Approach to management of penile fracture- Our Three-year experience at a Teaching Hospital

Introduction: Penile fracture is a rare surgical emergency. It usually occurs as a single rupture of the tunica albuginea in one of the two corpora cavernosa; a rupture of both masses is an uncommon finding. We conducted this study to determine the etiology, clinical presentation and to review the causes and management of penile fracture. Methods: The retrospective study was carried out on 17 patients, admitted in the department of Urosurgery from January 2017 to December 2020 with penile fracture in a tertiary care teaching hospital in Kathmandu. Patient demographic profile, etiology, clinical presentation, time interval from injury to presentation, investigation done, treatment given and intraoperative findings were analyzed. Results: The main cause of penile fractures was sexual intercourse (82.35%) followed by manual manipulation (17.65%). Crackling sound (100%) followed by penile hematoma and pain were the most common presenting symptoms among the patients. Surgical exploration and repair of injury was done in all patients. Conclusion: Most of the time diagnosis of penile fracture can be made reliably by history and physical examination. Early surgical intervention is associated with a good outcome, regardless of the timing of presentation.

Concept of 'Central' or 'Axial' Atlantoaxial Instability

The atlantoaxial joint is the most mobile joint of the spine and is most liable to develop instability. Atlantoaxial instability can be identified on observation of facetal alignment on lateral profile imaging, telltale clinical and radiological evidence and by direct observation of instability by manual manipulation of bones during surgery. Central or axial atlantoaxial instability is when there is no abnormal increase in atlantodental interval on dynamic imaging and there is no dural or neural compression by the odontoid process. Understanding and appropriately treating central or axial atlantoaxial instability can have clinical implications.

Task dynamics define the contextual emergence of human corralling behaviors

Social animals have the remarkable ability to organize into collectives to achieve goals unobtainable to individual members. Equally striking is the observation that despite differences in perceptual-motor capabilities, different animals often exhibit qualitatively similar collective states of organization and coordination. Such qualitative similarities can be seen in corralling behaviors involving the encirclement of prey that are observed, for example, during collaborative hunting amongst several apex predator species living in disparate environments. Similar encirclement behaviors are also displayed by human participants in a collaborative problem-solving task involving the herding and containment of evasive artificial agents. Inspired by the functional similarities in this behavior across humans and non-human systems, this paper investigated whether the containment strategies displayed by humans emerge as a function of the task’s underlying dynamics, which shape patterns of goal-directed corralling more generally. This hypothesis was tested by comparing the strategies naïve human dyads adopt during the containment of a set of evasive artificial agents across two disparate task contexts. Despite the different movement types (manual manipulation or locomotion) required in the different task contexts, the behaviors that humans display can be predicted as emergent properties of the same underlying task-dynamic model.

Design of a Mechatronic Interface with Compliant Manipulator for Robot Assisted Echocardiography

A compliant manipulator with a compound soft actuator is proposed for robot-assisted echocardiography. The target application is devoted to the TOE echo (Trans-oesophageal echocardiography), which is conventionally performed by medical practitioners. The manual manipulation of the echocardiography probe shows significant risks such as human errors, exposure to ionizing radiation, and multitasking complexity. Automation of TOE provides advantages in terms of control, safety, and workload of the operator. This paper proposes a teleoperated robotic system assisting the physician to perform TOE, to be used in cardiac catheterization laboratories as well as hybrid operation theatres. A system containing a holder with master-slave Dynamixel servos and a manipulator with soft actuators has been developed. To alleviate the major lack of the previous designs in conducting the insertion tube, a robotic arm with a soft structure is proposed that has not hazards of conventional robot manipulators. The fundamental equations and relations for quasi-static control of the system are developed in this paper.

Republished: Manual reduction of a radial artery loop under direct fluoroscopic visualization

Transradial access has become increasingly used in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70 s who underwent preoperative embolization of a carotid body tumor via right transradial access. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop allowing the procedure to continue transradially. Although a majority of radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method before converting the access site.

Manual reduction of a radial artery loop under direct fluoroscopic visualization

Transradial access (TRA) has become increasingly utilized in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70s who underwent preoperative embolization of a carotid body tumor via right TRA. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce, even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop, allowing the procedure to continue transradially. Although most radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method prior to converting the access site.

Novel combined crystallization plate for high-throughput crystal screening and in situ data collection at a crystallography beamline

In situ microplates are small in size, crystal cultivation and operation are difficult, and the efficiency of crystal screening is relatively low. To solve this problem, a novel combined crystallization plate was designed for high-throughput crystal cultivation and in situ data collection. A frame was used to hold 48 in situ microplates, and the in situ microplates were sealed on one side with an ultralow background-scattering Kapton film. An automatic liquid handler (Mosquito) was used to add a liquid drop to the in situ microplates in the frame, and CrystalClear HD tape was used to seal the frame. A sealed frame holding 48 microplates was developed as a novel combined crystallization plate and was used for crystal cultivation under different conditions and in situ data collection at the synchrotron beamline. Moreover, individual microplates can be separated from the combined crystal plate and then fixed on a magnetic base or loaded onto a UniPuck for in situ data collection. Automatic grid scanning was used to locate crystals. The efficiency of the combined crystallization plate for crystal screening was verified. This method avoids the manual manipulation of crystals during crystal screening and diffraction data collection; therefore, the combined crystallization plate is suitable for large-scale screening of microcrystals.

How Asymmetries Evolved: Hearts, Brains, and Molecules

Humans belong to the vast clade of species known as the bilateria, with a bilaterally symmetrical body plan. Over the course of evolution, exceptions to symmetry have arisen. Among chordates, the internal organs have been arranged asymmetrically in order to create more efficient functioning and packaging. The brain has also assumed asymmetries, although these generally trade off against the pressure toward symmetry, itself a reflection of the symmetry of limbs and sense organs. In humans, at least, brain asymmetries occur in independent networks, including those involved in language and manual manipulation biased to the left hemisphere, and emotion and face perception biased to the right. Similar asymmetries occur in other species, notably the great apes. A number of asymmetries are correlated with conditions such as dyslexia, autism, and schizophrenia, and have largely independent genetic associations. The origin of asymmetry itself, though, appears to be unitary, and in the case of the internal organs, at least, may depend ultimately on asymmetry at the molecular level.

Severe ischaemic gangrene of scalp in an extreme preterm: a fatal case of combined aetiology

A 24+5-week preterm neonate with a severe scalp lesion was admitted to the neonatal intensive care unit (NICU) after caesarean section due to maternal chorioamnionitis (MC). An Arabin pessary had been inserted in addition to a previous cervical cerclage due to cervix insufficiency at 21+5 weeks of pregnancy (wp). At 23+5 wp, preterm rupture of membranes was evidenced. Both devices were kept to provide fetal viability. On 24+4 wp, she developed MC. Urgent caesarean section was performed. Transvaginal manual manipulation was required during the procedure. On NICU, she presented severe shock which required high-dose vasopressors and blood products. Following surgical repair, a bilateral grade IV intracranial haemorrhage was evidenced. Subsequently, it was agreed to withdraw life support. We hypothesise that MC and local infection could have acted as predisposing factors, with the presence of a pessary in the setting causing uterine contractions and its manipulation acting as a precipitating factor.