Search

Purpose. The aim of this study is to analyze results according to postoperative pelvic incidence-lumbar lordosis (PI-LL) mismatch in the management of adult spine deformity (ASD) patients. Recently, it has been reported that in addition to lumbar lordosis amount, lordosis repartition between its proximal and distal parts was crucial. Methods. We enrolled 77 consecutive ASD patients who underwent posterior spinal fusion and deformity correction between 2015 and 2018. On preoperative and 1-year follow-up radiographs, we analyzed different parameters such as L1-S1 lumbar lordosis, L1-L4 proximal lordosis (PLL), L4-S1 distal lordosis (DLL), pelvic tilt (PT), sagittal vertical axis (SVA), and PI-LL mismatch. Comparisons were performed according to postoperative PI-LL mismatch (defined as “aligned” when PI-LL was 0.05). 35 patients were classified as “aligned” and 42 as “not aligned.” Patients from the “aligned” group had a significantly lower PI than patients from the “not aligned” group (52° vs. 61°, p=0.009). Postoperative PLL was not different between groups (18° vs. 16° p>0.05), whereas DLL was significantly higher in the “aligned” group (31° vs. 22°, p=0.003). PI-LL was significantly correlated to DLL (rho = 0.407, p

Surgical management of adult spinal deformities remains challenging, and one of the major goals is to restore sagittal alignment. Spinal rods used for posterior fixation are usually delivered straight and bended manually during surgery. This manual bending can be responsible for undercorrection of the deformity. In the last years, prebended patient-specific rods have been developed and might be a valuable tool in order to optimize surgical results. The objective is therefore to use the time between surgical decision and operative room in order to realize a precise surgical planning and obtain patient-specific rods. We describe here the planning process and our preliminary experience with patient-specific rods in the management of adult deformity about 77 cases. On the 77 cases, PSR were used without further modifications of the shape. Based on 3-month postoperative evaluation, a significant decrease of sagittal vertical axis (−41%, p

OBJETIVO: Os autores analisam os resultados por eles obtidos com a utilização de técnica específica para a preservação da valva aórtica. CASUÍSTICA E MÉTODOS: Esse método consiste no emprego habitual da circulação extracorpórea com uso de hipotermia moderada e infusão de solução cardioplégica nos óstios coronários. Realiza-se ressecção da válvula não coronariana e une-se as comissuras correspondentes utilizando-se fio de Mersilene 2-0 ancorado em feltro de teflon, tornando a valva "bivalvulada". Procede-se por fim à aortorrafia convencional. Foram operados 15 pacientes, 9 do sexo masculino. A idade variou entre 12 e 78 anos. Quatro pacientes tinham diagnóstico de insuficiência aórtica isolada, 2 com dupla disfunção aórtica associada à insuficiência coronária, 2 com doença da aorta ascendente, 4 com insuficiência aórtica e mitral, 1 com dupla disfunção aórtica e mitral, e 2 com insuficiência aórtica e insuficiência coronária. RESULTADOS: Em 12 pacientes não houve insuficiência aórtica residual pós-operatória, e em 3 identificou-se insuficiência aórtica leve ou moderada. Três pacientes foram reoperados no pós-operatório tardio devido a insuficiência aórtica, tendo sido substituída a valva aórtica em 2. Quatro pacientes foram submetidos a estudo hemodinâmico e em 1 deles havia gradiente supravalvar de 20 mmHg. Nos outros 3 pacientes, o gradiente sistólico transvalvar foi de 0, 9 e 12 mmHg, respectivamente. Os 11 pacientes restantes foram avaliados somente através de ecocardiografia, a qual não demonstrou estenose. Não houve óbito imediato e houve 1 óbito tardio, após reoperação. Quatorze pacientes tiveram melhora da classe funcional, tanto imediata quanto tardiamente, e foram acompanhados durante período entre 30 dias e 24 meses, encontrando-se em classe funcional I ou II (NYHA). CONCLUSÃO: Os autores acreditam que o método seja uma alternativa para o tratamento cirúrgico conservador da doença valvar aórtica.PURPOSE: The authors report a method of surgical treatment of the aortic valve disease, called "Surgical Remodeling of Aortic Valve". MATERIAL AND METHOD: The method consisted of the utilization of the habitual extracorporeal circulation, moderated hipothermia and the infusion of cardioplegic solution in the coronary ostia. The non-coronary valvula is resected and stitches anchored in the aortic valva anulus are given in a way to approximate the resected valvula commissures, in order to turn the trivalvular valva into a bivalvulate one. The Valsalva sinus corresponding to the resected valva stays situated below the commissure and the remaining aortic wall is sutured with a few separated stitches, followed with the conventional aortorraphy. Between March of 1996 and July of 1999, 15 patients were operated with the described technique. Nine were male and the age ranged from 12 to 78 years. Four patients had aortic valve insufficiency, 4 with aortic and mitral insufficiency, 2 with double aortic lesion and coronary artery disease, 2 with ascending aortic disease, 2 with aortic insufficiency and coronary artery disease, and 1 with double dysfunction of aortic and mitral valves. RESULTS: Three patients developed aortic insufficiency on the post-operative and 3 of them were operated on in the late post-operative. Four patients were submitted to hemodynamic study and one of them had a supravalvar gradient estimated at 20 mmHg. Eleven patients were studied by echocardiogram and did not have stenosis. There were neither immediate obits and one occurred in the late post-operative period. Fourteen patients were followed during 30 days to 24 months, and had a good evolution (Functional Class I or II of the NYHA). CONCLUSION: This method for the aortic valve preservation is an alternate option for the surgical treatment of the aortic valve disease.

Aims: Sexual dysfunction is one of the most important factors that can play a fundamental role in the individual and social health and adjustment of people. Chemical injury is one of the cases that can be considered as a serious factor in the occurrence or aggravation of sexual dysfunction by causing organic and psychological changes in male and female victims. The purpose of this study was to identify sexual dysfunctions in chemical warfare victims in Sardasht city. Participants & Methods: This qualitative phenomenological research was carried out in 2018 using grounded theory method among all chemical warfare victims in Sardasht city. At first, Hurlbert Index of Sexual Desire (HISD) was distributed among the identified individuals and 60 chemical victims (30 females and 30 males) with low score were selected by purposive sampling method for participation in the study. Semi-structured interviews were used to collect data. All interviews were recorded and then transcribed, and finally the data were analyzed using the Colaizzi’s seven step process and grounded theory method. Findings: The core code for "multiple sexual disfunctions" included 9 selected codes. Selected codes were identified with their primary and secondary concepts. Conclusion: Identified sexual disfunctions include disorder in initiating sexual relations, lack of sexual arousal, lack of perception of sexual pleasure, sexual organ dysfunction, lack of sexual desire, impotency, erectile dysfunction, multi-faceted disorder in ejaculation and masturbation.

The main objective of this paper is to examine the influence of the applied confining stress on the rock mass modulus of moderately jointed rocks (well interlocked undisturbed rock mass with blocks formed by three or less intersecting joints). A synthetic rock mass modelling (SRM) approach is employed to determine the mechanical properties of the rock mass. In this approach, the intact body of rock is represented by the discrete element method (DEM)-Voronoi grains with the ability of simulating the initiation and propagation of microcracks within the intact part of the model. The geometry of the pre-existing joints is generated by employing discrete fracture network (DFN) modelling based on field joint data collected from the Brockville Tunnel using LiDAR scanning. The geometrical characteristics of the simulated joints at a representative sample size are first validated against the field data, and then used to measure the rock quality designation (RQD), joint spacing, areal fracture intensity (P21), and block volumes. These geometrical quantities are used to quantitatively determine a representative range of the geological strength index (GSI). The results show that estimating the GSI using the RQD tends to make a closer estimate of the degree of blockiness that leads to GSI values corresponding to those obtained from direct visual observations of the rock mass conditions in the field. The use of joint spacing and block volume in order to quantify the GSI value range for the studied rock mass suggests a lower range compared to that evaluated in situ. Based on numerical modelling results and laboratory data of rock testing reported in the literature, a semi-empirical equation is proposed that relates the rock mass modulus to confinement as a function of the areal fracture intensity and joint stiffness. Keywords: Synthetic rock mass modelling (SRM), Discrete fracture network (DFN), Rock mass modulus, Geological strength index (GSI), Confinement

We present a useful formula for the expected number of maxima of a normal process ξ(t) that occur below a level u. In the derivation we assume chiefly that ξ(t),ξ′(t), and ξ′′(t) have, with probability one, continuous 1 dimensional distributions and expected values of zero. The formula referred to above is then used to find the expected number of maxima below the level u for the random algebraic polynomial. This result highlights the very pronounced difference in the behaviour of the random algebraic polynomial on the interval (−1,1) compared with the intervals (−∞,−1) and (1,∞). It is also shown that the number of maxima below the zero level is no longer O(logn) on the intervals (−∞,−1) and (1,∞).

Background: To determine any differences in clinical outcomes between patients in the supine vs the lateral position during anterior-based muscle sparing (ABMS) total hip arthroplasty (THA). Methods: A retrospective review was performed of 368 patients undergoing THA via the ABMS approach (201 lateral vs 167 supine position) at our institution (2015-2019) with a minimum follow-up of 12 months. Inclusion criteria were all patients undergoing primary THA. Exclusion criteria were any revision surgeries and patients who did not undergo the ABMS THA. Outcomes assessed were postoperative complication rates, ambulation distance, length of stay, and Western Ontario and McMaster Universities Osteoarthritis Index pain, stiffness, and physical function scores at 3 time periods (preoperative, 3 months postoperative, and 1 year postoperative). Results: The supine group had significantly greater postoperative day 0 ambulation distance (150 vs 60 meters; P < .001), while no difference was observed on postoperative day 1 (210 meters in supine vs 200 in lateral; P = .921). Median length of stay was significantly shorter in the supine group (1; interquartile range 0-1) with respect to the lateral group (1; interquartile range 0-2; P < .001). The in-hospital complication rates (2.4% in supine vs 1.5% in lateral; P = .780), return to operating room rates (2.4% in supine vs 1.5% in lateral; P = .780), and readmission rates (5.4% in supine vs 5.0% in lateral; P = .631) were not significantly different between the groups. No significant differences were observed across any Western Ontario and McMaster Universities Osteoarthritis Index scores. Conclusions: Both supine and lateral patient positioning provide acceptable early surgical outcomes, suggesting that satisfactory results can be obtained via both positions in THAs.

In this paper, we show that the asymptotic estimate for the expected number of K-level crossings of a random hyperbolic polynomial a1sinhx+a2sinh2x+⋯+ansinhnx, where aj(j=1,2,…,n) are independent normally distributed random variables with mean zero and variance one, is (1/π)logn. This result is true for all K independent of x, provided K≡Kn=O(n). It is also shown that the asymptotic estimate of the expected number of turning points for the random polynomial a1coshx+a2cosh2x+⋯+ancoshnx, with aj(j=1,2,…,n) as before, is also (1/π)logn.

This paper provides the asymptotic estimate for the expected number of real zeros of a random hyperbolic polynomial g1coshx+2g2cosh2x+…+ngncoshnx where gj,(j=1,2,…,n) are independent normally distributed random variables with mean zero and variance one. It is shown that for sufficiently large n this asymptotic value is (1/π)logn.

We determine conditions under which the partial sums of the Libera integral operator of functions of bounded turning are also of bounded turning.

For random coefficients aj and bj we consider a random trigonometric polynomial defined as Tn(θ)=∑j=0n{ajcos⁡jθ+bjsin⁡jθ}. The expected number of real zeros of Tn(θ) in the interval (0,2π) can be easily obtained. In this note we show that this number is in fact n/3. However the variance of the above number is not known. This note presents a method which leads to the asymptotic value for the covariance of the number of real zeros of the above polynomial in intervals (0,π) and (π,2π). It can be seen that our method in fact remains valid to obtain the result for any two disjoint intervals. The applicability of our method to the classical random trigonometric polynomial, defined as Pn(θ)=∑j=0naj(ω)cos⁡jθ, is also discussed. Tn(θ) has the advantage on Pn(θ) of being stationary, with respect to θ, for which, therefore, a more advanced method developed could be used to yield the results.