Fenestrated Aortic Aneurysm Repair in Patients Treated Inside Versus Outside of Instructions for Use

Objectives: The aim of this study was to compare outcomes of patients treated with the Cook Zenith Fenestrated (ZFEN) device for juxtarenal aortic aneurysms inside versus outside the IFU. Methods: We retrospectively reviewed our institutional ZFEN database for cases performed between 2012 and 2018, with analysis performed in 2020 in order to report midterm outcomes. The cohort was stratified based on treatment inside (IFU group) and outside (non-IFU group) the IFU for criteria involving the proximal neck: neck length 4 to 14 mm, neck diameter 19 to 31 mm, and neck angulation ≤45°. Patients with thoracoabdominal aneurysms or concurrent chimney grafting were excluded. The primary outcomes in question were mortality, type 1a endoleak, and reintervention. Univariate and multivariate analyses were performed to determine associations between adherence to IFU criteria and outcomes. Results: We identified 100 consecutive patients (19% female, mean age 73.6 years) for inclusion in this analysis. Mean follow-up was 21.6 months. Fifty-four patients (54%) were treated outside the IFU because of inadequate neck length (n=48), enlarged neck diameter (n=10), and/or excessive angulation (n=16). Eighteen patients were outside IFU for two criteria, and one patient was outside IFU for all three. Non-IFU patients were exposed to higher radiation doses (3652 vs 5445 mGy, p=0.008) and contrast volume (76 vs 95 mL, p=0.004). No difference was noted between IFU and non-IFU groups for 30-day mortality (0% vs 3.7%, p=0.18), or type 1a endoleak (0% vs 1.9%, p=0.41). Reintervention was also similar between cohorts (13% vs 27.8%, p=0.13). Being outside IFU for neck diameter or length was each borderline significant for higher reintervention on univariate analysis (p=0.05), but this was not significant on multivariate Cox proportional hazard modeling (HR 1.82 [0.53–6.25]; 2.03 [0.68–7.89]), respectively. No individual IFU deviations were associated with the primary outcomes on multivariate analysis, nor being outside IFU for multiple criteria. Conclusions: Patients with juxtarenal aortic aneurysms may be treated with the ZFEN device with moderate deviations from the IFU. While no differences were seen in mortality or proximal endoleak, larger studies are needed to examine the potential association between IFU nonadherence and reinterventions and close follow-up is warranted for all patients undergoing such repair.

Definitions of intracranial aneurysm size and morphology: A call for standardization

Background: Intracranial aneurysms (IAs) are classified based on size (maximal dome diameter) as well as additional parameters such as neck diameter and dome-to-neck ratio (DNR). The neurosurgical literature includes a wide variety of definitions for both IA size and neck classifications. Standardizing the definitions of IA size and wide-neck classifications would help eliminate inconsistencies and potential misunderstandings of aneurysm morphology and rupture risk. Methods: We queried the MEDLINE (EBSCO) database using the terms “unruptured IA” and (“small” or “medium” or “large”) and filtered based on publication date, language, and scholarly journals. The resulting articles and their references were further screened for eligibility. This identified 286 records, of which 104 were excluded, leaving 182 articles for analysis. The review found several different IA size classifications and neck classifications. Results: A review of the existing literature describing size and neck classifications revealed 13 size classifications for small aneurysms, four classifications for medium aneurysms, 15 classifications for large aneurysms, and one classification for giant aneurysms. There were also seven different wide-neck classifications found. Conclusion: It is imperative that a standardization in classification be implemented to help interventionalists make the most informed decisions regarding emerging treatment options as new endovascular technologies and devices are emerging with indications based around these classifications. Based on the database findings, this article recommends standardized quantitative measurement ranges for IA size and neck classifications.

Does Proximal Hip Geometry Affect Fracture Type in The Elderly Population?

Background The aim of this study was to determine the differences in proximal femoral geometric (PFG) parameters between patients with femoral neck fractures(FNFs) and patients with intertrochanteric fractures (ITFs). Methods We retrospectively evaluated 114 patients (33 FNFs, 81 ITFs.) who were hospitalized secondary to hip fractures. Patients were divided into two groups: patients with FNFs and patients with ITFs. The PFG parameters (the neck shaft angle, center-edge angle, femoral head diameter, femoral neck diameter, neck/head ratio, femoral neck axial length, femoral shaft diameter, hip axial length, and neck/hip length ratio) were measured on the hip joint radiographs. Results There were no statistically significant differences in age and gender between the FNF and ITF groups. In addition, there were no statistically significant differences in the PFG parameters between the FNF and ITF groups except in the neck/hip length ratio (NHLR) (0.86 ± 0.03 vs 0.84 ± 0.03, p = 0.05). When a 3-way multivariate analysis was performed according to gender, fracture type, and fracture site, the femoral head diameter, femoral neck diameter, femoral neck axial length, femoral shaft diameter, hip axial length, and NHLR were found to be greater in females than in males, and a statistically significant relationship was found between gender and these variables. Conclusion Only the NHLR was significantly higher in the ITF group, so this study revealed that a higher NHLR, which is the presence of a longer hip axis combined with a shorter neck axis, is a risk factor for ITF after a minor trauma.

Influence of Rhizobium and Mycorrhizae in the Production of Seedlings of Caesalpinia Spinosa L. Taya in San Pablo, Peru

This research study evaluated the symbiotic influence of Mycorrhizae in the production of propagating material of Caesalpinia Spinosa L. Taya, as well as the characterization of strains of mycorrhitic fungi in field, nursery, and laboratory work. No nodules were found as a product of nitrifying bacteria in the roots of plants Caesalpinea spinosa L., and ectomycorrhitic fungi were identified in the rhizosphere, such as Basidiomicetes and species of Rhizoctonia sp and Fusarium sp. From the evaluations, T4 exceeded all treatments, such as in height, neck diameter, number of leaves, root length, and the wet and dry weight of Taya seedling. In conclusion, we say that the Caesalpinia Spinosa L. Taya, despite of belonging to the legume family, does not present nodulation; but the presence of ectomycorrhitic fungi such as the basidiomicetes in the rhizosphere and high content of organic matter, positively influences the increase in the volume of seedling in the nursery, also reflected in the absorption of protein and phosphorus. Keywords: mycorrhizal association, seedlings, rhizobium. Resumen En el presente trabajo de investigación se evaluó la influencia simbiótica de micorrizas en la producción de plantones de Caesalpinea spinosa L. Taya, así como la caracterización de cepas de hongos micorríticos, realizándose el trabajo en campo, vivero, y laboratorio. No se encontró nódulos como producto de bacterias nitrificantes en las raíces de las plantas de Caesalpinea spinosa L., y se identificó hongos ectomicorríticos en la rizósfera, tales como Basidiomicetes y especies de Rhizoctonia sp y Fusarium sp. De las evaluaciones el T4, supera a todos los tratamientos como en altura, diámetro de cuello, número de hojas, longitud de raíz, peso húmedo y peso seco de plántula.Concluyendo finalmente, diremos que la Caesalpinea spinosa L. taya, a pesar de pertenecer a la familia de las Leguminosas no presenta nodulación; pero la presencia de los hongos ectomicorríticos como los basidiomicetes en la rizósfera y el alto contenido de materia orgánica, influye positivamente en el incremento del volumen de la plántula en vivero, reflejado también en la absorción de proteínas y fosforo. Palabras clave: asociación micorrítica, plantones, rizobium.

Restoration of Some Anatomical Dimensions By Spiron Short Stem Hip Replacement Applied To Vietnamese People

Background: The process of using proximal bone in hip arthroplasty will allow the remaining bone to be preserved in future surgeries. To take advantage of these advantages, many types of short stem prosthetics have been developed in recent years. The obtained survey parameters combined with the obtained anatomical parameters shown that the Spiron joint is suitable when applied to adult Vietnamese.Research subjects and methods: The anatomical dimensions of the hip joint related to Spiron joint replacement were analyzed by the authors.Results: The anatomical results with Spiron showed that the acetabular average diameter and tilt angle were 49.77 mm and 41.55°. The femoral neck-to-body angle, the femoral upper-neck diameter, the distance from the crest to the hard shell along the femoral neck axis was on average 131.52°, 34, 32mm, and 51.39mm, respectively. The offset distance from the center of the crest to the axis of the femur is 38.33mm. These parameters show the working ability as well as stability when replaced by the Spiron joint.Conclusion: When applied to adult Vietnamese, the femoral neck diameter is consistent with the Spiron diameter. Preoperative planning is needed to check the femoral neck angle and femoral neck length prior to surgery to see if the Spiron joint replacement is eligible. The findings of this study support the assumption that it is feasible to use Spiron prostheses in joint replacement in Vietnamese adults.

Radiographic Assessment of the Proximal Femoral Anatomy in An Indigenous African Adult Population

Background: Hip surgeries such as fracture fixation, corrective osteotomy, hemiarthroplasty, or total hip arthroplasty require accurate preoperative templating for a successful outcome. Such templating is done using the proximal femur and the acetabulum radiographs, depending on the planned surgery. Understanding the normal radiographic anatomy of the proximal femur is crucial to differentiate a normal from pathological anatomy. Proximal femoral anatomic indices include the femoral head diameter, femoral neck diameter, femoral neck length, femoral offset, femoral neck axis length and the femoral neck-shaft angle. Aim: This study assesses and establishes the average values of the proximal femoral anatomy in an indigenous African adult population. Method: This cross-sectional study examined 190 normal anteroposterior (AP) radiographs of the pelvis. The mean age, weight and height of the subjects were obtained. The following proximal femoral anatomic parameters were measured: femoral neck length (FNL), femoral neck diameter (FND), femoral head diameter (FHD), femoral neck-shaft angle (FNSA), femoral offset (FO) and femoral neck axis length (FNAL). The authors compared the mean difference of the parameters between the genders and the age categories and assessed the parameter correlations with the patients’ weight and height. Results: Males constituted 63 (33.2%) of the study population. The mean age of the subjects was 51.46 years (SD = 16.37). The mean weight was 76.13 kg, while the mean height was 1.62 m. The mean values of the proximal femoral parameters were as follows: FNL 4.52cm, FND 3.42cm, FHD 4.76cm, FNSA 132.960, FO 4.09cm, and FNAL 10.34cm. Males have a significantly higher mean value in all the parameters except the FO. None of the parameters showed any significant difference among the age categories except the FNL. A post-hoc analysis showed that the difference in the FNL lies between the young and the elderly age groups. The subjects’ height correlated with all the parameters except FNSA, while the weight correlated with the FND, FNSA and FNAL. Conclusion: The proximal femoral anatomy in Africans differed from those published in foreign literature. This knowledge is crucial for implant manufacturing companies and preoperative templating for hip surgeries. KEY WORDS: Proximal femur, Anatomy, Black population.

Effect of Abiotic Stress on Onion Yield: A Review

Onion (Allium cepa L.) is a spice crop and a valuable economic crop cultivated in a variety of environments around the world. Because of its export demand, it is extremely important in terms of foreign exchange. Drought stress, waterlogging stress, heat stress, cold stress, and salinity stress all have an impact on onion growth, production, and yield in different ways. A lack of water causes low productivity, therefore to increase onion yield, a constant supply of water is needed. Onions are particularly susceptible to salt stress. The number of bulbs per unit area, height, and fresh weight of onion bulbs, are all affected by salinity in irrigation water. It has an effect on bulbing and the quality of harvested bulbs. Waterlogging has a major effect on bulb development and yield at various growth stages. Waterlogging stress in onions may prevent moving from source to sink, lowering bulb yield. The possible flavor of onions can be affected by the surrounding climate. The bulbing response is influenced by temperature, and the degree to which it is influenced varies by variety. As the temperature increases, the number of leaves decreases. The bulb diameter, bulb weight, and bulbing index (bulb/neck diameter) all increase as the temperature rises. This review provides an in-depth description of the effect of abiotic stress on onion yield.

Semi-automated cerebral aneurysm segmentation and geometric analysis for WEB sizing utilizing a cloud-based computational platform

Background Accurate aneurysm measurements are important for selecting the WEB device. The objective was to validate a cloud-based platform, SurgicalPreview (SP) against manual measurements for aneurysm analysis. Methods Two sets of measurements each for SP and manual methods were obtained for 40 aneurysms. Reliability and agreement were assessed with intra-class correlation coefficient (ICC) and Bland-Altman plots respectively. Kappa coefficient was used to assess agreement for predicting WEB size. Results There was good reliability for repeat SP measurements: aneurysm diameter (ICC-1, 95%CI 0.98–1), height (ICC-1, 95%CI 0.99–1) and neck diameter (ICC-0.96, 95%CI 0.93–0.98). There was good reliability for the two manual diameter (ICC-0.97, 95%CI 0.9–0.97) and height (ICC-0.93, 95%CI 0.87–0.96) measurements and moderate for neck diameter (ICC-0.76, 95%CI 0.54–0.87). There was greater agreement for SP versus manual repeat measurements on Bland-Altman plots. Reliability between the SP and manual methods was good for aneurysm diameter (ICC-0.98, 95%CI 0.95–1) and height (ICC-0.96, 95%CI-0.93–0.98) and moderate for neck. (ICC-0.6, 95%CI -0.22–0.87). The Bland-Altman plots confirmed better agreement between the two methods for the aneurysm diameter and height than the neck. There was strong agreement between the methods for predicting the WEB diameter (Kappa-0.84, 95%CI 0.71–0.97) and moderate for predicting WEB height (Kappa-0.66, 95%CI 0.43–0.89). There was moderate agreement for predicted versus deployed WEB diameter: SP (Kappa-0.56, 95%CI 0.38–0.74), Manual (Kappa-0.53, 95%CI 0.34–0.71). Conclusion The SurgicalPreview® had greater agreement for repeat measurements. There was good reliability between the two methods for predicting WEB diameter and height and moderate agreement between predicted versus deployed WEB diameter.

Growth and Yield of Onion as Influenced by Sulphur and Boron with Mulch Materials

A field experiment was conducted at the research farm of Sher-e-Bangla Agricultural University, Dhaka. During the period from October, 2018 to March, 2019 to find out the growth and yield of onion as influenced by Sulphur and Boron with mulch materials. The experiment consisted of two factors: Factor A: Four doses of Sulphurand Boron fertilizer viz. F0 = S0kgB0kg/ha (Control), F1 = S20kgB1kg/ha, F2 = S40kgB2kg/ha, F3 = S60kgB3kg/ha and Factor B: Four types of mulch viz. M0 = No mulch and no irrigation, M1 = Black polythene, M2 = Water hyacinth and M3 = Rice straw. There were 16 treatment combinations and experiment was setup in a Randomized Complete Block Design (RCBD) with three replications. In case of Sulphur and Boron treatments at 60 days after transplanting (DAT), the highest plant height 53.38 cm, maximum leaf number 10.48, highest bulb length 4.83 cm,, maximum neck diameter (1.31 cm), highest dry matter content (15.98%), dry matter content of leaf (24.74%), single bulb weight (39.93 g), yield per plot (0.80 kg) and yield per hectare (9.98 t) were obtained from F3 treatment. Among the mulch materials, highest plant height at 60 DAT (52.51 cm), maximum leaf number (10.19), highest bulb length (4.52 cm), highest bulb diameter (5.74 cm), maximum neck diameter (1.26 cm), dry matter content of leaf (23.35%), single bulb weight (39.05 g), yield per plot (0.78 kg) and yield per hectare (9.76 t) were obtained from M1 treatment. In combined effect, the highest plant height at 60 DAT (55.54 cm), maximum leaf number (11.47), longest bulb length (5.51 cm), highest bulb diameter (6.68 cm), maximum diameter of neck (1.42 cm), dry matter content of leaf (27.48%), single bulb weight (42.40 g), yield per plot (0.85 kg) and yield per hectare (11.21 t) were obtained from F3M1 treatment (S60kg/ha + B3kg/ha with black polythene mulch). The highest gross return (Tk. 3, 36, 300/ha), net return (Tk. 1, 88, 934/ha) and benefit cost ration (2.28) was obtained from the treatment combination (F3M1). Accordingly, for high growth, high yield, and economic point of view, F3M1 treatment is recommended in onion cultivation.