Search

The use of embolic protection devices (EPD) in peripheral vascular procedures with higher risk of distal embolic shower has gained wider acceptance with evidence mounting in favor of its use. We report our unique experience on the circumstances leading to and management of entrapment of an EPD within peripheral stent during management of a patient with critical limb ischemia.

Abstract Background Xanthogranulomatous pyelonephritis (XGP) is common in middle-age female, involved kidney usually is hydronephrotic, non-functioning and associated with stones but giant hydronephrotic presentation is a very rare. Case presentation We report a case of 25-year-old female presented as huge cystic abdominal lump involving left hemi-abdomen and crossing midline associated with pain. On radiological evaluation, she had giant left non-functioning hydronephrotic kidney pushing small and large bowel on right side for which she underwent open simple nephrectomy. To our surprise, her histopathology report was Xanthogranulomatous pyelonephritis. Only one case reported till date of Xanthogranulomatous pyelonephritis presented as giant hydronephrosis in adult. Conclusion Xanthogranulomatous pyelonephritis is very rare cause of giant hydronephrosis with a varying clinical and radiological presentation and difficult to diagnose preoperatively. Diagnosis of XGP should be entertained in case long-standing gross hydronephrotic obstructed, infected kidney with stone disease.

Abstract Background Spongioplasty alone or in combination with local tissue flaps can be used as a second layer for the prevention of complications of tubularised incised plate urethroplasty (TIPU) of hypospadias repair. It can be used when wide urethral plate and well-developed robust spongiosum are present. This study aims to review the success rate and complications of TIPU performed utilising spongioplasty alone as a second layer in Type 3 well-developed robust spongiosum. Methods This is a retrospective observational study conducted between January 2015 and December 2019 at a tertiary care centre. A total of 21 patients aged 4–15.4 years with primary hypospadias having a Type 3 well-developed robust spongiosum, Glans score ≤ 2, Meatal score ≤ 4, and Shaft score ≤ 3 underwent TIPU using spongioplasty alone as a second layer. The hospital stay ranged from 10 to 14 days and follow-up from 12 to 36 months. Results Hypospadias was distal in 12 (57.1%), mid in 5 (23.8%), and proximal penile in 4 (19.1%) patients. The mean Glans Meatus Shaft score was 6.1 (G = 1.25, M = 2.95, S = 1.9) with a range of 3–9. An early post-operative complication of preputial oedema and bladder spasm developed in 1 (4.7%) patient each. Meatal stenosis developed in 1 (4.7%) patient. None developed urethrocutaneous fistula. At 3 months all patients had good urinary flow (> 15 ml/s) and good cosmesis. All the patients/parents (in case of minors) were satisfied with the result. Conclusion Spongioplasty alone as the second layer after TIPU for primary penile hypospadias in patients with well-developed robust spongiosal tissue is associated with minimal, easily manageable complications.

In this paper, we examine the region- and layer-specific collagen fiber morphology via second harmonic generation (SHG) in combination with planar biaxial tension testing to suggest a structure-based constitutive model for the human meniscal tissue. Five lateral and four medial menisci were utilized, with samples excised across the thickness from the anterior, mid-body, and posterior regions of each meniscus. An optical clearing protocol enhanced the scan depth. SHG imaging revealed that the top samples consisted of randomly oriented fibers with a mean fiber orientation of 43.3o. The bottom samples were dominated by circumferentially organized fibers, with a mean orientation of 9.5o. Biaxial testing revealed a clear anisotropic response, with the circumferential direction being stiffer than the radial direction. The bottom samples from the anterior region of the medial menisci exhibited higher circumferential elastic modulus with a mean value of 21 MPa. The data from the two testing protocols were combined to characterize the tissue with an anisotropic hyperelastic material model based on the generalized structure tensor approach. The model showed good agreement in representing the material anisotropy with a mean r2 = 0.92.

As a remarkable parameter, the discharge coefficient (Cd) plays an important role in determining weirs' passing capacity. In this research work, the support vector machine (SVM) and the gene expression programming (GEP) algorithms were assessed to predict Cd of piano key weir (PKW), rectangular labyrinth weir (RLW), and trapezoidal labyrinth weir (TLW) with gathered experimental data set. Using dimensional analysis, various combinations of hydraulic and geometric non-dimensional parameters were extracted to perform simulation. The superior model for the SVM and the GEP predictor for PKW, RLW, and TLW included , and respectively. The results showed that both algorithms are potential in predicting discharge coefficient, but the coefficient of determination (RMSE, R2, Cd(DDR)max) illustrated the superiority of the GEP performance over the SVM. The results of the sensitivity analysis determined the highest effective parameters for PKW, RLW, and TLW in predicting discharge coefficients are , , and Fr respectively. HIGHLIGHTS Three different types of weirs have been studied in this paper.; Two SVM and GEP algorithms have been implemented to predict the discharge coefficient of three weirs.; Eighteen combinations of dimensionless parameters have been tested to achieve optimum prediction of the discharge coefficient.; An equation for a superior model has been extracted to simulate discharge coefficient.;

Background: Initial teacher education (ITE) research in South Africa shows gaps in preservice teachers' (PSTs) primary mathematics knowledge. Aim: We study the mental mathematics understandings and teaching experiences of three PSTs who achieved high gains for learners they taught mental mathematics to using the Mental Starters Assessment Project (MSAP) jump strategy materials. Setting: The three PSTs, from one urban university, taught the jump strategy to Grade 3 classes in three different Gauteng schools. Methods: Learner pre- and post-tests around the taught unit provided the basis for categorising the three 'high gain' PSTs. Extended interviews with each PST were then transcribed. Initial grounded analyses of these data were subsequently overlaid with categories drawn from the mathematical knowledge for teaching literature. Results: All three PSTs indicated relatively strong common content knowledge of jump strategies and connected specialised content knowledge. They also exhibited strong awareness of the MSAP content. They differed in how they saw the relationship between fluency, calculation and equivalence tasks. Conclusion: The study's findings indicate the need for more explicit attention to the connection between mental maths fluencies and strategic calculation in ITE. Contribution: The study points to ways in which mental mathematics can be understood and taught for strong learning gains.

This study profiled various levels of engagement and related communication behaviours among 50 Asian Indian Tamil autistic children (AUT) and their mothers. The interaction was compared with two groups of mother-child dyads of non-autistic (NA) children, 50 in each group, matched for chronological age (CA), and for language level (LL). Results indicated that despite mother's efforts to engage with their children, autistic children were often 'engaged with objects' or remained 'unengaged' due to children's preference for solitary play, while NA children were often engaged in 'co-ordinated' and 'people engagement'. Across the three groups, mothers predominantly took the lead and dominated the interaction, irrespective of children's language levels. These initiations by the mothers were often to provide instructions and to ask 'What' questions. Autistic children initiated communication predominantly to ask for an object and responded often in the form of negations and protests with limited verbal output or non-verbally. Most of the communication behaviours of both children and mothers in AUT group was quantitatively and qualitatively different when compared to those in both the NA groups, indicating unique nature of interactions despite matching for CA or LL. The observations from the study highlights the need for considering adult's contingent behaviours also, while assessing communication skills of autistic children in order to provide effective intervention.

In this paper, a new model known as YOLO-v5 is initiated to detect defects in PCB. In the past many models and different approaches have been implemented in the quality inspection for detection of defect in PCBs. This algorithm is specifically selected due to its efficiency, accuracy and speed. It is well known that the traditional YOLO models (YOLO, YOLO-v2, YOLO-v3, YOLO-v4 and Tiny-YOLO-v2) are the state-of-the-art in artificial intelligence industry. In electronics industry, the PCB is the core and the most basic component of any electronic product. PCB is almost used in each and every electronic product that we use in our daily life not only for commercial purposes, but also used in sensitive applications such defense and space exploration. These PCB should be inspected and quality checked to detect any kind of defects during the manufacturing process. Most of the electronic industries are focused on the quality of their product, a small error during manufacture or quality inspection of the electronic products such as PCB leads to a catastrophic end. Therefore, there is a huge revolution going on in the manufacturing industry where the object detection method like YOLO-v5 is a game changer for many industries such as electronic industries.

Xanthogranulomatous pyelonephritis (XGP) is an uncommon chronic granulomatous infection of renal parenchyma. XGP is often associated with long-term urinary tract obstruction due to stones and infection. We aimed to analyze the clinical, laboratory, and microbial culture profiles from bladder and kidney urine of patients who were diagnosed with XGP. Databases of patients with histopathological diagnosis of XGP from 10 centers across 5 countries were retrospectively reviewed between 2018 and 2022. Patients with incomplete medical records were excluded. A total of 365 patients were included. There were 228 (62.5%) women. The mean age was 45 ± 14.4 years. The most common comorbidity was chronic kidney disease (71%). Multiple stones were present in 34.5% of cases. Bladder urine culture results were positive in 53.2% of cases. Kidney urine culture was positive in 81.9% of patients. Sepsis and septic shock were present in 13.4% and 6.6% of patients, respectively. Three deaths were reported. Escherichia coli was the most common isolated pathogen in both urine (28.4%) and kidney cultures (42.4%), followed by Proteus mirabilis in bladder urine cultures (6.3%) and Klebsiella pneumoniae (7.6%) in kidney cultures. Extended-spectrum beta-lactamases producing bacteria were reported in 6% of the bladder urine cultures. On multivariable analysis, urosepsis, recurrent urinary tract infections, increased creatinine, and disease extension to perirenal and pararenal space were independent factors associated with positive bladder urine cultures. On multivariable analysis, only the presence of anemia was significantly more frequent in patients with positive kidney cultures. Our results can help urologists counsel XGP patients undergoing nephrectomy.

Abstract Background Penile strangulation by various metallic and non-metallic objects is a true urological emergency that requires prompt emergency management. The cases in this report will help in highlighting the varied presentations one can face in the emergency department. Management of such cases at times needs out-of-the-box thinking and improvised skills as resources to remove the foreign body are often scarce within the hospital. Case presentation We present two such cases of penile strangulation in adult patients. Both patients presented to us in the emergency department, one with a large metallic cone and another with a rubber band constricting their penises. Both the patients had hugely different grades of injuries and were managed accordingly. Both the patients required different methods to remove the constriction objects as per the need of the situation. One of the patients required total penectomy with permanent perineal urethrostomy; however, in the other case, we were able to save the penis. Conclusion Penile strangulation needs urgent medical attention and timely removal of the offending object. Grade of injuries and complications are directly proportional to the type of object and the duration of the strangulation. The non-metallic objects are easy to cut and remove. However, one should be aware of the challenges and the complications in managing metallic foreign bodies which at times may need out-of-the-box thinking, like use of motorized cutting tools.

Supra-pubic catheterization of bladder is used as a short or long term alternative to per-urethtral catheterization. Some catheter materials are more resistant to encrustation than others. If kept indwelling for longer duration, sooner or later all catheters cause complications like urinary tract infection (UTI), trauma, peri-catheter leakage, non-deflation of balloon, encrustations and stone formations resulting into retained catheter. Stone formation over neglected indwelling catheter is not an unusual clinical scenario and its management depends on etiology of catheter retention and complication. This article discusses etiopathogenesis, clinical presentations, diagnosis and varied management options used for the neglected retained supra-pubic catheter in three cases

Traumatic dislocation of testis (TDT) is an uncommon event. During trauma, the cremasteric reflex can forcefully retract the testis out of the scrotal sac saving the testis from the injury. However, associated injuries in the form of skin degloving, penile avulsion, and amputation can be present. Early surgical intervention to locate and deposit the displaced testis to the scrotal sac is essential. We present a case of a 33-year-old man with bilateral congenital cryptorchidism who suffered blunt trauma to his genitalia following a road traffic injury. On presentation, based on a well-developed scrotum, it looked like a case of TDT. However, good history along with detailed physical and radiological evaluation helped us reach the correct diagnosis. TDT must be suspected in a case of blunt trauma to the genitalia when the scrotal sac (well-developed) is empty. This case report highlights the importance of detailed clinical and radiological evaluation in such cases.

Vesical stone formation is very rare in posttransplant recipients. We describe a patient who developed hanging vesical stone more than 10 years after receiving a transplant near the ureteroneocystostomy site on polypropylene suture, treated by cystolithotripsy using the removal of suture material with cystoscopic scissors. The use of nonabsorbable suture leads to very late formation of stones over it. Hence, it should be avoided.

Spontaneous dorsal cord herniations are very rare, with only 3 reported cases published in the literature. We report a case of a 15-year-old girl, presenting with progressive symptoms of myelopathy, diagnosed with dorsal cord herniation. She was managed surgically. The herniated arachnoid forming the cyst wall was opened to find a dorsally herniated mass of the dorsal spinal cord. The dura was opened above and below the herniation and then around it to free the herniating nodule of the spinal cord. The nodule was not reducible and was partially amputated for biopsy, and to facilitate dural closure. The patient's post-operative course was uneventful with no fresh deficits. Lower limb weakness improved to 5/5 power with normal gait at 3 months follow-up. We speculate, after a literature review, that the dorsal cord herniation is a ‘dorsal trans-dural appendage of the spinal cord' possibly resulting from (a) abnormal migration of neural crest cells during formation of dorsal meninges; or (b) abnormal differentiation of neural crest cells; or (c) abnormal signaling by the neural crest cells. Keywords: Congenital transdural appendage of spinal cord, dorsal cord herniation, ventral cord herniation, Author(s): Sanjay H. Murali [1]; Tobin George (corresponding author) [1]; Krishnakumar Kesavapisharady [1]; Ganesh Divakar [1]; Easwer H. Venkat [1] Key Message: Spontaneous dorsal cord herniation is a very rare [...]

Purpose: We evaluate here our experience with modified Cantwell–Ransley technique described by Gearhart for correction of isolated continent epispadias in adults with respect to its long-term functional outcome and complications. Introduction: Isolated male epispadias is a rare anomaly with a reported incidence of 1 in 11,700 males. Many surgical techniques with various modifications described to correct epispadias as treatment are debatable and challenging. The majority of the cases are treated at childhood as clinical presentation is striking at birth; hence, presentation in adulthood is extremely rare. Materials and Methods: During the past 5 years, modified Cantwell–Ransley technique described by Gearhart was performed in five cases of isolated continent epispadias which includes two cases of proximal penile, two distal penile and one penopubic. All cases were fresh except one had prior failed repair. Corporal rotation was done by delayed absorbable sutures without incision and anastomosis and suprapubic diversions placed in all the cases. Results: All cases followed up ranging from 6 months to 5 years and were having horizontal and downwards angled penis. No case had urethrocutaneous fistula or stricture. One case had superficial skin infection which healed by secondary intention did not require any secondary procedure. All cases maintained erection post-operatively too. Catheterisation with soft tube revealed easily negotiable channel in all cases on follow-up. Conclusion: Modified Cantwell–Ransley repair described by Gearhart has excellent cosmetic, functional and anatomical results in isolated continent epispadias in the adult.

ABSTRACT Ureterocalycostomy can be performed in patients in whom desired methods of treating secondary PUJ (Pelvi-Ureteric Junction) obstructions either failed or could not be used. In our study, one child and two adults in whom one redo-ureterocalycostomy and two ureterocalycostomies were performed for severely scarred PUJ. The causes for secondary PUJ obstruction were post-pyelolithotomy in one case, post-pyeloplasty and ureterocalycostomy for PUJ obstruction in the second patient and the third patient had long upper ureteric stricture post-ureteropyeloplasty due to tuberculosis. In all these cases ureterocalycostomy proved to be salvage/final resort for preserving functional renal unit.

This paper reports the application of poly(azomethinethioamide) (PATA) resin having the pendent chlorobenzylidine ring for the removal of heavy metal ions such as Zn(II) and Ni(II) ions from the aqueous solutions by adsorption technology. Kinetic, equilibrium and thermodynamic models for Zn(II) and Ni(II) ions adsorption were applied by considering the effect of contact time, initial metal ion concentration and temperature data, respectively. The adsorption influencing parameters for the maximum removal of metal ions were optimized. Adsorption kinetic results followed the pseudo-second order kinetic model based on the correlation coefficient (R2) values and closed approach of experimental and calculated equilibrium adsorption capacity values. The removal mechanism of metal ions by PATA was explained with the Boyd kinetic model, Weber and Morris intraparticle diffusion model and Shrinking Core Model (SCM). Adsorption equilibrium results followed the Freundlich model based on the R2 values and error functions. The maximum monolayer adsorption capacity of PATA for Zn(II) and Ni(II) ions removal were found to be 105.4 mg/g and 97.3 mg/g, respectively. Thermodynamic study showed the adsorption process was feasible, spontaneous, and exothermic in nature.