Arterial Injury Associated with Tension-Free Vaginal Tapes-SECUR Procedure Successfully Treated by Radiological Embolization

Various postoperative complications have been reported after the use of tension-free vaginal tapes (TVT). The transobturator approach was introduced to minimize the potential complications. The next generation of recently introduced TVT-SECUR is intended to minimize the incidence of complications. Herein we report a case of internal pudendal artery injury sustained during this procedure that was successfully treated by radiological embolization. Angiography with vessel embolization, when available, should be considered when the arterial injury is suspected

Comparison of a Head Mounted Impact Measurement Device to the Hybrid III Anthropomorphic Testing Device in a Controlled Laboratory Setting

Background: Reports estimate that 1.6 to 3.8 million cases of concussion occur in sports and recreation each year in the United States. Despite continued efforts to reduce the occurrence of concussion, the rate of diagnosis continues to increase. The mechanisms of concussion are thought to involve linear and rotational head accelerations and velocities. One method of quantifying the kinematics experienced during sport participation is to place measurement devices into the athlete’s helmet or directly on the athlete’s head. Purpose: The purpose of this research to determine the accuracy of a head mounted device for measuring the head accelerations experienced by the wearer. This will be accomplished by identifying the error in Peak Linear Acceleration (PLA), Peak Rotational Acceleration (PRA) and Peak Rotational Velocity (PRV) of the device. Study Design: Laboratory study. Methods: A helmeted Hybrid III 50th percentile male headform was impacted via a pneumatic ram from the front, side, rear, front oblique and rear oblique at speeds from 1.5 to 5 m/s. The X2 Biosystems xPatch® (Seattle, WA) sensor was placed on the headform’s right side at the approximate location of the mastoid process. Measures of PLA, PRA, PRV from the xPatch ® and Hybrid III were analyzed for Root Mean Square Error (RMSE), and Absolute and Relative Error (AE, RE). Result: Seventy-six impacts were analyzed. All measures of correlation, fixed through the origin, were found to be strong: PLA R2 =0.967 p \u3c 0.01, PRA R2 =0.933 p \u3c 0.01, PRV R2 =0.999 p \u3c 0.00. PLA RMSE was 34%, RE 31.0% ± 14.0, and AE 31.1% ± 13.7. PRA RMSE was 23.4%, RE -6.7 ± 22.4 and AE 18.9% ± 13.8. PRV RMSE was 2.2%, RE 0.1 ± 2.2, and AE 1.8 ± 1.3. Conclusion: Without including corrections for effect of skin artifact, the xPatch® produces measurements highly correlated with the gold standard yet above the average error of testing devices in both PLA and PRA, but a low error in PRV. PLA measures from the xPatch® system demonstrated a high level of correlation with the PLA data from the Hybrid III mounted data collection system. Level of Evidence:

Regional maps of rib cortical bone thickness and cross-sectional geometry

Here we present detailed regional bone thickness and cross-sectional measurements from full adult ribs using high resolution CT scans processed with a cortical bone mapping technique. Sixth ribs from 33 subjects ranging from 24 to 99 years of age were used to produce average cortical bone thickness maps and to provide average ± 1SD corridors for expected cross-section properties (cross-sectional areas and inertial moments) as a function of rib length. Results obtained from CT data were validated at specific rib locations using direct measurements from cut sections. Individual thickness measurements from CT had an accuracy (mean error) and precision (SD error) of -0.013 ± 0.167 mm (R2 coefficient of determination of 0.84). CT-based measurement errors for rib cross-sectional geometry were -0.1 ± 13.1% (cortical bone cross-sectional area) and 4.7 ± 1.8% (total cross-sectional area). Rib cortical bone thickness maps show the expected regional variation across a typical rib’s surface. The local mid-rib maxima in cortical thickness along the pleural rib aspect ranged from range 0.9 to 2.6 mm across the study population with an average map maximum of 1.4 mm. Along the cutaneous aspect, rib cortical bone thickness ranged from 0.7 to 1.9 mm with an average map thickness of 0.9 mm. Average cross-sectional properties show a steady reduction in total cortical bone area from 10% along the rib’s length through to the sternal end, whereas overall cross-sectional area remains relatively constant along the majority of the rib’s length before rising steeply towards the sternal end. On average, male ribs contained more cortical bone within a given cross-section than was seen for female ribs. Importantly, however, this difference was driven by male ribs having larger overall cross-sectional areas, rather than by sex differences in the bone thickness observed at specific local cortex sites. The cortical bone thickness results here can be used directly to improve the accuracy of current human body and rib models. Furthermore, the measurement corridors obtained from adult subjects across a wide age range can be used to validate future measurements from more widely available image sources such as clinical CT where gold standard reference measures (e.g. such as direct measurements obtained from cut sections) are otherwise unobtainable.Cortical Bone Mapping (CBM) of whole-rib CT scans was performed and maps of average adult cortical bone thickness and rib cross-sectional geometry were produced. Results were validated against cross-sectional rib histology images, whereby bone thickness accuracy was measured at under 0.02 mm and precision was measured at under 0.17 mm. Subsequent errors in bone cross-sectional area were under 5%. Results can drive advancements in the fidelity of current human body computational models.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/152009/1/joa13045.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/152009/2/joa13045_am.pd

Detailed subject-specific FE rib modeling for fracture prediction

Objective: The current state of the art human body models (HBMs) underpredict the number of\ua0fractured ribs. Also, it has not been shown that the models can predict the fracture locations. Efforts have been made to create subject specific rib models for fracture prediction, with mixed results. The aim of this study is to evaluate if subject-specific finite element (FE) rib models, based\ua0on state-of-the-art clinical CT data combined with subject-specific material data, can predict rib\ua0stiffness and fracture location in anterior-posterior rib bending.Method: High resolution clinical CT data was used to generate detailed subject-specific geometry\ua0for twelve FE models of the sixth rib. The cortical bone periosteal and endosteal surfaces were\ua0estimated based on a previously calibrated cortical bone mapping algorithm. The cortical and the\ua0trabecular bone were modeled using a hexa-block algorithm. The isotropic material model for the\ua0cortical bone in each rib model was assigned subject-specific material data based on tension coupon tests.\ua0\ua0Two different modeling strategies were used for the trabecular bone.\ua0The capability of the FE model to predict fracture location was carried out by modeling physical\ua0dynamic anterior-posterior rib bending tests. The rib model predictions were directly compared to the results from the tests. The predicted force-displacement time history, strain measurements at\ua0four locations, and rotation of the rib ends were compared to the results from the physical tests\ua0by means of CORA analysis. Rib fracture location in the FE model was estimated as the position\ua0for the element with the highest first principle strain at the time corresponding to rib fracture in\ua0the physical test.Results: Seven out of the twelve rib models predicted the fracture locations (at least for one of\ua0the trabecular modeling strategies) and had a force-displacement CORA score above 0.65. The\ua0other five rib models, had either a poor force-displacement CORA response or a poor fracture\ua0location prediction. It was observed that the stress-strain response for the coupon test for these\ua0five ribs showed significantly lower Young’s modulus, yield stress, and elongation at fracture compared to the other seven ribs.Conclusion: This study indicates that rib fracture location can be predicted for subject specific rib\ua0models based on high resolution CT, when loaded in anterior-posterior bending, as long as the\ua0rib’s cortical cortex is of sufficient thickness and has limited porosity. This study provides guide-lines for further enhancements of rib modeling for fracture location prediction with HBMs

Staphylococcal enterotoxin sensitization in a community-based population : a potential role in adult-onset asthma

Background: Recent studies suggest that Staphylococcus aureus enterotoxin sensitization is a risk factor for asthma. However, there is a paucity of epidemiologic evidence on adult-onset asthma in community-based populations. Objective: We sought to evaluate the epidemiology and the clinical significance of staphylococcal enterotoxin sensitization in community-based adult populations. Methods: The present analyses were performed using the baseline data set of Korean adult population surveys, consisting of 1080 adults (mean age=60.2years) recruited from an urban and a rural community. Questionnaires, methacholine challenge tests, and allergen skin tests were performed for defining clinical phenotypes. Sera were analysed for total IgE and enterotoxin-specific IgE using ImmunoCAP. Results: Staphylococcal enterotoxin sensitization (0.35kU/L) had a prevalence of 27.0%. Risk factors were identified as male sex, current smoking, advanced age (61years), and inhalant allergen sensitization. Current asthma was mostly adult onset (18years old) and showed independent associations with high enterotoxin-specific IgE levels in multivariate logistic regression tests. In multivariate linear regressions, staphylococcal enterotoxin-specific IgE level was identified as the major determinant factor for total IgE level. Conclusions and Clinical Relevance: Staphylococcal enterotoxin sensitization was independently associated with adult-onset asthma in adult community populations. Strong correlations between the enterotoxin-specific IgE and total IgE levels support the clinical significance. The present findings warrant further studies for the precise roles of staphylococcal enterotoxin sensitization in the asthma pathogenesis

Psychiatric understanding and treatment of patients with amputations

Amputation changes the lives of patients and their families. Consequently, the patient must adapt to altered body function and image. During this adaptation process, psychological problems, such as depression, anxiety, and posttraumatic stress disorder, can occur. The psychological difficulties of patients with amputation are often accepted as normal responses that are often poorly recognized by patients, family members, and their primary physicians. Psychological problems can interfere with rehabilitation and cause additional psychosocial problems. Therefore, their early detection and treatment are important. A multidisciplinary team approach, including mental health professionals, is ideal for comprehensive and biopsychosocial management. Mental health professionals could help patients set realistic goals and use adaptive coping styles. Psychiatric approaches should consider the physical, cognitive, psychological, social, and spiritual functions and social support systems before and after amputation. The abilities and limitations of physical, cognitive, psychological, and social functions should also be considered. To improve the patient’s adaptation, psychological interventions such as short-term psychotherapy, cognitive behavioral therapy, mindfulness meditation, biofeedback, and group psychotherapy can be helpful

Precise stacking of decellularized extracellular matrix based 3D cell-laden constructs by a 3D cell printing system equipped with heating modules

Three-dimensional (3D) cell printing systems allow the controlled and precise deposition of multiple cells in 3D constructs. Hydrogel materials have been used extensively as printable bioinks owing to their ability to safely encapsulate living cells. However, hydrogel-based bioinks have drawbacks for cell printing, e.g. inappropriate crosslinking and liquid-like rheological properties, which hinder precise 3D shaping. Therefore, in this study, we investigated the influence of various factors (e.g. bioink concentration, viscosity, and extent of crosslinking) on cell printing and established a new 3D cell printing system equipped with heating modules for the precise stacking of decellularized extracellular matrix (dECM)-based 3D cell-laden constructs. Because the pH-adjusted bioink isolated from native tissue is safely gelled at 37 degrees C, our heating system facilitated the precise stacking of dECM bioinks by enabling simultaneous gelation during printing. We observed greater printability compared with that of a non-heating system. These results were confirmed by mechanical testing and 3D construct stacking analyses. We also confirmed that our heating system did not elicit negative effects, such as cell death, in the printed cells. Conclusively, these results hold promise for the application of 3D bioprinting to tissue engineering and drug development.119Ysciescopu

Recurrent Renal Leiomyosarcoma Mimicking a Colonic Submucosal Tumor: A Case Report

A primary leiomyosarcoma of the kidney is a rare, but highly aggressive, neoplasm, accounting for only 0.1% of all invasive renal tumors. Local or systemic recurrence is common, but a leiomyosarcoma is difficult to diagnose preoperatively. We recently encountered an interesting case of an unusual recurrence of a renal leiomyosarcoma. A 57-year-old woman visited our hospital complaining of lower abdominal pain. Four years previously, she had undergone a left nephrectomy. She had a primary leiomyosarcoma of the kidney that had been misdiagnosed as a renal cell carcinoma. Colonoscopy revealed the presence of a lesion similar to a submucosal tumor in the descending colon. Postoperative pathologic examination confirmed that the mass was a recurrent leiomyosarcoma. We report this unusual case and present a review of the literature