Reconstruction of Cortical and Cancellous Bone in Tibia with Osteogenesis Imperfecta

Osteogenesis Imperfecta (OI) is the bone fragility disorder that leads to long bone bowing. Finite Element Analysis (FEA) has become the tool of choice to assess behaviour structural within bones. Currently, the FEA performed on the tibia is based on the bone constructed without considering different components of the bone, where the bone was created as a single material. In an attempt to further investigate the bone with OI, the present study was conducted to investigate the mechanical stress distribution using finite element model of the OI affected tibia. The model was reconstructed from the CT images composed of cortical and cancellous bones obtained from Osirix database. The segmentation of the cortical and cancellous of the tibia was performed on 346 images using two different methods which are global thresholding and the selection of the binary object. The segmented images were used to develop a three-dimensional model of the tibia using VOXELCON software. The boundary conditions were set to the meshed model in preparation for the finite element analysis using the same software. Displacements ranging from 5 mm to 35 mm were assigned to a point in between the proximal and distal of the tibia model. In the coronal plane, the highest stress levels were recorded on the medial side of the cortical bone, whereas in the sagittal plane, the highest stress levels were recorded on the anterior side of the cortical bone when the model was subjected to 35 mm displacement. The cancellous bone, however, showed lower stress levels on both planes when subjected to similar displacement. With each increment of displacement, the model experienced more stress and caused the higher percentage volume of individual cortical and cancellous that exceed critical stress of 115 MPa. There were no significant differences in the percentage volume of voxels affected between the cortical and cancellous bones for both coronal and sagittal planes with the pvalue of 0.29 and 0.32 respectively (p > 0.05). There was no significant difference obtained for the percentage volume of voxels affected between the coronal and sagittal planes with the p-value is 0.13 (p > 0.05)

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 percent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P &lt; 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P &lt; 0·001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P &lt; 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P &lt; 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P &lt; 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone