Three-stage Procedure Research Articles

Estimating monthly NO2, O3, and SO2 concentrations via an ensemble three-stage procedure with downscaled satellite remote sensing data and ground measurements

The gaseous air pollutants nitrogen dioxide (NO2), ozone (O3), and sulfur dioxide (SO2), in addition to particulate matter (PM2.5), are known to be associated with many adverse health effects. However, exposure estimates may not be available in rural or mountainous areas without monitoring stations. In this study, we retrieved satellite remote sensing data for NO2, O3, and SO2 from the Ozone Monitoring Instrument (OMI) L3 products. Together with ground measurements (air monitoring stations and meteorological and land use data), we estimated the monthly NO2, O3, and SO2 concentrations with a spatial resolution of 3×3 km across Taiwan from 2005 to 2019. A three-stage estimation procedure was utilized: in Stage 1, an ensemble generalized additive model (GAM) and machine learning method were used to determine the spatiotemporal variations; in Stage 2, the remote sensing data were downscaled; and in Stage 3, the downscaled concentrations were reused in the Stage 1 procedure for fine-tuning estimations. We obtained overall leave-one-out cross-validation (LOOCV) R2 values ranging from 0.927-0.950, 0.704-0.721, and 0.601-0.716, and root-mean-square-errors (RMSEs) ranging from 1.59-2.28, 3.81-4.18, and 0.67-1.32 ppb for NO2, O3, and SO2, respectively, via the random forest procedure. The annual NO2 and SO2 concentrations greatly improved from 2005-2019, especially in the western residential area of Taiwan. However, despite these improvements in air quality, the annual O3 concentrations tended to increase from 2015–2019. This might be due to the complex mixtures of precursors (e.g., NO2), atmospheric circulation, barriers of the Central Mountain Ridge, and increasing ground temperatures over the past decade. The proposed multistage estimation procedure performed well over the whole island with complex terrain and topography. The study outcomes may provide epidemiological information for long-term ambient exposure estimates and guidance for future administrative policies.

Development and validation of a scale for citizen distrust in public organizations

PurposeDistrust has been a neglected concept in public governance research, especially in comparison with the much more developed stream of studies on trust. Recently, however, there has been a growing recognition of the need to better understand distrust and separate it from trust, especially given contemporary social challenges which endanger trust within societies. This study aims to propose a validated and reliable scale to measure citizen distrust in public organizations through assessment of public organizations’ untrustworthiness.Design/methodology/approachA rigorous three-stage scale development procedure was used to identify, operationalize, evaluate and validate the dimensions of distrust. Data obtained from a research sample of 541 Polish citizens was subject to construct validation (exploratory and confirmatory factor analyses) with satisfactory discriminant and convergent validities. A homogeneity reliability analysis (Cronbach’s alpha) provided an evidence of internal consistency reliability.FindingsThe study presents a valid and reliable scale assessing distrust through three dimensions of untrustworthiness in the context of public administration. This scale was developed as a three-factor construct with 11 validated items.Originality/valueThe presented instrument allows researchers to study distrust systematically across sectors and countries. It may be useful in future research and may provide insights to design practical remedies for citizen distrust.

The Nexus between Cluster Farming and Household Dietary Diversity among Smallholder Wheat Farmers in Ethiopia

This study examined the nexus between cluster farming and household dietary diversity among smallholder wheat farmers in Oromia region, Ethiopia. Three-stage sampling procedures were employed to gather data from 384 household heads on a cross-sectional survey that was carried out in June 2022. Descriptive statistics and a binary logistic regression model were used for data analysis. The average, minimum, and maximum household dietary diversity scores were 7.10, 1, and 11, respectively. A significant difference was observed: participants in cluster farming had 14% more dietary diversity than their counterparts. Sex, marital status, participation in wheat cluster farming, home gardening, off-farm income, number of crops grown, cooperative membership, and access to training determined household dietary diversity. The study indicates that dietary diversity in households is influenced by a variety of factors. While wheat cluster-based farming is heavily promoted, household food and nutrition security also need to consider other elements like home gardening, off-farm income, cooperative membership, and training access.

A new optimization framework for piezoelectric actuators location identification

The study addresses piezoelectric actuator placement for active vibration control using an open-access framework that couples ANSYS and Python. It outlines a three-stage procedure: creating a finite element model in ANSYS APDL, using Python to determine the objective function, and applying a genetic algorithm optimization to find optimal actuator locations. Numerical simulations on plates and thin-walled conical structures demonstrate the effectiveness of the approach, showing it efficiently finds optimal placements with minimal search time and energy requirements. The study provides open-access codes for the framework, enhancing its accessibility and reproducibility.

Maternal factors promoting normal linear growth of children from impoverished Rwandan households: a cross-sectional study

BackgroundLinear growth faltering remains a pervasive public health concern that affects many children worldwide. This study aimed to investigate possible maternal factors promoting normal linear growth among children aged 6–23 months of age from impoverished Rwandan households.MethodsWe used a three-stage cluster sampling procedure. The study population consisted of children aged six to 23 months and their mothers who lived in the study districts. A structured questionnaire helped to collect data from 807 selected mother-child dyads. The primary outcome variable was height-for-age Z scores. The main predictors were maternal income-generating activity, maternal education, maternal depression, household decision making, number of ANC visits, use of family planning method, types of family planning, and mode of delivery. We used univariate analysis to establish median, frequencies, and percentages. Furthermore, we used the Kruskal-Wallis, Mann-Whitney U, and Spearman rank correlation tests for bivariate analysis. We included in the final model of robust linear regression for multivariate analysis the potential confounding variables identified as significantly associated with the outcome (child age, participation in works for both parents, good handwashing practice, owning a vegetable garden, and the total number of livestock) along with maternal factors.ResultsMaternal factors that promoted normal linear growth of children were the presence of maternal income generation activity (β= 0.640 [0.0269 1.253], p value = 0.041), the participation of the mother in the decision-making process of the household (β=0.147 [0.080 0.214], p-value < 0.001), and the higher frequency of consultations with ANC (β=0.189 [0.025 0.354], p-value = 0.024). Additionally, a combination of household decision-making with the number of ANC visits predicted an increase in the linear growth of the child (β=0.032 [0.019 0.045], p-value < 0.001).ConclusionMaternal factors such as maternal income-generating activity, maternal participation in household decision making, and increased number of ANC visits were found to promote normal child linear growth. These results contribute valuable information to the formulation of interventions and policies to improve child nutrition and growth in the community studied.

Meta-Analysis of the Evolution of Sports Management

Sports management is a fundamental subject for anyone interested in the world of sport. This article addresses the systemic evolution of sports management as a discipline that integrates several aspects, from the organization of sports events to the management of teams and athletes. The methodology consists of a three-stage procedure: bibliometric analysis, identification of key words, critical analysis of the books, which includes the Prisma search engine used in the Scopus database and analyzed by the Bibliometrix Software. The initial sample was n=450 studies included in the review, only Scopus, in Spanish and English. Among the main results, it is important to highlight how sports management allows sports teams and organizations to function effectively and efficiently. In conclusion, it was possible to establish as important variables the impact of sports management in specific contexts, organizational culture, quality, level of satisfaction of the processes, training and professional profile, communication management in sports events and perception of sports managers, being fundamental for success in sport. Furthermore, knowing how its theoretical, legal and ethical conception has evolved, transcends anti-doping regulations and athlete safety, towards the transformation of traditional sport into digital sport. Currently, sports management is experiencing a series of significant changes that are transforming the way in which this discipline is studied and applied.

Primary Anterior Sagittal Anorectoplasty Shift from Staged to Single-stage Procedure for Low Anorectal Malformations in Female Children: Our Initial Experience in Single Centre.

Anorectal malformation (ARM) is a common congenital anomaly found in the paediatric age group. Previously, the repair of the vestibular fistula (VF) was performed as three-stage procedure with initial colostomy followed by a definite procedure and, lastly, colostomy closure. At present, a single-stage procedure is preferred, especially in lower anomalies owing to the convenient and time-saving approach. The clinical profile and outcome of ASARP for treatment of ARM in females (vestibular anus and perineal fistula). A retrospective analytical study was conducted at Government Medical College, Jammu. A total of 60 patients were included in the study. Most of the patients were in the age group of 1-5 years (30%), followed by 6 months-1 year age group (25%). Forty-five (75%) females had VF while 15 (25%) had perineal fistula. Intraoperative complication was vaginal tear seen in 6 (10%) patients followed by rectal tear seen in 3 (5%) patients. Early post-operative complications were seen in 9 (15%) patients. Wound infection was the most common complication seen in 5 (8.3%) patients, wound dehiscence in 3 (5%) patients and retraction of rectum in 1 (1.6%) patient. Late post-operative complications were seen in 24 (40%) patients. Perineal excoriation was the most common complication seen in 6 (10%) patients, constipation seen in 5 (8.3%) patients, anal stenosis in 4 (6.6%) patients and mucosal prolapse in 4 (6.6%) patients. The single-staged ASARP procedure resulted in satisfactory outcomes. It is an excellent procedure for females with VF and perineal fistula. Appropriate selection, preparation of patient, optimal correction with minimal sphincter damage and needful post-operative care of wound give excellent cosmetic and functional outcomes in terms of continence. It also decreases the burden on treating the surgeon, family and psychological stress on the patients and parents.

Accessible practices and accommodations during lectures for students who are deaf or hard of hearing in higher education

ABSTRACT During the last decades, several students who are deaf or hard of hearing (SDHH) attend higher education institutions. The level of lecturers’ awareness regarding accessible practices and the provision of such practices or accommodations during lectures play a major role in students’ access. The purpose of this study was to investigate the educational practices and accommodations that lecturers used during lectures to enhance academic access to SDHH. In total, 51 lecturers were interviewed. The interviews were analysed using a thematic analysis and a three-stage coding procedure. Lecturers adopted various practices and accommodations that enhanced the access of SDHH during lectures, such as using visual educational tools, explaining difficult terms, monitoring comprehension, maintaining visual contact, repeating and providing environmental accommodations. Lecturers pointed out the importance of accessible educational practices for all students. The study indicates the need to make lecturers aware of the use of flexible teaching approaches and accommodations that benefit SDHH and other students promoting a culture of inclusion.

Variable selection and estimation for recurrent event model with covariates subject to measurement error

This article focuses on variable selection in the Andersen–Gill model for recurrent event analysis, particularly when covariates are subject to measurement errors. We propose a comprehensive three-stage procedure that incorporates simulation–extrapolation with various penalty functions. This approach allows for the simultaneous selection of significant covariates, estimation of regression parameters, and adjustment for measurement errors. Through extensive simulation studies, we demonstrate that our method outperforms approaches that fail to account for measurement errors or the need for variable selection. Specifically, our procedure excels in removing unimportant error-prone covariates and accurately estimating the coefficients of important variables. The results also reveal that the magnitude of measurement error has a substantial negative impact on variable selection outcomes. Additionally, we apply our method to a real-world dataset, further illustrating its practical effectiveness and robustness.

Diagnosis and surgical tactics in recurrent extrasphincteric fistulas of the rectum

Aim. To increase the effectiveness of surgical treatment in patients with recurrent forms of extrasphincteric rectal fistula.Material and Methods. Clinical data of 108 patients with recurrent extrasphincteric rectal fistulas were analysed. The patients were divided into two groups. The first, the main group, included 58 (53.7%) patients who underwent improved and developed surgical procedures. The second, control group, included 50 (46.3%) patients who were treated with traditional, well-known methods.In 6 (5.6%) cases grade I complexity of extrasphincteric recurrent rectal fistula was observed, in 23 (21.3%) cases grade II, in 62 (57.4%) cases grade III and in 17 (15.7%) cases grade IV complexity of fistula was observed.Results. In 13 (26.0%) cases, patients in the control group underwent surgery using the ligature method, and in 37 (74.0%) patients various known plastic surgery methods were used to close the internal hole. In patients with recurrent complex horseshoe-shaped extrasphincteric fistulas from the main group, a three-stage surgical procedure was performed, developed and improved in our clinic (n=18) to prevent disease recurrence and reduce the incidence of postoperative complications. In 21 (36.2%) patients, the method we developed for surgical correction of recurrent rectal fistulas of grade III-IV complexity with an extrasphincteric course was used.Conclusion. The developed and improved methods of surgical correction of recurrent extrasphincteric fistulas of the rectum allow radical excision of scar-inflammatory altered parafistula tissue, especially in fistulas of III-IV degree of complexity. These methods help to minimise both early and late postoperative complications, in particular they reduce the frequency of disease recurrence.

Perioperative Benefits of a 3D Printed Spine Biomodel in the Setting of Congenital Scoliosis Surgery

The spine community is continuously adding to its armamentarium of intraoperative techniques for visualization and instrumentation of the spine. Recently, three-dimensional printed spine models were introduced for use in preoperative planning, surgical simulation, and intraoperative guidance. We present a 14-year old African male with congenital kyphoscoliosis, small stature, an obvious gibbus deformity and coronal imbalance, who underwent a three-staged posterior surgical correction procedure, during which a 3D-printed spine biomodel was utilized for better appreciation of his complex spinal deformity patho-anatomy. During the first stage of the procedure, he developed diminished lower extremity motor strength bilaterally and bowel/bladder control, but, following his third stage procedure and with focused rehabilitation efforts, he has regained full control of his bowel and bladder function, and is able to ambulate and perform activities of daily living independently, albeit still requiring intermittent walking support with a single forearm crutch due to residual left leg weakness. The 3D spine biomodel functioned successfully as a valuable tool and surrogate anatomic blueprint for the surgeons, enabling adequate appreciation of the complex bony anatomy which could not be easily resolved on the conventionally available imaging modalities, intraoperative navigation or robotic platform. Theoretically, up to $2900 USD in savings, translated from the mean estimated time saved per procedure with the use 3D-printed spine models has been proposed in some studies. Therefore, 3D-printed spine models have utility in complex spinal deformity correction surgery.

Risk Factors Associated With Anastomotic Stricture in Patients Undergoing Minimally Invasive Esophagectomy: Experience From a High-Volume Center.

Esophageal cancer is aprevalent cancer, with a high incidence in low socioeconomic category countries. Minimally invasive esophagectomy is increasingly being used to treat this malignant condition. However, anastomotic stricture is a serious complication post esophagectomy. The study aims to enhance diagnostic consistency, improve treatment methods, guide patient management, stratify outcomes, and offer evidence-based preventive interventions. A retrospective analysis of 550 patients who had minimally invasive esophagus surgery was carried out at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore between 2015 and 2020. All patients were treated with radical resection. For tumors of the lower esophagus and gastroesophageal junction, transhiatal esophagectomy was used; for tumors of the middle and upper thoracic esophagus, right video-assisted thoracoscopic surgery (VATS) was used in a three-stage procedure. Patients were routinely followed up two weeks after discharge, then every three, six, and 12 months. The mean age and BMI were 46.7 years and 19.4 kg/m2, respectively. Anastomotic leaks were rare, with only 13 patients experiencing them. The grade of tumor differentiation was poor, moderate, and well-differentiated. The study found that older age, high Eastern Cooperative Oncology Group (ECOG) performance status, and malignancies located in the upper and middle one-third of the esophagus had significant associations with anastomotic stricture. However, some variables, like sex, did not show significant associations in either analysis. The study reveals that factors such as older patient age, high ECOG performance status, single comorbidity, and malignancies located in the upper and middle one-third of the esophagus significantly influence anastomotic stricture. The study suggests that measures against anastomotic stricture such as endoscopic procedures and minimally invasive esophagectomy should be implemented to minimize the complications.

Factors That Affect the Success of Consumer Cooperatives in Case of Bench Sheko, West Omo and Sheka Zones Ethiopia

The study aimed to identify external challenges that influence the success of consumer cooperatives in the case of southwest Ethiopia. An explanatory type of research design method was applied. The study was focused on seventeen (17) selected active consumer cooperatives in southwest Ethiopia. A three-stage random sampling procedure was adopted for the selection of the sample respondents. In stage one, seven woredas were selected from each zone proportionately. In stage two, from those woredas 17 sample consumer cooperatives were selected. Finally, 385 samples of respondents were selected by simple random method. Political, Technology, Management, Bureaucracy, Marketing, Finance and Infrastructure influence were selected as independent factors. Successes of consumer cooperatives were identified as the dependent variable for this study. The finding reveals variables like politics, management, marketing and finance are important factors that affect significantly the target variables. Factor bureaucracy had no significant influence on dependent variables. The study suggests giving special attention given on problems like lack of marketing and finance access shortage, lagging technological advances and political interference. Therefore, Bench Sheko, Sheka and West Omo zones should solve these challenges.

Understanding and Managing Metabolic Deficiencies Post Bariatric and Esophagectomy Surgeries: A Narrative Review of the Literature.

Gastrectomy and esophagectomy are the most performed surgeries in the treatment of both esophageal and gastric cancers. The type of esophagectomy depends on the type of malignancy, site of the tumor, criteria of resection, and field of resection. The three standard approaches to esophagectomy are the transhiatal approach, the left thoracoabdominal approach, and a three-stage procedure. The transhiatal approach involves abdominal and cervical incisions, while the left thoracoabdominal approach is a one-stage procedure that utilizes a single incision exposing the dissection field. The Ivor Lewis and McKeown esophagectomies are two-stage and three-stage surgeries that includelaparotomy with right thoracotomy. Malabsorption often emerges as a significant postoperative complication following esophagectomy and gastrectomy surgeries. Malnutrition linked with these cancers has detrimental effects, including heightened rates of postoperative complications, elevated infection risks, delayed wound healing, reduced tolerance to treatment, diminished quality of life, and heightened mortality rates. Our narrative review summarizes and sheds light on solutions to treat malabsorption disorders and malnutrition after gastric bypass surgery. These solutions include methods such as adjustments, supplements, and treatment. Although more research is needed to confirm their effectiveness, these methods indicate potential for lowering the impact on patients' diets. By considering the beneficial implications of these effects and considering solutions, we aim to improve the management of these adverse effects, ultimately improving the overall health and postoperative outcomes of patients.

Evaluation of the Feasibility of the Prediction of the Surface Morphologiesof AWJ-Milled Pockets by Statistical Methods Based on Multiple Roughness Indicators

Improvement of the surface quality of machined parts is essential in order to avoid excessive and costly post-processing. Although non-conventional processes can efficiently carry out the machining of difficult-to-cut materials with high productivity, they may also, for various reasons, be related to increased surface roughness. In order to optimize the surface quality of generated surfaces in a reliable way, surface profiles obtained during these processes must be adequately modeled. However, given that most studies have focused on Ra or Rz indicators or are based on the assumption of a normal distribution for the profile heights, relevant models cannot accurately represent the surface characteristics that exist in a real machined surface with a high degree of accuracy. Thus, in the present study, a new modeling approach based on the use of a statistical probability distribution for the surface profile height is proposed. After six different distributions were evaluated on the basis of a three-stage procedure involving different roughness indicators pertaining to the abrasive waterjet (AWJ) milling of pockets, it was found that, although it is not possible to model the nominal values of every roughness parameter simultaneously, in several cases, it is possible to approximate the values of critical indicators such as Ra, Rz, Rsk, Rku and Rp/Rv ratio by Weibull distribution with a sufficient degree of accuracy.

The mediating role of flow in the relationship between simulation design and simulation educational satisfaction in korean nursing students: a cross-sectional study

BackgroundIn Korea, there has been recent interest in nursing simulation education. In nursing, simulation education has many advantages, such as improving nursing students’ problem-solving and judgment skills. Simulation education satisfaction is an indicator for evaluating educational performance from the learners’ perspective and an important criterion for the development and progress of nursing education. Therefore, based on NLN/Jeffries simulation theory, this study aims to identify the relationship between simulation design and educational satisfaction and to confirm the mediating effect of flow.MethodsThis cross-sectional study was conducted using 143 fourth-year nursing students who had participated in classes using simulations at three universities in Seoul, Daegu, and Jeonbuk. Data were collected from April 24 to May 3, 2023. Demographic data, simulation design scale (SDS), flow in simulation, and the educational satisfaction scale in simulation were collected via an online questionnaire. The collected data were analyzed through t-test, ANOVA, Scheffé test, and Pearson’s correlation coefficient using SPSS 25.0. The mediating effect of flow was analyzed through the three-stage mediation effect procedure using hierarchical regression analysis and the Sobel test.ResultsThe simulation educational satisfaction had a statistically significant positive correlation with simulation design (r = .65, p < .001) and flow (r = .47, p < .001), and simulation design was positively correlated with the flow (r = .55, p < .001). The simulation design had a statistically significant effect on flow, which was the mediating variable (β = 0.55, p < .001). Additionally, simulation design had a statistically significant effect on simulation educational satisfaction (β = 0.56, p < .001). The significance of the mediating effect of flow on the relationship between simulation design and simulation educational satisfaction was investigated using the Sobel test, and the mediating effect of flow was found to be statistically significant (Z = 5.36, p < .001).ConclusionThe significance of the current study lies in its confirmation of the link between simulation design and simulation educational satisfaction, as well as the mediating function of flow. Nursing students can achieve simulation educational satisfaction through simulation-based education if simulation educators follow best practices that improve flow through well-organized simulation design.

Prevalence and Associated Factors of Overweight and Obesity among Primary School Children Aged 7–17 Years in Urban Mbarara, Uganda

Globally, overweight and obesity among children have been acknowledged as a growing public health concern. In sub-Saharan Africa, the prevalence of overweight and obesity is high. In Uganda, there is a significant burden of overweight and obesity. This study was conducted to determine the prevalence and associated factors that influence overweight and obesity among primary school children in Southwestern Uganda. A cross-sectional study utilized a self-administered questionnaire and anthropometric tools to collect data. A three-stage sampling procedure was used to select four schools that participated in this study. A total of 422 children participated in our study. Participant’s weight and height were measured using SECA Scale, Model 885, and a wall-mounted stadiometer, respectively. Data were analyzed using STATA v11.0. The prevalence of overweight/obesity was descriptively analyzed. Associated factors were determined using bivariate and multivariate analysis. Findings revealed that 54.3% of participants were walking to school compared to 45.7% that were cycling/bicycling and 76.3% playing and doing household chores as opposed to 23.7% that spent their leisure time through reading and watching TV, 74.2% took more than two meals per day, and 79.4% often took vegetables and fruits compared to 20.6% that took them most of the time. The study found an overall prevalence of 20% for overweight/obesity. There was a statistical association between overweight/obesity and ownership of residence (O.R.: 0.4, 95% C.I.: 0.2–0.8), modes of transport (O.R.: 8.2, 95% C.I.: 3.4–20.0), leisure time activities (O.R.: 0.4, 95% C.I.: 0.2–0.7), frequency of consuming vegetables and fruits (O.R.: 2.8, 95% C.I.: 1.4–5.5), and the type of school attended (O.R.: 0.2, 95% C.I.: 0.1–0.4). However, only the mode of transport (A.O.R.: 5.0, 95% C.I.: 1.9–13.0) was independently associated with overweight/obesity on multivariate logistic regression analysis. Girls who participated in our study were more overweight than boys. Overweight/obesity existed more in private schools than public schools. Modes of transport were only found to be strongly associated with overweight/obesity. There is a need to establish evidence-based strategies to inform policy on prevention of childhood overweight/obesity.

Three-stage versus modified two-stage surgery for ulcerative colitis: a patient-centred treatment trade-off study.

There is ongoing debate about whether ileal pouch-anal anastomosis needs temporary diversion at the time of construction. Stomas may reduce risk for anastomotic leak (AL) but are also associated with complications, emergency department visits and readmissions. This treatment trade-off study aims to measure patients' preferences by assessing the absolute risk of AL and pouch failure (PF) they are willing to accept to avoid a diverting ileostomy. Fifty-two patients with ulcerative colitis, with or without previous pouch surgery, from Mount Sinai Hospital, Toronto, participated in this study. Standardized interviews were conducted using the treatment trade-off threshold technique. An online anonymous survey was used to collect patient demographics. We measured the absolute increased risk in AL and PF that patients would accept to undergo modified two-stage surgery as opposed to traditional three-stage surgery. Thirty-two patients (mean age 38.7 ± 15.3) with previous surgery and 20 patients (mean age 39.5 ± 11.9) with no previous surgery participated. Patients were willing to accept an absolute increased leak rate of 5% (interquartile range 4.5%-15%) to avoid a diverting ileostomy. Similarly, patients were willing to accept an absolute increased PF rate of 5% (interquartile range 2.5%-10%). Younger patients, aged 21-29, had lower tolerance for PF, accepting an absolute increase of only 2% versus 5% for patients older than 30 (P = 0.01). Patients were willing to accept a 5% increased AL rate or PF rate to avoid a temporary diverting ileostomy. This should be taken into consideration when deciding between modified two- and three-stage pouch procedures.

Four-component of double-layer infinite coordination polymer nanocomposites for large tumor trimodal therapy via multi high-efficiency synergies

Multimodal /components tumors synergistic therapy is a crucial approach for enhancing comprehensive efficacy. Our research has identified lots of high efficiency synergies among four suitable components, revealing combinations with remarkably low combination index (CI) values (10-3-10-8). These combinations hold promise for large tumor powerful electrothermal-thermodynamic-multi-chemo trimodal therapy. To implement this approach, we developed four-component of double-layer infinite coordination polymer (ICP) nanocomposites, in which hypoxia-activated AQ4N and thermodynamic agent AIPH coordinated with Cu(Ⅱ) to form initial layer of positively charged ICPs-l NPs, chemotherapeutic agents gossypol-hyaluronic acid (G-HA) and CA4 coordinated with Fe(Ⅲ) to form out layer of negatively charged ICPs-2 NPs, then double-layer infinite coordination polymer nanocomposites (ICPs-1@ICPs-2 CNPs) were fabricated by electrostatic adsorption using ICPs-l NPs and ICPs-2 NPs. Cell experiments have extensively optimized the coordination combinations of the four components and the composition of the two layers. A programmable three-stage therapeutic procedure, assisted by a micro-electrothermal needle (MEN), was developed. Under this procedure the resulting nanocomposites demonstrate the powerful trimodal comprehensive therapeutic outcomes for large tumors using lower components dosage, achieving a tumor inhibition rate nearly reaching 100 % and no recurrence for 60 days. This study offers remarkable potential for tumor multimodal /components synergistic therapy in future.

Non-traumatic complete cervical spine dislocation with severe fixed kyphosis: successful multidisciplinary approach to a challenging case

BackgroundTo our knowledge, there is no previous report in the literature of non-traumatic neglected complete cervical spine dislocation characterized by anterior spondyloptosis of C4, extreme head drop, and irreducible cervicothoracic kyphosis.Case presentationWe report the case of a 33-year-old Caucasian man with a 17-year history of severe immune polymyositis and regular physiotherapy who presented with severe non-reducible kyphosis of the cervicothoracic junction and progressive tetraparesia for several weeks after a physiotherapy session. Radiographs, computed tomography, and magnetic resonance imaging revealed a complete dislocation at the C4–C5 level, with C4 spondyloptosis, kyphotic angulation, spinal cord compression, and severe myelopathy. Due to recent worsening of neurological symptoms, an invasive treatment strategy was indicated. The patient’s neurological status and spinal deformity greatly complicated the anesthetic and surgical management, which was planned after extensive multidisciplinary discussion and relied on close collaboration between the orthopedic surgeon and the anesthetist. Regarding anesthesia, difficult airway access was expected due to severe cervical angulation, limited mouth opening, and thyromental distance, with high risk of difficult ventilation and intubation. Patient management was further complicated by a theoretical risk of neurogenic shock, motor and sensory deterioration, instability due to position changes during surgery, and postoperative respiratory failure. Regarding surgery, a multistage approach was carefully planned. After a failed attempt at closed reduction, a three-stage surgical procedure was performed to reduce displacement and stabilize the spine, resulting in correct spinal realignment and fixation. Progressive complete neurological recovery was observed.ConclusionThis case illustrates the successful management of a critical situation based on a multidisciplinary collaboration involving radiologists, anesthesiologists, and spine surgeons.