Comparison of Arterial and Venous Interposition Grafting for Arterial Defects in a Rat Model.

BACKGROUND: Interposition microvascular grafting may be required to bridge arterial defects during digital replantation or revascularization and has traditionally been performed utilizing a venous autograft. Arterial interposition grafting has been shown to be superior in maintaining patency in large vessel surgery; there are case reports of its use in microsurgery. METHODS: Six fellowship-trained hand and microsurgeons performed arterial and venous interposition grafts on the femoral arteries of 40 Wistar rats. After sectioning one femoral artery a segment of the contralateral femoral artery or vein was obtained. The time was recorded per graft and patency tested 10 minutes following grafting by an independent assessor. Each surgeon also completed a questionnaire detailing regular microsurgical volume, technical ease, and conceptual preference for either graft. RESULTS: Time for arterial interposition (median time 51.7 minutes) was longer than venous grafting (median time 45.9 minutes, p = 0.075). Arterial grafts were more likely to be patent or questionably patent (odds ratio [OR] = 6.77, p = 0.031). All surgeons found arterial interposition grafting technically easier and preferred it conceptually. Improvements were noted in patency rates (OR = 11.29, p = 0.018) and avoidance of anastomotic leak (OR = 0.19, p = 0.029) when surgeons performed moderate levels or greater of microsurgery within their regular practice. CONCLUSION: Greater immediate patency was noted with arterial interposition grafting in a rodent model when compared to venous grafting, although procedural time was greater. All surgeons found arterial grafting technically easier. Arterial microvascular grafting may be useful in the setting of digital replantation or revascularization with an arterial defect.

A survey on investigating the need for intelligent power-aware load balanced routing protocols for handling critical links in MANETs.

In mobile ad hoc networks connectivity is always an issue of concern. Due to dynamism in the behavior of mobile nodes, efficiency shall be achieved only with the assumption of good network infrastructure. Presence of critical links results in deterioration which should be detected in advance to retain the prevailing communication setup. This paper discusses a short survey on the specialized algorithms and protocols related to energy efficient load balancing for critical link detection in the recent literature. This paper also suggests a machine learning based hybrid power-aware approach for handling critical nodes via load balancing.

Arthroscopic Lunate Excision for Stage 3 Kienbock's Disease.

Background The ideal treatment of stage 3 Kienbock's disease is uncertain, with current open procedures conferring the risk of carpal instability, ulnar translocation, and stiffness. We present our technique of arthroscopic lunate excision, and discuss our short- to medium-term results. Description of Technique Via standard wrist arthroscopic portals, the lunate is excised using a combination of shavers, burrs, and rongeurs. Care is taken to preserve the extreme dorsal and volar cortices of the lunate to prevent carpal instability. A short arm backslab is applied for 2 weeks, after which the patient commences range of motion. Patients and Methods Consecutive patients undergoing arthroscopic lunate excision at a single center in Paris, France, underwent pre- and postoperative assessment. Parameters assessed include range of motion, as well as patient-reported outcome measures (PROMs). Results A cohort of 13 patients (7 females and 6 males with a mean age of 27.2 years) underwent arthroscopic lunate excision, and were followed up for a mean of 1.96 years. Significant improvements were noted in flexion, extension, pronation, grip strength, and PROMs. Conclusions Arthroscopic lunectomy provides significant improvements in clinical and PROMs at short- to medium-term follow-up, and conserves other salvage options in case of failure. Long-term clinical follow-up and further biomechanical studies would be beneficial.

Injection of a Bone Substitute in the Treatment of Unicameral Bone Cysts.

Background: Simple bone cysts are benign bony lesions. Treatment strategies are varied for this particular pathology. It remains controversial as to what the ideal treatment strategy is. Recently, bony substitute injections have emerged as a potential option for treatment. This paper aimed to describe our institution's experience in using bony substitute injections to treat unicameral bone cysts. Methods: A retrospective review of consecutive patients over an 84-month period at a tertiary paediatric hospital was performed. Information regarding patients' presentation, diagnosis, and management was recorded and summarised. Results: A total of 15 patients were included in our study, with a mean follow-up of 118 weeks. 86.7% of patients demonstrated clinical resolution (absence of pain at the latest follow-up) and 80% of patients demonstrated radiographic resolution. Only one patient sustained a subtrochanteric fracture post-index operation, whilst two others demonstrated redevelopment of cystic architecture on follow-up. Conclusion: This study demonstrates that bone substitute injection is potentially a minimally invasive and seemingly successful technique in the treatment of unicameral bone cysts and other simple bone lesions. Further randomised and comparative studies are required to confirm and validate our findings.

Outcomes following reverse total shoulder arthroplasty vs operative fixation for proximal humerus fractures: a systematic review and meta-analysis.

INTRODUCTION: Proximal humerus fractures are common in the older population. A consensus on the optimal management of complex fractures requiring surgery has yet to be reached. A systematic review and meta-analysis was performed to compare clinical outcomes between reverse total shoulder arthroplasty (RTSA) and open reduction and internal fixation (ORIF). METHODS: A systematic search of the literature was undertaken using the Medline®, PubMed, Embase™ and Cochrane Central Register of Controlled Trials databases. Prospective and retrospective studies comparing clinical and patient reported results as primary outcome measures were included in this review, with secondary outcome measures including complications and revision surgery. A meta-analysis was conducted. RESULTS: A total of 326 patients from 5 studies were eligible for inclusion in this review. Superior Constant-Murley scores (mean difference [MD]: 13.4, 95% confidence interval [CI]: 6.2-20.6; p<0.001), Oxford shoulder scores (MD: 4.3, 95% CI: 1.2-7.4; p=0.007), simple shoulder test scores (MD: 0.95, 95% CI: 0.01-1.89; p=0.05) and DASH (Disabilities of the Arm, Shoulder and Hand) scores (MD: 5.1 [1 study], 95% CI: 2.1-8.1; p=0.034) were noted in patients receiving RTSA. Range of motion and revision surgery rates were also superior in this group. CONCLUSIONS: This study suggests that RTSA affords more favourable outcomes and lower revision rates than ORIF following proximal humerus fractures. Definitive conclusions are precluded, however, owing to small sample sizes and risk of bias in retrospective studies.

Design of Automated Deep Learning-Based Fusion Model for Copy-Move Image Forgery Detection.

Due to the exponential growth of high-quality fake photos on social media and the Internet, it is critical to develop robust forgery detection tools. Traditional picture- and video-editing techniques include copying areas of the image, referred to as the copy-move approach. The standard image processing methods physically search for patterns relevant to the duplicated material, restricting the usage in enormous data categorization. On the contrary, while deep learning (DL) models have exhibited improved performance, they have significant generalization concerns because of their high reliance on training datasets and the requirement for good hyperparameter selection. With this in mind, this article provides an automated deep learning-based fusion model for detecting and localizing copy-move forgeries (DLFM-CMDFC). The proposed DLFM-CMDFC technique combines models of generative adversarial networks (GANs) and densely connected networks (DenseNets). The two outputs are combined in the DLFM-CMDFC technique to create a layer for encoding the input vectors with the initial layer of an extreme learning machine (ELM) classifier. Additionally, the ELM model's weight and bias values are optimally adjusted using the artificial fish swarm algorithm (AFSA). The networks' outputs are supplied into the merger unit as input. Finally, a faked image is used to identify the difference between the input and target areas. Two benchmark datasets are used to validate the proposed model's performance. The experimental results established the proposed model's superiority over recently developed approaches.

Automated Cardioailment Identification and Prevention by Hybrid Machine Learning Models.

Accurate prediction of cardiovascular disease is necessary and considered to be a difficult attempt to treat a patient effectively before a heart attack occurs. According to recent studies, heart disease is said to be one of the leading origins of death worldwide. Early identification of CHD can assist to reduce death rates. When it comes to prediction using traditional methodologies, the difficulty arises in the intricacy of the data and relationships. This research is aimed at applying recent machine learning technology to identify heart disease from past medical data to uncover correlations in data that can greatly improve the accuracy of prediction rates using various machine learning models. Models have been implemented using naive Bayes, random forest algorithms, and the combinations of two models such as naive Bayes and random forest methods. These methods offer numerous attributes associated with heart disease. This proposed system foresees the chance of rising heart disease. The proposed system uses 14 parameters such as age, sex, quick blood sugar, chest discomfort, and other medical parameters which are used in the proposed system. Our proposed systems find the probability of developing heart disease in percentages as well as the accuracy level (accuracy of 93%). Finally, this proposed method will support the doctors to analyze the heart patients competently.

The psychological impact of facial changes in scleroderma.

The physical disabilities associated with scleroderma are well known but the psychological impact of the condition has received less attention. Few studies have examined appearance related issues, most notably of the face. The aim of this study is to evaluate the psychological impact of facial, aesthetic and functional changes in scleroderma. One hundred seventy-one patients with a clinical diagnosis of scleroderma were recruited into the study. Digital photographs were objectively graded into groups based on severity of disfigurement as judged by an observer. Facial movement was recorded using a modified House-Brackmann Grading Scale. Psychological evaluation comprised the Derriford Appearance Scale short-form (DAS), the Noticeability and Worry score and the Hospital Anxiety and Depression Scale (HADS). Severity of disfigurement predicted decreased mouth opening, the extent to which participants judged their appearance as noticeable to others, and the level of appearance-related concern as measured by the DAS24. There was an inverse relationship with age. Facial changes were ranked as the most worrying aspect of the condition. This study shows facial disfigurement impacts on patient with scleroderma independent of functional changes related to systemic disease. The major difficulty is with the perceived noticeably of the condition to other people and the resulting self-consciousness in social encounters.

Management of Fibro-adipose Vascular Anomalies (FAVA) in Paediatric Practice.

Fibro-adipose vascular anomaly (FAVA) is a discrete type of vascular anomaly. We describe our experience managing FAVA at a tertiary level paediatric hospital and offer a treatment algorithm. METHODS: A retrospective review of 27 patients with proven FAVA was undertaken. All patients had undergone MRI and USS evaluation. Patient demographics, presenting concerns, treatment methods, and outcomes were recorded and evaluation with the paediatric outcomes data collection instrument (PODCI) completed a minimum of 12 months after definitive treatment. RESULTS: Mean age at presentation was 8.9 years (range: 9 m-17.4 y) and mean post-treatment follow-up was 7.4 y (range: 2 y-11.6 y). Twenty of 27 lesions affected the lower limb. Severe neurogenic-type pain was present in 23 cases and contractures across joints in 11 cases. Sclerotherapy with sodium tetradecyl sulphate was used in 11 cases, with no improvement in symptoms. Cryoablation provided pain relief in 3/4 cases, but contracture subsequently increased in one patient and pain recurred in another.Fourteen cases underwent surgery (four surgical excisions alone, 10 in combination with other procedures). Three patients required four further surgical procedures that include one amputation for intractable pain and poor function.PODCI evaluations suggest overall good function, with surgical management and interventional radiology that provide comparable results. Surgery did correct deformity. CONCLUSION: If conservative measures or cryoablation fail to achieve symptomatic control, surgical excision should be considered, combined with adjunctive procedures, to correct contractures and balance muscle forces.Relief of pain may compensate for the loss of muscle mass and overall improves function. Multidisciplinary team working is essential.

Collocated burn and fracture injuries in major trauma: a 10 year experience.

INTRODUCTION: Collocated burn and fracture injuries, defined as a burn overlying the site of a fracture, represent a serious subset of major burns and trauma. The literature pertaining to these rare injuries is inconclusive. Recent studies cast doubt on the safety of operative fixation in this population. No study to date has examined outcomes of collocated burn and fracture injuries compared with control. The aim of this study was to compare characteristics, injury patterns and complication rates in major burns and fracture patients with a collocated injury to those without. METHODS: A retrospective chart review of all consecutive patients with dermal burns and major fractures were undertaken between January 2005 and December 2015 at a tertiary referral trauma hospital. Outcomes assessed included demographics, injury characteristics and complications, including infection. Orthopaedic infection was defined as orthopaedic surgical site infection or osteomyelitis. RESULTS: Of the 40 patients identified, 21 subjects sustained collocated injuries. Patients with collocated injuries demonstrated a trend towards higher injury severity, higher percentage of total body surface area affected, longer length of stay and greater overall and orthopaedic complication rate. Significant predictors of orthopaedic infection were related to injury severity rather than collocation or operative management. CONCLUSION: There are differences in the characteristics and complication rates between collocated and non-collocated burn and fracture injuries. Collocated injuries tend to result from greater energy mechanisms, undergo longer inpatient stays and demonstrate increased morbidity. Injury severity appears to be the most important factor in determining postoperative orthopaedic infection. These characteristics must be considered when managing these rare but significant injuries.

Modification of obturator to femoral nerve transfer for femoral nerve palsy.

Postoperative femoral nerve palsy with nerve division is a potentially devastating complication with a poor prognosis, especially when there is a delay in diagnosis. We present a novel 'belt and braces' approach for managing this unusual injury, using a modification of a nerve transfer, which has only been previously reported in the literature three times to our knowledge.

Effect of micronutrient supplementation on health and nutritional status of schoolchildren: growth and morbidity.

OBJECTIVE: We evaluated the effect of a micronutrient-fortified beverage on growth and morbidity in apparently healthy schoolchildren. METHODS: This was a double-blind, placebo-controlled, matched-pair, cluster, randomized study in semi-urban middle-income residential schoolchildren aged 6 to 16 y. Anthropometrics (height and weight), clinical symptoms of deficiency, and morbidity data were collected at baseline in the supplemented group (n = 446 in 10 grades) and the placebo group (n = 423 in 10 grades) and after 14 mo of supplementation (n = 355 in the supplement group and n = 340 in the placebo group from nine pairs). RESULTS: After 14 mo of supplementation, there was a significant increase in mean increments of height and weight z scores of -0.04 and 0.02, respectively, in the supplemented group compared with -0.14 and -0.09 in the placebo group. Velocity of weight (3.56 versus 3.00) was significantly (P < 0.01) higher with supplementation. Although there were no differences in the incidence of common childhood diseases such as fever, cough and cold, diarrhea, and ear infections elicited for a reference period of 1 mo at every quarterly follow-up examination, the mean duration of illness (calculated per person per year) was significantly shorter (5.0 d) in the supplemented group than in the placebo group (7.4 d). CONCLUSIONS: The micronutrient-fortified beverage was beneficial in promoting growth and decreasing duration of common illnesses among middle-class residential schoolchildren who had adequate energy and protein intakes.

Flexor tendon repairs in children: Outcomes from a specialist tertiary centre.

We evaluate the functional outcomes of early active mobilization (EAM) after paediatric flexor tendon repair at one centre from 2006 to 2013. A generic rehabilitation protocol was used for the first four to six weeks: boxing glove immobilization (<5 years), dorsal blocking splint and cage (5-10 years) or dorsal blocking splint ± cage (10-16 years). Outcomes were assessed using the Total Active Mobilization (TAM) method of the American Society for Surgery of the Hand and original Strickland criteria (OSC). Sixty-three fingers and 99 tendons were identified, in 57 children. Thirty-five per cent (n = 20) were in zone 2, 23% in zone 1, 18% in zone 5, 14% in zone 3 and 2% in zone 4. Good/excellent results were obtained in 82% by the TAM method and 79% by the OSC of those suitable for analysis (56 tendons in 44 children). The surgical approaches used varied in technique and material; a modified Kessler stitch (n = 42) using prolene (n = 60) represented the majority of core sutures. Epitendinous repair was employed in 76% of repairs (n = 75). The median length of hand therapy follow-up was 83.5 days (IQR 43.5-143.75 days). Complications included: one rupture, one post-operative infection requiring washout and three contractures, two requiring re-operation. EAM is a practical and safe way to rehabilitate children after flexor tendon repair, without increasing ruptures or adhesions. Most children under five are managed effectively in a bulky bandage.

Synthesis, crystal structure and characterization of a new optical di-lithium di-phthalate single crystals.

Single crystals of a new alkali phthalic complex salt of di-lithium di-phthalate (C32H30Li4O21) (DLDP) were grown by slow evaporation of an aqueous solution at room temperature. The compound crystallizes in a monoclinic system with a centrosymmetric space group having the unit cell parameters; a=17.037(5) Å, b=5.134(5) Å, and c=21.398(5) Å and α=90.000(5)°, ß=113.195(5)°, and γ=90.000(5)° with Z=2. The structure has been refined up to a R-value of 0.0828 from 26,248 observed reflections using a three-dimensional X-ray diffraction intensity data. The vibrational structure of the compound confirms the presence of various functional groups in the molecule. Mass spectrometric analysis provides the molecular weight of the compound and possible ways of fragmentations occurring in the compound. Thermal stability of the crystal was also studied by simultaneous TGA/DTA analyses. The UV-VIS-NIR spectrum was recorded to study the transmittance properties of the grown crystals. The obtained results are discussed in detail.

Efficient anti-corrosive coating of cold-rolled steel in a seawater environment using an oil-based graphene oxide ink.

We report the production of an efficient anti-corrosive coating of cold-rolled (CR) steel in a seawater environment (∼3.5 wt% NaCl aqueous solution) using an oil-based graphene oxide ink. The graphene oxide was produced by heating Aeschynomene aspera plant as a carbon source at 1600 °C in an argon atmosphere. The ink was prepared by cup-milling the mixture of graphene oxide and sunflower oil for 10 min. The coating of ink on the CR steel was made using the dip-coating method, followed by curing at 350 °C for 10 min in air atmosphere. The results of the potentiodynamic polarization show that the corrosion rate of bare CR steel decreases nearly 10,000-fold by the ink coating. Furthermore, the salt spray test results show that the red rusting in the ink-coated CR steel is initiated after 100 h, in contrast to 24 h and 6 h in the case of oil-coated and bare CR steel, respectively. The significant decrease in the corrosion rate by the ink-coating is discussed based on the impermeability of graphene oxide to the corrosive ions.

In vivo identification, survival, and functional efficacy of transplanted hepatocytes in acute liver failure mice model by FISH using Y-chromosome probe.

Hepatocyte transplantation has excited much interest in lending temporary metabolic support to a failing liver following acute liver injury. The exact site from which they act and the clinical, biochemical, and histological changes in the recipient body following hepatocyte transplantation is yet to be worked out. The present study is an attempt to delineate location and function of transplanted hepatocytes and also the overall survival of these cells with a fluorescent in situ hybridization (FISH) technique using a Y-chromosome-specific probe in a carbon tetrachloride (CCl4)-induced mice model of fulminant hepatic failure. Fifty-five syngenic adult Swiss female mice of approximately the same age and body weight were divided into three groups. Group-1 (n = 15), which received mineral oil, served as a negative control. Group-II (n = 15) received CCl4 (3 mL/kg) 40% vol/vol in mineral oil, by gavage served as positive control for hepatic failure. Group-III (n = 25) received intrasplenic transplantation of syngenic single cell suspension of hepatocytes in Hanks medium, after 30 h of CCl4 administration. Male Swiss adult mice (n = 15) served as donors of hepatocytes. The overall survival of animals in groups I to III was 100, 0, and 70%, respectively, by 2 wk of the study period. Transplanted hepatocytes were identified by Periodic Acid Schiff (PAS) staining and confirmed with a FISH technique using the Y-chromosome probe. The majority of exogenously transplanted hepatocytes were found in the liver and spleen sections even after 1 wk of hepatocyte transplantation. Transplanted cells were mostly found to be translocated into the sinusoids of the liver. Transplanted hepatocytes were found to be beneficial as a temporary liver support in a failing liver, significantly improving the survival of the animals. In the present study, the FISH technique was used to unequivocally distinguish the transplanted cells from the host, and thus describes a model for studying the distribution and survival of the transplanted cells.

Evaluation of a microspectrofluorimetric method or serum vitamin A.

A microspectrofluorimetric method for vitamin A was compared with spectrophotometric and trifluoroacetic acid-colorimetric procedures. Values obtained by the fluorimetric method showed a high degree of correlation with those obtained by other standard procedures. However, it was found that the fluorimetric method yielded values which were several-fold higher than those obtained with the spectrophotometric method when sera from pregnant women were tested. The fluorescence from sera of pregnant subjects showed a triphasic decline even when the samples were stored at --20 degrees C.

Effect of food restriction (undernutrition) on pharmacokinetics of levonorgestrel in rabbits.

Twelve female rabbits aged about 3-4 months were randomly divided into two groups (group A and group B) and were individually matched for their initial body weights. Animals of group A received a stock diet ad libitum while each of the animals in group B were fed 50% of the diet consumed by the corresponding matched control from group A. Pharmacokinetics of levonorgestrel were determined in all animals between 1 1/2-2 months after these diets were started, using an intravenous dose of 8-20 /uCi of 3H-levonorgestrel and 15-20 /ug of levonorgestrel per kg body weight. Urinary excretion of radioactivity was also measured in all the animals for a period of 5 days following the dose. The body weights of animals on the restricted diet were 17% lower than those of the ad lib fed animals. Haemoglobin levels and plasma albumin concentration were found to be in the normal range in both groups. There was a significant increase in Metabolic Clearance Rate (MCR) and t 1/2 pi and a decrease in elimination half-life in animals of group B as compared to those seen in animals of group A. The urinary excretion of label was found to be slightly increased in group B animals as compared to that in group A controls.

Bioavailability of levonorgestrel from intravaginal rings in women of low income groups.

Two types of intravaginal rings (IVR) containing 50-128 mg of levonorgestrel (LNOG) and 28-60 mg of estradiol were inserted in 18 apparently normal subjects belonging to the low socioeconomic group on day 5 of the cycle. A total of 120 cycles were studied with cyclic insertion and withdrawal. Data on menstrual cycle changes were noted. For bioavailability study, blood samples were collected twice weekly for a period of one month in the first cycle in 8 women. All the plasma samples were analysed for LNOG and progestrone by RIA. Cycle control was excellent in IVR users. Expulsion of the ring was noted in 4 instances. The plasma LNOG levels were found to reach a peak level ranging from 2.7-7.5 ng/ml within 4 days after the IVR insertion. In between day 9 to 24, the plasma levels appeared to be almost steady, and once the ring was removed, the levels dropped off rapidly. The mean plasma LNOG calculated during the steady-state period of the cycle ranged from 1.6-5.1 ng/ml. These mean LNOG levels were found to be inversely correlated with skin-fold at triceps. In all the subjects ovulation was found to be inhibited, as reflected by plasma progesterone values. The range of release rates calculated from plasma steady-state values was 51-119 micrograms/day. The average release rates over the entire period of observation based on area under curve were 102-200 micrograms/day. On the other hand, the release rates obtained from the residual drug in the ring after a period of use ranged from 184-259 micrograms/day.

Pharmacokinetics of norethisterone and levonorgestrel in experimental iron deficiency anemia in rabbits.

Mild-moderate anemia (hemoglobin, 10-12 g/100 ml) was induced in eight female rabbits by feeding a purified diet with low iron content over a period of 4 months and it could be maintained for a further period of 7 months. Nine control animals received the same diet supplemented with iron. Pharmacokinetics of intravenously administered contraceptive steriods, norethindrone and levonorgestrel, were determined in both control and anemic rabbits at the end of 150 and 171 days, respectively. No significant alterations were observed in the disposition of these steroids in deficient rabbits as compared to controls, indicating that mild-moderate forms of iron deficiency anemia may not influence the metabolic handling of either norethindrone or levonogestrel.