Mini-sternotomy for aortic valve replacement reduces the length of stay in the cardiac intensive care unit: meta-analysis of randomised controlled trials

Background Mini-sternotomy for isolated aortic valve replacement aims to reduce operative trauma hastening recovery and improving the cosmetic outcome of cardiac surgery. The short-term clinical benefits from the mini-sternotomy are presumed to arise because the incision is less extensive and the lower half of the chest cage remains intact. The basic conduct of virtually all other aspects of the aortic valve replacement procedure remains the same. Therefore, similar long-term outcomes are to be expected. Objectives To conduct a meta-analysis of the only available randomised controlled trials (RCT) in the published English literature. Data sources Electronic search for relevant publications in MEDLINE, EMBASE and CENTRAL databases were performed. Four studies met the criteria. Study eligibility criteria RCT comparing minimally invasive (inverted C or L (J)-shaped) hemi-sternotomy versus conventional sternotomy for adults undergoing isolated aortic valve replacement using standard cardiopulmonary bypass technique. Methods Outcome measures were the length of positive pressure ventilation, blood loss, intensive care unit (ICU) and hospital stay. Results The length of ICU stay was significantly shorter by 0.57 days in favour of the mini-sternotomy group (CI −0.95 to −0.2; p=0.003). There was no advantage in terms of duration of ventilation (CI −3.48 to 0.36; p=0.11). However, there was some evidence to suggest a reduction in blood loss and the length of stay in hospital in the mini-sternotomy group. This did not prove to be statistically significant (154.17 ml reduction (CI −324.51 to 16.17; p=0.08) and 2.03 days less (CI −4.12 to 0.05; p=0.06), respectively). Limitations This study includes a relatively small number of subjects (n=220) and outcome variables. The risk of bias was not assessed during this meta-analysis. Conclusion Mini-sternotomy for isolated aortic valve replacement significantly reduces the length of stay in the cardiac ICU. Other short-term benefits may include a reduction in blood loss or the length of hospital stay

Development of group method of data handling based on genetic algorithm to predict incipient motion in rigid rectangular storm water channel

Sediment transport is a prevalent vital process in uvial and coastalenvironments, and \incipient motion" is an issue inseparably bound to this topic. Thisstudy utilizes a novel hybrid method based on Group Method of Data Handling (GMDH)and Genetic Algorithm (GA) to design GMDH structural (GMDH-GA). Also, SingularValue Decomposition (SVD) was utilized to compute the linear coefficient vectors. Inorder to predict the densimetric Froude number (Fr), the ratio of median diameter ofparticle size to hydraulic radius (d=R) and the ratio of sediment deposit thickness tohydraulic radius (ts=R) are utilized as e ective parameters. Using three di erent sources ofexperimental data and GMDH-GA model, a new equation is proposed to predict incipientmotion. The performance of development equation is compared using GMDH-GA andtraditional equations . The results indicate that the presented equation is more accurate(RMSE= 0:18 andMAPE= 6:48%) than traditional methods. Also, a sensitivityanalysis is presented to study the performance of each input combination in predictingincipient motion (15) Development of Group Method of Data Handling based on Genetic Algorithm to predict incipient motion in rigid rectangular storm water channel

A Large-Scale Fifteen-Year Minimum Survivorship of a Cementless Triple Tapered Femoral Stem

© 2020 Elsevier Inc. Background: This study reports the long-term outcomes of a metaphyseal fit-and-fill cementless femoral component in total hip arthroplasty (THA) with a follow-up of 15-19 years. Methods: We conducted a retrospective review of 376 consecutive THAs (345 patients), using a triple tapered stem performed between 2000 and 2003 with a view to assessing survivorship and radiological and functional outcomes. Images were assessed for initial alignment, terminal osteolysis, or subsidence, while clinical outcomes were assessed using the St Michael\u27s Hip Score. Results: Forty-five (11.9%) hips were lost to follow-up, 20 (5.31%) had died before our 15-year cutoff follow-up, and 4 (1.06%) had declined follow-up early on, leaving 307 hips (81.64%, 276 patients) available for both clinical and radiological follow-up at a minimum of 15 years (range 15-19). The mean age at the time of operation was 49.6 years (range 19-71) and the cohort included 131 (42.67%) male and 145 (47.23%) female patients. Seven stems (2.28%) were revised: 4 due to periprosthetic fractures, 2 for periprosthetic joint infection, and 1 for adverse reaction to metal debris at the trunnion. The St Michael\u27s Hip Score improved from 14.2 (range 9-23) preoperatively to 22.3 (range 13 to 25) at the last documented follow-up (P = .000). Kaplan-Meier survivorship with stem revision for any reason as the end point was 97.70%. Worst-case scenario Kaplan-Meier survivorship, where all lost to follow-up are considered as failures, was 85.3%. No stem was revised for aseptic loosening. Conclusion: This triple tapered stem in THA shows excellent survivorship beyond a minimum of 15 years

A Soft-Input Soft-Output Target Detection Algorithm for Passive Radar

Abstract: This paper proposes a novel scheme for multi-static passive radar processing, based on soft-input soft-output processing and Bayesian sparse estimation. In this scheme, each receiver estimates the probability of target presence based on its received signal and the prior information received from a central processor. The resulting posterior target probabilities are transmitted to the central processor, where they are combined, to be sent back to the receiver nodes or used for decision making. The performance of this iterative Bayesian algorithm comes close to the optimal multi-input multi-output (MIMO) radar joint processing, although its complexity and throughput are much less than MIMO radar. Also, this architecture provides a tradeoff between bandwidth and performance of the system. The Bayesian target detection algorithm utilized in the receivers is an iterative sparse estimation algorithm named Approximate Message Passing (AMP), adapted to SISO processing for passive radar. This algorithm is similar to the state of the art greedy sparse estimation algorithms, but its performance is asymptotically equivalent to the more complex l1-optimization. AMP is rewritten in this paper in a new form, which could be used with MMSE initial filtering with reduced computational complexity. Simulations show that if the proposed architecture and algorithm are used in conjunction with LMMSE initial estimation, results comparable to jointly processed basis pursuit denoising are achieved. Moreover, unlike CoSaMP, this algorithm does not rely on an initial estimate of the number of targets

Micronucleus assay: A method for monitoring chromosomal aberration induced by fast Neutrons

In this research we examined the sensitivity of micronucleus assay for monitoring clastogenic effects of low dose fast neutrons. Syrian mice (12 weeks old) were irradiated by fast neutrons emitted from a 241Am-9Be source. The absorbed dose was 1.5, 2.25, 3.375 and 5.06 cGy. Mice were scarified by cervical dislocation at different post irradiation times (24, 48 and 72 h). The results obtained show that the frequency of neutron-induced micronuclei in polychromatic erythrocytes (PCES) is significantly higher than those of control groups (P<0.05) at neutron dose used in this experiment. We concluded that micronucleus assay is an effective and also inexpensive method for monitoring clastogenic effects of high LET radiation in low dose levels

Effect of valproic acid and radiotherapy on viability of MCF-7 breast cancer cell line

Background and Objective: Valproic acid is used in the epilepsy, bipolar and migraine therapy. As a histone deacetylase inhibitor, Valproic acid has been recently under investigation in cancer treatment, either alone or in combination with either chemotherapy or radiotherapy. This study was done to determine the effect of Valproic acid and radiotherapy on viability of MCF-7 breast cancer cell line. Methods: In this descriptive - analytic study, MCF-7 cell line was obtained from the Iranian Pasteur Institute. The cells were treated and incubated by different concentrations of Valproic acid (1, 2, 4, 8, 16, 32, 64 and 128 mM) either alone or in combination with various dosages (0 .5, 2, 4, 6 and 8 Gray) of radiotherapy. After cell viability assay, using the Neutral red staining, the most nearest results to LD50 were selected. Cell viability was evaluated with trypan blue staining. Results: The most nearest concentrations of LD50 was doses of 2, 8 and 16 mM of valproic acid and dosage of Gray 4 of radiation. There was a significant dose-dependent correlation between reduction of cell viability with valproic acid concentration (P<0.05). Conclusion: Valproic acid, either alone or combination with radiotherapy caused a significant decline in the cell viability of MCF-7 breast cancer cell line

Development of A Head Docking Device for Linac-based Stereotactic Radiosurgery System to be Installed on Neptun 10 PC Linac

Introduction:  Stereotactic  radiosurgery  is  a  technique  for  the  treatment  of  intracranial  lesions  with  highly  collimated  x-ray  beam.  Linac-based  radiosurgery  is  currently  performed  by  two  techniques:  couch or pedestal mounted. In the first technique, a device is required to affix patient's head to a couch  and  moreover  to  translate  it  accurately.  Structure  of  such  a  device  constructed  by  the  authors  in  addition to the acceptance test which was performed to evaluate the device has been described in this  article.  Materials and Methods:  A head docking device has been designed and constructed according to the  geometry of linac's couch and desired functions. The device is completely made from aluminum and  consists  of  four  major  components:  attachment  bar,  lower  structure  with  four  movements,  upper  structure with two movements equipped with a lock, two handles and a mounting ring for stereotactic  frame. Translating accuracy, mechanical stability and isocentric accuracy were assessed in the frame of  acceptance test.  Results:  Translating  accuracy,  mechanical  stability  and  isocentric  accuracy  within  95%  confidence  intervals were found to be 1, 1.64 and 3.2 mm, respectively.  Discussion and Conclusion: According to AAPM report no.54 recommendation head docking device  should translate head with accuracy of 1 mm, the property which was met by the constructed device.  Moreover  considering  the  measured  isocentric  accuracy,  encompassing  mechanical  stability,  constructed device can confidently be used in stereotactic treatment

Ten-year follow-up study of three alternative bearing surfaces used in total hip arthroplasty in young patients: A prospective randomised controlled trial

© 2017 The British Editorial Society of Bone & Joint Surgery. Aims We present the ten-year data of a cohort of patients, aged between 18 and 65 years (mean age 52.7 years; 19 to 64), who underwent total hip arthroplasty. Patients were randomised to be treated with a cobalt-chrome (CoCr) femoral head with an ultra-high molecular weight polyethylene (UHMWPE), highly cross-linked polyethylene (XLPE) or ceramic-on-ceramic (CoC) bearing surface. Patients and Methods A total of 102 hips (91 patients) were randomised into the three groups. At ten years, 97 hips were available for radiological and functional follow-up. Two hips (two patients) had been revised (one with deep infection and one for periprosthetic fracture) and three were lost to follow-up. Radiological analysis was performed using a validated digital assessment programme to give linear, directional and volumetric wear of the two polyethylene groups. Results There was a significantly reduced rate of steady-state linear wear with XLPE (0.07 mm/yr) compared with UHMWPE (0.37 mm/yr) (p = 0.001). Volumetric wear was also significantly reduced in the XLPE group (29.29 mm3/yr) compared with the UHMWPE group (100.75mm3/ yr) (p = 0.0001). There were six patients with UHMWPE who had non-progressive osteolysis and none in the XLPE group. All three bearing groups had significant improvements in 12-item short form health survey scores, Western Ontario and McMaster Universities Osteoarthritis Index score and Harris Hip Score. However, the improvement in HSS was significantly less in the UHMWPE group (p = 0.0188) than in the other two groups. At ten years, the rates of volumetric and linear wear in the XLPE group remain low and predominantly below the estimated threshold for osteolysis (1 mm/yr). The rate of linear wear in the XLPE group was three times less than in the UHMWPE group at five-year followup and five times less at ten years. The rate of volumetric wear was also three times less in the XLPE group at ten years. Conclusion While CoC also performs well, XLPE at ten years remains a safe and excellent bearing option in young patients, with low rates of wear and no evidence of osteolysis

Mortality rate of geriatric acetabular fractures is high compared with hip fractures. A matched cohort study

© 2020 Lippincott Williams and Wilkins. All rights reserved. Objectives:Compare acute complication and mortality rates of geriatric patients with acetabular fractures (AFs) matched to hip fractures (HFs).Design:Retrospective cohort study.Setting:American College of Surgeons National Surgical Quality Improvement Project.Patients:Using Current Procedural Terminology codes, the American College of Surgeons National Surgical Quality Improvement Project registry was used to identify all patients ≥60 years from 2011 to 2016 treated for AFs undergoing open reduction internal fixation (ORIF) and HFs (undergoing ORIF, hemiarthroplasty, or cephalomedullary nail).Outcome Measurements:Patient characteristics, comorbidities, functional status, acute complications, and mortality rates were recorded. Patients were matched 1:5 (AF:HF). Chi-square, Fisher exact, and Mann-Whitney U tests were used to compare groups, and multivariable logistic regression was used to compare the risk of complications or death while adjusting for relevant covariates.Results:A total of 303 AF patients (age: 78.2 ± 9.2 years/59.7% females/27.1% wall, 28.4% one column and 45.2% 2 columns ORIF) were matched to 1511 HF patients (age: 78.3 ± 9.1 years/60.2% females/37.2% hemiarthroplasty, 16.3% ORIF and 47.4% cephalomedullary nail). Length of stay (8.4 ± 7.1 vs. 6.4 ± 5.9 days) and time to surgery [(TS) 2.3 ± 1.8 versus 1.2 ± 1.4 days] were longer in the AF group (P \u3c 0.01). Unadjusted mortality rates were nonsignificantly higher for AFs versus HFs (6.6% vs. 4.6%, P = 0.14). After covariable adjustment, the risk of mortality was significantly higher for AFs versus HFs (odds ratio: 1.89, 95% confidence interval: 1.07-3.35).Conclusion:Geriatric AFs pose a significantly higher adjusted mortality risk when compared with HF patients. Strategies to mitigate risk factors in this population are warranted.Level of Evidence:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence