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Morel-Lavallée lesions (MLL), also referred to as closed degloving injuries, result from traumatic shearing forces with separation of the subcutaneous fat from the underlying fascia. The aim of this study was to determine the incidence and treatment of MLLs at a level 1 trauma centre.Single-centre retrospective cross-sectional study of consecutive patients with an imaging diagnosis of a Morel-Lavallee lesion from 1/1/2010-31/12/2019. Demographic data, mechanism of injury, volume of lesion, management and outcome data were collated.Sixty-six MLLs were identified in 63 patients (64% Male) with a median age of 49.5 years (19-94 years). Mechanism of injury were road traffic accidents in the majority (66%). Median injury severity score (ISS) was 17 (range 1-33). Patients on oral anti-coagulants had significantly larger lesions (181.9 cc v 445.5 cc, P = 0.044). The most common lesion location was the thigh (60.5%). Patients that underwent imaging within 72 h of injury had significantly larger lesions than those imaged more than 72 h after the inciting trauma (65 cc v 167 cc, P 0.05). Management data were documented in 59% of lesions (39/66) in which 66.6% (n = 26) had invasive treatment. In the 31 patients where follow-up was available, 64.5% (n = 20) were persistent but decreasing in size. There was no significant difference in follow-up size for those who had invasive compared to conservative treatment (P = 0.3).The diagnosis of MLL should be considered for soft-tissue swelling in the context of shearing trauma. A variety of management options have been employed, with good overall outcomes.

The natural lifespan of the ovary is occasionally interrupted by pathological processes; some are known, but many are unknown. Premature ovarian insufficiency (POI) can be a devastating diagnosis for an adolescent or for someone who has yet to start a family. Common causes of POI include genetic and chromosomal defects, autoimmune damage, and cancer treatments. Knowledge of the pathogenesis of this condition and an awareness of contemporary hormone replacement and fertility options are required to design a multidisciplinary therapeutic approach comprising reproductive medicine, endocrinology, clinical psychology, and assisted fertility expertise.

A methodology is developed where a fundamental parameters approach (FPA) description of a laboratory powder diffraction instrument (configured in divergent-beam Bragg–Brentano geometry) is used to determine GSAS-II profile parameters for peak asymmetry and instrumental peak widths. This allows the instrumental contribution to peak shapes to be robustly determined directly from a physical description of the instrument, even though GSAS-II does not directly implement FPA for peak shape computation. The FPA-derived parameters can be used as the starting point for instrument characterization, or to characterize sample broadening without the use of a standard to determine the instrument profile function. This new method can facilitate generation of training sets for machine learning. A plot is generated that shows the differences between the two approaches, demonstrating upper bounds for the accuracy of the GSAS-II profile model for a particular instrumental configuration.

Incorporating artificial intelligence (AI) in diagnostic medical imaging reports has the potential to improve efficiency. Although perception of radiologists, radiographers, medical students and patients on AI use in image reporting has been explored, there is limited literature on non-radiologist clinicians' opinion on this topic.Single-centre online survey targeting non-radiologist medical staff conducted from May to August 2021 at a tertiary referral hospital in Melbourne, Australia. Survey questions revolved around clinicians' level of comfort acting on AI-generated reports with varying levels of radiologist involvement and scan complexity, opinion on medicolegal responsibility for erroneous AI-issued reports and perception of data privacy and security.Eighty-eight responses were collected, including 47.9% of consultants. Non-radiologist clinicians across all seniorities and specialties felt significantly less comfortable acting on AI-issued reports compared with radiologist-issued reports (mean comfort radiologist 6.44/7, mean comfort AI 3.35/7, P 0.001) but felt equally comfortable with an AI-hybrid model of care (mean comfort hybrid 6.38/7, P = 0.676). Non-radiologist clinicians believed that medicolegal responsibility with errors in AI-issued reports mostly lay with hospitals or health service providers (65.9%) and radiologists (54.5%). Regarding data privacy and security, non-radiologist clinicians felt significantly less comfortable with AI issuing image reports instead of radiologists (P 0.001).A hybrid AI-generated radiologist-confirmed method of image reporting may be the ideal way of integrating AI into clinical practice based on the perception of our referring non-radiologist medical colleagues. Formal guidelines on medicolegal responsibility and data privacy should be established prior to utilising AI in the clinical setting.

Research question Can workflow during IVF be facilitated by artificial intelligence to limit monitoring during ovarian stimulation to a single day and enable level-loading of retrievals? Design The dataset consisted of 1591 autologous cycles in unique patients with complete data including age, FSH, oestradiol and anti-Mullerian concentrations, follicle counts and body mass index. Observations during ovarian stimulation included oestradiol concentrations and follicle diameters. An algorithm was designed to identify the single best day for monitoring and predict trigger day options and total number of oocytes retrieved. Results The mean error to predict the single best day for monitoring was 1.355 days. After identifying the single best day for evaluation, the algorithm identified the trigger date and range of three oocyte retrieval days specified by the earliest and the latest day on which the number of oocytes retrieved was minimally changed with a variance of 0–3 oocytes. Accuracy for prediction of total number of oocytes with baseline testing alone or in combination with data on the day of observation was 0.76 and 0.80, respectively. The sensitivities for estimating the total number and number of mature oocytes based solely on pre-IVF profiles in group I (0–10) were 0.76 and 0.78, and in group II (>10) 0.76 and 0.81, respectively. Conclusions A first-iteration algorithm is described designed to improve workflow, minimize visits and level-load embryology work. This algorithm enables decisions at three interrelated nodal points for IVF workflow management to include monitoring on the single best day, assign trigger days to enable a range of 3 days for level-loading and estimate oocyte number.

Erectile Dysfunction (ED) is defined as the inability to obtain or maintain an erection firm enough for satisfactory sexual performance and affects the quality of life of over 50% of men aged over 40 years. Venogenic ED is elucidated as a cause in a subgroup of patients. The study aims to investigate the clinical success, technical success, safety and durability of venous embolisation for management of venogenic ED.After providing informed consent, and subsequent to confirmation of venogenic ED by Doppler ultrasound (dUS) and cavernosography, 80 men referred for cavernosography and pelvic vein embolisation, will undergo randomisation by a computer system either to treatment or sham groups. Efficacy will be assessed using dUS and a validated questionnaire, the International Index of Erectile Function (IIEF). Pharmacologic agents used during the trial will be recorded. The primary outcome of PiVET-ED is to establish clinical success at 3 and 6 months post venous embolisation, as defined by end diastolic velocity in the cavernosal artery 5 cm/s with dUS and by a 4-point improvement in IIEF. Durability of the embolisation procedure will be assessed annually to 5 years. Quality of life will be assessed at all study time points using the 36-Item Short Form Survey (SF-36).The PiVET-ED trial is a prospective, randomised, single-blinded, single centre, sham controlled study, which aims to establish the safety, efficacy and durability of pelvic vein embolisation for the treatment of venogenic erectile dysfunction.Australian New Zealand Clinical Trials Registry ACTRN12620001023943, 08/10/2020.

INTRODUCTION Pseudoaneurysms are uncommon but potentially life-threatening. Treatment may involve a variety of interventions including observation, manual compression, ultrasound-guided thrombin injection and a variety of endovascular and surgical techniques. Current treatments are largely based on observational data and there is no consensus on management. This study aimed to provide evidence for guiding clinical decisions regarding visceral artery pseudoaneurysm and peripheral artery pseudoaneurysm management. METHODS Retrospective single-centre review of patients diagnosed with visceral and peripheral artery pseudoaneurysms at a tertiary hospital (2010-2020). RESULTS There were 285 patients included in this study. A total of 86 patients were diagnosed with a visceral artery pseudoaneurysm, and 49 of these (57%) were caused by trauma. A total of 199 patients were identified with a peripheral pseudoaneurysm; 76 of these (38%) were caused by trauma and 69 (35%) were due to access site complication during an endovascular procedure. Initial technical success was achieved in 266 patients (93.3%) with 19 requiring an additional treatment to achieve success. Conservative treatment (100% success), endovascular treatment (98.1%) and surgery (100%) were more successful than ultrasound-guided compression (63.6%) and thrombin injection (83.8%). The median time from diagnosis to intervention was

Zinc oxide nanoparticles (ZnO NPs) are known to be one of the multifunctional inorganic nanoparticles with its application in the treatment of bacterial pathogens, especially when synthesized through green nanotechnology. In this study, ZnO NPs were successfully synthesized through co-precipitation method and its antibacterial activity against Ralstonia solanacearum was evaluated. Surface morphology through scanning electron microscope (SEM) exhibited an agglomerated rod-like structures, with a mean particle size of 180.9 nm. Phytochemical screening was performed through various chemical qualitative tests, to which the presence of terpenoids and cardiac glycosides in Caesalpinia sappan leaves was confirmed in the aqueous extract. Five treatments were evaluated against R. Solanacearum in terms of their zone of inhibition. The highest zone of inhibition from the different concentrations was observed from the positive control (Gentamicin) with a mean value of 34.47 mm, followed by 0.57 g/mL ZnO NPs with a mean value of 21.69 mm, and no zone of inhibition on the negative control, 0.28 g/mL, and 0.19 g/mL of synthesized ZnO NPs. Antibacterial activity of ZnO using disc diffusion method resulted in a significant zone of inhibition which proves that synthesized nanoparticles can be used as a potent antibacterial agent against R. solanacearum.

A girl presenting with delayed puberty and elevated gonadotropins may have a range of conditions such as Turner syndrome (TS), primary ovarian insufficiency (POI), and 46,XY disorders of sexual development (DSD). An organized and measured approach to investigation can help reach a timely diagnosis. Management of young people often requires specialist multidisciplinary input to address the endocrine and nonendocrine features of these complex conditions, as well as the psychological challenges posed by their diagnosis. Next-generation sequencing within the research setting has revealed several genetic causes of POI and 46,XY DSD, which may further facilitate an individualized approach to care of these young people in the future. Pubertal induction is required in many and the timing of this may need to be balanced with other issues specific to the condition (eg, allowing time for information-sharing in 46,XY DSD, optimizing growth in TS). Shared decision-making and sign-posting to relevant support groups from the outset can help empower young people and their families to manage these conditions. We describe 3 clinical vignettes of girls presenting with delayed puberty and hypergonadotropic amenorrhea and discuss their clinical management in the context of current literature and guidelines.