The Incidence and Causes of Unplanned Reoperations as a Quality Indicator in Pediatric Surgery

Background: Unplanned return to the operating room (uROR) within the 30-day postoperative period can be used as a quality indicator in pediatric surgery. The aim of this study was to investigate and evaluate uROR as a quality indicator. Methods: The case records of pediatric patients who underwent reoperation within the 30-day period after primary surgery, from 1 January 2018 to 31 December 2020 were retrospectively reviewed. The primary outcome of the study was the rate of uROR as a quality indicator in pediatric surgery. Secondary outcomes were indications for primary and secondary surgery, types and management of complications, factors that led to uROR, length of hospital stay, duration of surgery and anesthesia, and starting time of surgery. Results: A total of 3982 surgical procedures, under general anesthesia, were performed during the three-year study period (2018, n = 1432; 2019, n = 1435; 2020, n = 1115). Elective and emergency surgeries were performed in 3032 (76.1%) and 950 (23.9%) patients, respectively. During the study period 19 (0.5%) pediatric patients, with the median age of 11 years (IQR 3, 16), underwent uROR within the 30-day postoperative period. The uROR incidence was 6 (0.4%), 6 (0.4%), and 7 (0.6%) for years 2018, 2019, and 2020, respectively (p = 0.697). The incidence of uROR was significantly higher in males (n = 14; 73.7%) than in females (n = 5; 26.3%) (p = 0.002). The share of unplanned reoperations in studied period was 4.5 times higher in primarily emergency surgeries compared to primarily elective surgeries (p < 0.001). The difference in incidence was 0.9% (95% CI, 0.4–1.4). Out of children that underwent uROR within the 30-day period after elective procedures, 50% had American Society of Anesthesiologists (ASA) score three or higher (p = 0.016). The most common procedure which led to uROR was appendectomy (n = 5, 26.3%) while the errors in surgical technique were the most common cause for uROR (n = 11, 57.9%). Conclusion: Unplanned reoperations within the 30-day period after the initial surgical procedure can be a good quality indicator in pediatric surgery. Risk factors associated with uROR are emergency surgery, male gender, and ASA score ≥3 in elective pediatric surgery.

LSALO-BP: A Hybrid Model for Children Adulthood Height Prediction

The prediction of children's adult height is a common procedure in childhood endocrinology. Through the prediction of children's adult height, it is possible to find abnormalities in children's growth and development. Many jobs in today's society have certain requirements for height, so the accuracy of children adulthood height prediction is important for children. Current methods for predicting adult height of children have some shortcomings such as inaccurate accuracy. To deal with these problems, this paper analyzes the data collected by the Chinese children and adolescents' physical and growth health projects in primary and secondary schools in Zhejiang Province, and proposes a method for predicting adult height based on back propagation neural network (BPNN) with the body composition of children and adolescents as input. Since the BP algorithm has the risk of falling into local optimization, and we propose LSALO-BP model that incorporates the ant lion optimizer (LSALO) into the BP algorithm as location strategy to avoid local optimization. The improvements achieved by the ant lion algorithm are mainly reflected in: improving the ant's walk mode, and enhancing the global search ability of the LSALO algorithm. The comparison experiment of 10 benchmark functions proves the feasibility and effectiveness of the location strategy. The LSALO-BP model is applied to the prediction of adult height of children and adolescents. The experimental results show that compared with other models, the LSALO-BP prediction model has increased the prediction accuracy by 6.67%~16.08% for boys and 4.67%~6.6% for girls, which can more accurately predict the adult height of children and adolescents.

Mechanical Properties of Rammed Earth Stabilized with Local Waste and Recycled Materials

Traditional techniques of construction using natural and locally available materials are nowadays raising the interest of architects and engineers. Clayey soil is widely present in all continents and regions, and where available it is obtained directly from the excavation of foundations, avoiding transportation costs and emissions due to the production of the binder. Moreover, raw earth is recyclable and reusable after the demolition, thanks to the absence of the firing process. The rammed earth technique is based on earth compressed into vertical formworks layer by layer to create a wall. This material owes its strength to the compaction effort and due to its manufacture procedure exhibits layers resembling the geological strata and possessing high architectural value. The hygroscopic properties of rammed earth allow natural control of the indoor humidity, keeping it in the optimal range for human health. Stabilization with lime or cement is the most common procedure to enhance the mechanical and weather resistance at once. This practice compromises the recyclability of the earth and reduces the hygroscopic properties of the material. The use of different natural stabilizers, fibers, and natural polymers by-products of the agriculture and food industry, can offer an alternative that fits the circular economy requirements. The present study analyses the mechanical strength of an Italian earth stabilized with different local waste and recycled materials that do not impair the final recyclability of the rammed earth.

Automated Prediction of Extraction Difficulty and Inferior Alveolar Nerve Injury for Mandibular Third Molar Using a Deep Neural Network

Extraction of mandibular third molars is a common procedure in oral and maxillofacial surgery. There are studies that simultaneously predict the extraction difficulty of mandibular third molar and the complications that may occur. Thus, we propose a method of automatically detecting mandibular third molars in the panoramic radiographic images and predicting the extraction difficulty and likelihood of inferior alveolar nerve (IAN) injury. Our dataset consists of 4903 panoramic radiographic images acquired from various dental hospitals. Seven dentists annotated detection and classification labels. The detection model determines the mandibular third molar in the panoramic radiographic image. The region of interest (ROI) includes the detected mandibular third molar, adjacent teeth, and IAN, which is cropped in the panoramic radiographic image. The classification models use ROI as input to predict the extraction difficulty and likelihood of IAN injury. The achieved detection performance was 99.0% mAP over the intersection of union (IOU) 0.5. In addition, we achieved an 83.5% accuracy for the prediction of extraction difficulty and an 81.1% accuracy for the prediction of the likelihood of IAN injury. We demonstrated that a deep learning method can support the diagnosis for extracting the mandibular third molar.

Effect of Insurance Type on Postoperative Tympanostomy Tube Follow-up

Objective Bilateral myringotomy with tube insertion (BMT) is a common procedure performed in children. Appropriate follow-up is necessary to ensure management of postoperative sequalae. The objectives are to investigate (1) the relationship between insurance type and postoperative follow-up attendance and (2) the effect of follow-up on need for further care after BMT. Study Design Retrospective cohort study. Setting The study included patients <3 years of age undergoing BMT for recurrent acute otitis media at a tertiary care children’s hospital within a single year and followed for 3 years. Patients were excluded if they had received a prior BMT; underwent a concurrent otolaryngologic procedure; or had a syndromic diagnosis, craniofacial abnormality, or any significant cardiac or respiratory comorbidity. Methods Number of follow-up appointments, demographics, socioeconomic status, and postoperative outcomes were analyzed. Results A total of 734 patients were included with mean (SD) age of 1.4 years (0.50). The majority of patients had private insurance (520/734, 70.8%). Patients with public insurance attended fewer postoperative appointments (1.5 vs 1.8, P < .001) and had a higher incidence of BMT-related emergency department (ED) visits (10.3% vs 3.8%, P = .001). There was no significance found when different insurance providers were compared. An adjusted multivariate regression analysis showed that patients with private insurance were more likely to attend postoperative appointments (odds ratio, 3.52 [95% CI, 2.12-5.82]; P < .001) and less likely to have a BMT-related ED visit (odds ratio, 0.42 [95% CI, 0.20-0.89]; P = .024). Conclusion Insurance type is related to outcomes after the treatment of recurrent acute otitis media with BMT. Future studies that survey individuals will help identify barriers that contribute to patient absence at follow-ups and need for subsequent ED visits.

The Grouting Process as an Innovative Tool for the Assessment of the State of Preservation and Internal Features of the Holy Aedicule of the Holy Sepulchre

Grouting of historic structures is a common procedure in many restoration projects, as the masonry in many cases requires additional strengthening. However, grouting of complex historic structures can also provide important information regarding the construction phases and the state of preservation of the internal structure of a monument, which may not be visible by the naked eye. This requires an innovative approach in order to reveal these aspects. In the current research, the data recorded from the grouting of the Holy Aedicule are implemented and analyzed, in order to obtain information regarding the construction phases of the complex Holy Aedicule structure, as well as information regarding the state of preservation of the internal structure behind the marble cladding that encloses it. The correlation of detailed grouting data with geospatial information allows for a more detailed analysis, which, coupled with ground-penetrating radar prospections, can provide critical information regarding the features of the internal structure. The results highlight the importance of this correlation to reveal information that may not be obtained through a typical approach. Thus, this study allowed for the development of an evolved interdisciplinary approach for the management of grouting data in a 2.5D environment, which can be applied in other historic structures and buildings.

Microbiological profiles of tracheostomy patients: a single-center experience

Background: This study compared the prevalence of common microorganisms in obstructed and non-obstructed cases across the four quarters on the first post-tracheostomy year.Methods: A retrospective chart review of the microbiological profiles of all adult patients who underwent a tracheostomy was conducted between June 2015 and September 2019 at our hospital. Based on the tracheostomy indications, patients were allocated to obstructed or non-obstructed group. Any patient with at least one positive sample was followed up quarterly for a year. The first culture result obtained was recorded at least one month following the last antibiotic dose in each quarter.Results: Out of the 65 tracheal aspirate results obtained from 58 patients (mean age, 57.5±16.48 years), the most common procedure and indications were surgical tracheostomy (72.4%) and non-obstructed causes (74.1%), respectively. Moreover, 47.7% of the culture results indicated Pseudomonas aeruginosa, which showed significantly different proportions across the quarters (p=0.006). Among obstructed patients, P. aeruginosa was the most common (35%), followed by methicillin-resistant Staphylococcus aureus (MRSA; 23.5%).Conclusions: The most common post-tracheostomy microorganism was P. aeruginosa. MRSA showed a strong association with tracheostomy for obstructive indications.

Simultaneous Bicompartmental Bucket Handle Injury Associated With a Chronic Anterior Cruciate Ligament Rupture: Case Report and Literature Review

Introduction: Simultaneously locked bucket handle injury of both menisci is a rare phenomenon. Clinically the knee is locked in flexion with pain in both joint lines. It has a high association rate with instability generated by an anterior cruciate ligament injury (ACL). There are a few reports regarding this association or without any associated injury treated either in one-stage or two-stage surgery.Objetive: To report a patient with a simultaneous bicompartmental locked bucket handle, highlighting the challenges of the surgical technique and a literature review.Case Report: We present the case of a 42-year-old male with a simultaneous bicompartmental locked bucket handle injury associated with chronic ACL deficiency. Treated in one stage by bilateral partial meniscectomy and ACL reconstruction. We discuss the MRI findings, treatment options and performed an up-to date review.Conclusions: Although partial meniscectomy is a common procedure, when performed in an unusual patient and in the absence of therapeutic guidelines or consensus when dealing with this association, an appropriate preoperative plan should be followed. This case provides a perioperative approach focused on a review of the most recent literature.

Nanostructured Modifications of Titanium Surfaces Improve Vascular Regenerative Properties of Exosomes Derived from Mesenchymal Stem Cells: Preliminary In Vitro Results

(1) Background: Implantation of metal-based scaffolds is a common procedure for treating several diseases. However, the success of the long-term application is limited by an insufficient endothelialization of the material surface. Nanostructured modifications of metal scaffolds represent a promising approach to faster biomaterial osteointegration through increasing of endothelial commitment of the mesenchymal stem cells (MSC). (2) Methods: Three different nanotubular Ti surfaces (TNs manufactured by electrochemical anodization with diameters of 25, 80, or 140 nm) were seeded with human MSCs (hMSCs) and their exosomes were isolated and tested with human umbilical vein endothelial cells (HUVECs) to assess whether TNs can influence the secretory functions of hMSCs and whether these in turn affect endothelial and osteogenic cell activities in vitro. (3) Results: The hMSCs adhered on all TNs and significantly expressed angiogenic-related factors after 7 days of culture when compared to untreated Ti substrates. Nanomodifications of Ti surfaces significantly improved the release of hMSCs exosomes, having dimensions below 100 nm and expressing CD63 and CD81 surface markers. These hMSC-derived exosomes were efficiently internalized by HUVECs, promoting their migration and differentiation. In addition, they selectively released a panel of miRNAs directly or indirectly related to angiogenesis. (4) Conclusions: Preconditioning of hMSCs on TNs induced elevated exosomes secretion that stimulated in vitro endothelial and cell activity, which might improve in vivo angiogenesis, supporting faster scaffold integration.

Preoperative Motion Planner for Steerable Needles Using Cost Map Based on Repulsive Field and Empirical Model of Needle Deflection

Needle insertion is a common procedure in percutaneous puncture. A motion planner for a steerable needle that considers the risk level of the path in anatomical environment and the actual deflection of clinical needle is necessary. A novel preoperative motion planner for a steerable needle controlled by robot is proposed. Our method utilizes sampling-based planner to compute candidate path in the reachable region, the path solutions are optimized by calculating the cost of a path based on a cost map. The cost-map, which is built based on repulsive field theory from CT image, encodes the information of the obstacle locations and the criticality of the anatomical environment. The empirical formula that can predict needle trajectory is obtained by insertion experiments. Experiments shown that positioning error in gelatin phantom under the guidance of our planner is less than 1.1mm. Comparing with the straight-line insertion method, the positioning error was reduced by 80%. The results indicate that the motion planner has the potential to provide effective guidance for robot-assisted puncture surgery while enhancing the position precision and patient safety.