Radiographic evaluation of posterior tibial slope in ACL deficient Indian patients

Background: There are several studies which have investigated various osseous morphologic characteristics as they relate to ACL injury. Tibial slope, notch width, and notch width index are some. However, there does not appear to be consensus across studies. The aim of this study was to validate association between posterior tibial slope (PTS) and ACL injury in an ACL deficient knee of Indian patients.Methods: This retrospective cum prospective study was done at a tertiary hospital from June 2017 to May 2018. 40 patients were included. Inclusion criteria were documented evidence of ACL tear to the affected knee; no history of osteoarthritis; no history of rheumatoid arthritis; patients voluntarily consented for the use of their radiographs for the study. The assessment was completed with a true lateral view of the knee with full length leg and ankle. The functional tibial slope as described by Julliard et al was used to determine the PTS. The mean and standard deviation (SD) for medial PTS were measured. Demographic data like age, sex were collected and entered into a database.Results: 95% of patients were male. Mean age was 29.25. The mean PTS was 13.037 which is reasonably high as compared to normal while the standard deviation was 4.487 reflecting large amount of variation.Conclusions: Increased posterior tibial slope can be concluded as a significant risk factor in ACL injury which corroborates the findings of various previously published studies. The findings presented may help identify patients who are at greater risk of ACL injury.

Study of surgical fixation of extra-articular distal third humerus fractures with a posterolateral locking compression plate

Background: Fractures of the adult distal humerus account for approximately 2% of all fractures and represent a third of all humerus  fractures. Fractures of the distal third of the humerus are challenging injuries due to their peri-articular location, small size of the distal bone fragments, and the osteopenic quality of the bone in older adults.  Aim of our study was to evaluate the clinical, radiographic and functional outcomes of posterolateral locking compression plate for extra-articular distal third humerus fractures through posterior triceps splitting approach.Methods: This is a prospective study done at All India Institute of Medical Sciences, Patna  in which 30 consecutive skeletally mature, closed extra-articular distal humerus fractures  underwent fixation with posterolateral  locking compression plate and outcome evaluated in terms of radiological  evidence of healing, functional outcome and complications if any.Results: Use of posterolateral plate results in predictably good union rates and excellent results terms of patient outcome without any implant related complications.Conclusions: We recommend using this posterolateral plate for these humerus fractures, because of its consistent results with respect to fracture union, stability across the fracture site and early mobilization for better functional results

Building Scalable Architectures Using Emerging Memory Technologies

A confluence of trends is reshaping computing today. On one end, the massive amounts of data being generated by the proliferation of sensing and internet services are creating a demand for better computer architectures and systems. The other stream of the confluence is the nanotechnology advances that are unearthing new memory device technologies with the potential to replace (or be combined with) conventional memories. Given these trends, this thesis examines emerging memory device technologies that provide a unique opportunity to build computer architectures with efficient and scalable data storage and processing capabilities. The associated memory architectures of these new systems promise to offer distinctive features such as intrinsic non-volatility, highly dense memory structures, extremely low-power consumption and even embedded processing capabilities. Among others, some examples of emerging memory technologies with such features are PCM, 3D Xpoint, STT-RAM and ReRAM. A central question with the new memory architectures built with emerging memory technologies is whether or not the resultant systems are scalable. Towards answering this question, this thesis identifies that conventional memory architecture specific scaling methods may not directly apply in case of emerging memory technologies. These methods were developed mostly for SRAM and DRAM, and today, they do not provide the desired outcomes for emerging memory technologies. As a result, there exist fundamental unsolved problems concerning scalability in building memory architectures. Unfortunately, this means that even though emerging memory technologies provide distinctive features, they may be largely left untapped. Given the scalability concerns, this thesis then advocates a scalability-first approach for building computer architectures using emerging memory technologies while being aware of the limitations and opportunities associated with them. As demonstrations of the scalability-first approach, the thesis discusses several scalability problems encountered in systems using emerging memory technologies. It also brings out potential solutions for each of these problems in the form of novel techniques and tools. For instance, the thesis discusses the problem and a solution for scaling write order enforcement mechanisms for data persistence on large non-volatile main memory systems, followed by the problem and a potential solution for scaling write bandwidth and thereby reducing memory interference on systems with dense non-volatile memory caches. Also discussed are methods for scaling system architectures with in-memory processing capability subject to its operational complexity and other limits. The proposed scalability-first approach points to prospects and ways for better adoption of emerging memory technologies within existing systems. The approach and the solutions also lead to likely transition paths to even more scalable and markedly different systems of the future

MEDICAL IMAGE FUSION USING CURVELET TRANSFORM

ABSTRACT The paper analyses the characteristics of the Fast Discrete Curvelet Transform and put forward an image fusion algorithm based on Discrete Wavelet Transform and the Fast Discrete Curvelet Transform. The Curvelet Transform is a new approach in the image fusion techniques adding a new, lesser redundant, fast and simple way of dealing the images especially at the edges and curves and hence it is very suitable for the analysis of various natural images like Medical images using tomographic images like MRI and CT scan, seismic images, satellite pictures for the weather monitoring etc. The experimental results show that the method could extract useful information from the source images to fused images so that clear images are obtained. In choosing the low-frequency coefficients, the concept of local area variance was applied to the measuring criteria. In choosing the high frequency coefficients, the window property and local characteristics of pixels were analysed. Finally, the proposed algorithm was applied to experiments of multi-focus image fusion and complementary image fusion

Remote preconditioning by aortic constriction: affords cardioprotection as classical or other remote ischemic preconditioning? Role of iNOS

Dose remote preconditioning by aortic constriction (RPAC) affords cardioprotection similar to classical or other remote ischemic preconditioning stimulus? Moreover study was also designed to investigate role of inducible nitric oxide synthase in remote preconditioning by aortic constriction. There are sufficient evidences that "ischemic preconditioning" has surgical applications and afford clinically relevant cardioprotection. Transient occlusion of circumflex artery, renal artery, limb artery or mesenteric artery preconditions the myocardium against ischemia reperfusion injury in case of ischemic heart disease leading to myocardial infraction. Here abdominal aorta was selected to produce RPAC. Four episodes of Ischemia-reperfusion of 5 min each to abdominal aorta produced RPAC by assessment of infract size, LDH and CK. These studies suggest RPAC produced acute (FWOP) and delayed (SWOP) cardioprotective effect. RPAC demonstrated a significant decrease in Ischemia-reperfusion induced release of LDH, CK and extent of myocardial infract size. L-NAME (10 mg/Kg i.v.), Aminoguanidine (150 mg/Kg s.c.), Aminoguanidine (300 mg/Kg s.c.), S-methyl isothiourea (3 mg/Kg i.v.), 1400W (1 mg/Kg i.v.) administered 10 min. before global ischemia reperfusion produced no marked effect. Aminoguanidine (150 mg/Kg s.c.), Aminoguanidine (300 mg/Kg s.c.), S-methyl isothiourea (3 mg/Kg i.v.), 1400W (1 mg/Kg i.v.) pretreatment after RPAC produced no significant effect on acute RPAC induced decrease in LDH, CK and infract size, whereas L-NAME (10 mg/Kg i.v.) increased RPAC induced decrease in LDH, CK and infract size. Most interesting observation is in delayed RPAC, where all NOS inhibitors pretreatment attenuate RPAC induced decrease in LDH, CK and infract size. In conclusions, "Remote preconditioning by aortic constriction" (RPAC) affords cardioprotection similar to classical or other remote ischemic preconditioning stimulus. Moreover, late or delayed phase of RPAC has been mediated by inducible nitric oxide synthase (iNOS) whereas it has not involved in acute RPAC

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Building Scalable Architectures Using Emerging Memory Technologies

A confluence of trends is reshaping computing today. On one end, the massive amounts of data being generated by the proliferation of sensing and internet services are creating a demand for better computer architectures and systems. The other stream of the confluence is the nanotechnology advances that are unearthing new memory device technologies with the potential to replace (or be combined with) conventional memories. Given these trends, this thesis examines emerging memory device technologies that provide a unique opportunity to build computer architectures with efficient and scalable data storage and processing capabilities. The associated memory architectures of these new systems promise to offer distinctive features such as intrinsic non-volatility, highly dense memory structures, extremely low-power consumption and even embedded processing capabilities. Among others, some examples of emerging memory technologies with such features are PCM, 3D Xpoint, STT-RAM and ReRAM. A central question with the new memory architectures built with emerging memory technologies is whether or not the resultant systems are scalable. Towards answering this question, this thesis identifies that conventional memory architecture specific scaling methods may not directly apply in case of emerging memory technologies. These methods were developed mostly for SRAM and DRAM, and today, they do not provide the desired outcomes for emerging memory technologies. As a result, there exist fundamental unsolved problems concerning scalability in building memory architectures. Unfortunately, this means that even though emerging memory technologies provide distinctive features, they may be largely left untapped. Given the scalability concerns, this thesis then advocates a scalability-first approach for building computer architectures using emerging memory technologies while being aware of the limitations and opportunities associated with them. As demonstrations of the scalability-first approach, the thesis discusses several scalability problems encountered in systems using emerging memory technologies. It also brings out potential solutions for each of these problems in the form of novel techniques and tools. For instance, the thesis discusses the problem and a solution for scaling write order enforcement mechanisms for data persistence on large non-volatile main memory systems, followed by the problem and a potential solution for scaling write bandwidth and thereby reducing memory interference on systems with dense non-volatile memory caches. Also discussed are methods for scaling system architectures with in-memory processing capability subject to its operational complexity and other limits. The proposed scalability-first approach points to prospects and ways for better adoption of emerging memory technologies within existing systems. The approach and the solutions also lead to likely transition paths to even more scalable and markedly different systems of the future