Technical Procedures Research Articles

Arthroscopic Bone Block and Arthroscopic Latarjet for Anterior Shoulder Dislocation—Technical Note with Tricks and Tips for Conversion and Successful Surgery

Background: The treatment of patients affected by recurrent anterior shoulder instability has received more attention in the last ten years, focusing on the management of bone loss, which is crucial in predicting postoperative recurrence risk. Recently, various bone grafting techniques and different fixation methods have been developed to preserve native anatomy and reduce complications. Nowadays, glenoid bone reconstruction is usually carried out via the Latarjet procedure or free bone block technique. While the Latarjet procedure has traditionally been considered the best option, the bone block has been demonstrated to be a successful procedure. Even though the indication to perform a free bone block or a Latarjet procedure may be given preoperatively, in cases where the choice between the two procedures is unclear, the decision can be made intraoperatively, given the possibility to switch from one to another. This technical note aims to outline our techniques for the arthroscopic Latarjet procedure and the arthroscopic free bone block, as well as discuss the indications, benefits and downsides of each procedure. Technical tips and tricks are provided. Methods: A step-by-step thorough description of bone block and Latarjet procedures is provided, as well as a comparison of advantages and disadvantages of each technique and tips to avoid complications. Respective indications are discussed. Results: Both the procedures have benefits and downsides. The arthroscopic Latarjet procedure is the most effective in addressing anterior shoulder instability, but is more elaborate, has a shallow learning curve and can have a high complication rate. The bone block technique is an anatomic procedure with a shorter learning curve but has fewer indications. Conclusion: The Latarjet is currently considered the gold standard for glenoid bone grafting. The bone block technique can allegedly be seen as being “in the middle” of the soft tissue repair and Latarjet procedures. Many factors should be considered when choosing the right surgical technique, and treatment plans must be customized for each patient. More studies with long-term follow-up are needed to evaluate the efficacy of arthroscopic bone grafting procedures in various subtypes of patients based on bipolar bone loss assessment and individual risk factors.

An in vitro investigation into the cytotoxic impact of antigen-presenting dendritic cell-tumor infiltrating lymphocytes on ovarian cancer cells

ObjectiveThe objective of this study is to develop a novel therapeutic approach for the treatment of ovarian cancer while investigating the role of tumor-infiltrating lymphocytes (TILs) in the context of ovarian cancer therapy. The primary aim is to establish a technical procedure for the isolation of tumor cells, lymphocytes, and dendritic cells (DCs) derived from ovarian cancer tissues or ascites. Subsequently, the focus lies on the generation of dendritic cell-tumor infiltrating lymphocytes (DC-TILs) exhibiting specific cytotoxic capabilities aimed at targeted therapeutic interventions. The cytotoxic impact of DC-TIL interactions on tumor cells was investigated through in vitro experimentation. This research aims to provide fundamental experimental insights for the future clinical advancement of TIL therapy in ovarian cancer.MethodsThe experimental samples included fresh surgical specimens and ascites specimens procured from three patients (ranging in age from 32 to 75), sourced from the Department of Gynecology at the Third Bethune Hospital of Jilin University. TILs were extracted through in vitro isolation from solid tumor tissues, while primary tumor cells and DCs were obtained from ascites specimens. Tumor-specific antigens derived from patient tumor cells were utilized to stimulate the maturation of DCs. TILs were subsequently co-cultured with antigen-stimulated DC cells. Subsequently, TILs with specific killing effects were obtained, and the cytotoxic impact of DC-TILs on tumor cells was detected in vitro.Results(1) TILs were successfully obtained through expansion from the tumor tissue of a patient diagnosed with ovarian cancer. (2) DCs were successfully induced from ascites cells harvested from patients diagnosed with ovarian cancer. (3) TILs significantly enhanced the cytotoxicity of tumor cells following DC stimulation.ConclusionTILs have the capacity to augment the cytotoxicity directed towards tumor cells following DC stimulation.

Management of genomic surveillance for respiratory viral infections circulating in the territory of the city of Moscow

Introduction. Outbreaks of respiratory viral infections have an economic impact on the healthcare system and pose a threat to public well-being. Monitoring for the incidence of acute respiratory viral infections in a metropolitan area, especially during the COVID-19 pandemic, was in dire need of an adequate tool to identify mutations and variants that evade vaccine immunity and initiate an increase in incidence. Genomic surveillance was required for a timely response. Purpose of the study. Management of the Moscow Genomic Center for genomic surveillance for acute respiratory viral infections and COVID-19, with an assessment of the results during seasonal outbreaks in the capital. Materials and methods. With the support of the Moscow City Health Department, management and logistics measures were developed and implemented, the NGS testing program in patient samples on a planned basis and during the period of increased incidence of acute respiratory viral infections and COVID-19, technical procedures for high-throughput sequencing were developed, the security of data exchange and biosafety of medical personnel were ensured. Results. The Moscow Genome Center was established within the structure of the Moscow City Health Department. For the period from October 2023 to April 2024, targeted NGS data (a panel of thirty two pathogens, 6528 samples were tested): SARS-COV-2 dominated the entire period, the incidence of influenza A (H3N2) increased sharply from the beginning of December and decreased sharply by the end of January. Sars-CoV-2 genetic lineage rotation: XBB lineage dominated (most represented: XBB.1.16, XBB.1.16.11) from October to the end of January, then JN lineage prevailed (most represented: JN.1, also found: JN.1.13, JN.1.18, JN.1.19, JN.1.4). Influenza A strain rotation: H3N2 (A/Massachusetts/01/2020) and H3N2 (A/Massachusetts/38/2019) dominated from December to February. Research limitations. A targeted panel of 32 respiratory viruses most common in the Moscow population was used for NGS. Incomplete coverage of the entire viriome is a conditional limitation. Conclusion. Representative, high-quality and continuous genetic surveillance has been managed in the capital. The Moscow Genome Center has successfully implemented the NGS Testing Program and support for the Russian Genomic Resource of Microorganisms VGARus.

Humanoid Robot-Assisted Learning for Level 1 Autistic Children: Developing Test Plans to Enhance Number Recognition Skills

Autism Spectrum Disorder (ASD) impacts the social, communication, and cognitive development of affected individuals. Level 1 autism, the mildest form of ASD, presents unique challenges in the acquisition of crucial skills such as number recognition, which serves as a foundational aspect of children's cognitive development. Recent studies have shown that humanoid robots can offer effective intervention strategies for children with autism, fostering learning in a structured, engaging, and interactive environment. This study aims to develop and evaluate test plans using humanoid robots to enhance number recognition skills in Level 1 children with autism. Based on the findings, a test plan was designed to address the unique learning needs of Level 1 children with autism in number recognition. Participants were selected based on specific criteria, ensuring a diverse and representative sample. The humanoid robot's capabilities and features were detailed, emphasizing its role in facilitating the test plan. The research methodology outlined the test plan components, implementation procedure, data collection, and analysis techniques. Results demonstrated that the humanoid robot-assisted test plan was effective in enhancing number recognition skills among Level 1 children with autism. The participants exhibited significant improvements in their abilities to identify and manipulate numbers, as well as increased engagement and motivation in learning tasks. The study also revealed that the interactive and supportive nature of the humanoid robot fostered a positive learning environment, which contributed to the observed improvements in number recognition skills. The implications of these findings extend to the broader field of autism intervention, highlighting the potential benefits of incorporating humanoid robots into educational programs for children with autism.

Ethanol stability from nine years of a blind quality control program in blood alcohol analysis.

A blind quality control (BQC) program in blood alcohol analysis was implemented at the Houston Forensic Science Center (HFSC) in September 2015. By mimicking authentic toxicology blood evidence, the laboratory can perform a concurrent evaluation of their technical and administrative casework procedures and test the accuracy and reliability of their volatile analysis method in a format that is blinded to the analyst. From September 2015 to November 2023, HFSC's Quality Division submitted 1228 antemortem whole blood samples: 292 ethanol-negative samples and 936 ethanol-positive samples at sixteen target concentrations (0.051, 0.080, 0.100, 0.110, 0.120, 0.130, 0.150, 0.160, 0.170, 0.180, 0.190, 0.200, 0.230, 0.240, 0.250, and 0.260 g/dL). A second, unopened blood tube in 168 of the 1228 BQCs was also analyzed after 721-1140 days: 24 ethanol-negative samples and 144 ethanol-positive samples at five target concentrations (0.080, 0.100, 0.130, 0.180, and 0.240 g/dL). All 316 ethanol-negative samples remained negative. After 42-758 days, the average (median, range) change in ethanol concentration of the 936 positive samples was -1.4% (-1.3%, -12.0% to +8.4%) with a statistically significant difference (P < 0.001) observed for the gradual decline in blood alcohol concentration (BAC) over time. The average BAC percentage differences per target concentration, ranged from -6.4% (-0.008 g/dL) to +5.7% (+0.011 g/dL), were within HFSC's current measurement uncertainty (9.4% at k=3), showing no apparent correlation between the change in ethanol and the theoretical target concentration. As the analysis time between the two blood specimens from the same evidence kit extended, the loss in ethanol significantly increased (P < 0.001).

Atherectomy Techniques: Rotablation, Orbital and Laser

Coronary artery disease remains the leading cause of morbidity and mortality worldwide despite advancements in percutaneous coronary intervention (PCI). With an increasing ageing population, there is a significant challenge in addressing severe calcification in atherosclerotic plaque during angioplasty. This review article focuses on atherectomy strategies such as rotational atherectomy (RA), orbital atherectomy (OA) and excimer laser coronary angioplasty (ELCA) aimed at modifying calcified lesions and improving PCI outcomes. RA modifies plaque through rotational ablation, OA uses eccentrically mounted diamond-coated crown and has a reduced entrapment risk compared to RA. ELCA uses pulsatile laser energy to precisely ablate plaque tissue. This review provides insights into the mechanisms, procedural techniques and clinical outcomes associated with these calcium modification techniques. The selection of appropriate devices and adequate training are crucial for optimising lesion modification and enhancing procedural success. Further research and standardised protocols are required to overcome challenges associated with using these devices and expand their usage in clinical practice.

Risk Management of Green Bean Farming Production in Gluranploso Village, Gresik District

Green beans are the most important food crop in Indonesia and production continues to increase to meet domestic demand. However, production is still insufficient due to several risks faced by farmers. This research analyzes the risk management of green bean production in Gluranploso Village using the Coefficient of Variation (KV) and Failure Mode and Effect Analysis (FMEA) methods. The results showed that yield variation was relatively low with a KV value of 17%, indicating good yield stability. The FMEA analysis identified four main sources of risk affecting production: seed aspect with an RPN value of 5.808, weather with an RPN value of 7.04, pests and diseases with an RPN value of 12.936, and technical aspects with an RPN value of 47.88, particularly delays in pest and disease control spraying. In addition, the market aspect is also a source of risk with the largest value in the increase in production input prices at 12.288. These sources require special attention in risk management. The study concludes that the implementation of appropriate risk management strategies, focusing on the identified key risk sources, can help farmers improve yield stability and farm profitability. These strategies include improving seed quality, mitigating weather risks, controlling pests and diseases, and improving technical procedures in cultivation and market risks. Thus, effective risk management can be key in increasing the productivity and sustainability of green bean farming in Gluranploso village.

Chemical neurolysis of genicular nerves for chronic non-cancer knee pain: A scoping review.

Chemical neurolysis of the genicular nerves is a treatment option for intractable non-cancer knee pain. This scoping review synthesizes the available literature on the effectiveness, adverse effects and procedural techniques of chemical neurolysis of genicular nerves for the management of knee pain. Scoping review. All clinical and research settings. Adult participants with chronic non-cancer knee pain undergoing chemical neurolysis of genicular nerves. A literature search in MEDLINE, EMBASE and Cochrane Library was conducted up to 4 September 2023. Articles were searched via terms and keywords relating to "knee", "pain", "knee osteoarthritis", "ablation", "alcohol", "phenol" and "chemical neurolysis". Included articles were full text primary studies and in English. Data was extracted using an electronic database by 2 independent reviewers. There were 8 studies included in this review (including 1 randomized controlled trial), comprising 192 patients. There were 4 studies that used phenol, 3 studies that used alcohol, and 1 study that used either alcohol or phenol for chemical neurolysis. Both fluoroscopy and/or ultrasound guidance were utilized for nerve target identification. All studies demonstrated that chemical neurolysis resulted in improved pain and/or functional outcomes, with no serious adverse events reported. Chemical neurolysis of the genicular nerves is a promising treatment strategy for chronic knee pain. Interpretation of the available studies are limited by study heterogeneity and small sample sizes. High-quality randomized controlled trials are required to clarify the selection of appropriate nerve targets, choice of image guidance, and to compare with other ablative modalities.

PROTECTION OF PERSONALITY RIGHTS IN THE INFORMATION SOCIETY: CONTRIBUTIONS TO THE DEBATE ON THE CONSTRUCTION OF A REGULATORY LAW

This article addresses the need to construct an effective regulatory law for data protection in the Brazilian context. In this sense, the research problem that emerges consists of what new configuration do personality rights assume in the context of the information society and what are the main challenges that arise, in this scenario, for the construction of a regulatory law for data protection? In order to answer the proposed problem, a hypothesis arises that discusses to what extent the information society requires a careful look at the issue of the effectiveness of personality rights, to the extent that the classical reading of these rights – as embodied in articles 11 to 21 of the Brazilian Civil Code – has not been considered sufficient to face the challenges that this model of society presents for this topic. In this sense, it is understood that the information society requires an expansion of personality rights in view of the human and social complexity of this societal model, which challenges the law to construct a regulatory framework that considers this complexity. The general objective of this research is to analyze the main challenges that arise in the context of the information society for the effective protection of the new configuration that personality rights assume in this context and to assess the limits and possibilities of constructing a regulatory law that contemplates this complexity. The hypothetical-deductive method developed through the bibliographic-documentary research technique and the monographic procedure technique was used.

Water Security in the Context of the Piracicaba River Sub-Basin During the COVID-19 Pandemic

Objective: To analyze the challenges for water security in municipalities belonging to the Piracicaba River (SP) sub-basin, during the COVID-19 pandemic. Method: This is an exploratory and bibliographical research with a qualitative approach and case study and with a technical documentary procedure. The data sources were: Water Resources Situation Report; number of COVID-19 cases and deaths obtained from the Brazilian Ministry of Health website. In addition, a questionnaire on aspects related to water was administered to experts from the Technical Chamber for Conservation and Protection of Natural Resources of the Piracicaba, Capivari and Jundiaí River Basin Committees. Results and conclusions: The number of cases and deaths from the COVID-19 pandemic increased significantly in the 1st half of 2021 compared to the same period in 2020. The experts interviewed attributed high importance to prevention measures, the trend of decreasing water availability and the reduction of losses from water distribution systems. Research implications: The research presented theoretical reflections on the COVID-19 pandemic and water security. Water is an extremely important resource, especially in times of epidemics, as occurred with COVID-19. Water security affects the availability of water both to meet the needs of the population and to maintain ecosystems. Originality/value: The research carried out highlights the need for public policies regarding water and sanitation in order to achieve the protection of the population's health and sustainable development.

Numerical simulation of impulse-induced surface acoustic waves for elastography purposes using k-Wave simulation toolbox

As elastography, an emerging medical imaging strategy, advances, surface acoustic waves have been utilized to examine superficial tissues quantitatively. So far, most studies are experimental, and a numerical method is needed to cost-effectively investigate surface acoustic wave generation and propagation for technical development and optimization purposes. This study aims to develop a reliable numerical method for simulating impulse-induced surface acoustic waves using the k-wave simulation toolbox. According to the physical process of surface acoustic wave based elastography, the proposed simulation method consists of two stages: compressional wave simulation and elastic wave simulation, which aim to generate acoustic radiation force impulse and elastic waves, respectively. The technical procedures were demonstrated by a wave simulation on a water–tissue model. Meanwhile, three acoustic radiation force modeling methods were adopted. The compressional wave simulation showed that the three force modeling methods could produce similar force distribution in space but largely different amplitudes. The elastic wave simulation confirmed the feasibility of numerically generating surface acoustic waves. The reliability of the simulated waves was verified by a quantitative comparison between the numerically acquired sound speeds and their theoretical expectations and by a qualitative comparison between the numerically generated waves and the experimental observations under similar conditions. In summary, this study confirms k-wave as an effective numerical method for simulating surface acoustic waves for elastography purposes. This study provides an immediate simulation platform for investigating Scholte waves, the surface acoustic wave at a liquid–solid interface, and also, a potential numerical framework to investigate other surface acoustic waves.

The Added Value of Sterility in Minor Surgical Procedures in Preventing Infection: A Systematic Review

Background: The necessity of maintaining sterility during minor surgical procedures is a debated topic due to concerns over the cost, environmental impact of sterile supplies, and the unclear benefits of sterility in minor surgical procedures. This review aims to evaluate the available evidence on this topic. Methods: A systematic review of studies comparing sterile and non-sterile techniques in minor surgical procedures was conducted. Databases searched included PubMed and Cochrane up to May 2024. Studies were selected based on predefined criteria. Results: A total of eight studies met the inclusion criteria. Non-sterility was mostly defined by the use of non-sterile gloves, whereas the remainder of the procedure was performed with the same technique as a sterile procedure. The analysis showed no significant difference in infection rates between sterile and non-sterile techniques. However, sterile techniques may reduce the risk of complications in specific contexts, such as in immunocompromised patients or in procedures performed in tissues deeper than subcutaneous fascia. Conclusions: The evidence suggests that for most minor surgical procedures, non-sterile techniques do not significantly increase the risk of postoperative infections. Further high-quality studies are needed to identify specific scenarios where sterility can be safely omitted to decrease surgical waste and costs without increasing the risk of infection.

Indirect Cost Burden as an Emerging Issue of Foreign Employment in Developing Nations

Background: The current migration patterns and shifts present significant challenges, including widespread human rights abuses, exploitation of migrant laborers, high indirect costs due to expensive travel, limited affordable credit options, scarce job opportunities for low-skilled workers, and inadequate domestic migration policies. This study aims to identify the additional financial burdens faced by Nepalese migrant workers in Gulf countries. Methodology: A qualitative research design was used, with purposive sampling to select participants who had migrated to Gulf countries. In-depth interviews with 55 migrant laborers were conducted to gather data on cost burdens and employment conditions. Findings: Results showed that the indirect cost burden increased significantly after 2015 due to extended processing periods and technical procedures. Respondents generally preferred regulations before 2015. Despite legal changes like the "Free Visa: Free Ticket" policy reducing direct expenses, intermediaries and other indirect costs have offset this reduction, increasing the financial burden on migrant workers. Conclusion: The study provides valuable insights into Nepal's foreign employment complexities, urging more research and measures for migrant worker well-being. Findings reveal intermediaries exploiting workers by altering passport photos or obtaining counterfeit birth certificates. Additionally, 2% of surveyed workers migrated as young returnees before age 18. These insights are essential to empower recruitment agencies and improve their practices, ensuring safer, prompt, and more productive labor migration. Novelty: This study uncovers the hidden financial burdens Nepalese migrant workers face in Gulf countries. It highlights the offsetting effect of intermediaries on legal reforms like the "Free Visa: Free Ticket" policy. It offers new insights into labor exploitation and emphasizes better regulation and worker protection.

Prevention and Management of Restenosis After Coronary Interventional Therapy

Percutaneous coronary intervention (PCI) is one of the key methods for treating coronary heart disease, yet post-procedural restenosis remains a significant clinical challenge. Restenosis refers to the re-narrowing of the coronary artery after PCI due to factors such as neointimal hyperplasia and smooth muscle cell proliferation, which adversely affects blood flow restoration and patient prognosis. To address this issue, this study systematically explores strategies for the prevention and management of restenosis. Effective preventive measures are discussed in terms of pharmacological prevention, stent selection, optimization of procedural techniques, and lifestyle interventions. Additionally, the article analyzes pharmacological treatment options and re-intervention strategies for patients experiencing restenosis. The findings indicate that personalized treatment plans, optimized stent selection, rigorous postoperative management, and long-term monitoring are key to reducing the incidence of restenosis. Future research should further investigate the application of genetic testing and smart healthcare technologies in the management of restenosis.

Ultrasound-Guided Venous Puncture Reduces Groin Complications in Electrophysiological Procedures.

Background: In electrophysiological procedures, multiple punctures on the femoral vein can be necessary depending on the number of catheters required. The femoral vein is typically located indirectly by using its anatomical relationship to the artery as a reference. However, this conventional approach can lead to significant complications, including bleeding, peri-interventional transfusion, pseudoaneurysms, or arteriovenous fistulas. Despite these risks, there is limited evidence comparing the safety of ultrasound-guided venipuncture versus the conventional technique in electrophysiological procedures. Objective: This study aimed to evaluate the impact of ultrasound-guided venipuncture on vascular access complications in electrophysiological procedures and to identify associated risk factors. Methods: In this single-center trial, patients scheduled for electrophysiological procedures at Ulm University Heart Center, Germany, were enrolled between November 2021 and October 2023. Venipuncture in the groin was performed using either the conventional or an ultrasound-guided approach. The primary composite endpoint was defined as peri-interventional major vascular access complications (Bleeding Academic Research Consortium (BARC) ≥2 bleeding, pseudoaneurysms, arteriovenous fistulas, and peri-interventional transfusion) and minor complications (BARC 1). Results: A total of 1370 patients were included: 749 in the conventional group and 621 in the ultrasound group. The primary endpoint was achieved in 19.2% of the conventional group and 12.1% of the ultrasound group (p < 0.001). An increased sheath diameter and a higher number of venous accesses were identified as risk factors for the primary endpoint. Conclusions: Ultrasound guidance for venous groin puncture in electrophysiological procedures reduces access-related complications, supporting its use with careful attention to sheath size and number.

GINGIVAL MARGIN, CORRECTION IN ORTHOPEDIC DENTISTRY

A big problem for obtaining aesthetic and functional results of dental treatment is the condition of the gingival papillae. The effectiveness of orthopedic interventions without high-quality correction of the marginal edge of the gums can lead to an unsatisfactory result and the occurrence of numerous complications Materials and methods. A literature search was conducted in the PubMed and Medline databases for the period 2000-2024, for which the following keywords were used: correction of soft gingival tissues, fixed dentures, effectiveness, front group of teeth. A general search revealed 112 sources regarding gingival margin correction in fixed dentures. The primary exclusion referred to literary sources in which the correction of the gingival margin applied to all types of prosthetics. Literary sources that contained only reference information were included in the secondary exclusion. As a result, only relevant full-text articles in professional journals remained (n=25). The purpose of the research is to analyze the methods of gingival margin correction in orthopedic dentistry at the current stage, to formulate relevant tasks for further research. Research results. Methods of restoration of the aesthetics of the marginal part of the gums during orthopedic treatment are divided into the following groups: plastic of soft and bone tissues; laboratory and technical procedures; use of materials for artificial gums. It has been established that the plastic-surgical method is used for the loss of the gingival papilla, defects of the ridge of the alveolar process, asymmetric contour of the gums, and their unaesthetic shape. Correction of the gums allows to achieve satisfactory aesthetic results both at the final stage of orthopedic treatment (prosthetics with fixed orthopedic prostheses) and at the intermediate stage of temporary prosthetics with plastic fixed prostheses. It was found that the most common methods of gingival margin correction are flap operations on the gums using the technique of lateral movement of the muco-osseous flap. These include the following types of interventions: endothelial modification from the tooth-alveolar ridge; oblique displaced flap; periosteally stimulated flap; partial or complete split flap. The positive effect of hyaluronic acid on the healing of the gingival margin and tissue regeneration has been proven. Several researches have shown the positive effects of hyaluronic acid on gingival margin healing and tissue regeneration due to its properties to stimulate cell adhesion, migration and proliferation, mediate cell signaling. The authors indicate a better effectiveness of hyaluronic acid in relation to periodontal parameters during the correction of the marginal gingival margin. The use of a laser scalpel is characterized by less pronounced traumatization of tissues, lower temporary costs for intervention, reduced blood loss, less pronounced signs of inflammation in the postoperative period, relative simplicity and cost-effectiveness of use. Conclusions. To date, only a combination of various orthopedic and surgical manipulations allows to achieve an optimal aesthetic result during prosthetics with fixed dentures of the front group of teeth.

Training Climbing Roses by Constrained Graph Search

ABSTRACTCultivated climbing roses are skillfully shaped by arranging their stems manually against support walls to enhance their aesthetic appeal. This study introduces a procedural technique designed to replicate the branching pattern of climbing roses, simulating the manual training process. The central idea of the proposed approach is the conceptualization of tree modeling as a constrained path‐finding problem. The primary goal is to optimize the stem structure to achieve the most impressive floral display. The proposed method operates iteratively, generating multiple stems while applying the objective function in each iteration for maximizing coverage on the support wall. Our approach offers a diverse range of tree forms employing only a few parameters, which eliminates the requirement for specialized knowledge in cultivation or plant ecology.

Management of radio-frequency interferences for space traffic management: Current regulations, operations practice, technology mitigation solutions and future trends

Radio-Frequency Interference (RFI) has a large impact on the business of commercial satellites communications and will have an increasingly important role in the next years and decades due to the spread of the launched spacecraft population.This paper presents the current state-of-the-art for Space Traffic Management -related RFI from a regulatory point of view, with regards to preventing and correcting harmful interference, linked to the International Telecommunication Union, and from a technical point of view, with technical procedures, workflows and innovative technology solutions for preventing and mitigating RFI. Finally, emerging technology trends and future directions are presented.

Analysis of selective neurocritical care admission costs following elective endovascular treatment of unruptured intracranial aneurysms.

No consensus exists on the necessity of neurocritical care unit (NCU)-level care following unruptured intracranial aneurysm (UIA) treatment. We aim to identify patients requiring NCU-level care post-treatment and determine potential cost savings utilizing a selective NCU admission protocol. A retrospective analysis of all UIA patients who underwent endovascular treatment at a single center from 2017-2022 was conducted. Data on demographics, preprocedural variables, radiographic features, procedural techniques, intra/postoperative events, and length of stay (LOS) were collected. Multivariable analysis was performed to identify patients requiring NCU-level care post-treatment. Cost analysis using hospital cost data (not charges/reimbursement) was performed using simulated step-down and floor protocols for patients without NCU indications following a hypothetical six-hour post-anesthesia care unit observation period. Of 209 patients, 179 were discharged within 24 h and 30 had prolonged LOS. In our analysis, intra- and postoperative events independently predicted prolonged LOS. In our subanalysis, 47 patients demonstrated NCU needs: 24 with intraoperative indications, 18 with postoperative indications, and five with both. Of the 23 with postoperative indications, 20 were identified within six hours, while three were identified within six to 24 h. The median variable cost per patient for the current NCU protocol was $31,505 (IQR, $26,331-$37,053) vs. stepdown protocol $29,514 (IQR, $24,746-$35,011;p = 0.061) vs. floor protocol $26,768 (IQR, $22,214-$34,107;p < 0.001). Total variable costs were $6,211,497 for the current NCU protocol vs. $5,921,912 for the step-down protocol (4.89% savings) and $5,509,052 for the floor protocol (12.75% savings). Most patients requiring NCU-level care following UIA treatment were identified within a six-hour postoperative window. Thus, selective NCU admission for this cohort following a six-hour observation period may be a logical avenue for cost reduction. Our analysis demonstrated 5% and 13% savings for uncomplicated patients using step-down and floor admission protocols, respectively.

Impact of Combining Iliac Branch Endoprosthesis and Physician-Modified Fenestrated-Branched Endovascular Repair for Complex Abdominal and Thoracoabdominal Aortic Aneurysms with Concomitant Iliac Artery Aneurysms

ObjectivesTreatment of iliac artery aneurysms (IAA) with the Iliac Branch Endoprosthesis (IBE) during endovascular repair of infrarenal abdominal aortic aneurysm (EVAR) has been well-documented as effective. However, limited data exists evaluating the safety and efficacy of treating complex abdominal (cAAA) and thoracoabdominal aortic aneurysms (TAAA) with associated IAA with combined physician-modified fenestrated branched endovascular aortic repair (PM-FBEVAR) and IBE. Moreover, limited studies exist assessing the impact of adding IBE on the outcomes following PM-FBEVAR. Therefore, we compared the clinical outcomes of patients who underwent PM-FBEVAR with and without IBE for the treatment of cAAA and TAAA. MethodsA single institution retrospective review of consecutive patients who underwent PM-FBEVAR between September 2015 and February 2021 was conducted. Patients with both unilateral and bilateral IBE implantation were included. Infected aneurysms and pseudoaneurysms were excluded. Demographics, technical success, and operative factors were analyzed. Primary outcomes were incidence of pelvic ischemia including buttock and thigh claudication, bowel and spinal cord ischemia, patency of internal and external limbs of IBE, and target vessel instability. Secondary outcomes included technical success, 30-day major adverse events (MAE), 30-day and all-cause mortality, and endoleaks. ResultsAmong 183 patients identified who underwent PM-FBEVAR, 22 patients underwent PM-FBEVAR and IBE with 3 patients treated with bilateral IBEs. There was no pelvic ischemia in the PM-FBEVAR and IBE group. Technical success, fluoroscopy time, and procedure time were comparable between the two groups. Contrast usage was higher in the PM-FBEVAR and IBE group (p=0.01). Thirty-day MAE and mortality were not statistically different between the two groups. At mean follow-up of 23 months, all-cause mortality was similar for both groups (21% vs 27%; p=0.47). Patency of internal iliac artery limb and external iliac artery limb of the IBE were 96% (24 of 25) and 100%, respectively, during mean follow-up of 23 months. The patient with occlusion of internal iliac limb was asymptomatic and received no re-intervention. ConclusionTreatment of cAAA and TAAA associated with IAA using combined PM-FBEVAR and IBE is feasible with high efficacy and safety, and without adverse effect on outcomes. Long-term follow-up is planned to assess durability of repair with PM-FBEVAR and IBE.