Surgical Resection of Gastro-Pleural-Bronchial Fistula after Prolonged Endoscopic Treatments

Sleeve gastrectomy is the most commonly performed bariatric surgery in the United States. While complication rates are typically low, some studies have reported leaks in up to 2.4-5.3% of cases. Here, we examine such a case with subsequent failure of numerous endoscopic interventions ultimately necessitating formal resection of a gastro-Pleural-bronchial fistula.

Effects of Surface Preparation on the Corrosion Behavior of Mild Steel

Surface preparation of engineering materials is necessary for preventing corrosion and subsequent failure of materials in service. There are different methods of surface preparations that can affect engineering materials in different ways. This study investigated the effect of surface preparation on the corrosion behavior of zinc sprayed and unsprayed mild steel. Quantitative analysis and potentiodynamic polarization techniques were used to evaluate the immersed samples of different surface preparations. The results indicated that the least corrosion rate was observed for the uncoated sample prepared with CC1200 grit paper at 0.041 mpy and successive samples in the order of CC220 grit paper at 0.047 mpy < P60 grit paper at 0.052 mpy < filing at 0.064 mpy and grinding at 0.074 mpy after 42-days of immersion. The prepared samples that were further coated with zinc spray demonstrated a similar trend. The sample prepared with CC1200 grit paper and further coated with zinc spray exhibited the lowest corrosion rate of 1.35 x 10-9 mpy. Potentiodynamic polarization results further suggested that the same behavior was observed in the quantitative analysis.

The outcome of direct composite restorations using the dental operating microscope

Background. The objective of the present study was to compare the outcome of direct composite restorations, with and without the use of additional magnification. Methods. Twenty extracted molars were selected for the study. Class 1 Black cavities were prepared. All teeth were etched, and bonding agent was applied. Teeth were assigned randomly into two groups of ten each. Group I: restorations were done without the use of magnification, first by placing a layer of SDR® flow +Bulk Fill Flowable on the base of the cavity, and then restoring the morphology with Ceram.X SphereTEC® One. Group II: the same protocol was applied, but using the dental microscope. Teeth were then evaluated before and after the finishing protocol by 5 dental professionals using a series of established criteria. The results were documented and statistically analyzed using the non-parametric Mann-Whitney test. Results. Statistically significant differences were found when using magnification, before the polishing protocol in “marginal adaptation integrity” and “excess material”, and after polishing in “marginal adaptation integrity”. Conclusions. Magnification may be used to increase the quality of the final direct posterior restoration by improving the marginal adaptation integrity, reducing excess material, preventing marginal microleakage, and avoiding subsequent failure.

Ventriculoperitoneal shunt failure in pediatric patients: an analysis of a national hospitalization database in Thailand

OBJECTIVE Shunt failure is common among patients undergoing ventriculoperitoneal shunting for treatment of hydrocephalus. The present study examined long-term shunt failure and associated risk factors in pediatric patients by using a national hospitalization database of Thailand. METHODS Patients 17 years or younger who had been admitted to 71 public hospitals in 2012–2017 for first-time ventriculoperitoneal shunting for diseases with known etiology and discharged alive were followed through 2019 to ascertain shunt failure. Shunt survivals were calculated using Kaplan-Meier estimates and time to failure was analyzed to identify risk factors for the first failure by using Cox proportional hazards regression. Differences in risks of subsequent failures with respect to place in the order of failures (i.e., first, second, third) were determined using a cumulative hazard function. RESULTS Over a median follow-up of 29.9 months, shunt failure occurred in 33.7% of 2072 patients (median age 8.8 months), with a higher proportion in patients < 1 year than in patients 1–17 years (37.8% vs 28.9%, p < 0.001), and ranged from 26.1% of those having posttraumatic hydrocephalus to 35.9% of those having infectious diseases. The shunt failure rates at 3, 6, and 12 months were 11.5%, 19.0%, and 25.2%, respectively. Patients < 1 year had a higher risk of the first failure than patients 1–17 years (hazard ratio 1.45, 95% CI 1.20–1.76). Among those with shunt failure, 35.8% had multiple failures and 52.9% failed within 180 days after the index shunting. The cumulative hazard of subsequent failure was consistently higher than that of an earlier failure regardless of age and etiology, and the cumulative hazard of the second failure in the patients with 180-day failure was higher than that in the patients in whom shunts failed beyond 180 days. CONCLUSIONS Shunt failure occurred more frequently in younger pediatric patients. Much attention should be placed on the initial shunt operation so as to mitigate the failure risk. Close follow-up was crucial once patients had developed the failure, because the risk of subsequent failure was more likely than an earlier one among those with multiple failures.

Prevalence, median time, and associated factors with the likelihood of initial antidepressant change: a cross-sectional study in Qatar

Background Major Depressive Disorder (MDD) requires therapeutic interventions during the initial month after being diagnosed for better disease outcomes. International guidelines recommend a duration of 4–12 weeks for an initial antidepressant (IAD) trial at an optimized dose to get a response. If depressive symptoms persist after this duration, guidelines recommend switching, augmenting, or combining strategies as the next step. Premature discontinuation of IAD due to ineffectiveness can cause unfavorable consequences. We aimed to determine the prevalence and the patterns of strategies applied after an IAD was changed because of a suboptimal response as a primary outcome. Secondary outcomes included the median survival time on IAD before any change; and the predictors that were associated with IAD change. Methods This was a retrospective study conducted in Mental Health Services in Qatar. A dataset between January 1, 2018, and December 31, 2019, was extracted from the electronic health records. Inclusion and exclusion criteria were defined and applied. The sample size was calculated to be at least 379 patients. Descriptive statistics were reported as frequencies and percentages, in addition, to mean and standard deviation. The median time of IAD to any change strategy was calculated using survival analysis. Associated predictors were examined using several cox regression models. Results A total of 487 patients met the inclusion criteria of the study, 431 (88%) of them had an occurrence of IAD change to any strategy before end of the study. Almost half of the sample (212 (49%); 95% CI [44–53%]) had their IAD changed less than or equal to 30 days. The median time to IAD change was 43 days with 95% CI [33.2–52.7]. The factors statistically associated with higher hazard of IAD change were: younger age, un-optimization of the IAD dose before any change, and comorbid anxiety. Conclusions Because almost half of the patients in this study changed their IAD as early as within the first month, efforts to avoid treatment failure are needed to ensure patient-treatment targets are met. Our findings offered some clues to help clinicians identify the high-risk predictors of short survival and subsequent failure of IAD.

Experience level as a predictor of entry into the hypotympanum during feline total ear canal ablation and lateral bulla osteotomy

Objectives The study hypotheses were as follows: (1) owing to the unique anatomy of the feline middle ear, the hypotympanum would be entered in less than 100% of cats during total ear canal ablation and lateral bulla osteotomies (TECA-LBOs); and (2) incomplete penetration of the septum and subsequent failure to enter the hypotympanum is more likely to occur in surgeries performed by a novice surgeon when compared with an experienced surgeon and may be under-recognized. Methods Head CT was performed in 12 feline cadavers to confirm absence of gross ear disease. A novice surgeon and an experienced surgeon were randomly assigned to perform TECA-LBO on the left or right ear. Surgeons were blinded to each other’s surgical technique. CT of cadavers was performed after the procedure. Successful penetration of the septum, entry into the hypotympanic cavity and amount of bone removed in bulla osteotomy, quantified via CT, were compared between the novice surgeon and experienced surgeon. Results The novice surgeon entered the hypotympanum in 3/12 (25%) procedures, compared with 9/12 (75%) procedures performed by the experienced surgeon. The experienced surgeon performed a larger osteotomy than the novice surgeon (3301 mm vs 1376 mm, P<0.0023). Regardless of surgeon experience, more bone was removed in surgeries in which the hypotympanum was entered. Conclusions and relevance Our results underscore the need for familiarity with feline middle ear anatomy when performing TECA-LBOs. Postoperative CT is recommended for novice surgeons to confirm entry into the hypotympanum.

Material modelling of FDM printed PLA part

This paper focuses on modelling inelasticity of additively manufactured polylactide (PLA) thermoplastic using Fused Deposition Modelling (FDM) printing technology. The material response of PLA is viscoplastic and temperature-dependent, as is typically seen for thermoplastics. The inelastic deformation of printed PLA undergoes initial yielding, strain softening, and subsequent failure. The Three-Network (TN) constitutive model was employed in this work, which captures experimentally observed material response and consists of three molecular equilibrium and time-dependent viscous networks that act in parallel. The parameter identification was performed in accordance with experimental data from uniaxial testing and a validation experiment was carried out by loading plate with a hole and measuring its strain distribution using Digital Image Correlation (DIC) method, which was compared with the predictions from Finite Element Analysis (FEA).

Narcissism, Entrepreneurial Learning and Entrepreneurial Failure

This study evidences that psychological construct in terms of narcissistic behavior through an excessive use of social media will not boost entrepreneurs to learn from past failure experiences in business. By considering excessive narcissism through social media as a personality disorder, this study examines it as a possible cause of entrepreneurial failure. The study uses data from two sets of questionnaire with one hundred and fifty failed entrepreneurs. Analysis is quantitatively undertaken with Structural Equation Modelling/SEM and is supported by the result of Narcissistic Personality Inventory-16/NPI-16 questionnaire which reflects the degree of respondents’ narcissistic behavior. The study infers that the greater narcissistic behavior entrepreneurs has, even with the presence of entrepreneurial learning from the past failures, may lead entrepreneurs to experience subsequent failure. Stubbornness and hypocrisy are two reasons behind this. Therefore, entrepreneurs should be aware of their negative character-personality and psychological aspects when performing entrepreneurial processes.

High concentrated mass transportation to the grinding zone

Transportation of high concentrated fibrous materials to the disk mill grinding zone may be accompanied by problems when the fibrous material clogs the knife gap and causes subsequent failure of the grinding equipment. The article considers one of the few recommendations helping to eliminate this negative effect taking into account main technological factors of the grinding process.