•Α new modified temporalis transfer technique for facial paralysis in elderly patients.•An algorithm that we developed to select the most appropriate treatment for our elderly patients.•Comparison ...between the standard Gilles-McLaughlin's technique and the modified one.
In patients with chronic facial palsy where the treatment by conservative means or only nerve grafting is no longer an option, reconstruction by dynamic procedures such as pedicled and/or free muscle transfer is required.
Five patients with chronic facial palsy were treaded by temporalis muscle transfer to the eye and mouth simultaneously. In four of them, the combined Gillies-McLaughlin technique was used, but for the fifth one, a modified technique was applied.
In all patients, immediate and late postoperative clinical outcomes were satisfactory and improved their everyday quality of life.
Depending on the duration of the disease, there are different techniques that can be used. For the chronic facial palsy in elderly patients, the muscle transfer has better results, and a self-developed algorithm give us the opportunity to choose the best possible treatment for each one of our patients. The modified technique was found to be better with less surgical time, and recovery period for the patients.
All the patients were satisfied with the results. For the fifth patient that the modified technique applied, the healing process was faster, and the aesthetic and functional reanimation achieved easiest, with no donor-site morbidity, comparatively with the rest patients where the standard Gillies-McLaughlin technique was used.
Langer's axillary arch (AA), the most common anatomical variant in the axillary area of definite clinical significance. This is an updated review of the reported variations in the structure, ...highlighting its morphological diversity and its potential in complicating axillary lymph node biopsy, lymphadenectomy, or breast reconstruction.
A review of the literature concerning the AA published between 1812 and 2020 was performed using the PubMed, Scopus, Embase, and Cochrane medical databases. The frequency, laterality, morphology, origin, lateral attachment points, vascularization, and neurosis of the AA were the parameters retrieved from the collected data.
The prevalence of AA ranged from 0.8% to 37.5%. It is more often unilateral, muscular in nature, and extending from the latissimus dorsi to the pectoralis major. It is vascularized by the lateral thoracic vessels or the subscapular artery and innervated by the thoracodorsal nerve.
Langer's AA, when present, may complicate surgical procedures in the area; therefore, every surgeon performing breast or axillary surgery should be aware of this entity and its variations to ensure maximal effectiveness and safety in the management of patients.
Reconstructing scalp defects after basal cell carcinoma removal in elderly patients is challenging. This case report emphasizes Matriderm® as a successful alternative, addressing limitations of ...traditional methods. The application of Matriderm® in resource-limited scenarios adds insights to surgical literature, and its' usage addresses challenges in patients, contributing to surgical knowledge.
Reconstructing scalp defects after basal cell carcinoma removal in elderly patients is challenging. This case report emphasizes Matriderm® as a successful alternative, addressing limitations of ...traditional methods. The application of Matriderm® in resource-limited scenarios adds insights to surgical literature, and its' usage addresses challenges in patients, contributing to surgical knowledge.
Novelty detection is the identification of new or unknown data or signal that a machine learning system is not aware of during training. Novelty detection is one of the fundamental requirements of a ...good classification or identification system since sometimes the test data contains information about objects that were not known at the time of training the model. In this paper we provide state-of-the-art review in the area of novelty detection based on statistical approaches. The second part paper details novelty detection using neural networks. As discussed, there are a multitude of applications where novelty detection is extremely important including signal processing, computer vision, pattern recognition, data mining, and robotics.
The European regulatory shift towards energy-efficient buildings and nearly zero energy buildings (NZEB) leads architects and engineers to the need for investigation of new innovative design ...methodologies. The reduction of the energy demand for cooling, heating and artificial lighting is now mandatory for new buildings and for large renovations of existing buildings, in order to comply with these new regulations. This is a challenge since the majority of the current building stock is consisted by over than 25-year-old existing buildings, which are inefficient in terms of energy needs. The aim of this study is to completely renovate an existing building in the centre of Nicosia, Cyprus, by applying a novel double façade system. This is consisted by a combination of a novel Building Integrated Photovoltaic/Thermal system (BIPV/T) and a Corridor Type Double façade system, which acts autonomously in every floor. The proposed research starts with an analysis of building and site geometry and moves through a literature review, along with the presentation of case studies where active solar energy systems are integrated on double building facades. Digital energy simulations are performed where the proposed double façade’s passive contribution is investigated. At the same time, these simulations aim to analyse whether the system can cover the energy needs of the aforementioned building. The investigation focuses into calculating the façade’s electricity production potential, whilst its passive contribution is recorded through the reduction potential of the building’s energy needs for heating, cooling and artificial lighting. Through a 3D simulations modelling, the existing energy needs are recorded and then compared to the calculated needs of the renovated building. The ultimate aim of this research is to determine whether the use of BIPV/T double façade solutions for the refurbishment of existing buildings consist an environmental viable solution.
Gangrenous cystitis is a rare condition of the urinary bladder with bladder wall ischemia as the main etiopathogenic factor and constitutes a surgical emergency. The risk factors for this condition ...include diabetes mellitus, prolonged labor, and topical chemotherapy, and the condition must be immediately treated because of its high mortality rate. This report describes a rare case of a patient with gangrenous cystitis who underwent radical surgical treatment; the incidence, etiology, diagnosis, management, and outcomes are also discussed.
This paper proposes a new model of "novelty detection" for image sequence analysis using neural networks. This model uses the concept of artificially generated negative data to form closed decision ...boundaries using a multilayer perceptron. The neural network output is novelty filtered by thresholding the output of multiple networks (one per known class) to which the sample is input and clustered for determining which clusters represent novel classes. After labeling these novel clusters, new networks are trained on this data. We perform experiments with video-based image sequence data containing a number of novel classes. The performance of the novelty filter is evaluated using two performance metrics and we compare our proposed model on the basis of these with five baseline novelty detectors. We also discuss the results of retraining each model after novelty detection. On the basis of Chi-square performance metric, we prove at 5 percent significance level that our optimized novelty detector performs at the same level as an ideal novelty detector that does not make any mistakes
Accurate preoperative risk assessment in emergency laparotomy (EL) is valuable for informed decision making and rational use of resources. Available risk prediction tools have not been validated ...adequately across diverse health care settings. Herein, we report a comparative external validation of four widely cited prognostic models.
A multicenter cohort was prospectively composed of consecutive patients undergoing EL in 11 Greek hospitals from January 2020 to May 2021 using the National Emergency Laparotomy Audit (NELA) inclusion criteria. Thirty-day mortality risk predictions were calculated using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), NELA, Portsmouth Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM), and Predictive Optimal Trees in Emergency Surgery Risk tools. Surgeons' assessment of postoperative mortality using predefined cutoffs was recorded, and a surgeon-adjusted ACS-NSQIP prediction was calculated when the original model's prediction was relatively low. Predictive performances were compared using scaled Brier scores, discrimination and calibration measures and plots, and decision curve analysis. Heterogeneity across hospitals was assessed by random-effects meta-analysis.
A total of 631 patients were included, and 30-day mortality was 16.3%. The ACS-NSQIP and its surgeon-adjusted version had the highest scaled Brier scores. All models presented high discriminative ability, with concordance statistics ranging from 0.79 for P-POSSUM to 0.85 for NELA. However, except the surgeon-adjusted ACS-NSQIP (Hosmer-Lemeshow test, p = 0.742), all other models were poorly calibrated ( p < 0.001). Decision curve analysis revealed superior clinical utility of the ACS-NSQIP. Following recalibrations, predictive accuracy improved for all models, but ACS-NSQIP retained the lead. Between-hospital heterogeneity was minimum for the ACS-NSQIP model and maximum for P-POSSUM.
The ACS-NSQIP tool was most accurate for mortality predictions after EL in a broad external validation cohort, demonstrating utility for facilitating preoperative risk management in the Greek health care system. Subjective surgeon assessments of patient prognosis may optimize ACS-NSQIP predictions.
Diagnostic Test/Criteria; Level II.
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