Operative Options Research Articles (Page 1)

Corporate Practice/Dental Service Organization.

Orthobiologics continues to advance in medicine due to its regenerative capabilities. In fact, there is a vast indication of use with regenerative medicine options such as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMAC) within the human body for various musculoskeletal conditions. While both options are different, the purpose of each is to promote a natural healing response with specific growth factors, proteins, or cells to aid in this. In this concept review, we present a current update on the literature surrounding these regenerative medicine options specifically with utilization in the foot and the ankle. We have found in our practice that regenerative medicine options offer our patients a nonoperative as well as operative biologic supplemental option for treatment on various foot and ankle conditions with relatively high success rates and overall high patient satisfaction. We hope this review educates the foot and ankle surgeon on this rapidly evolving treatment to enhance patient outcomes and improve quality of care.Levels of Evidence:4.

Introduction Acute severe ulcerative colitis (ASUC) is a medical emergency associated with high morbidity and around 1% mortality. Left-sided colitis (LSC) is a subtype of ulcerative colitis that requires timely multidisciplinary management, often involving gastroenterologists and colorectal surgeons. When corticosteroids and rescue therapies such as infliximab or cyclosporine fail, surgery is frequently indicated. Operative options include total proctocolectomy with ileal pouch–anal anastomosis (TPC-IPAA), total proctocolectomy with ileostomy (TPC-I), total abdominal colectomy (TAC), and subtotal colectomy (STC). In the United Kingdom, STC is the most common emergency operation, but it may not be optimal for patients with left-sided disease. This review aimed to determine the most appropriate surgical approach for acute LSC. Methods A systematic review was conducted in accordance with PRISMA guidelines. Searches of Ovid MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus identified studies published between 2001 and 1 November 2023. Eligible studies involved adult patients with LSC refractory to medical therapy who underwent surgery. Primary outcomes were patient-centred measures; secondary outcomes included short- and long-term surgical results. Studies on medical management alone, isolated proctitis, rectal cancer, non-human subjects, or non-English publications were excluded. Screening and data extraction were performed independently by two reviewers, with plans for GRADE assessment and meta-analysis if data permitted. Results Of 6,606 records screened, no study met full inclusion criteria. Six related studies were narratively reviewed. Outcomes were mixed: TAC was associated with higher complications in some studies but lower infection rates than TPC in others. Segmental colectomy carried a 35% reoperation rate and 4.2% mortality. Conclusion Evidence is insufficient to define the optimal emergency surgical strategy for acute LSC. While TAC remains the standard approach, its suitability for this subset is unclear. Disease-specific research is urgently needed. Registration: PROSPERO CRD42023473654.

Abstract Supercritical Carbon Dioxide (sCO2) power cycles have emerged as a promising technology for a variety of applications involving transient operations. These include load-following power plants and systems operating with intermittent heat inputs, such as waste heat recovery, CO2 batteries, and solar thermal power generation. This paper explores dynamic response and control system design of a 5 MW simple recuperated sCO2 Brayton cycle, focusing on inventory and turbine bypass control strategies. A linear control system for regulating inventory tank valves is analyzed through step-response testing, revealing rapid response characteristics of inventory rejection, while non-minimum phase behavior of inventory injection. Transfer function-based representation is proposed to aid control system design and analysis. Design of a Proportional-Integral (PI) controller is carried out using classical Bode plots technique. Although the PI controller improves tracking accuracy, its performance degrades at high ramp rates, and due to plant gain reduction and non-minimum phase behavior. Transient thermal analysis of the recuperator, performed a posteriori step using Flownex, quantifies time-varying heat duties and cycle efficiency. During part-load transients, small terminal temperature variations result in nearly constant wall temperature profiles, making the energy stored in the heat exchanger walls orders of magnitude smaller than the convective heat transfer rates. Turbine bypass control is demonstrated to serve as an alternative, offering first-order dynamics and faster ramp rates. Overall, the study demonstrates the efficacy of simple PI controllers for load regulation in sCO2 Brayton cycles.

Proximal humerus fractures (PHFs) are increasingly prevalent, particularly in the geriatric population, where they represent a significant burden both individually and societally. Vascular injury, though rare, can have profound implications for management and outcomes. The presence of these concomitant injuries has been shown to be associated with an increased length of hospital stay, total cost, and patient mortality underscoring the critical need for accurate identification of both osseous and vascular injuries to provide appropriate, comprehensive care. Despite extensive research, controversy remains regarding the optimal management of these injuries. Nonoperative management is suitable for fractures meeting specific criteria, while operative options vary based on fracture characteristics, patient factors, and surgeon expertise. The rise in reverse total shoulder arthroplasty (RSA) as a treatment of complex fracture patterns reflects evolving trends in clinical practice. This report presents the case of a 76-year-old woman with a complex, 4-part PHF dislocation sustained secondary to a ground-level fall. On examination, she exhibited diminished radial nerve sensation with wrist extension weakness but was otherwise neurovascularly intact. Cross sectional imaging demonstrated significant medialization of an anterior fracture dislocation of the proximal humerus. Computed tomography angiography of the left upper extremity showed a markedly tortuous axillary artery with possible intimal injury, prompting a multidisciplinary approach. A shared decision-making model led to combination surgical case with vascular and orthopaedic surgery for subclavian artery exposure followed by RSA. Postoperatively, the patient recovered without complication, demonstrating the importance of an individualized, multidisciplinary strategy for managing complex PHF with associated vascular insult. This case highlights the critical role of recognition of potential neurovascular injuries due to traumatic events and coordinated management of osseous and vascular injuries in complex PHF. We also describe a combined surgical approach and interdisciplinary coordination for PHF dislocations with concern for vascular compromise. Glenohumeral fracture dislocations are high-risk injuries where RSA offers predictable outcomes for complex fracture patterns but demands careful consideration in the setting of possible vascular trauma.

Introduction:Anterior Cruciate Ligament (ACL) injuries in skeletally immature patients present a multifaceted challenge for orthopedic surgeons, necessitating a nuanced understanding of developmental anatomy, growth physiology, and surgical techniques. Skeletally immature patients, characterized by ongoing skeletal growth with open physes, exhibit distinct biomechanical vulnerabilities predisposing them to ACL injuries. The dynamic interplay between skeletal maturation, neuromuscular coordination, and sports participation underscores the evolving nature of these injuries, demanding tailored management strategies.Clinical Review:Early surgical intervention emerges as a cornerstone in mitigating the sequelae of ACL rupture in skeletally immature patients, with mounting evidence supporting its efficacy in averting concomitant meniscal and chondral pathology. However, the intricate dance between surgical timing, technique selection, and growth plate preservation necessitates meticulous preoperative planning and intraoperative precision. Preoperative assessment entails a comprehensive evaluation of skeletal maturity, incorporating radiographic indices to delineate bone age and growth potential. Orthopedic surgeons navigate a spectrum of ACL reconstruction techniques, balancing the imperative for anatomical fidelity with the imperative to safeguard physeal integrity. Operative options include both the transphyseal technique, involving tunnel placement across the physis, and the physeal sparing technique, which aims to preserve the growth plate while reconstructing the ACL. Furthermore, graft selection is a critical consideration in ACL reconstruction for skeletally immature patients. Options such as patellar tendon, hamstring tendon, and quadriceps tendon grafts offer distinct advantages and disadvantages, requiring careful consideration of patient factors, surgical technique, and postoperative rehabilitation goals. Postoperative rehabilitation assumes paramount importance in fostering optimal functional recovery and mitigating the risk of growth disturbances. Graded rehabilitation protocols, coupled with proprioceptive training, constitute the bedrock of rehabilitation strategies tailored to the unique needs of skeletally immature patients.Clinical Discussion:Longitudinal surveillance emerges as an imperative in the postoperative care continuum, with orthopedic surgeons assuming stewardship in monitoring skeletal maturation and preempting potential growth disturbances. Furthermore, the imperative for ongoing research endeavors underscores the evolving landscape of ACL injury management in this demographic cohort.Conclusion:ACL injuries in skeletally immature patients epitomize a clinical conundrum demanding a synergistic amalgamation of anatomical acumen, surgical finesse, and rehabilitative prowess. Orthopedic surgeons assume a pivotal role in navigating this complex terrain, poised at the forefront of optimizing outcomes and fostering resilience in this vulnerable patient population.

Controversies in the Management of Proximal Humerus Fractures.

“Patient-Specific” Cost and Quality Value Comparison of Endoscopic Carpal Tunnel Release in Two Surgical Settings

BACKGROUND: Achilles tendon rupture incidence has been increasing over the past several decades with management including nonoperative and operative options. Little is known regarding the patient experience in those who transition from nonoperative to operative management due to re-rupture. CASE PRESENTATION: A 22-year-old male physical therapy student heard a “pop” while playing soccer. Per ultrasound imaging findings and patient goals, he trialed nonoperative management. However, he experienced re-rupture and underwent open Achilles tendon repair. OUTCOME AND FOLLOW-UP: After rehabilitation, he demonstrated normalized heel-rise endurance, quadriceps, and hamstring strength. He lacked heel-rise height compared to contralateral side. He resumed recreational running and lifting, but not sports. DISCUSSION: Initial nonoperative management after Achilles tendon rupture does not appear to diminish outcomes after subsequent Achilles tendon repair. However, the patient reported heightened fear of re-rupture after nonoperative management and relief with operative management. JOSPT Cases 2025;5(3):1-7. Epub 10 June 2025. doi:10.2519/josptcases.2025.0023

Technology for automated plant care has advanced quickly as a result of the increased need for sophisticated and effective agricultural systems. One of the most useful uses of sensor networks and embedded systems in daily life is the automatic watering of plants. These gadgets provide precise amounts of water to plants and track soil moisture levels without requiring human intervention. These systems, which make use of moisture sensors and microcontrollers, offer a sustainable option for both large-scale agricultural operations and home gardening. They are useful tools in modern agriculture because of their capacity to save labor and water waste while ensuring the best possible plant development. One significant step toward producing food in an environmentally conscious and technologically advanced manner is the integration of smart technology into conventional agricultural practices.

Background: Implantation of modularly built-up stems with a tapered and fluted design is currently state of the art in revision total hip arthroplasty (RTHA). Nevertheless, implant-specific major complications like breakage of taper junctions as well as periprosthetic fractures (PPFs) may lead to failure of reconstruction during follow-up. Methods: A cohort of 117 cases receiving femoral RTHA by a modular stem was investigated retrospectively with a mean follow-up of 5.7 (0.5-13.7) years. Cumulative risk and potential factors affecting the occurrence of PPFs were calculated with the Kaplan-Meier method. In addition, cases were presented to discuss operative treatment options. Results: A cumulative risk of PPF of 12.1% (95% CI: 0-24.6%) was calculated at 13.7 years. Female patients had significantly higher risk compared to male patients (0% after 13.5 years for male patients vs. 20.8% (95% CI: 0.5-41.2%) after 13.7 years for female patients; log-rank p = 0.0438) as all five patients sustaining a PPF during follow-up were women. Four fractures were treated by open reduction and internal fixation. Non-union and collapse of the fracture occurred in one patient after closed reduction and internal fixation. Conclusions: Postoperative PPF after femoral revision with a modular stem has shown to be a frequent complication within this mid-term follow-up. Female patients were at a significantly higher risk in this aged cohort, indicating osteoporosis as a risk factor. The surgical treatment of PPF with an integrated long-stemmed prosthesis is challenging and thorough considerations of adequate operative treatment of PPFs are strongly advised in order to limit complication rates.

Humeral shaft fractures occur with an incidence of approximately 12-25 per 100,000 per year and exhibit two age peaks, young patients following high-energy trauma and older patients with low-energy trauma. Principally, conservative treatment is aviable option, which requires high patient compliance but shows good healing rates in appropriate cases, particularly for fractures of the middle third of the shaft. Compared to surgical treatment there is aslightly increased rate of pseudarthrosis. In the case of surgical treatment, both plate osteosynthesis and intramedullary nailing show good results. Adistinction must be made between primary radial nerve injury, which occurs immediately after trauma and generally has good spontaneous recovery rates, and secondary radial nerve injury, which is aconsequence of the initiated treatment. In this case, careful consideration should be given to the potential need for a surgical intervention. Overall, both conservative and surgical treatment approaches lead to good functional outcomes in appropriately selected patients. The choice of treatment should be made individually, considering the patient's age, fracture complexity, comorbidities and expected patient compliance.

Evaluating Clinical Outcomes and Management Strategies for Isolated Blunt Cerebrovascular Injury in Adult Trauma Patients: A Nationwide Cohort Study.

Review of Posterior Cruciate Ligament Injuries in Athletes.

Comparison of hook plates vs. locking plates for Neer type IIB fractures of lateral end clavicle: A systematic review.

This case report describes a 44-year-old woman who suffered a radial nerve compression injury from self-administered myofascial release using a lacrosse ball. She underwent decompression of the right radial nerve at the spiral groove of the humerus with intraoperative nerve stimulation. At 18-month follow-up, the patient had regained partial function of the radial nerve. This case highlights mechanisms of radial nerve compression injuries and discusses nonoperative versus operative treatment options.

This study offers a systematic review and quantitative evaluation of the methodological quality of prospective studies comparing open reduction and internal fixation (ORIF) and reverse total shoulder arthroplasty (RTSA) for the treatment of proximal humerus fractures. A systematic review was conducted in accordance with PRISMA guidelines identifying prospective cohort studies or randomized controlled trials (RCTs) comparing ORIF and RTSA for the management of traumatic proximal humerus fractures in skeletally mature patients. Two reviewers independently evaluated the methodologic quality and risk of bias of the included studies. Scarcity and heterogeneity of data precluded any pooled analysis from being performed. The search yielded 1064 unique articles, of which five met inclusion criteria. The Methodological Index for Non-randomized Studies (MINORS) score for the comparative prospective cohort studies ranged from 12 to 19, corresponding to low (1), moderate (1), and high (2) quality studies. The mean modified Coleman Methodology score of the lone RCT was 70.5, corresponding to a categorical rating of "good," while the mean revised Consolidated Standards of Reporting Trials (CONSORT) score was 19, corresponding to a categorical rating of "excellent." The RCT had a low risk of bias, while the prospective cohort studies exhibited serious risk of bias. There is a paucity of comparative literature evaluating ORIF and RTSA for the treatment of proximal humerus fractures, which is of variable methodological quality. In the absence of consistent, high-quality evidence, surgeons should consider patient-specific factors and technical experience when considering operative treatment options.

In this study, focus on the task of human pose estimation. High-resolution networks (HRNet), while adept at continuously integrating multi-resolution information, tend to compel the network to assimilate redundant information, thereby amplifying computational complexity. The single-path one-shot Neural Architecture Search (NAS) method, an efficacious solution to mitigate this issue. This research introduces a novel NAS method, denoted as SP-HRNet, based on Single-Path One-Step architecture. SP-HRNet meticulously selects the most suitable operator within a high-resolution network and identifies the optimal deep fusion construction methodology. Within SP-HRNet, we propose a hybrid search space incorporating an enhanced search strategy. Unlike the original high-resolution network, instead of modifying the network branches with a fixed decrement or increment, our network structure will be free to choose the most appropriate one among multiple branches. For this purpose, we devise two distinct search spaces labeled as Mixed Operator and Depth Fusion Options and formulate a novel search strategy tailored to this space. A myriad of experiments substantiates the effectiveness of this method. Our proposed network attains outstanding performance on the COCO human pose estimation dataset, achieving heightened accuracy while concurrently reducing the number of model parameters.

Threshing and cleaning are crucial for efficient harvest procedures that are carried out to separate the grains from the biomass and eliminate any potential contaminants or foreign debris. This study examines the cleaning capabilities of the grain cleaning equipment Kimseed Cleaner MK3, a vibratory sieve and air-screen device, for tiny oilseed crops, particularly kalonji (Nigella sativa) and sesame (Sesamum indicum L.), which are valued for their industrial, medicinal, and nutritional properties. These crops frequently provide post-harvest cleaning issues because of their tiny size and vulnerability to contamination from weed seeds, plant residues, and immature or damaged conditions. In order to determine the ideal operating parameters, 0.5 kg of threshed seed samples with 10% moisture content were utilised in the experiment. A variety of shaker frequencies (0.1–10 Hz) and airflow speeds (0.1–10 m/s) were assessed. A two-stage cleaning method was applied for sesame: the first stage targeted larger contaminants (6.5–7.0 Hz and 1.25–1.5 m/s), while the second stage targeted finer impurities (5.25–5.5 Hz and 1.75–2.0 m/s). With a single-stage procedure (5.5–6.0 Hz and 1.0–1.5 m/s), kalonji was successfully cleaned. The findings demonstrated that sesame attained 98.5% purity at the output rate of 200.6 g/min (12.03 kg/h) while kalonji reached 97.6% seed purity at an output rate of 370.2 g/min (22.2 kg/h). These results demonstrate how important carefully regulated shaker frequency and airflow speed are for improving output quality and cleaning effectiveness. The study shows that the Kimseed MK3 is a suitable low-cost, scalable option for research operations and smallholder farmers, providing better seed quality and processing efficiency for underutilised yet economically valuable oilseed crops.

Complicated colonic diverticulitis remains a frequent cause of hospital admissions in Western countries, associated with significant morbidity and health care utilization. Complications include abscess formation, perforation, sepsis, fistulas, and colonic stenosis, which may be present at initial presentation or develop during the disease course. Approximately 10%-20% of hospitalized diverticulitis cases are classified as complicated. Over recent decades, the management of this condition has undergone a paradigm shift-from routine surgical intervention to more individualized, evidence-based strategies emphasizing conservative treatment where appropriate. This review provides a comprehensive, clinically oriented summary of current diagnostic approaches, including the role of cross-sectional imaging, as well as non-operative and operative treatment options. It also outlines recommendations for follow-up, including indications for colonoscopy, and discusses ongoing controversies and future directions in the management of complicated diverticulitis.