Comparative Study on Finger Gloves Nasal Packing Vs Merocel Nasal Packing After Intranasal Surgery: Randomized Controlled Trial.

Nasal packing is one of the common procedures done following various intranasal surgeries in order to prevent the various complications that can arise post-operatively. Some of the complications noted include bleeding from the nose, septal hematoma, septal abscess and formation of mucosal adhesions. There are different types of nasal packing materials available. Few of the commonly used nasal packing material are ribbon gauzes impregnated with antibiotics, merocel, gel foam, glove fingers and Vaseline gauze. This study compared the effectiveness of Merocel nasal packing with Glove finger nasal packing after Septoplasty and Polypectomy. Merocel, a widely used expandable non-absorbable material, was compared with conventional ribbon gauze packs inserted into glove fingers. Results showed no significant differences in post-operative bleeding, pain, discomfort, mucociliary clearance, or late complications between the two groups. However, a slightly earlier return of mucociliary clearance in patients packed with Glove finger nasal packs was observed. Therefore, it can be concluded that both Merocel and Glove finger nasal packs are equally effective in managing post-operative complications following these procedures.

Clinical Study and Management of Epistaxis.

Epistaxis is the most common emergency in otorhinolaryngology affecting up to 60% of the population in their lifetime. There are various local and systemic cause and includes both medical and surgical management. This study has been undertaken to study various etiopathogenesis and management of epistaxis. This is a prospective hospital-based study conducted on 100 patients of all age groups and both genders presenting with epistaxis to the Department of Otorhinolaryngology both on outpatient and inpatient basis. A detailed history taking with clinical examination is done. Data is entered in a structured performa, master chart prepared and is subjected to statistical analysis by SPSS software version 23. The most common age group was first decade (26%) followed by fourth decade (15%) with male (71%) predominance. Anterior epistaxis (87%) and bilateral nasal cavity involvement (65%) was predominantly seen. Most common causes for epistaxis are trauma (20%) followed by nasal infections (18%) and hypertension (17%). Majority of the patients underwent medical line of treatment (80%) followed by anterior nasal packing (12%), surgical intervention (7%), posterior nasal packing (1%). Epistaxis needs immediate restoration of hemodynamic parameters with first aid, airway assessment and control of bleeding. Majority of the cases were managed conservatively which is safe and cost effective method. Patients should be advised to avoid strenuous activity, nose picking and vigorous nose blowing. Severe recurrent epistaxis needed invasive interventions like nasal packing and blood transfusion.

Improving Adherence and Reducing Health Care Costs Through Blister-Packaging: An Economic Model for a Commercially Insured Health Plan.

Purpose: To model the potential clinical and economic impact of blister-packaging medications for chronic conditions on medication adherence and healthcare costs in a commercially insured population. Methods: A health economic model was developed to evaluate the potential impact of blister-packaging chronic medications for a commercially insured population. The chronic medication classes assessed were renin-angiotensin-system (RAS) antagonists, statins, non-insulin oral antidiabetics, and direct oral anticoagulants (DOACs). The model was designed to reflect the perspective of a hypothetical commercially insured health plan with 100,000 members, over a one-year time horizon. Literature-based or best available epidemiologic references were used to inform the number of patients utilizing each medication class, the impact of blister-packaging on the number of patients who become adherent, as well as the impact of medication adherence in a commercially insured population on healthcare costs for each medication class assessed. Impact on costs was measured in total net healthcare costs, as well as being stratified by medical costs and medication costs. Results: Following the blister-packaging intervention, there were an additional 591 patients adherent to RAS antagonists, 1196 patients adherent to statins, 169 patients adherent to oral antidiabetics, and 25 patients adherent to DOACs. While pharmacy costs increased, these costs were more than offset by the reduction in medical costs. Overall, the increase in patients adherent to therapy due to blister-packaging led to a reduction in total healthcare costs of $879,312 for RAS antagonists (-$0.73 per-member per-month (PMPM)), $343,322 for statins (-$0.29 PMPM), $78,917 for oral antidiabetics (-$0.07 PMPM), and $120,793 for DOACs (-$0.10 PMPM). Conclusion: Blister-packaging chronic medications in a commercially insured population has the potential to reduce healthcare costs. Future research is needed to confirm these findings in real-world settings and to fully understand the clinical and economic implications of blister-packaging chronic medications.

Patients not taking their medications as prescribed is common in the United States, leading to disease progression, increased healthcare visits, and increased healthcare costs. Blister-packaging medications is an intervention shown to increase medication adherence, or patients taking their medication as prescribed, and has been around for several decades. While there is research and literature available that shows the impact that blister-packaging medications has on improving adherence, and there is literature available that shows patients taking their medications as prescribed reduces healthcare costs, there is minimal literature available that directly ties these two concepts together. As a result, we modeled from a hypothetical commercial insurance health plan perspective what the impact would be of blister-packaging chronic medications on healthcare costs using the best available peer-reviewed literature and epidemiologic data. This analysis found that for a commercially insured health plan with 100,000 members, 591 additional patients would become adherent to their renin-angiotensin-system (RAS) antagonists blood pressure medications, 1196 additional patients would become adherent to their statins, 169 additional patients would become adherent to their oral antidiabetics, and 25 additional patients would become adherent to their direct oral anticoagulants (DOACs). Additionally, this would lead to a reduction in healthcare costs for the health plan of $879,312 for RAS antagonists (-$0.73 per-member per-month (PMPM)), $343,322 for statins (-$0.29 PMPM), $78,917 for oral antidiabetics (-$0.07 PMPM), and $120,793 for DOACs (-$0.10 PMPM).

[Surgical management of severe noncompressible torso and organ hemorrhages]. / Chirurgisches Management von schweren nichtkomprimierbaren Stamm- und Organblutungen.

BACKGROUND: Noncompressible torso hemorrhages (NCTH) are now recognized as the leading cause of preventable death in the context of severe military and civilian injuries. Approximately 20% of all trauma patients still die from uncontrolled bleeding associated with rapidly evolving disorders of blood coagulation function. OBJECTIVE: Summary of recent advances in the field of nonsurgical and surgical management, presentation of current treatment concepts and future research directions. MATERIAL AND METHODS: Selective literature review and analysis. RESULTS: The concepts for the early treatment of NCTH have considerably evolved over the last decade. The updated definition of NCTH includes a combination of high-grade anatomic body trunk injury, hemodynamic instability, urgent need for hemorrhage control, and aggressive hemostatic treatment. The treatment concepts consider the following 3 aspects: controlling the source of bleeding (close the tap), maintaining organ perfusion and restoring hemostasis (fill the tank) and increasing the body's resistance to ischemia (upgrade the armor). New tools, well-established damage control concepts and early and aggressive therapeutic intervention for hemostatic failure have significantly improved the outcomes. CONCLUSION: Future research needs to refine and validate the current concepts for further clinical application.

A novel micro-aqueous cold extraction of salmon head oil to reduce lipid oxidation and fishy odor: Comparison with common methods.

Traditional heat extraction (HE) has a low efficiency (75.2 wt%) and induces lipid oxidation of PUFAs. The novel micro-aqueous cold (<25 °C) extraction (MAE) was applied to extract salmon head oil. The recovery rate was 93.4 wt% at oil volume fraction Φ = 74 %. The extraction mechanism was agitation-induced droplet coalescence at an unstable and close-packing state (Φ = 74 %), increasing the portions of the large-sized droplets (>50 µm) from 2.8 vol% to 91.7 vol%. The MAE reduced the oil oxidation level and odor intensity compared to HE, although the lipid profile differed slightly. The HE head oil had more key fishy odor compounds, including hexanal (0.98 mg/kg), 3-methyl-butanal (0.25 mg/kg), 1-penten-3-ol (0.49 mg/kg), and 2-ethylfuran (0.19 mg/kg). The MAE oil had only 2-methyl-butanal (0.10 mg/kg) and 1-penten-3-ol (0.47 mg/kg). Overall, micro-aqueous extraction has great potential to replace industrial heat extraction with a better product quality.

Vaginal Packing After Pelvic Floor Reconstructive Surgery: Does the Soaking Agent Used for Packing (Bupivacaine, Estrogen or Saline) Impact Post-operative Pain Scores?"

STUDY OBJECTIVE: Vaginal packing is traditionally placed after pelvic floor reconstructive surgery (PFRS) to prevent hematoma formation. We seek to determine if there is a difference in post-operative pain scores after PFRS if vaginal packing is soaked with estrogen cream, bupivacaine, or saline. The primary outcome was pain as measured by a visual analog scale (VAS) at 2 hours, 6 hours, and 1 day post-operatively. Secondary outcomes include change in hemoglobin, urinary retention and length of stay (LOS) in hospital. DESIGN: Prospective cohort study SETTING: Tertiary care academic teaching hospital. All PFRS performed by fellowship-trained urogynecologists. PARTICIPANTS: Consenting patients undergoing PFRS. INTERVENTIONS: At the completion of surgery, gauze packing soaked with either estrogen cream 0.25% bupivacaine with 1% epinephrine, or normal saline was placed inside the vagina and removed on post-operative day 1. RESULTS: We included 210 patients (74 estrogen, 66 bupivacaine, 70 saline). There was no significant difference in mean post-operative pain scores between the groups (estrogen, bupivacaine, saline-soaked vaginal packs respectively) at 2 hours (2.66±2.25, 2.30±2.17, 2.24±2.07; p=.4656), 6 hours (2.99±2.38, 2.52±2.30, 2.36±2.01; p=.2181) or on post operative day 1 (1.89±2.01 vs. 2.08±2.15 vs. 2.44±2.19; p=.2832) as measured by VAS scores (0-10). There was no difference in the secondary outcomes of change in pre-/post-operative hemoglobin (21.8±10.73g/L, 20.09±11.55g/L, 21.7±9.62g/L, p=.68), urinary retention (37%, 45% and 48%, p=.45), LOS (1.05±0.46 days, 1.02±0.12, 1.03±0.24, p=.97) or in-hospital opioid usage during admission (represented in morphine milligram equivalents (median (IQR1, IQR3), Kruskal-Wallis test): 11.25mg (0,33), 7.5mg (0, 22.5) and 15mg (0, 33.88) p =0.41. CONCLUSION: There was no difference found between soaking vaginal packing with estrogen cream, bupivacaine, or saline after PFRS with respect to post-operative pain scores, LOS, in-hospital opioid usage, or urinary retention. Saline-soaked packing is an equivalent alternative to estrogen or bupivacaine vaginal packing. CLINICAL TRIAL REGISTRATION: NCT03266926. Registered February 1, 2017. https://clinicaltrials.gov/study/NCT03266926.

Do ethoxylated polymeric coacervate micelles respond to temperature similarly to ethoxylated surfactant aggregates?

HYPOTHESIS: Ethoxylated complex coacervate core micelles (C3Ms), formed by the electrostatic coacervation of a charge-neutral diblock copolymer and an oppositely charged homopolymer, exhibit morphology governed by molecular packing principles. Additionally, this morphology is temperature-dependent, leading to transitions similar to those observed in classical ethoxylated surfactant aggregates. EXPERIMENTS: To explore the thermal effects on the size and morphology of C3Ms, we employed dynamic light scattering (DLS), small-angle X-ray scattering (SAXS), and cryogenic transmission electron microscopy (cryo-TEM). These techniques were applied to C3Ms formed by copolymers with varying poly(ethylene oxide) (EO) lengths. FINDINGS: Increasing the temperature-induced a transition from spherical to elongated aggregates, contingent on the EO block length. This morphological transition in EO-containing C3Ms parallels the behavior of classical ethoxylated surfactant aggregates. Despite the fundamental differences between hydrophobically driven and electrostatic coacervate micelles, our findings suggest that similar molecular packing principles are universally applicable across both systems. Our results offer valuable insights for predicting the structural properties of these coacervate platforms, which is crucial for envisioning their future applications.

Recent Advances in Hollow Nanostructures: Synthesis Methods, Structural Characteristics, and Applications in Food and Biomedicine.

The development and investigation of innovative nanomaterials stand poised to advance technological progress and meet the contemporary demand for efficient, environmentally friendly, and intelligent products. Hollow nanostructures (HNS), characterized by their hollow architecture, exhibit diverse properties such as expansive specific surface area, low density, high drug-carrying capacity, and customizable structures. These elaborated structures, encompass nanospheres, nanoboxes, rings, cubes, and nanowires, have wide-ranging applications in biomedicine, materials chemistry, food industry, and environmental science. Herein, HNS and their cutting-edge synthesis methods, including solvothermal methods, liquid-interface assembly methods, and the self-templating methods are discussed in-depth. Meanwhile, the potential applications of HNS in food and biomedicine such as food packing, biosensor, and drug delivery over the past three years are summarized, together with a prospective view of future research directions and challenges. This review will offer new insights into designing next generation of hollow nanomaterials for food and biomedicine applications.

Comparison of two crystal polymorphs of NowGFP reveals a new conformational state trapped by crystal packing.

Crystal polymorphism serves as a strategy to study the conformational flexibility of proteins. However, the relationship between protein crystal packing and protein conformation often remains elusive. In this study, two distinct crystal forms of a green fluorescent protein variant, NowGFP, are compared: a previously identified monoclinic form (space group C2) and a newly discovered orthorhombic form (space group P212121). Comparative analysis reveals that both crystal forms exhibit nearly identical linear assemblies of NowGFP molecules interconnected through similar crystal contacts. However, a notable difference lies in the stacking of these assemblies: parallel in the monoclinic form and perpendicular in the orthorhombic form. This distinct mode of stacking leads to different crystal contacts and induces structural alteration in one of the two molecules within the asymmetric unit of the orthorhombic crystal form. This new conformational state captured by orthorhombic crystal packing exhibits two unique features: a conformational shift of the ß-barrel scaffold and a restriction of pH-dependent shifts of the key residue Lys61, which is crucial for the pH-dependent spectral shift of this protein. These findings demonstrate a clear connection between crystal packing and alternative conformational states of proteins, providing insights into how structural variations influence the function of fluorescent proteins.

Quantitative characterization of fluorine-centered noncovalent interactions in crystalline benzanilides.

Six isomeric molecules, featuring a minimum of three fluorine atoms on either the benzoyl or aniline side, have been synthesized, crystallized and characterized through single crystal X-ray diffraction (SCXRD). In addition, two other compounds, containing six fluorine atoms, three on each of the benzoyl and aniline side of the benzanilide scaffold have also been characterized through SCXRD. This current study aims to augment the capacity for hydrogen bond formation, specifically involving organic fluorine, by elevating the acidity of the involved hydrogens through the incorporation of highly electronegative fluorine atoms, in the presence of strong N-H×××O=C H-bonds. Lattice energy calculations and assessment of intermolecular interaction energies elucidate the contributions of electrostatics and dispersion forces in crystal packing. The topological analysis of the electron density is characterized by the presence of bond critical points (BCPs) involving C-H×××F and F×××F contacts, thus establishing the bonding nature of these interactions which play a crucial role in the crystal packing in addition to the presence of traditional N-H×××O=C H-bonds.

A geometric-tension-dynamics model of epithelial convergent extension.

Convergent extension of epithelial tissue is a key motif of animal morphogenesis. On a coarse scale, cell motion resembles laminar fluid flow; yet in contrast to a fluid, epithelial cells adhere to each other and maintain the tissue layer under actively generated internal tension. To resolve this apparent paradox, we formulate a model in which tissue flow in the tension-dominated regime occurs through adiabatic remodeling of force balance in the network of adherens junctions. We propose that the slow dynamics within the manifold of force-balanced configurations is driven by positive feedback on myosin-generated cytoskeletal tension. Shifting force balance within a tension network causes active cell rearrangements (T1 transitions) resulting in net tissue deformation oriented by initial tension anisotropy. Strikingly, we find that the total extent of tissue deformation depends on the initial cellular packing order. T1s degrade this order so that tissue flow is self-limiting. We explain these findings by showing that coordination of T1s depends on coherence in local tension configurations, quantified by a geometric order parameter in tension space. Our model reproduces the salient tissue- and cell-scale features of germ band elongation during Drosophila gastrulation, in particular the slowdown of tissue flow after approximately twofold elongation concomitant with a loss of order in tension configurations. This suggests local cell geometry contains morphogenetic information and yields experimentally testable predictions. Defining biologically controlled active tension dynamics on the manifold of force-balanced states may provide a general approach to the description of morphogenetic flow.

Differential responses in the core, active site and peripheral regions of cytochrome c peroxidase to extreme pressure and temperature.

In consideration of life in extreme environments, the effects of hydrostatic pressure on proteins at the atomic level have drawn substantial interest. Large deviations of temperature and pressure from ambient conditions can shift the free energy landscape of proteins to reveal otherwise lowly populated structural states and even promote unfolding. We report the crystal structure of the heme-containing peroxidase, cytochrome c peroxidase (CcP) at 1.5 and 3.0 kbar and make comparisons to structures determined at 1.0 bar and cryo-temperatures (100 K). Pressure produces anisotropic changes in CcP, but compressibility plateaus after 1.5 kbar. CcP responds to pressure with volume declines at the periphery of the protein where B-factors are relatively high but maintains nearly intransient core structure, hydrogen bonding interactions and active site channels. Changes in active-site solvation and heme ligation reveal pressure sensitivity to protein-ligand interactions and a potential docking site for the substrate peroxide. Compression at the surface affects neither alternate side-chain conformers nor B-factors. Thus, packing in the core, which resembles a crystalline solid, limits motion and protects the active site, whereas looser packing at the surface preserves side-chain dynamics. These data demonstrate that conformational dynamics and packing densities are not fully correlated in proteins and that encapsulation of cofactors by the polypeptide can provide a precisely structured environment resistant to change across a wide range of physical conditions.

The effects of plant flavones on the membrane boundary potential and lipid packing stress.

Here we have revealed the effects of different plant flavones on the physicochemical properties of model lipid membranes. We have demonstrated that baicalein increases the boundary potential of membranes composed of phosphatidylcholine, while wogonin does not affect it. Other flavones tested reduce membrane boundary potential, with this ability increasing among scutellarein, chrysin, apigenin, morin, fisetin, and luteolin. Molecular dynamics simulations demonstrate connection of alteration in boundary potential with the preferential orientation of intrinsic flavone dipole moments in membranes. We have also shown that flavones reduce the melting point of phosphatidylcholine, and this ability increases in the series of luteolin, morin, wogonin, scutellarein, apigenin, baicalein, chrysin, and fisetin. The introduction of baicalein, chrysin and fisetin also leads to a significant decrease in the sharpness of the lipid phase transition. We have hypothesized that the localization of flavones in the glycerol backbone or in the C1-C8 methylene region of lipid hydrocarbon chains leads to an increase in the area per lipid and, as a consequence, to an expansion of the lipid melting peak. Replacement of neutral phosphatidylcholine with negatively charged phosphatidylserine affects the membrane-modifying activity of flavones which given the externalization of phosphatidylserine on the surface of cancer cells may be crucial in the flavone anticancer effects.

Achieving Controllable Thermochromic Fluorescence via Synergistic Intramolecular Charge Transfer and Molecular Packing.

Thermochromic fluorescent materials (TFMs) have attracted significant attention due to their unique fluorescent colorimetric response to temperature. However, existing TFMs still suffer from weak stimulus responsiveness, broad temperature response ranges, uncontrollable emission color changes, and low quantum yields. In this study, we address these issues by designing and synthesizing three diketone-boron complexes with distinct emission wavelengths (NWPU-(2-4)). Utilizing a molecular engineering strategy to manipulate intramolecular charge transfer transitions and molecular packing modes, our synthesized complexes exhibit efficient fluorescence emission in both solution and solid states. Moreover, their emission wavelengths are highly sensitive to environmental polarity. By incorporating these compounds into thermosensitive matrices of long-chain alkanes, we produced TFMs with varied fluorescence emission peak variation ranges. Notably, the TFM based on NWPU-4, owing to its strong charge transfer transitions and dense J-aggregate packing configuration, not only exhibits intense fluorescence emission spanning the deep red to near-infrared spectrum but also displays a remarkable 90 nm broad range of thermochromic properties. Ultimately, it was successfully applied to programmable, thermally controlled, multi-level information encryption.

Evaluation of a New In Chemico Skin Corrosion Test.

The purpose of this study is to evaluate a novel macromolecular test method for the identification of dermal corrosives. The simple in chemico test procedure involves allowing the material to be tested to interact with a skin biomarker for corrosivity and then adding a detection reagent. The corrosivity of the test substance is predicted based on the measured macromolecular damage, which results in reduced optical density of the detection reagent as compared with controls. This study aims to determine if such an extremely simple, cell-free test method can accurately identify dermal corrosives. To determine predictivity and repeatability, we tested 60 chemicals (30 in vivo dermal corrosives and 30 in vivo dermal noncorrosives; all tested in triplicate) representative of a broad range of chemical classes, functional groups, mixtures, and levels of toxicity. Validation results indicate the GHS multicategory and packing group assignment accuracy is on par with that of the Reconstructed Human Epidermis test method and the Membrane Barrier test method and for the global identification of corrosives, the method has a considerably higher accuracy (98 % vs. ∼80 %).

Approaches for predicting the soil-water characteristic curves of compacted quartz sand based on particle packing theory.

The soil-water characteristic curve (SWCC) is an important basis for describing hydraulic properties, which is closely related to environmental problems such as the migration of toxic substances from groundwater and soil. The SWCC models vary considerably with respect to the void ratio or bulk density. However, the void ratio and bulk density of the same soil change at different depths or positions within a flat space. Accurate simulation or calculation requires a precise SWCC, but measuring every SWCC under each density or void ratio condition is difficult. In this study, two particle packing models, the Kwan model and the modified linear packing density model (MLPDM), were introduced into the van Genuchten (VG) model to predict the SWCC for soil at the minimum void ratio (the maximum dry density). Then, the prediction method of the SWCCs for the same soil with different densities or void ratios was given. A series of laboratory tests using quartz sand mixtures were conducted to verify the accuracy of two extended models (the K-VG model and the M-VG model). For the K-VG model, the average RMSE was 0.020. For the M-VG model, the average RMSE was 0.017. In general, the SWCCs predicted by the two extended models were consistent with the measured values.

On the abundance and importance of AXXXA sequence motifs in globular proteins and their involvement in CßCß interaction.

The AXXXA and GXXXG motifs are frequently observed in helices, especially in membrane proteins. The motif GXXXG is known to stabilize helix-helix association in membrane proteins via CαHO bonding. AXXXA sequence motif additionally stabilizes the folded state of proteins. We found 27,000 and 18,000 occurrences of AXXXA and GXXXG motifs in a non-redundant set of 6000 obligate homodimeric (OD) complexes. Interestingly, this is less pronounced in transient homodimers (TD) and heterodimers (HetD). On average each obligate homodimer contains four AXXXA motifs, it is 2 and 3.5 for HetD and TD, respectively. Focusing on the binding surface it is seen that 27 % of the ODs contain at least one AXXXA motif at the interface, whereas it is 17 % and 15 % for HetD and TD respectively. AXXXA predominantly stabilizes the OD quaternary structure via the side chain CßCß interactions. This interaction is energetically favorable and is found to be a major driving force for OD quaternary structure stability. Cß-Cß interactions are observed ∼6 times higher than the known CαHO interaction for helix-helix stabilization. Two additional new interactions of CßO and OO are observed at the AXXXA containing interface regions. The occurrence of the motif gets drastically reduced if any of the terminal Ala residues are replaced by Gly. Our findings show the importance of AXXXA in providing stability to the quaternary structure through specific hydrophobic interactions and the specificity of the Ala residue at motif termini. The knowledge gained can be used for designing synthetic proteins of improved stability and for designing peptide-based therapeutics.

Incarcerated gravid uterus liberated by vaginal gauze packing under general anesthesia: a case report.

Incarceration of the gravid uterus is a rare and serious obstetric complication that can lead to severe complications. We present the case of a 32-year-old woman (gravida 5, para 2022) at 12 weeks and 5 days of gestation who presented with urinary retention and lower abdominal pain. Despite attempts at positional changes and manipulative repositioning under epidural anesthesia, the incarceration of the gravid uterus persisted. Subsequent intervention under general anesthesia involved partially reducing the uterine fundus into the abdominal cavity and using gauze strips in the posterior vaginal fornix to maintain traction. In addition, the bilateral round ligaments of the uterus were sutured to release the incarcerated uterus via laparoscopy. Vaginal gauze packing under general anesthesia may be a beneficial intervention for addressing cases of an incarcerated uterus, particularly in patients in whom passive maneuvers and manual pressure fail to resolve the condition.

Atención médica de body packers en un territorio colombiano / Medical care for body packers in a Colombian territory

Introducción. El número de capturas a los body packers, que son aquellas personas que ingieren paquetes con estupefacientes para tráfico ilegal, ha aumentado paulatinamente. El objetivo de este estudio fue presentar los casos de body packers atendidos en dos instituciones de salud de Florencia, un territorio al sur de Colombia, entre 2003 y 2017. Métodos. Este es un estudio retrospectivo descriptivo. Se hizo un análisis univariado en RStudio y Microsoft Excel® de variables sociodemográficas y clínicas. Se emplearon medidas de tendencia central y dispersión para las variables continuas, frecuencias y proporciones para las variables categóricas. Resultados. Se incluyeron 72 pacientes. La mayoría de los casos fueron reportados entre 2007 y 2012 (77,5 %). La relación entre hombres y mujeres fue de 4,9:1. La edad media fue de 29,1 años. El principal motivo de admisión fue para chequeo médico tras captura por parte de los organismos de seguridad nacional (76,4 %). En 9 de cada 10 admitidos se realizaron estudios de imagen (94,4 %); la principal ayuda diagnóstica fue la radiografía de abdomen simple (84,7 %), con una sensibilidad del 91,6 %. Se realizó manejo expectante en tres de cada cuatro pacientes (74,6 %). El 6,9 % presentaron complicaciones, con una mortalidad (1,4 %). Conclusiones. La radiografía de abdomen simple es una ayuda diagnóstica adecuada para el tamizaje de los body packers. El manejo conservador es aceptable, teniendo en cuenta el porcentaje bajo de complicaciones.

Introduction. The number of arrests of body packers, who are those people who ingest packages with narcotics for illegal trafficking, has gradually increased. The objective of this study was to present the cases of body packers treated in two health institutions in Florencia, a territory in southern Colombia, between 2003 and 2017. Methods. This is a descriptive retrospective study. A univariate analysis was performed in RStudio and Microsoft Excel® of sociodemographic and clinical variables. Measures of central tendency and dispersion were used for continuous variables, frequencies and proportions for categorical variables. Results. 72 patients were included. Most cases were reported between 2007 and 2012 (77.5%). The ratio between men and women was 4.9:1. The mean age was 29.1 years. The main reason for admission was for medical check-up after capture by national security agencies (76.4%). In nine out of ten admitted patients, imaging studies were performed (94.4%); the main diagnostic imaging was simple abdominal X-ray (84.7%), with a sensitivity of 91.6%. Expectant management was performed in three out of four patients (74.6%). 6.9% presented complications, with one mortality (1.4%). Conclusions. Simple abdominal x-ray is an adequate diagnostic tool for screening body packers. Conservative management is acceptable, taking into account the low percentage of complications.

Integrating Heuristic Methods with Deep Reinforcement Learning for Online 3D Bin-Packing Optimization.

This study proposes a method named Hybrid Heuristic Proximal Policy Optimization (HHPPO) to implement online 3D bin-packing tasks. Some heuristic algorithms for bin-packing and the Proximal Policy Optimization (PPO) algorithm of deep reinforcement learning are integrated to implement this method. In the heuristic algorithms for bin-packing, an extreme point priority sorting method is proposed to sort the generated extreme points according to their waste spaces to improve space utilization. In addition, a 3D grid representation of the space status of the container is used, and some partial support constraints are proposed to increase the possibilities for stacking objects and enhance overall space utilization. In the PPO algorithm, some heuristic algorithms are integrated, and the reward function and the action space of the policy network are designed so that the proposed method can effectively complete the online 3D bin-packing task. Some experimental results illustrate that the proposed method has good results in achieving online 3D bin-packing tasks in some simulation environments. In addition, an environment with image vision is constructed to show that the proposed method indeed enables an actual robot manipulator to successfully and effectively complete the bin-packing task in a real environment.