Preoperative Factors Affecting the Outcome of Single Stage Hypospadias Repair- An Observational Study

Background:Hypospadias is one of the commonest congenital anomaly in boys which requires either a single stage repair or staged repair. The success of the procedure depend upon the type, anatomy, experience of the surgeon, method of repair and preoperative hormonal stimulation. Aim: The aim of the study was to evaluate the various preoperative factors responsible for outcome of single stage repair in distal penile, mid penile and proximal penile hypospadias. Methods: There were 48 patients in this observational study which were divided into two groups. Group A comprised of 24 patients with glanular and coronal hypospadias while Group B comprised of 16 patients with distal penile, 5 mid penile and 3 proximal penile types with minimal chordae. All the 24 (50%) patients in group A underwent meatal advancement and glanuloplasty incorporated (MAGPI) repair while in group B 15 (31.25%) patients underwent Tabularized Incised Plate (TIP) repair and 9 (18.75%) patients underwent combined TIP and Mathieu’s repair. Results: Overall operative success rate observed in the study was 41 (85.41%) patients. In 7 (14.58%) patients urethrocutaneous fistula as a major complication occurred which included 1 patient in Group A and 2 patients with Distal Penile Hypospadias (DPH), 2 patients with Mid Penile Hypospadias (MPH) and 2 patients with Proximal Penile Hypospadias (PPH) in Group B. In 2 (4.16%) patients, mild meatal stenosis was noted which settled with meatal dilatation. Urethrocutaneous fistula (UCF) disappeared in 2 (4.16%) patients on follow up with regular urethral dilatation. Conclusion: MAGPI is the ideal procedure for glanular/coronal hypospadias. For distal penile hypospadias, TIP alone or combined TIP and Mathieu’s repair gives equally good results. Preoperative testosterone therapy reduces the incidence of complications in a single stage hypospadias repair.

Single-Stage Adaptive Multi-Scale Point Cloud Noise Filtering Algorithm Based on Feature Information

This paper proposes a single-stage adaptive multi-scale noise filtering algorithm for point clouds, based on feature information, which aims to mitigate the fact that the current laser point cloud noise filtering algorithm has difficulty quickly completing the single-stage adaptive filtering of multi-scale noise. The feature information from each point of the point cloud is obtained based on the efficient k-dimensional (k-d) tree data structure and amended normal vector estimation methods, and the adaptive threshold is used to divide the point cloud into large-scale noise, a feature-rich region, and a flat region to reduce the computational time. The large-scale noise is removed directly, the feature-rich and flat regions are filtered via improved bilateral filtering algorithm and weighted average filtering algorithm based on grey relational analysis, respectively. Simulation results show that the proposed algorithm performs better than the state-of-art comparison algorithms. It was, thus, verified that the algorithm proposed in this paper can quickly and adaptively (i) filter out large-scale noise, (ii) smooth small-scale noise, and (iii) effectively maintain the geometric features of the point cloud. The developed algorithm provides research thought for filtering pre-processing methods applicable in 3D measurements, remote sensing, and target recognition based on point clouds.

Hydraulic Fracturing Design Optimization Guidelines for Heterogeneous Reservoir

This paper describes the journey of hydraulic fracturing design solutions and implementation in Khazzan field. More than 100 wells have been stimulated with hydraulic fracturing in the field in the last decade. Most of these wells were treated with a single-stage massive propped hydraulic fracturing treatment aimed at stimulating the entire vertical productive zone in a single treatment. More recently, hydraulic fracturing has begun on the southern acreage from Khazzan, referred to as Ghazeer. Producing layers in this area are thicker and higher permeability and, as a result, more prolific. Based on the available data and experiences, the establishment of clear guidelines has become a requirement to help the understanding and adjust the hydraulic fracturing design for each well to be become a well-specific optimum design. During the stimulation journey, surveillance techniques have been utilized and implemented in the Khazzan and Ghazeer fields to provide and develop better understanding of the fracture propagation process. These data have proven essential to support stimulation design evolvement and determine if multiple fracturing stages are justified or whether a single stage would be sufficient. Based on a wide range of hydraulic fracture stimulation operations performed across the Khazzan and Ghazeer fields, a flowchart was developed to integrate all the lessons learned from the previous experience and help optimize future fracture design. Clear guidelines include the rationale between the selection of single or multiple fracturing stages, the selection of optimal pad fractions, and other associated details of the fracture design. This flowchart has been extensively validated with surveillance and has proven its inherent value in many stimulated wells, with either single or multiple proppant fracturing stages.

Risk of Malocclusion Among Patients Undergoing Single-Stage Versus Two-Stage Cleft Palate Repair

Objective Evaluate impact of single-stage versus staged palate repair on the risk of developing malocclusion among patients with cleft palate (CP). Design Retrospective cohort study 2000–2016 Setting Academic, tertiary children’s hospital. Patients Patients undergoing CP repair between 1999–2015. Interventions CP repair, categorized as either single-stage or staged. Main Outcome Measure Time to development of Class III malocclusion. Results 967 patients were included; 60.1% had a two-stage CP repair, and 39.9% had single-stage. Malocclusion was diagnosed in 28.2% of patients. In the model examining all patients at ≤5 years ( n = 659), patients who were not white had a higher risk of malocclusion (HR 2.46, p = 0.004) and staged repair was not protective against malocclusion (HR 0.98, p = 0.91). In all patients >5 years ( n = 411), higher Veau classification and more recent year of birth were significantly associated with higher hazard rates ( p < 0.05). Two-staged repair was not protective against developing malocclusion (HR 0.86, p = 0.60). In the model examining patients with staged repair ≤5 years old ( n = 414), higher age at hard palate closure was associated with reduced malocclusion risk (HR 0.67, p < 0.001) and patients who were not white had increased risk (HR 2.56, p = 0.01). In patients with staged repair >5 years old, more recent birth year may be associated with a higher risk of malocclusion (HR 1.06, p = 0.06) while syndrome may be associated with lower risk of malocclusion diagnosis (HR 0.46, p = 0.07). Conclusion Our data suggests that staged CP repair is not protective against developing Class III malocclusion.