Predictable Results Research Articles

Visual and refractive outcomes after implantation of two models of trifocal intraocular lenses in eyes with previous corneal ablation to treat hyperopia

BackgroundTo assess whether a trifocal intraocular lens (IOL) with neutral spherical aberration (SA) provides better visual and refractive outcomes than a trifocal IOL with negative SA after hyperopic corneal laser ablation.MethodsThis is a retrospective comparative study. Patients were classified according to the IOL implanted after cataract or clear lens phacoemulsification [group 1, PhysIOL FineVision Pod-F (negative SA); group 2, Rayner RayOne Trifocal (neutral SA)]. We evaluated uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), uncorrected intermediate visual acuity (UIVA), uncorrected near visual acuity (UNVA), predictability, safety, efficacy, and satisfaction.Results198 eyes of 119 patients met the inclusion criteria. Group 1 comprised 120 eyes and group 2 comprised 78 eyes. At completion, the refractive and predictability results were significantly better in group 1 than in group 2 for manifest refraction spherical equivalent (MRSE) (P < 0.001). Differences were not significant for UDVA (P = 0.647), CDVA (P = 0.343), UIVA (P = 0.059), UNVA (P = 0.382), binocular UIVA (P = 0.157), or binocular UNVA (P = 0.527). Safety and efficacy indices in refractive lens exchange (RLE) eyes were 0.96 and 0.91, and 0.89 and 0.93 in groups 1 and 2, respectively (P = 0.254 and 0.168). Patient satisfaction was similar in both groups (P > 0.05, all items).ConclusionIn eyes previously treated with hyperopic corneal ablation, implantation of a trifocal IOL with neutral SA provided better efficacy and safety outcomes but worse predictability outcomes than those obtained with a trifocal model with negative SA.

Deep-Plane Rhytidectomy: Pearls in Maximizing Outcomes while Minimizing Recovery.

The deep-plane rhytidectomy was first described in 1990 and has gained traction in the past decade as supported by anatomy, embryology, and clinical evidence. Consumer dissatisfaction in facial rejuvenation procedures often occurs because procedures are too conservative and are undone. From the consumer's perspective, an outcome is a combination of the esthetic result, predictability, and the length of the recovery process. The length of the recovery process is often the limiting issue affecting the consumer's willingness to proceed with the procedure. As one of the early pioneers in deep-plane rhytidectomy, the lead author will define contemporary advances in deep-plane techniques such as dissection entry point, flap design, and flap fixation concepts that allow an aggressive approach to treating both the superficial soft tissue envelope and deeper facial aging structures. These technique modifications and insights will provide the surgeon with an understanding of how to achieve significant, natural, long-lasting results with predictable short recovery periods-maximizing outcomes and minimizing postoperative processes.

Engineering aquatic plant community composition on floating treatment wetlands can increase ecosystem multifunctionality

Phytoremediation using floating treatment wetlands (FTWs) is an emerging nature-based solution for freshwater restoration. However, the potential to design these systems by manipulating macrophyte community composition to provide multiple ecosystem services remains unexplored. Using a tank experiment, we simulated aquatic environments impacted by multiple pollutants and employed a comparative ecological approach to design emergent macrophyte communities using the trait of plant stature (plant height) to structure communities. Ecosystem functions were quantified, and a threshold-based method used to compute an ecosystem multifunctionality index that was weighted based on three different management-driven restoration objectives: equal importance, phytoremediation, and regulation and cultural services. Across all restoration scenarios, ecosystem multifunctionality was higher when community types performed more diverse functions. Small emergent plant communities outperformed all other community types due to their increased provision of both regulation and maintenance, cultural, and provisioning services. Conversely, large emergent communities that are more typical candidates for phytoremediation had the highest levels of multifunctionality only when function was lower. Arranging emergent macrophytes in mixed-statured communities led to intermediate or poorer performance both in terms of multifunctionality and specific functions, suggesting that diversity on the plant stature axis leads to negative plant interactions and represents a ‘worst of both worlds’ combination. Employing comparative ecology to generalise plant selection by stature demonstrates that large emergent macrophytes are more likely to better deliver provision-based services, while small emergent communities can provide additional benefits from cultural and regulatory services. Selecting macrophytes for FTWs employed in freshwater restoration by stature is a simple and widely applicable approach for designing plant communities with predictable outcomes in terms of (multiple) ecosystem service provision and highlights the need for environmental managers to closely align restoration objectives with potential community types.

Current Landscape of Hyaluronic Acid Filler Use in the United States.

Hyaluronic acid (HA) fillers are among the most used fillers for soft-tissue augmentation. There are now many FDA-approved HA products, and the successful use of injectable HA fillers requires an understanding of the available options.&nbsp; Objective: The purpose of this manuscript is to provide a comprehensive list of HA fillers and their indications. An overview of their biochemical properties and formulations will aid dermatologists in appropriate use. A comprehensive search of all the FDA-approved dermal fillers was conducted via the FDA "pre-market approval" (PMA) site. Additional details regarding filler properties were obtained using the respective agent's package inserts.&nbsp; Results: A total of 28 HA dermal fillers were identified and key pharmaceutical properties were discussed. These findings will help the physician match the appropriate HA filler with the area that is to be treated.&nbsp; Conclusion: Understanding the available fillers and their properties can help physicians select the appropriate fillers for more predictable and sustainable results.&nbsp; J Drugs Dermatol. 2024;23(1):1247-1252. &nbsp;&nbsp; doi:10.36849/JDD.7858.

Road safety impact assessment practices and recommendations

Abstract This article reviews the practices for conducting Road Safety Impact Assessment (RIA). An overview of current research and methodologies related to this field is presented, and various aspects of the preparation of RSIA are analysed. The DIRECTIVE OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL on road infrastructure safety management (RISM Directive) defines the procedure “road safety impact assessment” as a strategic comparative analysis of the impact of a new road or a substantial modification to the existing network on the safety performance of the road network”; The RISM Directive provides only the basic framework for conducting such analysis by just pointing out its basic elements without providing specific methodology for it. Some countries have developed their own methodologies, others not. Although the RIA is a procedure, that was included in the initial RISM Directive (2008), Bulgaria has not yet had much experience with it, nor has a developed methodology or recommendations for it. The main aim of this article is to review and analyse international experience in conducting road safety impact assessment and to present some recommendations about it for such procedures from national teams. The article draws attention to the methods and tools used in the preparation of the RIA. This includes the collection and analysis of road infrastructure and traffic data, the study of previous safety analyses, modelling and simulations of the proposed measures, and the assessment of social and economic aspects. One of the main aspects discussed in the article is the possibility of using computer models and artificial intelligence (AI) in the preparation of the RIA. AI can be applied to process large volumes of data and perform complex risk and scenario analyses. This allows practitioners to obtain more accurate and predictable results to serve as a basis for making informed road safety decisions. In conclusion, the article emphasizes the importance of preparing Road safety impact assessment and presents different practices and methodologies that can be used in this process. The use of computer models and AI can improve the efficiency and accuracy of RSIA and contribute to achieving higher standards of road safety.

A new treatment of concealed penis: symmetrical pterygoid flap surgery.

Considerable controversy exists regarding the surgery for concealed penis. We describe a new technique for repairing concealed penis by symmetrical pterygoid flap surgery. From January 2016 to July 2022, we evaluated 181 cases of concealed penis that were surgically treated using the symmetrical pterygoid flap surgery. We measured the penile size preoperative and 2, 4, 12 weeks, and 1 year postoperative to confirm the improvement. A questionnaire was administered to the patients and parents to assess satisfaction regarding penile size, morphology, and hygiene. The perpendicular penile length was1.59±0.32cm preoperative and 3.82±1.02 cm after the procedure (p < 0.05), and 4.21±1.91cm after one year of postoperative (p < 0.05). The overall satisfaction of patients was 97.89%, while the overall satisfaction of older children patients (age>7) was 75.24%. Parents focus more on the penile exposure size, while patients focus more on the penile morphology. Almost every patient had postoperative penile foreskin edema. However, this symptom had spontaneously resolved by 4-6 weeks. The complications such as skin necrosis, tissue contracture, or wound infection were 4.42%. The symmetrical pterygoid flap surgery is an effective surgical technique for the management of concealed penis in children producing predictable results and excellent satisfaction of the parents and patients.

Considerations for predictable outcomes in static computer- aided implant surgery in the esthetic zone.

To provide technical and clinical recommendations for implementing a digital workflow in Static Computer-Aided Implant Surgery in the anterior maxilla. An optimal 3D implant position is crucial for achieving satisfying results in implant rehabilitation in the esthetic area. Due to its complexity, implant placement in the esthetic zone should be executed with precision and predictability. Static Computer-Aided Implant Surgery requires thorough planning and detailed attention to every step of the digital workflow protocol. Implant positioning in the esthetic zone using Static Computer-Aided Implant Surgery is a technique-sensitive procedure that requires precise execution of each step. This approach ensures accurate prosthetically driven 3D implant placement and prevents potential errors that could lead to inaccurate positioning. The proper implementation of Static Computer-Aided Implant Surgery may increase the level of agreement between the planned and definitive implant 3D positions in the esthetic zone, thus enhancing the esthetic outcomes of implant rehabilitation.

Refining accuracy of RV–PA coupling in patients undergoing transcatheter tricuspid valve treatment

BackgroundAssessing right ventricular (RV) function is paramount for risk stratification, which remains challenging in patients with tricuspid regurgitation (TR). We assessed RV–pulmonary artery (PA) coupling and its predictability of outcomes after transcatheter tricuspid valve repair (TTVR).MethodsStudy participants comprised patients undergoing transcatheter tricuspid valve repair to treat symptomatic TR from June 2015 to July 2021. We calculated an RV–PA coupling ratio using a formula, which is dividing tricuspid annular plane systolic excursion (TAPSE) by echocardiographically estimated (ePASP) or invasively measured PASP (iPASP) at baseline. The primary outcome was all-cause mortality or heart failure rehospitalization within one year.ResultsThe study participants (n = 206) were at high surgical risk (EuroSCORE II: 7.4 ± 4.8%). The primary outcome occurred in 57 patients within one year. The c-statistics for the outcome were 0.565 (95% CI 0.488–0.643) for TAPSE/ePASP and 0.695 (95% CI 0.631–0.759) for TAPSE/iPASP. The correlation between the ePASP and iPASP was attenuated in patients with massive/torrential TR compared to those with severe TR (interaction p = 0.01). In the multivariable Cox proportional model, TAPSE/iPASP was inversely associated with the risk of the primary outcome (per 0.1-point increase: adjusted-HR 0.67, 95% CI 0.56–0.82, p < 0.001), independent of baseline demographics. According to the TAPSE/iPASP quartiles (i.e., ≤ 0.316; 0.317–0.407; 0.408–0.526; ≥ 0.527), the event-free survival was 43.4%, 48.3%, 77.9%, and 85.4% at one year after TTVR.ConclusionRV–PA coupling predicts one-year mortality and heart failure rehospitalization after TTVR in patients with TR. The predictability is improved if invasively-measured PA pressure is included.Graphical abstractAssessing right ventricular (RV) function is paramount for risk stratification. The present analysis confirms that RV–PA coupling, measured as TAPSE/PASP, predicts one-year mortality and heart failure rehospitalization in patients undergoing TTVR. There is a significant interaction between TR severity and the correlation of ePASP with iPASP, and therefore the correlation is attenuated in patients with massive to torrential TR. The predictability of RV–PA coupling is improved if PA pressure is measured invasively and included in the formula.

Primary Hepatic Ectopic Pregnancy: Diagnosis and Laparoscopic Management

To demonstrate and discuss a case of primary hepatic ectopic pregnancy and laparoscopic management. Case presentation with demonstration of surgical hepatic wedge resection. Tertiary referral center in Manchester, United Kingdom. A 33-year-old women gravida 13 para 2 with a body mass index of 55 kg/m2 and previous 2 cesarean sections and a laparoscopic cholecystectomy presented to the emergency services after a private ultrasound scan showing a pregnancy of unknown location and a serum human chorionic gonadotropin (hCG) of 18 336 IU/mL. A diagnostic laparoscopy was performed but fallopian tubes were normal with no signs of ectopic pregnancy seen. An abdominal ultrasound scan was performed but did not identify the ectopic pregnancy. Owing to worsening symptoms of pain and rising hCG levels, she underwent a further laparoscopy converted to laparotomy and a left salpingo-oophorectomy for suspected left ovarian pregnancy. However, serum hCG levels continued to rise after the surgery, reaching 36 960 IU/mL. An magnetic resonance imaging scan of her abdomen and pelvis was arranged that showed a 4 cm cystic lesion in the segment V of the liver. Further ultrasound correlation showed a hyperechoic lesion with echogenic components suspicious of an ectopic pregnancy with a fetal pole. Fetal heart action was not visualized. A multidisciplinary team approach was adopted with involvement of the hepatobiliary surgical team, and the option of medical management with methotrexate and surgical excision was considered. A decision was made for surgical excision based on the accessible location of the ectopic pregnancy on segment V and the more controlled and predictable outcome with surgical excision. A preoperative computed tomography scan confirmed the lesion in segment V of liver in keeping with liver capsular implantation of ectopic pregnancy (Video still 1). At laparoscopy the ectopic pregnancy was visualized on the inferior surface of liver close to the inferior margin with a band of overlying omental adhesion (Video still 2). The overlying omental adhesions were sealed and cut with advanced bipolar diathermy, keeping a safe margin from the ectopic pregnancy to minimize any bleeding. The liver capsule was then opened with monopolar diathermy, and the small segment of liver with the ectopic pregnancy was excised using a combination of Bowa-Lotus liver blade (Bowa Medical Ltd). Hemostasis was controlled using Floseal hemostatic matrix and applied pressure laparoscopically. Total operating time was 80 minutes with an estimated blood loss of 500 mL. The patient was discharged on day 3 postoperatively, and follow-up serum hCG excluded residual trophoblastic disease. On review of the clinical case, earlier imaging of the upper abdomen when confronted by a persistent pregnancy of unknown location with high levels of serum hCG would have prevented the second laparoscopy, laparotomy, and salpingo-oophorectomy. In similar cases, it would also help exclude poorly differentiated malignancies as a source of serum hCG. Only 27 cases of ectopic pregnancy on the liver have been identified in English literature since 1952, based on a MEDLINE and Embase enquiry and further review of all case reports by the authors to avoid duplicates. Estimated incidence of hepatic implantation is 1 in 15 000 pregnancies; 4 case reports of laparoscopic liver resection have been identified and another case managed by suction from the liver surface [1,2]. The key principle demonstrated is to resect the ectopic pregnancy with a safe margin of liver tissue and any adhesions to avoid catastrophic bleeding from direct handling of the ectopic pregnancy.

Compassionate Juveniles: Socialistic ways to Subside Transgression in Children

From the time a child is born, they go through development stages that are very much predictable, some reach development goals early, some hit the stages a little later but a few of them follow a peculiar pace where certain pattern of defiant behaviors are found, which leads to various predictable outcomes that are questionable in general and unacceptable equally. One major aspect of defiant behavior is transgression. This paper discusses the detailed issues that lead to cause transgression in children and proposes viewpoint that enable parents to deal with the weaknesses innately. This paper finds prime factor like socialist Interactivity drills with children of different age groups as major measure to deal with transgressive traits in children.

Quantification of the Culture Stability of Stem Cell Fractions from Oral-Derived, Human Mesenchymal Stem Cell Preparations: A Significant Step toward the Clinical Translation of Cell Therapies.

A continuing limitation and major challenge in the development and utilization of predictable stem cell therapies (SCTs) is the determination of the optimal dosages of stem cells. Herein, we report the quantification of stem cell fractions (SCF) of human mesenchymal stem cell (MSC) preparations derived from oral tissues. A novel computational methodology, kinetic stem cell (KSC) counting, was used to quantify the SCF and specific cell culture kinetics of stem cells in oral alveolar bone-derived MSC (aBMSCs) from eight patients. These analyses established, for the first time, that the SCF within these heterogeneous, mixed-cell populations differs significantly among donors, ranging from 7% to 77% (ANOVA p < 0.0001). Both the initial SCF of aBMSC preparations and changes in the level of the SCF with serial culture over time showed a high degree of inter-donor variation. Hence, it was revealed that the stability of the SCF of human aBMSC preparations during serial cell culture shows inter-donor variation, with some patient preparations exhibiting sufficient stability to support the long-term net expansion of stem cells. These findings provide important insights for the clinical-scale expansion and biomanufacturing of MSCs, which can facilitate establishing more effective and predictable outcomes in clinical trials and treatments employing SCT.

Is obesity the next step in evolution through brain changes?

Obesity is a disease of complex and multifactorial nature characterized by the interplay of genetic and environmental factors. The prevailing consensus suggests that obesity arises from an imbalance in energy homeostasis, largely driven by excessive consumption of a high-caloric diet and insufficient physical activity. Over time, therapeutic interventions have traditionally focused on addressing this energy imbalance, as well as the medicalization of all types of obesity. However, there is an alarming increase in the prevalence of obesity, reaching pandemic proportions, with significant consequences for the health of a substantial part of the global population, undoubtedly necessitating a change in strategy.Our purpose is to analyze the obesity pandemic from an evolutionary perspective, and review how its social and cultural causes interact with its pathophysiological determinants. Thus, the culture-brain co-evolution hypothesis is proposed as a compelling framework within niche construction theory that acts as an evolutionary driver for brain expansion and physiological changes in the human species. Some cultural innovations as the invention of tools, and the adoption of processed and cooked foods, have enabled greater energy intake and improved nutrient quality for human diets. These behavioral changes results in the expansion and growth of the human brain, while simultaneously reconditioning the digestive apparatus, leading to a shortening in the time dedicated to foraging and food digestion. These adaptations may have been favored by natural selection, promoting the survival and reproductive success of individuals carrying genetic variants conducive to brain growth and to shape our evolutionary trajectory.In the 20th and 21st centuries, the obesogenic environments were placed in our lifestyles, characterized by extreme sedentary behaviors and the spread of highly processed and high-energy diets. These evolutionary mechanisms may inevitably contribute to the emergence of a new niche that, in addition to explaining the obesity pandemic, could ultimately lead to the “normalization” of phenotypes and genomes associated with obesity. This phenomenon represents a predictable outcome that derives from our biological predispositions developed over countless generations. Addressing this global challenge necessitates the creation of non-obesogenic environments that promote healthy lifestyles to reduce the prevalence of obesity. The failure to take action could perpetuate the current evolutionary trajectory toward a human species characterized by obesity-related genotypes and phenotypes.

The ideal buttock: some aesthetic and morphometric considerations

Remodeling surgical procedures of the gluteal region are increasingly popular and in demand. In most cases, preoperative considerations and planning are largely based on the surgeon’s own experience. This article reviews the existing literature on the subject, adding and encoding some personal notes in order to standardize the ideally predictable results in cosmetic surgery of the gluteal region. Anatomical and morphological considerations are described as indications for an accurate preoperative planning, outlining morphological-geometric guidelines on the ideal beauty of the buttocks, with the aim to facilitate such process for the less experienced surgeon.

Successful rehabilitation after multiple severe complications following orthognathic surgery: a case report

BackgroundComplications of orthognathic surgery are quite rare, but they cause suffering in affected individuals. The range of complications is broad and includes both hard and soft tissue.Case presentationWe here present a case of a fully healthy woman without signs of impaired healing capacity. The patient underwent bimaxillary orthognathic surgery and experienced multiple complications both peri- and post-operatively. During the post operative period, the patient also suffered from soft tissue complications after an orthopaedic injury. Therefore, we referred the patient to her general practitioner for further medical investigation. We also present the result after restorative surgery and endodontic and prosthodontic treatment resulting in a successful rehabilitation.ConclusionThis case report clearly shows the need for a good collaboration between different odontological and medical fields to achieve a good and predictable result. In situations where normal healing processes do not occur, in-depth analysis must be carried out.HighlightsOrthognathic surgery affects soft and hard tissue which can result in adverse healing and complications. It is of great importance to follow up performed surgery to see late complications. Be restrictive with early re-operations when there are signs of necrosis. Always use a multidisciplinary approach when handling complications after surgery.

Towards a functional understanding of rehabilitated urban road verge grasslands: Effects of planting year, site conditions, and landscape factors

Urbanization causes ecosystem degradation and losses of biodiversity. Still, urban landscapes favor organisms, depending on how well they fit the anthropogenic conditions. Creating urban green spaces of high ecological quality, such as pollinator-friendly road verges, promotes biodiversity in cities. We sowed a seed mixture consisting of 26 native plant species with diverse functional traits in 46 road verge patches along four urban roads in Munich (South Germany) in 2019/20 and monitored in 2020/21. Control were pre-existing turfgrass patches with conventional management. We assessed species richness, Shannon diversity, and Pielou's evenness, whereas functional composition was evaluated via functional richness, evenness, and divergence, based on 13 plant traits. To study urbanization effects on species and functional composition, we analyzed soil characteristics and tree shading at the local level, as well as distance to city center, imperviousness, and edge density at the landscape level. We used linear models and ordination analysis to assess treatment, local and landscape effects, and the influence of planting year on taxonomic and functional composition. Rehabilitation treatment explained most differences in species and functional composition. Species richness was lower in the city center and at sites with high soil organic matter; Pielou's evenness increased with soil pH. Trait composition differed between rehabilitated and control patches, and varied according to planting year. Soil bulk density negatively affected functional richness for all traits combined, and edge density reduced functional evenness of establishment traits. We conclude that urban filtering, in combination with planting year, shapes species and trait composition of rehabilitated road verges. Hence, local and landscape-level trait–environment interactions affect the assembly of road verge grasslands. Finally, our findings suggest that establishment traits have a pivotal role in the development of rehabilitated road verges, while the predictability of rehabilitation outcomes may be hindered even when seeding specifically designed seed mixtures.

Sensitive detection of borax in real food samples by red emissive carbon nanoparticle displaying multiformat compatibility including faraway smartphone based sensing

Predictable chemical outcome is foremost important to obtain optical output in sensing mechanism that offer excellent leverage to the detection formats. This is demonstrated herein through the ultra-sensitive detection of Borax in real food samples using Carbon Nanoparticle (CNP). An instrument-free, inexpensive, sensitive, on-site, and visual detection is achieved by engaging the surface functional groups of CNP to trap the boronate ion of borax as a crosslinker to enforce an optical outcome in the form of Aggregation Induced Emission (AIE). Drastic amplification of the red fluorescence of CNP after borax addition is achieved within a minute with scope to extend the strategy to multiple formats including 96-well and microfluidic device irrespective of chemical interferences with LOD in micromolar range. The digital images of red emissive aggregated CNP served as input for colour recognition application of smartphones whereby Red-Green-Blue (RGB) channel values were extracted making the detection possible from faraway location.

Unipolar Hemiarthroplasty, Bipolar Hemiarthroplasty, or Total Hip Arthroplasty for Hip Fracture in Older Individuals.

Practice patterns regarding the use of unipolar hemiarthroplasty, bipolar hemiarthroplasty, and total hip arthroplasty (THA) for femoral neck fractures in older patients vary widely. This is due in part to limited data stipulating the specific circumstances under which each form of arthroplasty provides the most predictable outcome. The purpose of this study was to investigate the patient characteristics for which unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA might be preferable due to a lower risk of all-cause revision. A U.S. health-care system's hip fracture registry was used to identify patients ≥60 years old who underwent unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA for hip fracture from 2009 through 2021. Unipolar and bipolar hemiarthroplasty were compared with THA within patient subgroups defined by age (60 to 79 versus ≥80 years) and American Society of Anesthesiologists (ASA) classification (I or II versus III); patients with an ASA classification of IV or higher were excluded. Multivariable Cox proportional hazard regression analysis was used to evaluate all-cause revision risk while adjusting for confounders, with mortality considered as a competing risk. There were 14,277 patients in the final sample (median age, 82 years; 70% female; 80% White; 69% with an ASA classification of III; median follow-up, 2.7 years), and the procedures included 7,587 unipolar hemiarthroplasties, 5,479 bipolar hemiarthroplasties, and 1,211 THAs. In the multivariable analysis of all patients, both unipolar (hazard ratio [HR] = 2.15, 95% confidence interval [CI] = 1.48 to 3.12; p < 0.001) and bipolar (HR = 1.92, 95% CI = 1.31 to 2.80; p < 0.001) hemiarthroplasty had higher revision risks than THA. In the age-stratified multivariable analysis of patients aged 60 to 79 years, both unipolar (HR = 2.17, 95% CI = 1.42 to 3.34; p = 0.004) and bipolar (HR = 1.69, 95% CI = 1.08 to 2.65; p = 0.022) hemiarthroplasty also had higher revision risks than THA. In the ASA-stratified multivariable analysis, patients with an ASA classification of I or II had a higher revision risk after either unipolar (HR = 3.52, 95% CI = 1.87 to 6.64; p < 0.001) or bipolar (HR = 2.31, 95% CI = 1.19 to 4.49; p = 0.013) hemiarthroplasty than after THA. No difference in revision risk between either of the hemiarthroplasties and THA was observed among patients with an age of ≥80 years or those with an ASA classification of III. In this study of hip fractures in older patients, THA was associated with a lower risk of all-cause revision compared with unipolar and bipolar hemiarthroplasty among patients who were 60 to 79 years old and those who had an ASA classification of I or II. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Transverse Cordotomy with Thyroarytenoid Myectomy for Bilateral Vocal Fold Immobility.

We propose a modification of the transverse cordotomy procedure which improves the predictable airway outcome and allows for better voice. Laryngoscope, 134:2790-2792, 2024.

Reflective reviews on Japanese high-level waste (HLW) vitrification – Exploring the obstacles encountered in active tests at Rokkasho

Vitrification is currently the most widely used technology for the treatment of high-level waste (HLW) generated from spent nuclear fuel (SNF) reprocessing. Glasses for the solidification of HLW have been developed over half a century at different times in each country. Likewise in Japan, repeated system evaluations of borosilicate waste glass matrices and the liquid-fed joule-heated ceramic-lined melter (LFCM) process have been found to be applicable to a wide range of HLW compositions. The Rokkasho vitrification facility located in northern Japan encounters significant operational issues owing to the presence of sparsely soluble elements including noble metals (NMs) and separated phases, such as the yellow phases (YPs) constituents, in glass melts. These elements cause serious disruptions, jeopardizing the stable functioning of the LFCM. The active vitrification test was suspended because of the formation of YPs in the glass melts and subsequent sedimentation of NMs at the bottom of the melter. First, we analyzed the testing data to identify the fundamental causes behind the unstable LFCM operation. Our investigation revealed that the presence of significant amounts of Mo and S, along with NMs, specifically Ru, Rh, and Pd, in the Rokkasho HLW stream triggers the formation of molybdate and sulfate salt phases (YPs), which subsequently enabled the sedimentation of NMs at the bottom of the melter. Second, we selected eight major tasks related to difficulties of LFCM operation in the active tests and studied the findings in each task considering the preconditions of task success. Moreover, we strengthened our analysis by subjecting each task to 22 hypotheses tests in a systematic manner to minimize the risk of issues associated with generalizability. Third, we combined these findings and classified them into two categories based on the action system theory on management: variable system (Y) and actor’s system (X), assuming that the indirect or mechanism/environment factors of X should influence on the directly observed factors of Y. Our approach involved implementing a reflective actor’s system (X’) to improve the variable system for the controllable system (Y’), thereby mitigating unexpected events. We then summarized the main implications of this method to ensure predictable and reliable outcomes for the associated tasks. Finally, we concluded the potential effectiveness of strategic actions that could leverage organizational capabilities and processes to improve task performances in the context of a controllable system given the implications we identified.

Predictive Biomarkers of Treatment Response in Major Depressive Disorder.

Major depressive disorder (MDD) is a highly prevalent, debilitating disorder with a high rate of treatment resistance. One strategy to improve treatment outcomes is to identify patient-specific, pre-intervention factors that can predict treatment success. Neurophysiological measures such as electroencephalography (EEG), which measures the brain's electrical activity from sensors on the scalp, offer one promising approach for predicting treatment response for psychiatric illnesses, including MDD. In this study, a secondary data analysis was conducted on the publicly available Two Decades Brainclinics Research Archive for Insights in Neurophysiology (TDBRAIN) database. Logistic regression modeling was used to predict treatment response, defined as at least a 50% improvement on the Beck's Depression Inventory, in 119 MDD patients receiving repetitive transcranial magnetic stimulation (rTMS). The results show that both age and baseline symptom severity were significant predictors of rTMS treatment response, with older individuals and more severe depression scores associated with decreased odds of a positive treatment response. EEG measures contributed predictive power to these models; however, these improvements in outcome predictability only trended towards statistical significance. These findings provide confirmation of previous demographic and clinical predictors, while pointing to EEG metrics that may provide predictive information in future studies.