Removal Procedure Research Articles

Median Nerve Displacement during Hardware Removal after Distal Radius Fractures

Abstract Background This retrospective study aimed to evaluate median nerve displacement observed during hardware removal procedures following volar plating for distal radius fractures. Methods We reviewed all cases involving removal of distal radial volar locking plates at our institution by two surgeons from 2016 to 2021. Plating procedures and hardware removals were performed using the flexor carpi radialis (FCR) approach. We examined the position of the median nerve at the time of hardware removal. Results Median nerve displacement to the radial side of the FCR occurred in 17 out of 67 cases (25%). There were no significant differences in the degree of fracture severity or involved surgeons between the normal position and displaced groups. Conclusions The median nerve may be displaced radially from the FCR during hardware removal, and care should be taken to avoid causing iatrogenic nerve injury. Level of Evidence Level II.

INFLUENCE OF DIAMOND BURNISHING ON CORE HEIGHT AN TEN-POINT HEIGHT

Diamond burnishing is a cold plastic forming process, which used as surface improvement finishing treatment after conventional chip removal procedures. This paper presents the experimental study of the impact of different burnishing parameters on 3D surface roughness on cylindrical low alloyed aluminium workpieces. To carry out comparative analysis, measurement of surface roughness was implemented before and after burnishing with an Altisurf 520 measuring device. The results enable a more accurate understanding of the processes that take place during the procedure and, for industrial applications, can help reduce machining time and costs by better defining the set-up parameters.

Parotid sialolithiasis - Long term follow-up analyzing surgical approaches.

Present follow-up data comparing transoral and transfacial parotid gland procedures for stone removal to offer insight addressing technical considerations and complications. Retrospective study of a consecutive series of surgical treatments for parotid sialolithiasis from 2013 to 2018 at an academic institution by one surgeon provided review of 16 transoral and 10 transfacial procedures supplemented by long-term follow-up through telephone or mail. Clinical and radiographic parameters, additional treatment, and persistence of symptoms were evaluated. Four of 10 patients treated with the transfacial approach had parotid-cutaneous fistulas addressed with transdermal scopolamine patches and pressure dressings (one also with intraductal steroid infusion) with closure at a median of 12.5 days. A fifth fistula failed to resolve at 23 days and was addressed with parotidectomy. All 8 patients who were contacted (median: 106 months) reported complete resolution of symptoms. None had facial weakness.Six of 16 patients treated by a transoral approach had persistent stone fragments at the conclusion of operation. Four of these 6 patients underwent subsequent procedures (two transoral, one transfacial, one parotidectomy). Among the 11 patients who responded to long-term follow-up (median: 107 months), one reported mild symptoms insufficient to request treatment. Larger stone size coupled with proximal location correlated with the conversion from transoral to include transfacial approach. Patients with retained stone remnants at the conclusion of transoral stone removal are more likely to require additional procedures that result in long-term favorable results. The transfacial approach to stone removal offers long-term favorable results following the common short-term complication of salivary fistula. OCEBM Level 4.

A magnetic macroporous α-Fe2O3/Mn2O3 nanocomposite as an efficient adsorbent for simple and rapid removal of Pb(II) from wastewater and electronic waste leachate.

A magnetic nanocomposite adsorbent, comprised of macroporous iron oxide/manganese oxide (α-Fe2O3/Mn2O3), is prepared, characterized, and used for lead(II) removal from both industrial wastewater and leachate of electronic waste. The synergistic interaction between iron oxide and manganese oxide significantly enhances the adsorption performance. The surface characteristics and structural composition of the nanocomposite are examined using high-resolution transmission microscopy, X-ray spectroscopy, and Brunauer-Emmett-Teller methods. Under optimized conditions, the present method offers a significantly high adsorption capacity (377.5 ± 8.9 mg.g-1), short contact time (10 min), and an excellent removal efficiency (98.0 ± 0.9%) compared with most of the previously suggested methods. The adsorption kinetics of Pb(II) on the nanocomposite surface follows pseudo-second-order kinetics and exhibits a good fit with the Dubinin-Radushkevich (D-R) model. These findings highlight the applicability of the α-Fe2O3/Mn2O3 magnetic nanocomposite as a promising efficient adsorbent for the rapid removal of lead(II) from hazardous wastewater. Moreover, the proposed nanocomposite adsorbent exhibits remarkable stability and can be easily isolated from the test sample solution for subsequent reuse. The efficacy of the developed adsorptive removal procedure is confirmed by achieving a complete lead(II) ion removal from some industrial wastewater discharged from lead battery factories and from the leachate of electronic waste.

Sediment TIE Validation Study Using South Korean Domestic Species Glyptotendipes tokunagai to Evaluate Contamination with Two Heavy Metals and Ammonia

Toxicity identification evaluation (TIE) is used to support sustainable soil management. However, TIE studies for sediment contamination have been limited and no previous study has validated its applicability to a species native to South Korea, to the best of our knowledge. Therefore, this study aims to validate the applicability of domestic species inhabiting East Asia to a TIE framework. We selected Glyptotendipes tokunagai, a common benthic invertebrate in urban areas. Contaminated sediment samples were generated using cadmium, copper, and ammonia, which are the major pollutants in sediment. Three different adsorbents were chosen as pollutant removal agents to validate the applicability of TIE using G. tokunagai. In the results, G. tokunagai exhibited a mortality rate that was dependent on the concentration of each pollutant. The mortality rate dramatically decreased after adding the chosen adsorbents to the contaminated sediments. Additionally, the observed reduction in toxicant concentrations suggests that these additives are efficient for toxicant removal. In contrast, WCA10L showed a mortality higher than 20% and seems not to be a proper additive for a toxicity assay. Through this study, G. tokunagai was demonstrated to be sufficiently sensitive to sediment contaminated with different pollutants and showed reproducible measurements, making it a suitable test organism for the TIE framework. Moreover, suitable adsorbents were suggested by measuring efficiency and toxicity after the toxicant removal procedure.

Dynamics in Quality of Life of Breast Cancer Patients Following Breast-Conserving Surgery Versus Mastectomy: Protocol for Systematic Review and Meta-Analysis.

Background: Quality of life (QoL) may change in female patients with breast cancer over time due to its dynamic construct. Recent studies have provided statistics on the diverse predictors of QoL in breast cancer patients. Still, the literature findings on the prognostication of QoL are scarce. Objectives: With this meta-analysis, we aim to describe the dynamics of overall QoL and its dimensions: mental status, physical functioning, and social interactions. Methods: To reach this aim, we will systematically evaluate the peer-reviewed literature on QoL of women who have undergone either mastectomy or breast-conserving surgery. The proposed study will focus on, but not be limited to, the analysis of BIRS, FACT-B, and EORTC QLQ-C30 questionnaires, which are most commonly used in the assessment of the quality of life of cancer patients. Then, we will extract the following outcome measures: The participants' age, time since surgery, type of tumor removal procedure (mastectomy or breast-conserving surgery), breast reconstruction technique, mean value, and standard deviation in a QoL score. A random-effects model will then compute the pooled QoL and construct the trend lines for scores received from each diagnostic tool. The findings will be adjusted according to the reconstruction techniques and tumor removal surgery. Finally, we will model the QoL dynamics with a set of predictors identified in the extracted studies. Conclusions: The study findings may serve as a tool for stratifying female patients with breast cancer by the risk of significant reduction in QoL.

Does Pb2+ Form Holodirected or Hemidirected Solvation Geometries in Water?

The hydration properties of the Pb2+ ion in aqueous solution have been investigated by using a synergic approach based on Classical and Car-Parrinello molecular dynamics (CPMD) simulations and extended X-ray absorption fine structure (EXAFS) spectroscopy. A definite answer has been given to the main question on the Pb2+ hydration structure, which concerns the formation of either holodirected or hemidirected solvation geometries, such terms referring to the arrangements of the ligands that can be directed either throughout the surface of an encompassing globe around Pb2+ or throughout only part of the globe, respectively. Our CPMD results show that the Pb2+ ion in water forms a hemidirected 4-fold cluster with a well-defined distorted pyramidal geometry. This cluster is directed throughout one side of the first shell globe, while the other side contains either two or three very mobile water molecules that do not form a well-defined geometry around the Pb2+ ion. The Pb2+ first shell structural arrangement determined from the CPMD simulation was confirmed by the EXAFS experimental results. A homodirected Pb2+ first shell complex like the 8-fold SAP structure obtained from the classical MD simulations cannot be reconciled with the EXAFS experimental data. These findings represent a significant step forward in the understanding of the solvation chemistry of the Pb2+ ion, which is fundamental to improving the efficiency of lead removal procedures that are crucial to the safety of water resources.

Abstract 4135279: The Watchman Device needs to be Watched: A Case of Device Related Thrombus

Introduction: Left atrial appendage (LAA) harbors approximately 90% of thrombi in non-valvular atrial fibrillation (AF) for which an anticoagulant (AC) is indicated to prevent cardio-embolic stroke. Alternatively, the benefits of LAA occlusion (LAAO) devices to those patients who encounter life-threating bleeding with AC are also well established. However, the LAAO device comes with the risk of device related thrombus (DRT), which is a real challenge. Case: A 68 year-old-male with history of chronic AF on apixaban and recurrent ischemic and hemorrhagic stroke was evaluated for LAAO device placement procedure. Initially, when the patient was not taking AC, he had an ischemic stroke likely cardio-embolic source, which necessitated the initiation of apixaban. Unfortunately, while he was taking apixaban, he had a right thalamic bleed causing persistent left sided paresis. Subsequently, AC was held for 6 months and he underwent watchman device placement. He remained on apixaban for 45 days post procedure and was continued on aspirin only. After 10 months, on routine cardiac computerized tomographic arteriography (CTA), a large filling defect measuring 1.7 x 1.4 cm on the left atrial side of the watchman device was seen (Figure 1A) which was confirmed with transesophageal echocardiogram. Then, he was re-started on apixaban for a short period of time, which culminated him to have a right temporal bleed. After holding AC for 3 months, repeat CTA showed persistent filling defect suggestive of DRT (Figure 1B). Therefore, AC was permanently discontinued and patient was evaluated for DRT removal procedure. Utilizing a shared decision model, the option of mechanical thrombectomy with cerebral protection device (CPD) was chosen to mitigate the risk of embolic stroke. Post procedure, he was continued on apixaban 2.5 mg twice daily for 3 months and then aspirin forever. Subsequent surveillance CTA did not show DRT (Figures 1C and D). Patient has remained asymptomatic thereafter. Conclusion: 3-7% of patients with Watchman device suffer from DRT. Life threatening bleeding from AC further complicates the management of such patients. Mechanical thrombectomy with CPD is an established procedure for the removal of intra-arterial or intravenous thrombus. However, the feasibility of the routine use of mechanical thrombectomy with CPD for persistent DRT in-patient like ours is yet to be studied in detail.

Ultrasound-Assisted Community Bureau of Reference (BCR) Procedure for Heavy Metal Removal in Sewage Sludge.

Sewage sludge (SS) resulting from wastewater treatment plants (WWTP) is commonly applied worldwide as a fertilizer in agriculture. This can be done following a rigorous analysis of the sewage sludge composition. Due to its toxic potential, heavy metal ion content is one of the key parameters to test when evaluating SS sample usage as fertilizer. The distribution of metals present in SS samples produced by five municipal WWTPs in Romania was studied. To obtain information regarding metal distribution in SS, a modified ultrasound-assisted extraction procedure of the Community Bureau of Reference (BCR) was employed for As, Cd, Cr, Cu, Mo, Ni, Pb, Zn, and Co quantitation. Concentrations of these metals were measured using ICP-EOS spectrometry. Method extraction accuracy was verified using CRM-483 certified reference material. Results show that extraction efficiency was lowest for the exchangeable fraction for all studied metals. The detected ion metals were found distributed in fractions (F) 2, 3 and 4, which are unavailable for plants and groundwater under natural environmental conditions. One noteworthy finding was that using ultrapure water for the leachate test resulted in low metal solubility, indicating slight metal desorption in real environmental samples. Furthermore, maize stalk bio-adsorbent was used to minimize metal ion content in WWTP leachate samples produced by the storage of SS in terms of metal ion adsorption.

The effects of virtual reality on pain, anxiety, and comfort during the chest tube removal procedure: A randomized clinical trial

PurposeThe purpose of the current study is to determine the effects of virtual reality on pain, anxiety, and comfort during chest tube removal. Materials and methodsThe research was conducted in the Cardiovascular Surgery Department of Atatürk University Health Practice and Research Hospital between January 2023 and April 2024. The study was performed as a randomized controlled experimental trial with a pretest-posttest control group. Eighty-two patients (41 in the intervention group and 41 in the control group) were included in the research. Patients in the intervention group watched a video with virtual reality glasses during chest tube removal. The “Descriptive Information Form,” “Visual Analog Scale,” “Verbal Pain Scale,” “State Anxiety Inventory,” and “Comfort Scale” were used to collect data. Number, percentage, mean, standard deviation, chi-square, paired sample t-test, independent sample t-test, Mann-Whitney U test, Wilcoxon test, and linear regression analysis were used in data evaluation. Our study was recorded in the Clinical Trials database with protocol number “NCT06550323.” ResultsThe groups had similar descriptive characteristics (p > 0.05). The pre-procedural mean pain, anxiety, and comfort scores were similar in the two groups (p > 0.05). The post-procedural mean VAS and verbal pain scores, mean anxiety, and comfort scores of the intervention group were lower in comparison with the control group (p < 0.05). ConclusionThe research findings showed that virtual reality significantly reduced pain and anxiety while increasing comfort levels during chest tube removal. Therefore, it is recommended that virtual reality be used during chest tube removal.

Ultrasound-guided minimally invasive removal of deep contraceptive implants: outcomes and challenges.

Contraceptive arm implants, such as Implanon NXT®/Nexplanon®, are reversible methods of birth control that have gained global popularity, with over 20 million worldwide users. While palpable implants can be easily removed, deep or non-palpable implants pose complications during extraction, often requiring open surgery. This ultrasound-guided removal technique offers a minimally invasive, safe, and effective alternative, providing real-time control over the implant and neurovascular structures. Our study aims to evaluate the effectiveness and challenges of this implant removal method. In this retrospective observational study, all cases referred to our institution for ultrasound-guided removal of contraceptive implants, from June 2022 to December 2023, were reviewed. Our facility serves as a referral center for handling challenging implants. Twenty-nine women with contraceptive implants were referred for implant removal in this period of time. Thirty implants were sent for removal in total (one patient had a double implant). Data specific to the patients were collected: age and body mass index (BMI). Data specific to the implant were also collected: time since implant insertion (months), history of a previous removal attempt, type of implant (single or double rod), implant palpability, laterality of the implant, supra or subfascial location, success or failure of the ultrasound-guided removal procedure and presence of complications in the post-procedure. Statistical analysis was conducted to determine the relationship between the procedure success rate and these variables, and also between these variables and the supra or subfascial location of the implant. Twenty-six of the 30 implants (86.67%) were successfully removed with this fully ultrasound-guided technique. In cases where the implant could not be removed, there was a higher rate of subfascial implant location (75%), while in cases where the removal was successful, the rate of subfascial implant location was significantly lower at 19.23% (P=0.048). Patients whose implants could be removed had a median BMI of 23.71 kg/m2, which was higher than the BMI of patients whose implants could not be removed (20.82 kg/m2), with a P=0.022. No complications were registered. Percutaneous real-time ultrasound-guided implant removal is effective, safe and offers a minimally-invasive alternative to open surgery. The removal of subfascial implants is also feasible but more challenging, leading to a reduction of success rate in this group. These positive outcomes suggest its potential as a standard initial approach for deep contraceptive implant removal.

Revisiting the Hβ Size–Luminosity Relation Using a Uniform Reverberation-mapping Analysis

We revisit the relation between active galactic nucleus (AGN) broad-line region (BLR) size and luminosity by conducting a uniform Hβ reverberation-mapping analysis for 212 AGNs with archival light curves. Our analysis incorporates three different lag measurement methods, including the interpolated cross-correlation function (ICCF), JAVELIN, and PyROA, alongside a consistently defined lag-searching window and an alias removal procedure. We find that ICCF, albeit with larger uncertainties compared to other methods, is the most reliable method based on our visual inspection of the matches between Hβ and the shifted continuum light curves. Combining this sample with the 32 AGNs from Seoul National University AGN Monitoring Project, we obtain the best-fit relation between the BLR size (R BLR) and the continuum luminosity at 5100 Å (L 5100) with a slope significantly flatter than 0.5. By selecting a subsample of 157 AGNs with the best-quality lag measurements using a set of quantitative criteria and visual inspection, we find a consistent slope and a slightly decreased intrinsic scatter. We further investigate the effect of luminosity tracers, including L 5100, Hβ luminosity (L Hβ ), [O iii] luminosity (L [O III]), and 2–10 keV hard X-ray luminosity L 2–10keV. We find that sub-Eddington and super-Eddington AGNs exhibit systematic offsets in both R BLR–L 5100 and R BLR–L Hβ relations, while they show comparable R BLR–L [O III] and R BLR–L 2–10keV relations. We discuss the potential causes for these different deviations when employing different luminosity tracers.

Return to Activity After Patellofemoral Osteochondral Fracture: A Comparison of Metallic Screw and Bioabsorbable Fixation.

Patellofemoral osteochondral fractures (OCFs) have the potential to hinder patients' function and quality of life. Several fragment fixation techniques have been described, with both metallic screw and bioabsorbable fixation showing favorable functional outcomes. Despite the promising results associated with both fixation methods, no study has directly compared their functional outcomes. To compare the functional and radiographic outcomes between bioabsorbable and metallic screw patellofemoral OCF fixation in an adolescent cohort. Cohort study; Level of evidence, 2. A retrospective review was conducted identifying surgically treated pediatric patients (<18 years of age) with OCFs of the patellofemoral joint. Inclusion criteria were treatment with metallic screw or bioabsorbable fixation (bioabsorbable compression screw, suture bridge, or chondral darts), with preoperative radiographs and operative notes available for review. Patient information, injury characteristics, treatments, and outcomes were collected with a specific focus on return-to-activity time and postoperative complications. Univariate analyses were conducted to compare radiographic and functional outcomes between groups. According to the study criteria, 37 knees in 37 patients (84% male), with a mean age of 14.2 ± 1.8 years, were identified. A total of 24 patients were injured during sports participation, with basketball and football being the most common sports. OCF fixation cohorts consisted of 12 patients treated with metallic screw fixation and 25 with bioabsorbable fixation. No statistically significant differences were appreciated when comparing median time to full activity between the fixation groups (P = .427). However, time to full activity was unequally distributed, with 66.7% of the metallic screw fixation group returning to activity later than the total cohort's median, compared with 42.9% of the bioabsorbable fixation group (P = .04). Two-thirds (8/12) of patients treated with metallic screws required return to the operating room for hardware removal compared with no patient treated with bioabsorbable fixation (P < .001). Two complications occurred with no significant differences appreciated between groups (P = .202). However, both postoperative complications were recorded in the metallic screw fixation group: 1 patient with osteochondral malunion and another with arthrofibrosis. This study demonstrated that pediatric patellofemoral OCFs had good outcomes with high healing and low complication rates regardless of fixation type. Because of the high rate of secondary hardware removal procedures, metallic screw constructs delayed the return to sports and activity time. Patients treated with bioabsorbable fixation did not require a secondary operation for hardware removal and thus were more likely to recover sooner. Future studies are necessary to assess the potential outcome differences between different types of bioabsorbable fixation methods. Based on these findings, surgeons can consider bioabsorbable fixation as an option for the management of OCF lesions.

Ozonation procedure for removal of mycotoxins in maize: A promising screening approach for improvement of food safety.

Mycotoxins are well known secondary metabolites of various fungi. They pose a significant threat to human and animal when present in food or feed. They can be responsible for losses in grain production and in livestock or human intoxication. In this study, several mycotoxins were detected in Aspergillus fumigatus contaminated maize kernels. The contaminated kernels were treated with gaseous ozone at a concentration of 500 and 3000 ppm for 1 hour. Depending on the specific compound, the contamination level was reduced by up to 100%. This screening research showed that a concentration of ozone as high as 3000 ppm could be sufficient to completely remove several toxic compounds from the maize matrix.

Preoperative Immersive Virtual Reality (iVR) Applied to Percutaneous Nephrolithotomy: A Prospective Randomized Clinical Study of Surgical Planning and Clinical Outcomes.

Percutaneous nephrolithotomy (PCNL) is the procedure of choice for the management of complex or large renal stones. A major challenge for the surgeon, however, is the need to assimilate the nearly 2000 static images from a CT scan into a functional mental image to enable surgical planning. Accordingly, we investigated the potential of immersive virtual reality (iVR) to enhance surgical planning and its impact on the outcomes among patients undergoing PCNL. Between 2019-2023, 175 patients undergoing PCNL were pre-operatively randomized into a CT-only group (N=89) or a CT+iVR group (N=86). CT scans were rendered into iVR models that allowed the surgeon not only to visualize and manipulate each patient's relevant anatomy, but also simulate the percutaneous approach to the proposed calyx. Post-operative CT scans were defined as absolute stone-free, <2mm remnants or 2.1-4mm remnants. Pre-operative visualization of the iVR model resulted in a changed calyx of entry in 30% of cases. The CT+iVR group had a significant improvement in absolute stone-free rate (33.70% vs. 20.22%, p=0.043) and overall <4mm remnant rate (62.79% vs. 48.20%, p=0.044). Clavien-Dindo II+IIIa complications were less in the iVR group (3.48% vs. 12.30%, p=0.03). The results were independent of the surgeon's years of PCNL experience. Pre-operative iVR model visualization benefited surgeons and patients alike. From a surgical standpoint, viewing the iVR model resulted in a safer, more effective percutaneous stone removal procedure.

Efficient Capture of Phosphate From Aqueous Media Using Bimetallic La‐Zr‐MOF

ABSTRACTDeposition of excessive phosphate in natural water column caused several issues, like the eutrophication and destruction of aquatic ecosystems. Adsorption has been an effective and convenient method for phosphate elimination. Herein, a novel bimetallic metal–organic framework adsorbent, namely, La‐Zr‐MOF, was prepared, and the morphology, crystallite, characteristic functional groups, specific surface area, and composite material surfaces were analyzed using XRD, FT‐IR, SEM‐EDS, and BET. The adsorption performance of the adsorbent was systematically evaluated by batch adsorption experiments, and the adsorption thermodynamic and kinetic properties were analyzed. The results reveal that La‐Zr‐MOF exhibits a high selectivity and sorption performance for phosphate, and the adsorption of La‐Zr‐MOF follows the Langmuir and pseudo–second‐order models; the phosphate removal procedure is a chemisorption accompanied by an endothermic reaction, and the maximum capacity was 127.7 mg g−1. Combined with batch adsorption experiments, kinetic and thermodynamic studies and various characterization analyses together revealed the phosphate removal mechanism, mainly ligand exchange and electrostatic interactions.

Optimisation of artefact detection in photoplethysmography heart rate data: influence of different classifiers in machine learning models

Abstract Background Heart rate (HR) tracking by wrist-worn devices using photoplethysmography (PPG) could assist in continuously following up physical activity. However, the accuracy can be impacted by (motion) artefacts. Machine learning models could help to recognise artefacts in PPG-based HR data. The choice of classifier in these machine learning models is a determing factor for task performance of the model. Purpose This study evaluates and determines the optimal classifier for a new machine learning-based approach to enhance the reliability of artefact detection in PPG-based HR data. Methods A total of 62 participants (27 cardiac rehabilitation patients, 35 healthy athletes) wore both a test device and a reference device measuring HR continuously for 24 hours. A training dataset was prepared, assigning two independent labels (i.e. anomaly and activity) to each HR episode based on the reference device data. Fitbit data were processed using our in-house designed artefact removal procedure, which involves the application of two classification models: one for anomaly detection and another for activity detection. Four distinct classifiers were employed for both models: Balanced Bagging, Balanced Bagging with Random Forest, Balanced Random Forest, and Logistic Regression. Each classifier was evaluated using area under the receiver operating characteristic curve (ROC-AUC), accuracy, sensitivity and specificity. Results Of the 1,647,328 HR data points collected, 103,095 (6.26%) were identified as artefacts. Figure 1 and Figure 2 summarise the performance of the distinct classifiers for the anomaly model and the activity model, respectively. Balanced Bagging and Balanced Bagging with Random Forest consistently demonstrate the highest AUC values and accuracies across both anomaly and activity detection models (anomaly detection: AUC = 0.95, accuracy = 89-85%; activity detection: AUC = 0.98, accuracy = 95%). Comparing these two, Balanced Bagging with Random Forest emerges as the preferred option, given the highest sensitivity in both anomaly detection (93%&amp;gt;86%) and activity detection models (99%&amp;gt;96%). In contrast, Balanced Random Forest and Logistic Regression exhibit inferior performance. In the anomaly detection model, Balanced Random Forest exhibits a lower sensitivity of 75%, while Logistic Regression performs even worse with a sensitivity of 25%. Similarly, in the activity detection model, both Balanced Random Forest and Logistic Regression demonstrate diminished performance. Conclusions Balanced Bagging with Random Forest emerges as the optimal classifier to detect anomalies and activities in continuous PPG-based HR data, thus contributing to the optimisation of our in-house designed procedure for removing artefacts. This processing aims to provide a reliable and automatic way for continuous HR monitoring, which can help monitor and guide physical activities.

The effect of the age at the time of targeting a lead implantation on the difficulty with the transvenous lead extraction technique

Abstract Background In transvenous lead removal procedures, the number of years since the lead implantation is an indicator of procedural difficulty and complications. However, even with the same number of years since the lead implantation, we considered the possibility that a younger age at the time of the implantation (AoI) would increase the difficulty of the procedure. Objective To elucidate the procedural difficulty in the transvenous lead extraction procedure according to the age at the time of targeting the lead implantation. Method A total of 471 consecutive transvenous lead extraction cases were analyzed. The patient AoI of the oldest lead in extraction procedure cases was divided into two groups: those younger than 60 years (implant age &amp;lt;60 yrs old: AoI&amp;lt;60) and those older than 60 years (implant age ≧60 yrs old: AoI≧60). The analysis was conducted by the number of years since the lead implantation (&amp;lt;10 years: group A, 10 to 20 years: group B, and &amp;gt;20 years: group C). Results The number of AoI&amp;lt;60 and AoI≧60 patients were 60 and 254 (Group A), 51 and 56 (Group B), and 41 and 9 (Group C). The patient age significantly differed among the groups between an AoI&amp;lt;60 and AoI≧60 (group A: 51.7 vs. 77.1; P&amp;lt;0.001, group B: 61.6 vs. 83.1; P&amp;lt;0.001, group C: 71.2 vs. 88; P&amp;lt;0.001). But the oldest dwell time (years) was similar for all groups (group A: 4.6 vs. 4.2; P=0.324, group B: 14.2 vs. 13.5; P=0.148, and group C: 25.7 vs. 22.6; P=0.097). The complete removal rate (group A: 97.7% vs. 98.4%; P=0.722, group B: 90.4% vs. 93.3%; P=0.567, and group C: 78.05 vs. 90.95; P=0.337) and major complication-free rate (group A: 98.8% vs. 100%; P=0.391, group B: 96.2% vs. 100%; P=0.125, and group C: 90.2% vs. 100%; P=0.281) were not statistically significant in all groups but were higher for an AoI≧60. An AoI&amp;lt;60 resulted in a longer procedure time (group A: 78.4 min. vs. 65.3 min.; P=0.006, group B: 96.0 min. vs. 72.3 min.; P=0.002, and group C: 100.9 min. vs. 94.8 min.; P=0.709), longer fluoroscopy time (group A: 12.0 min. vs. 10.2 min.; P=0.247, group B: 19.2 min. vs. 11.6 min.; P=0.017, and group C: 22.2 min. vs. 16.0 min.; P=0.008), and higher number of laser pulses (group A: 779.6 vs. 433.7; P=0.002, group B: 2089.6 vs. 1032.9; P=0.017, and group C: 1509.3 vs. 831.5; P=0.201) in all groups. Conclusion This study suggested that the difficulty of transvenous lead extraction procedures may increase with a younger AoI, even if the lead dwelling time is the same.

Clinical Features and Complications of External Auditory Canal Foreign Bodies in the ENT Emergency Unit.

Objective: To determine the risk factor for developing complications in patients undergoing removal procedures for foreign bodies (FBs) in the external auditory canal (EAC) in the otolaryngology (ENT) emergency unit. Methods: Cases involving patients with EAC FBs treated at the ENT emergency unit of a tertiary medical center were retrospectively recruited. Patients were classified into the age < 10 years and ≥10 years groups. Univariate analyses of the complication rates were performed in all patients and the two age groups. Results: The mean age of the 457 patients was 29.9 ± 19.9 (range, 1.0-89.0) years; 42.7% (n = 195) were under 10 years of age, and 57.1% (n = 261) were male. Complications following FB removal occurred in 40 cases (8.8%), with EAC laceration being the most common (4.4%). Patients under 10 years of age had a higher risk of developing complications than those over 10 years (13.8% vs 5.0%, P = .001), with the younger group also showing an increased risk of EAC laceration (6.7% vs 2.7%, P = .039). Conclusion: Patients under 10 years of age had a significantly-higher rate of complications after EAC FB removal in the ENT emergency unit. Sedation or surgical removal under general anesthesia should be considered to minimize the risk of complications after a failed removal under direct vision in this patient group. Further studies are warranted to verify this implication for clinical practice.

Bubble plume effects on the flotation kinetics of nonmetallic inclusions based on experimental observations

AbstractSteelmaking has shown an increasing concern toward nonmetallic inclusions, leading to new technologies in the secondary metallurgy of steel. Although the typical inclusion removal procedure is by injecting inert gas into the ladle, this vessel does not fulfill all the requirements to accept a porous structure tailored to produce “clean steels.” Consequently, the spotlight has moved to the tundish, the last vessel before solidification, in which gas injection can continuously operate. Therefore, this work focuses on understanding the influence of typical gas flow rates (10–60 NL/min) on the kinetics of inclusion flotation, considering two bubble diameters (0.6 and 1.1 mm). For this purpose, experimental measurements were conducted in a water model, where glass hollow spheres played the role of inclusions, and their concentration was fitted by an exponential decay. In general, injecting bubbles into the system contributed positively to a faster and greater flotation of particles. The smaller bubbles led to a higher maximum efficiency, whereas the larger ones allowed a shorter time scale (i.e., a faster removal), defining a trade‐off to tune the bubble size. Regarding the gas flow rate, the results indicate an optimum range to decrease the time scale, and suggestions for bubble curtains in tundishes are drawn.