Multidisciplinary Procedure Research Articles

Malformation and plastic surgery in childhood.

Malformations of the head and neck show a huge variety of clinical symptoms with functional and esthetic consequences. Often times its rehabilitation requires multi-staged and multi-disciplinary procedures and concepts. These must consider eating, speech, mimic expression, hearing and “esthetics” or at least “normality”.A survey of the most common head and neck malformations and their treatment options are presented here.

Dewatering of a deep excavation undertaken in a layered soil

In order to carry out deep excavations under the water table in urban environments, the safety of the work site and of the adjacent buildings is a major cause for concern. One of the most common and effective methods of undertaking these excavations involves combining the cut and cover method with a dewatering system. The success of a construction depends on the stability of the excavation bottom, the effects produced outside the excavation by dewatering (soil movements) and/or the state of the enclosure (defects in the diaphragm walls). This study proposes a realistic multidisciplinary procedure to address these issues. The work emphasizes the importance of soil characterisation and underlines the need to perform a Watertightness Assessment Test (WTAT) before the excavation stage. The procedure was applied to the excavation of a deep shaft of the High Speed Train (HST) tunnel in Barcelona. An earlier geological characterisation at large scale ruled out the use of deep pumping wells. However, a subsequent hydrogeological characterisation, which involved borehole logging, grain size analyses, Natural Gamma Ray and pumping tests, revealed the presence of thin transmissive layers inside the low hydraulic conductivity materials. The dewatering system was designed by considering different model scenarios and the safest design was selected for the excavation. Depths of the enclosure and of the pumping wells differed in accordance with the scenarios. The impacts (settlements due to pumping) and the stability in each scenario were computed. The state of the enclosure underwent a WTAT before the start of the excavation, but after constructing the enclosure, to verify its low permeability. The test consisted in pumping inside the enclosure and monitoring the groundwater behaviour outside the enclosure. Numerical interpretation of this test showed a defect in the diaphragm walls below the excavation bottom. Since this defect was not repaired because of its location (below the bottom of the excavation), the dewatering system had to be redesigned to ensure safety. Surface settlements, which were also a source of concern, were small. They were computed using coupled hydro-mechanical models.

Fehlbildungen und plastische Chirurgie im Kindesalter

Malformations of the head and neck show a huge variety of -clinical symptoms with functional and esthetic consequences. Often times its rehabilitation requires multi-staged and multi-disciplinary procedures and concepts. They must consider eating, speech, mimic expression, hearing and "esthetics" or at least "normality". A survey of the most common head and neck malformations and their treatment options are presented here.

Funktionelle Langzeitergebnisse nach Sarkomresektionen

Multimodal treatment of malignant tumors of the musculoskeletal system with R0 in sano resection plays a key role in prevention of local recurrence in soft tissue and bone sarcoma. In cases of unavoidable neuromuscular or osseous defects, current plastic and orthoplastic reconstruction techniques avoid limb amputation in the majority of patients. Clinical long-term results demonstrate that large resection defects do not necessarily result in impaired limb function if multidisciplinary procedures are integrated. In oncologically necessary major limb amputation, segmental resection and replantation of distal limb parts should be considered which provide end-bearing long stump formation. The functional conditions of long-term surviving elderly patients should be integrated into surgical decision-making and rehabilitation efforts.

A Robust Workflow of a Multidisciplinary Team-Involved Radiation Therapy Procedure -- A Case in Yttrium-90 Microsphere Radioembolization

A Robust Workflow of a Multidisciplinary Team-Involved Radiation Therapy Procedure -- A Case in Yttrium-90 Microsphere Radioembolization

English

English

English

English

The trimeric model: a new model of periodontal treatment planning.

Treatment of periodontal disease is a complex and multidisciplinary procedure, requiring periodontal, surgical, restorative, and orthodontic treatment modalities. Several authors attempted to formulate models for periodontal treatment that orders the treatment steps in a logical and easy to remember manner. In this article, we discuss two models of periodontal treatment planning from two of the most well-known textbook in the specialty of periodontics internationally. Then modify them to arrive at a new model of periodontal treatment planning, The Trimeric Model. Adding restorative and orthodontic interrelationships with periodontal treatment allows us to expand this model into the Extended Trimeric Model of periodontal treatment planning. These models will provide a logical framework and a clear order of the treatment of periodontal disease for general practitioners and periodontists alike.

Modified kraske procedure with mid-sacrectomy and coccygectomy for en bloc excision of sacral giant cell tumors.

Sacral giant cell tumors are rare neoplasms, histologically benign but potentially very aggressive due to the difficulty in achieving a complete resection, their high recurrence rate, and metastization capability. Although many treatment options have been proposed, en bloc excision with tumor-free margins seems to be the most effective, being associated with long term tumor control, improved outcome, and potential cure. An exemplifying case of a 29-year-old female with progressive complaints of pain and paresthesias in the sacral and perianal regions, constipation, and weight loss for 6 months is presented. The surgical technique for en bloc excision of a large sacral giant cell tumor through a modified Kraske procedure with mid-sacrectomy and coccygectomy is described. Complete resection with wide tumor-free margins was achieved. At 5 years of follow-up the patient is neurologically intact, without evidence of local recurrence on imaging studies. A multidisciplinary surgical procedure is mandatory to completely remove sacral tumors. In the particular case of giant cell tumors, it allows minimizing local recurrence preserving neurovascular function, through a single dorsal and definitive approach.

Bioinspired Functional Materials

This special issue is focused on the nanoscale or micro-/nanoscale structures similar to the biological features in multilevels or hierarchy and so on. Research by mimicking biological systems has shown more impact on many applications due to the well-designed micro-/nanostructures inspired from the biological surfaces or interfaces; therefore, the materials may achieve the fascinating functionality. In conclusion, the bioinspired functional materials may be fabricated by developing novel technology or methods such as synthesis, self-assembly, and soft lithography at micro- or nanolevel or multilevels and, in addition, the multidisciplinary procedures of physical or chemical methods and nanotechnology to mimic the biological multiscale micro-/nanostructures onto one-/two-dimensional surface materials.

From the Angio Suite to the γ-Camera: Vascular Mapping and 99mTc-MAA Hepatic Perfusion Imaging Before Liver Radioembolization—A Comprehensive Pictorial Review

Endovascular mapping and conjoint (99m)Tc-macroaggregated albumin ((99m)Tc-MAA) hepatic perfusion imaging provide essential information before liver radioembolization with (90)Y-loaded microspheres in patients with primary and secondary hepatic malignancies. The aims of this integrated procedure are to determine whether there is a risk for excessive shunting of (90)Y-microspheres to the lungs; to detect extrahepatic perfusion emerging from the injected vascular territory, which might lead to nontargeted radioembolization; to reveal incomplete coverage of the liver parenchyma involved by the tumor, which may be related to anatomic or acquired variants of the arterial vasculature; and to aid in calculation of the (90)Y-microsphere dose to be delivered to the liver. This pictorial essay presents an integrated comprehensive review of the anatomic, angiographic, and nuclear imaging aspects of planned liver radioembolization. The relevant anatomy of the liver, including the standard and the variant arterial vasculature, will be shown using digital subtraction angiography, SPECT/CT, contrast-enhanced CT, and anatomic illustrations. Technical details that will optimize the imaging protocols and important imaging findings will be discussed. From the angio suite to the γ-camera-the goal of this review is to help the reader better understand how the technical details of the angiographic procedure are reflected in the imaging findings of the (99m)Tc-MAA hepatic perfusion study. In addition, the reader should learn to better recognize the pertinent findings and their clinical implications. This knowledge will enable the reader to provide a more useful interpretation of this complex multidisciplinary procedure.

Inequal benefits from regionalization of cancer care: The pancreatic cancer surgery paradigm.

4059 Background: Regionalization has been proposed for high-level care, including multidisciplinary cancer treatment and complex procedures. Pancreatic resections can serve as a marker for both. Using Massachusetts Division of Health Care Finance and Policy (DHCFP) data, we investigated regionalization of surgery for pancreatic cancer (PCa), its potential effect on perioperative outcomes, and disparities in access to high-volume PCa surgery centers. Methods: Using MA DHCFP Hospital Inpatient Discharge Data, 2005-2009, 10,524 discharges for PCa were identified, of which 746 were associated with pancreatic resection. Discharges with missing or out-of-state residence were excluded (n=704). Using geodetic methods and ZIP codes, center-to-center distances were calculated between patient (pt) and treating hospital. Median ZIP income was estimated from 2009 census data. High volume hospitals (4 of 25 performing pancreatic resections in MA) were defined using Leapfrog Criteria (> 11 per year (87th percentile for MA). Chi-square and logistic regression analyses were performed using SAS software. Results: Median age was 65. Pts were predominantly White (87.2%), with median ZIP income of $54,677. Pts travelled in-state up to 112 miles (median 15.4), with the majority resected at high volume hospitals (76%). Median length of stay (LOS) was 8.0 days, with LOS>1 week associated with low volume hospitals (p=0.0002). Of 14 in-hospital deaths, 7 were at low volume hospitals (4.14% of 169 pts) compared to 7 at high volume hospitals (1.31% of 535 pts) (p=0.0214). Predictors of shorter travel distance were: Black race (OR 4.45 (95% CI 1.66-11.93)), operation at low volume hospital (OR 2.62 (95% CI 1.81-3.77), and increased age (per year) (OR 1.02 (95% CI 1.00-1.03), but not sex or median income. Conclusions: Using MA statewide discharge data, regionalization of pancreatic cancer surgery to high-volume, better-outcome centers is seen to be occurring. However, it is not uniform, and disparities exist between groups of cancer pts that do and do not travel for their care. In the current era of scrutiny on cost, quality, and access to cancer care, further study into predictors of pts receiving optimal care is warranted.

Presymptomatic Genetic Testing in Minors at Risk of Paraganglioma and Pheochromocytoma: Our Experience of Oncogenetic Multidisciplinary Consultation

The aim of the work was to define quality criteria for presymptomatic genetic testing in minors at risk of paraganglioma/pheochromocytoma. A 3-step multidisciplinary procedure was developed: 1) preparatory consultations for parents, providing decision support and advice concerning the way of informing the children; 2) consultation with the minor and blood sampling; and 3) announcement of the result of the genetic test to the minor and his/her parents. Twenty-three minors (mean age=9.22) were tested. The result was positive in 16 cases (presence of the familial mutation) and negative in 7. The 23 procedures were classified according to emotional reactions at the announcement of the result: calm (18/23) or tense (5/23). In parallel, 4 criteria for a good testing procedure was defined: 1) both parents agreeing to have their child tested when they felt ready; 2) parents being given advice concerning the way to inform their child; 3) the most appropriate time for testing being discussed for each child; and 4) avoidance of testing during medical examination periods for the carrier parent. The frequencies of the above criteria were as follows: 1 (17/23); 2 (19/23); 3 (17/23); and 4 (17/23). The overall quality of the testing procedure, calculated as the sum of the four criteria, differed significantly between calm and tense announcements (p<0.01). This study highlights the important role of careful preparation with the parents in emotional acceptance of the result of testing. The 4 criteria identified should be evaluated in further prospective studies.

Optimization of Hybrid Sounding Rockets for Hypersonic Testing

The use of ground-launched hybrid rockets to bring subscale models to flight conditions within the hypersonic flight corridor is investigated. The analysis is based on a multidisciplinary optimization procedure that couples the direct optimizations of the parameters that rule the engine geometry and operation and the indirect optimization of the trajectory. The final Mach number is maximized for given initial conditions and assigned payload and final altitude. Different rocket configurations are considered; in particular, the performance of single-stage and two-stage rockets are determined for different payload fractions. Results show that hybrid motors are suitable to accomplish this kind of mission, and that single-stage rockets are preferable. Only when the payload fraction is very small and large final velocity are sought, two-stage rockets may offer better performance.

Using of Particle Swarm for Performance Optimization of Helicopter Rotor Blades

As part of a research activity at Politecnico di Torino, aiming to develop multi-disciplinary design procedures implementing nature inspired meta-heuristic algorithms, a performance design optimization procedure for helicopter rotors has been developed and tested. The procedure optimizes the aerodynamic performance of blades by selecting the point of taper initiation, the root chord, the taper ratio, and the maximum twist which minimize horsepower for different flight regimes. Satisfactory aerodynamic performance is defined by the requirements which must hold for any flight condition: the required power must be minimized, both the section drag divergence Mach number on the advancing side of the rotor disc and the maximum section lift coefficient on the retreating side of the rotor disc must be avoided and, even more important, the rotor must be trimmed. The procedure uses a comprehensive mathematical model to estimate the trim states of the helicopter and the optimization algorithm consists of a repulsive particle swarm optimization program. A comparison with an evolutionary micro-genetic algorithm is also presented.

Staged interventional management of a massive thrombus related to coronary artery ectasia in acute coronary syndrome

Coronary artery ectasia (CAE), which is reported in 0.3-5.3% of coronary angiograms, is known as a risk factor of acute coronary syndrome (ACS). Optimal treatment of CAE in ACS has not yet been established because of few clinical reports and no randomized trial. We describe a 78-year-old woman in whom thrombolysis with recombinant tissue-plasminogen activator, heparin and dual antiplatelet therapy were performed, and an angiogram after 3 days revealed the disappearance of massive thrombus in the CAE of the left circumflex coronary artery. Staged percutaneous coronary intervention and multidisciplinary procedure are feasible to treat ACS with massive thrombus.

Mycoplasma leachiisp. nov. in Calves, China

<i>Mycoplasma leachii</i>sp. nov. in Calves, China

Hydraulic Support Development Based on Virtual Prototype Collaborative Development Platform

In this paper, based on virtual prototype Collaborative Development Platform for Hydraulic support, a new technology way to the design and study of the mining hydraulic support is provided.The function constitute of the platform which can support the whole multi-disciplinary collaborative development procedure of Hydraulic support are given. The Development of Hydraulic support based on virtual prototype Collaborative Development Platform is given, which includes the following key steps: Team member management modeling, Process management modeling and Co-simulation. The development of hydraulic support shows the effectiveness of the virtual prototype collaborative development for hydraulic support.

Spatial and temporal occurrence of rainfall-induced shallow landslides of flow type: A case of Sarno-Quindici, Italy

Rainfall-induced shallow landslides of flow type provide unstable masses which often travel long run-out distances with high velocities, thus posing a high societal risk when they affect large areas. Therefore, analysis of their spatial and temporal occurrence is relevant to landslide hazard assessment as the first step of the risk analysis. In order to address this issue, this paper outlines a multidisciplinary procedure that is applied to the May 1998 Sarno-Quindici landslides (southern Italy), whose spatial and temporal occurrence is not satisfactorily addressed in current literature. The spatial occurrence of the landslides is analysed using heuristic models for both the source and propagation areas. The temporal occurrence of the landslides is firstly compiled and then related to the cumulated rainfall, stratigraphy and hydraulic boundary conditions. Finally, the spatial and temporal occurrence of the main landslide triggering mechanism is modelled over the whole affected area by analysing the groundwater regime and slope stability conditions. The obtained results show that the spatial and temporal occurrence is strongly related to stratigraphy and hydraulic boundary conditions at both the slope and massif scales. They also highlight a suitable procedure for assessing the spatial and temporal occurrence of complex landslides over large areas.

Video assisted thoracic surgery sublobar resection of intralobar pulmonary sequestration after preoperative embolization of systemic blood supply

Intralobar pulmonary sequestration is abnormal lung tissue of embryonic origin that receives arterial blood supply from the systemic arterial circulation from the abdominal aorta. The arterial blood supply traverses the diaphragm and courses through the inferior pulmonary ligament. Intralobar pulmonary sequestrations are usually treated by anatomic lobar or sublobar resections via an open thoracotomy. Recent reports suggest the utility of a video assisted thoracic surgery (VATS) pulmonary resection. However, the presence of the feeding systemic artery often makes VATS resection difficult or impossible, due to the risk of injury to the feeding vessel, and subsequent retraction below the diaphragm. We present procedural video recordings describing a multidisciplinary procedure, where precedent coil embolization of the feeding systemic vessel allows for relative risk-free VATS sublobar resection of the intralobar pulmonary sequestration.