Perioperative thromboprophylaxis in digital replantation: a systematic review

Background There is no international consensus on the use of perioperative thromboprophylaxis in digital replantation. Suboptimal perioperative management may lead to replant failure which compromises extremity function, worsens psychosocial outcomes for patients and incurs significant cost. This systematic review evaluates and compares the efficacy and safety of perioperative antithrombotic protocols used in digital replantation. Methods A PRISMA-compliant prospectively registered (PROSPERO CRD42018108695) systematic review was conducted. Cochrane Central Register of Controlled Trials, Medline, EMBASE and Scopus were searched up until December 2019. Articles were assessed for eligibility in duplicate by two independent reviewers. All comparative studies which examined the use of perioperative thromboprophylaxis in digital replantation were eligible for inclusion. Results Collectively, 1,025 studies were identified of which 7 met full inclusion criteria reporting data from 635 patients (908 digital replants, 86% male, average age 37.3 years). Laceration was the most commonly reported mechanism of injury (68%) with 33% of replantation occurring in Tamai zone III. Fourteen distinct perioperative protocols were identified. One study reported significantly higher digital survival with continuous heparin infusion versus bolus heparin. Five studies demonstrated a significantly higher incidence of complications amongst patients treated with systemic heparin. Conclusions The clinical efficacy and safety of peri-operative antithrombotic therapy following digital replantation remains equivocal. The perceived benefits of improved digital survival must be tempered against the adverse systemic side effects of antithrombotic and anticoagulant therapies until further prospectively collected data sets become available

Coming to America: Iranians' use of Telegram for immigration information seeking

Purpose This study examines Iran-US migrants' use of the most popular messaging application in Iran—Telegram—and shows how they use it to manage their migration information practices. Design/methodology/approach This study took a qualitative observation approach. Over the course of six months, over 80 h of observations were conducted on Iran-US migration-related settings within Telegram. Findings This work identifies the information practices that emerge as users seek and share information related to Iran-US migration. Telegram plays a vital role across the immigration stages, predominantly in the pre-migration stage. This work also shows how the constraints and features of Telegram influence users' information sharing and seeking practices. Practical implications The findings support the implication that a social media platform that provides multiple ways to interact is likely to better support niche or unanticipated uses. Originality/value This study is the first of its kind to explore Iranian Immigrants information practices in the US. The immigration information practices observed during this study represent a valuable example of end-user appropriation within extraordinary constraints, which may be of use in other information-seeking contexts where dedicated or bespoke tools are impractical or ill-advised

Multi-port coordination: Unlocking flexibility and hydrogen opportunities in green energy networks

\ua9 2024Seaports are responsible for consuming a large amount of energy and producing a sizeable amount of environmental emissions. However, optimal coordination and cooperation present an opportunity to transform this challenge into an opportunity by enabling flexibility in their generation and load units. This paper introduces a coordination framework for exploiting flexibility across multiple ports. The proposed method fosters cooperation between ports in achieving lower environmental emissions while leveraging flexibility to increase their revenue. This platform allows ports to participate in providing flexibility for the energy grid through the introduction of a green port-to-grid concept while optimising their cooperation. Furthermore, the proximity to offshore wind farms is considered an opportunity for the ports to investigate their role in harnessing green hydrogen. The proposed method explores the hydrogen storage capability of ports as an opportunity for increasing the techno-economic benefits, particularly through coupling them with offshore wind farms. Compared to existing literature, the proposed method enjoys a comprehensive logistics-electric model for the ports, a novel coordination framework for multi-port flexibility, and the potentials of hydrogen storage for the ports. These unique features position this paper a valuable reference for research and industry by demonstrating realistic cooperation among ports in the energy network. The simulation results confirm the effectiveness of the proposed port flexibility coordination from both environmental and economic perspectives

Survival Statistics of Digital Replantation in the UK

Background Digital replantation is associated with a substantial risk of failure. There is considerable variation in survival rates globally, and the current data are limited by poor statistical methods and bias of selection, which limits its translation to Europe and the USA. We aimed to establish a more representative survival rate of digit replantation for western populations and evaluate espoused prognostic variables using robust statistical methodology. Materials and Methods Retrospective data were collected from 58 consecutive patients who underwent digital replantation following traumatic amputation in three tertiary care hand centres in the UK over seven years. The unit of analysis was the digit. Generalized linear modelling was used to estimate the odds ratio (OR) of digit survival. Results Forty-six of 68 replanted digits survived (68%). The typical replant candidate was a 40-year-old male manual worker. Digit survival was more likely with guillotine injuries (adjusted OR 25.5 [95% CI 5.60, 115]) and when intraoperative skeletal shortening was performed (adjusted OR 15.3 [95% CI 2.62, 89.5]). The age of the patient, seniority of the operating surgeon, and use of vein grafts was not associated with digit survival. Conclusion We provide robust data to show that guillotine amputations have more favourable survival rates, which can be further improved by skeletal shortening at the time of replantation. We suggest that research networks worldwide set up digit amputation registries to capture individual patient data on this uncommon injury

Influence of surface geometry on the culture of human cell lines: a comparative study using flat, round-bottom and v-shaped 96 well plates

© 2017 Shafaie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.In vitro cell based models have been invaluable tools for studying cell behaviour and for investigating drug disposition, toxicity and potential adverse effects of administered drugs. Within this drug discovery pipeline, the ability to assess and prioritise candidate compounds as soon as possible offers a distinct advantage. However, the ability to apply this approach to a cell culture study is limited by the need to provide an accurate, in vitro-like, microenvironment in conjunction with a low cost and high-throughput screening (HTS) methodology. Although the geometry and/or alignment of cells has been reported to have a profound influence on cell growth and differentiation, only a handful of studies have directly compared the growth of a single cell line on different shaped multiwell plates the most commonly used substrate for HTS, in vitro, studies. Herein, the impact of various surface geometries (flat, round and v-shaped 96 well plates), as well as fixed volume growth media and fixed growth surface area have been investigated on the characteristics of three commonly used human cell lines in biopharmaceutical research and development, namely ARPE-19 (retinal epithelial), A549 (alveolar epithelial) and Malme-3M (dermal fibroblastic) cells. The effect of the surface curvature on cells was characterised using a combination of a metabolic activity assay (CellTiter AQ/MTS), LDH release profiles (CytoTox ONE) and absolute cell counts (Guava ViaCount), respectively. In addition, cell differentiation and expression of specific marker proteins were determined using flow cytometry. These in vitro results confirmed that surface topography had a significant effect (p < 0.05) on cell activity and morphology. However, although specific marker proteins were expressed on day 1 and 5 of the experiment, no significant differences were seen between the different plate geometries (p < 0.05) at the later time point. Accordingly, these results highlight the impact of substrate geometry on the culture of a cell line and the influence it has on the cells' correct growth and differentiation characteristics. As such, these results provide important implications in many aspects of cell biology the development of a HTS, in vitro, cell based systems to further investigate different aspects of toxicity testing and drug delivery.Peer reviewedFinal Published versio

Congenital goiter in North of Iran: A case report

Congenital goiter (CG) is one of the rarest disorders observed in a newborn at birth diagnosed with hypothyroidism. Considering the simultaneity of pregnancy and baby's hypothyroidism at birth, the goiter can be caused by diabetes during pregnancy and hypothyroidism emergence in the baby. © 2020 The Authors. Clinical Case Reports published by John Wiley & Sons Lt

FIB patterning of stainless steel for the development of nano-structured stent surfaces for cardiovascular applications

Stent implantation is a percutaneous interventional procedure that mitigates vessel stenosis, providing mechanical support within the artery and as such a very valuable tool in the fight against coronary artery disease. However, stenting causes physical damage to the arterial wall. It is well accepted that a valuable route to reduce in-stent re-stenosis can be based on promoting cell response to nano-structured stainless steel (SS) surfaces such as by patterning nano-pits in SS. In this regard patterning by focused ion beam (FIB) milling offers several advantages for flexible prototyping. On the other hand FIB patterning of polycrystalline metals is greatly influenced by channelling effects and redeposition. Correlative microscopy methods present an opportunity to study such effects comprehensively and derive structure–property understanding that is important for developing improved patterning. In this chapter we present a FIB patterning protocol for nano-structuring features (concaves) ordered in rectangular arrays on pre-polished 316L stainless steel surfaces. An investigation based on correlative microscopy approach of the size, shape and depth of the developed arrays in relation to the crystal orientation of the underlying SS domains is presented. The correlative microscopy protocol is based on cross-correlation of top-view scanning electron microscopy, electron backscattering diffraction, atomic force microscopy and cross-sectional (serial) sectioning. Various FIB tests were performed, aiming at improved productivity by preserving nano-size accuracy of the patterned process. The optimal FIB patterning conditions for achieving reasonably high throughput (patterned rate of about 0.03 mm2/h) and nano-size accuracy in dimensions and shapes of the features are discussed as well

Helping Their Child, Helping Each Other: Parents’ Mediated Social Support in the Children's Hospital

During a health crisis, such as the hospitalization of a child with a serious illness, families must adjust and support each other in coordinating care. CSCW researchers have shown the potential for collaborative technologies to enhance social support in different settings. However, less is known about the potential for CSCW technologies to augment social support practices within family caregiving circles. In this poster, we describe findings from 14 interviews with parents of children hospitalized for cancer treatment. We categorized the support practices between parents and found that they rely heavily on technology to support each other from a distance. We identified opportunities for designing future collaborative technology to augment social support in caregiving teams