Plastic Fruit Stickers in Industrial Composting─Surface and Structural Alterations Revealed by Electron Microscopy and Computed Tomography.

Often large quantities of plastics are found in compost, with price look-up stickers being a major but little-explored component in the contamination path. Stickers glued to fruit or vegetable peels usually remain attached to the organic material despite sorting processes in the composting plant. Here, we investigated the effects of industrial composting on the structural alterations of these stickers. Commercial polypropylene (PP) stickers on banana peels were added to a typical organic material mixture for processing in an industrial composting plant and successfully resampled after a prerotting (11 days) and main rotting step (25 days). Afterward, both composted and original stickers were analyzed for surface and structural changes via scanning electron microscopy, Fourier-transform infrared spectroscopy, and micro- and nano-X-ray computed tomography (CT) combined with deep learning approaches. The composting resulted in substantial surface changes and degradation in the form of microbial colonization, deformation, and occurrence of cracks in all stickers. Their pore volumes increased from 16.7% in the original sticker to 26.3% at the end of the compost process. In a similar way, the carbonyl index of the stickers increased. Micro-CT images additionally revealed structural changes in the form of large adhesions that penetrated the surface of the sticker. These changes were accompanied by delamination after 25 days of composting, thus overall hinting at the degradation of the stickers and the subsequent formation of smaller microplastic pieces.

First clinical experience following the consensus guide for calibrating a proton stopping power ratio curve in a new proton centre.

BACKGROUND AND PURPOSE: This work introduces the first assessment of CT calibration following the ESTRO's consensus guidelines and validating the HLUT through the irradiation of biological material. METHODS: Two electron density phantoms were scanned with two CT scanners using two CT scan energies. The stopping power ratio (SPR) and mass density (MD) HLUTs for different CT scan energies were derived using Schneider's and ESTRO's methods. The comparison metric in this work is based on the Water-Equivalent Thickness (WET) difference between the treatment planning system and biological irradiation measurement. The SPR HLUTs were compared between the two calibration methods. To assess the accuracy of using MD HLUT for dose calculation in the treatment planning system, MD vs SPR HLUT was compared. Lastly, the feasibility of using a single SPR HLUT to replace two different energy CT scans was explored. RESULTS: The results show a WET difference of less than 3.5% except for the result in the Bone region between Schneider's and ESTRO's methods. Comparing MD and SPR HLUT, the results from MD HLUT show less than a 3.5% difference except for the Bone region. However, the SPR HLUT shows a lower mean absolute percentage difference as compared to MD HLUT between the measured and calculated WET difference. Lastly, it is possible to use a single SPR HLUT for two different CT scan energies since both WET differences are within 3.5%. CONCLUSION: This is the first report on calibrating an HLUT following the ESTRO's guidelines. While our result shows incremental improvement in range uncertainty using the ESTRO's guideline, the prescriptional approach of the guideline does promote harmonization of CT calibration protocols between different centres.

The neural dynamics of conflict adaptation induced by conflict observation: Evidence from univariate and multivariate analysis.

Conflict adaptation can be expressed as greater performance (shorter response time and lower error rate) after incongruent trials when compared to congruent trials. It has been observed in designs that minimize confounding factors, i.e., feature integration, contingency learning, and temporal learning. Our current study aimed to further elucidate the temporal evolution mechanisms of conflict adaptation. To address this issue, the current study employed a combination of behavioral, univariate, and multivariate analysis (MVPA) methods in a modified color-word Stroop task, where half of the trials required button presses (DO trials), and the other half only required observation (LOOK trials). Both behavioral and the ERP results (N450 and SP) in the LOOK-DO transition trials revealed significant conflict adaptation without feature integration, contingency learning, and temporal learning, providing support for the conflict monitoring theory. Furthermore, during the LOOK trials, significant Stroop effect in the N450 and SP components were observed, indicating that conflict monitoring occurred at the stimulus level and triggered reactive control adjustments. The MVPA results decoded the congruent-incongruent and incongruent-incongruent conditions during the conflict adjustment phase but not during the conflict monitoring phase, emphasizing the unique contribution of conflict adjustment to conflict adaptation. The current research findings provided more compelling supporting evidence for the conflict monitoring theory, while also indicating that future studies should employ the present design to elucidate the specific processes of conflict adaptation.

Look-alike sound-alike (LASA) medication errors in Thai hospitals / Errores de medicación por sonido similar (LASA) en hospitales tailandeses

Look-alike sound-alike (LASA) drugs cause a high proportion of medication errors in hospitals. Drug lists available in hospitals are diverse and complicated. Presently, each hospital has its own LASA drug list and unique management strategies to minimize and prevent LASA errors. Objective: This study aimed to explore the prevalence of LASA drug lists, types of LASA drugs, and categories of medication errors in hospitals in Thailand. Methods: For this crosssectional study, questionnaires were developed and distributed along with a letter to 500 government hospitals (selected from a total of 1,309 hospitals) in Thailand via mail from April to June 2021. Data were analyzed using descriptive statistics (frequencies and percentages). Results: A total of 128 hospitals participated in this study (response rate: 25.60%), including 12 tertiary hospitals (9.38%), 33 secondary hospitals (25.78%), 24 large primary hospitals (18.75%), 51 small primary hospitals (39.84%), and eight private hospitals (6.25%). A total of 2,510 pairs of LASA drugs were identified, which included 1,674 (66.69%) tablets/capsules (Simvastatin 10-Simvastatin 20 pair had the highest frequency), 427 injections (17.01%) (Ceftriaxone-Ceftazidime pair had the highest frequency), 85 liquid dosage forms (3.39%) (Milk of magnesia-alum milk pair had the highest frequency), 74 special techniques in medicine (2.95%) (Seretide evohaler®-Seretide accuhaler® pair had the highest frequency), 49 external used drugs (1.95%) (Clotrimazole cream-Clobetasol cream pair had the highest frequency), and 28 powder dosage forms (1.12%) (ORS for pediatrics-ORS for adult pair had the highest frequency). Conclusion: Despite relevant awareness among healthcare professionals, LASA medication errors occur in hospitals. The most frequent similarities among LASA drugs were detected in their names/pronunciations, and the most common errors belonged to Category B.(AU)

Effects of concurrent cartilage procedures on cartilage regeneration in high tibial osteotomy: a systematic review.

PURPOSE: This systematic review aimed to evaluate the effects of concurrent cartilage procedures on cartilage regeneration when performed alongside high tibial osteotomy (HTO). MATERIALS AND METHODS: The systematic review followed the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). A comprehensive search was conducted on databases including PubMed, Embase, Cochrane Library, and Google Scholar, covering articles published until August 31, 2023. RESULTS: Sixteen studies (1277 patients) revealed that HTO, with or without concurrent cartilage procedures, leads to cartilage regeneration based on the International Cartilage Repair Society (ICRS) grade during second-look arthroscopy. No concurrent procedure showed improvement in ICRS grade (mean difference: - 0.80 to - 0.49). Microfracture (mean difference: - 0.75 to - 0.22), bone marrow aspirate concentrate (BMAC) (mean difference: - 1.37 to - 0.67), and human umbilical cord blood-derived mesenchymal stem cell (hUCB-MSC) (mean difference: - 2.46 to - 1.81) procedures also demonstrated positive outcomes. Clinical outcome assessments for each cartilage procedure were also improved during postoperative follow-up, and no specific complications were reported. CONCLUSIONS: HTO with or without concurrent cartilage procedures promotes cartilage regeneration observed during second-look arthroscopy, with improved clinical outcomes. Future randomized controlled trials on the same topic, along with subsequent meta-analyses, are necessary for conclusive findings.

Native myocardial T1 mapping using inversion recovery T1-weighted turbo field echo sequence.

This study proposes the use of the inversion recovery T1-weighted turbo field echo (IR-T1TFE) sequence for myocardial T1 mapping and compares the results obtained with those of the modified Look-Locker inversion recovery (MOLLI) method for accuracy, precision, and reproducibility. A phantom containing seven vials with different T1 values was imaged, thereby comparing the T1 measurements between the inversion recovery spin-echo (IR-SE) technique, MOLLI, and the IR-T1TFE. The accuracy, precision, and reproducibility of the T1-mapping sequences were analyzed in a phantom study. Fifteen healthy subjects were recruited for the in vivo comparison of native myocardial T1 mapping using MOLLI and IR-T1TFE sequences. After myocardium segmentation, the T1 value of the entire myocardium was calculated. In the phantom study, excellent accuracy was achieved using IR-T1TFE for all T1 ranges. MOLLI displayed lower accuracy than IR-T1TFE (p =0.016), substantially underestimating T1 at large T1 values (> 1000 ms). In the in vivo study, the first mean myocardial T1 values ± SD using MOLLI and IR-T1TFE were 1306 ± 70 ms and 1484 ± 28 ms, respectively, and the second were 1297 ± 68 ms and 1474 ± 43 ms, respectively. The native myocardial T1 obtained with MOLLI was lower than that of IR-T1TFE (p < 0.001). The reproducibility of native myocardial T1 mapping within the same sequence was not statistically significant (p = 0.11). This study demonstrates the utility and validity of myocardial T1 mapping using IR-T1TFE, which is a common sequence. This method was found to have high accuracy and reproducibility.

[Indications and surgical strategy for bowel resection in mesenteric ischemia : Resection margins considering current guidelines and literature as well as the influence of new technical possibilities]. / Indikation und Operationsstrategie zur Darmresektion bei Mesenterialischämie : Resektionsgrenzen unter Berücksichtigung aktueller Leitlinien und Literatur sowie des Einflusses neuer technischer Möglichkeiten.

Acute mesenteric ischemia (AMI) is still a time-critical and life-threatening clinical picture. If exploration of the abdominal cavity is necessary during treatment, an intraoperative assessment of which segments of the intestines have a sufficient potential for recovery must be made. These decisions are mostly based on purely clinical parameters, which are subject to high level of uncertainty. This review article provides an overview of how this decision-making process and the determination of resection margins can be improved using technical aids, such as laser Doppler flowmetry (LDF), indocyanine green (ICG) fluorescence angiography or hyperspectral imaging (HSI). Furthermore, this article compiles guideline recommendations on the role of laparoscopy and the value of a planned second-look laparotomy. In addition, an overview of strategies for preventing short bowel syndrome is given and other aspects, such as the timing and technical aspects of placement of a preternatural anus and an anastomosis are highlighted.

Second-Look Arthroscopy Shows Inferior Cartilage after Bone Marrow Stimulation Compared with Other Operative Techniques for Osteochondral Lesions of the Talus: A Systematic Review and Meta-Analysis.

OBJECTIVE: To compare cartilage quality after different surgical interventions for osteochondral lesions of the talus (OLT), evaluated by second-look arthroscopy. Secondary aims were to report concomitant diagnoses, and to correlate cartilage quality with clinical and radiological outcomes. This review hypothesizes that the cartilage repair after bone marrow stimulation (BMS) is inferior to the other available treatment options. METHODS: PROSPERO ID: CRD42022311489. Studies were retrieved through PubMed, EMBASE (Ovid), and Cochrane Library. Studies were included if they reported cartilage quality after second-look investigation after surgical treatment of OLT. The primary outcome measure was the cartilage quality success and failure rates (%) per surgical intervention group. Correlations between the cartilage quality and clinical or radiological outcomes were calculated. RESULTS: Twenty-nine studies were included, comprising 586 ankles that had undergone second-look arthroscopy on average 16 months after initial surgery. The success rate for BMS was 57% (95% confidence interval [CI] = 48%-65%), for fixation (FIX) 86% (95% CI = 70%-94%), for osteo(chondral) transplantation (OCT) 91% (95% CI = 80%-96%), for cartilage implementation techniques (CITs) 80% (95% CI = 69%-88%), and for retrograde drilling 100% (95% CI = 66%-100%). The success rate of BMS was significantly lower than FIX, OCT, and CIT (P < 0.01). There were no significant differences between other treatment groups. A moderate positive significant correlation between the Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score and the International Cartilage Repair Society score (ICRS) was found (ρ = 0.51, P < 0.001). CONCLUSIONS: Successful restoration of cartilage quality was found in the majority of surgically treated OLTs. However, BMS yields inferior cartilage quality compared with FIX, OCT, and CIT. Study Design. Systematic review and meta-analysis. Level of evidence. Level IV, systematic review and meta-analysis.

A deep learning-based approach for axle counter in free-flow tolling systems.

Enhancements in the structural and operational aspects of transportation are important for achieving high-quality mobility. Toll plazas are commonly known as a potential bottleneck stretch, as they tend to interfere with the normality of the flow due to the charging points. Focusing on the automation of toll plazas, this research presents the development of an axle counter to compose a free-flow toll collection system. The axle counter is responsible for the interpretation of images through algorithms based on computer vision to determine the number of axles of vehicles crossing in front of a camera. The You Only Look Once (YOLO) model was employed in the first step to identify vehicle wheels. Considering that several versions of this model are available, to select the best model, YOLOv5, YOLOv6, YOLOv7, and YOLOv8 were compared. The YOLOv5m achieved the best result with precision and recall of 99.40% and 98.20%, respectively. A passage manager was developed thereafter to verify when a vehicle passes in front of the camera and store the corresponding frames. These frames are then used by the image reconstruction module which creates an image of the complete vehicle containing all axles. From the sequence of frames, the proposed method is able to identify when a vehicle was passing through the scene, count the number of axles, and automatically generate the appropriate charge to be applied to the vehicle.

Accelerated liver water T1 mapping using single-shot continuous inversion-recovery spiral imaging.

PURPOSE: Liver T1 mapping techniques typically require long breath holds or long scan time in free-breathing, need correction for B 1 + inhomogeneities and process composite (water and fat) signals. The purpose of this work is to accelerate the multi-slice acquisition of liver water selective T1 (wT1) mapping in a single breath hold, improving the k-space sampling efficiency. METHODS: The proposed continuous inversion-recovery (IR) Look-Locker methodology combines a single-shot gradient echo spiral readout, Dixon processing and a dictionary-based analysis for liver wT1 mapping at 3 T. The sequence parameters were adapted to obtain short scan times. The influence of fat, B 1 + inhomogeneities and TE on the estimation of T1 was first assessed using simulations. The proposed method was then validated in a phantom and in 10 volunteers, comparing it with MRS and the modified Look-Locker inversion-recovery (MOLLI) method. Finally, the clinical feasibility was investigated by comparing wT1 maps with clinical scans in nine patients. RESULTS: The phantom results are in good agreement with MRS. The proposed method encodes the IR-curve for the liver wT1 estimation, is minimally sensitive to B 1 + inhomogeneities and acquires one slice in 1.2 s. The volunteer results confirmed the multi-slice capability of the proposed method, acquiring nine slices in a breath hold of 11 s. The present work shows robustness to B 1 + inhomogeneities ( wT 1 , No B 1 + = 1.07 wT 1 , B 1 + - 45.63 , R 2 = 0.99 ) , good repeatability ( wT 1 , 2 ° = 1 . 0 wT 1 , 1 ° - 2.14 , R 2 = 0.96 ) and is in better agreement with MRS ( wT 1 = 0.92 wT 1 MRS + 103.28 , R 2 = 0.38 ) than is MOLLI ( wT 1 MOLLI = 0.76 wT 1 MRS + 254.43 , R 2 = 0.44 ) . The wT1 maps in patients captured diverse lesions, thus showing their clinical feasibility. CONCLUSION: A single-shot spiral acquisition can be combined with a continuous IR Look-Locker method to perform rapid repeatable multi-slice liver water T1 mapping at a rate of 1.2 s per slice without a B 1 + map. The proposed method is suitable for nine-slice liver clinical applications acquired in a single breath hold of 11 s.

Initial tension at suture fixation affects the suture breakage following medial meniscus posterior root repair: A retrospective cohort study.

OBJECTIVES: This study aimed to investigate whether the initial suture tension when pullout sutures are fixed affects postoperative clinical outcomes following medial meniscus posterior root repair. METHODS: The data of 48 patients who underwent transtibial pullout repair using two simple stitches (outer and inner sutures) with an additional all-inside posteromedial pullout were retrospectively investigated. The patients were sequentially divided into two groups to compare the clinical efficacy of the initial pullout tension (N) when pullout sutures were fixed: the 30 N Group (April 2019 to September 2019, 24 patients) and the 15 N group (October 2019 to February 2020, 24 patients). The rate of suture breakage (suture cutout or rupture) at the second-look arthroscopy at 1 year postoperatively and clinical outcomes at 2 years postoperatively were compared between the two groups. RESULTS: In both groups, each clinical score significantly improved at 2 years postoperatively. At the second-look arthroscopy, the rate of posteromedial suture breakage was significantly higher in the 30 N group (19 patients, 79 â€‹%) than in the 15 N group (10 patients, 42 â€‹%); the rate of outer suture breakage was also higher in the 30 N group (five patients, 21 â€‹%) than in the 15 N group (no patients). On comparing 2 years of preoperative clinical scores between the groups categorized according to posteromedial suture breakage, the pain score was significantly higher in the suture breakage group. CONCLUSIONS: The initial tension of pullout repair of the medial meniscus posterior root tear is related to suture breakages. To prevent suture breakage, 15 N is a more initially suitable condition than 30 N. LEVEL OF EVIDENCE: Level III.

Comparative Sensing and Judgment Control System for Temperature Maintenance for Optimal Treatment in Hyperthermic Intraperitoneal Chemotherapy Surgery.

For tumors wherein cancer cells remain in the tissue after colorectal cancer surgery, a hyperthermic anticancer agent is injected into the abdominal cavity to necrotize the remaining cancer cells with heat using a hyperthermic intraperitoneal chemotherapy system. However, during circulation, the processing temperature is out of range and the processing result is deteriorated. This paper proposes a look-up table (LUT) module design method that can stably maintain the processing temperature range during circulation via feedback. If the temperature decreases or increases, the LUT transmits a command signal to the heat exchanger to reduce or increase heat input, thereby maintaining the treatment temperature range. The command signal for increasing and decreasing heat input is Tp and Ta, respectively. The command signal for the treatment temperature range is Ts. If drug temperatures below 41 and above 43 °C are input to the LUT, it sends a Tp or Ta signal to the heat exchanger to increase or decrease the input heat, respectively. If the drug's temperature is 41-43 °C, the LUT generates a Ts signal and proceeds with the treatment. The proposed system can automatically control drug temperature using temperature feedback to ensure rapid, accurate, and safe treatment.

Identical clinical outcomes between neutral and classic targeted alignments after high tibial osteotomy in medial meniscus posterior root tear: a prospective randomized study.

PURPOSE: This study aimed to compare the clinical and radiographic outcomes and arthroscopic findings after high tibial osteotomy (HTO) between neutral and classic targeted coronal alignments in patients with medial meniscus posterior root tears (MMPRTs). METHODS: Ninety-eight patients with MMPRT were prospectively enrolled in the final cohort and randomized into two groups. Fifty-two patients with the targeted alignment through the Fujisawa point (60-62.5% of the entire tibial plateau width measured from the medial side) during HTO were included in group A, whereas 46 patients with the targeted alignment through the point at 50-55% of the tibial plateau width were included in group B. The clinical and radiographic outcomes and second-look arthroscopic findings were statistically compared for comprehensive assessments. RESULTS: After a mean follow-up of 37.1 months, we found no significant differences between the two groups regarding the final Lysholm (p = 0.205) and Hospital for Special Surgery scores (p = 0.084). However, we only observed significant differences between the two groups in terms of the final hip-knee-ankle angle, weight-bearing line ratio, and medial proximal tibial angle (p < 0.001). Second-look arthroscopy did not reveal a significant difference in meniscal healing rate (p = 0.786). CONCLUSIONS: Performing HTO with the aim to achieve neutral alignment leads to similar clinical outcomes in patients with MMPRT compared to classic alignment. Although subsequent research is required, the current study provides clinical evidence for the safety and efficacy of the new targeted alignment during HTO, which may avoid long-term complications associated with overcorrection when using the traditional technique.

Magnetic Resonance Imaging Artifact Associated With Transcutaneous Bone Conduction Implants: Cholesteatoma and Vestibular Schwannoma Surveillance.

OBJECTIVE: To evaluate the magnetic resonance (MR) image artifact and image distortion associated with the two transcutaneous bone conduction implants currently available in the United States. STUDY DESIGN: Cadaveric study. METHODS: Two cadaveric head specimens (1 male, 1 female) were unilaterally implanted according to manufacturer guidelines and underwent MR imaging (General Electric and Siemens 1.5 T scanners) under the following device conditions: (1) no device, (2) Cochlear Osia with magnet and headwrap, (3) Cochlear Osia without magnet, and (4) MED-EL Bonebridge with magnet. Maximum metal mitigation techniques were employed in all conditions, and identical sequences were obtained. Blinded image scoring (diagnostic vs nondiagnostic image) was performed by experienced neuroradiologists according to anatomical subsites. RESULTS: All device conditions produced artifact and image distortion. The Osia with magnet produced diagnostic T1- and T2-weighted images of the ipsilateral temporal bone, however, non-echo planar imaging diffusion-weighted imaging (DWI) was nondiagnostic. The Osia without magnet scanned on the Siemens MR imaging demonstrated the least amount of artifact and was the only condition that allowed for diagnostic imaging of the ipsilateral temporal bone on DWI. The Bonebridge produced a large area of artifact and distortion with the involvement of the ipsilateral and contralateral temporal bones. CONCLUSION: In summary, of the three device conditions (Osia with magnet, Osia without magnet, and Bonebridge), Osia without magnet offered the least amount of artifact and distortion and was the only condition in which diagnostic DWI was available for the middle ear and mastoid regions on the Siemens MR imaging scanner.

Applicant Perceptions of Postinterview Communication During the 2022 to 2023 Neurosurgery Recruitment Cycle: A Cross-Sectional Survey Study.

OBJECTIVES: To evaluate and describe neurosurgery applicant perceptions of the postinterview communication (PIC) process during the US residency match. METHODS: A voluntary and anonymous postmatch web-based survey was developed and sent to 209 candidates who applied to 1 academic neurosurgery practice during the 2022-2023 recruitment cycle, approximately 1 week following match day. Survey questions focused on their perceptions of and participation behaviors with PIC and how this impacted their final rank list. RESULTS: Seventy-eight (37.3%) of the 209 candidates responded to the survey. Sixty-four (84.2%) respondents reported submitting a letter of intent (LOI) to their number 1 ranked program. Sixty-one (82%) felt pressured to send a LOI to improve their rank status, fearing that it may harm them if they did not. Fifty-four (73.0%) respondents felt pressured to send an early LOI despite not seeing the program in person to communicate interest before programs certified their rank lists. Fourteen (18.9%) respondents agreed that a second look experience impacted their rank list enough to where they regretted an early LOI. Fifty-five (76.4%) respondents disagreed that second-look attendance had no impact on their rank status with a program. Fifty (71.4%) respondents agreed that PIC causes undue stress during the match process. Sixty-one (84.7%) respondents agreed that aspects of PIC require universal guidelines. CONCLUSIONS: This is the first study to describe the perceptions of PIC and behaviors of neurosurgery applicants during the US residency match process. Standardized PIC practices may help to ensure transparency and relieve stress for applicants during the match process.

Current Aspects of Intraoperative High-Field (3T) Magnetic Resonance Imaging in Pediatric Neurosurgery: Experiences from a Recently Launched Unit at a Tertiary Referral Center.

OBJECTIVE: To evaluate the neurosurgical and economic effectiveness of a newly launched intraoperative high-field (3T) magnetic resonance imaging (MRI) suite for pediatric tumor and epilepsy neurosurgery. METHODS: Altogether, 148 procedures for 124 pediatric patients (mean age, 8.7 years; range, 0-18 years) within a 2.5-year period were undertaken in a 2-room intraoperative MRI (iopMRI) suite. Surgery was performed mainly for intractable epilepsy (n = 81; 55%) or pediatric brain tumors (n = 65; 44%) in the supine (n = 113; 76%) and prone (n = 35; 24%) positions. The mean time of iopMRI from draping to re-surgery was 50 minutes. RESULTS: IopMRI was applied not in all but in 64 of 148 procedures (43%); in 45 procedures (31%), iopMRI was estimated unnecessary at the end of surgery based on the leading surgeon's decision. In the remaining 39 procedures (26%), ultra-early postoperative MRI was carried out after closure with the patient still sterile in the head coil. Of the 64 procedures with iopMRI, second-look surgery was performed in 26% (in epilepsy surgery in 17%, in tumor surgery in 9%). We did not encounter any infections, wound revisions, or position-related or anesthesiology-related complications. CONCLUSIONS: We used iopMRI in less than half of pediatric tumor and epilepsy surgery for which it was scheduled initially. Therefore, high costs argue against its routine use in pediatric neurosurgery, although it optimized surgical results in one quarter of patients and met high safety standards.

Self-perception of natural outcome, appearance, and emotional well-being after OnabotulinumtoxinA treatment for upper facial lines: Post hoc analysis across age and gender.

BACKGROUND: OnabotulinumtoxinA (onabotA) is indicated for upper facial lines (UFL). Fear of unnatural-looking outcomes is a frequently reported treatment barrier. AIMS: Examine patient-reported outcomes (PROs) after onabotA treatment for UFL. METHODS: A post hoc analysis was conducted on two 12-month pivotal studies of onabotA for forehead and glabellar lines (20 U each), with/without treatment of crow's feet lines (±24 U). This analysis used PROs from the Facial Line Satisfaction Questionnaire: Items 4 (natural look), 5 (treatment effect), 11 (met expectations), and Impact Domain (appearance and psychological impact). The analysis included 458 neurotoxin-naive adults achieving a ≥2-grade improvement in forehead line (FHL) severity on the Facial Wrinkle Scale at Day 30 (primary endpoint). [Corrections made on 28 December 2023, after first online publication: 'UFL' in the previous sentence has been corrected to 'forehead line (FHL)' in this version.] Data were further stratified into millennials and men. RESULTS: At Day 30, 90.5% of all participants, 94.6% of millennials, and 85.7% of men were satisfied with receiving a natural look. Millennials had higher odds of being satisfied with natural outcomes at Day 30. This measure remained > 80% for all groups throughout the 12 months. Additionally, ≥80% were satisfied with the treatment effect, and >90% reported results met expectations. At Day 30, ≥50% reported positive impacts on self-perceived appearance and psychological well-being, but millennials had higher, and men had lower odds of reporting these improvements. CONCLUSIONS: Participants achieving a ≥2-grade improvement in FHL severity after onabotA reported high satisfaction with natural outcomes and the treatment effect, with improved self-perceived appearance and psychological well-being. [Corrections made on 28 December 2023, after first online publication: 'UFL' in the previous sentence has been corrected to 'FHL' in this version.] These results may help aesthetic providers and patients address fears regarding unnatural results with onabotA.

Look-alike medications in the perioperative setting: scoping review of medication incidents and risk reduction interventions.

BACKGROUND: Look-alike medications, where ampoules or vials of intravenous medications look similar, may increase the risk of medication errors in the perioperative setting. AIM: This scoping review aimed to identify and explore the issues related to look-alike medication incidents in the perioperative setting and the reported risk reduction interventions. METHOD: Eight databases were searched including: CINAHL Complete, Embase, OVID Emcare, Pubmed, Scopus, Informit, Cochrane and Prospero and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR). Key search terms included anaesthesia, adverse drug event, drug error or medication error, look alike sound alike, operating theatres and pharmacy. Title and abstracts were screened independently and findings were extracted using validated tools in collaboration and consensus with co-authors. RESULTS: A total of 2567 records were identified to 4th July 2022; however only 18 publications met the inclusion criteria. Publication types consisted of case reports, letters to the editor, multimodal quality improvement activities or survey/audits, a controlled simulation study and one randomised clinical trial. Risk reduction intervention themes identified included regulation, procurement, standardisation of storage, labelling, environmental factors, teamwork factors and the safe administration. CONCLUSION: This review highlighted challenges with look-alike medications in the perioperative setting and identified interventions for risk reduction. Key interventions did not involve technology-based solutions and further research is required to assess their effectiveness in preventing patient harm.

Comparison of clinical, imaging and second-look arthroscopic outcomes between varus knee patients with and without preoperative tibial varus deformity after medial opening-wedge high tibial osteotomy.

PURPOSE: This study aimed to compare the regeneration status of articular cartilage, clinical, and radiologic outcomes between varus knee patients with and without preoperative tibial varus deformity (PTVD) after medial opening-wedge high tibial osteotomy (OWHTO) METHODS: Varus knee patients who had undergone OWHTO were divided into two groups according to preoperative medial proximal tibial angle (MPTA): a great varus (GV) group (MPTA <85°) and a mild varus (MV) group (85°≤preoperative MPTA <87°). The hip-knee-ankle (HKA) angle, weight-bearing line ratio (WBL%), MPTA, joint line convergence angle and joint line obliquity were measured. Second-look arthroscopy was undertaken 24 months after HTO. The Knee Society (KS) function score and knee score, and Lysholm score were used to evaluate the functional outcomes. All parameters were evaluated preoperatively and 24 months after HTO. RESULTS: The GV group had greater varus than the MV group in HKA and WBL% before surgery, but greater valgus after surgery. The arthroscopic probe before HTO revealed the advanced chondral damage in the GV group and lighter chondral damage in the MV group. The regeneration of medial femoral condyle was considerably more frequent in the GV group (72.5%, 45/62) than in the MV group (50.0%, 27/54) (P = 0.030). No significant differences were observed in all functional outcomes preoperatively and 24 months after HTO. CONCLUSION: The extent of cartilage regeneration in patients without PTVD was inferior to that in those with PTVD, but the functional outcomes were comparable. OWHTO may be a treatment option in a selected subset of varus knee patients without PTVD.

Evolution of neurosurgical advances and nuances in medulloblastoma therapy.

Medulloblastoma, the most common malignant brain tumor in children, presents a complex treatment challenge due to its propensity for infiltrative growth within the posterior fossa and its potential attachment to critical anatomical structures. Central to the management of medulloblastoma is the surgical resection of the tumor, which is a key determinant of patient prognosis. However, the extent of surgical resection (EOR), ranging from gross total resection (GTR) to subtotal resection (STR) or even biopsy, has been the subject of extensive debate and investigation within the medical community. Today, the impact of neurosurgical EOR on the prognosis of medulloblastoma patients remains a complex and evolving area of investigation. The conflicting findings in the literature, the challenges posed by critical surrounding anatomical structures, the potential for surgical complications and neurologic morbidity, and the nuanced interactions with molecular subgroups all contribute to the complexity of this issue. As the field continues to advance, the imperative to strike a delicate balance between maximizing resection and preserving quality of life remains central to the management of medulloblastoma patients.