Post Reduction Research Articles

Endarterectomy in CTEPH: hemodynamic improvement and RV-PA coupling

Abstract Introduction Pulmonary artery endarterectomy (PAE) remains the gold standard in treating chronic thromboembolic pulmonary hypertension (CTEPH). Reducing the thrombotic burden and mechanical obstruction of the pulmonary artery (PA) leads to significant hemodynamic improvement, allowing for favorable right ventricular (RV) remodeling. Methods Single center retrospective study, including 30 pts submitted to PEA over a 7-year period. Hemodynamic assessment was performed by right heart catheterization (RHC) before PEA, immediately after and at 6-month follow-up (FUP). Echocardiographic assessment of RV function was acquired at baseline and 6m FUP. Mean absolute differences were calculated before and after PEA. Differences between groups were assessed with ANOVA analysis and ROC curve analysis allowed us to define a cut-off point in mPAP reduction to predict favorable RV remodeling. Results We included 30 pts with a mean age of 57,9 ± 13 years old and slight predominance of female sex (57%). Regarding risk assessment with the 4 strata tool at baseline, 23% of pts were high risk, 20% intermediate high, 27% intermediate low and 6% at low risk. Pulmonary hemodynamics improved immediately after PEA, as indicated by a mean reduction of 28,3 ±17 mmHg in mPAP; 44,4±27,6mmHg in sPAP; 8±3,4 Wu in PVR and an increase in CO of 0,5±1 l/min. This improvement was sustained at 6-m post PEA assessment, with a mean reduction of 31,5 ±26,7 mmHg in mPAP; 48,3±41,2mmHg in sPAP; 6,3±6,2Wu in PVR and a 0,5±1 l/min increase in CO. Regarding RV remodeling at 6m post PEA, an increase of 0.15±0.2mm/mmHg in TAPSE/PSAP ratio and 3±2,8cm/s in Tricuspid S’ were recorded. RV/PA uncoupling, defined as TAPSE/PSAP <0,31 mm/mmHg, was evident in 73% of pts at baseline, 25% of which recovered at 6m follow-up. There were no significant differences between groups, according to the 4 strata risk assessment at baseline, regarding pulmonary hemodynamics and RV remodeling. Through ROC curve analysis, we were able to define a cut-off point of 37mmHg in immediate mPAP post-op reduction to predict RV-RA coupling normalization at 6-m FUP (sensitivity 70%, specificity 89%). Conclusions PEA remains a cornerstone of CTEPH treatment. It’s impact on improving pulmonary hemodynamics is immediate and maintained at 6-month FUP. This improvement may be expected regardless of risk assessment at baseline. Reducing RV afterload allows favorable remodeling and an immediate post operative reduction of mPAP > 37mmHg may predict normalization of RV-PA coupling.

THE ACUTE MANAGEMENT OF PILON FRACTURES (ENFORCE) STUDY: A TRAINEE-LED NATIONAL COLLABORATIVE EVALUATION OF PRACTICE

IntroductionTibial Pilon fractures are potentially limb threatening, yet standards of care are lacking from BOFAS and the BOA. The mantra of “span, scan, plan” describes staged management with external fixation to allow soft tissue resuscitation, followed by a planning CT-scan. Our aim was to evaluate how Tibial Pilon fractures are acutely managed.MethodsENFORCE was a multi-centre retrospective observational study of the acute management of partial and complete articular Tibial Pilon fractures over a three-year period. Mechanism, imaging, fracture classification, time to fracture reduction and cast, and soft tissue damage control details were determined.Results656 patients (670 fractures) across 27 centres were reported. AO fracture classifications were: partial articular (n=294) and complete articular (n=376). Initial diagnostic imaging mobilities were: plain radiographs (n=602) and CT-scan (n=54), with all but 38 cases having a planning CT-scan. 526 fractures had a cast applied in the Emergency Department (91 before radiological diagnosis), with the times taken to obtain post cast imaging being: mean 2.7 hours, median 2.3 hours, range 28 mins – 14 hours). 35% (102/294) of partial articular and 57% (216/376) of complete articular (length unstable) fractures had an external fixator applied, all of which underwent a planning CT-scan. Definitive management consisted of: open reduction internal fixation (n=495), fine wire frame (n=86), spanning external fixator (n=25), intramedullary nail (n=25), other (n=18).ConclusionThe management of Tibial Pilon fractures is variable, with prolonged delays in obtaining post cast reduction radiographs, and just over half of length unstable complete articular fractures being managed with the gold standard “span, scan, plan” staged soft tissue resuscitation. A BOFAS endorsed BOAST (British Orthopaedic Association Standard for Trauma) for Tibial Pilon fractures is suggested for standardisation of the acute management of these potentially limb threatening injuries, together with setting them apart from more straightforward ankle fractures.

The medium is the message: toxicity declines in structured vs unstructured online deliberations

Humanity needs to deliberate effectively at scale about highly complex and contentious problems. Current online deliberation tools—such as email, chatrooms, and forums—are however plagued by levels of discussion toxicity that deeply undercut the willingness and ability of the participants to engage in thoughtful, meaningful, deliberations. This has led many organizations to either shut down their forums or invest in expensive, frequently unreliable, and ethically fraught moderation of people's contributions in their forums. This paper includes a comprehensive review on online toxicity, and describes how a structured deliberation process can substantially reduce toxicity compared to current approaches. The key underlying insight is that unstructured conversations create, especially at scale, an “attention wars” dynamic wherein people are often incented to resort to extremified language in order to get visibility for their postings. A structured deliberation process wherein people collaboratively create a compact organized collection of answers and arguments removes this underlying incentive, and results, in our evaluation, in a 50% reduction of high-toxicity posts.

Social Media Metrics as Predictors of Publishers’ Website Traffic

The relationship between legacy media and social media has become a crucial topic in the discussions about new media. The debate intensified after Facebook announced a reduction in news posts in user timelines in 2018. In the era of the “Like economy”, social media holds significant economic value, prompting media outlets to adopt a “let’s try and see” approach to reach new audiences and increase their online advertising share. The present study, based on a large-scale survey of 50 publishers’ websites, Facebook pages, and Twitter accounts, deepens our understanding of the relationship between legacy and social media as indicators of audience feedback. Through the lens of network gatekeeping and reciprocal journalism theories, it contributes to the development of new evaluation tools that predict publishers’ website traffic based on social media metrics. Results show that Facebook and Twitter metrics can predict publishers’ website traffic indicators at a rate exceeding 60%. This study underscores the importance of social media metrics in evaluating media practices and the need to shift research toward specific indicators to understand the relationship between legacy and social media.

Far-field effects of the Nile damming on the silica cycle in the Southeastern Mediterranean Sea

Silica plays a key role in the growth of silicifying primary producers (e.g., diatoms) and hence the ocean carbon pump. The Mediterranean Sea's eastern Levantine Basin (ELB) is a low silica (and low N and P) ultra-oligotrophic basin. Before 1965, Nile autumn floods were a major source of dissolved silica (DSi) and other nutrients to primary producers of the ELB continental shelf, also known as the Nilotic cell. The construction of the Aswan High Dam (AHD) in the mid-1960s, blocked these floods, drastically diminishing the autumn-diatom blooms offshore the Nile delta. However, the far-reaching and long-lasting effects of the Nile damming on the Si cycle in the ELB remain unclear. Here, we studied the changes in DSi in the surface water offshore Israel and the distribution of biogenic silica in deep-sea short sediment cores, collected hundreds of kilometers from the Nile outlet, at depths range of 1100–1900 m, offshore the ELB Israeli coast. We show post dam reduction and termination in flood related seasonality of DSi and a concurrent decrease (of up to 79 %) in biogenic silica (BSi) accumulation rates in surficial sediments relative to underlying sediments. These changes reflect the effects of Si (dissolved and particulate) retention by the AHD on diatoms production, export and burial in the ELB. This far-field effect was demonstrated in deep-sea areas subjected to intense lateral transport of resuspended sediments from the shelf via intermediate nepheloid layers and to coastal water intrusions, along the path of the pre-dam, flood plumes. Our core records show that the AHD worsened nutrient-diminished, exceptionally unfavorable conditions for diatoms that persisted in the deep ELB at least during the last four millennia.

Novel Advances in Qualitative Diagnostic Imaging for Decision Making in Multidisciplinary Treatment for Advanced Esophageal Cancer.

Background: Recently, neoadjuvant therapy and the succeeding surgery for advanced esophageal cancer have been evaluated. In particular, the response to the therapy has been found to affect surgical outcomes, and thus a precise evaluation of treatment effect is important for this strategy. In this study, articles on qualitative diagnostic modalities to evaluate tumor activities were reviewed, and the diagnostic indices were examined. Methods: For prediction of the effect, perfusion CT and diffusion MRI were estimated. For the histological response evaluation, perfusion CT, diffusion-MRI, and FDG-PET were estimated. For downstaging evaluation of T4, tissue-selective image reconstruction using enhanced CT was estimated and diagnostic indices were reviewed. Results: The prediction of the effect using perfusion CT with 'pre CRT blood flow' and diffusion MRI with 'pre CRT ADC value'; the estimation of the histological response using perfusion CT with 'post CRT blood flow reduction, using diffusion MRI with 'post CRT ADC increasing', and using FDG-PET with 'post CRT SUV reduction'; and the downstaging evaluation of T4 using CT image reconstruction with 'fibrous changed layer' were performed well, respectively. Conclusions: Qualitative imaging modalities for prediction or response evaluation of neoadjuvant therapy for progressive esophageal cancer were useful for the decision making of the treatment strategy of the multidisciplinary treatment.

Morphology of uranium oxides reduced from magnesium and sodium diuranate

Abstract Morphological analysis of uranium materials has proven to be a key signature for nuclear forensic purposes. This study examines the morphological changes to magnesium diuranate (MDU) and sodium diuranate (SDU) during reduction in a 10 % hydrogen atmosphere with and without steam present. Impurity concentrations of the materials were also examined pre and post reduction using energy dispersive X-ray spectroscopy combined with scanning electron microscopy (SEM-EDX). The structures of the MDU, SDU, and UO x samples were analyzed using powder X-ray diffraction (p-XRD). Using this method, UO x from MDU was found to be a mixture of UO2, U4O9, and MgU2O6 while UO x from SDU were combinations of UO2, U4O9, U3O8, and UO3. By SEM, the MDU and UO x from MDU had identical morphologies comprised of large agglomerates of rounded particles in an irregular pattern. SEM-EDX revealed pockets of high U and high Mg content distributed throughout the materials. The SDU and UO x from SDU had slightly different morphologies. The SDU consisted of massive agglomerates of platy sheets with rough surfaces. The UO x from SDU was comprised of massive agglomerates of acicular and sub-rounded particles that appeared slightly sintered. Backscatter images of SDU and related UO x materials showed sub-rounded dark spots indicating areas of high Na content, especially in UO x materials created in the presence of steam. SEM-EDX confirmed the presence of high sodium concentration spots in the SDU and UO x from SDU. Elemental compositions were found to not change between pre and post reduction of MDU and SDU indicating that reduction with or without steam does not affect Mg or Na concentrations. The identification of Mg and Na impurities using SEM analysis presents a readily accessible tool in nuclear material analysis with high Mg and Na impurities likely indicating processing via MDU or SDU, respectively. Machine learning using convolutional neural networks (CNNs) found that the MDU and SDU had unique morphologies compared to previous publications and that there are distinguishing features between materials created with and without steam.

A note on sufficient dimension reduction with post dimension reduction statistical inference

A note on sufficient dimension reduction with post dimension reduction statistical inference

The Effect of Benson's Relaxation on Pain in Patients Post Open Reduction Internal Fixation (orif) Extremity Fractures

The most common complaint felt by patients due to fractures and the main complaint of patients after surgery is pain. Pain that is felt continuously can result in clinical and psychological changes. Benson's relaxation can be an alternative intervention in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures to reduce pain by stimulating the pituitary gland to release endorphins and inhibit pain impulses from the cerebral cortex and thalamus. Benson Relaxation is safe and easy to do, has no risk of injury/side effects. The purpose of this study was to determine the effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures in the Dahlia Room at Mardi Waluyo General Hospital, Blitar. The research design uses a quasi-experimental pre-post test design. The population was all post ORIF patients with extremity fractures in the Dahlia (surgical) room at Mardi Waluyo Blitar Hospital with a total of 35 patients. The sample was post ORIF extremity fracture patients in the Dahlia Room of Mardi Waluyo General Hospital Blitar with a total sample of 13 respondents in each group using the Consecutive Sampling technique. Pain measurement data uses a Numerical Rating Scale. Statistical test using independent t-test. The results showed that the mean decrease in pain score in the Benson relaxation intervention group was 1.10, while the mean decrease in pain score in the control group was 0.44 with a pvalue of 0.00 <��� 0.05. It was concluded that there was an effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures. Benson relaxation is effective in reducing pain in patients with post open reduction internal fixation (ORIF) limb fractures. There needs to be a standard operating procedure regarding Benson's relaxation, so that later it can be implemented by all nurses.Keywords: Benson Relaxation, Pain, Fracture, Post ORIF

The Effect of Benson's Relaxation on Pain in Patients Post Open Reduction Internal Fixation (orif) Extremity Fractures

The most common complaint felt by patients due to fractures and the main complaint of patients after surgery is pain. Pain that is felt continuously can result in clinical and psychological changes. Benson's relaxation can be an alternative intervention in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures to reduce pain by stimulating the pituitary gland to release endorphins and inhibit pain impulses from the cerebral cortex and thalamus. Benson Relaxation is safe and easy to do, has no risk of injury/side effects. The purpose of this study was to determine the effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures in the Dahlia Room at Mardi Waluyo General Hospital, Blitar. The research design uses a quasi-experimental pre-post test design. The population was all post ORIF patients with extremity fractures in the Dahlia (surgical) room at Mardi Waluyo Blitar Hospital with a total of 35 patients. The sample was post ORIF extremity fracture patients in the Dahlia Room of Mardi Waluyo General Hospital Blitar with a total sample of 13 respondents in each group using the Consecutive Sampling technique. Pain measurement data uses a Numerical Rating Scale. Statistical test using independent t-test. The results showed that the mean decrease in pain score in the Benson relaxation intervention group was 1.10, while the mean decrease in pain score in the control group was 0.44 with a pvalue of 0.00 <��� 0.05. It was concluded that there was an effect of Benson relaxation on pain in patients with Post Open Reduction Internal Fixation (ORIF) limb fractures. Benson relaxation is effective in reducing pain in patients with post open reduction internal fixation (ORIF) limb fractures. There needs to be a standard operating procedure regarding Benson's relaxation, so that later it can be implemented by all nurses.Keywords: Benson Relaxation, Pain, Fracture, Post ORIF

Therapist competence, homework engagement, and client characteristics in CBT for youth depression: A study of mediation and moderation in a community-based trial

ABSTRACT Objective Prior studies of Cognitive Behavioral Therapy (CBT) have focused on the quantity and quality of clients’ homework completion and only rarely have considered the role of therapist competence. Methods The present study examined (a) therapist competence across the entire process of integrating homework into CBT, including the review, design, and planning of tasks; (b) homework engagement, including client appraisals of the difficulty and obstacles encountered in task completion using the Homework Rating Scale – Revised (HRS-II); (c) pre–post symptom reduction as the index of outcome; and (d) considered client factors such as suicide risk in a community-based trial for adolescent depression. Trained independent observers assessed therapist competence and engagement with homework at two consecutive sessions of CBT for N = 80 young people (M age = 19.61, SD = 2.60). Results Significant complementary mediation effects were obtained; there was an indirect mediation effect of HRS-II Beliefs (b = 1.03, SE B = 0.42, 95% BCa CI [0.35, 2.03]) and HRS-II Perceived Consequences on the Competence-Engagement relationship (b = 0.85, SE B = 0.31, 95% BCa CI [0.39, 1.61]). High levels of suicidal ideation were also shown to moderate this relationship. Conclusions The present findings contribute to the growing body of CBT process research designed to examine the complex interrelationships of client and therapist variables, in a manner that reflects the actual process of therapy, and advances beyond studies of isolated predictors of symptom change.

Iterated Clique Reductions in Vertex Weighted Coloring for Large Sparse Graphs.

The Minimum Vertex Weighted Coloring (MinVWC) problem is an important generalization of the classic Minimum Vertex Coloring (MinVC) problem which is NP-hard. Given a simple undirected graph G=(V,E), the MinVC problem is to find a coloring s.t. any pair of adjacent vertices are assigned different colors and the number of colors used is minimized. The MinVWC problem associates each vertex with a positive weight and defines the weight of a color to be the weight of its heaviest vertices, then the goal is the find a coloring that minimizes the sum of weights over all colors. Among various approaches, reduction is an effective one. It tries to obtain a subgraph whose optimal solutions can conveniently be extended into optimal ones for the whole graph, without costly branching. In this paper, we propose a reduction algorithm based on maximal clique enumeration. More specifically our algorithm utilizes a certain proportion of maximal cliques and obtains lower bounds in order to perform reductions. It alternates between clique sampling and graph reductions and consists of three successive procedures: promising clique reductions, better bound reductions and post reductions. Experimental results show that our algorithm returns considerably smaller subgraphs for numerous large benchmark graphs, compared to the most recent method named RedLS. Also, we evaluate individual impacts and some practical properties of our algorithm. Furthermore, we have a theorem which indicates that the reduction effects of our algorithm are equivalent to that of a counterpart which enumerates all maximal cliques in the whole graph if the run time is sufficiently long.

#5026 ESTIMATED PROXIMAL TUBULE FLUID PHOSPHATE CONCENTRATION AS AN ELEMENT OF DECREASED RENAL FUNCTION IN PATIENTS UNDERGOING UNILATERAL NEPHRECTOMY

Abstract Background and Aims Patients with chronic renal failure (CRF) develop early alterations in mineral metabolism called Chronic Kidney Diseases Mineral Bone Disorders (CKD-MBD), detectable with the available markers (PTH, Ca, Ps) only in the most advanced stages of disease. Recent evidence suggests that the early development of CKD-MBD is related to the nutritional phosphorus intake and the reduction of the number of nephrons (renal functional reserve). Infact with the reduction in the nephrons number, compensation systems must be activated for the maintenance of the phosphoric balance with an increase in urinary phosphate and in the concentration of phosphorus in the single nephron (ePTFp). Therefore, the measurement of ePTFp has been proposed as a new early marker of CKD-MBD and effective renal functional reserve. Threshold values of ePTFp (2.2 mg/dl) have been identified to indicate patients with reduced renal functional reserve and therefore at increased risk of progression of renal damage. The measurement of residual renal function with ePTFp may be a useful parameter to be evaluated in patients who undergo unilateral nephrectomy due to renal neoplasia. In fact, post-nephrectomy some patients have a high reduction of the renal function not identified by preoperative GFR assessment or other risk factors. In these patients, ePTFp could represent a measure of pre nephrectomy kidney functional reserve and thus indicate the risk of reduce renal function after nephrectomy. The aim of the study was to evaluate the relationship between pre-operative ePTFp and renal function after nephrectomy. Methods This is a transversal monocentric observational study. From January 2022 to November 2022, we enrolled patients diagnosed with renal cell carcinoma for which has been indicated unilateral nephrectomy surgery. In all patients we evaluated pre nephrectomy and three months after surgery, renal function, and ePTFP with the formula [ePTFp = (Phosphaturia / creati-ninuria) x creatininemia x 3,33]. 30 subjects with normal renal function (eGFR 100±10 ml/min, no proteinuria) were evaluated for the ePTFp reference values. Results We evaluated 13 patients: age 57.5 ± 13.6; Cr 1.48±0.7 mg/dl; eGFR 58.5 ± 23.3, mil/min; Pi, mg/dl 3.2± 0.6; Ca 9.9± 0.6 mg/dl,PTH 58,8± 41 pg/ml FA 176,7± 108 IU/L, proteinuria 500±150 mg 24H. Compared to the control population (GFR 100 ml/min) the 24-hour phosphaturia was no different while ePTFp was increased 2.1± 0.9 vs 1.2±0.2 mg/dl; p: 0.05. In the post-nephrectomy assessment, creatinine and GFR were stable (Cr 1.48±0.7 vs 1.5 ±0.7 mg/dl; p: n.s; eGFR 58.5 ± 23.3, vs 56.5 ± 22.3, mil/min; p: n.s), while ePTFp was increased (ePTFp pre 2.1± 0.9 vs ePTFp post 3.3± 2.7; p<0.01). Patients with pre-nephrectomy ePTFP ≥ 2.2 mg/dl (n. 6, eGFR 56.5 ± 20.3, proteinuria 550±100 mg/24h) had a greater renal function reduction post nephrectomy (mean GFR delta -9.5±2 ml/min) respect to patients with pre-nephrectomy ePTFP <2.2 mg/dl (n. 7, eGFR 59.7 ± 24.3, proteinuria 500±200 mg/24h; mean GFR delta -0.5±2 ml/min; p: 0.05). In all the population there was direct correlation between ePTFp and the reduction of GFR post nephrectomy (r: 0.667; p: 0.05). Conclusion In our patients ePTFp was higher than the control group and correlate with the entity of the GFR reduction post nephrectomy. The group with a preoperatory ePTFp ≥ 2,2 mg/dl had a higher post nephrectomy GFR reduction. These results suggest that ePTFp identify the pre nephrectomy kidney functional reserve. In particular and ePTFp higher than limits highlighted in the literature (2.2 mg/dl) pre nephrectomy identify a greater risk of kidney function reduction post nephrectomy. ePTFp may be proposed as a parameter to identify patients with higher risk of decreased renal function post nephrectomy.

Tranexamic Acid Treatment Reduces Blood Loss After Elective and Semi-Urgent Reverse Total Shoulder Arthroplasty.

Post operative blood loss after reverse shoulder arthroplasty (RSA) is associated with the need for blood transfusion and prolonged hospital stay, among other complications. Tranexamic acid (TXA) reduces perioperative blood loss and is effective when delivered systemically or locally. We compared the effects of TXA on perioperative blood loss between elective and semi-urgent RSA. We retrospectively reviewed patients who underwent either elective or semi-urgent RSA for fracture repair, with and without TXA treatment. Demographics, clinical records, and laboratory results were collected and analyzed to compare peripheral blood hemoglobin concentrations before and after surgery, the need for blood transfusion, and length of hospital stay between the 2 groups. In a cohort of 158 patients, 91 (58%) underwent elective RSA. TXA was administered in 91 (58%) patients from the entire group. TXA administration was associated with a significant decrease in post operative hemoglobin concentration reduction in both the elective and fracture groups (P = .026 and P = .018, respectively), a significant decrease in post operative blood transfusion rates (P = .004 and P = .003, respectively), and a decrease in the need for prolonged hospitalization (P = .038 and P = .009, respectively). The local application of TXA during RSA yielded a significant reduction in perioperative blood loss. We showed a significant positive effect of local TXA administration during RSA that is comparable for both elective and semi-urgent patients. Due to the baseline characteristics of fracture patients, their clinical benefits may be more notable. The positive outcomes for surgical patients with the use of TXA during RSA can possibly cause future consideration in clinical practice.

A multicenter study of factors affecting nonunion by radiographic analysis after intramedullary nailing in segmental femoral shaft fractures

The factors affecting the outcomes of segmental femoral shaft fractures are currently unknown. We evaluated the outcomes of intramedullary (IM) nail fixation and investigated factors affecting nonunion of femoral shaft segmental fractures. A total of 38 patients who underwent IM nail fixation for femoral shaft segmental fractures (AO/OTA 32C2) at three university hospitals with a minimum 1-year follow-up period were retrospectively reviewed. The patients were divided into union (n = 32) and nonunion (n = 6) groups. We analyzed smoking status, diabetes mellitus, location of the segmental fragment, segment comminution, filling of the IM nail in the medullary canal, residual gap at the fracture site, use of a cerclage wire or blocking screws as factors that may affect the surgical outcome. In the union group, the average union time was 5.4 months (4–9 months). In the nonunion group, five patients required additional surgery within an average of 7.2 months (5–10 months) postoperatively, whereas one patient remained asymptomatic and did not require further intervention. On comparing the two groups, insufficient canal filling of the IM nail (union, 25.0%; nonunion, 83.3%; p = 0.012) and the presence of a residual gap at the fracture site after reduction (union, 31.3%; nonunion, 83.3%; p = 0.027) were significantly different. In the multivariate analysis, only insufficient canal filling of the IM nail was found to be a factor affecting nonunion, with an odds ratio of 13.3 (p = 0.036). In this study, a relatively high nonunion rate (15.8%) was observed after IM nail fixation. Insufficient IM nail canal filling and a residual gap at the fracture site post reduction were factors affecting segmental femoral shaft fracture nonunion after IM nail fixation.

Medical Rehabilitation in Patient with Post ORIF et causa Neglected Epiphyseal Fracture Distal Radius-Ulna Sinistra: A Case Report

Distal radius-ulna fracture is one of the most common human osseous injuries, with incidence rate increasing worldwide. There are two peaks of prevalence: the first around the 10th and the second around the 60th year of life. During childhood, they are among the most common pediatric fractures accounting for 19.9 to 35.8% of all pediatric fractures. We reported a case of a boy 13 years old diagnosed as post open reduction internal fixation distal radius ulna et causa epiphyseal fracture. He came to rehabilitation outpatient clinic with chief complaint pain on his left forearm. He underwent a surgery two weeks ago at the distal radius ulna. The surgeon did osteotomy on ulna and then fixated with plate and screw. On physical examination, there were pain and range of motion limitation mainly on the forearm and wrist joint. The patient was treated with low level laser therapy at the surgical wound to promote healing and decrease edema, initial digital motion exercise along with active range of motion of the uninvolved joints. He was also educated about icing and medicamentation if pain still persisted. Once adequate bony healing had occurred, active, active-assisted, progressive passive wrist motion, and strengthening exercise using resistance were performed to maximize the result. At the end of rehabilitation program, there was great improvement on pain and also range of motion improvement. Albeit, there was still a slight range of motion limitation on ulnar deviation and wrist extension by 5 degrees. In conclusion, rehabilitation program is very beneficial in treating post-surgery patient using modalities and exercises to improve functional function. Keywords: epiphyseal fracture; radius-ulna; medical rehabilitation

Gastric peroral endoscopic myotomy versus surgical pyloromyotomy/pyloroplasty for refractory gastroparesis: systematic review and meta-analysis.

Background and study aims Gastric per-oral endoscopic myotomy (G-POEM) has been recently compared with surgical techniques (i. e. pyloromyotomy and pyloroplasty) for managing patients with refractory gastroparesis. Given the varying results, we performed a systematic review and meta-analysis of available studies to assess the safety and efficacy of each technique. Patients and methods A comprehensive review of the literature using the following databases was undertaken through July 29, 2022: MEDLINE, Embase, Web of Science, KCI - Koran Journal index, Global Index Medicus, and Cochrane. Comparative studies including case-control, cohort and randomized controlled trials (RCTs) were included. Random effects model using DerSimonian laird approach was used to compare outcomes. Relative risk (RR) and mean difference (MD) were calculated for binary and continuous outcomes respectively. Results A total of four studies with 385 patients (216 in the G-POEM group and 169 in the surgical group were included. The mean age was 46.9 (± 3.41) and 46.2 (± 0.86) and the female proportion was 79.6 % and 74.0 % for the G-POEM and surgery group respectively. The mean procedural time (MD: -59.47 mins, P < 0.001) and length of hospital stay (MD: -3.10 days, P < 0.001) was significantly lower for G-POEM compared to surgery. The post procedure GCSI score (MD: -0.33, P = 0.39) and reduction in GCSI score preoperatively and postoperatively (MD: 0.27, P = 0.55) was not significantly different. Conclusions G-POEM appears promising as it may provide a cost-effective approach for managing refractory gastroparesis compared to surgical techniques. RCTs are needed to further confirm these results.

Oxygen defect-mediated NiCo2O4 nanosheets as the electrode for pseudocapacitors with improved rate capability.

Transition metal oxide-based supercapacitors have attracted much attention due to their high theoretical specific capacitances. However, due to an insufficient utilization ratio and poor intrinsic conductivity of active materials, the rate performance of these electrodes is usually low. Herein, oxygen defect-mediated NiCo2O4 nanosheets with enhanced electrical conductivity (1.9 S m-1vs. 0.2 S m-1 of original NiCo2O4 NSs) are fabricated using a post NaBH4 reduction strategy (denoted as r-NiCo2O4 NSs). The derived r-NiCo2O4 materials have sheet-like morphology, increased oxygen defects and low valence metal species, and an unprecedented rate capability comparable to that of carbon-based electrode materials, with a satisfactory capacitance of 1812 F g-1 and 91.5% retention at 20 A g-1. The general strategy can be extended to other transition metal oxides to construct enhanced conductivity electrodes for related energy storage and conversion devices.

Prospective observational study of Nipple–Areola Complex Position post breast reduction

Prospective observational study of Nipple–Areola Complex Position post breast reduction

Pulsatile energy consumption as a surrogate marker for vascular afterload improves with time post transcatheter aortic valve replacement in patients with aortic stenosis.

The effect of arterial stiffening on elevated pulsatile left ventricular afterload patients with aortic stenosis (AS) is pronounced beyond systemic hypertension. Circulatory afterload pulsatile efficiency (CAPE) is a marker of vascular function, defined as the ratio of steady state energy consumption (SEC) to maintain systemic circulation and pulsatile energy consumption (PEC). Twenty patients aged 80 ± 7 years were assessed at baseline and a median of 60 days post transcatheter aortic valve replacement (TAVR), with pulsatile vascular load calculated using simultaneous radial applanation tonometry derived aortic pressure and cardiac magnetic resonance phase-contrast imaging derived ascending aortic flow. Eight out of 20 patients had a reduction in PEC post TAVR, and the reduction of PEC correlated strongly with the number of days post TAVR (R = 0.62, P < 0.01). Patients assessed within the 100 days of TAVR had a rise in their PEC when compared to baseline (0.19 ± 0.09 vs 0.14 ± 0.08 W, P = 0.04). Baseline PEC correlated moderately with baseline SEC (R = 0.49, P = 0.03), and a high baseline PEC was predictive of post TAVR PEC reduction (R = 0.54, P =0.01). Overall, no significant differences were found between baseline and post TAVR for systolic aortic pressure (131 ± 20 vs 131 ± 20 mmHg), systemic vascular resistance (1894 ± 493 vs 2015 ± 519 dynes.s/cm5), aortic valve ejection time (337 ± 22 vs 324 ± 34 ms) or aortic characteristic impedance (120 ± 48 vs 107 ± 41 dynes.s/cm5). Improved flow profiles after TAVR likely unmask the true vascular properties by altering ventriculo-valvulo-arterial coupling, leading to downstream vascular remodelling secondary to flow conditioning, and results in eventual improvement of pulsatile afterload as reflected by our proposed index of CAPE.