Reducing radiation dose for a linear slot scanning digital X-ray machine using a filtration technique

This study describes the development of a filtration technique applied to the Lodox Statscan linear slotscanning digital X-ray system to reduce radiation dose to paediatric patients whilst preserving diagnostic image quality. The Statscan is an FDA approved, commercially available digital X-ray system commonly used for trauma and emergency patients. The Statscan provides significantly lower radiation dose to patients than conventional Xray systems for comparable studies without loss of image quality. This is particularly beneficial in paediatric radiology, where the risks associated with ionizing radiation are much higher. A static dose prediction model for the Statscan which was previously developed at the University of Cape Town has been adapted to create a dynamic dose prediction model which allows the user to adjust the system scanning parameters. The model calculates the patient entrance dose from an energy spectrum generated using the input parameters. The effective dose for a paediatric sized patient is then calculated using a Monte Carlo simulation. The dynamic model allows for variation of the scan parameters and direct observation of the expected dose levels for specific examinations. Filtration is a well-known technique for reducing radiation dose, where a filter material is placed in the path of the X-ray beam to reduce patient exposure to radiation. The dynamic model was used to design a new filtration technique for the paediatric settings on the Statscan

Reconstructive Plastic Surgery An Atlas of Essential Procedures

A reader-friendly, how-to guide on reconstructive plastic surgery from international experts Reconstructive Plastic Surgery: An Atlas of Essential Procedures edited by esteemed authors, educators, and surgeons Robert X. Murphy Jr. and Charles K. Herman is a comprehensive resource detailing head-to-toe surgical procedures for a broad range of conditions. The senior editors have more than 50 years of collective surgical experience and expertise training hundreds of medical students and plastic surgery residents. A distinguished and diverse group of contributors from more than 15 countries and five continents share clinical pearls throughout the book. Sixty-seven chapters organized in five sections start with head and neck chapters detailing cleft palate defects and repair, followed by functional rhinoplasty, neoplasms, and trauma. Section two encompasses breast reduction/reconstruction techniques and other breast deformities; and management of trunk ulcers, deep wounds, and defects. The hand and upper extremity section details reconstructive techniques for infections, trauma, and Dupuytren's contracture. The final two sections cover a wide spectrum of nerve-related conditions and syndromes, followed by burns, melanoma, and vascular anomalies. Key Features High-quality illustrations and intraoperative photographs enhance understanding of step-by-step operative procedures More than 30 procedural videos provide hands-on guidance on how to perform specific steps in reconstructive plastic surgery A broad range of reconstructive techniques cover trauma, tumor resection, burns, congenital deformities, and degenerative conditions Consistent chapter formatting includes a clear and concise introduction, discussion of pertinent anatomy, surgical indications, operative techniques, complications, and long-term results This highly accessible yet comprehensive procedural guide is must-have reading for medical students, plastic surgery residents, and early-career plastic surgeons. It will also benefit veteran reconstructive plastic surgeons looking for a robust refresher with an international perspective

Empagliflozin in Patients with Chronic Kidney Disease

Background The effects of empagliflozin in patients with chronic kidney disease who are at risk for disease progression are not well understood. The EMPA-KIDNEY trial was designed to assess the effects of treatment with empagliflozin in a broad range of such patients. Methods We enrolled patients with chronic kidney disease who had an estimated glomerular filtration rate (eGFR) of at least 20 but less than 45 ml per minute per 1.73 m(2) of body-surface area, or who had an eGFR of at least 45 but less than 90 ml per minute per 1.73 m(2) with a urinary albumin-to-creatinine ratio (with albumin measured in milligrams and creatinine measured in grams) of at least 200. Patients were randomly assigned to receive empagliflozin (10 mg once daily) or matching placebo. The primary outcome was a composite of progression of kidney disease (defined as end-stage kidney disease, a sustained decrease in eGFR to < 10 ml per minute per 1.73 m(2), a sustained decrease in eGFR of & GE;40% from baseline, or death from renal causes) or death from cardiovascular causes. Results A total of 6609 patients underwent randomization. During a median of 2.0 years of follow-up, progression of kidney disease or death from cardiovascular causes occurred in 432 of 3304 patients (13.1%) in the empagliflozin group and in 558 of 3305 patients (16.9%) in the placebo group (hazard ratio, 0.72; 95% confidence interval [CI], 0.64 to 0.82; P < 0.001). Results were consistent among patients with or without diabetes and across subgroups defined according to eGFR ranges. The rate of hospitalization from any cause was lower in the empagliflozin group than in the placebo group (hazard ratio, 0.86; 95% CI, 0.78 to 0.95; P=0.003), but there were no significant between-group differences with respect to the composite outcome of hospitalization for heart failure or death from cardiovascular causes (which occurred in 4.0% in the empagliflozin group and 4.6% in the placebo group) or death from any cause (in 4.5% and 5.1%, respectively). The rates of serious adverse events were similar in the two groups. Conclusions Among a wide range of patients with chronic kidney disease who were at risk for disease progression, empagliflozin therapy led to a lower risk of progression of kidney disease or death from cardiovascular causes than placebo