Successful Reduction Research Articles

Enabling automated high-throughput Density Functional Theory studies of amorphous material surface reactions

Amorphous materials are increasingly considered for electronic and energy applications. However, modeling site-specific processes on amorphous materials is prohibitively expensive due to the large configuration space, and the large simulation cell needed to properly capture material properties. In this work, we develop a high-throughput workflow, powered by semiempirical methods in combination with Density Functional Theory, to simulate amorphous surfaces and utilize statistical sampling methods to assess surface reaction kinetics. We employ the Smooth Overlap of Atomic Positions (SOAP) to featurize surface species and apply a Bayesian Gaussian Mixture clustering model to perform a site reduction analysis. Finally, we automate the generation of input images for Improved-Tangent Nudged Elastic Band (IT-NEB) to simulate an etching reaction on the reduced sites. The resulting etching barriers are found to follow experimental etching trends for both amorphous silicon and amorphous carbon. Notably, our method reproduces etching barriers using a significantly reduced amount of sites (6 sites) out of all potential sites on the amorphous material surfaces. The successful site reduction method described in this study opens amorphous materials to high-throughput explorations of interfacial chemistry and surface properties.

The identification, approaches to cleaning and removal of a lead-rich salt crust from the surface of an 18th century oil painting

A thin, grey surface layer was noticed after removing the varnish of an eighteenth century Dutch oil painting, by an unknown artist titled Vision of Saint Lutgard of Tongeren. This layer masked the paint layer almost entirely, casting a greyish veil that greatly influenced the painting’s appearance, colour, and saturation. Using scanning electron microscopy coupled with elemental analysis (SEM–EDX), this layer was identified as a lead-rich salt crust. The crust was a distinct layer on top of the paint layer, closely following the topography of the layer underneath but not embedded in it. The article discusses the possible theories behind the formation of this lead-rich salt crust by characterizing the painting’s material, past treatments, and environmental history. Furthermore, the article reports the decision-making process behind the removal of the crust, focusing specifically on the ethical and technical challenges of the cleaning treatment. Tests with different cleaning agents targeting separate components of the crust to remove it and different application techniques are described. The chelating agent Ethylenediaminetetraacetic acid (EDTA) was found to be the most effective in the removal of the crust and was chosen for its removal. The pH of the EDTA cleaning solution and its application had to be modified according to the colour of the paint the crust lay upon. Visual observations and analytical assessments using optical microscopy and SEM after cleaning indicate a successful reduction of the crust resulting in a significant improvement in the painting’s appearance.

Activated Carbon-Embedded Reduced Graphene Oxide Electrodes for Capacitive Desalination

Capacitive deionization of saline water is one of the most promising water purification technologies due to its high energy efficiency and cost-effectiveness. This study synthesizes porous carbon composites composed of reduced graphene oxide (rGO) and activated carbon (AC) with various rGO/AC ratios using a facile chemical method. Surface characterization of the rGO/AC composites shows a successful chemical reduction of GO to rGO and incorporation of AC into rGO. The optimized rGO/AC composite electrode exhibits a specific capacitance of ~243 F g<sup>−1</sup> in a 1 M NaCl solution. The galvanostatic charging-discharging test shows excellent reversible cycles, with a slight shortening in the cycle time from the ~260<sup>th</sup> to the 530<sup>th</sup> cycle. Various monovalent sodium salts (NaF, NaCl, NaBr, and NaI) and chloride salts (LiCl, NaCl, KCl, and CsCl) are deionized with the rGO/AC electrode pairs at a cell voltage of 1.3 V. Among them, NaI shows the highest specific adsorption capacity of ~22.2 mg g<sup>−1</sup>. Detailed surface characterization and electrochemical analyses are conducted.

A Novel Stepwise Technique for Safe and Effective Transoral Release of Irreducible Atlantoaxial Dislocation: A Retrospective Study of 201 cases.

Retrospective cohort study. To verify the clinical efficacy of a novel Transoral Stepwise Release Technique (TSRT) for treatment of irreducible atlantoaxial dislocations (IAAD). Anterior release for IAAD remains challenging, with 3.2 times higher complication rate than posterior release. However, there are some patients who cannot achieve successful reduction from a posterior approach, and require the higher-risk anterior release. Our work presents a novel anterior release technique that aims to minimize iatrogenic injury and associated complications from an anterior release. IAAD cases who were treated with TSRT were retrospectively studied. Primary outcomes included fusion rate, complications, and neurological function over the course of minimum one-year follow-up. Radiographic differences between preoperative and postoperative imaging were also considered. A preoperative prediction model for the actual release grade was developed using multivariate logistic regression based on demographic factors and the craniovertebral abnormalities identified on preoperative images, evaluating the need for higher-grade TSRT release. We included 201 IAAD cases, with 42% (84/201) demonstrating degeneration of the atlantoaxial joint or anterior-hook-like dens. Reduction was achieved in all cases, with 80% (160/201) of cases only requiring relatively low-grade (grade I) TSRT release. Degeneration of the atlantoaxial joint was significantly associated with the need for higher-grade TSRT release (OR 16.68, CI: 2.91-94.54, P=0.002). The overall complication rate was 4.5% (9/201). Over the course of follow-up, the fusion rate reached 98.5%, and the ASIA and JOA score were significantly improved to 97.28 and 16.25 (P<0.01 and P<0.01), respectively. This study demonstrated that our novel TSRT anterior release technique demonstrated complication rates similar to those published in the literature for posterior release. TSRT can be used as an alternative to posterior release techniques for refractory cases or when a posterior approach is not considered viable.

Black Titania and Niobia within Ten Minutes - Mechanochemical Reduction of Metal Oxides with Alkali Metal Hydrides.

Partially or fully reduced transition metal oxides show extraordinary electronic and catalytic properties but are usually prepared by high temperature reduction reactions. This study reports the systematic investigation of the fast mechanochemical reduction of rutile-type TiO2 and H-Nb2 O5 to their partially reduced black counterparts applying NaH and LiH as reducing agents. Milling time and oxide to reducing agent ratio show a large influence on the final amount of reduced metal ions in the materials. For both oxides LiH shows a higher reducing potential than NaH. An intercalation of Li+ into the structure of the oxides was proven by PXRD and subsequent Rietveld refinements as well as 6 Li solid-state NMR spectroscopy. The products showed a decreased band gap and the presence of unpaired electrons as observed by EPR spectroscopy, proving the successful reduction of Ti4+ and Nb5+ . Furthermore, the developed material exhibits a significantly enhanced photocatalytic performance towards the degradation of methylene blue compared to the pristine oxides. The presented method is a general, time efficient and simple method to obtain reduced transition metal oxides.

Short cervix and preterm birth in the top end.

Reducing rates of preterm birth (PTB) remains a significant challenge. The Northern Territory (NT) records some of the highest rates of PTB in the country, especially in First Nations women. In 2014, a Western Australian (WA) preterm birth prevention initiative involved the implementation of seven key initiatives. One of these was routine mid-trimester cervical length measurement. The initiative successfully reduced PTB rates following its first year of implementation. This was the first successful reduction in PTB, including the earlier gestational ages, across a population. To assess the uptake of routine cervical length measurement in the Top End of the NT after the success of the WA PTB prevention initiative and assess if treatment of a short cervix improved PTB rates. A retrospective cohort study of all women who received antenatal care and delivered their baby at the NT's only tertiary hospital was performed. Mid-trimester ultrasound scan data were collected from two separate time windows, before and after the implementation of the WA intervention. Treatments and gestational age at birth were recorded. Adoption of routine screening of cervical length measurement at mid-trimester ultrasound in the NT was successful, increasing from 4 to 88%. Detection rates of short cervix doubled. However, there was no difference to PTB rates despite targeted management. PTB remains a significant challenge in the NT, especially for First Nations women who are found to have a short cervix more commonly than non-Indigenous women in the Top End.

Preoperative glucose in surgical oncology patient is not associated with postoperative outcomes after adjustment for frailty.

Observational studies have shown associations between even small elevations in preoperative glucose and poorer outcomes, including increased length of stay (LOS) and higher mortality. This has led to calls for aggressive glycemic control in the preoperative period, including delay of treatment until glucose is reduced. However, it is not known whether there is a direct causal effect of blood glucose or whether adverse outcomes result from overall poorer health in patients with higher glucose. Analysis was performed using a retrospective database of patients aged 65 and older who underwent cancer surgery. The last measured preoperative glucose was the exposure variable. The primary outcome was extended LOS (>4 days). Secondary outcomes included mortality, acute kidney injury (AKI), major postoperative complications during the admission period, and readmission within 30 days. The primary analysis was a logistic regression with prespecified covariates: age, sex, surgical service, and the Memorial Sloan Kettering-Frailty Index. In an exploratory analysis, lasso regression was used to select covariates from a list of 4160 candidate variables. This study included 3796 patients with a median preoperative glucose of 104 mg/dL (interquartile range: 93-125). Higher preoperative glucose was univariately associated with increased odds of LOS > 4 days (odds ratio [OR]: 1.45, 95% confidence interval [CI]: 1.22-1.73), with similar results for AKI, readmission, and mortality. Adjustment for confounders eliminated these associations for LOS (OR: 0.97 [95% CI: 0.80-1.18]) and attenuated all other glucose-outcome associations. Lasso regression gave comparable results to the primary analysis. Using the upper bound of the respective 95% confidence interval, we estimated that, at best, successful reduction of elevated preoperative glucose would reduce the risk of LOS > 4 days, 30-day major complication, and 30-day mortality by 4%, 0.5%, and 1.3%, respectively. Poor outcomes following cancer surgery in older adults with elevated glucose are most likely related to poorer overall health in these patients rather than a direct causal effect of glucose. Aggressive glycemic management in the preoperative period has very limited potential benefits and is therefore unwarranted.

The Usefulness of Dynamic Ultrasonography in Nursemaid's Elbow: A Prospective Case Series of 13 Patients Reconsideration of the Pathophysiology of Nursemaid's Elbow.

Nursemaid's elbow is a common musculoskeletal disorder among children under 5 years of age. However, diagnostic imaging to confirm a nursemaid's elbow diagnosis is still unavailable. Through the use of a high-frequency ultrasound probe, we determined the etiology and possible pathophysiology of nursemaid's elbow. Thirteen consecutive patients with the clinical suspicion of nursemaid's elbows were examined. A high-frequency linear array 6 to 24 MHz hockey stick transducer was used to detect small changes (partial eclipse signs) of the radial head in the axial view before and after manipulation. All patients in this study had a successful reduction. A partial eclipse sign was found in all patients before reduction and disappeared after successful reduction. These pathologic features detected through high-frequency ultrasonography suggest the role of the escaped posterior synovial fringe in the pathogenesis of the nursemaid's elbow. The specific finding of a "partial eclipse sign" could be a useful additional clue leading to the correct diagnosis of the nursemaid's elbow and may help avoid the unnecessary reduction in patients who do not have a "partial eclipse sign". Level II, diagnostic studies.

Contemporary Concise Review 2022: Chronic obstructive pulmonary disease.

International respiratory organizations now recommend using lower limit of normal and standardized residuals to diagnose airflow obstruction and COPD though using a fixed ratio <0.7 is simpler and robustly predicts important clinical outcomes. The most common COPD comorbidities are coronary artery calcification, emphysema and bronchiectasis. COPD patients with psychological (high anxiety and depression) and cachectic (underweight and osteoporotic) comorbidity have higher mortality and exacerbate more. Serum eosinophil count remains an important COPD biomarker and we have greater clarity about normal eosinophil levels in COPD and the wider population. Criteria for entry into COPD clinical trials continue to exclude many patients, in particular those at greater risk of exacerbation and death. The effect of hyperinflation on cardiac function impacts COPD mortality and is an important target for successful lung volume reduction procedures.

A Young Skier with Leg Pain

BackgroundProximal tibiofibular joint (PTFJ) dislocation is a rare injury that can disrupt the proximal tibia-fibula joint. The abnormalities in knee x-ray imaging can be subtle and difficult to detect, requiring careful assessment. This rare cause of lateral knee pain requires a high level of suspicion for diagnosis. Treatment is closed reduction; unstable PTFJ dislocations often require surgical intervention. Case ReportA 17-year-old young man presented to the emergency department (ED) with right lateral knee pain and difficulty walking after colliding with another skier 2 days prior. The examination showed right lateral ecchymosis and tenderness over the lateral proximal fibula. He remained neurovascularly intact with a full passive and active range of motion. X-ray studies were obtained. The patient was referred by his outpatient orthopedic surgeon after the initial knee x-ray study was concerning for PTFJ dislocation and unsuccessful reduction. In the ED, the patient underwent moderate sedation and successful orthopedic-guided reduction via medial force on the lateral fibular head, while hyper-flexing the knee and holding the foot dorsiflexed and everted. Post-reduction radiographs showed improved proximal tibiofibular alignment without fracture. Why Should an Emergency Physician Be Aware of This?PTFJ dislocation is a rare injury that can be missed easily and requires a high level of suspicion when presented with an acute traumatic knee pain. Closed reduction of PTFJ dislocation can be achieved in the ED and early identification can prevent long-term sequelae.

Worth Syndrome—Patient Report, Diagnostic Work-Up, and Surgical Management of a Rare Craniofacial Entity

Worth syndrome is a rare genetic bone disorder that often presents with cortical thickening of the mandible and an increase in mandibular width. The authors report the preoperative considerations in a young female with Worth syndrome, operative planning, and successful mandibular reduction using cutting guides.

A Nod for Meckel: A Novel Surgical Position Utilizing Meckel's Cave Anatomy for Percutaneous Glycerol Rhizotomy in Trigeminal Neuralgia.

Objective We aim to describe a novel positioning technique using a specific surgical table to achieve the optimal angle during percutaneous glycerol rhizotomy (PGR) for trigeminal neuralgia (TN). Design This is a descriptive and photographic analysis of successful cases for future implementation. Setting This study was conducted at a single-institution, academic center. Participants The participants were adult patients with TN who underwent PGR and provided consent for publication. Main Outcome Measures Primary outcomes of this study were TN symptomatic relief and surgical complications. Results The use of a beach chair sliding headboard surgical table for PGR is plausible and ensures precise and immobile head flexion for 1 hour postglycerol injection. There were no intraoperative or postoperative complications. All patients achieved successful reduction of TN symptoms. Conclusions Utilizing this new method of intraoperative navigation with a unique surgical table in the upright position, surgeons may achieve precise head adjustments post-PGR. Head flexion has been postulated as a means of ensuring glycerol containment in Meckel's cave. This method can help standardize this procedure for future systematic studies on the importance of head positioning post-PGR.

Closed reduction and minimally invasive screw osteosynthesis of Pipkin femoral head fractures.

Femoral posterior hip dislocation with associated femoral head fractures (Pipkin fractures) are rare high-energy injuries. Published treatment modalities involve conservative treatment, head fragment resection, open reduction and internal fixation, and total hip replacement. The experience with mini-invasive screw osteosynthesis of these fractures is the main focus of our study. Seven Pipkin fractures (five Pipkin II and two Pipkin I) in six patients were treated by closed reduction of hip dislocation, followed by minimal invasive lag screw osteosynthesis. Cancellous screw(s) were inserted from the incision on the lateral hip through the femoral neck to the reduced fracture fragment. In all patients, postoperative CT was performed to check the quality of surgery. Active physiotherapy with immediate toe-touch weight bearing was the routine postoperative protocol. In all patients, radiological and clinical results were evaluated with the Thompson Epstein, Merle d'Aubigne and Postel score, and Harris hip score. All fractures united, and all femoral heads survived. Infectious complications were not observed, and no secondary surgery was needed. After an average follow-up of 18.4 months, the average Merle d'Aubigne and Postel score was 17.7 points, while the mean Harris hip score reached 98.1 points. The majority of patients achieved an excellent Thompson-Epstein clinical and radiological outcome. All patients returned to their original occupation. Mini-invasive screw osteosynthesis can be used for the treatment of Pipkin type I-II femoral head fractures. Successful reduction of hip dislocation and head fracture is necessary for using this technique. Long-term follow-up is necessary to confirm this technique.

Thirty-day and one-year outcomes following transcatheter mitral valve edge-to-edge repair versus transapical mitral valve replacement in patients with left ventricular dysfunction

A comparison of 30-day and 1-year clinical outcomes in patients with pre-existing left ventricular (LV) dysfunction undergoing transcatheter mitral valve edge-to-edge repair (TEER) or transcatheter transapical mitral valve replacement (TMVR) has not previously been reported. We aimed to compare 30-day and 1-year rates of all-cause and cardiovascular mortality as well as rehospitalisation for heart failure (HFH). All patients with severe (≥3+) symptomatic mitral regurgitation (MR) and an LV ejection fraction ≤50% who underwent TEER or TMVR over a 5-year period were evaluated. Ninety-six patients (50 TEER, age 80±9 years, 70% secondary MR and 46 TMVR, age 72±9 years, 91% secondary MR) were studied. Baseline demographic and transthoracic echocardiogram characteristics were well-matched, with the exception of age (TEER 80±9 vs TMVR 72±9; p=0.01). Successful device implantation occurred in 96% of TEER patients and 97.8% of TMVR patients. Ninety-two percent of TEER patients had ≤2+MR predischarge, whilst no TMVR patient had ≥1+MR (p<0.01). No significant difference in the combined endpoint of 30-day all-cause mortality or HFH was observed (p>0.05). At 1 year, freedom from all-cause mortality and HFH was 79.2% across the entire study population but was significantly higher in patients undergoing TEER (TEER: n=45 [90%] hazard ratio 11.26, 95% confidence interval [CI]: 10.59-11.93 vs TMVR: n=39 [67.4%] 95% CI: 10.09-11.33;p=0.008). Despite comparable rates of successful device implantation, MR reduction, and 30-day all-cause mortality/HFH, TEER patients had lower all-cause mortality and HFH rates at 1 year.

Successful Glenohumeral Shoulder Reduction With Combined Suprascapular and Axillary Nerve Block

BackgroundAnterior glenohumeral dislocation is a common injury seen in the emergency department (ED) that sometimes requires procedural sedation for manual reduction. When compared with procedural sedation for dislocation reductions, peripheral nerve blocks provide similar patient satisfaction scores but have shorter ED length of stays. In this case report, we describe the first addition of an ultrasound-guided axillary nerve block to a suprascapular nerve block for reduction of an anterior shoulder dislocation in the ED. Case ReportA 34-year-old man presented to the ED with an acute left shoulder dislocation. The patient was a fit rock climber with developed muscular build and tone. An attempt to reduce the shoulder with peripheral analgesia was unsuccessful. A combined suprascapular and axillary nerve block was performed with 0.5% bupivacaine, allowing appropriate relaxation of the patient's musculature while providing excellent pain control. The shoulder was then successfully reduced without procedural sedation. Why Should an Emergency Physician Be Aware of This?Procedural sedation for reduction of anterior shoulder dislocations is time consuming, resource intensive, and can be risky in some populations. The addition of an axillary nerve block to a suprascapular nerve block allows for more complete muscle relaxation to successfully reduce a shoulder dislocation without procedural sedation.

BRASD trial: biomechanical reposition techniques in anterior shoulder dislocation—a randomized multicenter clinical trial

BackgroundBiomechanical reduction techniques for shoulder dislocations have demonstrated high reduction success rates with a limited pain experience for the patient. We postulated that the combination of biomechanical reduction techniques with the shortest length of stay would also have the lowest pain experience and the highest first reduction success rate.MethodsA randomized multicenter clinical trial was performed to compare different biomechanical reduction techniques in treating anterior shoulder dislocations without the use of invasive pain relief. Patients who were able to perform adduction of the arm were randomly assigned to Cunningham, the modified Milch, and the scapular manipulation technique. Those who were not able to do so were randomly assigned to modified Milch and the scapular manipulation technique. Primary outcomes were emergency department length of stay and pain experienced during the reduction process, measured by the numeric pain rating scale. Secondary outcomes were reduction time, reduction success, use of analgesics or sedatives, and complications.ResultsThree hundred eight patients were included, of whom 134 were in the adduction group. In both groups, no differences in emergency department length of stay and experienced pain were observed between the treatment arms. In the adduction group, the modified Milch technique had the highest first reduction success rates 52% (p = 0.016), within protocol 61% (p = 0.94), and with sedation in the ED 100% ( −). In the no-adduction group, the modified Milch was also the most successful primary reduction technique with 51% success (p = 0.040), within protocol 66% (p = 0.90), and with sedation in the ED 98% (p = 0.93). No complications were recorded in any of the techniques.ConclusionA combination of biomechanical techniques resulted in a similar length of stay in the emergency department and showed similar pain scores with an overall high success rate of reduction. In both groups, the modified Milch had the highest first-reduction success rate.Trial registrationNetherlands Trial Register NTR5839—1 April 2016. Ethical committee Noord-Holland with the CCMO-number NL54173.094.15

Interactions of Factors Related to the Stunting Reduction Program in Indonesia: A Case Study in Ende District.

Previous stunting-related studies focus more on causes or determinants of stunting. Little is known about factors contributing to the success of stunting reduction programs. This study aims to fill those gaps using a case study from Ende District, Province of Nusa Tenggara Timur, Indonesia. A group model-building workshop with stunting-related stakeholders was conducted in November 2021. The system dynamic approach in the form of a causal loop diagram was used. Five variables related to the stunting reduction program were included in the analysis: the budget for the stunting reduction program; stunting-related stakeholder's cooperation and coordination; sufficient water supply; the ability of the related stakeholders to execute the program; and water, sanitation, and hygiene-related behavior. We found that the budget for the program and the cooperation and coordination between stakeholders were the most influential variables in the system. The feedback loop between these 2 variables was also the most prominent in the system, suggesting that sufficient funding and strong collaboration between stakeholders could lead to successful stunting reduction programs. Finally, this study implies that the stunting reduction programs in developing countries should be seen holistically and improvement should be conducted in all aspects, including financial, institutional, environmental, technical, and social.

An Analysis of Three Decades of Increasing Carbon Emissions: The Weight of the P Factor

A dominant narrative in the climate change debate is that addressing population is not relevant for mitigation because population is only growing in the poorest countries, whose contribution to global carbon emissions is negligible, while the largest contribution comes from rich countries where the population no longer grows. We conducted an analysis of 30 years of emission data for all world countries showing that this narrative is misleading. Splitting the countries into four income groups according to the World Bank’s standard classification, we found that: (i) population is growing in all four groups; (ii) low-income countries’ contribution to emissions increase is indeed limited; (iii) the largest contribution to global carbon emissions comes from the upper-middle group; (iv) population growth is the main driver of emissions increase in all income groups except the upper-middle one; (v) the successful reduction in per capita emissions that occurred in high-income countries was nullified by the parallel increase in population in the same group. Our analysis suggests that climate change mitigation strategies should address population along with per capita consumption and technological innovation, in a comprehensive approach to the problem.

SG-APSIC1180: Successful reduction in the number of hospital-acquired dialysis- catheter–related bloodstream infections: Quality improvement initiative

Objectives: Patients undergoing hemodialysis using a catheter are at significant risk of developing central venous catheter–related bloodstream infections (CRBSIs), especially with methicillin-resistant Staphylococcus aureus (MRSA), resulting in increased morbidity, mortality, and cost. In our 1,000-bed regional hospital, the average CRBSI (any bacteria) rate in patients dialyzing via dialysis catheters was 1.44 per 1,000 catheter days, and the average CRBSI (MRSA) rate was 0.56 per 1,000 catheter days. A quality improvement project was initiated to reduce the overall dialysis CRBSI and CRBSI-MRSA by 50%. Methods: Following the formation of a multidisciplinary team, the catheter-insertion protocols and catheter-care protocols were standardized throughout the hospital. We adopted a well-established scientific quality improvement method, plan–do–study–act (PDSA) cycle model for all interventions that were implemented. The patients and general ward nursing staff were provided education and training in dialysis catheter care. Results: The project was initiated in January 2016, and the initial improvement was seen from July 2017 onward. Analysis of the data since 2016 showed a steady improvement in the overall CRBSI rates, as well as CRBSI-MRSA rates. The average CRBSI rate improved to 0.76 per 1,000 catheter days, and the average CRBSI-MRSA rates improved to 0.15 per 100 catheter days in the calendar year 2021. Conclusions: Because the causes of these infections are multifactorial, emphasis should be placed on improving care processes from the patient preparation phase prior to catheter insertion to regular catheter care in the inpatient wards and dialysis units. We attribute the success of our project to involving all stakeholders and obtaining constant feedback from the staff. We successfully applied PDSA cycles to make relevant incremental changes.

Transdiaphragmatic Intercostal Hernia Repair in a Patient with Previous Thoracic Surgery

A transdiaphragmatic intercostal hernia (TDIH) describes the herniation of abdominal contents through diaphragm and chest wall defects. It has been documented following traumatic injuries as well as after episodes of increased thoracoabdominal pressure. However, those resulting from iatrogenic cause remain uncommon and are less often recorded. We report an iatrogenic TDIH in a patient presenting 39 days after a complicated thoracic procedure, highlighting the surgical technique used for successful hernia reduction, diaphragmatic closure, and rib re-approximation. The case reinforces the possibility of a TDIH occurring as a post-surgical complication. Surgeons should anticipate the potential development of TDIH, particularly after thoracic procedures in patients with significant pre-existing conditions, such as chronic obstructive pulmonary disease (COPD) and cirrhosis. Such clinical awareness should be coupled with apt corrective surgical strategies thereby providing greater opportunity for successful patient recovery.