Ergonomics and health risk awareness of workers involved in manual material handling at Sabon Gari Market in Zaria, Nigeria.

This study assessed the manual handling of materials in a local market environment and evaluated workers' awareness of ergonomics and health risks. Of 315 workers surveyed, 308 responded. The findings revealed a high prevalence rate of 96.4% for injuries and musculoskeletal discomfort, attributed to a low ergonomics and health risk awareness rate of only 6.8%. Consequently, 75% of workers resorted to self-medication or drug abuse for relief. The study also explored barriers to using engineering equipment, finding that 26.3% of respondents cited cost as a barrier, while 51% believed that the introduction of engineering equipment would lead to job loss. This research is valuable for practitioners and researchers as it highlights the current state of ergonomics and health risk awareness among workers who handle heavy loads. The study also highlights the need for improved ergonomic practices and health risk awareness to reduce injury rates and promote safer work environments.

Two cases of sigmoid colon cancer with intussusception prolapsing through the anus in adults: consideration of preoperative reduction and surgical approaches: case reports.

Background: Adult intussusception is a rare condition that is often associated with a high incidence of malignancy. The optimal management strategy remains controversial, particularly regarding the necessity for bowel reduction before resection. To date, there is a paucity of data on adult intussusception in the English literature. We present two cases of sigmoid colon cancer with intussusception prolapsing through the anus and highlight the different surgical approaches. Case Description: Case 1: an 84-year-old woman presented with sigmoid colon prolapse and biopsy-confirmed adenocarcinoma. Urgent surgery revealed intussusception. Despite unsuccessful manual reduction, the Hutchinson technique successfully resolved the intussusception. Resection with a temporary colostomy was performed. Histopathological examination revealed mucinous adenocarcinoma without metastasis; the patient recovered well. Case 2: a 76-year-old woman with sigmoid colon prolapse presented with abdominal pain and blood-streaked stools. Emergency surgery was performed because of failed reduction attempts and persistent symptoms. Intussusception resolution was achieved through transanal insertion of a circular sizer. Resection with temporary colostomy was performed, after which tubular adenocarcinoma was identified. The patient remains symptom-free 3 years post-surgery. Conclusions: Choice of the surgical approach depends on the ease of intussusception reduction. In cases wherein reduction is straightforward, routine preoperative examinations are preferred given the low risk of injury or cancer cell dissemination. Conversely, in situations such as ours, gentle reduction under general anesthesia might be crucial. In addition, laparoscopic surgery could be beneficial. Importantly, accumulation of reports on adult intussusception could contribute to the standardization of this approach.

Case Report: The effect of automated manual lymphatic drainage therapy on lymphatic contractility in 4 distinct cases.

Introduction: Automated manual lymphatic drainage therapy (AMLDT) is available for home use in the form of a pneumatic mat of 16 pressurized air channels that inflate and deflate to mimic the stretch and release action of manual lymphatic drainage therapy. Four cases (a patient with complex regional pain syndrome and lymphedema, a healthy patient, a breast cancer survivor with chronic pain, and a patient with a history of abdominal surgery) underwent near-infrared fluorescence lymphatic imaging (NIRFLI) with AMLDT to evaluate the effect of AMLDT on lymphatic pumping and pain. Methods: Each patient received 32-36 injections of 25 µg indocyanine green (ICG) on the anterior and posterior sides of their body and underwent 1 h of NIRFLI to assess the drainage of ICG laden lymph toward regional nodal basins at baseline. Each patient lay supine on the mat for 1 h of AMLDT with NIRFLI to assess lymphatic flow during treatment. A final NIFRFLI assessment was done 30-60 min posttreatment with the patient in the supine and prone position. Patients reported baseline and posttreatment pain using the Visual Analogue Scale. An imager analyzed NIRFLI images using ImageJ (US National Institutes of Health). Using time stamps of the first and last images to determine time lapsed and the number of pulses observed in a timeframe, pulsing frequency (pulses/min) was obtained to assess lymphatic function. Results: All 4 cases completed the NIRFLI and AMLDT without complications; all 3 patients with baseline pain reported reduced pain posttreatment. AMLDT appeared to alter lymphatic contractility, with both increased and decreased pulsing frequencies observed, including in nonaffected limbs. Pulsing frequencies were very heterogeneous among patients and varied within anatomic regions of the same patient. Discussion: This proof-of-concept study suggests that AMLDT may impact lymphatic contractility. Further research on its effect on lymphatic function is warranted.

Evaluating the accuracy of lung-RADS score extraction from radiology reports: Manual entry versus natural language processing.

INTRODUCTION: Radiology scoring systems are critical to the success of lung cancer screening (LCS) programs, impacting patient care, adherence to follow-up, data management and reporting, and program evaluation. LungCT ScreeningReporting and Data System (Lung-RADS) is a structured radiology scoring system that provides recommendations for LCS follow-up that are utilized (a) in clinical care and (b) by LCS programs monitoring rates of adherence to follow-up. Thus, accurate reporting and reliable collection of Lung-RADS scores are fundamental components of LCS program evaluation and improvement. Unfortunately, due to variability in radiology reports, extraction of Lung-RADS scores is non-trivial, and best practices do not exist. The purpose of this project is to compare mechanisms to extract Lung-RADS scores from free-text radiology reports. METHODS: We retrospectively analyzed reports of LCS low-dose computed tomography (LDCT) examinations performed at a multihospital integrated healthcare network in New York State between January 2016 and July 2023. We compared three methods of Lung-RADS score extraction: manual physician entry at time of report creation, manual LCS specialist entry after report creation, and an internally developed, rule-based natural language processing (NLP) algorithm. Accuracy, recall, precision, and completeness (i.e., the proportion of LCS exams to which a Lung-RADS score has been assigned) were compared between the three methods. RESULTS: The dataset includes 24,060 LCS examinations on 14,243 unique patients. The mean patient age was 65 years, and most patients were male (54 %) and white (75 %). Completeness rate was 65 %, 68 %, and 99 % for radiologists' manual entry, LCS specialists' entry, and NLP algorithm, respectively. Accuracy, recall, and precision were high across all extraction methods (>94 %), though the NLP-based approach was consistently higher than both manual entries in all metrics. DISCUSSION: An NLP-based method of LCS score determination is an efficient and more accurate means of extracting Lung-RADS scores than manual review and data entry. NLP-based methods should be considered best practice for extracting structured Lung-RADS scores from free-text radiology reports.

Physical Therapy Management for a Patient with Hallux Rigidus in a Baseball Player.

Hallux rigidus is a common condition affecting the foot. There is a paucity of evidence describing the management of patients with hallux rigidus with manual physical therapy consisting of hands-on manual therapy techniques and movement reinforcing exercise. This case highlights the management of a patient with hallux rigidus by a physical therapist. The patient was a 60-year-old male baseball player with pain, loss of metatarsophalangeal joint motion, and radiographically visible degenerative changes suggesting a diagnosis of hallux rigidus. Treatment involved non-thrust joint manual distraction mobilization to the 1st metatarsophalangeal joint. Improvements were noted immediately in the patient's ability to run with decreased symptoms. I carefully instructed the patient to perform the manual distraction techniques at home. After 4 clinical visits, the patient returned to baseball the following spring. Outcomes were maintained 8 years after initial evaluation.

Analysis of Different Lymphedema Assessment Tools in Women with Breast Cancer After Mastectomy.

Background: Lymphedema is a common complication after mastectomy in women with breast cancer. Several methods have been described to assess and diagnose lymphedema, one of the most studied being the perimeter and ultrasonography. However, the reliability of these methods and the correlation between them are still controversial. The aim of this study was to analyze the reliability of cytometry and ultrasound imaging in the assessment of lymphedema after mastectomy in women with breast cancer and to study the correlation between them. Methods and Results: A cross-sectional study was conducted in 29 women with mastectomy after breast cancer. Lymphedema in the arm was measured both with cytometry and ultrasonography. Reliability was calculated with intraclass correlation coefficient. The correlation between the two methods was carried out with the Pearson correlation coefficient. Both cytometry (M1: α = 0.999, ICC = 0.996; M2=: α = 0.998, ICC = 0.994) and ultrasonography (M1: α = 0.992, ICC = 0.976; M2=: α = 0.991, ICC = 0.973) are reliable methods to assess lymphedema in the arm. No significant correlation was found between them (p > 0.05). Conclusions: Cytometry and ultrasonography appear to be adequate for the measurement of edema in women with breast cancer after mastectomy. However, for an accurate measurement of lymphedema, these measurements should not be used interchangeably.

Feasibility, safety, and efficacy of a novel external compression vascular closure device: The LockeT® study.

INTRODUCTION: Hemostasis following large-bore femoral vein access remains a challenge. Manual compression has been the standard of care but requires bedside staff, prolonged bed rest, and longer length of stay. The LockeT is an external compression device that attempts to address these issues while achieving venous hemostasis. OBJECTIVES: We evaluate postprocedural hemostasis and vascular closure outcomes after using LockeT following cardiac electrophysiologic procedures. METHODS: We performed a single-center, observational study of patients who underwent vascular closure for electrophysiology procedures using LockeT. Postprocedural outcomes were subsequently analyzed. RESULTS: We studied 102 patients (N) for whom LockeT was used to close 182 separate vascular access sites (n). Common procedures were atrial fibrillation ablation (56.9%, N = 58) and left atrial appendage occlusion (28.4%, N = 29). Most often, 8-Fr [48.3% (n = 126)], 11-Fr [27.2% (n = 71)], and 8.5-Fr [16.9% (n = 44)] sheaths were used, with an average procedure time of 82.1 ± 29.4 min. Hemostasis was achieved in 97.8% (n = 187) of all LockeT cases. Time to ambulation and discharge were 3.93 ± 1.10 h and 8.1 ± 4.4 h, respectively. No major complications were noted. Postprocedurally, 52% (N = 53) of patients were discharged on the same day. There were no differences in hemostasis (p = .859) or ambulation times (p = .202) between procedure types. CONCLUSION: The LockeT can effectively close venous access sites with no major complications.

An implementation manual for an interprofessional enhanced recovery after surgery protocol in cardiac surgery following international established frameworks.

Introduction: Enhanced Recovery After Surgery (ERAS) protocols represent a paradigm shift in perioperative care, aim to optimize patient outcomes and accelerate recovery. This manual presents findings from implementing the INCREASE study, a bicentric prospective randomized controlled trial focusing on ERAS in minimally invasive heart valve surgery. Methods: Utilizing the Consolidated Framework for Implementation Research (CFIR) and the Template for Intervention Description and Replication (TIDieR), the study examined contextual factors, intervention components, and implementation strategies. Results: Key findings from the CFIR analysis revealed critical domains influencing implementation success. These included innovation characteristics, external and internal settings, and individual dynamics. The study showcased ERAS's adaptability to diverse healthcare systems, emphasizing its potential for successful integration across varying contexts. Furthermore, the importance of interprofessional collaboration emerged as a foundation of practical implementation, fostering teamwork, communication, and patient-centered care. Utilizing the TIDieR framework, this manual comprehensively describes ERAS intervention components, detailing preoperative counseling, intraoperative management, and postoperative care strategies. The manual underscored the importance of tailored, patient-centered approaches, highlighting the role of an academic ERAS nurse, early mobilization, and psychosomatic interventions in promoting optimal recovery outcomes. Discussion: In conclusion, the INCREASE study provided valuable insights for creating an implementation manual for ERAS in cardiac surgery, emphasizing adaptability, collaboration, and ongoing evaluation as key drivers of successful implementation. These findings have broad implications for improving patient care outcomes and advancing perioperative practices in cardiac surgery settings.

Impact of blue-collar vs. white-collar occupations on disease burden in psoriatic arthritis patients: A Swiss clinical quality management in rheumatic diseases cohort study.

Biomechanical stress may exacerbate inflammation in psoriatic arthritis (PsA). This study aimed to investigate disease activity, work disability, and drug response/retention rates in PsA patients among two different occupation's types: blue-collar workers (BCol) with manual labor versus white-collar workers (WCol) with sedentary occupations. PsA patients registered in the Swiss cohort (SCQM) were classified as BCol or WCol workers and assessed at the initiation of a biologic or targeted synthetic disease-modifying anti-rheumatic drug (b-/tsDMARD). We compared the baseline characteristics at treatment start and the DAS28-CRP for the 1-year remission. Treatment retention was investigated using Kaplan-Meier curves and Cox regression analysis. Multivariable models were adjusted for potential confounders. Of 564 patients, 29% were BCol, and 71% were WCol workers. Baseline disease activity was comparable between both groups. BCol workers were predominantly male (79.8%) and more work disabled at baseline (84.0% vs. 27.9%; p < 0.01). One hundred seventy-four treatment courses (TCs) of 165 PsA patients were included for longitudinal analysis. Occupation did not significantly influence the achievement of DAS28-CRP remission at 1 year. Kaplan-Meier analysis (n = 671) indicated longer retention for BCol workers (mean retention duration: 3.15 years vs. 2.15 years, (p = 0.006). However, adjusted Cox regression analysis did not corroborate these findings. This study indicates that physically demanding occupations correlate with increased rates of work disability among PsA patients, while treatment response seems to be unaffected by the patients' occupation type. Additional research is required to thoroughly comprehend the relationship between physical workload, disease activity, and treatment outcomes. Key Points • This study indicates that physically demanding occupations correlate with increased rates of work disability among PsA patients. • The treatment response among of PsA patients seems unaffected by the patients' occupation type.

Pelvic Palpatory Tests in Manual Therapy and Osteopathy: A Critical Review of the Literature and Suggestions for New Research.

Manual therapists apply physical interventions to the entire structure of the body to promote healing, prevent pathologies, and improve patient health. In osteopathic practice, palpatory evaluation is considered a fundamental clinical practice requirement for identifying somatic dysfunction. Most of the articles published in this area have failed to demonstrate a level of reproducibility that supports palpation in evidence-based clinical practice. When considering the poor reliability of the palpatory tests highlighted in the literature, a discrepancy is noted with what is known about the tactile sensitivity of human hands. For static touch, the minimum size that can be detected, in the absence of applied movement or vibration, is approximately 0.2 mm. Yet, it seems that this high level of precision is insufficient to ensure reliability in the tests used to evaluate osteopathic somatic dysfunction. The purpose that underscores this article is to determine how these two contradictory elements, high sensitivity and low reliability, can be present in palpatory tests. The article reports the literature findings regarding palpatory tests of pelvic, which is an important structure for clinical purposes. Additionally, a critical review of how these studies were conducted is provided to identify any elements that may justify the obtained results. Following recent accredited guidelines present in the literature, we propose suggestions on vision training methods, manual perception refinement training, the search for anatomical markers, and the position of the examiner in relation to the examinee that may be useful for future studies on the topic covered by the article.

Pulmonary Embolism With Syncope Treated With Inari FlowTriever®.

Pulmonary embolism (PE) is a devastating disease that can range in severity from asymptomatic to fatal. The severity and the intervention required depend on the degree of hemodynamic instability and evidence of right heart strain demonstrated on diagnostic testing. Interventions include solely anticoagulation, systemic thrombolysis, catheter-directed therapies, or surgical embolectomy depending on the severity, patient's clinical picture, and clinician choice. Currently, there is a lack of evidence regarding which treatment is most suitable for submassive PE. This report demonstrates the benefits of aspiration thrombectomy, a catheter-directed therapy, utilizing the 24Fr Triever Aspiration Catheter (FlowTriever® system;Inari Medical, Irvine, California, United States) in a 57-year-old male patient with submassive PE. The FlowTriever retrieval/aspiration system is a single-use mechanical thrombectomy device indicated for use in the peripheral vasculature and pulmonary arteries. The patient presented with syncope and concern for head trauma ultimately requiring suction embolectomy utilizing the Inari FlowTriever system. We conclude that submassive PE can be effectively treated with aspiration thrombectomy in addition to long-term anticoagulation with excellent clinical outcomes.

Programa de gimnasia laboral para los moldeadores manuales metalúrgicos

Los trastornos músculo-esqueléticos relacionados con el trabajo constituyen motivo de preocupación para la comunidad científica, avalado por su efecto negativo en la vida de los trabajadores y la productividad de las empresas. En el proceso de fundición de metales, los moldeadores manuales con pisón neumático exteriorizan manifestaciones de estas afecciones. Ello indujo a realizar una investigación que tuvo como objetivo elaborar un programa de Gimnasia Laboral para contribuir a la atención de los trastornos músculo-esqueléticos en los moldeadores manuales metalúrgicos. Para recopilar, analizar y procesar los datos se emplearon métodos teóricos, empíricos y matemático-estadísticos, entre ellos el histórico-lógico, analítico-sintético, inductivo-deductivo, sistémico-estructural-funcional, la observación participante, encuesta, entrevista, revisión documental, el experimento, criterio de usuarios y la estadística descriptiva e inferencial. La población objeto de estudio estuvo conformada por 19 moldeadores manuales metalúrgicos, seleccionados de forma intencional. El diagnóstico y la sistematización teórica alcanzada posibilitaron elaborar un programa de Gimnasia Laboral, en correspondencia con los requerimientos del proceso de moldeo, cuya efectividad fue constatada.

As lesões músculo-esqueléticas relacionadas com o trabalho são motivo de preocupação para a comunidade científica, sustentadas pelos seus efeitos negativos na vida dos trabalhadores e na produtividade das empresas. No processo de fundição do metal, os moldadores manuais com compactador pneumático externalizam as manifestações dessas condições. Isso originou uma pesquisa que teve como objetivo desenvolver um programa de Ginástica Laboral para contribuir no cuidado de lesões osteomusculares em moldadores manuais metalúrgicos. Para coletar, analisar e tratar os dados foram utilizados métodos teóricos, empíricos e matemático-estatísticos, incluindo histórico-lógico, analítico-sintético, indutivo-dedutivo, sistêmico-estrutural-funcional, observação participante, levantamento, entrevista, revisão documental, o experimento, critérios de usuário e estatísticas descritivas e inferenciais. A população em estudo foi composta por 19 modeladores manuais metalúrgicos, selecionados intencionalmente. O diagnóstico e a sistematização teórica conseguidos permitiram desenvolver um programa de Ginástica Laboral, em correspondência com as exigências do processo de moldagem, cuja eficácia foi verificada.

Work-related musculoskeletal disorders are a cause of concern for the scientific community, supported by their negative effect on the lives of workers and the productivity of companies. In the metal casting process, manual molders with pneumatic tamper externalize manifestations of these conditions. This led to carrying out a research that aimed to develop a Labor Gymnastics program to contribute to the care of musculoskeletal disorders in metallurgical manual shapers. To collect, analyze and process the data, theoretical, empirical and mathematical-statistical methods were used, including historical-logical, analytical-synthetic, inductive-deductive, systemic-structural-functional, participant observation, survey, interview, documentary review, the experiment, user criteria and descriptive and inferential statistics. The population under study was made up of 19 metallurgical manual shapers, intentionally selected. The diagnosis and theoretical systematization achieved made it possible to develop a Labor Gymnastics program, in correspondence with the requirements of the molding process, whose effectiveness was verified.

Two-Y Crushing Technique: A Simple Technique to Crack the Nucleus in a Posterior Polar Cataract Using Two-Y Rotators.

Cataract surgeries in posterior polar cataracts (PPCs) are always challenging for an ophthalmologist, in spite of multiple techniques described for phacoemulsification surgery. The most important objective of cataract surgeries in PPCs is to achieve maximum removal or debulking of the nucleus so that, if any complications happen, they can be easily manageable. We describe a new technique to manually crush the nucleus after it is manually prolapsed out of the bag into multiple pieces with the help of two Y-rotators which were then removed by using a phacoemulsification probe so that complications of posterior capsular rupture because of inadvertent rotation of the nucleus during the phacoemulsification part could be avoided.

Soil Fungal Community Differences in Manual Plantation Larch Forest and Natural Larch Forest in Northeast China.

Soil fungal communities are pivotal components in ecosystems and play an essential role in global biogeochemical cycles. In this study, we determined the fungal communities of a natural larch forest and a manual plantation larch forest in Heilongjiang Zhongyangzhan Black-billed Capercaillie Nature Reserve and Gala Mountain Forest using high-throughput sequencing. The interactions between soil fungal communities were analysed utilising a co-occurrence network. The relationship between soil nutrients and soil fungal communities was determined with the help of Mantel analysis and a correlation heatmap. The Kruskal-Wallis test indicated that different genera of fungi differed in the two forest types. The results show that there was a significant change in the alpha diversity of soil fungal communities in both forests. In contrast, nonmetric multidimensional scaling (NMDS) analysis showed significant differences in the soil fungal community structures between the manual plantation larch forest and the natural larch forest. The soil fungal co-occurrence network showed that the complexity of the soil fungal communities in the manual plantation larch forest decreased significantly compared to those in the natural larch forest. A Mantel analysis revealed a correlation between the soil fungal co-occurrence network, the composition of soil fungi, and soil nutrients. The RDA analysis also showed that AN, TK, and pH mainly influenced the soil fungal community. The null model test results showed the importance of stochastic processes in soil fungal community assembly in manual plantation larch forests. Overall, this study enhances our understanding of the differences in soil fungal communities in manual plantation larch forests and natural larch forests, providing insights into their sustainable management. It also serves as a reminder that the ecological balance of natural ecosystems is difficult to restore through human intervention, so we need to protect natural ecosystems.

System Design for Sensing in Manufacturing to Apply AI through Hierarchical Abstraction Levels.

Activity recognition combined with artificial intelligence is a vital area of research, ranging across diverse domains, from sports and healthcare to smart homes. In the industrial domain, and the manual assembly lines, the emphasis shifts to human-machine interaction and thus to human activity recognition (HAR) within complex operational environments. Developing models and methods that can reliably and efficiently identify human activities, traditionally just categorized as either simple or complex activities, remains a key challenge in the field. Limitations of the existing methods and approaches include their inability to consider the contextual complexities associated with the performed activities. Our approach to address this challenge is to create different levels of activity abstractions, which allow for a more nuanced comprehension of activities and define their underlying patterns. Specifically, we propose a new hierarchical taxonomy for human activity abstraction levels based on the context of the performed activities that can be used in HAR. The proposed hierarchy consists of five levels, namely atomic, micro, meso, macro, and mega. We compare this taxonomy with other approaches that divide activities into simple and complex categories as well as other similar classification schemes and provide real-world examples in different applications to demonstrate its efficacy. Regarding advanced technologies like artificial intelligence, our study aims to guide and optimize industrial assembly procedures, particularly in uncontrolled non-laboratory environments, by shaping workflows to enable structured data analysis and highlighting correlations across various levels throughout the assembly progression. In addition, it establishes effective communication and shared understanding between researchers and industry professionals while also providing them with the essential resources to facilitate the development of systems, sensors, and algorithms for custom industrial use cases that adapt to the level of abstraction.

Influence of saw chain type and wood species on the concentration of wood dust in a forestry operation.

This study examines the impact of chainsaw chain type and tree species on the concentration of inhalable wood dust generated during motor-manual harvesting in forested areas. The effects of conducting real-world measurements of inhalable dust within the operator's breathing zone during forestry work are investigated. Two different chain types were evaluated: the commonly used 3/8" pitch chain (conventional chain) and the 0.325" pitch chain. Additionally, measurements were taken for three tree species: beech, oak, and pine (including both live and standing dead trees after a fire). Results showed that, overall, using the conventional 3/8" chain type yielded the highest concentration of wood dust for all three tree species. Notably, the highest wood dust concentration was observed in the burned Pinus brutia cluster, also with the 3/8" chain pitch. These findings emphasize the importance of understanding how chain type and tree species contribute to wood dust levels.

Holistic Approaches in Endometriosis - as an Effective Method of Supporting Traditional Treatment: A Systematic Search and Narrative Review.

Endometriosis is one of the gynecological diseases where women suffer from pain, quality of life decreased. The aim of this review was to describe the most common non-medical methods used in the treatment of symptoms associated with endometriosis and to determine their effectiveness. The review was performed in PubMed, Embase and Web of Science databases. Randomized controlled trials, case studies, observational studies, retrospective studies, prospective studies, pilot studies, trails, publications in English or Polish were searched based on the Participant-Intervention-Comparator-Outcomes-Study design (PICOS) format. The criteria used to select studies were: women with endometriosis, no cancer, included any physiotherapeutic or non-medical intervention. 3706 articles were found, however only 26 met the inclusion criteria and were included in the review. Quality of the studies was assessed by Risk of Bias 2 tool and ROBINS-1 tool. The most holistic approach used in the treatment of symptoms of endometriosis include physical therapy, manual therapy, electrophysical agents acupuncture, diet and psychological interventions. Most research has focused on relieving pain and increasing quality of life. Non-medical methods showed reduction of symptoms of endometriosis. Physical activity, manual therapy, electrophysical agents, acupuncture, diet and cognitive behavioral therapy showed no negative side effects and reduced pain, what improved the quality of life and reduced the perceived stress.

Comparing Obtura Vascular Closure Device to Manual Compression for Achieving Hemostasis After Percutaneous Transfemoral Procedures: A Randomized Study.

PURPOSE: This trial was designed and aimed to compare safety and efficacy of Obtura™ vascular closure device (VCD) to manual compression (MC) among patients undergoing transfemoral catheterization. MATERIAL AND METHODS: This prospective, randomized, controlled, multicenter trial of Obtura VCD against MC randomized patients in 1:1 (n=268; 134:134) ratio. Safety and efficacy were measured by primary endpoints (time to hemostasis [TTH] and deployment success) and secondary endpoints which included technical success, device-related adverse events, and time to ambulation (TTA). RESULTS: The procedural access using right femoral artery was performed in 95.52% of patients in Obtura VCD versus 96.27% in standard MC method, whereas 2.99% of patients in each group underwent left femoral access. Bilateral access was performed in 1.49% (n=2) versus 0.75% (n=1) in Obtura VCD versus MC, respectively. Both the technical success and deployment success were 100%. Patients in Obtura VCD group had shorter TTH (3.26±3.39 vs 23.95±8.24 minutes; p<0.0001) and TTA (155.44±125.32 vs 723.84±197.98 minutes; p<0.0001) than MC group. No access site complications (re-bleeding, infection, arteriovenous fistula, and transient access site nerve injury) were noted at 2-week, 1-month, and 3-month follow-ups. There were 4 (3%) and 6 (4.5%) cases of hematoma, respectively, in Obtura VCD versus MC and 1 case (0.7%) of post-procedural arterial pseudoaneurysm each in both the groups which were successfully resolved and patients were discharged with no further complications. Further follow-up was without any adverse events. CONCLUSIONS: The study demonstrated favorable safety and efficacy of Obtura™ VCD with a significantly short TTH and TTA compared to MC. CLINICAL IMPACT: In patients undergoing cardiac catheterization, vascular closure devices (VCDs) can achieve hemostasis faster after successful implantation of the device with fewer complications such as bleeding and ambulation can be achieved faster. In terms of effectiveness, Obtura VCD was found to be better than manual compression in achieving early hemostasis and higher technical and deployment success was accomplished. Obtura VCD does not require enlargement of the route through the tissues, uses the same existing arterial sheath as its conduit, and does not cause patients' access sites to feel uncomfortable while it is being deployed.

Time to redefine prolonged third stage of labor? A systematic review and meta-analysis of the length of the third stage of labor and adverse maternal outcome after vaginal birth.

OBJECTIVES: (1) To assess the association between the duration of the third stage of labor and adverse maternal outcome after vaginal birth and (2) evaluate whether earlier manual placenta removal reduces this risk of adverse outcome. DATA SOURCES: PubMed/MEDLINE, EMBASE, ClinicalTrials.gov, Cochrane Library, Journals@Ovid and the WHO International Clinical Trials Registry from January 1st 2000-June 13th 2023. STUDY ELIGIBILITY CRITERIA: All studies that assessed adverse maternal outcome, defined as any maternal complication after vaginal birth, in relation to duration of the third stage of labor and timing of manual placenta removal. STUDY APPRAISAL AND SYNTHESIS METHODS: Included studies were evaluated according the COSMOS-E (Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Etiology) methodology. Pooled odds ratios with 95% confidence intervals were calculated. We assessed heterogeneity (I2 test); performed subgroup analyses; and calculated 95% prediction intervals. RESULTS: To answer the first objective, 18 cohort studies were included. Assessed cut-offs of third stage were: 15, 30 and 60 minutes. Women with a third stage ≥15 minutes had an increased risk of postpartum hemorrhage compared to <15 minutes (Odds Ratio [OR] 5.55; 95%CI 1.74,17.72). For women without risk factors for postpartum hemorrhage, the OR was 2.20; 95%CI 0.75,6.49. Among women with a third stage ≥60 minutes versus <60 minutes, the OR was 3.72; 95%CI 2.36-5.89. Incidence of red blood cell transfusion was increased for a third stage ≥30 minutes versus <30 minutes (OR 3.23; 95%CI 2.26-4.61). Three studies assessed the timing of placenta removal and risk of adverse maternal outcome yet could not be pooled due to different outcome measures. One randomized controlled trial reported a significantly higher incidence of hemodynamic compromise in women with manual placenta removal at 15 versus 10 minutes (19.2%,30/156 6.4%,10/156) while two observational studies reported a lower risk of bleeding among women without manual placenta removal. CONCLUSION: Although the risk of adverse maternal outcome after vaginal birth increases when the third stage of labor exceeds 15 minutes, there is no convincing evidence supporting a reduction of the third stage of labor by earlier manual removal of the placenta to reduce the incidence of adverse maternal outcome.

Total kidney volume in autosomal dominant polycystic kidney disease: intraobserver and interobserver agreement of two methods with MRI.

Background/aim: Total kidney volume (TKV) is a parameter used in both treatment decision and follow-up in autosomal dominant polycystic kidney disease (ADPKD) patients. The objective of this study was to evaluate intra- and interobserver agreement of the ellipsoid formula (EF) and manual boundary tracing method (MBTM) used in TKV measurement of ADPKD patients across different levels of experience radiologists. Additionally, the study aimed to evaluate the correlation between the EF and MBTM, which is considered the gold standard for TKV. Materials and methods: A retrospective evaluation was conducted on magnetic resonance imaging (MRI) data from 55 ADPKD patients who underwent abdominal MRI between January 2017 and November 2021 to evaluate TKV. TKV measurements were performed by three independent observers (observer 1, an abdominal imaging radiologist with 5 years of experience; observer 2, a fourth-year radiology resident; observer 3, a second-year radiology resident).To assess intraobserver variability, all observers repeated the measurements at two-week intervals. The ICC was used to assess both intraobserver and interobserver variability. A comparison of the two methods was performed by linear regression for all three observers. Results: The ICC (95% CI) indicated excellent agreement between the observers for both methods (among all observers, p < 0.001). Furthermore, excellent intraobserver agreement was found between all observer measurements either EF or MBTM based on ICC (95% CI) (p < 0.001). The results of the linear regression analysis demonstrated high correlations between the two methods in all three observers (r = 0.992, p < 0.001 for the first observer; r = 0.975, p < 0.001 for the second observer; r = 0.989, p < 0.001 for the third observer). Conclusion: Both the EF and MBTM methods used for the measurement of TKV provided excellent intra- and interobserver reproducibility. The EF is as accurate and precise as the MBTM. It may therefore be preferred in radiology departments with heavy workload, as it is a reliable method for rapid and easy assessment, independent of experience.