Transtubular Transoral Approach for Irreducible Ventral Craniovertebral Junction Compressive Pathologies: Surgical Technique and Outcome.

Introduction: To investigate the use of a tubular retractor to provide access to the craniovertebral junction (CVJ) sparing the soft palate with the aim of reducing complications associated with traditional transoral approach but yet allowing adequate decompression of the CVJ. Materials and methods: Twelve consecutive patients with severe myelopathy (JOA-score less than 11) from ventral CVJ compression were operated between 2014-2020 using a tubular retractor assisted transoral decompression. Results: All patients improved neurologically statistically (p=0.02). There were no posterior pharynx wound infections or rhinolalia. There was one case with incomplete removal of the lateral wall of odontoid and one incidental durotomy. Conclusions: A Tubular retractor provides adequate access for decompression of the ventral compression of CVJ. As the tubular retractor pushed away the uvula, soft palate and pillars of the tonsils as it docked on the posterior pharyngeal wall, the traditional complications associated with traditional transoral procedures is completely avoided.

Knowledge and attitude of nurses towards diabetic foot care in a secondary health care centre in Malaysia.

INTRODUCTION: Nurses play a vital role in the care and prevention of ulcers in patients with diabetic foot. Patient education, prevention of ulcers and rehabilitation are some of the vital aspects that nurses provide on a daily basis. Thus, good knowledge and attitude of nurses towards diabetic foot ulcers and its care will ensure better patient care. OBJECTIVES: The aim is to study the level of knowledge and attitude of nurses towards diabetic foot ulcers and its care in Hospital Segamat, Malaysia. METHODS: A validated questionnaire was used between February 2019 to May 2019 covering area such as demography, predisposing factors of ulcer formation, characteristics of ulcers, complications of ulcers, and attitude towards diabetic foot care. RESULTS: A total of 101 nurses took part and 57% of the participants scored poorly in the knowledge section of the questionnaire. In all 72% had scored poorly when asked regarding complications of diabetic foot ulcers; 49.5% of the nurses had positive attitude towards diabetic foot care; and 79.3% thought that care for diabetic foot ulcer is timeconsuming. Majority of them think that their colleagues are the main source of information. All demographic variables were deemed to be confounders with the knowledge and attitude of nurses towards diabetic foot ulcers and its care. CONCLUSIONS: Nurses in this centre had poor knowledge towards diabetic foot ulcers and its care. None of the variable studied were correlated with the level know knowledge. Good or poor knowledge of nurses does not correspond equally to good or poor attitude towards diabetic foot ulcers care. More frequent formal training of diabetic foot care would be needed to ensure better knowledge.

Diabetic foot infection and surgical treatment in a secondary health care centre in Malaysia.

INTRODUCTION: Diabetic foot infection is often associated with high morbidity, disability and poor quality of life. This study focuses on the demography, the number of repetitive surgery and length of stay in hospital of patients with diabetic foot infection. METHOD: This is a retrospective observational study. Patients who were admitted to the Orthopaedic ward of Hospital Segamat (HS), Johor, Malaysia from January 2016 to December 2018 and required surgical intervention were included in the study. Data was collected from the computer system of HS and medical notes of patients. RESULTS: 35.6% of the total orthopaedic emergency surgeries performed were for patients with diabetic foot infection, 25% of the surgical procedures performed were major amputations of lower limb and 40% of the patients with diabetic foot infection required more than one surgical operation. DISCUSSION: The demographics of the patients is consistent with the demographics of Malaysia where majority of them are Malays followed by Chinese, Indians and others. Despite being only 10% of total admission to the department, this group of patients contributed to 35.6% of the total emergency surgeries performed. The amputation rate in the centre is comparable to the other local studies. The average length of stay in hospital was found to be shorter compared to overseas due to different rehabilitation protocols.

Necrotising fasciitis caused by aeromonas sobria: Not just a simple catfish sting.

Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.

A New Technique for Solving Tightrope Cutout during Acromioclavicular Joint Fixation: A Case Report.

Acromioclavicular joint (ACJ) dissociation is one of the common injuries affecting adults. The stability of ACJ largely depends on the integrity of acromioclavicular ligament, coracoclavicular ligament, capsule, trapezius muscle and deltoid muscle. The injury has been classified by Rockwood into six types and treatment options can be guided by the classification. TightRope fixation is one of the many surgical procedures available to address acromioclavicular joint separation. It consists of tensioning of a no. 5 Fibrewire suture secured at both ends to low-profile metallic buttons. Despite various advantages of using this technique, complications such as suture cut-out, clavicle fracture and suture failure have been documented. The author presents a case of a type III acromioclavicular joint dissociation treated with TightRope which suture cutout was noted intra-operatively. Decision to amend the fixation using a cut one-third tubular plate as an additional anchor for the metallic button on the clavicle was made. Patient's progress was evaluated using the University of California at Los Angeles Shoulder Score (UCLA Shoulder Score) and significant improvement was noted six months post operatively. We propose this technique as a solution to the encountered problem.

Exploiting sparsity and low-rank structure for the recovery of multi-slice breast MRIs with reduced sampling error.

It has been shown that, magnetic resonance images (MRIs) with sparsity representation in a transformed domain, e.g. spatial finite-differences (FD), or discrete cosine transform (DCT), can be restored from undersampled k-space via applying current compressive sampling theory. The paper presents a model-based method for the restoration of MRIs. The reduced-order model, in which a full-system-response is projected onto a subspace of lower dimensionality, has been used to accelerate image reconstruction by reducing the size of the involved linear system. In this paper, the singular value threshold (SVT) technique is applied as a denoising scheme to reduce and select the model order of the inverse Fourier transform image, and to restore multi-slice breast MRIs that have been compressively sampled in k-space. The restored MRIs with SVT for denoising show reduced sampling errors compared to the direct MRI restoration methods via spatial FD, or DCT. Compressive sampling is a technique for finding sparse solutions to underdetermined linear systems. The sparsity that is implicit in MRIs is to explore the solution to MRI reconstruction after transformation from significantly undersampled k-space. The challenge, however, is that, since some incoherent artifacts result from the random undersampling, noise-like interference is added to the image with sparse representation. These recovery algorithms in the literature are not capable of fully removing the artifacts. It is necessary to introduce a denoising procedure to improve the quality of image recovery. This paper applies a singular value threshold algorithm to reduce the model order of image basis functions, which allows further improvement of the quality of image reconstruction with removal of noise artifacts. The principle of the denoising scheme is to reconstruct the sparse MRI matrices optimally with a lower rank via selecting smaller number of dominant singular values. The singular value threshold algorithm is performed by minimizing the nuclear norm of difference between the sampled image and the recovered image. It has been illustrated that this algorithm improves the ability of previous image reconstruction algorithms to remove noise artifacts while significantly improving the quality of MRI recovery.

Anatomical landmark localization in breast dynamic contrast-enhanced MR imaging.

In this article, we present a novel approach to localize anatomical features-breast costal cartilage-in dynamic contrast-enhanced MRI using level sets. Current breast MRI diagnosis involves magnetic-resonance compatible needles for localization. However, if the breast costal cartilage structure can be used as an alternative to the MR needle, this will not only assist in avoiding invasive procedures, but will also facilitate monitoring of the movement of breasts caused by cardiac and respiratory motion. This article represents a novel algorithm for achieving reliable detection and extraction of costal cartilage structures, which can be used for the analysis of motion artifacts, with possible shape variations of the structure caused by uptake of contrast agent, as well as a potential for the registration of breast. The algorithm represented in this article is to extract volume features from post-contrast MR images at three different time slices for the analysis of motion artifacts, and we validate the current algorithm according to the anatomic structure. This utilizes the level-set method for the size selection of the region of interest. The variable shape of contours acquired from a level-set-based segment image actually determines the feature region of interest, which is used as a guide to achieve initial masks for feature extraction. Following this, the algorithm uses a K-means method for classification of the feature regions from other types of tissue and morphological operations with a choice of an appropriate structuring element to achieve reliable masks and extraction of features. The segments of features can be therefore obtained with the application of extracted masks for subsequent motion analysis of breast and for potential registration purposes.

Tensor based sparse decomposition of 3D shape for visual detection of mirror symmetry.

This study explores an approach for analysing the mirror (reflective) symmetry of 3D shapes with tensor based sparse decomposition. The approach combines non-negative tensor decomposition and directional texture synthesis, with symmetry information about 3D shapes that is represented by 2D textures synthesised from sparse, decomposed images. This technique requires the center of mass of 3D objects to be at the origin of the coordinate system. The decomposition of 3D shapes and analysis of their symmetry are useful for image compression, pattern recognition, as well as there being an emerging interest in the medical community due to its potential to find morphological changes between healthy and pathological structures. This paper postulates that sparse texture synthesis can be used to describe the decomposed basis images acting as symmetry descriptors for a 3D shape. We apply the theory of non-negative tensor decomposition and sparse texture synthesis, deduce the new representation, and show some application examples.

The impact of hydration changes in fresh bio-tissue on THz spectroscopic measurements.

We present a study of how residual hydration in fresh rat tissue samples can vastly alter their extracted terahertz (THz) optical properties and influence their health assessment. Fresh (as opposed to preserved) tissue most closely mimics in vivo conditions, but high water content creates many challenges for tissue handling and THz measurement. Our THz measurements of fresh tissue over time highlight the effect of tissue hydration on tissue texture and dimension, the latter directly influencing the accuracy of calculated optical properties. We then introduce lyophilization (freeze drying) as a viable solution for overcoming hydration and freshness problems. Lyophilization removes large amounts of water while retaining sample freshness. In addition, lyophilized tissue samples are easy to handle and their textures and dimensions do not vary over time, allowing for consistent and stable THz measurements. A comparison of lyophilized and fresh tissue shows for the first time that freeze drying may be one way of overcoming tissue hydration issues while preserving tissue cellular structure. Finally, we compare THz measurements from fresh tissue against necrotic tissue to verify freshness over time. Indeed, THz measurements from fresh and necrotic tissues show marked differences.

Enhanced T-ray signal classification using wavelet preprocessing.

This study demonstrates the application of one-dimensional discrete wavelet transforms in the classification of T-ray pulsed signals. Fast Fourier transforms (FFTs) are used as a feature extraction tool and a Mahalanobis distance classifier is employed for classification. Soft threshold wavelet shrinkage de-noising is used and plays an important role in de-noising and reconstruction of T-ray pulsed signals. An iterative algorithm is applied to obtain three optimal frequency components and to achieve preferred classification performance.

Lower degree of mineralization found in cortical bone of adolescent idiopathic scoliosis (AIS).

UNLABELLED: A lowered bone mineral density (BMD) was observed in trabecular bone in a significant number of AIS patients. The present study aims at investigating whether lower BMD is a systemic phenomenon, which would also be present in the cortical component of long bone. SUBJECTS AND METHODS: 78 AIS girls (age:15-18y.o) with either moderate (Cobb: 20-40) or severe (Cobb: >40) curve and 44 age-matched controls were recruited. The BMD of the distal region and the mid-shaft of radius were measured with a multi-layer peripheral quantitative computed tomography (pQCT). The trabecular bone and cortical bone BMD and the morphology of mid-shaft were compared. RESULTS: Both trabecular and cortical BMD in severe AIS group was significantly lower than the control by 8.7% and 1.7% (p<0.05 for both), respectively. However, the cortical bone area of the mid-shaft did not show any differences from the normal control subjects. DISCUSSION: This study demonstrates a systemic low BMD including the cortical bone. It is suggested that AIS girls may have disturbance in mineralization and ossification during peripubertal growth.

Fine needle aspiration in the diagnosis of metastatic melanoma.

BACKGROUND: Fine needle aspiration is an accurate technique to diagnose metastatic melanoma. Few reports exist in the literature describing its usefulness in many patients with melanoma confirmed by open biopsy. OBJECTIVE: The purpose of this study was to determine the utility and predictive value of fine needle aspiration in patients with malignant melanoma who presented with lesions suspected to be metastatic. METHODS: We retrospectively reviewed 99 cases of fine needle aspiration and the corresponding histologic findings obtained by open biopsy in 82 patients. RESULTS: Of the 99 cases, 86 were positive for melanoma, 12 were negative, and one was indeterminate. The positive predictive value of fine needle aspiration was 99%. One patient had a false-positive diagnosis. CONCLUSION: Fine needle aspiration is a rapid, accurate, and minimally invasive procedure that is useful in the diagnosis of metastatic melanoma. Patients with a positive aspirate of palpable regional nodes can proceed directly to surgery, bypassing the need for an open biopsy.