Reconstruction of massive tibial defect caused by osteomyelitis using induced membrane followed by trifocal bone transport technique: a retrospective study and our experience

Objective To evaluate clinical outcomes of the application of induced membrane followed by trifocal bone transport technique in the treatment of massive tibial defect caused by osteomyelitis. Method A total of 18 eligible patients with tibial defect > 6 cm caused by osteomyelitis who were admitted to our institution from January 2010 to January 2016 and treated by induced membrane followed by trifocal bone transport technique. There were 12 male and 6 females with an average age of 40.4 years old. A detailed demographic data (age, sex, etiology, previous operation time, defect size and location, interval from Masquelet technique to trifocal bone transport technique, external fixation index (EFI), duration of regenerate consolidation and docking union) were collected, bone and functional outcomes were evaluated by Association for the Study and Application of the Method of Ilizarov (ASAMI) scoring system. Complications during and in the period of follow up were recorded and evaluated by Paley classification at a minimum follow-up of 2 years. Results The etiology include posttraumatic osteomyelitis in 13 cases and primary osteomyelitis in 5 cases. An average of previous operation time was 3.4 times. Mean tibial defect after radical debridement was 6.8 cm. An average interval duration from formation of induced membrane to trifocal bone transport was 4.8 weeks. An average of EFI was 37.1 days/cm, the duration of regenerate consolidation and docking union were 124.7 days and 186.4 days, respectively. An average time of follow-up after removal of external fixator was 28.5 month without recurrence of osteomyelitis. The bony outcome was excellent in 6 cases, good in 8 cases, fair in 3 cases and poor in 1 case, and functional outcome was excellent in 4 cases, good in 10 cases, fair in 2 cases and poor in 2 cases. The most common complication was pin tract infection which occurred in 15 cases and there were no major complications such as nerve or vascular injury. Conclusion Massive tibial defect caused by osteomyelitis can be successfully treated first stage using induced membrane followed by second stage using trifocal bone transport technique, which is an effective method in terms of radical elimination of osteomyelitis with expected clinical outcomes.

The Operational Technique of Increasing Service Life Time of the Major Components of the Fighter Aircraft Engine Rotors

The operational technique for the major components of the fighter aircraft engine rotors has been introduced basing on the real conditions of their cyclic loading in each flight or ground test and a priori information on their previous operation. It has been confirmed that the obtained technical solutions not only conform to the current methods of accounting for the depletion of the life cycle of the Afterburning Turbofan Engine (ATE) but also introduce additional opportunities to consider individual characteristics and conditions of their cyclic loading throughout the overall operating time. A method for estimating the depletion of the life cycle in accordance with the Total Accumulated Cycle (TAC) has been proposed. It allows us to compare the actual operating time of the ATE in hours and the accumulated value of cyclic damage to the engine and its major components (within the TAC parameter) during the previous operation.

A Word of Caution for Gossypiboma

Gossypiboma, a retained nonabsorbable surgical sponge, is a major safety issue despite being infrequent, causing serious malpractice debates. In addition to this, it may mimic a range different disease within the thorax and even have unpleasant clinical presentations even after years.In this article, we report four gossypiboma cases with nonspecific clinical presentations to emphasize the importance of keeping this diagnosis in mind with all patients who have had a previous operation.

The Long-Term Outcome of Cyberknife Radiotherapy for Central Skull Base Meningiomas: A Single-Center Experience

Few reports exist demonstrating the effects of CyberKnife radiotherapy (CKRT) on the central skull base meningiomas (CSMs). Retrospective analysis of 113 patients were performed. The median age was 62 (IQR 50 – 72) years old, and 78 patients (69%) were female. Upfront CKRT was performed in 41 (36%), where 17 (15%) patients were asymptomatic. The other CKRT was for postoperative adjuvant therapy in 32 (28%), and for the recurrent or relapsed tumors in 40 (35%) patients. Previous operation was done in 74 patients (66%). Among the available pathology in 46 patients, 37 (80%) were WHO grade I, 8 (17%) were grade II, and 1 (2%) were grade III. The median prescribed dose covered 95% of the planning target volume was 2500 (IQR 2100 – 2500) cGy and the median target volume was 9.5 (IQR 3.9 – 16.9) cm3. The median PFS was 48 (IQR 23 – 73) months and 84% and 78% were free of tumor progression at five, and 10 years respectively. The median follow-up was 49 (IQR 28 – 83) months. PFS was better in grade I than grade II (p = 0.02). No other baseline factors including the history of previous operation was associated with PD or PFS. Adverse events of radiation therapy were radiation- induced optic neuropathy (0.9%), and cerebral edema (4.4%). Asymptomatic cavernous carotid stenosis was found in three (2.7%), five (4.4%) underwent ventriculoperitoneal shunt placement for normal pressure hydrocephalus, and five (4.4%) died. CKRT is useful for the management of CSMs with low rate of adverse events.

Anatomically Complete Supraclavicular Reoperation for Recurrent Neurogenic Thoracic Outlet Syndrome: Clinical Characteristics, Operative Findings, and Long-term Outcomes

Background: The clinical outcomes of reoperations for recurrent neurogenic thoracic outlet syndrome (NTOS) remain undefined. Methods: From 2009 to 2019, 90 patients with recurrent NTOS underwent anatomically complete supraclavicular reoperation after previous operation(s) performed at other institutions using either supraclavicular (Prev-SC = 48), transaxillary (Prev-TA = 31), or multiple/combination (Prev-MC = 11) approaches. Prospectively maintained data were analyzed retrospectively. Results: The mean patient age was 39.9 ± 1.4 years, 72% were female, and the mean interval after previous operation was 4.1 ± 0.6 years. The mean Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score was 62 ± 2, reflecting substantial preoperative disability. Residual scalene muscle was present in 100% Prev-TA, 79% Prev-SC, and 55% Prev-MC ( P < .05). Retained/residual first rib was present in 90% Prev-TA, 75% Prev-SC, and 55% Prev-MC ( P < .05). There were no differences in operative time (overall 210 ± 5 minutes), length of hospital stay (4.7 ± 0.2 days), or 30-day readmissions (7%). During follow-up of 5.6 ± 0.3 years, the improvement in QuickDASH scores was 21 ± 2 (36% ± 3%) ( P < .01) and patient-rated outcomes were excellent in 10%, good in 36%, fair in 43%, and poor in 11%. Conclusions: Anatomically complete decompression for recurrent NTOS can be safely and effectively accomplished by supraclavicular reoperation, regardless of the type of previous operation. Residual scalene muscle and retained/residual first rib are more frequently encountered after transaxillary operations than after supraclavicular or multiple/combined operations. Supraclavicular reoperation can achieve significant symptom reduction and functional improvement for approximately 90% of patients with recurrent NTOS.

Analyzing and Solving Stability Problems during the Commissioning of the Steam Turbine

The commissioning of the steam turbine in the CCPP of Vlore (Albania) was carried out after a shutdown of about one year. During previous operation of the unit, in particular in a couple of shutdowns, were observed high vibration at bearing MAD 21. Before the restart, the oil deflector of the MAD21 bearing (the bearing located in the front standard, on the inlet side of the steam turbine and adjacent to the clutch) was modified increasing the radial clearance on the part of the oil deflector acting as a thermal shield with the aim of eliminating / preventing the risk of rubbings. Rubs at the location of the above mention oil deflector were considered as the very likely cause of high vibration at bearing MAD 21. A lot of tests were carried out during the recommissioning phase and the data received were analyzed. This paper details the discovery of the problems, initial attempts to address them and the use of the rotor dynamics tools to find a solution of the problem by the optimization of the bearings. The bearings were not optimized as per rotordynamics analysis (RDA) findings, because it was a too expensive solution. The solution was found making some modification on control system of the ST, without affecting the mechanical integrity of the machine.

Verification of the UR5 robot’s properties after a crash caused by a fall of a transferred load from a crane

Installing robots in small businesses is primarily dependent on the ratio of money spent to achieve profit. In addition, from consumer pressure on the production, quality and low cost, the increasing cost of human labour leads to robot deployment. With falling prices of robots, their use is becoming increasingly common, which leads to small firms trying to implement robots that are not new. They try to buy a cheaper older robot or a robot that was damaged during its previous operation. It is necessary to eliminate the risk that arises from more serious damage to the robot, therefore, the requirements for verification of the robot’s resultant parameters after its repair performed in own interest. Based on such a requirement, the solution was to verify the parameters of the UR5 robot to confirm the possibility of its further use. After replacing the damaged parts, the robot was subjected to its parameter verification according to standard ISO 9283:2012. For measurement purposes, a measuring cube was designed and manufactured, as well as a measuring nest for Heidenhain sensors.

Prototipos interpretativos, prácticas de apropiación y luchas simbólicas. Replanteando las relaciones entre estos términos a la luz de un estudio empírico sobre la recepción del tango

Toda práctica de apropiación supone dos cosas: por una parte, se encuentra motivada por los intereses del agente social. Por la otra, supone a la interpretación como operación lógicamente anterior. Tan anterior se la concibe, que la semiótica cognitiva prescindió por completo del estudio de los usos de los signos. Sin embargo, creemos que existen razones para revisar el vínculo entre apropiación e interpretación, y la relación de esto último con los intereses de los intérpretes. Esta es la tesis que pretendemos desarrollar, que surge como resultado de un trabajo empírico sobre la recepción del tango por parte de milongueros.All appropriation practices suppose two things: on the one hand, it is motivated by the interests of the social agent. On the other, it assumes interpretation as a logical previous operation. This is so to such an extent that cognitive semiotics completely disregarded the study of the uses of signs. However, we believe that there are reasons to review the link between appropriation and interpretation, and the relationship of the latter with the interests of the interpreters. This is the thesis that we intend to develop, which arises as a result of an empirical work on the reception of tango by milongueros.

Multi-objective optimization for sustainable groundwater management by developing of coupled quantity-quality simulation-optimization model

This study addresses the issue of optimal management of aquifers using a mathematical simulation- optimization model which relies on the stability of water quality and quantity, considering salinity. In this research first we developed a hydrological model (SWAT) to estimate recharge rates and its spatiotemporal distribution. Then, groundwater simulation of the basin was simulated and calibrated using MODFLOW 2000 and water quality was simulated and calibrated using MT3DMS. Afterwards, a multi-objective optimization model (MOPSO) and embed simulation models as tools to assess the objective function was carried out in order to produce a simulation-optimization model. Finally, a sustainability index to assess Pareto front's answers and three management scenarios (continuing previous operation, 30% increasing and reduction in previous operation) was developed. The results show that the majority of Pareto optimal answers have more sustainability index than a 30% reduction of operation with the best answer of 0.059. Relatively, the sustainability index of 30% reduction of operation is 0.05.