The pattern of blood loss in adolescent idiopathic scoliosis

Background context Previous studies have shown that modern intraoperative blood-saving techniques dramatically reduce the allogeneic transfusion requirements in surgery for adolescent idiopathic scoliosis (AIS). No studies have looked at the pattern of postoperative hemoglobin (Hb) in AIS patients undergoing corrective spinal surgery and correlated this with the timing of allogeneic transfusion. Purpose To describe the pattern of perioperative blood loss in instrumented surgery for AIS. We look at the recommendations regarding an ideal preoperative Hb, the need for preoperative cross-matching, and the timing of postoperative Hb analysis. Study design This was a retrospective case series. Surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3-year period. Patient sample A consecutive series of 86 patients who underwent posterior instrumented fusion for AIS were included: 10 males and 76 females. Mean age was 14 years (range 10–17 years). All patients had posterior instrumented fusion using various blood-saving techniques (eg, cell-saver). All patients were cross-matched preoperatively, and our transfusion trigger value (TTV) was 7 g/dL. Outcome measures Hemoglobin level was the outcome measure. Hemoglobin readings were obtained preoperatively, within 2 hours of surgery, and daily up to 5 days after surgery. This physiologic measure was assessed using routine blood sampling techniques and standardized laboratory processing. Methods Patient predictor variables (demographic and surgical) were assessed for association with Hb levels in a hierarchical model, with repeated Hb readings at the lower level being clustered within an individual patient at the upper level of the structure. The variation of Hb levels within individuals was compared with mean levels in different individuals via the variance partition coefficient of the model structure. Results No patients required intraoperative allogeneic transfusion. Only four patients (4.65%) received allogeneic transfusion, all within 2 days of surgery. A clinically important drop in Hb occurred within the first 2 postoperative days, rising thereafter. The average postoperative drop in Hb was 4.1 g/dL. Young males had lower postoperative Hb values. Neither the preoperative curve magnitude (Cobb angle of major curve) nor the number of vertebrae/levels fused significantly affected the blood loss. Conclusions We recommend setting a minimum preoperative Hb value that is 5 g/dL higher than your TTV. Because no patients required an intraoperative transfusion when using modern blood-saving techniques, preoperative cross-matching is unnecessary and potentially wasteful of blood reserves. Hemoglobin analysis beyond the second postoperative day is unnecessary unless clinically indicate

Outcome of vascularised muscle pedicle bone graft for scaphoid non-union

Background: The objective of the study was to assess the outcome of vascularised muscle pedicle bone graft for scaphoid non-union.Methods: 14 men and 6 women aged 18-45 (mean 25) years with non-union of scaphoid involving proximal pole (n=4), waist (n=14), distal pole (n=2) were randomized to undergo vascularised muscle pedicle bone graft with Herbert screw fixation. The mean duration of non-union was 10 months (range 4-14 months).Results: The mean follow up duration was 24 months. 17 of 20 achieved union. 12 of 20 achieved correction of both scapholunate and radiolunate angle. 5 of 20 did not achieve full correction of sacpholunate and radiolunate angle. 3 of 20 did not achieve union. 2 of these 3 were associated with proximal pole absorption. There was no hardware failure or any iatrogenic fracture during pedicle dissection. Conclusions: The use of vascularised bone graft has proved to be an effective method for treating scaphoid non-union, especially non-union with an avascular proximal pole and those that have failed to heal after previous procedure

Analysing the Security Aspects of IoT using Blockchain and Cryptographic Algorithms

Technological advancement is a never-ending field that shows its evolution from time to time. In 1832, with the invention of the electromagnetic telegraph, the era of the Internet of Things (IoT) began. Within the time of 190 years, this technological domain has revolutionized IoT and made it omnipresent. However, with this evolved and omnipresent nature of IoT, many drawbacks, privacy, interoperability, and security issues have also been generated. These different concerns should be tackled with some newer technologies rather than the conventional ones as somehow, they are only the generator of those issues. Outdated Security could be an appropriate issue of IoT along with the centralized point of failure. It also possesses more concerns and challenges to tackle. On the other side, there is a visible solution to address the challenges of IoT in this developing domain of technology. The visible approach is Blockchain which acted as the backbone in securing Bitcoin in 2008, which was created by the pseudo group named Satoshi Nakamoto. Blockchain has evolved from Blockchain 1.0 to Blockchain 4.0 as the latest one depicts its amalgamation with another component of Industry 4.0 i.e., Artificial Intelligence (AI). AI will give the ability to think logically and like humans. In addition to this SMART solution, there is also an advanced cryptographical technique known as the Elliptic Curve Digital Signature Algorithm (ECDSA) which can enhance the security spectrum of IoT if applied appropriately. This paper produces a vision to enhance and optimize the security of IoT using a network peer-to-peer technology Blockchain along with advanced cryptography

Change in spinal height following correction of adolescent idiopathic scoliosis

Background Context Corrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature. Purpose This study aimed to identify predictors of gain in SH following corrective surgery for AIS. We present a unique model to predict postoperative height prior to intervention, which could contribute to the preoperative counseling and consenting process. Study Design This was a retrospective case series. All surgeries were performed by one of four substantive pediatric spinal surgeons within a single regional center over a 3.5-year period. Patient Sample There were 104 patients who had instrumented posterior spinal fusion for AIS included. There were 93 females, and the age range was from 11 to 17 years. All patients had posterior instrumented fusion using rods and anchors (pedicle screws±hooks). Outcome Measures Postoperative SH was the primary outcome measure. The SH (C7–L5) and Cobb angles were measured from a pre- and postoperative standing X-ray of each patient. Methods Variables associated with patients (demographic and radiological) and the surgical constructs were analyzed for predictability of height gain. A model was derived including only significant predictors of substantive importance using hierarchical regression methods. Cross-validation procedures verified the adequacy of the model fit. Analysis was performed using IBM SPSS Statistics for Windows version 20.0 (IBM Corp. Armonk, NY, USA). Results The major curve was thoracic in 90% of cases. The number of vertebrae fused ranged from 5 to 15. The average preoperative Cobb angle was 66°, with an average correction of 45°. The average change in SH was 4.66 cm (SD 2.13 cm). The model presented included preoperative height, preoperative Cobb angle, and number of vertebrae within the construct, with coefficients of 1.00 (95% CI: 0.90, 1.09), 0.067 (95% CI: 0.039, 0.095), and 0.26 (95% CI: 0.11, 0.41), respectively. This model had an adjusted-R2 value of 0.83 and a R2 for prediction of 0.79, and can be shown to have similar predictive capability as a model comprising a wider range of predictors. Conclusion The greatest postoperative height values following posterior spinal fusion for AIS could be expected from a patient with greater preoperative height and Cobb angle, and whose construct spans a large number of vertebrae

Comparative evaluation of pre and post operative functional outcomes determined by Lysholm knee score of patients undergoing arthroscopic anterior cruciate ligament reconstruction

Background: The anterior cruciate ligament (ACL) is the primary stabilizer of the knee joint and prevents the knee against anterior translation. After ACL tears, most patients experience recurrent episodes of instability (give way), pain and decreased function. Purpose of our study was to comparative evaluation of functional outcomes of pre and post operative patients after arthroscopic ACL reconstruction by using Lysholm knee score and its complications.Methods: This is a prospective interventional study which were included total 45 patients undergoing arthroscopic ACL reconstruction by using hamstring autograft. Postoperatively patients were followed up at 6, 9 and 12 months for functional assessment by using Lysholm knee score.Results: After ACL reconstruction increment in mean Lysholm knee score during follow up from 69.33 to 96.03 at final followup (p<0.001) which indicate that significant improvement in functional status of patients.Conclusions: Reconstruction of ACL leads the patient to return to a normal activity level and prevent the occurrence of associate meniscal injury and post-traumatic osteoarthritis. A regular followup based and well-organized rehabilitation program provide a key role in functional outcome of knee after ACL reconstruction

Choosing Glucose-lowering Therapy: A Collaborative Choice Model

Diabetes care is challenging, and the increasing number of available therapeutic options has made it even more complex. Moreover, with an increasing prevalence across the world, it needs to be managed right from the primary care level to a quaternary care hospital. This calls for an easy-to-use algorithm that can be used by a general practitioner, who is often the first contact of a patient to manage diabetes in many countries. There are multiple models to assist in choice of pharmacotherapy, and these have evolved over time. We propose a user-friendly collaborative choice, as an aid to clinical decision-making. This alliterative framework supplements and strengthens existing guidance, by creating a comprehensive, yet simple, thought process for the diabetes care professional

Formulation, Development and Evaluation of Transfersomal Gel of Metronidazole

Metronidazole is an antibiotic that is used to treat a wide variety of infections. It works by stopping the growth of certain bacteria and parasites. This antibiotic treats only certain bacterial and parasitic infections. It may also be used with other medications to treat certain stomach/intestinal ulcers caused by bacteria (H. pylori). A transferosome is the first generation of an elastic liposome prepared from phospholipids and edge activators. An edge activator is often a single-chain surfactant with a high radius of curvature that destabilizes the lipid bilayers of vesicles and increases the deformability of the bilayers, thereby making the vehicle ultra-deformable. The aim of the present study was to investigate the potential of transfersomal gel formulations for transdermal delivery of metronidazole and to evaluate the effect of lipid concentration, ethanol concentration, drug concentration and stirrer time. Characterization of transfersomes performed by vesicle size, surface charge, entrapment efficiency and zeta potential. Characterization of transfersome containing gel performed by the measurement of viscosity, drug content, extrudability study, spreadability and in vitro drug diffusion study. It was found that viscosity of prepared gel was 3560cps, % assay was 98.89±0.45, extrudability was 1156g and spreadibility (g.cm/sec) was found that 11.23(g.cm/sec) respectively.  In vitro drug release from transfersomes gel was carried out using Franz diffusion cell method and found 85.56% in 12 hr. In first 30 min it was 22.2 % drug release which slightly high. It was due to the release of free drug present in bag after leaching from transfersomes. Drug release from transferosomal gel formulation was found in very sustained and controlled manner. The results were obtained which showed that transfersomal gel was a promising candidate for transdermal delivery with targeted and prolonged release of a drug. It also enhances skin permeation of many drugs. Keywords: Transfersomal gel, Metronidazole, Antibiotic, Characterization, Franz diffusion cel

Application of Multi Criteria Decision Making tools in Selection of Concrete Mix

304-309Now a day decision making plays a major role in deciding the execution of any task. Two key tools are available to serve the purpose of decision-making. These include AHP as well as TOPSIS, both falls under Multi Criteria Decision Making (MCDM) tools. These techniques are now also brought in the field of civil engineering. MCDM techniques are used in various applications of civil engineering. This paper presents comparison of AHP and TOPSIS for making final decisions for the best concrete mix with fibres of steel and basalt available with different proportions. The comparison is made on the tests of split tensile strength, compressive strength and flexure results. Results of the experiment are used to validate results of AHP and TOPSIS. Optimum hybrid mixes for mechanical properties is M-S0.5-B0 at 28 days

Sodium Percarbonate Fuel Cells Based on Porous Paper Supports

A self-pumping T-shaped paper based fuel cell was fabricated using sodium percarbonate as a fuel and potassium permanganate as an oxidant. The cell is portable, economic, lightweight and compact, consumes less fuel, and can be easily regenerated. Whatman filter papers served as porous supports for fluids. Different electrolytes (for fuel and oxidant) and different gel electrolytes were attempted. Among acidic media, mixed media and basic media, the mixed media combination outperforms both acidic and basic media combinations. A T-shaped mixed media paper based fuel cell at 3 M sodium percarbonate (SPC) as fuel concentration produces OCV of 1.22 V. It generates a maximum current density of 3.21 mA/cm2 and a maximum power density of 1.2 mW/cm2at optimum fuel (3 M SPC) concentration without any catalyst. Au NPs were used as catalyst, and the maximum current and maximum power densities increased to 5.357 mA/cm2 and 2.15 mW/cm2 respectively