A potential crack region method to detect crack using image processing of multiple thresholding

In this paper, a potential crack region method is proposed to detect road pavement cracks by using the adaptive threshold. To reduce the noises of the image, the pre-treatment algorithm was applied according to the following steps: grayscale processing, histogram equalization, filtering traffic lane. From the image segmentation methods, the algorithm combines the global threshold and the local threshold to segment the image. According to the grayscale distribution characteristics of the crack image, the sliding window is used to obtain the window deviation, and then, the deviation image is segmented based on the maximum inter-class deviation. Obtain a potential crack region and then perform a local threshold-based segmentation algorithm. Real images of pavement surface were used at the Su Tong Li road in Suzhou, China. It was found that the proposed approach could give a more explicit description of pavement cracks in images. The method was tested on 509 images of the German asphalt pavement distress (Gap) dataset: The test results were found to be promising (precision = 0.82, recall = 0.81, F1 score = 0.83).

Hallux Valgus Recurrence After Simple Bunionectomy: Algorithm Treatment

Background: Recurrences of hallux valgus can be difficult to manage, especially after a prior simple bunionectomy. This study aimed to present a treatment algorithm for the correction of recurrences after a simple bunionectomy.Methods: This was a single-center, descriptive, and retrospective comparative study. Thirty-four consecutive patients were classified according to the bone stock and the presence or absence of end-stage arthritis of the first metatarsophalangeal joint (MTPJ). According to our algorithm, we only performed an osteotomy as the salvage procedure in cases with sufficient bone stock and absence of or mild arthritis. In the other cases, we performed an MTPJ fusion. Exceptionally, we chose a Keller-Brandes arthroplasty for patients with advanced age and comorbidities. Results: We performed 17 scarf osteotomies (50%), 15 MTPJ arthrodeses (44.1%), and 2 Keller-Brandes arthroplasties (5.9%). Following the algorithm, we achieved an improvement of the AOFAS score of >30 points without severe complications in all groups.Conclusions: The proposed operative algorithm successfully addresses the recurrences considering the lack of bone stock and the presence of MTPJ arthritis.Level of EvidenceLevel 3: retrospective comparative study

Evidence-Based Surgical Treatment Algorithm for Unstable Syndesmotic Injuries

Background: Surgical treatment of unstable syndesmotic injuries is not trivial, and there are no generally accepted treatment guidelines. The most common controversies regarding surgical treatment are related to screw fixation versus dynamic fixation, the use of reduction clamps, open versus closed reduction, and the role of the posterior malleolus and of the anterior inferior tibiofibular ligament (AITFL). Our aim was to draw important conclusions from the pertinent literature concerning surgical treatment of unstable syndesmotic injuries, to transform these conclusions into surgical principles supported by the literature, and finally to fuse these principles into an evidence-based surgical treatment algorithm. Methods: PubMed, Embase, Google Scholar, The Cochrane Database of Systematic Reviews, and the reference lists of systematic reviews of relevant studies dealing with the surgical treatment of unstable syndesmotic injuries were searched independently by two reviewers using specific terms and limits. Surgical principles supported by the literature were fused into an evidence-based surgical treatment algorithm. Results: A total of 171 articles were included for further considerations. Among them, 47 articles concerned syndesmotic screw fixation and 41 flexible dynamic fixations of the syndesmosis. Twenty-five studies compared screw fixation with dynamic fixations, and seven out of these comparisons were randomized controlled trials. Nineteen articles addressed the posterior malleolus, 14 the role of the AITFL, and eight the use of reduction clamps. Anatomic reduction is crucial to prevent posttraumatic osteoarthritis. Therefore, flexible dynamic stabilization techniques should be preferred whenever possible. An unstable AITFL should be repaired and augmented, as it represents an important stabilizer of external rotation of the distal fibula. Conclusions: The current literature provides sufficient arguments for the development of an evidence-based surgical treatment algorithm for unstable syndesmotic injuries.

Surgical Management of Juvenile Idiopathic Arthritis Related Dentofacial Deformities

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease of childhood and frequently affects the temporomandibular joints (TMJ). JIA TMJ management requires a team approach. Initially, TMJ JIA involvement is managed with systemic therapy or intra-articular medications to treat symptoms and limit the growth deformity, however may later require surgical intervention. This case series describes 4 patients with different presentations and treatments of juvenile idiopathic arthritis affecting the temporomandibular joints to illustrate a proposed treatment algorithm. This algorithm is not designed to be an absolute treatment regimen but a framework to help clarify the presenting problems and interventions that may be considered to treat JIA associated temporomandibular dysfunction and dentofacial deformity. This case series represents the variety of JIA temporomandibular joint disease and offers a graduated appropriate treatment algorithm.

Procalcitonin-Guided Treatment Regarding Antibiotic Use for Acute COPD Exacerbations (PRECISION): Study Protocol for a Prospective Randomized Controlled Trial.

Background: Chronic Obstructive Pulmonary Disease (COPD) is a worldwide prevalent disease. It is estimated to be the 3rd leading cause of death worldwide in 2020, and it is also a leading cause of disability-adjusted life years (DALY’s). COPD accounts for just over 3% of the total health care budget in the European Union. The majority of these costs are attributed to acute exacerbations of COPD (AECOPD). Given the contribution of exacerbations, it is of paramount importance to improve the current treatment of exacerbations to reduce the burden of disease for patients (mortality and DALY’s) and for society (costs). Treatment of AECOPD generally consists of corticosteroids and antibiotics, mostly in one-size fits all fashion. Pulmonary physicians are well aware of overuse of antibiotics, but lack the tools to decide which medication to give. Biomarkers may aid towards a more personalized treatment of AECOPD by identifying which patient would benefit from antibiotics. Procalcitonin (PCT) is the precursor of calcitonin and is released in response to a bacterial infection. PCT levels are minimally raised in viral infections, making it a relative specific diagnostic tool for bacterial infections. Several trials have shown a reduction in antibiotic consumption in AECOPD when using a PCT-guided treatment algorithm. One meta-analysis suggested that PCT-based protocols may be superior to standard care, but the authors stated that appropriately powered confirmatory trials are necessary. The objective of our study is to assess that at hospitalization for a severe AECOPD, PCT-guided treatment to guide antibiotic administration is non-inferior to usual care, in terms of treatment failure at day 30. Methods: The study is set up as a prospective randomized trial. A total of 693 patients with a severe exacerbation of COPD will be included and randomized between usual care and PCT-guided treatment regarding antibiotic therapy. The primary endpoint will be treatment failure within 30 days after inclusion, the endpoint comprises disease-related mortality and other disease-related adverse events. Discussion: We believe this trial can add to the currently available evidence with PCT being tested in a clinical setting in a treatment algorithm specifically in COPD with the primary objective being treatment failure. Trial registration: Netherlands Trial Register. Registration number: NL9122. Date of registration: 24-11-2020. URL of trial registry record: https://www.trialregister.nl/trial/9122

Reconstruction of the Distal Oblique Bundle for DRUJ Instability

Background Treatment algorithm for disruption of the triangular fibrocartilage complex (TFCC) from the ulnar fovea includes direct TFCC repair, tendon reconstruction of the radioulnar ligaments, or a salvage procedure in cases with painful distal radioulnar joint (DRUJ) degeneration. Case Description We describe our surgical technique for reconstruction of the distal oblique bundle (DOB), to attain DRUJ stability in a young man, after failed attempts of direct TFCC reinsertion and radioulnar ligament reconstruction with the Adams procedure. Literature Review Reconstruction of the central band of the interosseous membrane is well recognized for Essex-Lopresti injuries that demonstrate longitudinal forearm instability. The role for reconstruction/reinforcement of the DOB to restore DRUJ stability after TFCC injury has not gained the same recognition and needs further clarification. Clinical Relevance DOB reconstruction technique described is extra-articular and technically straightforward. We believe that the procedure could be considered for patients with an irreparable TFCC injury as a part of the treatment algorithm for younger patients, who otherwise would face a more extensive salvage procedure.

Treatment of Sialolithiasis: What Has Changed? An Update of the Treatment Algorithms and a Review of the Literature

Treatment for sialolithiasis has undergone significant changes since the 1990s. Following the development of new minimally invasive and gland-preserving treatment modalities, a 40–50% rate of gland resection was reduced to less than 5%. Extracorporeal shock-wave lithotripsy (ESWL), refinement and extension of methods of transoral duct surgery (TDS), and in particular diagnostic and interventional sialendoscopy (intSE) are substantial parts of the new treatment regimen. It has also become evident that combining the different treatment modalities further increases the effectiveness of therapy, as has been especially evident with the combined endoscopic–transcutaneous approach. In the wake of these remarkable developments, a treatment algorithm was published in 2009 including all the known relevant therapeutic tools. However, new developments have also taken place during the last 10 years. Intraductal shock-wave lithotripsy (ISWL) has led to remarkable improvements thanks to the introduction of new devices, instruments, materials, and techniques, after earlier applications had not been sufficiently effective. Techniques involving combined approaches have been refined and modified. TDS methods have been modified through the introduction of sialendoscopy-assisted TDS in submandibular stones and a retropapillary approach for distal parotid sialolithiasis. Recent trends have revealed a potential for significant changes in therapeutic strategies for both major salivary glands. For the submandibular gland, ISWL has replaced ESWL and TDS to some extent. For parotid stones, ISWL and modifications of TDS have led to reduced use of ESWL and the combined transcutaneous–sialendoscopic approach. To illustrate these changes, we are here providing an updated treatment algorithm, including tried and tested techniques as well as promising new treatment modalities. Prognostic factors (e.g., the size or location of the stones), which are well recognized as having a strong impact on the prognosis, are taken into account and supplemented by additional factors associated with the new applications (e.g., the visibility or accessibility of the stones relative to the anatomy of the duct system).