Floating hip injury managed in a single stage with good outcome

Introduction: The term floating hip is used to denote a fracture pattern involving fracture of pelvis or acetabulum and ipsilateral femur. These injuries are seen as a result of high velocity trauma. Objective: Our objective was to highlight the usefulness of single stage surgery using a common incision, the order of fracture fixation, in lateral decubitus position for type B floating hip injuries. Case report: A 58-year-old male, was brought presented to our emergency department with pain, swelling, deformity of right lower limb following a road traffic accident. On primary examination, patient was in hypovolemic shock. Imaging revealed the right posterior column and posterior wall of acetabulum with ipsilateral diaphyseal femur fracture. After stabilizing the patient, we operated on him in a single stage in lateral decubitus position, in which we fixed the femur first followed by acetabulum. Conclusion: Single stage fixation in lateral decubitus position after adequate resuscitation and evaluation can offer a good outcome by reducing the operative time and post- operative complications.

Introducción: El término cadera flotante se utiliza para denotar un patrón de fractura que implica fractura de pelvis o acetábulo y fémur ipsilateral. Estas lesiones se ven como resultado de un trauma a alta velocidad. Objetivo: Destacar la utilidad de la cirugía de una sola etapa mediante una incisión común, el orden de fijación de la fractura en decúbito lateral para lesiones de cadera flotante tipo B. Informe de caso: Un varón de 58 años fue llevado a nuestro servicio de urgencias con dolor, hinchazón, deformidad del miembro inferior derecho después de un accidente de tráfico. En el examen primario, el paciente estaba en shock hipovolémico. Las imágenes revelaron la columna posterior derecha y la pared posterior del acetábulo con fractura ipsilateral diafisaria del fémur. Después de estabilizar al paciente, se operó en una sola etapa en posición decúbito lateral, en la que primero se fijó el fémur seguido del acetábulo. Conclusión: La fijación de un solo estadio en posición decúbito lateral después de una reanimación y evaluación adecuadas puede ofrecer un buen resultado al reducir el tiempo de operación y las complicaciones postoperatorias.

Hydrothermal pre-treatment followed by anaerobic digestion for the removal of tylosin and antibiotic resistance agents from poultry litter.

Hydrothermal pretreatment (HPT) followed by anaerobic digestion (AD) is an alternative for harvesting energy and removing organic contaminants from sewage sludge and animal manure. This study investigated the use, in an energetically sustainable way, of HPT and AD, alone or combined, to produce methane and remove tylosin and antimicrobial resistance genes (ARG) from poultry litter (PL). The results showed that HPT at 80 °C (HPT80), followed by single-stage AD (AD-1S), led to the production of 517.9 ± 4.7 NL CH4 kg VS-1, resulting in 0.11 kWh kg PL-1 of electrical energy and 0.75 MJ kg PL-1 of thermal energy, thus supplying 33.6% of the energy spent on burning firewood at a typical farm. In this best-case scenario, the use of HPT alone reduced tylosin concentration from PL by 23.6%, while the process involving HPT followed by AD-1S led to the removal of 91.6% of such antibiotic. The combined process (HPT80 + AD-1S), in addition to contributing to reduce the absolute and relative abundances of ARG ermB (2.13 logs), intI1 (0.39 logs), sul1 (0.63 logs), and tetA (0.74 logs), led to a significant removal in the relative abundance of tylosin-resistant bacteria present in the poultry litter.

Single-Stage Complete Removal of Dumbbell-Shaped Trigeminal Schwannoma: 3-Dimensional Operative Video.

Intracranial trigeminal schwannomas are rare tumors that may extend into multiple cranial compartments and may emerge from the root, ganglion, or intracranial portion of any of its branches.1-6 The aim of this 3-dimensional operative video is to present a single-stage complete removal of a dumbbell-shaped trigeminal schwannoma through a pretemporal approach (Video 1). Informed consent was given by the patient for use of images and the surgical video. We describe the case of a 43-year-old female presenting with chronic headaches and left facial pain in the trigeminal territory of V2 and V3. Magnetic resonance imaging showed a tumoral lesion located within the cerebellopontine angle, petroclival region, and middle fossa. Due to the patient's symptoms, tumor size, and growth on sequential imaging, single-stage surgical removal was determined through a frontotemporal approach. There were no adverse outcomes posterior to the surgery, and the patient evolved favorably without neurologic deficits. Postoperative imaging showed complete resection of the tumoral lesion. Presurgical planning is essential for an effective and safe surgical strategy. For cases of trigeminal schwannomas with extension to the middle and posterior fossa, single-stage surgery is feasible for complete and safe removal.

Real-time instance segmentation of surgical instruments using attention and multi-scale feature fusion.

Precise instrument segmentation aids surgeons to navigate the body more easily and increases patient safety. While accurate tracking of surgical instruments in real-time plays a crucial role in minimally invasive computer-assisted surgeries, it is a challenging task to achieve, mainly due to: (1) a complex surgical environment, and (2) model design trade-off in terms of both optimal accuracy and speed. Deep learning gives us the opportunity to learn complex environment from large surgery scene environments and placements of these instruments in real world scenarios. The Robust Medical Instrument Segmentation 2019 challenge (ROBUST-MIS) provides more than 10,000 frames with surgical tools in different clinical settings. In this paper, we propose a light-weight single stage instance segmentation model complemented with a convolutional block attention module for achieving both faster and accurate inference. We further improve accuracy through data augmentation and optimal anchor localization strategies. To our knowledge, this is the first work that explicitly focuses on both real-time performance and improved accuracy. Our approach out-performed top team performances in the most recent edition of ROBUST-MIS challenge with over 44% improvement on area-based multi-instance dice metric MI_DSC and 39% on distance-based multi-instance normalized surface dice MI_NSD. We also demonstrate real-time performance (>60 frames-per-second) with different but competitive variants of our final approach.

Minimally invasive surgery for pediatric dumbbell neuroblastoma: systematic literature review and report of a single-stage neurosurgical and thoracoscopic approach.

INTRODUCTION: Traditional surgical strategies for dumbbell neuroblastoma entail, among others, high risk of spinal deformity. Less invasive procedures might reduce these sequelae, however, there is small evidence comparing different strategies. Indications of minimally invasive surgery in neuroblastoma are still developing. Our aim is to identify and analyze different surgical approaches described in the recent literature and to suggest a minimally invasive option. METHODS: A systematic review of the literature was conducted in PubMed (Jan 2000-Dec 2021) to identify reports describing surgical resection of dumbbell neuroblastoma in children, according to the PRISMA guidelines. Only full-text articles were included. RESULTS: 7 articles met the inclusion criteria which, added to the present case, represent a total of 43 patients. All were retrospective studies, most of them small series. Tumor location was mostly thoracic. Most of combined approaches were performed in two stages. Spinal deformity after surgery was reported in 3 patients. Minimally invasive approach was described in only one paper, with no reported cases of its use in a single-stage combined surgery. We also report, to our knowledge, the first single-stage posterior neurosurgical approach combined with thoracoscopy for resection of a dumbbell neuroblastoma in an infant. CONCLUSION: Surgical resection of dumbbell neuroblastomas is challenging. There is no consensus on best surgical approach. Dumbbell tumors should not be considered a contraindication for minimally invasive surgery. A single stage and minimally invasive strategy is proposed.

Partial Single Stage Exchange Arthroplasty With Retention of a Well Fixed Cemented Femoral Stem for the Treatment of Culture Negative Infection in a Bipolar Hemiarthroplasty: A Case Report.

BACKGROUND: Prosthetic joint infection (PJI) is the second most common cause for revision following hip hemiarthroplasty (HHA) resulting in a mortality rate of 5.6%. The treatment of PJI is both challenging and controversial, without general consensus on best practice. In an attempt to avoid surgery, patients are commonly prescribed antibiotics, reducing the chance of detecting a microorganism, and culture negative infections are reported to occur in up to 21% of all PJI. Two stage revision is arguably the gold standard treatment but frequently these patients are too frail to undergo such extensive procedures. Some surgeons have attempted to avoid this by leaving well fixed implants undisturbed, effectively performing a partial single-stage revision. CASE PRESENTATION: A previously well 83 -year-old female patient presented with a gradual onset of increasing pain and difficulty walking. Just over 1 year prior to this presentation she fell at home and underwent an uncomplicated bipolar hemiarthroplasty. Clinical examination as well as serological and radiological investigations were suspicious for a periprosthetic infection. Her rapidly deteriorating clinical picture required prompt surgical intervention. In theater the patient underwent a single stage partial exchange arthroplasty leaving the well cemented femoral stem undisturbed. Although multiple samples were taken, no microorganism was identified. The patient has been followed up for 1 year and remains well, with no recurrence of infection. Her inflammatory markers have returned to normal and radiographs demonstrate no evidence of loosening of the total hip replacement. CONCLUSION: The burden of infection following hip hemiarthroplasty is likely to parallel the predicted increase in hip fractures. The combination of physiologic frailty, osteoporosis and multiple medical comorbidities are pertinent factors for consideration in the development of a treatment strategy. A partial single stage revision THR performed by an experienced arthroplasty surgeon, along with expertly led antimicrobial therapy may be considered in carefully selected patients.

Results of hatching and rearing broiler chickens in different incubation systems.

Hatchery efficiency is based on hatchability and the number of salable chicks. The hatchery sector has been seeking new alternatives to optimize production rates, including the use of different systems (multistage [MS] or single-stage [SS] machines) to improve incubation conditions. The present study aimed to compare results for hatchability, chick quality, and broiler performance of chicks from 2 incubator systems-MS and SS. The experimental design for hatchability, hatch window, egg weight loss, and chick performance variables was completely randomized with 2 treatments (MS and SS). Performance variables were analyzed as a 2 x 2 factorial arrangement (incubator type x chick sex). Egg weight loss between incubation and transfer was higher for eggs incubated in MS (P < 0.05). Hatchability was higher for eggs incubated in SS (P < 0.05), and chicks in SS had a longer hatch window (P < 0.05). Embryo diagnosis revealed higher final mortality for embryos incubated in MS (P < 0.05), as well as higher percentages of alive and dead pipped and cracked eggs (P < 0.05). Physical quality was better for chicks from SS (P < 0.05). There was no interaction between the studied factors for performance results (P > 0.05). Incubator type did not affect broiler performance for any of the studied ages (P > 0.05), whereas male broilers had better performance than females (P < 0.05). The SS incubation system proved better than the MS system at meeting embryo requirements during embryo development, with better hatching rates and chick quality, although performance variables were not influenced by incubation type.

Laparoscopic Common Bile Duct Exploration Using a Single-Operator Cholangioscope.

Background: Gallbladder stones are a very common disease, with a prevalence of 21.9% in Argentina. The incidence of common bile duct stones (CBDS) varies with age and with the clinical presentation; ∼3%-10% of patients with gallbladder lithiasis have concomitant choledocholithiasis. In the past decades, the development of ultrasound and magnetic resonance cholangiography and endoscopic ultrasound has expanded for the preoperative diagnosis of gallbladder lithiasis. Materials and Methods: We describe the step-by-step technique using the single-operator cholangioscope (pSOC) (SpyGlass™ Discover; Boston Scientific, Natick, MA) under laparoscopic guidance, in a patient with huge stones in the bile duct that was treated with a choledocotomy. Results: The patient underwent the procedure well and the closure of the bile duct was with a primary suture. The current devices, standard cholangioscopes or bronchoscopes, only have a two-way deflection. This problem might be solved with the introduction of a new pSOC device (SpyGlass Discover; Boston Scientific). Conclusion: In conclusion, the combination of laparoscopy and pSOC is a feasible, safe, and effective technique for the treatment of CBDS, and may be considered as an alternative approach in clinical cases where gastrointestinal anatomy is altered or when endoscopic retrograde cholangio-pancreatography (ERCP) failed. pSOC has the potential to reduce peri-procedural adverse events and costs.

Minimally Invasive Single-Stage Removal of a Thoracic Dumbbell Tumor from a Posterior Approach: 2-Dimensional Operative Video.

Dumbbell-shaped thoracic tumors usually involve the spinal canal and the posterior thoracic cavity. Gross total resection is the treatment of choice, but techniques for surgical excision remain controversial. An anterolateral transthoracic approach may remove the paravertebral component of the tumor, but has limited or no control of the intracanal lesion. A combined posteroanterior approach requires a 2-stage surgery with significant morbidity. The preferred approach depends mainly on the tumor location, size, shape, and its specific anatomical relationship with the surrounding vital structures. We present a surgical video of a single-stage posterior minimally invasive approach for the management of a thoracic dumbbell tumor.

Seven Cerebral Aneurysms: A Challenging Case from the Andean Slopes Managed with 1-Stage Surgery.

BACKGROUND: Treatment of multiple intracranial aneurysms is particularly demanding and even more so in a developing country where access to specialized centers may be prevented by different factors. METHODS: Single-stage surgical treatment of 7 cerebral aneurysms was performed in a 58-year-old woman from the northern Peruvian Andes. RESULTS: All 7 aneurysms were successfully and safely clipped through 2 lateral supraorbital craniotomies. The double clip technique was used in 3 aneurysms to prevent any residual aneurysmal neck. CONCLUSIONS: Good teamwork and correct application of microsurgical principles may allow effective treatment in complex neurosurgical cases even in resource-challenged environments.

Effect of incubator type and broiler breeder age on hatchability and chick quality

Two experiments were conducted to evaluate the effect of broiler breeder age and incubator type on hatching parameters, hatch window, embryo diagnosis results, and hatchling physical quality. The treatments consisted of a combination of three broiler breeder ages (29, 35 and 59 weeks of age) and two incubator types (single stage, SS; or and multiple stage, MS). A completely randomized design in a 3x2 factorial arrangement was applied. In Experiment I, 1,896 eggs were used and 360 eggs in Experiment II. There was an interaction between breeder age and incubator type only for hatchling physical quality score. Independently of incubator type, hatchability rate, late embryo mortality, and egg contamination were higher in the eggs laid by older breeders (59-wk-old). Early mortality (0-4 days) was higher in the embryos from young breeders (29-wk-old). A shorter hatch window birth was obtained in the SS incubator, resulting in higher hatchling body weight relative to egg weight, and better hatchling physical quality score. Both types of incubators provide good conditions for embryo development; however, the physical quality of chicks derived from eggs from intermediate-aged breeders (35-wk-old) is better when eggs are incubated in SS incubators.(AU)

Effect of incubator type and broiler breeder age on hatchability and chick quality

Two experiments were conducted to evaluate the effect of broiler breeder age and incubator type on hatching parameters, hatch window, embryo diagnosis results, and hatchling physical quality. The treatments consisted of a combination of three broiler breeder ages (29, 35 and 59 weeks of age) and two incubator types (single stage, SS; or and multiple stage, MS). A completely randomized design in a 3x2 factorial arrangement was applied. In Experiment I, 1,896 eggs were used and 360 eggs in Experiment II. There was an interaction between breeder age and incubator type only for hatchling physical quality score. Independently of incubator type, hatchability rate, late embryo mortality, and egg contamination were higher in the eggs laid by older breeders (59-wk-old). Early mortality (0-4 days) was higher in the embryos from young breeders (29-wk-old). A shorter hatch window birth was obtained in the SS incubator, resulting in higher hatchling body weight relative to egg weight, and better hatchling physical quality score. Both types of incubators provide good conditions for embryo development; however, the physical quality of chicks derived from eggs from intermediate-aged breeders (35-wk-old) is better when eggs are incubated in SS incubators.

Comparação de métodos para mapeamento digital de solos com utilização de sistema de informação geográfica / Comparison of methods for digital soil mapping using a geographical information system

Mapas pedológicos são fontes de informações primordiais para planejamento e manejo do uso do solo, porém apresentam altos custos de produção. A fim de produzir mapas de solos a partir de mapas existentes, neste trabalho, foram comparados métodos de classificação em estágio único (Regressões Logísticas Múltiplas Multinomiais e Bayes) e em estágios múltiplos (Classification and Regression Trees (CART), J48 e Logistic Model Trees (LMT)) com a utilização de sistemas de informações geográficas e de variáveis geomorfométricas para produção de mapas pedológicos com legenda original e simplificada. A base de dados foi gerenciada em aplicativo computacional ArcGis, em que as variáveis e o mapa original foram relacionados por meio de amostras de treinamento para os algoritmos. Os resultados dos algoritmos obtidos no software Weka foram implementados no ArcGis, para a confecção dos mapas. Foram geradas matrizes de erros para análise de acurácias dos mapas. As variáveis geomorfométricas de declividade, perfil e plano de curvatura, elevação e índice de umidade topográfica são aquelas que melhor explicam a distribuição espacial das classes de solo. Os métodos de classificação em estágio múltiplo apresentaram sensíveis melhoras nas acurácias globais, porém significativas melhoras nos índices Kappa. A utilização de legenda simplificada aumentou significativamente as acurácias do produtor e do usuário.

Soil maps are sources of important information for land planning and management, but are expensive to produce. This paper proposes testing and comparing single stage classification methods (Multiple Multinomial Logistic Regression and Bayes) and multiple stage classification methods (Classification and Regression Trees (CART), J48 and Logistic Model Trees (LMT)) using geographic information system and terrain parameters for producing soil maps with both original and simplified legend. The database was managed in ArcGis computer application in which the variables and the original map were related through training of the algorithms. The results from statistical software Weka were implemented in ArcGis environment to generate digital soil maps. The terrain parameters that best explained soil distribution were slope, profile and planar curvature, elevation, and topographic wetness index. The multiple stage classification methods showed small improvements in overall accuracies and large improvements in the Kappa index. Simplification of the original legend significantly increased the producer and user accuracies, however produced small improvements in overall accuracies and Kappa index.

Comparação de métodos para mapeamento digital de solos com utilização de sistema de informação geográfica

Soil maps are sources of important information for land planning and management, but are expensive to produce. This paper proposes testing and comparing single stage classification methods (Multiple Multinomial Logistic Regression and Bayes) and multiple stage classification methods (Classification and Regression Trees (CART), J48 and Logistic Model Trees (LMT)) using geographic information system and terrain parameters for producing soil maps with both original and simplified legend. The database was managed in ArcGis computer application in which the variables and the original map were related through training of the algorithms. The results from statistical software Weka were implemented in ArcGis environment to generate digital soil maps. The terrain parameters that best explained soil distribution were slope, profile and planar curvature, elevation, and topographic wetness index. The multiple stage classification methods showed small improvements in overall accuracies and large improvements in the Kappa index. Simplification of the original legend significantly increased the producer and user accuracies, however produced small improvements in overall accuracies and Kappa index.

Mapas pedológicos são fontes de informações primordiais para planejamento e manejo do uso do solo, porém apresentam altos custos de produção. A fim de produzir mapas de solos a partir de mapas existentes, neste trabalho, foram comparados métodos de classificação em estágio único (Regressões Logísticas Múltiplas Multinomiais e Bayes) e em estágios múltiplos (Classification and Regression Trees (CART), J48 e Logistic Model Trees (LMT)) com a utilização de sistemas de informações geográficas e de variáveis geomorfométricas para produção de mapas pedológicos com legenda original e simplificada. A base de dados foi gerenciada em aplicativo computacional ArcGis, em que as variáveis e o mapa original foram relacionados por meio de amostras de treinamento para os algoritmos. Os resultados dos algoritmos obtidos no software Weka foram implementados no ArcGis, para a confecção dos mapas. Foram geradas matrizes de erros para análise de acurácias dos mapas. As variáveis geomorfométricas de declividade, perfil e plano de curvatura, elevação e índice de umidade topográfica são aquelas que melhor explicam a distribuição espacial das classes de solo. Os métodos de classificação em estágio múltiplo apresentaram sensíveis melhoras nas acurácias globais, porém significativas melhoras nos índices Kappa. A utilização de legenda simplificada aumentou significativamente as acurácias do produtor e do usuário.

Comparação de métodos para mapeamento digital de solos com utilização de sistema de informação geográfica

Soil maps are sources of important information for land planning and management, but are expensive to produce. This paper proposes testing and comparing single stage classification methods (Multiple Multinomial Logistic Regression and Bayes) and multiple stage classification methods (Classification and Regression Trees (CART), J48 and Logistic Model Trees (LMT)) using geographic information system and terrain parameters for producing soil maps with both original and simplified legend. The database was managed in ArcGis computer application in which the variables and the original map were related through training of the algorithms. The results from statistical software Weka were implemented in ArcGis environment to generate digital soil maps. The terrain parameters that best explained soil distribution were slope, profile and planar curvature, elevation, and topographic wetness index. The multiple stage classification methods showed small improvements in overall accuracies and large improvements in the Kappa index. Simplification of the original legend significantly increased the producer and user accuracies, however produced small improvements in overall accuracies and Kappa index.

Mapas pedológicos são fontes de informações primordiais para planejamento e manejo do uso do solo, porém apresentam altos custos de produção. A fim de produzir mapas de solos a partir de mapas existentes, neste trabalho, foram comparados métodos de classificação em estágio único (Regressões Logísticas Múltiplas Multinomiais e Bayes) e em estágios múltiplos (Classification and Regression Trees (CART), J48 e Logistic Model Trees (LMT)) com a utilização de sistemas de informações geográficas e de variáveis geomorfométricas para produção de mapas pedológicos com legenda original e simplificada. A base de dados foi gerenciada em aplicativo computacional ArcGis, em que as variáveis e o mapa original foram relacionados por meio de amostras de treinamento para os algoritmos. Os resultados dos algoritmos obtidos no software Weka foram implementados no ArcGis, para a confecção dos mapas. Foram geradas matrizes de erros para análise de acurácias dos mapas. As variáveis geomorfométricas de declividade, perfil e plano de curvatura, elevação e índice de umidade topográfica são aquelas que melhor explicam a distribuição espacial das classes de solo. Os métodos de classificação em estágio múltiplo apresentaram sensíveis melhoras nas acurácias globais, porém significativas melhoras nos índices Kappa. A utilização de legenda simplificada aumentou significativamente as acurácias do produtor e do usuário.

Comparação de métodos para mapeamento digital de solos com utilização de sistema de informação geográfica

Soil maps are sources of important information for land planning and management, but are expensive to produce. This paper proposes testing and comparing single stage classification methods (Multiple Multinomial Logistic Regression and Bayes) and multiple stage classification methods (Classification and Regression Trees (CART), J48 and Logistic Model Trees (LMT)) using geographic information system and terrain parameters for producing soil maps with both original and simplified legend. The database was managed in ArcGis computer application in which the variables and the original map were related through training of the algorithms. The results from statistical software Weka were implemented in ArcGis environment to generate digital soil maps. The terrain parameters that best explained soil distribution were slope, profile and planar curvature, elevation, and topographic wetness index. The multiple stage classification methods showed small improvements in overall accuracies and large improvements in the Kappa index. Simplification of the original legend significantly increased the producer and user accuracies, however produced small improvements in overall accuracies and Kappa index.

Mapas pedológicos são fontes de informações primordiais para planejamento e manejo do uso do solo, porém apresentam altos custos de produção. A fim de produzir mapas de solos a partir de mapas existentes, neste trabalho, foram comparados métodos de classificação em estágio único (Regressões Logísticas Múltiplas Multinomiais e Bayes) e em estágios múltiplos (Classification and Regression Trees (CART), J48 e Logistic Model Trees (LMT)) com a utilização de sistemas de informações geográficas e de variáveis geomorfométricas para produção de mapas pedológicos com legenda original e simplificada. A base de dados foi gerenciada em aplicativo computacional ArcGis, em que as variáveis e o mapa original foram relacionados por meio de amostras de treinamento para os algoritmos. Os resultados dos algoritmos obtidos no software Weka foram implementados no ArcGis, para a confecção dos mapas. Foram geradas matrizes de erros para análise de acurácias dos mapas. As variáveis geomorfométricas de declividade, perfil e plano de curvatura, elevação e índice de umidade topográfica são aquelas que melhor explicam a distribuição espacial das classes de solo. Os métodos de classificação em estágio múltiplo apresentaram sensíveis melhoras nas acurácias globais, porém significativas melhoras nos índices Kappa. A utilização de legenda simplificada aumentou significativamente as acurácias do produtor e do usuário.