Surrounding Structures Research Articles

Mode of Mechanical Ventilation in a Case of Venolymphatic Malformation: Spontaneous-Saves, Positive-Precludes.

Mediastinal venolymphatic malformations (VLM) are rare tumours, with very few reported cases in the literature. Arising often from the anterior mediastinum, VLM manifests symptoms based on invaded surrounding structures. Masses from the anterior and superior mediastinum pose an anaesthetic challenge for airway and hemodynamic management. A 7-month-old male child presented with a progressively growing mass over the left anterior chest wall for one month, about 4x4 cm, with diffuse margins and now expanded to involve the root of the neck and into the axilla. The patient was free from any apparent systemic illness. The breathing difficulty worsened in the past week with noisy respiration associated with feeding difficulty and hence sought medical admission to the paediatrics emergency unit. In conclusion, such huge mediastinal masses are managed better under spontaneous ventilation with an adequate surgical depth of anaesthesia to maintain appropriate respiratory compliance and necessitate lower peak inspiratory pressure. Given rare cases reported in the literature, similar topics would help choose the modus of ventilation and their safe management.

Role of CBCT in sleep apnea – A review

Sleep apnoea is a common condition in the elderly population with potentially significant consequences, including comorbidity and cognitive decline. There is now a wealth of information indicating that untreated sleep apnea is associated with an increased risk of fatal and nonfatal cardiovascular event, a higher propensity of sudden death during sleep and a greater risk for stroke and all-cause mortality. Consequently, OSA represents a significant evolving public health challenge in both the developed and developing world. Currently many cases of obstructive sleep apnoea syndrome are unrecognized which leads to unnecessary morbidity and even mortality. By posing a few additional questions during the routine clinical interview, patients in need for further diagnostic testing can be easily identified. The best methods of diagnosis are costly and increased sophistication of screening devices and interpreting physicians are required to reduce the need for full polysomnography. CBCT, with its 3D presentation of the airway and its surrounding structures, offers the increased visualization of both untreated obstruction tendencies and potentially of changes in the airway by treatment modality.

Ex Vivo Perfusion of Porcine Pancreas and Liver Sourced from Commercial Abattoirs after Circulatory Death as a Research Resource: A Methodological Study.

Machine perfusion (MP) is increasingly used for human transplant organ preservation. The use of MP for research purposes is another opportunity for this technology. The porcine pancreas and liver are similar in anatomical size and function to their human counterparts, making them an excellent resource for research, but they have some important differences from human organs which can influence their research use. In this paper, we describe a technique developed and tested for the retrieval of porcine organs for use in research on perfused viable organs. Whole-organ porcine pancreata and livers were harvested at a commercial abattoir, following standard slaughterhouse processes. The standard slaughterhouse process involved a thoracotomy and mid-line laparotomy, and all the thoracoabdominal organs were removed. The pancreas, fixed in the retroperitoneum, was carefully dissected from its attachments to the surrounding structures, and tissue planes between the pancreas, spleen, duodenum, and colon were meticulously identified and dissected. Vessel exposure and division: The aorta, portal vein (PV), hepatic vein (HV), and hepatic artery (HA) were dissected and isolated, preserving the input and output channels for the liver and pancreas. A distal 3 cm of the aorta was preserved and divided and served as the input for the pancreas perfusions. The liver, PV, HV, and HA were preserved and divided to preserve the physiological channels of the input (PV and HA) and output (HV) for the liver perfusions. The porcine hepatic and pancreas anatomy shares significant resemblance with the gross anatomy found in humans, and this was taken into consideration when designing the perfusion circuitry. The porcine pancreas and spleen shared a common blood supply, with branches arising from the splenic artery. The organs were flushed with cold, heparinised normal saline and transported in a temperature-regulated receptacle maintained at a core temperature between 4 and 8 °C, in line with the standards of static cold storage (SCS), to a dedicated perfusion lab and perfused using our novel perfusion machine with autologous, heparinised porcine blood, also collected at the abattoir.

Treatment of Anterior Dislocation of the Sacroiliac Joint via the Lateral-rectus Approach: Surgical Techniques and Preliminary Outcomes.

Anterior dislocation of the sacroiliac joint (ADSIJ) is caused by strong violence, and because of its low morbidity, there are no standardized diagnostic and therapeutical guidelines at this moment. This study aims to explore the surgical techniques and preliminary outcomes of the lateral-rectus approach (LRA) for treating ADSIJ. A retrospective study was conducted of 15 patients with ADSIJ from January 2016 to January 2021. The patients' age ranged from 1.8 years old to 57 years old (37 ± 18 years old). All patients underwent open reduction and internal fixation (ORIF) through the LRA. Eight patients were combined with lumbosacral plexus injury and underwent neurolysis during operation. Patients' fracture type, mechanism of injury, associated injuries, operation time and intraoperative bleeding volume were accessed by reviewing medical history. Quality of fracture reduction was evaluated with the Matta score. At 1-year follow-up, the functional rehabilitation was evaluated by the Majeed rehabilitation criteria. For those with lumbosacral plexus injury, the neuromotor function was evaluated using muscle strength grading proposed by the British Medical Research Council (BMRC) and recovery was recorded. All 15 patients underwent the operation successfully. The surgical time ranged from 70 to 220 min (126 ± 42 min), and the intraoperative blood loss ranged from 180 to 2000 mL (816 ± 560 mL). Eighty percent of the cohort (12/15) were rated as excellent and good in the Matta score for fracture reduction quality after operation without surgical incision-related complications. At 1-year follow-up, the overall excellent and good rate was 73.3% (11/15) according to the Majeed criteria, the neuromotor function recovered completely in six cases and partially in two cases according to the BMRC muscle strength grading, and the recovery of sensory function was evaluated as excellent in six cases, good in one case and poor in one case, with an overall excellent and good rate of 87.5%. The LRA can well expose the surrounding structures of the sacroiliac joint from the front, which helps surgeons reduce and fix the anterior dislocation of the sacroiliac joint under direct vision and effectively decompress the entrapment of the lumbosacral plexus to achieve better clinical efficacy.

Real-Time and Delayed Imaging of Tissue and Effects of Prostate Tissue Ablation.

Prostate ablation is increasingly being utilized for the management of localized prostate cancer. There are several energy modalities with varying mechanism of actions which are currently used for prostate ablation. Prostate ablations, whether focal or whole gland, are performed under ultrasound and/or MRI guidance for appropriate treatment plan execution and monitoring. A familiarity with different intraoperative imaging findings and expected tissue response to these ablative modalities is paramount. In this review, we discuss the intraoperative, early, and delayed imaging findings in prostate from the effects of prostate ablation. The monitoring of ablation both during and after the therapy became increasingly important due to the precise targeting of the target tissue. Recent findings suggest that real-time imaging techniques such as MRI or ultrasound can provide anatomical and functional information, allowing for precise ablation of the targeted tissue and increasing the effectiveness and precision of prostate cancer treatment. While intraprocedural imaging findings are variable, the follow-up imaging demonstrates similar findings across various energy modalities. MRI and ultrasound are two of the frequently used imaging techniques for intraoperative monitoring and temperature mapping of important surrounding structures. Follow-up imaging can provide valuable information about ablated tissue, including the success of the ablation, presence of residual cancer or recurrence after the ablation. It is critical and helpful to understand the imaging findings during the procedure and at different follow-up time periods to evaluate the procedure and its outcome.

Manipulation Planning for Wiring Connector-Attached Cables Considering Linear Object’s Deformability

In this paper, we propose a method of manipulation planning for cable wiring. The method enables to take into account the deformation of cables while connector incorporation process. Using a physical simulation that predicts the shape of a cable based on the pose of both ends of the cable, we generate a connector moving path that avoids intereference between the cable and surrounding structures. We conducted experiments under several different environments and several different lengths of cables, and confirmed that actual cable manipulation can stably be achieved by using the proposed method.

The shape of water: adaptations of cochlea morphology in seals and otters

Abstract Seals (Pinnipedia) and otters (Lutrinae) are two major taxa of the mammalian order Carnivora that independently adapted to a semi-aquatic lifestyle. Their sensory capabilities, including hearing, are still not fully understood. Notably, the functional morphology of amphibious hearing presents an interesting example for studying convergent evolution. We therefore investigated the shape and dimensions of morphological traits of the inner ear and the surrounding structures involved in sound perception using Micro-Computer Tomography (µCT) data of 52 skulls belonging to 38 species of the carnivoran subgroup Caniformia. Principal component analysis (PCA) of cochlea shape variables revealed that 82% of shape variation is explained by PC1 and PC2. A number of traits (e.g. cochlea shape, reduction in cochlea turns, flattening of the cochlea, relative size of tympanum and round window) are significantly different from terrestrial Caniformia. We also found an external cochlea foramen in all Pinnipedia, which is likely related to coping with pressure compensation during diving. Finally, we demonstrate that hearing parameters, such as characteristic hearing frequency, correlate with changes in the morphological traits that separate seals and otters from other Caniformia. Our data suggest that large parts of the morphology of ear region of these semi-aquatic carnivorans have independently adapted to allow hearing in air and water.

Morphology of hypertrophied basal septum contributes to left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy: a retrospective case-control study.

Detailed assessment of basal septal morphology is essential for understanding the morphological mechanism of left ventricular outflow tract (LVOT) obstruction. We aimed to analyze the morphological alterations of the basal septum (BS) and its surrounding structures and explore their role in LVOT obstruction (LVOTO) in patients with hypertrophic cardiomyopathy (HCM). During January 2019 and December 2019, 239 patients were diagnosed with HCM at Fuwai Hospital. We retrospectively reviewed echocardiographic data sets from 105 consecutive patients with HCM [64 with hypertrophic obstructive cardiomyopathy (HOCM) and 41 with hypertrophic non-obstructive cardiomyopathy (HNOCM)] and 28 healthy controls. For quantitatively assessing the basal septal morphology, a novel measurement method was used to obtain the IVSa (the area of the BS protruding into the LVOT), LA (the largest distance of the BS protruding into the LVOT), LB (IVSa length in the direction perpendicular to the LA), and S-IVSa (IVSa divided by LB). Echocardiographic parameters associated with LVOTO were analyzed using multivariable logistic regression analyses. There was no significant difference in the maximal basal septal thickness between the HOCM and HNOCM patients (P>0.99). Among the three groups, there were significant differences in the length of the anterior and posterior mitral leaflets (AML and PML), the angle between the mitral valve orifice and ascending aorta (MV-AO) angle, IVSa, LA, LB, and S-IVSa (all P<0.001). Compared with HNOCM patients, HOCM patients had significantly longer AML and PML, as well as larger MV-AO angle, IVSa, LA, and S-IVSa (P<0.001, P<0.001, P<0.001, P=0.002, P<0.001, and P=0.03, respectively). In the multivariate analysis, AML, MV-AO angle, IVSa, and S-IVSa were associated with LVOTO {odds ratio (OR) [95% confidence interval (CI)]: 0.649 (0.462-0.911), P=0.01; 0.842 (0.768-0.923), P<0.001; 1.025 (1.001-1.049), P=0.04; and 0.276 (0.101-0.754), P=0.01, respectively}. Morphological alterations of the BS relative to the LVOT may provide additional value for estimating the extent of LVOTO. The length of AML, MV-AO angle, IVSa, and S-IVSa were associated with LVOTO.

Knowledge mapping of cool pavement technologies for urban heat island Mitigation: A Systematic bibliometric analysis

In the last few decades, researchers have sought ways to counterbalance the effect of the urban heat island (UHI) phenomenon of increased urban temperatures resulting from human activities and the surrounding structures. A significant portion of any urban area is made up of paved surfaces, which greatly contributes to the UHI effect. The concept of utilising cool pavement technologies (where ‘pavement’ refers to all paved surfaces) has gained popularity lately. These technologies tend to involve releasing less sensible heat and lowering pavement surface temperatures, which may result in substantial changes to the heating in areas with high urban temperatures. However, no quantitative study of the pertinent numerical features of the research and the development of cool pavement technology research has been published. This paper presents a science mapping and bibliometric analysis of cool pavement technology research represented by 342 selected publications in the Scopus database, a widely recognised scientific database. This analysis revealed that the production of documents related to cool pavements has increased exponentially since 1993, reaching a peak of 44 articles in 2022. China had the most publications, followed by the USA. An analysis of topical trends showed that most research on cool pavement technology has focused on increasing the solar reflectance of the pavement surface—the subject of 159 of the total of 342 documents. Surprisingly, the total number of studies on evaporative pavements was only about one-third of the number (53) conducted on reflective pavements. In addition to research on reflective and evaporative pavements, significant efforts have been undertaken in the past few years to identify techniques to help lower paved surface temperatures to mitigate the UHI effect. This indicates that this research area is still evolving and far from fully mature.

Digital Techniques for Construction of Maxillofacial Prosthesis

Physiological flaws that impair appearances or functioning and prohibit a person from having a functional life often lead to the person seeking therapy that will restore an adequate standard of normality. The eye had been referred to several writers throughout history as the most priceless of endowments. It brings the whole outside world into our awareness that provides the deal with life, character, or respect. Consequently, the disappearance of an eye has traditionally been thought of as the ultimate sorrow as well as calls for prompt restoration so that the sufferer might resume living normally. Ocular prostheses use artificial material to simulate biological structure to provide the appearance of such a completely functional, regular eye as well as its surrounding structures. The precise replica of color, shape, or size is thus highly stressed in order to just provide people reality or harmony.&#x0D; The custom-made acrylics ophthalmic prosthetic or the implantation-maintained system are available as treatments. A bespoke ocular prosthetic is used because it offers the advantages of tight tissues interface adaptability with optimal convenience. This review outlines a more straightforward method for creating personalized ophthalmic prostheses.

Preoperative Magnetic Resonance Elastography (MRE) of Skull Base Tumours: A Review.

Conventional magnetic resonance imaging (MRI) can detect tumors consistency, but it can't predict tumor stiffness or adherence of the tumor to nearby structures. Magnetic resonance elastography (MRE) is a known non-invasive MRI based imaging technique used to assess the viscoelasticity of the tissues particularly liver fibrosis. This study discussed the importance of preoperative MRE in skull base tumors and the future implications of this new imaging modality. We did review of the English literature (by searching PubMed) regarding the use of MRE in preoperative assessment of skull base tumours stiffness and adherence to surrounding tissues. Recent research demonstrated that MRE can detect the stiffness and adherence of skull base tumors to surrounding structures by recording the spread of mechanical waves in the different tissues. In addition to non-radiation exposure, this technique is fast and can be incorporated into the conventional (MRI) study. MRE can palpate skull base tumours by imaging, allowing the stiffness of the tumour to be assessed. Preoperative assessment of brain tumours consistency, stiffness, and adherence to surrounding tissues is critical to avoid injury of important nearby structures and better preoperative patient counselling regarding surgical approach (endoscopic or open), operative time, and suspected surgical complications. However, the accuracy of MRE is less in small and highly vascular tumors. Also, MRE can't accurately detect tumour-brain adherence, but the new modality (slip-interface imaging) can. Hence, adding MRE to the conventional MRI study may help in preoperative diagnosis and treatment of skull base tumours.

An Insight Into the Effect of Odontogenic Keratocysts on Surrounding Structures: Cone-Beam Computed Tomography-Based Analysis of Cases.

Introduction An odontogenic keratocyst (OKC) is a benign intraosseous lesion with potential to demonstrate aggressive and invasive behavior. The aim of this retrospective study was to analyze the imaging features of the OKCusing cone-beam computed tomography (CBCT) and to evaluate the association between the internal structure of the lesion and the effect of the lesion on surrounding structures. Methods Overall, 32 CBCT scans of histopathologically diagnosed cases of OKC were analyzed retrospectively. The following variables were analyzed: anatomic location of the lesions (mandible body (right/left), ramus (right/left), mandible body+ramus (right/left), maxilla (right/left), and both jaws), the internal structure of the lesion (unilocular/multilocular), and the effect ofthe lesion on the surrounding anatomical structures (involvement of the inferior alveolar nerve canal (IANC), displacement of the IANC, cortical expansion, displacement of the tooth, resorption of the root, associated impacted tooth, associated missing tooth). We also looked for the association between the internal structure and the effect of the lesion on anatomic structures. Results Out of 32 cases, 29 (90.6%) cases involved the mandible alone. Statistically significant association (p-value 0.005) was present between the internal structure and mean age of presentation as well as between the internal structure and impacted tooth (p-value 0.027). The association between the internal structure and other variables was statistically not significant. Conclusions The radiographic features of OKCs can be variable, and these lesions have a considerable effect on the tooth, IANC, and cortical bone. Significant association was found between the internal structure, age, and impacted tooth. Since OKCs have a high recurrence rate, CBCT is advised for evaluating the extent and location of any cortical perforations.

Importance, influence and limits of CFD radiation modeling for containment atmosphere simulations

In the appearance of steam, the CFD modeling of thermal-hydraulic phenomena in reactor containments during various phases of an accident necessarily requires consideration of radiative heat transfer. These radiation phenomena involve (i) energy transfer within the gas mixture and (ii) between the gas and the surrounding structures which have a much higher thermal inertia. Preliminary calculations performed for the present experiments in the OECD/NEA HYMERES-2 project with the CFD code containmentFoam using a Monte Carlo thermal radiation solver with non-gray gas modeling of steam absorption, showed that radiant heat transfer is important even with a very low amount of steam (≈ 2%). Therefore, the test matrix was tailored to the two opposite extremes: Either gas compositions with low steam content, where radiative heat transfer can be neglected, or gas mixtures containing larger amounts of steam, so that radiative heat transfer plays a dominant role. For the two selected experiments within the H2P2 series and the corresponding CFD calculations, a vessel with a diameter of 4 m and a height of 8 m was preconditioned with different mixtures of air/steam at room and elevated temperatures. This was followed by the build-up of a stable helium stratification in the upper part of the vessel. Helium was then injected from the top at a higher mass flow rate, which (a) compresses the gas atmosphere, (b) resembles piston compression and (c) leads to a height-dependent and transient increase in gas temperature below this helium stratification, influenced by thermal radiation effects — or their absence. These experiments and the associated CFD calculations were developed to isolate the thermal radiation phenomena as much as possible from convective and diffusive effects. They are the first of their kind to be conducted in a large-scale thermal-hydraulic facility. It is demonstrated (a) that neglecting thermal radiation for the high steam content case, the temperature rise is significantly over-predicted by a factor of two compared to the application of the suggested Monte Carlo thermal radiation solver with non-gray gas modeling, (b) the computational effort considering CFD and non-gray gas radiation is feasible with the suggested tailored Monte Carlo solver and (c) that the suggested radiation model outperforms the widespread used P1 radiation model.

Multiple Esophageal Leiomyomas: Case Report

Esophageal leiomyoma is uncommon. It is the most common benign tumor of the esophagus accounting for 0.4% of esophageal neoplasms and approximately two-thirds of benign esophageal tumors. About 90% of them are reported to be solitary and intramural lesions, and multiple or diffuse lesions seem to be very rare. We report the observation of a 75 years old male patient who was evaluated for chronic epigastric pain, Physical examination findings were typically normal, the patient underwent upper GI endoscopy. In esophagus, many submucosal tumor covered with intact mucosa, varying between 5mm and 20mm in size and located in the middle and lower part of oesophagus were noted. The radial endoscopic ultrasonography showed multiple (&gt;10 masses), homogenous hypoechoic masses with clear margins, originated from the submucosa layer with normal surrounding structures, located in the middle and lower part of the oesophagus, and their size was &lt; 2 cm, these lesions are followed periodically as they have a slow growth rate and negligible risk of malignant transformation. Multiple esophageal leiomyomas seems to be very rare, EUS is a valuable technique for the diagnosis of the disease and for making treatment decisions.

Predictors of outcome in cryptoglandular anal fistula according to magnetic resonance imaging: A systematic review.

Anal fistula (AF) with cryptoglandular origin tends to recur, and multiple risk factors are implicated. Recently, some magnetic resonance imaging (MRI) findings with predictive value for disease outcomes have been proposed. These intrinsic anatomic features include those of the AF and its surrounding structures. This study aims to clarify the prognostic role of MRI in AF. We performed a systematic search of PubMed, Embase, and EBSCO databases. Two independent reviewers conducted the search and screened the articles. We selected studies that used MRI to assess AF and reported its relationship to disease outcome. We extracted data regarding the study design, type of intervention, outcome, MRI-measured items, and their significance. Out of 1230 retrieved articles, 18 were eligible for final inclusion, and a total of 4026 patients were enrolled in the selected studies. For preoperative MRI, the significant items affecting the outcome were the length of the fistula, horseshoe type, presence of multiple tracts, supralevator extension, and apparent diffusion coefficient (ADC) value. Other studies investigated the healing process using postoperative MRI. This review found that MRI can be useful in the management of AF, both preoperatively and postoperatively. Factors, such as fistula length, horseshoe type, presence of multiple tracts, supralevator extension, and ADC value were found to be significantly associated with treatment outcomes. The presence of the fistula tract and the development of new abscesses on postoperative MRI was found to hinder the healing process. Further studies are needed to confirm these findings.

ROLES OF SPINAL OSTEOTOMIES ON CORRECTION OF POST-TRAUMATIC THORACOLUMBAR KYPHOSIS

Thoracolumbar (T–L) fracture may create focal kyphosis accompanied by altered sagittal alignment, instability and potential neurological deficits. Surgical intervention for post-traumatic T–L kyphosis aims to restore sagittal balance, release compromised neural structures, and to improve the symptoms related to the malalignment. It is best indicated when there is a progression of kyphotic deformity, and/or when there are new or progressive neurological deficits. A kyphotic deformity [Formula: see text] is susceptible to persistent chronic pain in the kyphotic region and surgical correction is often required. Those with posterior ligamentous complex injury may also warrant surgical correction as there is a higher risk of kyphosis progression. A number of surgical procedures could be employed to correct post-traumatic T–L kyphosis. Spinal osteotomies are often needed to improve global, sagittal or coronal balance including in the late and fixed post-traumatic kyphosis. Based on different extent of focal kyphosis and global malalignment, surgical options may include posterior column osteotomy (PCO), pedicle subtraction osteotomy (PSO), disc-bone osteotomy (DBO), vertebral column resection (VCR) or closing opening wedge osteotomy (COWO). The type of spinal osteotomy utilized to correct post-traumatic T–L kyphosis should be chosen based on the severity of the deformity, the alignment of the spine, and the surrounding structures. In the meantime, potential complications should be reduced with novel techniques and proper constructs. When all associated factors are considered, surgical correction composing a suitable spinal osteotomy can be a beneficial and rewarding procedure for patients with post-traumatic T–L kyphosis.

Development of a bespoke phantom to optimize molecular PET imaging of pituitary tumors

BackgroundImage optimization is a key step in clinical nuclear medicine, and phantoms play an essential role in this process. However, most phantoms do not accurately reflect the complexity of human anatomy, and this presents a particular challenge when imaging endocrine glands to detect small (often subcentimeter) tumors. To address this, we developed a novel phantom for optimization of positron emission tomography (PET) imaging of the human pituitary gland. Using radioactive 3D printing, phantoms were created which mimicked the distribution of 11C-methionine in normal pituitary tissue and in a small tumor embedded in the gland (i.e., with no inactive boundary, thereby reproducing the in vivo situation). In addition, an anatomical phantom, replicating key surrounding structures [based on computed tomography (CT) images from an actual patient], was created using material extrusion 3D printing with specialized filaments that approximated the attenuation properties of bone and soft tissue.ResultsThe phantom enabled us to replicate pituitary glands harboring tumors of varying sizes (2, 4 and 6 mm diameters) and differing radioactive concentrations (2 ×, 5 × and 8 × the normal gland). The anatomical phantom successfully approximated the attenuation properties of surrounding bone and soft tissue. Two iterative reconstruction algorithms [ordered subset expectation maximization (OSEM); Bayesian penalized likelihood (BPL)] with a range of reconstruction parameters (e.g., 3, 5, 7 and 9 OSEM iterations with 24 subsets; BPL regularization parameter (β) from 50 to 1000) were tested. Images were analyzed quantitatively and qualitatively by eight expert readers. Quantitatively, signal was the highest using BPL with β = 50; noise was the lowest using BPL with β = 1000; contrast was the highest using BPL with β = 100. The qualitative review found that accuracy and confidence were the highest when using BPL with β = 400.ConclusionsThe development of a bespoke phantom has allowed the identification of optimal parameters for molecular pituitary imaging: BPL reconstruction with TOF, PSF correction and a β value of 400; in addition, for small (< 4 mm) tumors with low contrast (2:1 or 5:1), sensitivity may be improved using a β value of 100. Together, these findings should increase tumor detection and confidence in reporting scans.

Risk Assessment of an Old Building Exposed to Loads Beyond the Scope of its Design

In order to save money, time, and work for expanding the current residential space for residential or illegal commercial use, many people modify the existing structure. Most of these are residential bungalows/small houses that were inherited from preceding generations. For Example, many people inherit one or two storied building which was constructed about 30-40 years ago. They modify the building for more space with some rehabilitation and repair, instead of demolishing and designing a new structure. This might save money but cause a problem later because the existing structure has already reached half its service life and increasing the size of the structure will result in introduction of even more load on the existing structure. Nowadays many people also utilize the modified residential structure for small-scale commercial use (Example: Setting up an MSME, GYM). All these factors might be a threat to the overall structure and its surroundings because the preliminary structure which has already reached more than half of its service life might not always be able to sustain the excessive loads for which it wasn’t designed.This paper refers & analyzes a live structure by increasing the number of floors (beyond the scope of design) to check for stability, safety, and usability of the resulting structure. While considering different cases in which the structure is either used for ‘purely residential’ or ‘combined residential and small-scale commercial purposes. Finally, it concludes the preliminary risk due to the structure to the surrounding structures and residents.

Effects of morphological characteristics of patent foramen ovale by transesophageal echocardiography on minimalist transcatheter closure in southern China.

Transcatheter closure has become one of the main treatment methods for patent foramen ovale (PFO). However, the population in southern China is generally thin and the size of PFO is small, so the application of minimalist surgery is challenging. This study aimed to analyze the morphological characteristics of PFOs in southern China by transesophageal echocardiography (TEE), and to explore the influence on minimalist transcatheter closure. About 110 patients with PFO closure in our hospital were selected. All cases were examined by TEE including the PFO size, length, septum secundum thickness, color characteristic and surrounding structures, and morphologically classified. During the operation, the procedure time, number of times for the guidewire attempting to pass the interatrial septum and the success rate of simply using J guidewire to cross the interatrial septum were recorded. About 110 cases of PFO were classified into two categories and four subtypes, including 55 cases with Uniform Channel Type (UCT, 50.0%), 16 cases with Irregular Channel Type (ICT, 14.6%), 15 cases with Right Funnel Type (RFT, 13.6%), and 24 cases with Left Funnel Type (LFT, 21.8%). According to the complexity of the procedure, they were divided into simple procedure (n=73) and complex procedure (n=37). Multivariate logistic regression showed that the anatomical types of PFO, the tunnel entrance size, and the tunnel entrance size <2mm were independent factors affecting the complexity of procedure [OR=2.819, 95% CI (1.124, 7.066), p=.027; OR=.027, 95% CI (.004, .208), p=.001; OR=4.715, 95% CI (1.028, 21.619), p=.046]. With ICT and LFT groups, the procedure duration was relatively long (p<.001), number of times for the guidewire attempting to pass the interatrial septum was significantly increased (p<.001), and the success rate of simply using J guidewire to cross the interatrial septum was relatively low (p<.001). The PFO size in southern China was relatively small and characterized by large tunnel tension. It was concluded that TEE could clearly show the morphological characteristics of PFO, which could provide guidance for making more reasonable surgical plans in clinical practice, shorten the procedure time and improve the success rate of PFO closure.

New insight into the morphological characteristics of patella cubiti.

Accessory bones in the elbow region are rare anatomical variations with important clinical significance as they can be misdiagnosed as pathological lesions. Usually, they are asymptomatic and found incidentally during X-ray examination in the context of trauma. Although these bones have been previously described, their development is not fully understood. The present case provides complex macroscopic, X-ray and histological descriptions of a sesamoid bone in the posterior region of the elbow-patella cubiti and the related surrounding structures. Moreover, this report indicates the presence of a well-defined syndesmosis between patella cubiti and the proximal ulna.