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New Zealand Veterinary Journal May 2024To compare the biomechanical properties of three different sternal closure techniques in a 3D-printed bone model of a sternum from a 30-kg dog.
AIM
To compare the biomechanical properties of three different sternal closure techniques in a 3D-printed bone model of a sternum from a 30-kg dog.
METHODS
Median sternotomy was performed on a total of 90 three-dimensional (3D) copies of a polycarbonate (PC) model of a sternum, generated from the CT images of the sternum of a 30-kg German Shepherd dog. Three different methods were used to repair the sternotomies: polydioxanone suture (group PDS, n = 30), stainless steel bone staples (group SS, n = 30), and nitinol bone staples (group NS, n = 30). Each repair method was tested by applying tensile force in one of three ways (longitudinally, laterally, or torsionally) resulting in a sample size of n = 10 for each repair method-loading combination. In all experiments, the loads at 1-mm and 2-mm gap formation, failure, and the displacement at the failure point were measured.
RESULTS
In lateral distraction and longitudinal shear tests, NS and SS staple repairs required application of significantly greater force than PDS across all displacement criteria (1 and 2 mm). NS exhibited significantly greater failure load than PDS. In torsion tests, NS required significantly greater application of force compared to SS or PDS at all displacement criteria (1 and 2 mm) and exhibited a greater failure load than PDS. In terms of displacement at failure point, PDS suture showed more displacement than SS or NS across all experiments (laterally, longitudinally, torsionally).
CONCLUSIONS
In this study, bone staples were mechanically superior to PDS suture in median sternotomy closure using 3D-printed bone model in terms of 1-mm, 2-mm displacement loads, and displacement at failure. NS had a higher failure load than PDS under lateral, longitudinal, and torsional distraction.
CLINICAL RELEVANCE
These study results imply that bone staples can be considered as an alternative surgical method for median sternotomy closure in dogs.
PubMed: 38777331
DOI: 10.1080/00480169.2024.2350432 -
Poultry Science Jul 2024The global egg industry is rapidly transitioning to cage-free egg production from conventional cages. Hens housed in cage-free systems have an increased prevalence of...
The global egg industry is rapidly transitioning to cage-free egg production from conventional cages. Hens housed in cage-free systems have an increased prevalence of keel damage that could lead to reduced egg production and compromised well-being. The objective of this study was to determine the effects of dietary supplementation of n-3 fatty acids and vitamin D on keel damage in hens housed in multi-tier aviary systems (AV). Brown hens were placed in 4 AV system rooms after rearing at 17 wk of age (woa) with each room containing 576 birds. At 12 woa, rooms were randomly assigned to a dietary treatment of flaxseed oil, fish oil, vitamin D, or control. Focal birds (36 per treatment) were longitudinally examined for keel damage using quantitative computed tomography (QCT) at nine timepoints from 16 to 52 woa. Three-dimensional digital twins of the keels were created from the QCT scans and visually assessed for damage. An overall keel severity score was recorded as well as the location, direction, and severity of each deviation or fracture. Severity was ranked on a 0 to 5 scale with 0 being no damage and 5 being severe. Damage scores were analyzed utilizing odds ratios with main effects of age and treatment. At 16 woa, 80% of hens had overall keel scores of 0 and 20% had scores of 1. At 52 woa, all hens had damage, with 31% having a score of 1, 61% scored 2 to 3, and 8% scored 4 to 5. Most fractures were not observed until peak lay. Dietary treatments did not affect likelihood of fracture incidences, but younger birds had lower odds of incurring keel fractures than older birds (P < 0.0001). The initial incidences of keel deviations occurred earlier than fractures, with most birds obtaining a keel deviation by 28 woa. Keel damage was not able to be prevented, but the age at which keel fractures and deviations initiate appear to be different, with deviations occurring during growth and fractures during lay.
Topics: Animals; Chickens; Female; Diet; Sternum; Animal Feed; Cholecalciferol; Dietary Supplements; Fatty Acids, Omega-3; Random Allocation; Fish Oils; Housing, Animal; Fractures, Bone; Tomography, X-Ray Computed; Imaging, Three-Dimensional
PubMed: 38776860
DOI: 10.1016/j.psj.2024.103804 -
Case Reports in Veterinary Medicine 2024Sternal luxation/dislocation is a rare condition and is most often the result of trauma. Medical and surgical management have been described, with scarce information...
Sternal luxation/dislocation is a rare condition and is most often the result of trauma. Medical and surgical management have been described, with scarce information regarding the best treatment option for these cases. A 1-year-old domestic shorthair cat was presented for severe sternal dislocation and a left humeral fracture. Given the displacement observed at the level of the sternum and pain associated, surgical stabilization was elected. A partial lung lobe hernia was identified during the open stabilization of the sternum. Management of the hernia and sternal luxation stabilization were performed with the aid of video-assisted thoracoscopy. The cat recovered uneventfully, and no postoperative complications were reported.
PubMed: 38774560
DOI: 10.1155/2024/3719641 -
Heart Views : the Official Journal of... 2024Recent advances in coronary revascularization include total arterial grafting, however, in a few cases, harvesting the right internal thoracic artery (RITA) is not...
Recent advances in coronary revascularization include total arterial grafting, however, in a few cases, harvesting the right internal thoracic artery (RITA) is not possible due to various reasons. In such cases, where the aorta is also calcified, few surgeons perform Y anastomosis configuration with the left internal thoracic artery(LITA) and saphenous vein which can have disastrous complications. Our patient is a 65-year-old man who was diagnosed with multivessel coronary disease and presented with a coronary steal during coronary artery bypass grafting surgery. The RITA was not harvested due to osteoporosis sternum. LITA-saphenous vein Y anastomosis configuration was done as the aorta was calcified. The anastomosis was done between the LITA to the left anterior descending (LAD) artery and the Y arm saphenous vein was anastomosed to an obtuse marginal (OM)branch. He developed coronary steal following anastomosis of the Y graft to the OM branch. The patient had ischemic changes inside the operation theatre in LAD territory, hence grafts were revised following which the patient became stable. There is a high possibility of a coronary steal when the caliber of the Y arm does not match with the LITA. LITA-saphenous vein Y anastomosis can cause more complications as the saphenous vein is much bigger in caliber compared to the LITA.
PubMed: 38774546
DOI: 10.4103/heartviews.heartviews_38_23 -
Clinics (Sao Paulo, Brazil) 2024Approximately 30 % of cardiac surgeries are conducted on women by median sternotomy, which often causes discomfort such as pain, affects quality of life, and delayed... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Approximately 30 % of cardiac surgeries are conducted on women by median sternotomy, which often causes discomfort such as pain, affects quality of life, and delayed recovery compared with men. Breast size is related to operative wound complications, such as incisional pain, sternum dehiscence, and infection, which may affect hospital costs due to prolonged hospital stays.
OBJECTIVE
To evaluate breast size and operative wound complications and the effect of breast support on the incidence of pain, infection, and quality of life in women after coronary artery bypass grafting.
METHOD
Women were randomly assigned to one of three groups: group A (surgical breast support), group B (ordinary breast support), and group C (no-support). Observations were taken daily between the second and seventh postoperative days and at 30, 60, and 180 days. Pain was assessed using the Short-Form 36 Health Survey (SF36) for quality of life and a verbal numerical scale. The authors used the nonparametric Kruskal-Wallis and Friedman tests to examine variance. The authors used the Pearson correlation coefficient or the Spearman correlation for correlations between variables. A multivariate study was conducted to evaluate the occurrence of infection, and the logistic regression model with "stepwise" variable selection was used. A linear regression model with the "stepwise" variable selection was also used for hospitalization. The authors used SPSS 17.0 software for Windows, with a significance level of p < 0.05.
RESULTS
There was no difference in pain evaluation between the groups in 190 women (p > 0.05). When comparing quality of life, there was a statistically significant difference in the functional capacity domain at 30 and 60 days, with group A having the best functional capacity (p < 0.05). The larger the breast size, the longer the hospital stay (p < 0.001) and the higher the probability of infection (p = 0.032). Patients with a history of stroke had a 3.8 higher incidence of infection (p = 0.040).
CONCLUSION
The use of surgical support did not affect acute pain or sternal infection rate in the 6-month follow-up. However, it was effective in the functional capacity domain 30 days after surgery and maintained at 60 days.
Topics: Humans; Female; Coronary Artery Bypass; Quality of Life; Middle Aged; Surgical Wound Infection; Pain, Postoperative; Aged; Breast; Time Factors
PubMed: 38772100
DOI: 10.1016/j.clinsp.2024.100370 -
International Medical Case Reports... 2024Although percutaneous osteoplasty (POP) has been widely accepted and is now being performed for the treatment of painful bone metastases outside the spine. It is...
BACKGROUND
Although percutaneous osteoplasty (POP) has been widely accepted and is now being performed for the treatment of painful bone metastases outside the spine. It is emerging as one of the most promising procedures for patients with painful bone metastasis who are unsuitable for surgery or who show resistance to radiotherapy and/or analgesic therapies. However, there are only scarce reports regarding osteoplasty in painful sternal metastases.
SUBJECTS AND METHOD
We report four patients with sternal metastases suffered with severe pain of anterior chest wall. The original tumors included lung cancer and thyroid cancer. For the initially pain medication failing, all the four patients received POP procedure under fluoroscopic and cone-beam CT (CBCT) guidance, and obtained satisfying resolution of painful symptoms at 6-month postop follow-up.
CONCLUSION
POP is a safe and effective treatment for pain caused by metastatic bone tumors in the sternum. In practice, however, percutaneous puncture of pathologic sternal fractures can be a challenge because of the long flat contour and the defacement by lytic tumor of bony landmarks. We find that the use of fluoroscopic and CBCT can facilitate POP for flat bone fractures with displacing the trajectory planning, needle advancement, and cement delivery in time.
PubMed: 38765866
DOI: 10.2147/IMCRJ.S454210 -
Cureus Apr 2024Identification is an important aspect of forensic medicine. Identification plays an imperative role, especially in highly decomposed bodies, mutilated bodies, and...
INTRODUCTION
Identification is an important aspect of forensic medicine. Identification plays an imperative role, especially in highly decomposed bodies, mutilated bodies, and undisclosed and fragmentary human remains. The estimation of sex is an essential parameter of human identification. In forensic anthropometry, sex determination is related to morphometric characteristics of skeletal bones, such as the skull and mandible, clavicle, sternum, scapula, humerus, pelvic bone, sternum, and femur. Since teeth are decay-resistant, conscientious analysis of teeth can accredit reliable sex estimation of an individual, especially when other determinants are fragmented or destroyed.
AIM
The aim of the study was to explore the association between sex and buccolingual crown dimensions of teeth.
MATERIALS AND METHODS
The study sample consists of 100 volunteer subjects (50 male subjects and 50 female subjects) aged between 20 and 35 years. Alginate was used to take impressions of the teeth and the cast was prepared using pouring by dental stone. Measurements of buccolingual parameters of all the teeth (except the third molars) of both jaws were done on dental casts by using a digital caliper.
RESULTS
Collected data were analyzed using SPSS software (IBM Corp., Armonk, NY) and were outlined as mean and standard deviation (SD). The male and female groups were compared using an independent Student's t-test or unpaired test. The results of this study revealed that 16 out of 28 odontometric parameters (except third molar) of the two groups (male and female) were higher in the male group as compared to the female group (p < 0.05).
CONCLUSION
Buccolingual odontometric parameters can be used for sex estimation in the North Indian population.
PubMed: 38765404
DOI: 10.7759/cureus.58495 -
Journal of Bodywork and Movement... Apr 2024Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present...
INTRODUCTION
Patients submitted to heart surgery are restricted to the bed of the Intensive Care Units (ICUs), due to this period of immobility the individual is likely to present clinical and functional alterations. These complications can be avoided by early mobilization; however, in some hospitals, this is not feasible due to the use of subxiphoid drain in the immediate postoperative period.
OBJECTIVE
To verify the safety and feasibility of mobilizing patients after cardiac surgery using subxiphoid drain.
METHODS
This was a prospective cohort study. On the first day the patient was positioned in sedestration in bed, then transferred from sitting to orthostasis, gait training and sedestration in an armchair. On the second postoperative day the same activities were performed, but with walking through the ICU with a progressive increase in distance. At all these moments, the patient was using the subxiphoid and intercostal drain. The patients were seen three times a day, but physical rehabilitation was performed twice. The adverse events considered were drain obstruction, accidental removal or displacement, total atrioventricular block, postoperative low output syndrome, cardiorespiratory arrest, pneumomediastinum, infection, and pericardial or myocardial damage.
RESULTS
176 patients were evaluated. Only 2 (0.4 %) of the patients had complications during or after mobilization, 1 (0.2 %) due to drain obstruction and 1 (0.2 %) due to accidental removal or displacement.
CONCLUSION
Based on the data observed in the results, we found that the application of early mobilization in patients using subxiphoid drain after cardiac surgery is a safe and feasible conduct.
Topics: Humans; Early Ambulation; Male; Prospective Studies; Female; Middle Aged; Cardiac Surgical Procedures; Aged; Drainage; Feasibility Studies; Postoperative Complications; Adult; Xiphoid Bone
PubMed: 38763556
DOI: 10.1016/j.jbmt.2024.01.007 -
The Annals of Thoracic Surgery May 2024Limited data exist regarding outcomes of delayed sternal closure (DSC) in adults with congenital heart disease (ACHD).
BACKGROUND
Limited data exist regarding outcomes of delayed sternal closure (DSC) in adults with congenital heart disease (ACHD).
METHODS
We reviewed 159 ACHD patients undergoing cardiac operation from 1993 to 2023 who required DSC (open sternum at the end of operation, n = 112) or sternum emergently reopened (n = 47). Regression models were performed to determine factors associated with outcomes.
RESULTS
Of 112 patients undergoing DSC, 87 patients (77.6%) underwent DSC ≤4 days and 25 patients (22.3%) >4 days. The most common operations were valve (n = 35 [31.2%]), aortic (n = 33 [29.4%]), and right ventricular outflow tract procedures (n = 23 [20.5%]). Median time to chest closure was 2 days (interquartile range, 1-5 days). Apart from sex, baseline characteristics were similar between DSC groups. A stepwise increase in early mortality was observed from DSC ≤4 days to DSC >4 days (6.8% vs 32%), as well as the incidence of early complications, except sternal infection. Risk factors associated with early mortality were age (P = .02), DSC >4 days (P < .001), hemodynamic indication (P = .03), and single ventricle (P = .02). On multivariable analysis, lower ejection fraction (P = .04), hemodynamic indication (P = .02), single ventricle (P = .004), and diabetes mellitus (P = .03) were predictors of prolonged time to chest closure. Among hospital survivors, late survival was similar between patients undergoing DSC ≤4 days vs >4 days (P = .48).
CONCLUSIONS
A brief duration of DSC in ACHD patients is associated with low morbidity and mortality. Higher early mortality and complications were observed among patients who did not achieve chest closure within 4 days.
PubMed: 38763220
DOI: 10.1016/j.athoracsur.2024.04.031 -
Medical Science Monitor : International... May 2024BACKGROUND Computer-aided design (CAD) has been used in the Nuss procedure to determine the bar length and shape. Despite computer aid, the shape and design remain quite...
BACKGROUND Computer-aided design (CAD) has been used in the Nuss procedure to determine the bar length and shape. Despite computer aid, the shape and design remain quite intuitive. We tested a new algorithm to determine the optimal bar shape. MATERIAL AND METHODS The normal sterno-vertebral distance was defined on computed tomography (CT) scans of patients without pectus excavatum (PEx) at the same level where the deepest depression was found on CT scans of 97 patients with PEx. Four points were marked on the CT scan of 60 patients with PEx at the deepest deformity: P1: edge of the vertebra; P2: edge of the deformity; P3: the expected contact point of the bar and the rib; and P4: the expected end of the bar. The algorithm generated 3 circles upon these points, and the fusion of the arcs drew the line of the ideal bar. Corrected and normal sterno-vertebral distance values were compared with the Mann-Whitney U test. Ten bars were bent manually guided by a 1: 1 printout of the designed bar and were implanted in 10 adolescents. RESULTS The shortest sterno-vertebral distance was 3 cm below the intermammillary line in PEx patients. The normal mean sterno-vertebral distance at this level was 10.16±1.35 cm in non-PEx patients. The mean virtually corrected sterno-vertebral distance was 10.28±1.27 cm. No significant difference was found (P=0.44). The bars were seamless and were successfully implanted. No bar needed adjustment, the operation time was shorter, and the patient satisfaction score was 9.4/10. CONCLUSIONS With our new algorithm, an optimal Nuss bar can be designed.
Topics: Humans; Funnel Chest; Adolescent; Male; Algorithms; Female; Computer-Aided Design; Tomography, X-Ray Computed; Child; Sternum
PubMed: 38760925
DOI: 10.12659/MSM.943705