Median Width Research Articles

MOVER-R and Penalized MOVER-R Confidence Intervals for the Ratio of Two Quantities

Developing a confidence interval for the ratio of two quantities is an important task in statistics because of its omnipresence in real world applications. For such a problem, the MOVER-R (method of variance recovery for the ratio) technique, which is based on the recovery of variance estimates from confidence limits of the numerator and the denominator separately, was proposed as a useful and efficient approach. However, this method implicitly assumes that the confidence interval for the denominator never includes zero, which might be violated in practice. In this article, we first use a new framework to derive the MOVER-R confidence interval, which does not require the above assumption and covers the whole parameter space. We find that MOVER-R can produce an unbounded confidence interval, just like the well-known Fieller method. To overcome this issue, we further propose the penalized MOVER-R. We prove that the new method differs from MOVER-R only at the second order. It, however, always gives a bounded and analytic confidence interval. Through simulation studies and a real data application, we show that the penalized MOVER-R generally provides a better confidence interval than MOVER-R in terms of controlling the coverage probability and the median width.

Impact of width of susceptibility vessel sign on recanalization following endovascular therapy

Background and purposeWe aimed to investigate the relationship between arterial recanalization following endovascular therapy and the susceptibility vessel sign (SVS) length and width on susceptibility-weighted imaging. MethodsWe retrospectively evaluated consecutive patients with anterior circulation ischemic stroke who underwent magnetic resonance imaging preceded endovascular therapy, and measured the SVS length and width. Successful recanalization was defined as expanded thrombolysis in cerebral infarction grade of 2b to 3. Logistic regression analysis was executed to determine the independent predictors of successful recanalization and first-pass reperfusion (FPR) after endovascular therapy. ResultsAmong 100 patients, successful recanalization and FPR were observed in 77 and 34 patients, respectively. The median SVS length and width were 10.3 mm (interquartile range, 6.8–14.1 mm) and 4.2 mm (interquartile range, 3.1–5.2 mm), respectively. In multivariate logistic regression analysis, SVS width was associated with successful recanalization (odds ratio, 1.88; 95% confidence interval, 1.14–3.07; p = 0.005) and FPR (odds ratio, 1.38; 95% confidence interval, 1.01–1.89; p = 0.039). The optimal cutoff value for the SVS width to predict successful recanalization and FPR were 4.2 mm and 4.0 mm, respectively. ConclusionsLarger SVS width may predict successful recanalization and FPR following endovascular therapy.

Management of diastasis recti during ventral hernia repair: an analysis of the abdominal core health quality collaborative.

Advancements of minimally invasive techniques leveraged routine repair of concomitant diastasis recti (DR), as those approaches facilitate fascial plication and wide mesh overlap while obviating skin incision and/or undermining. Nevertheless, evidence on the value of such intervention is lacking. We aimed to investigate the management and outcomes of concomitant DR during ventral hernia repair (VHR + DR) from surgeons participating in the Abdominal Core Health Quality Collaborative (ACHQC). Patients who have undergone VHR + DR with a minimum 30-day follow-up complete were identified. Outcomes of interest included operative details, surgical site occurrences (SSO), medical complications, and readmissions. 169 patients (51% female, median age 46, median body mass index 31kg/m2) were identified. Most hernias were primary (64% umbilical, 28% epigastric). Median hernia width was 3cm (IQR 2-4) and median diastasis width and length were 4cm (IQR 3-6) and 15cm (IQR 10-20), respectively. Most operations were robotic (79%), with a synthetic mesh (92%) placed as a sublay (72%; 59% retromuscular, 13% preperitoneal). DR was repaired with absorbable (92%) and running suture (93%). Considering our cohort's relatively small diastasis and hernia size, a high rate of transversus abdominis release was noted (14.7%). 76% were discharged the same day and the 30-day readmission rate was 2% (2 ileus, 1 pneumonia). SSO rate was 4% (6 seromas, 1 skin necrosis) and only one patient required a procedural intervention. ACHQC participating surgeons usually perform VHR + DR robotically with a retromuscular synthetic mesh and close the DR with running absorbable sutures. Short-term complications occurred in approximately 6% of patients and were mainly managed without interventions. Larger studies with longer-term follow-up are needed to determine the value of VHR + DR.

Roadway and Traffic Attributes Influencing Occupancy Time of Minor-Road Right-Turning Vehicles at Urban Uncontrolled Intersections

The performance of uncontrolled intersection is usually measured based on delay of the least priority movement. Perhaps, most of the studies assumed single stage crossing and had to overlook additional factors for estimating occupancy time. The present study examines occupancy time under two-stage crossing under the influence of roadway and traffic attributes. Field data for this study are collected at five different isolated intersections. The analysis of field data is performed by observing the movements of individual vehicles from the minor road approach by considering various factors affecting it under mixed traffic conditions. And it was observed that Two-wheelers are tended to encroach into smaller gaps in between the vehicles due to its physical dimension and easy maneuvering followed by threewheelers. The occupancy time is observed had strong correlation with conflicting area, conflicting flow the proportion of U-turning major road traffic, vehicle dimension, and the increase of median width.

Safety of hydrogel spacers for rectal wall protection in patients with prostate cancer: A retrospective analysis of 200 consecutive cases.

To evaluate the safety and complications of hydrogel spacer implantation. This single-center historical cohort study retrospectively analyzed cases of hydrogel spacer implantation between October 2018 and March 2022. The survey items were the rates of possible hydrogel injection implementation, the success rate of hydrogel implantation including asymmetry, higher position, rectal wall infiltration, subcapsular injection, and other adverse events, and width created by the spacer. To investigate the learning curve, 1, 2, and 3 points were assigned to adverse event grades G1, G2, and G3, respectively. Spacer effectiveness obstruction, such as asymmetry was assigned 3 points. A Mann-Whitney U test was performed to assess statistically significant differences. The study included a total of 200 patients with a median (range) age of 70 (44-85) years. In 10 (5%) patients, hydrogel injection implementation was not possible. Of 190 patients who underwent hydrogel spacer placement, 168 (88%) received a satisfactory placement. The median (range) width of hydrogel spacers was 13.1 (4.4-18.7) mm. Spacer asymmetry, higher position, rectal wall infiltration, and prostate subcapsular infiltration occurred in 7 (3.7%), 5 (2.6%), 12 (6.3%), and 1 (0.5%) patients, respectively. G1 and G3 adverse events occurred in 13 (7%) and 4 (2%) patients, respectively. Practitioner #1 who performed the highest number of procedures had significantly (p=0.04) lower total scores in group B. Spacer implantation yielded favorable outcomes with a high percentage of appropriate spacer implantation, and few major complications.

Study on the Disturbance of Existing Subway Tunnels by Foundation Sloping Excavation

Urban subway tunnels are located in a very complex operating environment, and the surrounding construction disturbances can lead to the deformation of existing tunnels or even produce tunnel disease issues. The disturbance of adjacent tunnels by pit excavation is an important geotechnical issue among scholars. In our study, the two-stage method is used to derive the deformation of the existing tunnel caused by the use of sloping excavation in the foundation pit. Subsequently, the correctness of the theoretical calculation formulae and the results are verified by constructing numerical calculation models. The effects of different slope footings θ, different slope widths b and different excavation depths H on the deformation of the existing tunnel are analyzed. The results show that: the excavation of the foundation pit can effectively reduce the tunnel deformation by using the sloping excavation method. The soil directly above the tunnel is the main factor causing the deformation of that tunnel. When the foundation pit spans a single-lane existing tunnel, the sloping excavation method of excavating soil on both sides and reserving the middle core soil can be used. When the foundation pit spans a double-lane existing tunnel, the sloping excavation method of excavating the middle soil and reserving core soil on both sides can be adopted. The error between the theoretical calculation results and the numerical simulation results is small, which verifies the correctness of the theoretical calculation results. The load distribution width of the soil after sloping excavation can be taken as the median line width. The deformation of the existing tunnel is influenced, to a greater extent, by changes in the one-time excavation depth H and slope width b, and to a lesser extent, by changes in the slope angle θ.

Study on the Median Opening Length of a Freeway Work Zone Based on a Naturalistic Driving Experiment

Median openings are an effective traffic organization mode for freeway crossover work zones, and their length is one of the most important control indicators to ensure traffic safety in work zones. In this paper, a theoretical calculation model of the median opening length was established according to the lane-changing demands of vehicles crossing through the median opening of the freeway. Based on the calculation model, the influencing factors of the median opening length were analyzed, and the calculation values of the median opening length under different speed limits, median widths and cross slopes were proposed. A naturalistic driving experiment of drivers’ safety and comfort, with 48 participants at four opening lengths of 40, 70, 100 and 130 m in a typical freeway work zone, was carried out based on the calculated length values and the driving workload, expressing drivers’ safety and comfort. It was found that the median opening length of the freeway had a positive correlation with the vehicles’ running speed and the drivers’ driving workload: the shorter length reduced the running speed of the vehicles and led to uncoordinated running speeds in the work zone; the longer length caused driver tension and led to the vehicles’ running speed and speed variability being too high. The research results indicated that the median opening length of freeway work zones is an important factor affecting the vehicle running speed, driving workload and speed limit compliance rate.

Evaluation of the location, number and diameter of bezoars in patients with a history of previous gastrointestinal surgery.

Bezoars are foreign bodies developed due to the swallowing of indigestible substances in the stomach that accumulate in the lumen of the gastrointestinal tract. This study aimed to compare the location, size, and diameter of bezoars between patients with and without a history of previous gastrointestinal surgery and between operated and non-operated patients retrospectively. A total of 188 patients who presented to our gastroenterology clinic and in whom bezoar was suspected on clinical examination and the diagnosis confirmed through abdominal CT scans were included in the study. The patients were divided into two groups; patients with a history of previous gastrointestinal surgery were assigned to Group 1 (n = 70), and those who had no history of previous surgery (n = 118) to Group 2. The mean age was found as 56.16 ± 15.75years in Group 1 and 57.71 ± 15.95years in Group 2. The mean bezoar width was significantly higher in Group 1 (p = 0.049). The mean bezoar length was significantly higher in Group 1 (p = 0.004). Considering localization of bezoars, the rate of patients who underwent enterotomy (80%) was statistically significantly higher than the patients who underwent gastrotomy (23.50%), gastrotomy + milking (28.60%) and milking (44.70%) in the operations performed in the jejunum. Bezoars are a rare cause of intestinal obstruction. The median width and length of the bezoars were significantly higher in patients with a history of previous gastric surgery. There was no significant difference in other parameters. The most common localization was jejunum.

Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors

Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). Data from 2577 LLDs who underwent living donor hepatectomy (n=2511) or aborted living donor hepatectomy (n=66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n=446; 17.9%), adenomyomatosis (n=9), and papillary hyperplasia (n=6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n=207; 0.4%), cholelithiasis (n=53), cholesterol polyp (n=31), and noncholesterol polyp (n=19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P=.001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P=.015). The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.

3-D assessment of skeletal and dentoalveolar bilateral dimensions in unilateral impacted palatal canine cases - A CBCT study.

The aim of this study was to compare skeletal and dentoalveolar dimensions in subjects with maxillary unilateral impacted palatal canines versus the unaffected contralateral side using CBCT. Skeletal and dentoalveolar variables (Anterior alveolar ridge height, Anterior dentoalveolar height , nasal cavity width, basal nasal width, Lateral angulation of long axis of the incisors and canines with respect to the nasal horizontal plane, premolar to median raphe width, dimensions of lateral incisor and canine, root resorption of lateral incisors, crown-root angulation of lateral incisor, and sector classification of canine) were compared between the impacted and the contralateral sides. As the data had normal distribution, means were compared using students t test. The significance was set at p<0.05. The root resorption in lateral incisor was compared using Chi square test. Lateral angulation of long axis of canines, nasal cavity width, basal lateral width, and premolar to median raphe width were found to be significantly different. Maximum number fell in sector 4 (n = 23, 38.3%) in sector classification. Root resorption of lateral incisor on impacted side was insignificant. Skeletal and dento-alveolar dimensions vary between the impacted and non-impacted sides in unilateral palatal canine impaction cases. Canines on the impacted side were more mesially angulated compared to the non-impacted side. The nasal cavity width, basal lateral width and premolar to median raphe width were significantly less on the impacted side compared to the non- impacted side. Key words:Impacted canine, CBCT, skeletal dimensions, diagnosis, orthodontic treatment.

Системные взаимоотношения строения грудных позвонков и околопозвоночных мышц у мужчин зрелого возраста с избыточным весом

Objective - to identify patterns of structure and relationship of elements of the thoracic spine and surrounding muscles in males of the 2nd period of adulthood with overweight and obesity of the 1st degree. Materials and methods. The study was performed on computed tomograms of the thoracic spine of 63 healthy men aged 36 to 60 years with a height of 170 to 186 cm and a body weight of up to 74.3 to 110 kg. The vertebral dimensions and the width of the paravertebral muscle mass were evaluated ((Me; IQ-IIIQ), factor analysis by the principal component method). Results. With an increase in the ordinal number of the vertebra, the increase in the width and anterior-posterior size of the bodies occurs unevenly, two points of decrease in the median value of the size of the vertebral bodies are determined - ThV and ThX. A narrowing of the spinal canal ThI to ThVII was revealed, followed by an increase in size to ThXII. A decrease in the median values of the anterior and posterior heights of bodies ThIII and IX was found. The median values of the height of the legs increase with an increase in the ordinal number of the vertebra, however, a decrease in the median values was found in ThIV, ThVI, ThVIII 1 and ThX. A decrease in size was found between the vertices of the transverse processes of the vertebrae and the vertices of the transverse and spinous processes. The decrease in their median value is most pronounced in the upper thoracic vertebrae from ThI to ThVII. Analysis of the width of the muscle arrays revealed a wave-like decrease in the median width, with three rises at the level of ThIII, ThVI and ThXI and declines at the level of ThV, ThIX and ThXII. The results of factor analysis revealed two segments in the thoracic spine. The maximum influence on the structure of the first segment of ThI-VII is exerted by the width of the paravertebral muscle array. In the second segment from ThVIII to ThXII, the width and angle of inclination of the spinous process have the maximum effect. Conclusion. The thoracic spine in men includes two segments that differ in function: the cranial segment, which depends on the activity of the paravertebral muscles, and the caudal segment, which reflects the supporting function.

Wide-based oblique anastomosis reduces urethral stricture rate following the transverse preputial island flap procedure.

The transverse preputial island flap (TPIF) procedure remains one of the classic single-stage procedures for severe hypospadias repairs. The incidence of postoperative complications remained high. This study aims to describe a modified urethral anastomosis technique during the TPIF procedure for severe hypospadias repairs and report its outcomes. Data were collected retrospectively from consecutive patients who underwent the TPIF procedure by the same pediatric urologist between January 2018 and June 2023. Collected information included age at surgery, operative details, and outcomes at follow-up. Wide-based oblique anastomosis (WOA) technique was used as a modified urethral anastomosis in all cases. In brief, the dorsal edge of anastomosis was breadthwise anchored to the corpus cavernosum with 4-5 stitches, forming a spade-shaped anastomotic surface. A total of 72 patients were included in the study. The location of the corpus spongiosum division was penile in 27 patients (37.5%) and proximal in 45 patients (62.5%). The median glans width was 13 mm (range, 6-30 mm). The median ventral curvature after degloving was 45° (range, 30-150°). At a median follow-up of 4.1 years, complications occurred in 15 patients (20.8%), including nine cases of fistula, seven cases of urethral diverticulum and two cases of meatal stenosis. No cases of urethral stricture (US), urethral dehiscence, or ventral curvature occurred. Subsequent reoperations for diverticulum repairs showed that the dorsal side of the anastomosis was extensively fixed to the corpus cavernosum, forming a wide-based, spacious lumen. WOA technique is straightforward and effective, especially in the prevention of postoperative US.

EVALUATION FACTORS OF BOAT ACCIDENTS IN THE MUSI RIVER WATERS, INDONESIA

Musi River is a river placed in South Sumatra, Indonesia. The Musi River is also the biggest river with a median width of 504 meters (the widest is 1350 meters round Kemaro Island, and the shortest 250 meters is positioned around the Musi II River Bridge).The only means of transportation that can reach the area is by boat via the Musi River. People use the Musi River as a transportation route to travel from one place to another around Palembang City or to areas far from Palembang City and use ships to travel in order to shop for daily needs, work and others. However, in the operation of the ship on its way there are still accidents, which often occur are accidents caused by human error, besides that there are often obstacles with natural conditions. For example, waves and on every bank of the Musi river, there are lots of tree plants that interfere with the smooth flow of traffic. Recently, in the Musi River there was an accident other than in Akibarka, the natural condition of the accident was caused by human negligence Two speedboats with the brand Rahendi Putra and Five Brothers collided while in the waters of the Musi River, Palembang, South Sumatra (South Sumatra), Wednesday (30/5/2018). Accidents in the Last Two Years Tuesday on the Awet Muda speedboat revealed new facts. In the last two years, the fast boat company has had two accidents that claimed lives.

Genital Hypoplasia before Gender-Affirming Vaginoplasty: Does the Robotic Peritoneal Flap Method Create Equivalent Vaginal Canal Outcomes?

Insufficient genital tissue has been reported as a barrier to achieving depth in gender-affirming vaginoplasty. The authors sought to characterize vaginal depth and revision outcomes in patients with genital hypoplasia undergoing robotic peritoneal flap vaginoplasty. Retrospective case-control analysis of patients undergoing robotic peritoneal vaginoplasty between September of 2017 and August of 2020 was used. All 43 patients identified as having genital hypoplasia (genital length <7 cm) were included with 49 random controls from the remaining patients with greater than 7 cm genital length. Baseline clinical characteristics and perioperative variables were recorded to identify potential confounders. Outcomes measured included vaginal size reported at last visit and undergoing revision surgery for depth or for vulvar appearance. Patients were well matched other than median body mass index at the time of surgery, which was greater in the hypoplasia cohort by 3.6 kg/m 2 ( P < 0.0001). Patients had a median of 1-year of follow-up, with a minimum follow-up of 90 days. No significant differences in outcomes were observed, with a median vaginal depth of 14.5 cm (interquartile range, 13.3 to 14.5 cm), and a median width of dilator used of 3.8 cm (interquartile range, 3.8 to 3.8 cm). No depth revisions were observed, and an 11% ( n = 10) rate of external revision occurred. Patients with genital hypoplasia had equivalent dilation outcomes in a case-control analysis with consistent follow-up past 90 days. The robotic peritoneal flap vaginoplasty technique provides vaginal depth of 14 cm or greater regardless of genital tissue before surgery. Further investigation with patient-reported outcome measures is warranted. Risk, II.

Down‐delta hydraulic geometry and its application to the rock record

ABSTRACTPalaeodischarge estimation is largely undertaken within fluvial settings. However, there are limited palaeodischarge estimates specifically from delta deposits, despite their significance globally. Estimating water palaeodischarges for deltas using catchment‐based approaches developed using data from fluvial settings requires estimating parameters from the rock record (for example, palaeotemperature, palaeoslope and palaeorelief). These may be difficult to determine, leading to under‐estimation or over‐estimation of palaeodischarge values due to differences in process‐form relationships between alluvial rivers and deltas. When a sediment‐conveying fluvial channel enters a standing body of water, delta lobes develop through repeating mouth bar deposition due to flow deceleration, forming a deltaic morphology with distributary channel networks that differ morphologically from those developed in unidirectional flowing alluvial rivers. This study provides empirical relationships determined across five climate regions, using 3823 measurements of distributary channel width from 66 river deltas alongside the trunk river bankfull discharge that feeds into the entire delta, using a hydraulic geometry scaling approach. Empirical relationships are developed from the global delta dataset between bankfull discharge and catchment area (Qb–A), and bankfull discharge and median distributary channel width (Qb–Wmed). These empirical relationships produce very strong statistical correlations, especially between Qb and Wmed, across different climate regions (Qb = 0.34 Wmed1.48, R2 = 0.77). However, both Qb–A and Qb–Wmed relationships have outliers that may be explained by particular hydrological or geomorphic conditions. These new empirical relationships derived from modern systems are then applied to Cretaceous outcrops (Ferron Sandstone and Dunvegan Formation). The comparatively simple scaling relationships derived here produced palaeodischarge estimates within the same order of magnitude as palaeodischarge values previously obtained using existing, more complex approaches. This study contributes to source‐to‐sink investigations by enabling palaeodischarge estimates that intrinsically account for climate impacts on channel geometry at the time of deposition, using measurements of channel width or catchment area of a deltaic outcrop.

Traffic speed prediction techniques in urban environments

The present study developed Multiple Linear Regression (MLR) and machine learning (ML) models, including Artificial Neural Network (ANN), Support Vector Machine (SVM), and Random Forest (RF), to predict the mean free-flow speed (FFS) using several geometric, traffic, and pavement condition variables. The traffic features group includes spot speed, speed limit, average speed, 85th percentile speed, traffic and crossing pedestrian volumes, volume of exiting vehicles, percentage of elderly crossing pedestrians (Elderly%), percentage of heavy vehicles (HV%), and traffic calming measures (TCMs). The geometric characteristics include lateral clearance, number of effective lanes, number of access points (including median openings), road grade, effective lane width, and median width. The pavement condition category includes pavement roughness in the International Roughness Index (IRI). A total of 11 urban arterials were used to develop the MLR model and train the ML models. Test data were collected from two randomly selected roads to evaluate the performance of each model, investigate the differences between conventional linear regression and ML approaches, and determine the best prediction models based on the results of the two techniques. Results showed that the proposed ML algorithms outperformed linear regression models. They are believed to be valuable and strong tools to predict the mean FFS that adapts to sudden changes in traffic flow caused by exogenous conditions on urban arterials and can be employed in determining the most influential factors and building reliable prediction models where spot study is not feasible due to time and resource limitations.

Identification and Geomorphometric Characterization of Volcanic Cones in the Marius Hills, the Moon

AbstractInvestigation of the detailed geological characteristics of lunar volcanic cones can peer into their formation and emplacement processes, thus deepening our understanding of pyroclastic eruptions on the Moon. In this work, we focus on the Marius Hills region (centered at 13°N, 55°W), a volcanic plateau in south Oceanus Procellarum, which hosts the most abundant volcanic cones on the Moon, along with other volcanic features. The range of volcanic features indicates various eruption styles and complicated sequences of regional magmatic activities. Based on the SLDEM2015 topography data, with assistance from other multisource topography and image data sets, we identified 360 known and suspected volcanic cones and 22 volcanic domes in the Marius Hills. Following detailed morphological characterizations, the volcanic cones show various morphology types, including C‐shaped, elliptical‐shaped, elongated‐shaped, irregular‐shaped, and rounded‐shaped. The cones (median basal width ∼2.7 km, height ∼115 m, and volume 0.25 km3) contain summit pit craters (15%; median width ∼358 m), exhibiting smaller basal widths and summit pit crater widths compared with lunar mare domes. The mean slope (3.5°–15.6°) and rock abundance (0.3%–3.8%) of volcanic cones in Marius Hills are larger than those of the mare dome, suggesting different eruption mechanisms. Marius Hills cones also show larger basal widths and smaller height/width ratios than terrestrial volcanic cones, which are attributed to multiple factors, including subaerial environment, volatile content of the magma, eruption rate, and lava viscosity.

OC-012 THE COMBINATION OF THE THREE MODIFICATIONS OF THE COMPONENT SEPARATION TECHNIQUE IN THE MANAGEMENT OF COMPLEX SUBCOSTAL WALL DEFECT

Abstract Aim To present a concept combining three modifications of the component separation technique (CST) in one procedure as an original solution for the management of complex subcostal abdominal wall defect. Material and Methods Between January 2010 and January 2022, seven patients with complex subcostal hernia defects compromised by infection, radiation, or chemotherapy underwent surgery in which three modifications of CST were combined into one procedure. Major complex subcostal hernia was defined by either width or length of the defect being greater than 10 cm. The following were the stages of the operative technique: (a) the “method of wide myofascial release” at the side of the hernia defect; (b) “openbook variation” of the component separation technique at the opposite side of the hernia defect; (c) a modified component separation technique for closure of midline abdominal wall hernias in the presence of enterostomies; (d) suturing of the myofascial flaps to each other to cover the defect; and (e) repair augmentation with an absorbable mesh in the onlay position. Results The median (range) length and width of the complex subcostal hernias were 15 cm (10–19) and 15 cm (8–24), respectively. The overall morbidity rate was 57.1% (wound infection, seroma and skin necrosis). There was no hernia recurrence during the median follow-up time of 19 (range 3–84) months. Conclusion The operative technique integrating three modifications of CST in one procedure with onlay absorbable mesh reinforcement is a feasible solution for the management of complex subcostal abdominal wall defect.

Application of Component Separation and Short-Term Outcomes in Ventral Hernia Repairs

IntroductionComponent separation (CS) techniques have evolved in recent years. How surgeons apply the various CS techniques, anterior component separation (aCS) versus posterior component separation (pCS), by patient and hernia-specific factors remain unknown in the general population. Improving the quality of ventral hernia repair (VHR) on a large scale requires an understanding of current practice variations and how these variations ultimately affect patient care. In this study, we examine the application of CS techniques and the associated short-term outcomes while taking into consideration patient and hernia-specific factors. MethodsWe retrospectively reviewed a clinically rich statewide hernia registry, the Michigan Surgical Quality Collaborative Hernia Registry, of persons older than 18 y who underwent VHR between January 2020 and July 2021. The exposure of interest was the use of CS. Our primary outcome was a composite end point of 30-d adverse events including any complication, emergency department visit, readmission, and reoperation. Our secondary outcome was surgical site infection (SSI). Multivariable logistic regression examined the association of CS use, 30-d adverse events, and SSI with patient-, hernia-, and operative-specific variables. We performed a sensitivity analysis evaluating for differences in application and outcomes of the posterior and aCS techniques. ResultsA total of 1319 patients underwent VHR, with a median age (interquartile range) of 55 y (22), 641 (49%) female patients, and a median body mass index of 32 (9) kg/m2. CS was used in 138 (11%) patients, of which 101 (73%) were pCS and 37 (27%) were aCS. Compared to patients without CS, patients undergoing a CS had larger median hernia widths (2.5 cm (range 0.01-23 cm) versus 8 cm (1-30 cm), P < 0.001). Of the CS cases, 49 (36%) performed in hernias less than 6 cm in size. Following multivariate regression, factors independently associated with the use of a CS were diabetes (odds ratio [OR]: 2.00, 95% confidence interval [CI]: 1.19-3.36), previous hernia repair (OR: 1.88, 95% CI: 1.20-2.96), hernia width (OR: 1.28, 95% CI: 1.22-1.34), and an open approach (OR: 3.83, 95% CI: 2.24-6.53). Compared to patients not having a CS, use of a CS was associated with increased odds of 30-d adverse events (OR: 1.88 95% CI: 1.13-3.12) but was not associated with SSI (OR: 1.95, 95% CI: 0.74-4.63). Regression analysis demonstrated no differences in 30-d adverse events or SSI between the pCS and aCS techniques. ConclusionsThis is the first population-level report of patients undergoing VHR with concurrent posterior or aCS. These data suggest wide variation in the application of CS in VHR and raises a concern for potential overutilization in smaller hernias. Continued analysis of CS application and the associated outcomes, specifically recurrence, is necessary and underway.

CO(J = 1 – 0) Observations toward the Filamentary Cloud in the Galactic Region of 153.°60 ≤ l ≤ 156.°50 and 1.°85 ≤ b ≤ 3.°50

We present observations of the J = 1 – 0 transition lines of 12CO, 13CO, and C18O toward the Galactic region of 153.°60 ≤ l ≤ 156.°50 and 1.°85 ≤ b ≤ 3.°50, using the Purple Mountain Observatory 13.7 m millimeter telescope. Based on the 13CO data, one main filament and five subfilaments are found together as a network structure in the velocity interval of [−42.5, −30.0] km s−1. The kinematic distance of this molecular cloud is estimated to be ∼4.5 kpc. The median length, width, excitation temperature, and line mass of these filaments are ∼49 pc, ∼2.9 pc, ∼8.9 K, and ∼39 M ⊙ pc−1, respectively. The velocity structures along these filaments exhibit oscillatory patterns, which are likely caused by the fragmentation or accretion process along these filaments. The maximum accretion rate is estimated to be ∼700 M ⊙ pc−1. A total of ∼162 13CO clumps and ∼103 young stellar objects are identified in this region. Most of the clumps are in gravitationally bound states. Three H ii regions (G154.359+2.606, SH2-211, and SH2-212) are found to be located in the apexes of the filaments. Intense star-forming activity is found along the entire filamentary cloud. The observed results may help us to better understand the link between filaments and massive star formation.