Median Width Research Articles

Stratospheric aerosol size reduction after volcanic eruptions

Abstract. The stratospheric aerosol layer plays an important role in the radiative balance of Earth primarily through scattering of solar radiation. The magnitude of this effect depends critically on the size distribution of the aerosol. The aerosol layer is in large part fed by volcanic eruptions strong enough to inject gaseous sulfur species into the stratosphere. The evolution of the stratospheric aerosol size after volcanic eruptions is currently one of the biggest uncertainties in stratospheric aerosol science. We retrieved aerosol particle size information from satellite solar occultation measurements from the Stratospheric Aerosol and Gas Experiment III mounted on the International Space Station (SAGE III/ISS) using a robust spectral method. We show that, surprisingly, some volcanic eruptions can lead to a decrease in average aerosol size, like the 2018 Ambae and the 2021 La Soufrière eruptions. In 2019 an intriguing contrast is observed, where the Raikoke eruption (48∘ N, 153∘ E) in 2019 led to the more expected stratospheric aerosol size increase, while the Ulawun eruptions (5∘ S, 151∘ E), which followed shortly after, again resulted in a reduction in the values of the median radius and absolute distribution width in the lowermost stratosphere. In addition, the Raikoke and Ulawun eruptions were simulated with the aerosol climate model MAECHAM5-HAM. In these model runs, the evolution of the extinction coefficient as well as of the effective radius could be reproduced well for the first 3 months of volcanic activity. However, the long lifetime of the very small aerosol sizes of many months observed in the satellite retrieval data could not be reproduced.

Middle meningeal artery embolization without surgical evacuation for chronic subdural hematoma: a single-center experience of 209 cases.

Middle meningeal artery (MMA) embolization is a minimally invasive treatment option for new and recurrent chronic subdural hematomas (cSDH). To examine the safety and efficacy profile of MMA embolization without surgical evacuation for cSDH patients. A single-center retrospective study of patients with cSDHs treated by MMA embolization was undertaken. Patient demographics, hematoma characteristics, procedural details, and clinical and radiological outcomes were collected. The primary outcome was the need for retreatment, and the secondary outcomes were at least a 50% reduction in the maximum width of cSDH on the last CT imaging, complications, and an improvement in the modified Rankin scale (mRS) score. All results were presented as descriptive statistics. A total of 209 MMA embolizations were successfully performed on 144 patients. Polyvinyl alcohol particles were the primary embolization agent in all procedures. Of the total of 206 cSDH, the median maximum width at pre-intervention and last follow-up were 12 and 3 mm, respectively, and the median reduction percentage was 77.5%, with a >50% improvement observed in 72.8% at the last follow-up imaging. A total of 13.8% of patients needed retreatment for recurrent, refractory, or symptomatic hematomas after embolization. The mRS score improved in 71 (49.3%) patients. Of 144 patients, 4 (2.8%) experienced complications related to the procedure, and 12 (8.4%) died during follow-up due to causes unrelated to the MMA embolization procedures. This study supports the fact that MMA embolization without surgical evacuation is a safe and effective minimally invasive option for the treatment of cSDHs.

New endoscopic closure technique, “internal traction–assisted suspended closure,” for GI defect closure: a pilot study (with video)

After endoscopic full-thickness resection (EFTR), reliable closure of the perforation is critical. However, it is technically difficult to close some defects by using metal clips alone or by purse-string suturing, which may lead to unreliable closure. Inspired by the process of pulling up the 2 ends of the incision in the surgical suture, we developed a new endoscopic closure technique, the "internal traction-assisted suspended closure" technique. This pilot study was performed as an initial evaluation of the feasibility and safety of this new endoscopic closure technique. Data from patients in whom this suspended closure technique was used to close full-thickness defects after EFTR were retrospectively reviewed. The primary outcome was successful closure rate. Secondary outcomes were closure time, length of postprocedural hospital stay, and incidence of postprocedural adverse events. Defect size and tumor characteristics were also analyzed. Eight patients who underwent the suspended closure technique after EFTR were included. All patients were successfully treated with the suspended closure technique, and no patient developed serious adverse events. The median length of the defect was 3.25 cm (range, 2.5-9.0) and the median width was 2.8 cm (range, 1.8-6.0). The median closing time was 13 minutes (range, 6-24). The internal traction-assisted suspended closure technique is a simple, reliable, and easy-to-use technique for large full-thickness defects after endoscopic resection.

No Doppler Single Position-Lateral Intercostal Artery Perforator Flap (NDSP-LICAP):a Safe and Versatile Flap for Breast Oncoplasty in Resource-Limited Setting.

The lateral intercostal artery perforator flap (LICAP) has emerged as one of the safest and less morbid flaps for lateral and central breast defects. We hereby describe a reproducible no Doppler single position (NDSP) technique to harvest it in single position without handheld Doppler, making it a versatile flap for lateral breast defects in resource-limited setting also. With this technique, we performed a total of 22 LICAP turnover flaps over a period of 18months from January 2020 to June 2021. In all 22 cases, the indication of flap was to fill the post-breast conservation surgery (BCS) defects in outer quadrant of breast. All LICAP flaps were harvested by surface marking of anatomical landmarks and without handheld Doppler. Out of 22 LICAP turnover flaps, thirteen were harvested for left breast and nine for right breast. The median width and length of the flap were 12.2cm and 19.6cm, respectively. The additional mean operative time was 41min. All LICAP flaps survived well, and grade 1 Clavien-Dindo morbidity was documented in four cases. Mean hospital stay was 2.6days. All patients received radiotherapy on their stipulated schedule. Early cosmetic outcome was good, and long-term outcomes are awaited. NDSP-LICAP flap is a workhorse for lateral breast defects. Precise knowledge of perforators and anatomical landmarks can be used for harvesting these flaps, thus avoiding ultrasound Doppler and dedicated training for perforator localization. This technique has short learning curve without the need for any plastic surgery training. The early cosmetic outcomes are good.

The [O iii] Profiles of Far-infrared Active and Inactive Optically Selected Green Valley Galaxies

We present a study of the [O iii] λ5007 line profile in a subsample of eight active galactic nuclei (AGNs) and six non-AGNs in the optically selected green valley at z < 0.5 using long-slit spectroscopic observations obtained with the 11 m Southern African Large Telescope. Gaussian decomposition of the line profile was performed to study its different components. We observe that the AGN profiles are more complex than the non-AGN ones. In particular, in most AGNs (5/8) we detect a blue wing of the line. We derive the FWHM velocities of the wing and systemic component, and find that the AGNs show higher FWHM velocities than the non-AGNs in their core component. We also find that the AGNs show blue wings with a median velocity width of approximately 600 km s−1, and a velocity offset from the core component in the range −90 to −350 km s−1, in contrast to the non-AGN galaxies, where we do not detect blue wings in any of their [O iii] λ5007 line profiles. Using the spatial information in our spectra, we show that at least three of the outflow candidate galaxies have centrally driven gas outflows extending across the whole galaxy. Moreover, these are also the galaxies which are located on the main sequence of star formation, raising the possibility that the AGNs in our sample are influencing the star formation of their host galaxies (such as positive feedback). This is in agreement with our previous work where we studied the star formation, morphology, and stellar population properties of a sample of green valley AGNs and non-AGN galaxies.

Exploring the significance of road and traffic factors on traffic crashes in a South African city

• Road and traffic factors significantly influence traffic crashes in South Africa. • Road width, access roads, and medians influence traffic crashes significantly. • The influence of the number of lanes on traffic crashes is not significant. • While speed influences traffic crashes significantly, the influence of ADT is not conclusive. • The combined effect of limiting road width, access roads, speed and increasing medians reduce traffic crashes. Traffic crashes on the roads of South African cities is a critical problem. Road and traffic-related parameters are argued to contribute significantly to this challenge. Therefore, this study assessed the relative impact of the major road and traffic parameters on the incidence of traffic crashes on the roads of the cities of South Africa. Data collected both from surveys and authentic organisations, as well as inferential statistics with Negative Binomial regression modelling approaches, were used. Findings suggested that road width, number of access roads, median width, and vehicle speed influence the incidence of traffic crashes in that order. A combined effect of restriction of the road width, limiting the number of access roads, increase in median width and reduction in the speed can reduce the incidence of traffic crashes by more than three-fifth of the total crashes that occur in the business as usual scenario. The findings of the study can assist the road and traffic departments and municipalities to take the appropriate road and traffic-related interventions to improve road safety on urban roads.

Study on Pedestrian Rolling Gap Crossing Behavior at Intersection Crosswalks: A Case Study of Gambella Town

Due to rapid urbanization, a rise in vehicle growth, and a lack of adherence to traffic rules and regulations by drivers and pedestrians, traffic accidents involving pedestrians have become a significant safety problem in most developing countries, including Ethiopia. Urban areas account for the majority of pedestrian accidents. Traffic accidents involving pedestrians are more likely to occur when they are crossing the road. The majority of these accidents occur when pedestrians use rolling gap crossing behavior. The main objective of this study is to explore pedestrian rolling gap crossing behavior at intersection crosswalks in Gambella town. Data regarding pedestrian rolling gap crossing, pedestrian, geometric and environmental characteristics were collected through videography survey method, on-site observation, and measurement. An observational checklist was used to conduct on-site observations at each crosswalk at the selected intersection. Road width, lane width, and median width were also measured using meter tape. Using the collected data, a binary logistic regression model was developed. The developed model revealed that three statistically significant factors significantly affected pedestrian rolling gap crossing. These factors included gender, age, and crosswalk condition. Furthermore, secondary sources were reviewed, including ERA manual, AASHTO manual, and Gambella town master plan. The results of on-site observation, measurements, and the review of secondary sources were used to suggest remedial measures at existing intersection crosswalks.

Comprehensive Investigation of Commercial Motor Vehicle Crashes at Signalized and Unsignalized Intersections in Kentucky

This study develops safety performance functions (SPFs) for “fatal and injury” (FI) commercial motor vehicle (CMV) crashes (here, a CMV is defined as a large truck or a bus) at both signalized and unsignalized intersections in Kentucky. Five count-response regression models—negative binomial, Conway–Maxwell–Poisson, heterogeneous Conway–Maxwell–Poisson, zero-inflated Conway–Maxwell–Poisson, and zero-inflated heterogeneous Conway–Maxwell–Poisson (ZI-HTCMP)—were developed and compared at each of the selected signalized and unsignalized intersections. FI CMV intersection-related crash data in Kentucky over a period of five years (2015 to 2019) were used. Information on road-specific characteristics, for example, shoulder width, median width and type, International Roughness Index (IRI) value, and traffic volume (including annual average daily traffic [AADT] and heavy vehicle percentage [HVP]) was collected. Additionally, information on intersection-specific characteristics, for example, number of through lanes and presence of exclusive left- and right-turn lanes on major and minor roads, was collected using Google Maps’ street view time slider back to the crash year. For both signalized and unsignalized intersections, the ZI-HTCMP model (with a varying dispersion parameter) outperformed the other comparative models. With regard to signalized intersections, a speed limit of greater than 45 mph on the major road, a speed limit greater than 45 mph on the minor road, and a median on the major road wider than 3 ft were significantly associated with increased FI CMV crashes. As far as unsignalized intersections were concerned, higher major road AADT, 4-legged configuration, a speed limit greater than 45 mph on the major road, and an IRI value of greater than 100 for the major road were significantly associated with increased FI CMV crashes. The SPF results (for each of the signalized and unsignalized intersections) were then used to identify the top 10 hazardous locations for each intersection type.

Cardiac resynchronization therapy via left bundle branch area pacing and a dual-chamber ICD; a CROSS-LEFT substudy

Abstract Funding Acknowledgements Type of funding sources: None. Background Left bundle branch area pacing (LBBAP) has emerged as a promising technique to deliver cardiac resynchronization therapy (CRT). Purpose We sought to evaluate the feasibility of a single LBBAP lead connected to a dual-chamber ICD in patients indicated with a CRT-D implantation. Methods The CROSS-LEFT study prospectively included consecutive sinus rhythm patients with a reduced ejection fraction and a complete left bundle branch block. A DF-1 lead was implanted at the right ventricular apex, and an LBBAP lead through the interventricular septum. Patients were implanted with a dual-chamber DF-1 defibrillator (ICD) connected to the atrial lead (RA port), the LBBAP lead (RV IS-1 port), and the defibrillation lead (RV DF-1 port), the IS-1 pin being capped. Atrioventricular delay was optimized to ensure fusion between LBBAP and native conduction from the right bundle. Patients were followed during 6 months. Results A total of 22 patients were included (median age 68 years, 77% male, 41% ischemic). LBBAP resulted in a significant reduction of median QRS width from 161 to 128ms (p&amp;lt;0.0001). At 6 months, median ventricular sensing was 18mV (range 5–31, IQR 9), and LBBAP threshold 0.5V (range 0.25–0.75, IQR 0). Median LVEF significantly improved from 27 to 45% at 6 months (p&amp;lt;0.0001), with a median reduction of LV end-systolic volume of 32% (p=0.0002), 67% of patients being considered as super-responders. Conclusion In patients with a left bundle branch block indicated with a biventricular defibrillator, CRT can be safely and efficiently performed via a single LBBAP lead connected to a dual-chamber ICD, and is associated with significant electromechanical reverse remodeling.

Firn aquifer water discharges into crevasses across Southeast Greenland

AbstractIn Southeast Greenland, summer melt and high winter snowfall rates give rise to firn aquifers: vast stores of meltwater buried beneath the ice-sheet surface. Previous detailed studies of a single Greenland firn aquifer site suggest that the water drains into crevasses, but this is not known at a regional scale. We develop and use a tool in Ghub, an online gateway of shared datasets, tools and supercomputing resources for glaciology, to identify crevasses from elevation data collected by NASA's Airborne Topographic Mapper across 29000 km2of Southeast Greenland. We find crevasses within 3 km of the previously mapped downglacier boundary of the firn aquifer at 20 of 25 flightline crossings. Our data suggest that crevasses widen until they reach the downglacier boundary of the firn aquifer, implying that crevasses collect firn-aquifer water, but we did not find this trend with statistical significance. The median crevasse width, 27 meters, implies an aspect ratio consistent with the crevasses reaching the bed. Our results support the idea that most water in Southeast Greenland firn aquifers drains through crevasses. Less common fates are discharge at the ice-sheet surface (3 of 25 sites) and refreezing at the aquifer bottom (1 of 25 sites).

Towards identifying a learning curve for robotic abdominal wall reconstruction: a cumulative sum analysis.

Over the past decade, an increase has been seen in robotics used for hernia repair, specifically robotic abdominal wall reconstruction (rAWR). However, the learning curve for rAWR can be steep and presently, little is understood regarding the optimal case volume required to achieve proficiency. The aim of our study was to review skill acquisition and describe the learning curve for rAWR. A retrospective, single-surgeon case series of consecutive patients who underwent rAWR from 2018 to 2022. The primary outcome was operative time, obtained from console time identified through the MyIntutive application. A one-sided cumulative sum analysis (CUSUM) curve for the total operative time was derived based on the mean operative time of chronological procedures (207min). 185 patients underwent rAWR between 2018 and 2022. These patients were more likely to be female, Caucasian, and have undergone two previous hernia repairs. ASA complexity increased over time with ASA 3 being predominant from 2020 onwards. The median hernia length was 15.0cm and the median width was 7cm. Average operative time was 207.8min and decreased over time. The CUSUM analysis identified four phases of skill acquisition with the following case volumes: Initial Learning Curve (0-20), Stabilization Phase (21-55), Second Learning Curve (56-70), 4) Skill Proficiency (> 70). In the early learning curve of rAWR, operative time decreased consistently after 70 cases, with an initial inflection after 20 cases. We identified varying stages of skill acquisition that are likely typical of a surgeon as they would progress through the learning curve of advanced robotic surgery. Future studies are needed to confirm the optimal case volume for determining the skill level for the performance of rAWR.

Characterization of the reticulum-mitochondria coupling in human immortalized B lymphocytes

During myocardial infarction (MI), dying cardiomyocytes induce an acute inflammatory response that, if prolonged, will weaken the heart even beyond the initially injured area and promote the occurrence of secondary cardiac events. This inflammatory response is partially mediated by circulating immune cells, including B lymphocytes which have emerged as a new therapeutic target of interest to prevent damages related to this post-MI inflammation. B cell activation is a Ca2± dependent process, which promotes the production of pro- and anti-inflammatory cytokines. Ca2+ homeostasis is therefore essential to ensure their proper functioning. Whether an alteration of Ca2+ homeostasis in B lymphocytes occurs during MI remains unknown. Ca2+ signaling relies notably on the reticulum-mitochondria coupling (MAM); however, the role of MAM in B cell activation is not yet elucidated. Our aim is to characterize the role of the reticulum-mitochondria coupling in B lymphocyte function in order to further establish their potential alteration during MI. B cells from three healthy patients were immortalized with the Epstein–Barr virus, as an alternative to native B cells since their short lifespan limits analyses. MAM composition and structure were respectively analyzed by Western blot and electron microscopy (EM). Intracellular Ca2+ measurements in the different cell compartments (cytosol, endoplasmic reticulum and mitochondria) were performed using fluorescent chemical or genetic Ca2+ probes followed by wield-field microscopy. We confirmed the expression of proteins involved in Ca2+ transfer at MAM interface (IP3R, GRP75, VDAC1, MCU, MICU1) in immortalized B lymphocytes of the three patients. EM preliminary results revealed a reticulum-mitochondria median width of ∼31.15 nm compatible with Ca2+ transfer, and a median of ∼10.9% of the mitochondrial surface involved in MAM formation, with no significant difference between patients. Ca2+ imaging is still ongoing. Immortalized B lymphocytes display MAM structural and functional characteristics. Therefore, immortalized B cells may represent a relevant model to study the role of MAM during MI.

Utility of Ultrasound for Identifying Median Nerve Changes Indicative of Acute Carpal Tunnel Syndrome After Distal Radius Fracture

Ultrasound offers a fast and inexpensive way to evaluate the median nerve. However, there is a paucity of data assessing ultrasound in acute trauma. Our study aimed to characterize median nerve changes indicative of acute carpal tunnel syndrome (ACTS) in a cadaveric distal radius fracture (DRF) model. We used 10 upper-extremity specimens. We induced ACTS (carpal tunnel pressure >40 mm Hg) in a distraction-only model and then used a DRF model as a neutral position, under traction, or wrist extension. We measured the median nerve cross-sectional area (CSA), height, and width with ultrasound in each model. We used a novel calculation, height-width ratio (HWR), to describe nerve shape. A low HWR indicates an elliptical shape; as the HWR increases toward one, the shape becomes more circular. The CSA measurements and HWR at pressures >40 mm Hg were used to calculate a 95% confidence interval, which defined the threshold for ACTS. Wrist distraction created carpal tunnel pressures >40 mm Hg in all specimens. Distraction increased CSA compared with baseline (9.1 ± 0.9 mm2 vs 6.3 ± 1.2 mm2, P < .001). Under ACTS-level pressures, the thresholds for CSA and HWR were 8.5 mm2 and 0.41, respectively. HWR significantly increased with distraction compared with baseline (0.47 ± 0.10 vs 0.28 ± 0.09, P= .006). Most neutral DRF models (n= 8, 80%) met the CSA threshold for ACTS, whereas all specimens with a DRF extended or under traction had CSAs above the ACTS threshold. Compared to the baseline, the shape of the median nerve was more circular in all DRFs, including neutral (0.28 ± 0.09 vs 0.39 ± 0.13), under traction (0.43 ± 0.09), and extended (0.45 ± 0.09). ACTS should be suspected in patients with median nerves demonstrating increased CSA and adopting a more circular shape. Fracture positioning impacts median nerve CSA with wrist extension, causing the greatest change. Median nerve HWR may offer an easier ultrasonographic alternative to CSA. Diagnostic III.

Risk perceptions of pedestrians for traffic and road features

Traffic fatalities from 2015 to 2019 in Uttar Pradesh (UP), India show that pedestrians and cyclists have the largest share of total road fatalities. This study analyzed the pedestrian’s perceptions of risk in the medium-sized city-Bulandshahr-UP, India regarding the traffic and road features. Perception of risk provides important information in identifying potential risks and explaining travel choices by pedestrians. The study locations were selected based on identified blackspots i.e. clustering of actual fatal crashes during 2015–2019 in UP. The types of locations at the blackspots were intersections below flyover, four-way signalized intersections, midblocks and foot of flyovers. An empirical analysis is presented in the study by taking pedestrians’ ranking of the selected risk factors like traffic speed, free left turn at intersections, unmarked crosswalks, median width, traffic volume and the number of lanes and using the Rank-ordered logit model. Traffic speed and median width were ranked as the two highest risk factors by pedestrians. The results also indicated that increased numbers of lanes are more likely to be perceived riskier by older age groups of pedestrians and females at intersections below flyovers and midblocks. A comparison of different locations shows that all the factors were significant at four-way signalized intersections, indicating more perceived risk by pedestrians at intersections. These significant results can be used by practitioners to design safer intersections and midblocks at selected locations for pedestrians in UP, India.

Mediumweight polypropylene mesh fractures after open retromuscular ventral hernia repair: incidence and associated risk factors.

Mediumweight (MW) and heavyweight (HW) polypropylene have demonstrated similar clinical and patient-reported outcomes in the setting of open retromuscular ventral hernia repair (VHR). While MW mesh has an anecdotal risk of central mesh fracture, that phenomenon is not well-characterized. We sought to assess the incidence of and risk factors for MW polypropylene mesh fractures after VHR. The ACHQC registry was queried for patients with CT-documented hernia recurrence after open retromuscular VHR with MW polypropylene mesh at our institution with 1-year follow-up between January 2014 and April 2022. Images were reviewed by five blinded surgeons at Cleveland Clinicto reach consensus that hernia recurrence mechanism was central mesh fracture.Patients without clinical recurrence or patient-reported bulge were used as a comparator group. Eighty patients were identified with radiographically documented recurrence; 28 had recurrence from mesh fractures and these were compared to 644 patients without recurrence. Incidence of MW fracture was 4.2%. Bridging of anterior fascia was more common in the group with the central mesh fracture (33.3% vs 3.3%, p < 0.001); the incidence of fracture was 30% (9/30) in patients requiring a bridged closure. Mesh fracture was associated with larger hernias (median width: 20cm [16-26] vs 15cm [12-18], p < 0.001,), length (25cm [23-30] vs 23cm [19-26], p = 0.004). MW polypropylene mechanical failures are surprisingly common, particularly in settings of bridged fascial closure and larger hernias. Use of HW polypropylene should be considered in this setting, and industry should be encouraged to create larger pieces of HW polypropylene mesh.

Long-term maintenance treatment of recurrent ureteropelvic junction obstruction with covered metallic ureteral stent.

Whether or not the covered metallic ureteral stent can be used as maintenance treatment for recurrent ureteropelvic junction obstruction (UPJO) after pyeloplasty is unknown. Therefore, this study aims to analyze its feasibility. We retrospectively analyzed the records of 20 patients with recurrent UPJO who were treated with the covered metallic ureteral stents from March 2019 to June 2021 at our institution. Then, we assessed their renal function, stent patency and stent-related quality of life by the blood creatinine, renal ultrasound (or computed tomography), and the Chinese version of the ureteral symptom score questionnaire (USSQ). The last follow-up mean blood creatinine dropped from 0.98 ± 0.22 to 0.91 ± 0.21 mg/dL (P = .04), and the median renal pelvic width was reduced from 3.25 (3.10) to 2.00 (1.67) cm (P = .03) compared with the preoperative conditions. Meanwhile, the last follow-up mean USSQ total score of the covered metallic ureteral stent among the 16 patients with preoperative indwelling double-J ureteral stent was 78.56 ± 14.75, significantly lower than the preoperative USSQ total score, which was 102.25 ± 5.57 (P < .001). During the median duration of follow-up of 27.00 (18.00) months, 85% (17/20) of patients maintained unobstructed drainage from the renal pelvis to the ureter. Stent-related complications occurred in 7 patients, 3 of which failed because of complications, including stent migration (1 patient), stent encrustation (1 patient), and stent-related infection (1 patient). The covered metallic ureteral stent is feasible for the long-term maintenance treatment of recurrent UPJO after pyeloplasty.

First extensor compartment morphology and clinical significance: a cadaver series study.

The first extensor compartment of the wrist is a distinctly variable anatomical area. Anatomical variations in this region contribute to the pathophysiology and treatment failure of de Quervain's disease, which is a kind of tenosynovitis that develops in the first extensor compartment of the wrist. We aim to describe the first extensor compartment morphology, to evaluate the septum frequency, location of the septum, and the number of tendons of abductor pollicis longus (APL) and extensor pollicis brevis muscles (EPB). First extensor compartment of 87 wrists of 45 cadavers were dissected. The presence or absence of septum and number of tendon slips of APL and EPB revealed. The proximal and distal widths of the compartments were measured. Septums were detected in 60.9% (n=53) of the wrists. Incomplete (distal) and complete (proximal) septa were present in 35.6% (n=31) and 25.3% (n=22) of the cases. Only 26.4% of the wrists had a single slip of APL tendon. The Remaining had multiple slips. The median inner width of the proximal and distal compartments in all wrists were calculated as in the order of 9.11±1.14 mm and 8.55±1.12 mm. We believe that understanding the anatomy of the first extensor compartment in the Turkish population would be helpful to surgeons, radiologists, and physiotherapists to diagnose and manage de Quervain's disease.

Asbestiform fibers and cleavage Fragments: Conceptual approaches for differentiation in laboratory practice and data analysis

The respirable fractions from 46 different crushed amphibole samples were separated by water elutriation. The dimensions of approximately 200 elongate mineral particles (EMPs) longer than 5 μm in each of these fractions were measured by transmission electron microscopy (TEM). The data were used to address three questions:1. Can amphiboles be classified on a scale that represents the level of inhalation hazard they present?2. Can prismatic amphibole be discriminated from amphibole asbestos on the basis of EMP size distributions and concentration measurements?3. How do different exposure indices (Phase Contrast Microscopy Equivalent (PCME), Berman & Crump protocol fibers, Chatfield extra-criteria EMPs) compare when applied to these amphibole samples?For each sample, the number of respirable EMPs longer than 5 μm per gram of respirable dust and the number of extra-criteria EMPs per gram of respirable dust were calculated. The number of respirable EMPs longer than 5 μm per gram of respirable dust and the proportion of those with dimensions associated with mesothelioma in animal studies were considered to be contributors to the inhalation hazard presented by amphibole dust. In addition to these concentration measurements, the median EMP width, median aspect ratio and the aspect ratio geometric standard deviation (GSD) were considered to be relevant parameters in discriminating prismatic amphibole from asbestiform amphibole. A plot of the aspect ratio GSD against either the concentration of respirable EMPs per gram of respirable dust, the median aspect ratio or the median width allowed discrimination.The data showed a close correspondence between exposures in terms of Chatfield extra-criteria EMPs and Berman and Crump protocol structures for all of the amphibole samples. However, although for commercial asbestos varieties exposures in terms of PCME fibers were comparable to those of the other two metrics, they greatly exceeded those for non-asbestiform amphiboles.

Size and morphology of the coracoid and glenoid in pediatric and adolescent patients: implications for Latarjet procedure

Glenohumeral instability is a challenging problem in children and adolescents. For patients with anterior glenoid bone loss, the Latarjet procedure is an effective treatment option. However, concerns about coracoid size and morphology may limit its utilization within this patient population. The purpose of this study was to establish normative data on coracoid and glenoid size and morphology among a large cohort of adolescent patients and describe the anatomic relationships with demographic factors. This is a retrospective cross-sectional study of a consecutive series of 584 patients aged 12-21 years after a chest computed tomography scan for non-shoulder related trauma at a single level I trauma center. Demographic characteristics were collected from the electronic medical record, and the following coracoid anatomic measurements were obtained from computed tomography scans: coracoid length, coracoid thickness, coracoid width, glenoid height, and glenoid width. The ratio of coracoid thickness to glenoid width was calculated to estimate the percent bone loss that could be addressed with a traditional Latarjet coracoid transfer. To ensure reliability among 3 reviewers, all measured the same 25 scans and inter-rater reliability was excellent with all Kappa coefficients >0.81. The remaining scans were divided equally and assessed separately by these reviewers. Correlation coefficients were used to quantify the relationships between all anatomic measures and the age, weight, and height of individuals. Growth curves for each measurement were modeled using quantile regression with height and height∗height as predictors. Additionally, we stratified the growth curves by sex, when significant. Of the 584 subjects, 55% were male, and average age was 19 years (range 12, 21). All growth curves illustrated increase anatomic size across the height range of 145-190 cm. The growth curve including all patients (Fig.1) illustrated that the 50% percentile of median coracoid length increased from approximately 28 to 32 mm. In addition to height, sex was a significant predictor for coracoid width and glenoid width. The median coracoid width increased from approximately 9.5 to 10.2 mm for females compared to an increased width from approximately 10 to 11 mm for males. The median glenoid width for females increased from approximately 21 to 25 mm and for males the median glenoid width increased from just under 22 to 25.5 mm. Among children and adolescents, coracoid and glenoid size are correlated with patient height. These data can help guide patient selection for the Latarjet procedure.

Middle meningeal artery embolization as a perioperative adjunct to surgical evacuation of nonacute subdural hematomas: An multicenter analysis of safety and efficacy.

By 2030, nonacute subdural hematomas (NASHs) will likely be the most common cranial neurosurgery pathology. Treatment with surgical evacuation may be necessary, but the recurrence rate after surgery is as high as 30%. Minimally invasive middle meningeal artery embolization (MMAE) during the perioperative period has been posited as an adjunctive treatment to decrease the potential for recurrence after surgical evacuation. We evaluated the safety and efficacy of concurrent MMAE in a multi-institutional cohort. Data from 145 patients (median age 73 years) with NASH who underwent surgical evacuation and MMAE in the perioperative period were retrospectively collected from 15 institutions. The primary outcome was the rate of recurrence requiring repeat surgical intervention. We collected clinical, treatment, and radiographic data at initial presentation, after evacuation, and at 90-day follow-up. Outcomes data were also collected. Preoperatively, the median hematoma width was 18 mm, and subdural membranes were present on imaging in 87.3% of patients. At 90-day follow-up, median NASH width was 6 mm, and 51.4% of patients had at least a 50% decrease of NASH size on imaging. Eight percent of treated NASHs had recurrence that required additional surgical intervention. Of patients with a modified Rankin Scale score at last follow-up, 87.2% had the same or improved mRS score. The total all-cause mortality was 6.0%. This study provides evidence from a multi-institutional cohort that performing MMAE in the perioperative period as an adjunct to surgical evacuation is a safe and effective means to reduce recurrence in patients with NASHs.