RESUMO
Cardiopulmonary resuscitation (CPR) is a life-saving technique used in emergencies when the heart stops beating, typically involving chest compressions and ventilation. Current adult CPR guidelines do not differentiate based on age beyond infancy and childhood. This oversight increases the risk of fatigue fractures in the elderly due to decreased bone density and changes in thoracic structure. Therefore, this study aimed to investigate the correlation and impact of factors influencing rib fatigue fractures for safer out-of-hospital manual cardiopulmonary resuscitation (OHMCPR) application. Using the finite element analysis (FEA) method, we performed fatigue analysis on rib cage models incorporating chest compression conditions and age-specific trabecular bone properties. Fatigue life analyses were conducted on three age-specific rib cage models, each differentiated by trabecular bone properties, to determine the influence of four explanatory variables (the properties of the trabecular bone (a surrogate for the age of the subject), the site of application of the compression force on the breastbone, the magnitude of applied compression force, and the rate of application of the compression force) on the fatigue life of the model. Additionally, considering the complex interaction of chest compression conditions during actual CPR, we aimed to predict rib fatigue fractures under conditions simulating real-life scenarios by analyzing the sensitivity and interrelation of chest compression conditions on the model's fatigue life. Time constraints led to the selection of optimal analysis conditions through the use of design of experiments (DOE), specifically orthogonal array testing, followed by the construction of a deep learning-based metamodel. The predicted fatigue life values of the rib cage model, obtained from the metamodel, showed the influence of the four explanatory variables on fatigue life. These results may be used to devise safer CPR guidelines, particularly for the elderly at a high risk of acute cardiac arrest, safeguarding against potential complications like fatigue fractures.
RESUMO
In the evolving landscape of spinal surgery, technological advancements play a pivotal role in enhancing surgical outcomes and patient experiences. This paper delves into the cutting-edge technologies underpinning endoscopic spine surgery (ESS), specifically highlighting the innovations in scope cameras, RF equipment, and drills. The modern scope camera, with its capability for high-resolution imaging, offers surgeons unparalleled visualization, enabling precise interventions. Radiofrequency (RF) equipment has emerged as a crucial tool, providing efficient energy delivery for tissue modulation without significant collateral damage. Drills, with their enhanced torque and adaptability, allow for meticulous bone work, ensuring structural integrity. As minimally invasive spine surgery (MISS) becomes the standard, the integration and optimization of these technologies are paramount. This review captures the current state of these tools and anticipates their continued evolution, setting the stage for the next frontier in spinal surgery.
RESUMO
Retained surgical gauze and the surrounding foreign body reaction constitute a mass referred to as a textiloma. Textiloma has acute and chronic forms; the acute form is symptomatic in the early postoperative period and the chronic form may be asymptomatic or display mild and nonspecific symptoms. Usually, textiloma after previously infected surgery has acute forms. We report here on a case of a 46-year-old male who had retained surgical gauze for 12 years. The patient had received revision surgery for infected spinal instrumentation 12-years previously and had no specific symptom after surgery. One month prior to the present admission, the patient experienced low back pain and left thigh pain. Based on the prior operative history and present imaging results, the patient was diagnosed with an abscess due to a foreign body reaction. The patient underwent surgery, which discovered retained gauze with granuloma. This case is the third longest reported case after entire spinal surgery and the longest time of textiloma after previously infected spine surgery.
