Behavior of Masonry Walls with Respect to Seismic Stress, Analysis and Recommendation

Structures with masonry infill panels and reinforced concrete frame are widely used structural systems and by lack of knowledge considered secondary, masonry infill walls are considered until now as non-load-bearing elements, therefore the role of taking and transmitting vertical and horizontal loads (seismic)  is  ensured  only  by  the  reinforced  concrete  structure.  However, experience from past earthquakes around the world has shown that this calculation approach is simplifying and approximate, because we have found during the analysis of earthquake damage that the neglect of masonry walls in calculations can decisively influence and even upset the response of structures to seismic forces. The tests carried out in our research and the numerical modelling carried out on several cases have shown that the effect of shear stress on gantry masonry structures can be taken into account by replacing in the numerical modelling the masonry with equivalent diagonals  whose  thickness  will  be  calculated  according  to  the  physical  and mechanical characteristics of the gantry and the masonry

Behavior of Masonry Walls with Respect to Seismic Stress, Analysis and Recommendation

Structures with masonry infill panels and reinforced concrete frame are widely used structural systems and by lack of knowledge considered secondary, masonry infill walls are considered until now as non-load-bearing elements, therefore the role of taking and transmitting vertical and horizontal loads (seismic)  is  ensured  only  by  the  reinforced  concrete  structure.  However, experience from past earthquakes around the world has shown that this calculation approach is simplifying and approximate, because we have found during the analysis of earthquake damage that the neglect of masonry walls in calculations can decisively influence and even upset the response of structures to seismic forces. The tests carried out in our research and the numerical modelling carried out on several cases have shown that the effect of shear stress on gantry masonry structures can be taken into account by replacing in the numerical modelling the masonry with equivalent diagonals  whose  thickness  will  be  calculated  according  to  the  physical  and mechanical characteristics of the gantry and the masonry

Rare intraoperative findings during the management of pediatric inguinal pathologies: a decade of experience

BackgroundPediatric inguinal surgeries, including procedures for inguinal hernias, undescended testes, and hydroceles, are among the most common surgical interventions in children. While these conditions are well-understood, rare intraoperative findings and anatomical variations can complicate surgical management. This study reviews a decade of experience at a single institution to evaluate the incidence, management, and outcomes of such rare findings.MethodsA retrospective observational study was conducted at a tertiary pediatric surgery center in Egypt, analyzing all inguinal surgeries performed between 2013 and 2022. Patients aged ≤14 years with complete operative records were included. Rare findings were defined as anomalies not typically encountered in standard procedures and were independently reviewed by two surgeons. Data were extracted from surgical logs, operative notes, and electronic records.ResultsAmong 8,756 patients (85.5% male, 14.5% female), rare intraoperative findings were identified in 69 cases (0.8%). These included Amyand's hernia (n = 12), looping vas deferens (n = 34), splenogonadal fusion (n = 2), complete androgen insensitivity syndrome (CAIS, n = 7), congenital unilateral absence of the vas deferens (CUAVD, n = 5), crossed ectopic testes (n = 5), ureteroinguinal hernia (n = 1), Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome (n = 1), and encysted hydrocele (n = 1, female). Most anomalies were identified incidentally, with management tailored to preserve function and minimize complications.ConclusionRare findings in pediatric inguinal surgery, though uncommon (<1%), necessitate surgical adaptability and awareness. Preoperative imaging and laparoscopic techniques enhance detection and management. Training programs should emphasize these anomalies to optimize outcomes

Digital watermarking : applicability for developing trust in medical imaging workflows state of the art review

Medical images can be intentionally or unintentionally manipulated both within the secure medical system environment and outside, as images are viewed, extracted and transmitted. Many organisations have invested heavily in Picture Archiving and Communication Systems (PACS), which are intended to facilitate data security. However, it is common for images, and records, to be extracted from these for a wide range of accepted practices, such as external second opinion, transmission to another care provider, patient data request, etc. Therefore, confirming trust within medical imaging workflows has become essential. Digital watermarking has been recognised as a promising approach for ensuring the authenticity and integrity of medical images. Authenticity refers to the ability to identify the information origin and prove that the data relates to the right patient. Integrity means the capacity to ensure that the information has not been altered without authorisation. This paper presents a survey of medical images watermarking and offers an evident scene for concerned researchers by analysing the robustness and limitations of various existing approaches. This includes studying the security levels of medical images within PACS system, clarifying the requirements of medical images watermarking and defining the purposes of watermarking approaches when applied to medical images

Modified Dismembered Technique of Laparoscopic Transperitoneal Pyeloplasty in Children

Background: Laparoscopic pyeloplasty in children gained more and more popularity over the past two decades. However, it remains technically challenging with the most steps of the procedure are ureteric spatulation, DJ insertion, and intracorporeal anastomosis. Many modifications have been proposed to address these issues. In this article, we present our surgical approach to laparoscopic transperitoneal modified dismembered pyeloplasty highlighting some tips to make it easy. Objectives: This study was conducted to evaluate the outcomes of laparoscopic management of ureteropelvic junction obstruction children. Patients and Methods: This was a prospective study carried out on patients who presented with UPJO to our center from May 2019 to October 2021. All the cases underwent laparoscopic transperitoneal modified dismembered pyeloplasty where complete dismembering is deferred after the ureteropelvic anastomosis to prevent ureteral torsion and to use the redundant pelvis as a handle for ureteric manipulation. We used 3 simple techniques for antegrade insertion of DJ. Results: The study included 25 patients (19 males and 6 females) The mean age at operation was 30.88 ± 27.48 months. The mean time needed for the anastomosis was 80 minutes while the mean total operative time was 155 minutes. No conversion was needed. Apart from 2 cases, all other patients showed significant improvement of the degree of hydronephrosis and renal split function. Conclusion: The described modifications facilitated performing the procedure rendering laparoscopic pyeloplasty to be a less demanding and much easier procedure than the conventional technique

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Serum anti-endometrial antibodies as a biomarker for implantation rate in patients with endometriosis who had recurrent implantation failure and prepared for Intracytoplasmic Sperm Injection

Background: Endometriosis is a common disease that affects 10% of reproductive-age women, which extrapolates to approximately 190 million women worldwide. Objectives: we aimed to assess the prognostic value of serum anti-endometrial antibodies estimation in connection to the implantation rate in endometriosis patients with recurrent implantation failure who underwent intracytoplasmic sperm injection cycles (ICSI). Patients and Methods: A prospective cohort study examined infertile patients with endometriosis who underwent ICSI cycles after recurrent implantation failure at assisted reproduction units, Obstetrics and Gynecology departments, South Valley University, and Cairo University. All patients were evaluated and serum anti-endometrial antibodies were measured, followed by an ICSI procedure, and the implantation rate was recorded Results: 32 patients were included; 24 (75%) had primary infertility, and 8 (25%) had secondary infertility. Antiendometrial antibodies were positive in 21 (65.62%) patients, with a significant negative correlation between anti-endometrial antibodies and implantation rate in patients with recurrent implantation failure (P= 0.010). Conclusion: Serum anti-endometrial antibodies exhibited a negative association with implantation rate and oocyte quality, suggesting a potential use as a biomarker in endometriosis patients with recurrent implantation failure undergoing ICSI cycles

Machine Learning and External Validation of the IDENTIFY Risk Calculator for Patients with Haematuria Referred to Secondary Care for Suspected Urinary Tract Cancer

Background: The IDENTIFY study developed a model to predict urinary tract cancer using patient characteristics from a large multicentre, international cohort of patients referred with haematuria. In addition to calculating an individual's cancer risk, it proposes thresholds to stratify them into very-low-risk (<1%), low-risk (1–<5%), intermediate-risk (5–<20%), and high-risk (≥20%) groups. Objective: To externally validate the IDENTIFY haematuria risk calculator and compare traditional regression with machine learning algorithms. Design, setting, and participants: Prospective data were collected on patients referred to secondary care with new haematuria. Data were collected for patient variables included in the IDENTIFY risk calculator, cancer outcome, and TNM staging. Machine learning methods were used to evaluate whether better models than those developed with traditional regression methods existed. Outcome measurements and statistical analysis: The area under the receiver operating characteristic curve (AUC) for the detection of urinary tract cancer, calibration coefficient, calibration in the large (CITL), and Brier score were determined. Results and limitations: There were 3582 patients in the validation cohort. The development and validation cohorts were well matched. The AUC of the IDENTIFY risk calculator on the validation cohort was 0.78. This improved to 0.80 on a subanalysis of urothelial cancer prevalent countries alone, with a calibration slope of 1.04, CITL of 0.24, and Brier score of 0.14. The best machine learning model was Random Forest, which achieved an AUC of 0.76 on the validation cohort. There were no cancers stratified to the very-low-risk group in the validation cohort. Most cancers were stratified to the intermediate- and high-risk groups, with more aggressive cancers in higher-risk groups. Conclusions: The IDENTIFY risk calculator performed well at predicting cancer in patients referred with haematuria on external validation. This tool can be used by urologists to better counsel patients on their cancer risks, to prioritise diagnostic resources on appropriate patients, and to avoid unnecessary invasive procedures in those with a very low risk of cancer. Patient summary: We previously developed a calculator that predicts patients’ risk of cancer when they have blood in their urine, based on their personal characteristics. We have validated this risk calculator, by testing it on a separate group of patients to ensure that it works as expected. Most patients found to have cancer tended to be in the higher-risk groups and had more aggressive types of cancer with a higher risk. This tool can be used by clinicians to fast-track high-risk patients based on the calculator and investigate them more thoroughly

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care