Clinical and functional outcomes of pre-contoured plate fixation in displaced intraarticular calcaneum fracture

Background: We evaluated the clinical and functional outcome of intra-articular calcaneal fractures treated with pre-contoured plating. The functional outcome was measured by the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system.Methods: Twenty-five adult patients with displaced intra-articular calcaneus fractures, treated with by open reduction and internal fixation using pre-contoured plates, and those who were available for follow up were evaluated for the outcomes such as operative procedure, anatomical reduction, postoperative hospital stays early mobilization and functional outcome postoperatively. Follow-up was at three, six and twelve months radiological and clinical union were also considered.Results: Twenty-five adult patients presented with calcaneal fractures were operated during the study period. The mean time for union of fracture was 12.5±1.8 weeks. When we assessed the functional outcome in those patients who had radiological and clinical union using AOFAS score, we found that 16 out of 23 (64%) had good results with mean AOFAS score of 83.5±2.0 and 7/25 (28%) had fair results with mean score of 73.3±1.3, and 2/25 (8%) had poor results with mean score of 54.0±8.5. In 2 out of 16 (12.5%) patients, with good AOFAS scores, implants were removed after one and a half year from the day of surgery after confirming complete union of the fracture.Conclusions: We believe that pre-contoured reconstruction plate fixation for displaced intraarticular calcaneus fracture is excellent in terms of the union of the fracture, attaining anatomical reduction. It gives better outcomes concerning the function and range of movements

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

EFFICIENT SEARCH ALGORITHM DESIGN FOR UNSTRUCTURED PEER-TO-PEER NETWORKS

Peer-to-peer systems are becoming increasingly popular, with millions of simultaneous users and a wide range of applications. Understanding existing systems and devising new peer-to-peer techniques relies on access to representative models derived from empirical observations. Due to the large and dynamic nature of these systems, directly capturing global behavior is often impractical. Sampling is a natural approach for learning about these systems, and most previous studies rely on it to collect data. This paper addresses the common problem of selecting representative samples of peer properties such as peer degree, link bandwidth, or the number of files shared. A good sampling technique will select any of the peers present with equal probability. However, common sampling techniques introduce bias in two ways. First, the dynamic nature of peers can bias results towards short-lived peers, much as naively sampling flows in a router can lead to bias towards shortlived flows. Second, the heterogeneous overlay topology can lead to bias towards high-degree peers. We present preliminary evidence suggesting that applying a degree-correction method to random walk-based peer selection leads to unbiased sampling, at the expense of a loss of efficiency