Operative Side Research Articles

Considerable Long-Term Aesthetic Outcomes and Oncologic Safety of Breast-Conserving Surgery Via a Periareolar Incision: A Retrospective Study

BackgroundTo investigate the application effect of periareolar incision breast-conserving surgery in patients with early breast cancer. MethodsFrom January 2017 to November 2021, a clinician in our research center performed a total of 533 breast-conserving surgery. After screening, we collected the information of 209 patients through telephone, online questionnaires, and outpatient follow-up. One hundred seventeen patients with early breast cancer underwent breast-conserving surgery under the periareolar incision, while 92 patients underwent surgery through the tumor surface incision. We compared the differences between the 2 groups in the length of stay, postoperative complications, adjuvant therapy, and other clinical indicators, as well as the subjective and objective evaluation of the long-term postoperative breast aesthetic outcome, local recurrence, distant metastasis, and survival. ResultsWith a mean follow-up of 3.9 years, patients in the periareolar incision group (PAIG) and tumor surface incision group (TSIG) had no significant differences in clinical indicators, local recurrence, distant metastasis, and survival. However, PAIG patients had better subjective satisfaction with postoperative breast appearance. In the evaluation of objective aesthetic outcomes, PAIG was significantly better than TSIG in texture and elasticity, symmetry, sunken degree of the operative side, skin color, surgical scar, and breast compliance difference. ConclusionBy observing and comparing the clinical indicators, postoperative recurrence, and metastasis of the enrolled patients, this study found that periareolar incision surgery could achieve radical therapeutic effects similar to those achieved through tumor surface incision, and had advantages in improving postoperative aesthetic outcomes, which could provide certain references for clinical practice.

Rotational gland dissection for refractory granulomatous mastitis: A single-center retrospective study

BackgroundRefractory granulomatous mastitis (RGM) is a chronic benign breast disease that commonly occurred in women of childbearing age and is usually treated with surgery, with numerous cases suffering from unsatisfied postoperative recovery of breast shape, high rates of surgical complications, and even high recurrence. This study tries to evaluate the efficacy of an innovative surgical procedure, the rotational gland dissection for the treatment of RGM. Methods129 patients with RGM who underwent surgical treatment at the Second Affiliated Hospital of Xi'an Jiaotong University between Apr. 2017 and May. 2021 were retrospectively included in this study. The article analyzed the age, local symptoms, lesion location, and size, days in hospital, recurrence rate, and satisfaction rate of the patients. ResultsPatients ranged in age from 19 to 58 years, with a median age of onset of 32 years. In 63 patients (48.84%), their lesions coverage exceeded two quadrants, and 52.71% of patients had lesions larger than 10 cm2. The average days in hospital of patients was 7.5 days, and 85.27% of them were satisfied with their post-surgery breast appearance. Within the median follow-up of 56 months, only 3.10% of patients experienced a recurrence of mastitis on the operation side. ConclusionThis novel surgical procedure we created is an effective treatment for RGM with a high success rate, high patient satisfaction, and low recurrence rate, and is significantly superior to other studies for it has the largest sample size and longest follow-up in this field.

Financial Literacy and its Relationship to the Indebtedness of a Bank's Customers

The success or failure of economic agents, especially families, depends on decision making, which in turn will depend on the capabilities, knowledge and skills acquired through financial education. In this sense, the lack of financial capabilities is considered one of the most pressing problems in today's societies. In Peru, one of the main barriers to financial inclusion is the lack of financial education; these low levels of education affect the contracting of active and passive operations in the financial system. The objective of this research was to determine the relationship between financial literacy and the indebtedness of the clients of a banking agency. The methodology has a quantitative approach, correlational level, cross-sectional and non-experimental design. The population considered is finite, 1600 customers in the bank and the study sample was 310 customers. A survey was used as a technique and a 36-question Likert scale questionnaire was used as an instrument. The correlational results present a Spearman's Rho =0.474; the research also finds that 73.23 % of the bank's clients are interested in knowing the interest rate (TCEA) before contracting a loan on the active operations side and on the passive operations side 54. Regarding savings, 60% of the bank's clients consider it important to save in the financial system, which is consistent with the fact that 65.49% tend to keep their savings in the banking system for a period of more than 12 months, demonstrating confidence in the Peruvian financial system. It is concluded that there is a relationship between financial literacy and the indebtedness of the clients of the Lima branch of a bank, obtaining a positive correlation.

A prospective study on total hip arthroplasty outcome in hip fracture compared with matched elective cohort

Background: We conducted a prospective study to compare the outcomes of THA for hip fractures with a best-matched elective cohort. Method: We prospectively reviewed patients underwent THA for hip fractures from 2017 to 2019. The modified Harris Hip Score (mHHS) and complications were recorded. Our control group was elective THA cases matched for the month of operation, age, gender, implants, side of operation and surgeon’s grade. Unmatched cases were excluded. Results: Forty-one THA for hip fractures and forty-one matched elective THA were compared. The total modified Harris Hip Score [mHHS (total)] was significantly lower preoperatively in elective cohort (trauma vs. elective: 60.3 vs. 41.4, P<0.001) and achieved significantly higher score than trauma cohort one-year postoperatively (82.6 vs. 88.2, P= 0.029). The trauma cohort had similar mHHS (function) pre- and postoperatively, and no significant difference was witnessed between both cohorts postoperatively (35.1 vs. 37.6, P= 0.142). The mHHS (pain) was significantly higher in trauma cohort preoperatively (19.8 vs. 12.7, P=0.034), but the elective cohort achieved significantly higher mHHS (pain) than trauma cohort at one-year postoperative (40.1 vs. 42.7, P=0.027). Both cohorts had similar complication rates. Conclusions: This is the first matched prospective study on hip fracture patients that underwent THA, with one year follow up results and the involvement of preoperative and postoperative functional outcomes. With careful patient selection, trauma THA patients can return to their pre-injured function within a year and had comparable function scores with elective THA patients, without increased complication rates.

Investigation of center-specific saphenous vein utilization rates in femoral popliteal artery bypass and associated impact of conduit on outcomes

ObjectiveThe purpose of this study is to investigate variation in great saphenous vein (GSV) use among the various centers participating in the Vascular Quality Initiative infrainguinal bypass modules. Further, differences in outcomes in femoral-popliteal artery bypass with single segment GSV conduit vs prosthetic conduit will be documented. Center GSV use rate impact on outcomes will be investigated. MethodsPrimary exclusions were patients undergoing redo bypass, urgent or emergent bypass, and those in whom prosthetic graft was used while having undergone prior coronary artery bypass grafting. The distribution of GSV use across the 260 centers participating in Vascular Quality Initiative infrainguinal bypass module was placed into histogram and variance in mean GSV use evaluated with analysis of variance analysis. Centers that used GSV in >50% of bypasses were categorized as high use centers and centers that used the GSV in <30% of cases were categorized as low use centers. Baseline differences in patient characteristics and comorbidities in those undergoing bypass with GSV vs prosthetic conduit were analyzed with χ2 testing and the Student t test, as were those undergoing treatment in high vs low use centers. Multivariable time-dependent Cox regression analyses were then performed for the primary outcomes of major amputation ipsilateral to the operative side and mortality in long-term follow-up. High vs low use center was a dichotomous variable in these regressions. Secondary outcomes of freedom from graft infection and freedom from loss of primary patency were performed with Kaplan-Meier analysis. ResultsAmong centers with >50 patients meeting inclusion criteria for this study, GSV use ranged from 15% to 93% (analysis of variance P < .001). When considering all centers irrespective of number of patients, the range was 0% to 100%. On Kaplan-Meier analysis, GSV conduit use was associated with improved freedom from loss of primary or primary assisted patency, improved freedom from major amputation after index hospitalization, improved freedom from graft infection after the index hospitalization, and improved freedom from mortality in long-term follow-up (log-rank P < .001 for all four outcomes). Both low use center (hazard ratio, 1.35; P < .001) and prosthetic graft use (hazard ratio, 1.24; P < .001) achieved multivariable significance as risks for mortality in long-term follow-up. Other variables with a multivariable mortality association are presented in the manuscript. Low use center and prosthetic bypass were significant univariable but not multivariable risks for major amputation after index hospitalization. ConclusionsThere is remarkably wide variation in GSV use for femoral popliteal artery bypass among various medical centers. GSV use is associated with enhanced long-term survival as well as freedom from loss of bypass patency and graft infection. The data herein indicate institutional patterns of prosthetic conduit choice, which has the potential to be altered to enhance outcomes.

Force-reflecting event-triggered predefined-time cooperative control for teleoperation of NMMs via data-driven based observer

This paper investigates the cooperative control problem for the teleoperation system of networked mobile manipulators (NMMs), in which each mobile manipulator is subject to nonholonomic constraints, model uncertainty and external disturbances. The control objective of such a teleoperation system is to synchronize the task-space position between the human-controlled master manipulator and the slave mobile manipulators, and meanwhile enable the slave mobile manipulators to achieve a formation. For this purpose, a hierarchical predefined-time cooperative control (HPTCC) framework involving predefined-time distributed event-triggered (PTDET) estimator, predefined-time stability (PTS) controller and data-driven based (DDB) observer, is proposed. The PTDET estimator is used to generate the information that the slave mobile manipulators need to track and enable multiple slave mobile manipulators to interact through an event-triggered communication network. The PTS controller is presented to ensure the predefined-time stability of the master manipulator and the slave ones. Moreover, for improving the telepresence of the considered teleoperation system, the DDB observer is proposed to reestablish the interaction force between the slave mobile manipulators and the complex operating environment (i.e., the environmental force) on the human operator side. Based on the hierarchical control analysis as well as Lyapunov theory, several sufficient conditions are derived to guarantee the predefined-time stability for the teleoperation system of NMMs. Finally, several simulations are conducted to demonstrate the effectiveness of the proposed control scheme.

Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report

BackgroundPrevious studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy.MethodsGuide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed.ResultsSurgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal.ConclusionThe UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.

Establishing a new model of cancer neuropathic pain in rats

To guide the treatment of malignant neuropathic pain (MNP) in clinical practice, by inoculating MADB-106 breast cancer cells into the right L4 nerve root in Sprague-Dawley rats, a rat model of MNP was established, providing basic conditions for the study of neuropathic pain and development and application of therapeutic drugs. As the tumor grew over time, it pressed the nerve roots, causing nerve damage. The spinal nerve ligation (SNL) model, which is a neuropathic pain model widely used in rats, was compared with the L4 nerve root SNL model, and histologic examination of the nerve tissue of both models was performed by electron microscopy. In addition to the infiltration and erosion of the L4 nerve by tumor cells, the tumor tissue gradually grew and compressed the L4 nerve roots, resulting in hyperalgesia of the rat's posterior foot on the operative side. Some spontaneous pain phenomena were also observed, such as constant lifting or licking of the posterior foot on the operative side under quiet conditions. Electron microscopy images showed that nerve injury was due to progressive compression by the tumor, cells of which were visualized, but the injury was lighter than that in SNL rats. Imaging showed a paravertebral tumor near the L4 nerve root in the carcinomatous neuropathic pain model rat. These results suggest that progressive compression of the nerve by a malignant tumor leads to nerve damage similar to the behavioral changes associated with chronic compression injury resulting from a loose ligature of the nerve. The cancer neuropathologic pain model at the L4 nerve root was successfully established in Sprague-Dawley rats.

Odd couples: reconciling academic and operational cultures for whole-institution sustainability governance at universities

PurposeThis study aims to explore barriers and pathways to a whole-institution governance of sustainability within the working structures of universities.Design/methodology/approachThis paper draws on multi-year interviews and hierarchical structure analysis of ten universities in Canada, the USA, Australia, Hong Kong, South Africa, Brazil, the UK and The Netherlands. The paper addresses existing literature that championed further integration between the two organizational sides of universities (academic and operations) and suggests approaches for better embedding sustainability into four primary domains of activity (education, research, campus operations and community engagement).FindingsThis research found that effective sustainability governance needs to recognise and reconcile distinct cultures, diverging accountability structures and contrasting manifestations of central-coordination and distributed-agency approaches characteristic of the university’s operational and academic activities. The positionality of actors appointed to lead institution-wide embedding influenced which domain received most attention. The paper concludes that a whole-institution approach would require significant tailoring and adjustments on both the operational and academic sides to be successful.Originality/valueBased on a review of sustainability activities at ten universities around the world, this paper provides a detailed analysis of the governance implications of integrating sustainability into the four domains of university activity. It discusses how best to work across the operational/academic divide and suggests principles for adopting a whole institution approach to sustainability.

Effects of joint replacement on spinal movement

Although studies after joint replacement show significant improvements in important gait parameters during rehabilitation, the gait pattern at the end of rehabilitation is still clearly deficient. Patients show compensation strategies that also suggest changes in spinal movement. The aim of the present study was to analyse the spinal movement in dynamics in patients after total hip and knee replacement and to identify abnormalities in comparison to areference group. 3D gait analyses and 4D spinal analyses were performed with the subjects at the beginning and at the end of rehabilitation. The analysis of the movement patterns showed abnormalities in all three movement dimensions, which manifested themselves in increased trunk forward tilt and lordosis, lateral tilt on the operative side and altered pelvic rotation. In consequence therapeutic measures after total hip and knee replacement should, therefore, include neighbouring joints such as the spine in order to avoid consequential complications.

Unilateral acute eosinophilic pneumonia on the operative side: A case 9 years after lung lobectomy.

The typical clinical manifestation of acute eosinophilic pneumonia is acute onset of respiratory symptoms due to smoking or medication use, accompanied by bilateral ground-glass opacity with consolidations on chest radiography. However, differential diagnosis with acute eosinophilic pneumonia should not be excluded in cases of unilateral pneumonia of postoperative lung.

Improvement in Sleep Disturbance Following Anatomic and Reverse Shoulder Arthroplasty.

Sleep disturbance is commonly reported by patients with arthritis and rotator cuff disease. Small cohort studies have demonstrated sleep improvements following anatomic total shoulder arthroplasty (TSA) and reverse shoulder arthroplasty (RSA). However, to our knowledge, no large cohort study has evaluated sleep improvement after shoulder arthroplasty. The purpose of the present study was to determine the effects of shoulder arthroplasty on sleep improvement, including the speed of sleep recovery, improvement plateaus, and any differences observed between TSA and RSA. A retrospective analysis of our institution's shoulder and elbow repository evaluated patients who had been managed with TSA and RSA between 2012 and 2021. Our analysis focused on visual analog scale (VAS) pain scores as well as specific sleep-related questions included in the Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) questionnaires. Preoperative characteristics were compared, and comparisons at the 3-month, 6-month, 1-year, and most recent follow-ups were performed to evaluate the efficacy of improvement, speed of recovery, improvement plateaus, and differences among implant types. Our search identified 1,405 patients who were treated with shoulder arthroplasty, including 698 who underwent TSA and 707 who underwent RSA. Six hundred and seventy-six (97%) of those who underwent TSA and 670 (95%) of those who underwent RSA reported sleep disturbance prior to surgery and were eligible for inclusion. With the exclusion of 357 patients without complete follow-up, 989 patients (517 who underwent TSA and 472 who underwent RSA) met the inclusion criteria, with a median follow-up of 36 months for the TSA group and 25 months for the RSA group. Postoperatively, significant improvements in the ability to sleep comfortably and sleep on the affected side were observed in both the TSA group and the RSA group (p < 0.001). The ability to sleep comfortably returned faster than the ability to sleep on the affected side, with the ability to sleep comfortably reaching a plateau at 3 months and the ability to sleep on the affected side reaching a plateau at 6 months. Despite improvements in terms of sleep disturbance, at the time of most recent follow-up, 13.2% of patients in the TSA group and 16.0% of those in the RSA group could not sleep comfortably and 31.4% of those in the TSA group and 36.8% of those in the RSA group could not sleep on the operative side. The results of the study demonstrated that both TSA and RSA provide significant and rapid improvement in patients' ability to sleep comfortably and, to a lesser extent, improves their ability to sleep on their affected side. Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.

In Vivo Measurement of Ear Ossicle and Bony Wall Vibration by Sound Stimulation of Cartilage Conduction.

The cartilage-conduction pathway was recently proposed as a third auditory pathway; however, middle-ear vibrations have not yet been investigated in vivo. We aimed to measure the ossicles and bone vibration upon cartilage-conduction stimulation with a non-contact laser Doppler vibrometer. We recruited adult patients with normal ear structures who underwent cochlear implant surgery at our hospital between April 2020 and December 2022. For sound input, a cartilage-conduction transducer, custom-made by RION Corporation (Tokyo, Japan), was fixed to the surface of the tragus and connected to an audiometer to regulate the output. A posterior tympanotomy was performed and a laser beam was directed through the cavity to measure the vibration of the ossicles, cochlear promontory, and posterior wall of the external auditory canal. Five participants (three men, mean age: 56.4 years) were included. The mean hearing loss on the operative side was 96.3 dB HL in one patient, and that of the other patients was off-scale. The vibrations were measured at a sound input of 1 kHz and 60 dB. We observed vibrations of all three structures, demonstrating the existence of cartilage-conduction pathways in vivo. These results may help uncover the mechanisms of the cartilage-conduction pathway in the future.

THE USE OF INFORMATION AND COMMUNICATION TECHNOLOGIES BY FUTURE TEACHERS IN THE EDUCATIONAL PROCESS OF A HIGHER EDUCATION INSTITUTION

It has been found that the use of information and communication technologies in the educational process of higher education institutions is predetermined by the urgent need of training future teachers to be able to perform their professional functions in the modern society. As information is increasingly becoming a socially significant resource, it requires highly qualified specialists who have a good command of ICT and effectively use them in their professional activities. It is worth noting that in educational activities, it is often necessary to use laboratory equipment, stands and complexes in order to increase the visibility of various phenomena and processes, so information and communication technologies are part of such complex that should perform various functions.&#x0D; It has been established that the large-scale introduction of information and communication technologies into the educational process leads to the fact that future teachers and pedagogues can be separated in the educational process and in space and time, but at the same time there is an alleged face-to-face didactic interaction between them. The peculiarities of the use of information and communication technologies by future teachers of professional training in the educational process of a higher education institution are revealed. The process of using information and communication technologies by teachers of professional education in higher educational institutions is determined and substantiated, and the peculiarities of students’ mental development before the use of information and communication technologies are characterized.&#x0D; It is established that while mastering the educational material, the formation of the motivational sphere of students is carried out through the awareness of the target setting, drawing the attention of future teachers not only to the importance of this educational component, but also to the further professional activities. The effectiveness of learning is determined not only by the content, but also by the way of learning, or the operational side of the activity. The identification of the operational side of learning activities and the process of forming it in future teachers is a central psychological problem of learning. It is proved that in the course of training, future teachers have the opportunity to analyse the received computer model and make quantitative measurements, solve the problem of choosing optimal parameters. As a part of this work, they perform the role of researchers who conduct an experiment and interpret its results. The program provides the possibility of reusing the material and choosing an individual pace of work in the classroom.

The effects of monoplanar and biplanar medial open wedge high tibial osteotomy on pain and functional capacity.

This prospective cross-sectional study aimed to compare the effects of operation types on pain and functional capacity in patients who underwent monoplanar and biplanar medial open wedge high tibial osteotomy. The study included a total of 117 patients who presented at our clinic between January 2012 - January 2016 and underwent monoplanar (n=63) and biplanar (n=54) medial open wedge high tibial osteotomy. The groups were evaluated in age, gender, Body Mass Index (BMI), operation side, operation time, follow-up period, Modified Insall Salvati ratio, Blackburn Peel Index (BPI), Slope, Knee Society Function Score (KSSF), Knee Society Score (KSSK), Visual Analog Scale (VAS), Kellgren Lawrence score, tibiofemoral angle varus, and Tegner score. Most of the patients in the monoplanar group were operated on the right side, while most patients in the biplanar group on the left side, and the difference between the groups was significant (p<0.05). The operation time was significantly longer in the biplanar group, while the duration of follow-up was statistically significantly longer in the monoplanar group (p<0.05). The preoperative BPI and Kellgren Lawrence scores were significantly higher in the monoplar group, while BMI, KSSK, and tibiofemoral angle varus scores were statistically significantly higher in the biplanar group (p<0.05). Postoperative VAS and Kellgren Lawrence scores were higher in the monoplanar group, and the Modified Insall Salvati ratio, BPI, BMI, KSS function score, KSSK score, tibiofemoral angle varus, and Tegner scores were statistically significantly higher in the biplanar group (p<0.05). Postoperatively, the mean VAS score was lower in the biplanar group, and the range of change was greater. In the monoplanar group, the postoperative VAS values were closer to each other and were higher than in the biplanar group. The mean postoperative KSS function score was higher in the biplanar group, and the range of change was higher in the monoplanar group. The study results showed that biplanar medial open wedge high tibial osteotomy was more successful in terms of both pain and functional capacity. However, the operation time was longer than the monoplanar method.

Stabilization of DC‐link voltage in single‐phase AC/DC converter with power factor correction using predictive control algorithm

SummaryThis paper proposes a power factor correction (PFC) method in a single‐phase AC/DC converter using a predictive control algorithm (PCA) through a boost DC/DC converter. The minimum value of the DC‐link capacitor has been evaluated on the DC distribution side for stable operation of the converter. The proposed technique can be applied to the cascade connection of the converters, that is, the uncontrolled rectifier with boost converter and load. The value of the minimum capacitance is obtained as a function of the reference voltage of the DC‐link capacitor, the frequency of the supply, the input power, and the maximum DC‐link voltage. The proposed design is applied to control the boost converter for PFC applications using PCA at the minimum DC‐link capacitor value. The calculated value of DC‐link capacitance has been reduced to a greater extent as compared to the conventional calculation of DC‐link capacitance. The converter operation with the designed value of DC‐link capacitance has been verified through the MATLAB and Typhoon Simulink environment, and an experimental prototype model is used for the validation by using the FPGA based Typhoon HIL‐402 kit.

The Incidence of Carpal Tunnel Syndrome Diagnosis Increases after Arthroscopic Shoulder Surgery

Arthroscopic shoulder surgery has been identified as a potential risk factor for carpal tunnel syndrome (CTS). The purposes of this study were as follows: to (1) examine the percentage of patients who underwent arthroscopic shoulder procedures and later developed ipsilateral CTS within 1 year of the procedure, (2) determine the percentage of those patients with CTS who subsequently underwent an injection or release, and (3) examine comorbidities associated with developing CTS after surgery. Patients who underwent arthroscopic rotator cuff repair (RCR), labral repair, or biceps tenodesis were retrospectively identified in a national database. Within 1 year, we compared the rates of ipsilateral CTS diagnoses versus the contralateral side. The rates of comorbidities between those who did and did not develop CTS were also compared. Within 1 year, arthroscopic RCR patients (1.47% vs 1.00%; odds ratio [OR], 1.48; P < .001) and arthroscopic labral repair patients (0.76% vs 0.52%; OR, 1.47; P < .001) had a significantly higher rate of ipsilateral carpal tunnel diagnosis versus contralateral side diagnosis. Arthroscopic RCR patients were also significantly more likely to have ipsilateral carpal tunnel injection (0.16% vs 0.11%; OR, 1.45; P < .001) and release (0.46% vs 0.37%; OR, 1.24; P < .001). Patients who had an ipsilateral carpal tunnel diagnosis following arthroscopic RCR and labral repair were both significantly older (both P < .001), a higher percentage of women (both P<.001), and more likely to have had a preoperative nerve block (both P < .05). Both cohorts had significantly higher mean Elixhauser comorbidity Index (P < .001) and more comorbidities. This study demonstrated a significantly higher incidence of operative side CTS within 1 year following arthroscopic RCR and labral repairs. Arthroscopic RCR was also demonstrated to result in significantly higher rates of injections and carpal tunnel release. The cohort that developed ipsilateral CTS was older, had higher percentage of women, and had more comorbidities. Prognostic III.

Factors Affecting The Measurement of Intermediation Margin in Islamic Banks in Indonesia

Main Purpose - The purpose of this study is to empirically assess the main factors that affect the bank margin of Islamic operations in Indonesia.Method - Hypothesis testing and data analysis used the Structural Equation Model - Partial Least Square (SEM-PLS. The research sample was conducted on 10 Islamic banks that have a dual banking system in Indonesia.Main Findings - The results of the study proved that the Capital Adequacy Ratio (CAR) had a positive and significant effect on the Net Intermediation Margin (NIM) and the size of the bank had a positive and significant effect on the Net Intermediation Margin (NIM). Meanwhile, Non-Performing Financing (NPF) and Operating Expenses of Operating Income (BOPO) had no effect on the net intermediation margin (NIM) in Islamic Banks.Theory and Practical Implications - The significant impact of the CAR and the size of the bank showed that there was an analysis of capital policy and product diversification on the bank. The high level of margin in Islamic banks can be an obstacle for Islamic banks to pursue the development process, therefore, there is a need for improvement in terms of liability, asset side, and operational side of the Bank in order to reduce NIM in Sharia Banks. Novelty - This research used BI rate and inflation as control variables in contrast to other studies that included BI Rate and inflation as independent variables.

Combining Shelf Osteotomy With Proximal Femoral Reconstruction After Oncologic Resection

Introduction: Oncologic proximal femoral resection and reconstruction in skeletally immature children remains a formidable task due to the risk of developing hip instability with patient growth or interval leg lengthening through the prosthesis. Shelf pelvic osteotomy increases femoral head coverage and containment, and favorable long-term results have been reported in the setting of developmental dysplasia of the hip and Perthes disease. We present a technique of combining shelf osteotomy with expandable proximal femoral endoprosthesis reconstruction in pediatric limb-sparing surgery. Materials and Methods: Four surgeons at 2 centers from 2012 to 2020 performed proximal femoral reconstruction with shelf osteotomy. Data were collected retrospectively on operative technique, radiographic measurements, and complications including dislocation, subluxation, implant loosening, pain, function, and radiographic outcomes. Results: Five patients were included in the study. The mean follow-up was 49 months (range: 17 to 104 mo). The mean lateral center edge angle status postproximal femoral resection and reconstruction shelf osteotomy was 56.1 degrees (±30.5). There were no reported incidences of subluxations, dislocations, periprosthetic fractures, or soft tissue complications. The 3 patients with the longest follow-up at 3, 5, and 8 years tolerated serial lengthening of the endoprosthesis totaling 1 cm, 7.25 cm, and 9 cm, respectively, and demonstrated earlier triradiate cartilage closure in the operative side compared with the nonoperative side. All patients have returned to independent ambulation. Discussion: Combining proximal femoral reconstruction with shelf osteotomy in limb salvage pediatric orthopedic oncology may help to improve hip stability with serial lengthening and patient growth.

A hybrid simulation model for modules installation in modular integrated construction projects

Proper management of the installation process in Modular Integrated Construction (MiC) is essential to achieve the time-saving benefit of MiC. The analysis of the installation process should cover its operational and contextual sides to realistically mimic the problem. In this connection, the parameters governing the operational and contextual realms of the MiC installation process were identified and investigated through literature; afterwards, a hybrid model was developed to estimate installation rate, duration, and cost of MiC projects. In this model, discrete event simulation was used to consider the operational aspects of the process, e.g. tasks, durations, and logical sequence, while system dynamics was utilized to capture its contextual factors, e.g. absenteeism, rework, resource utilization, fatigue, and weather conditions. BIM was used to feed the model by modules’ coordinates and visualize the process. Monte Carlo simulation was adopted to tackle uncertainty and sensitivity analysis was performed to measure outputs variation. The study achieved its aim and objects and the model proved high sensitivity against resource variation and weather conditions, where it was concluded that doubling the resources would reduce the project duration by more than 50% and the weather conditions had an impact of 8.5% increase in project duration. Finally, the model was validated using a case study from the literature.