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We are rapidly approaching the 2-year anniversary since Vascular Surgery became a distinct speciality in surgery. Dr Chan addressed the importance of the subspeciality Vascular Nurse as an essential partner in modern vascular service. Dr Pang reviewed his 3-year results of advanced endovascular interventions for high-grade Trans-Atlantic Inter-Society Consensus-Class D (TASC-D) femoropopliteal inventions, and compared patency and clinical outcomes with the traditional bypass operations. [Extracted from the article] Copyright of Surgical Practice is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Over the past decade, additive manufacturing (AM) has become widely adopted for both prototyping and, more recently, end-use products. In particular, fused deposition modeling (FDM) is the most widespread form of additive manufacturing due to its low cost, ease of use, and versatility. While additive processes are relatively automated, many steps in their operation and repair require trained human operators. Finding such operators can be difficult, as highlighted during the recent COVID-19 pandemic. Augmented reality (AR) systems could significantly help address this challenge by automating the training for 3D printer operators. Given multidimensional design choices, however, a research gap exists in the system requirements for such immersive guidance. To address this need, we explore the applicability of AR to guide users through a repair process. In that context, we report on the system design as well as the results of the AR system assessment in a qualitative study with experts. © 2023 IEEE.
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This review highlights ten important advances in the neuromuscular disease field that were first reported in 2020. The overarching topics include (i) advances in understanding of fundamental neuromuscular biology; (ii) new / emerging diseases; (iii) advances in understanding of disease etiology and pathogenesis; (iv) diagnostic advances; and (v) therapeutic advances. Within this broad framework, the individual disease entities that are discussed in more detail include neuromuscular complications of COVID-19, supervillin-deficient myopathy, 19p13.3-linked distal myopathy, vasculitic neuropathy due to eosinophilic granulomatosis with polyangiitis, spinal muscular atrophy, idiopathic inflammatory myopathies, and transthyretin neuropathy/myopathy. In addition, the review highlights several other advances (such as the revised view of the myofibrillar architecture, new insights into molecular and cellular mechanisms of muscle regeneration, and development of new electron microscopy tools) that will likely have a significant impact on the overall neuromuscular disease field going forward.
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Advertising connects the institutional and business sector with the public, responding to a persuasive and commercial interest. Advertising connects the institutional and business sector with the public, responding to a persuasive and commercial interest. The promotion of tourist destinations is a key activity for public and private advertisers to effectively communicate with their audiences. These advertisements show citizens' interests and motivations for travelling in the 21st century. This study analysed 95 advertisements published in 2020 in the newspaper El Pais, the most widely read generalist print media in Spain, on the day of the week coinciding with the publication of the specialised supplement "El viajero" (The Traveller). A quantitative and qualitative content analysis has been carried out in order to respond to the main objective of identifying the main advertisers and the usual sales proposition in this type of advertisement, also explaining the narrative strategies used in tourism campaigns. The main conclusions are the importance of wellbeing in the campaigns carried out and the important presence of public bodies in the promotion of destinations, especially Spanish destinations, highlighting historical, cultural and environmental heritage, which take on the same importance as the offer of beaches or cruises. This is an advertisement aimed especially at young people who travel as a couple, reflecting social concerns and trends in an irregular year for tourism promotion due to the covid-19 pandemic. This time period was an exceptional context, with consequences on citizen attitudes towards travel, which undoubtedly limits the application of these conclusions to that specific time context.
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Introduction: Liver abscesses are caused by direct spread from peritonitis, biliary tract infection or via hematogenous seeding from a distant source. Most are polymicrobial, however Escherichia coli and Klebsiella pneumoniae are the most common offending pathogens. Patients usually present with pain, fever, and clinical signs of infection. We describe a case of spontaneous liver abscess in a non-toxic patient that recurred 10 years after a previous abscess. Case Description/Methods: A 73-year-old-man with a history of type 2 diabetes mellitus, hypertension, CAD status post CABG and PCI 3 years ago, and abdominal aortic aneurysm status post endovascular aneurysm repair presented with 2 weeks of dark urine. After receiving his COVID-19 booster and influenza vaccinations, he developed flu-like symptoms with a self-resolving fever of 101.8degreeF. He had dark amber urine without dysuria or hematuria. Later, he experienced generalized weakness and decreased oral intake. Outpatient labs showed elevated liver function tests, and he was told to present to the ED. On arrival, he was afebrile with stable vitals. Physical exam was unremarkable. Laboratory evaluation showed a hemoglobin of 11.7 g/dL, sodium of 133 mEq/L, creatinine of 1.4 mg/dL, aspartate aminotransferase of 117 U/L, alanine aminotransferase of 212 U/L, alkaline phosphatase of 825 U/L, total bilirubin of 4.1 mg/dL, and direct bilirubin of 2.1 mg/dL. Triple-phase CT showed a 2.8 cm mass in the right liver lobe with linear enhancement. Ultrasound showed mixed echogenicity measuring 3.6 x 2.9 x 3.3 cm in segment 8 of the liver. On further evaluation, patient had an E. coli abscess diagnosed 10 years prior, managed with antibiotics and drainage. At that time, the abscess was within the right inferior liver lobe, similar to his current abscess. LFTs downtrended. Abscess was aspirated, with culture growing oxidase negative, gramnegative rods, likely E. coli. Patient started on ceftriaxone and metronidazole, to undergo colonoscopy as an outpatient and rule out colonic bacterial translocation. Discussion(s): Pyogenic liver abscess can result in significant morbidity and mortality because of worsening infection and sepsis. Abscesses occur because of spread from adjacent infection or after recent surgeries. Recurrence is very rare. Here, we describe a very unusual case of a pyogenic liver abscess growing E. coli in a non-toxic patient, with the same location and causative organism as an abscess managed 10 years prior. (Figure Presented).
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It is known that viral infections induce DNA damage by different mechanisms and cause genomic instability. DNA damage that is not properly repaired contributes to pathological mechanisms associated with various diseases such as cancer, type 2 diabetes (T2D), neurodegenerative disorders as well aging. There are findings supporting that coronaviruses cause DNA damage, genomic instability, and cell cycle dysregulation in the host cells while replicating their genomes. Increased DNA damage and aberrant DNA repair are shown in cancer, diabetes, neurodegenerative disorders, and cardiovascular diseases. As for coronavirus infection, if DNA damage cannot be repaired, it contributes to the amplification of viral infection-induced pathologies. The adaptive immune system is very important in fighting against SARS-COV-2, and clinical studies have shown that adaptive immunity is weakened and delayed in individuals with severe Coronavirus Disease 19 (COVID-19). In vitro studies revealed that the SARS-COV-2 spike protein, which is effective in adaptive immunity, significantly inhibits DNA damage repair. Prolonged COVID-19 is associated with colorectal cancer that is characterized by defects in DNA mismatch repair mechanisms. PARP1 is an enzyme that regulates cellular processes such as DNA repair, and gene transcription. PARP1 inhibitors are used effectively to treat acute lung injury in patients with COVID-19. In light of such preliminary data, it is concluded that a close interaction between DNA repair and the severity of Covid-19 may be available. Deficient DNA repair may contribute to life-threatening conditions in severe Covid -19, and may be one of the underlying mechanisms of long-term consequences of SARS-CoV-2 infection. In this chapter, the role of DNA repair in the acute and long-term pathological effects of COVID-19 was evaluated. © 2023 Nova Science Publishers, Inc. All rights reseverd.
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A casing leak repair alternative is presented to allow continued hydraulic fracture treatment of an unconventional formation. Analysis of diagnostic operations, selection of the best alternative, and the results are detailed. This paper details the diagnostic operations (annular circulation test, multifinger caliper log, leak chase with hydraulic packer on Coiled Tubing, fluid transit evaluation, and real-time camera downhole images acquisition) to identify the casing leak zone and the analyzed repair alternatives with the final selection of a casing patch. To verify the pipe body shield strength and burst pressure post-patch expansion, a finite element analysis in dynamic condition was carried out to limit the hydraulic fracture pumping parameters. This paper covers details on repair operations executed, verification analysis to confirm original frac treatment continuity, and lower & upper completion installation. The diagnostics operations allowed pinpointing casing leak detection and selection of possible repair alternatives. The repair was carried out as planned involving many services companies. A solution was implemented with local staff and services considering the COVID context with travel restrictions of the patch owners. Web broadcasting CT surface parameters allowed real-time support from casing patch suppliers during the entire intervention. The completion plan with 24 frac stages performed through the casing patch was successfully executed. The production packer with an OD of 99.5% of the casing patch drift was run through the casing patch and wireline set without any problem. Considering well integrity conditions throughout the entire well production life as the main intervention objective, this paper introduces a successful alternative to repair casing failures on an unconventional well that allowed hydraulic fractures continuity to accomplish the original frac plan. The well production was higher than the Estimated Ultimate Recovery (EUR) expected for the landing zone. Copyright 2023, Society of Petroleum Engineers.
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Background: The New Global Economy is represented by a series of major features, such as the use of green energy, the reduction of the carbon footprint in all industrial and civil fields, as well as finding alternative food resources. Our main objective was the research of a sustainable food product with a special nutritional purpose in the vision of nutrivigilance, developed in Romania, as an adjuvant in the repair of gastric mucosa. Methods: The materials used in the research and development of the new food are the following: inulin, lactoferrin, sericin, and sodium bicarbonate. The new adjuvant food product in the repair of the gastric mucosa was added to certain foods in order to prevent the patients from being satiated by a single food from a sensory point of view. The resulting food products were organoleptically and physico-chemically analyzed. Results: The new food is sustainable and has versatile uses. It can be hydrated with water, non-carbonated drinks, mixed with cottage cheese, or with fruit puree and oatmeal. It is stable under normal storage conditions and microbiologically safe. Conclusions: Through its versatile use, the new food product for special nutritional conditions represents a worldwide novelty. Through the development of forestry for the cultivation of white or black mulberry (Morus alba and Morus nigra), the raising of silkworms (Bombyx mori), the processing of fibroin to obtain natural silk and the processing of sericin resulting as a residue in the textile industry, the new food product developed actively contribute to the global economy II.
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Background: Better understanding of host inflammatory changes that precede development of severe COVID-19 could improve delivery of available antiviral and immunomodulatory therapies, and provide insights for the development of new therapies. Method(s): In plasma from individuals with COVID-19, sampled <=10 days from symptom onset from the All-Ireland Infectious Diseases Cohort study, we measured 61 biomarkers, including markers of innate immune and T cell activation, coagulation, tissue repair, lung injury, and immune regulation. We used principal component analysis (PCA) and k-means clustering to derive biomarker clusters, and univariate and multivariate ordinal logistic regression to explore association between cluster membership and maximal disease severity, adjusting for risk factors for severe COVID-19, including age, sex, ethnicity, BMI, hypertension and diabetes. Result(s): From March 2020-April 2021, we included 312 individuals, (median (IQR) age 62 (48-77) years, 7 (4-9) days from symptom onset, 54% male) in the analysis. PCA and clustering derived 4 clusters. Compared to cluster 1, clusters 2-4 were significantly older and of higher BMI but there were no significant differences in sex or ethnicity. Cluster 1 had low levels of inflammation, cluster 2 had higher levels of markers of tissue repair and endothelial activation (EGF, VEGF, PDGF, TGFalpha, serpin E1 and p-selectin). Cluster 3 and 4 were both characterised by higher overall inflammation, but compared to cluster 4, cluster 3 had downregulation of growth factors, markers of endothelial activation, and immune regulation (IL10, PDL1), but higher alveolar epithelial injury markers (RAGE, ST2). In univariate analysis, compared to cluster 1, cluster 3 had the highest odds of severe disease (OR (95% CI) 9.02 (4.62-18.31), followed by cluster 4: 5.59 (2.75-11.72) then cluster 2: 4.5 (2.38-8.81), all p < 0.05). Cluster 3 remained most strongly associated with severe disease in fully adjusted analyses;cluster 3: OR(95% CI) 5.99 (2.69-13.35), cluster 2: 3.14 (1.54-6.42), cluster 4: 3.13 (1.36-7.19), all p< 0.05). Conclusion(s): Distinct early inflammatory profiles predicted maximal disease severity independent of known risk factors for severe COVID-19. A cluster characterised by downregulation of growth factor and endothelial markers and early evidence of alveolar injury was associated with highest risk of developing severe COVID19. Whether this reflects a dysregulated inflammatory response that could improve targeted treatment requires further study. Heatmap of biomarker derived clusters and forest plot of association between clusters and disease severity. A: Heatmap demonstrating differences in biomarkers between clusters B: Forest plot demonstrating odds ratio of specific clusters for progressing to moderate or severe disease (reference Cluster 1), calculated using ordinal logistic regression. Odds ratio (95% CI) presented as unadjusted and fully adjusted (for age, sex, ethnicity, BMI, hypertension, diabetes, immunosuppression, smoking and baseline anticoagulant use). Maximal disease severity graded per the WHO severity scale.
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Electronic cigarette (e-cig) vaping is increasing rapidly in the United States, as e-cigs are considered less harmful than combustible cigarettes. However, limited research has been conducted to understand the possible mechanism that mediate, toxicity and pulmonary health effects of e-cigs. We hypothesized that sub-chronic e-cig exposure induces inflammatory response and dysregulated repair/extracellular matrix (ECM) remodeling, which occur through the α7 nicotinic acetylcholine receptor (nAChR α7). Adult wild-type (WT), nAChRα7 knockout (KO), and lung epithelial cell-specific KO (nAChRα7 CreCC10) mice were exposed to e-cig aerosol containing propylene glycol (PG) with or without nicotine. Bronchoalveolar lavage fluids (BALF) and lungs tissues were collected to determine e-cig induced inflammatory response and ECM remodeling, respectively. Sub-chronic e-cig exposure with nicotine increased the inflammatory cellular influx of macrophages and T-lymphocytes including increased pro-inflammatory cytokines in BALF and increased ACE2 Covid-19 receptor, whereas nAChR α7 KO mice show reduced inflammatory responses associated with decreased ACE2 receptor. Interestingly, matrix metalloproteinases (MMPs), such as MMP2, MMP8, and MMP9 were altered both at the protein and mRNA transcript levels in female and male, but WT mice exposed to PG alone showed a sex-dependent phenotype. Moreover, MMP12 was increased significantly in male mice exposed to PG with or without nicotine in a nAChR α7-dependent manner. Additionally, sub-chronic e-cig exposure with or without nicotine altered the abundance of ECM proteins, such as collagen and fibronectin significantly in a sex-dependent manner, but without the direct role of nAChR α7 gene. Overall, sub-chronic e-cig exposure with or without nicotine affected lung inflammation and repair responses/ECM remodeling, which were mediated by nAChR α7 in a sex-dependent manner.
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INTRODUCTION: Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. METHODS: A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. RESULTS: Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. CONCLUSION: The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.
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During the 2(nd) phase of COVID-19 pandemic, pharmaceutical plant industry is facing lot of production pressure and machine availability plays vital role in maximizing the manufacturing pharmacy product output. In this paper, Artificial Neural Networks (ANNs) based information processing algorithm has been used to provide a solution to this problem and it has been found suitable to predict machines availability as a prediction function. The considered pharmaceutical plants are dealing with production of medicines related common symptoms in case of COVID-19 (fever, coughing, and breathing problems). The pharmaceutical plant data corresponding to different values of repair and failure rates of different subsystems is collected from plant and analyzed with the help of validated neural network value of availability. This configuration of ANNs approach developed in this research allowed simplifying computational complexities of conventional approaches to solve a large plant machines availability problem. The ANNs methodology in the paper permitted making no assumption, no explicit coding of the problem, no complete knowledge of system configuration, only raw input and clean data found to be sufficient to determine the value of machine availability function for different value of failure and repair rates considered in the paper. The results obtained in the paper are useful for the plant leadership, as the value of failure and repair rates of various subsystems can be fine-tuned at a require clear-cut level to achieve higher availability, and avoid considerably loss of production, loss of man power, and by-pass complete breakdown of concerned system.
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In recent years, new orthopaedic surgical simulation and virtual reality (VR) training models have emerged to provide unlimited education medium to an unlimited number of trainees with no time limit, especially in response to trainee work-hour restrictions. Surgical simulators range from simple wooden boxes to animal and cadaver models to three-dimensional-printed and VR simulators. The coronavirus disease 2019 pandemic further highlighted the need for at-home learning tools for orthopaedic surgical trainees. Advancement in simulating shoulder and knee arthroscopies using VR simulators surpasses the other fields in orthopaedic surgery. Despite the high degree of precision needed to operate at a microscopic level involving vessels, nerves, and the small bones of the hand, the simulation tools have limited advancement in the field of orthopaedic hand surgery. This narrative review summarizes the status of surgical simulation and training techniques available to orthopaedic hand surgical trainees, factors affecting their application, and areas in hand surgery that still lag behind their surgical subspecialty counterparts.
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Coronavirus disease 2019 (COVID-19) is the most dramatic pandemic of the new millennium and patients with serious infection can stay in intensive care unit (ICU) for weeks in a clinical scenario of systemic inflammatory response syndrome, likely related to the subsequent development of critical illness polyneuropathy (CIP). It is in fact now accepted that COVID-19 ICU surviving patients can develop CIP;moreover, prone positioning-related stretch may favor the onset of positioning-related peripheral nerve injuries (PNI). Therefore, the urgent need to test drug candidates for the treatment of these debilitating sequelae is emerged even more. For the first time in medical literature, we have successfully treated after informed consent a 71-year-old Italian man suffering from post-COVID-19 CIP burdened with positioning-related PNI of the left upper extremity by means of ultramicronized palmitoylethanolamide 400 mg plus ultramicronized luteolin 40 mg (Gl & igrave;alia), two tablets a day 12 hours apart for 6 months. In the wake of our pilot study, a larger clinical trial to definitively ascertain the advantages of this neuroprotective, neurotrophic, and anti-inflammatory therapy is advocated.
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OBJECTIVES/GOALS: Methods for recruitment and retention of participants in research have been extensively discussed, but procedures to end studies in a way that is respectful to participants and keeps them engaged are seldom described. We relate the procedures to close a study focused on genomic DNA damage and DNA repair capacity in a longitudinal population sample. METHODS/STUDY POPULATION: Data collection, which included the provision of 30 ml blood sample along with a health status survey and anthropometric measurements, was discontinued earlier than anticipated during the fourth of a five-year Community Engaged Research (CEnR) study focused on residents of historically marginalized, low wealth communities. In collaboration with the project's Community Advisory Board, we devised a strategy to inform study participants of the study closure, which included: 1) attempts at one-on-one contact via phone, 2) provision of a study closure packet, 3) periodic mailing of study updates through study year five, 4) sustained interaction with participants through invitations to participate in additional research projects. RESULTS/ANTICIPATED RESULTS: Among 149 participants (65% female, 99% of African American descent), 106 (71%) have been reached by phone. The communication included: 1) expressions of gratitude for their participation;2) explanation of study findings to date;and 3) assurance that data analysis continued. Among those reached, 96% agreed to ongoing communication and 97% agreed to be contacted about future studies. We continue procedures to reach the remaining 43 participants. Over the study closure period, two qualitative studies offered opportunities for participants to join in focus groups (FG). The first one queried perceptions of community-based research. The response rate was 66% among 65 persons invited. The second study, focused on COVID-19 knowledge and invited 39 individuals with 24 scheduled to participate (62% response rate). DISCUSSION/SIGNIFICANCE: Translational research views the participant as an active partner. Study closure offers an opportunity to foster a long-lasting participant-research institution partnership, while also promoting participants' broad engagement and familiarity with research. Respectful research closure is an important step in CEnR.
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BACKGROUND: Corona Virus Disease 2019 (COVID-19) is a highly contagious, rapidly variable, and dangerous infectious disease. However, no specific and effective treatment for COVID-19 is available until now. The safety and efficacy of mesenchymal stem cells and their exosomes have been well verified in numerous clinical trials. Their immunomodulatory and tissue regeneration capabilities may support them as a prospective therapy for COVID-19 application in the clinic. OBJECTIVE: To focus on the development, pathogenesis and the current treatment status of COVID-19, efficacy and possible immunomodulatory mechanisms of mesenchymal stem cells and their exosomes for COVID-19 so as to provide new insights into the clinical treatment for the disease in the future. METHODS: Articles were searched on PubMed and CNKI with the key words of "SARS-CoV-2, COVID-19, cytokine storm, acute respiratory distress syndrome, mesenchymal stem cells, exosomes, immune regulation, tissue repair” in Chinese and English. Finally, 64 articles were collected for this review. RESULTS AND CONCLUSION: Acute respiratory distress syndrome and acute lung injury caused by cytokine storm are the primary precipitating factors of death in individuals with COVID-19. Mesenchymal stem cells and their exosomes can effectively treat the symptoms of acute respiratory distress syndrome and repair the damaged lung tissue in COVID-19 patients by reducing the cytokine storm and promoting the regeneration of alveolar epithelial cells through the interaction with immune cells and their paracrine effects. All of these investigations confirmed that mesenchymal stem cells and their exosomes can fight the COVID-19 infection, and this might be a promising, safe and effective strategy. However, more preclinical studies and randomized, controlled clinical trials are needed to conduct the biodistribution, metabolic fate, and the potential treatment risks of mesenchymal stem cells and their derived exosomes in vivo to fully exploit their clinical efficacy. (English) [ FROM AUTHOR] 背景：2019 冠状病毒病 (Corona Virus Disease 2019，COVID-19) 的传播性强、变异速度快、且危害较大，目前没有针对 COVID-19 的特异治疗 策略。间充质干细胞及其外泌体的安全性和有效性已在众多临床试验中得到证实，其具有的免疫调节和组织修复能力，可作为COVID-19 前 瞻性疗法的主要应用依据，具有巨大的治疗潜力。 目的：重点阐述 COVID-19 的发生发展、致病机制、治疗现状，以及间充质干细胞与其衍生外泌体治疗 COVID-19 患者的有效性和可能的免疫 调控机制，为该疾病的临床治疗提供更多的理论参考。 方法：通过检索PubMed、中国知网数据库中收录的相关文献，英文搜索词为："SARS-CoV-2，COVID-19，cytokine storm，acute respiratory distress syndrome，mesenchymal stem cells，exosomes，immune regulation，tissue repair”，中文搜索词为："新型冠状病毒，2019 冠状病 毒病，细胞因子风暴，急性呼吸窘迫综合征，间充质干细胞，外泌体，免疫调节，组织修复”，最终对64篇文献进行归纳总结。 结果与结论：由细胞因子风暴所引起的急性呼吸窘迫综合征和急性肺损伤是导致 COVID-19 重症患者出现死亡的主要原因。间充质干细胞及 其外泌体通过与免疫细胞之间的相互作用及其旁分泌效应，降低 COVID-19 患者体内细胞因子风暴同时促进其肺泡上皮细胞再生，可有效治 疗急性呼吸窘迫综合征且能够修复其损伤肺组织，证明是一种能够对抗 COVID-19 感染且安全、有效的治疗策略。不过仍然需要更多的临床 前和随机对照临床试验对间充质干细胞及其外泌体移植后的生物分布、体内代谢命运、潜在风险进行更多的研究，以便于更充分发挥其临 床疗效。 (Chinese) [ FROM AUTHOR] Copyright of Chinese Journal of Tissue Engineering Research / Zhongguo zu zhi gong cheng yan jiu is the property of Chinese Journal of Tissue Engineering Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
VirtualWorx™ began as a 2015 Raytheon Six Sigma process improvement project to solve challenges faced by customers who were being asked to "do more with less"such that Operations Sustainment (OS) costs became a significant aspect in the planning and awarding of new systems, as well as for upgrades to existing systems. This raised the need to investigate opportunities that reduced OS costs, which spanned the spectrum from technology-enabled maintenance operations to autonomy and analytics. VirtualWorx™ focused on the former and in particular, the process of flying technicians to international field sites to solve challenging troubleshooting and repair issues that were beyond the capabilities of the local maintainers but would have broader implications affecting product maintainability.The opportunity focused on business process improvement through the insertion of technology to better leverage global human resources and extend the significant breadth and depth of engineering expertise from Raytheon Centers of Excellence. This would allow support of deployed systems anywhere in the world through secure two-way audiovideo communication up to and including augmented reality-based interactive remote collaboration. Figure 1 depicts the brainstorming session that resulted in a "back-of-The-napkin"design.The vision was to provide a secure enterprise, technical collaboration solution by implementing augmented reality-based communication capability to improve operational availability (Ao) of a system to perform its mission, reduce overall sustainment costs (including significant reduction in program travel), and provide effective troubleshooting of systems under repair.The proposed strategy prioritized customer driven use cases and network architecture development to:•Establish scalable Outside Contiguous United State (OCONUS) reach-back connectivity for technical support between a remote user and subject matter expert over a secure infrastructure worldwide•Facilitate technical support via a common environment using Augmented Reality (AR) capabilities over existing company network infrastructure•Enable the spectrum of collaboration across the enterprise to reduce staffing costs, leverage technical expertise, and provide improved Efficiency, Effectiveness, Capacity, and Capability (E2C2).With a strong business case, a successful proof-of-concept phase gained support from senior leadership in engineering and digital technology and earned further investment through Raytheon Independent Research and Development (IRAD) funding to move the project forward into a pilot phase for the first use case-remotely supported maintenance.To date, VirtualWorx™ has been successfully piloted and deployed on various internal and customer programs handling a variety of data and communication-rich exchanges that span the entire development life cycle.Underneath the system's hardware and Raytheon Technologies' global network infrastructure, VirtualWorx™ is powered by Librestream's Onsite software platform that provides responsive technical support throughout the product life cycle allowing the emerging workforce to respond in a way employees feel most comfortable-via video.VirtualWorx™ has become a Raytheon Technologies Enterprise solution for end-To-end augmented reality collaboration specifically tailored to support remote maintenance of aerospace and defense repairable assets. The on-premises solution carries export controlled technical data and delivers live reach-back support over an increasing variety of use cases since the initial proof-of-concept-to support maintenance and repair of deployed systems around the world. It streams AR-enhanced live audiovideo between field service engineers, subject matter experts, domestic and international business partners and is accessible anywhere on the company's global network and through virtual private networking (VPN) access from off-site locations.Return on investment (ROI) has been realized from the initial remote maintenance use case to broader applications of the technology to reso ve both internal and external challenges. Many of these recent challenges were especially brought on by recent COVID pandemic conditions that restricted global travel, limited face-To-face communication, and prevented movement of personnel as sites were locked-down due to COVID exposure concerns. © 2023 IEEE.
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Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.