures, 647 flap closures, 327 mesh closures). The meta-analysis of Groups A and B showed PC to be associated with an increase in the rate of total (Group A: OR 0.55, 95% CI 0.43–0.71; p < 0.01/Group B: OR 0.54, CI 0.17–1.68; p = 0.18) and major perineal wound complications (Group A: OR 0.49, 95% CI 0.35–0.68; p < 0.001/Group B: OR 0.38, 95% CI 0.12–1.17; p < 0.01). PC was associated with a decrease in total (OR 2.46, 95% CI 1.39–4.35; p < 0.01) and major (OR 1.67, 95% CI 0.90–3.08; p = 0.1) perineal complications in Group C. Conclusions. Our results confirm the contribution of the VRAMf in reducing major complications in APR. Similarly, biological prostheses offer an interesting alternative in pelvic reconstruction. For PE, an adapted reconstruction must be proposed with specialized expertise.

A multicenter, prospective randomized trial of negative pressure wound therapy for infrainguinal revascularization with a groin incision

BackgroundWound complications after open infrainguinal revascularization are a frequent cause of patient morbidity, resulting in increased healthcare costs. The purpose of the present study was to assess the effects of closed incision negative pressure therapy (ciNPT) on groin wound complications after infrainguinal bypass and femoral endarterectomy. MethodsA total of 242 patients who had undergone infrainguinal bypass (n = 124) or femoral endarterectomy (n = 118) at five academic medical centers in New England from April 2015 to August 2019 were randomized to ciNPT (PREVENA; 3M KCI, St Paul, Minn; n = 118) or standard gauze (n = 124). The primary outcome measure was a composite endpoint of groin wound complications, including surgical site infections (SSIs), major noninfectious wound complications, or graft infections within 30 days after surgery. The secondary outcome measures included 30-day SSIs, 30-day noninfectious wound complications, readmission for wound complications, significant adverse events, and health-related quality of life using the EuroQoL 5D-3L survey. ResultsThe ciNPT and control groups had similar demographics (age, 67 vs 67 years, P = .98; male gender, 71% vs 70%, P = .86; white race, 93% vs 93%, P = .97), comorbidities (previous or current smoking, 93% vs 94%, P = .46; diabetes, 41% vs 48%, P = .20; renal insufficiency, 4% vs 7%, P = .31), and operative characteristics, including procedure type, autogenous conduit, and operative time. No differences were found in the primary composite outcome at 30 days between the two groups (ciNPT vs control: 31% vs 28%; P = .55). The incidence of SSI at 30 days was similar between the two groups (ciNPT vs control: 11% vs 12%; P = .58). Infectious (13.9% vs 12.6%; P = .77) and noninfectious (20.9% vs 17.6%; P = .53) wound complications at 30 days were also similar for the ciNPT and control groups. Wound complications requiring readmission also similar between the two groups (ciNPT vs control: 9% vs 7%; P = .54). The significant adverse event rates were not different between the two groups (ciNPT vs control: 13% vs 16%; P = .53). The mean length of the initial hospitalization was the same for the ciNPT and control groups (5.2 vs 5.7 days; P = .63). The overall health-related quality of life was similar at baseline and at 14 and 30 days postoperatively for the two groups. Although not powered for stratification, we found no differences among the subgroups in gender, obesity, diabetes, smoking, claudication, chronic limb threatening ischemia, bypass, or endarterectomy. On multivariable analysis, no differences were found in wound complications at 30 days for the ciNPT vs gauze groups (odds ratio, 1.4; 95% confidence interval, 0.8-2.6; P = .234). ConclusionsIn contrast to other randomized studies, our multicenter trial of infrainguinal revascularization found no differences in the 30-day groin wound complications for patients treated with ciNPT vs standard gauze dressings. However, the SSI rate was lower in the control group than reported in other studies, suggesting other practice patterns and processes of care might have reduced the rate of groin infections. Further study might identify the subsets of high-risk patients that could benefit from ciNPT.

Single Center Observational Study to Evaluate the Safety and Efficacy of Self-expanding Composite Mesh for Repair of Small Umbilical Hernias

Background: There is evidence that mesh repair for umbilical hernias results in fewer recurrences. Early and late complication rates of mesh repair are variable with different techniques of mesh repair. In recent years, several mesh device for the repair of small ventral hernias have been developed, but some reports have been published reporting some adverse outcomes like high recurrences or wound related complications encountered with those mesh devices. The purpose of this study was to evaluate the safety and efficacy of small umbilical hernia(&lt;3cm) repair using self expanding dual mesh.&#x0D; Methods: In this study we used a composite self-expanding mesh with Polypropylene(PP) on one side and expanded polytetrafleuroethylene(ePTFE) on the other side. We introduced this technique in our department at BIRDEM General Hospital and IMC in March 2017 and collected patients data and outcome in an observational study of 25 consecutive patients matching our inclusion criteria until February 2019. In addition to the routine 1st week postoperative follow-up, We did a prospective follow-up at 1 month,6 month and 1 year which included a questionnaire, clinical examination and ultra sonogram after 12 months.&#x0D; Results: The study included 15 female and 10 male patients with age ranging from 25-62 years(Mean- 47) having 16 primary umbilical hernia and 9 umbilical port hernias. The size of gap was &lt;3cm and all except 2 hernias were reducible. In all patients a self expanding dual mesh was used with a diameter of 8cm(18 patients) or 6.4(7 patients) cm. Early complications included superficial wound infection-1(4%), seroma-1(4%), serosanguinous discharge-1(4%) and ecchymosis-1(4%). No major wound problems were noted in 1 month or 6 month follow-up except 1 patient reporting hypertrophied scar. At 1st month follow up 21 patientswere pain free, after 6 month only 1 patient reported mild pain, after 1 year 100% patients were pain free. 24 out of 25 patients ie 96% were very satisfied with the result of their repair. There was no recurrence after one year.&#x0D; Conclusion: Umbilical and umbilical port hernia repair with Self expanding dual mesh is effective and is cosmetically very appreciated by patients as good as laparoscopic repair. Therefore, we recommend using these meshes only for umbilical and umbilical port hernias smaller than 3 cm. For larger or incisional hernias other techniques allowing the use of larger meshes is advocated.&#x0D; Journal of Surgical Sciences (2020) Vol. 24 (2) : 43-50

Wake‐effect aware optimal online control of wind farms: An explicit solution

Wake effects impose significant aerodynamic interactions among wind turbines. To improve the wind farm operating performance, practical wind farm online control considering wake effects becomes very important. To achieve online optimal wind farm control while responding to grid demands, this paper proposes a novel optimal wind farm supervisory control (SC) model and its explicit solutions. From the controller modelling perspective, the two major wind farm operating modes, the maximum power point tracking mode and the set-point tracking mode, are first analysed and unified in one optimisation model while considering wake effects. In this way, wind farm power production and rotor kinetic energy reserve can be simultaneously considered to conveniently modify the operation mode in response to different grid demands. Aside from controller modelling, the collocation method is first introduced to address the online application problem of such wake-effect aware optimal WF control. Although a few optimisation algorithms have been proposed to find the optimum offline, online optimal control is still challenging because of the computational complexity brought by wake model non-linearity and non-convexity. The proposed collocation method explicitly approximates the optimal solutions to the proposed supervisory control model, through which only a direct algebraic operation is required for online optimal control instead of repeated optimisations. Case studies are carried out on different wind farms under various wind conditions, showing that the wind farm power production potential and releasable power reserve are improved compared to traditional greedy control in both modes. The accuracy of the collocation method is verified. A detailed analysis of the wind farm production capacity under different wind speeds and directions is also provided.

The contradictory role of androgens in cutaneous and major burn wound healing.

Wound healing is a complex process involving four overlapping phases: haemostasis, inflammation, cell recruitment and matrix remodeling. In mouse models, surgical, pharmacological and genetic approaches targeting androgen actions in skin have shown that androgens increase interleukin-6 and tumor necrosis factor-α production and reduce wound re-epithelization and matrix deposition, retarding cutaneous wound healing. Similarly, clinical studies have shown that cutaneous wound healing is slower in men compared to women. However, in major burn injury, which triggers not only local wound-healing processes but also systemic hypermetabolism, the role of androgens is poorly understood. Recent studies have claimed that a synthetic androgen, oxandrolone, increases protein synthesis, improves lean body mass and shortens length of hospital stay. However, the possible mechanisms by which oxandrolone regulates major burn injury have not been reported. In this review, we summarize the current findings on the roles of androgens in cutaneous and major burn wound healing, as well as androgens as a potential therapeutic treatment option for patients with major burn injuries.

Pediatric burn wound complicated with herpes simplex virus infection: A rare case report and literature review

Herpes simplex virus infection in major burn wounds is a well-known entity. Here, I am reporting a relatively rare case of a pediatric patient who presented with superficial partial-thickness scald burn injury over his face and neck. He was managed in outpatient department services with topical antibiotic dressings. After 2 weeks, he presented with multiple vesicular lesions over his lower face and neck with delayed wound healing in that area. Clinical suspicion of superadded viral infection was made. Tzanck smear and polymerase chain reaction test confirmed the infection with herpes simplex virus. Antiviral treatment was started, and regular dressings were continued. The patient responded well to the treatment, and lesions were disappeared. Later, he developed hypertrophic scarring over the lower part of face. Now, he is being managed on massage and pressure therapy. There has been no relapse of viral infection till 6 months of follow-up.

Magnesium sulfate infiltration of pectoralis major muscle for postoperative analgesia following mastectomy: a randomized controlled study

Background Effect of adding magnesium sulfate infiltration of pectoralis major muscle on postoperative pain following modified radical mastectomy (MRM) especially during arm movement. Patients and methods A total of 75 female patients with American Society of Anesthesiologists physical status I and II scheduled for MRM were allocated into three groups (25 patients each). Group M received magnesium sulfate infiltration in pectoralis major muscle plus bupivacaine wound infiltration. Group B received saline in pectoralis major muscle plus bupivacaine wound infiltration. Group C received saline for both pectoralis major muscle and wound infiltration. Postoperative pain score at rest and during arm elevation, time to first analgesic request, cumulative morphine consumption in 24 h, and possible complications were recorded. Results Assessment showed overall lower pain scores at rest and during elevation of the related arm in group M compared with groups B and C. Time to first analgesic request was longer in patients of group M, with significantly less amount of postoperative opioid consumption (P Conclusion Magnesium sulfate infiltration of pectoralis major muscle following MRM is simple and provides effective postoperative analgesia at rest and during arm elevation superior than bupivacaine wound infiltration alone, resulting in greater opioid-sparing and better patient comfort.

Laparoscopic necrosectomy for acute necrotizing pancreatitis: retrospective analysis of a decade long experience from a tertiary centre

Introduction: To evaluate the role of minimally invasive surgery for management of necrotizing pancreatitis in the acute setting and to propose tailor made approaches to deal with various locations of pancreatic necrosis. Methods: A total of 112 patients (75 males, 37 females) with mean age of 41.5+10.3 years, with necrotizing pancreatitis underwent minimally invasive necrosectomy between January 2009 and May 2019. Laparoscopic necrosectomy was performed by transperitoneal approach in 81 patients , by retroperitoneoscopy in 18 patients and combined approach in 13 patients. Out of 81 patients treated by transperitoneal approach, 21 were approached through lesser sac, 48 through mesocolic route and 12 through paracolic route. In cases of retroperitoneoscopy, all cases were accessed through the left flank. Results: All patients tolerated the procedure well. Mean BMI was 26.45±3.78 kg/sqm. Mean operating time was 56.40±20.48 minutes and mean blood loss was 120±31.45 ml.Eight patients required reoperation (6 underwent open procedure and 2 underwent laparoscopic redo necrosectomy). Six patients died of multi-organ failure. The mean duration of return of bowel function was 5±1.8 days. The mean length of hospital stay after surgery was 8.19 ±4.09 days. There were no major wound related complications. Conclusion: Minimally invasive approach to pancreatic necrosectomy is safe and feasible with good outcomes in centres with adequate expertise . In addition to careful case selection, proper timing and optimal route of access determines the outcome. Minimally invasive procedures are suitable alternatives especially in critically ill patients providing lower morbidity and mortality rates.

An Overview of Wind Resource Assessments With Special Reference to The Emirate of Ajman, UAE

The continuous increase in clean energy demand and reduced CO2 emissions in the UAE and specifically the Emirate of Ajman has put an extreme challenge to the Government. Ajman is one of the seven emirates constituting the United Arab Emirates (UAE). Ajman is located along the Arabian Gulf on its West and bordered by the Emirate of Sharjah on its North, South, and East. The government is taking huge steps in including sustainability principles and clean energy in all of its developments. Successful implementation of green architecture law decree No 10 of 2018 effectively is a sign of such an initiative. Renewable energy sources in this country have had two folds of interest in solar and wind. Recent research works supported the feasibility of using wind energy as an alternative clean source of energy. Site-specific and accurate wind speed information is the first step in the process of bankable wind potential and wind Atlas. This study has compared how wind speed and its distribution varies for similar offshore and onshore locations between two different mesoscale data sources. Also, discussed the main environmental characteristics of Ajman that would influence the implementation of a major wind energy project. In addition, the study made a brief critical overview of the major studies undertaken in the Middle East and North Africa (MENA) region on wind resource assessment. Finally, based on the results, the study makes conclusions, recommendations and a way forward for a bankable wind resources assessment in the Emirate of Ajman. This paper would alert the wind energy industry about the consequence of not considering the best error corrected site specific suitable wind resource data along with other environmental characteristics. The study results show that for offshore, there is 2.9 m/s and for Onshore 4.9 m/s variations in wind speed at the same location between ECMWF Reanalysis (ERA-5) and NASA Satellite data. Hence It is concluded that error corrected site-specific wind resource assessment is mandatory for assessing the available bankable wind potential since there are considerable variations in wind speed distributions between mesoscale data sets for similar locations. The study also identifies that the Emirate of Ajman has limited space for onshore wind farms; hence the offshore site seems to have good potential that can be utilised for energy generation. However, individual wind turbines can be installed for exploiting the available site-specific onshore wind energy. Finally, the study recommends a way forward for a comprehensive wind resource assessment to help the Emirate of Ajman form a sustainable wind power generation policy.

Efficacy and safety of aspirin and rivaroxaban for venous thromboembolism prophylaxis after total hip or knee arthroplasty: A protocol for meta-analysis.

Background:The purpose of this meta-analysis is to compare the efficacy and safety of aspirin and rivaroxaban in the prevention of venous thromboembolism (VTE) following either total knee arthroplasty or total hip arthroplasty.Methods:A comprehensive literature search of several electronic databases (PubMed, Embase, and Web of Science) was conducted to identify relevant studies. Outcomes of interest included VTE rate, deep vein thrombosis (DVT) rate, pulmonary embolism rate, major bleeding events, mortality rate, blood transfusion, and wound complication. Risk ratio (RR) with 95% confidence intervals (95%CIs) were calculated using a fixed-effects model or random-effects model.Results:A total of 8 studies with 97,677 patients met the inclusion criteria and were included in this meta-analysis. Compared with rivaroxaban, aspirin had a significantly higher incidence of DVT (RR = 1.48, 95%CI: 1.27, 1.72; P < .001), and decreased risk of blood transfusion (RR = 0.94, 95%CI: 0.93, 0.94; P < .001). However, there were no significant differences between the 2 drugs in terms of total VTE rate (RR = 1.39%, 95%CI: 0.94, 2.05; P = .101), pulmonary embolism rate (RR = 1.64, 95%CI: 0.92, 2.92; P = .094), mortality rate (RR = 1.13, 95%CI: 0.15, 8.27; P = .907), major bleeding (RR = 1.00, 95%CI: 0.44, 2.27; P = .995), and wound complication rate (RR = 0.37, 95%CI: 0.07, 1.87; P = .229).Conclusion:Our results suggested that aspirin and rivaroxaban offered similar effect in the prevention of VTE after total knee arthroplasty or total hip arthroplasty. However, rivaroxaban seemed to have better effect than aspirin in reducing the risk of DVT, and aspirin was safer than rivaroxaban in decreasing the blood transfusion rate.

Manejo endovascular de la isquemia crítica distal: análisis de una serie contemporánea

Background Chronic limb ischemia can lead to high rates of limb loss and mortality. Open surgery is the gold standard for treatment of distal disease. Endovascular surgery should have less complications with similar outcomes. Aim To report a cohort of patients with distal arterial disease treated with endovascular surgery at our institution. Material and methods Review of angioplasty records of patients undergoing distal lower extremity endovascular procedures between 2016 and 2019. Demographics, comorbidities, form of presentation, type of intervention, perioperative complications, and length of stay were analyzed. The primary outcomes were wound healing, reinterventions and freedom from major amputation. Secondary outcomes were overall survival and amputation-free survival. Results Forty-eight limbs of 41 patients with a mean age 75 years (78% males) were treated. Ninety-three percent had hypertension, 88% diabetes, 30% chronic kidney disease. 73% presented with major wounds. Plain balloon and drug coated balloon angioplasties were carried out in 65 and 31% of procedures respectively, with no difference in results. In 46% of the cases, only chronic total occlusions were treated. Wound healing was achieved in 85% of procedures and 90% of patients were free from amputation at one year of follow up. Complications were observed in 18% of procedures, perioperative mortality was 2% and one-year survival was 76%. Conclusions Endovascular therapy achieves high rates of wound healing and freedom from amputation with low perioperative mortality and moderate complication rates.

Hypofractionated versus conventional fractionated radiotherapy for breast cancer in patients with reconstructed breast: Toxicity analysis

PurposeThis study investigated whether hypofractionated adjuvant radiotherapy (RT) increased breast-related complication(s) compared to conventional fractionated RT in reconstructed breast cancer patients. MethodsWe conducted a retrospective review including 349 breast cancer patients who underwent immediate breast reconstruction following mastectomy or breast-conserving surgery (BCS) between 2009 and 2018 at two institutions. All patients were treated with adjuvant RT via either a conventional fractionated or hypofractionated regimen. We defined a major breast complication as a breast-related toxic event requiring re-operation or re-hospitalization during the follow-up period after the end of RT. ResultsThe median follow-up was 32.3 months (4.8–118.5 months); 126 patients had conventional fractionated RT, and 223 patients received hypofractionated RT. In patients with mastectomy, there was no significant difference in the occurrence of any or major breast-related complications between the two fractionation regimens. In patients undergoing BCS, incidence of any breast complication showed no difference between two RT groups and no major breast complication was reported as well. Hypofractionated RT did not increase major wound problem (infection and dehiscence) compared to conventional RT. Incidence of major contracture was significantly lower in hypofractionated RT. ConclusionsThere was no significant difference in the occurrence of any or major breast-related complications between the two different fractionation regimens, even in patients with mastectomy. Hypofractionated RT may be used comparable to conventional fractionated RT in terms of breast-related complications in reconstructed breast cancer patients. The prospective randomized trial would be necessary to clarify this issue.

A Spatio-Temporal Multiscale Neural Network Approach for Wind Turbine Fault Diagnosis With Imbalanced SCADA Data

The supervisory control and data acquisition (SCADA) systems are widely installed on wind turbines (WTs) in major wind farms, which produce a large amount of sensory data that can be used for fault diagnosis of WTs. However, these SCADA data are naturally multivariate time series, which represent complex temporal correlations within each sensor variable and spatial correlations between different sensor variables. To effectively capture spatio-temporal correlations in SCADA data, we propose a new spatio-temporal multiscale neural network (STMNN). The proposed STMNN model contains two parallel feature extraction modules: first, a multiscale deep echo state network module to extract temporal multiscale features; second, a multiscale residual network module to extract spatial multiscale features. Additionally, as the WTs are in a normal working state most of the time, there are a large amount of normal SCADA data and few failure SCADA data. To address the data imbalance problem of SCADA data and enhance the fault diagnosis performance, instead of cross-entropy loss, the STMNN model adopts focal loss as loss function. Our proposed STMNN method can provide an end-to-end fault diagnosis solution with imbalanced SCADA data, and is evaluated through experiments on an SCADA dataset from a real wind farm. The experimental results and comparative analysis have proved the effectiveness of our proposed STMNN model in practical applications.

Chimeric Anterolateral Thigh and Rectus Femoris Flaps for Reconstruction of Complex Oral and Maxillofacial Defects.

Complex oral and maxillofacial defects are continuously a challenge for reconstructive surgeons. This study evaluates the effects of chimeric anterolateral thigh (ALT) and rectus femoris flaps for the reconstruction of such defects. A retrospective review was performed of 10 patients who underwent reconstruction of oral and maxillofacial defects with chimeric ALT and rectus femoris flaps from October 2014 through August 2016 at the Second Xiangya Hospital. All 10 patients were male, with a mean age of 53.6 years. Postoperatively, all flaps survived completely, without vascular compromise or major wound complications. Salivary fistula occurred in 1 patient, and wound effusion of the thigh occurred in another patient. Gradual wound healing was observed after repeated dressing changes. The patients were followed for approximately 3 to 46 months, the appearance and oral functions were recovered well, and no thigh motor dysfunctions were observed. Because of the convenient flap design, effective avoidance of recipient site complications, lower donor site morbidity, and acceptable functional and esthetic results, chimeric ALT and rectus femoris flaps are a good choice for the reconstruction of complex oral and maxillofacial defects.

Outcomes of Immediate Alloplastic Breast Reconstruction in Patients Receiving Post-Mastectomy Radiotherapy.

Immediate alloplastic breast reconstruction is traditionally avoided in patients who require post-mastectomy radiation therapy (PMRT). However, a subset of patients who undergo alloplastic reconstruction may unpredictably require adjuvant radiation. The purpose of this study was to compare outcomes and complications in patients at our institution who had undergone immediate alloplastic breast reconstruction and received PMRT to either the permanent implant or temporary tissue expander. A retrospective cohort study was performed looking at patients who underwent immediate alloplastic breast reconstruction over a 10-year period (2009-2019) at our regional breast centre. All patients who underwent immediate alloplastic breast reconstruction and had PMRT were included in the study. Major (wound dehiscence with device exposure, or reconstructive failure) and minor (infection, capsular contracture, revision surgery) complication rates between those patients receiving radiation to a tissue expander versus implant were compared using Fisher exact test (P < .05). Six-hundred ninety-two patients were identified, and 43 patients met inclusion criteria. Of this group, 29 received PMRT to implants and 14 received PMRT to tissue expanders. Complication rates were similar between groups for superficial wound infection (3.4% vs 7.1%), periprosthetic infection (3.4% vs 7.1%), capsular contracture (41.4% vs 21.4%), revision surgery for aesthetics (41.4% vs 21.4%), wound dehiscence and device exposure (3.4% vs 21.3%), and reconstructive failure (10.3% vs 6.7%). Total complication rates were similar between groups (51.7% vs 42.9%). Overall 6.4% of patients who underwent immediate alloplastic breast reconstruction required PMRT over a 10-year period. Complication rates for infection, capsular contracture, revision surgery, wound dehiscence and device exposure, and reconstructive failure were similar between both groups. Total complication rates were similar between groups. This information will help to inform decision-making regarding immediate alloplastic reconstruction and expected complications when PMRT is needed.