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Background: Laparoscopic cholecystectomy (LCC) carries a 0.3-1.8% risk of bile duct injury (BDI). This study investigated if intraoperative photo documentation of the critical view of safety (CVS) is related to lower rates of BDIs and postoperative complications in LCC. Methods: Surgeons were instructed to take photos of the view before clipping the cystic duct and artery. Two independent raters scored the photos 0-6 using predefined criteria for CVS. Mean scores of >= 4.5 were satisfactory. Results: The study consisted of 1532 patients undergoing LCC between April 2018 and October 2019. CVS was satisfactory in 354 (23.1%), unsatisfactory in 823 (53.7%), and photos were missing in 355 (23.2%) patients. Patients with satisfactory CVS had the lowest BDI rate compared with unsatisfactory CVS or missing photos (0.3% vs. 1.0% vs. 2.3%, p = 0.012). Four major BDIs (Strasberg D-E) occurred, but none in patients with satisfactory CVS. Patients with satisfactory CVS had the lowest postoperative complication rate compared with patients with unsatisfactory CVS or without photos (4.8% vs. 7.9 vs. 9.9%, p = 0.011). Of patients with acute cholecystitis, 15.7% had satisfactory CVS, whereas 26.8% without cholecystitis had satisfactory CVS (p < 0.001). Conclusion: Intraoperative photo documentation of satisfactory CVS is associated with lower rates of BDIs and complications.

In order for enterprise imaging to be successful across a multitude of specialties, systems, and sites, standards are essential to categorize and classify imaging data. The HIMSS-SIIM Enterprise Imaging Community believes that the Digital Imaging Communications in Medicine (DICOM) Anatomic Region Sequence, or its equivalent in other data standards, is a vital data element for this role, when populated with standard coded values. We believe that labeling images with standard Anatomic Region Sequence codes will enhance the user’s ability to consume data, facilitate interoperability, and allow greater control of privacy. Image consumption—when a user views a patient’s images, he or she often wants to see relevant comparison images of the same lesion or anatomic region for the same patient automatically presented. Relevant comparison images may have been acquired from a variety of modalities and specialties. The Anatomic Region Sequence data element provides a basis to allow for efficient comparison in both instances. Interoperability—as patients move between health care systems, it is important to minimize friction for data transfer. Health care providers and facilities need to be able to consume and review the increasingly large and complex volume of data efficiently. The use of Anatomic Region Sequence, or its equivalent, populated with standard values enables seamless interoperability of imaging data regardless of whether images are used within a site or across different sites and systems. Privacy—as more visible light photographs are integrated into electronic systems, it becomes apparent that some images may need to be sequestered. Although additional work is needed to protect sensitive images, standard coded values in Anatomic Region Sequence support the identification of potentially sensitive images, enable facilities to create access control policies, and can be used as an interim surrogate for more sophisticated rule-based or attribute-based access control mechanisms. To satisfy such use cases, the HIMSS-SIIM Enterprise Imaging Community encourages the use of a pre-existing body part ontology. Through this white paper, we will identify potential challenges in employing this standard and provide potential solutions for these challenges.

Aim. Comparison of the results of the use of dermatoscopic algorithms «Chaos and Clues», «Triage Amalgamated Dermoscopic Algorithm» (TADA) and BLINCK technique in the diagnosis of melanoma and other malignant skin tumors depending on the presence of previous dermatoscopy experience. Materials and methods. Algorithms were tested on 85 patients with 85 skin formations who visited the polyclinic of Kursk Regional Clinical Oncology Clinic in 2017–2019. The average age of the patients was 54.8 years old. Dermatoscopy was performed by the non-polarized dermatoscope HEINE mini 3000, photo documentation by the Canon PowerShot SX540 HS camera. Immersion medium – ethyl alcohol (conc. 70%). Patients were carefully examined physiologically and clinically. A clinical and epiluminescence pattern of all neoplasms was obtained, their morphological examination was performed. For the research 2 groups of 3 participants were formed based on the criterion of previous dermatoscopy experience. Each algorithm was evaluated by objective (sensitivity, specificity) and subjective (speed, convenience) criteria. The dermatoscopic results obtained by the techniques used were compared to the histological findings. Results. Using algorithms by a group having previous dermatoscopy experience, the following results were obtained: in the method «Chaos and Clues» sensitivity – 93.75±3.3%, specificity – 77.4±4.6%, speed – 3 points, convenience – 3 points. TADA sensitivity – 96.8±2.2%, specificity – 79.2±4.8%, speed – 4 points, convenience – 5 points. BLINCK sensitivity – 96.8±2.2% specificity – 77.4±4.6%, speed – 4 points, convenience – 5 points. In the group with no previous dermatoscopy experience, the results were as follows: in the «Chaos and Clues» algorithm, sensitivity – 93.75±3.3%, specificity – 62.3±5.7%, speed – 3 points, convenience – 3 points. TADA sensitivity – 84.4±4.6%, specificity – 64.2±5.8%, speed – 4 points, convenience – 5 points; BLINCK sensitivity – 80.6±4.4%, specificity – 77.4±4.6%, speed – 5 points, convenience – 4 points. Thus, these algorithms can be used in the diagnosis of malignant skin neoplasms. At the same time, individuals with no experience of dermatoscopy are encouraged to use the «Chaos and Clues» algorithm. In a group having experience in dermatoscopy, both the TADA and the BLINCK technique can be used equally.

Batik Tulis in the Klang Valley has motif and pattern design that identified its own identity. The purpose of this study is to find out the development of the Batik tulis industry in the Klang valley from year 2000 until 2018. Next, it also to study the design and identity of the Batik tulis motif and pattern in the Klang valley from year 2000 until 2018. This study used several methods and approach for data collection consist of interviews, observations and photo documentation. Three Batik tulis manufacturers in Klang Valley have been identified in carrying out this study. The data were then analysed using analytical design approach. The findings showed that, each product of Batik tulis has a uniqueness in terms of subject matters as well as assertions in pattern and designs used. The development of the Batik tulis industry has been changed in terms of design according to the demand of batik users themselves who want differentiation in the design concept of batik products. Most of the batik products in this Klang valley are more focused on the concept of modern and contemporary design. It involves the use of colours, the type of fabrics and the selection of motifs characterized by flora and fauna in modern style. In conclusion, Batik tulis designs and identity in the Klang Valley from year 2000 until 2018 are still retain the originality of the flora and fauna motifs themselves but have made the design of the traditional style to a more modern and contemporary design. However, the design aspect of Hand drawn Batik products in the Klang Valley today needs to be disclosed to the public so that, it can maintain the textile arts, especially the Batik tulis as a Malay textile heritage.Keywords: Klang Valley, batik Tulis, Design, Manufacturer, Identity

Introduction: The doctor-patient relationship is based on good quality of communication and interaction with thepatient, so that it not only can help speed up the healing process, but also make the patient feel comfortable sincethe first visit to the health service. When dealing with pediatric patients, the ability to build a relationship of mutualtrust is done with a more open, honest attitude and understanding what they are feeling. Aim of study: This studyaims to see a real picture of the relationships, interactions and interpersonal communication between doctors andpatients in health care. Method: This study uses a qualitative descriptive study where data is obtained throughinterview transcripts, field observation data notes and photo documentation. A total of 7 participants were obtainedthrough a purposive sampling technique on pediatricians who are accustomed to engaging in effective relationships,interactions and communication with pediatric patients, families and introductors. Data were then analyzed usingthe Miles and Huberman method. Results and Discussions: The results showed three important aspects related torelations, interactions and interpersonal communication between patient physicians in terms of educating,providing entertainment and strengthening patient motivation while in health care. Conclusions: Effectiveinterpersonal communication requires the optimal role of the doctor as a communicator to deliver messages to thepatient or family or patient introduction. In addition, the communication relationship between doctor and patientshould be therapeutic, especially in patients who are still children so that they do not feel scared while in healthcare, which in turn has an impact on the development of patient recovery.

Background The technical competence of oesophagogastroduodenoscopy (OGD) is rapidly acquired but to support the practice of complete examination, the British Society of Gastroenterology (BSG) and Association of Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) strongly recommend photo-documentation of 8 standardized set stations in an OGD. Photo-documentation ensures complete examination, opportunity to inspect area of interest and serves as a legal record of adequate procedure. Methods Retrospective single center study involving review of randomly selected 100 OGD reports from 1/1/2018 till 31/3/2020 from the Endorad system. The reports on online Endorad system were reviewed for photo-documentation of 8 set stations and was also used to collect data on age, sex and the endoscopist. Microsoft Excel was used for data entry and analysis. Results Out of the 100 OGDs reviewed, 58% were males and 42% females. The mean age being 62.7 +/- 13.5. 60% of OGDs were done by surgeons, 25% by gastroenterologist and 15% by Advanced Nurse Practioner. No report had photo-documentation of all 8 stations. Most (40%) had photos of 5 stations, most common was photo evidence at retroflexion (95%) followed by photographic evidence of intubation to D2 (84%). Conclusions OGD is the gold standard test for the investigation of upper gastrointestinal symptoms, the importance lies in the early detection of cancers which maybe amenable to endoscopic treatment. For this reason its important to adhere to guidelines to improve quality in OGD

Corneal calcification is a vision-threatening manifestation of calcium containing agents in ocular burn. As we previously reported, our interest was sparked by a particular discrepancy of a case: A patient treated for a non-calcium containing agent in eye burn from exposure to an alkaline mixture of NaOH and KOH, who unexpectedly developed corneal calcification. This current study aims to elucidate whether the 2 min lasting irrigation with a phosphate-buffered saline itself, regardless of rinsing regimen, triggers corneal calcification. The Ex Vivo Eye Irritation Test (EVEIT) system was used on rabbit corneas to replicate the very same phosphate-buffered saline solution the patient was treated with. The rabbit corneas were first burned with 1 M NaOH, rinsed with 4.9% phosphate-buffered saline for 2 min, and were then moisturized with an artificial tear solution for 48 h. All corneas were fluorescein-stained for photo documentation, snap-frozen, lyophilizated, and the electrolyte content was analyzed by Energy-Dispersive X-ray spectroscopy (EDX). The EDX analysis revealed pathological phosphorous in corneal stroma after a single rinsing with phosphate-buffered saline. Ongoing application of artificial tears containing physiological 14.581 mmol Ca2+ /l led to macroscopically visible calcification, but only in areas of induced corneal erosion. Regardless of the rinsing protocol neither 2 or 15 min of eye rinsing with phosphate containing rinsing solutions, we have given proof that corneal calcification is a foreseeable effect of the phosphate-buffered saline rinsing of mechanically epithelial damaged and chemically burnt eyes. Thus, it is crucial to legally restrict the formulations of phosphate-buffered salines in the medical treatment of eye burns, corneal erosions or chemical splashes of the eye.

Purpose To report the results of the survey for the role of anti-VEGF in the management of retinopathy of prematurity (ROP) among the members of Indian ROP (iROP) society. Methods A questionnaire was designed in English using Google forms and its link was circulated to the members of the iROP society on their mobile numbers. The survey included questions pertaining to demographics, anti-VEGF agents, injection technique, post-injection follow-up, and documentation pertaining to their ROP practice. Anonymous responses were obtained and analyzed for individual questions. Results 226 members of the society were contacted and 157 responded (69.4%) to the survey. 137 (87.2%) respondents used anti-VEGF in the management of ROP. Aggressive posterior ROP (APROP) was the most common indication (78, 52.7%). The procedure was carried out in the main operation room (102, 70.3%) simultaneously for both the eyes (97; 68%) under topical anesthesia (134; 86.4%) by most of the respondents. One-hundred thirteen (77.9%) respondents used half of the adult dose, irrespective of the agent used; however, more than half of them preferred bevacizumab (85, 54%). 53 (36.3%) respondents followed up infants as per disease severity rather than a fixed schedule while only 33 (23%) performed photo documentation. 151 (96.2%) respondents felt the need for guidelines regarding the usage of anti-VEGF in ROP. Conclusion There is an increase in the trend towards the use of anti-VEGF in the management of severe ROP, particularly APROP. However, there are considerable variations among the ROP practitioners regarding the agent, dosage, follow-up schedule, and documentation, suggesting the need for uniform guidelines.

ObjectiveIntraocular lens (IOL) opacification may cause severe visual impairment. The pathogenesis remains unclear. The aim of this study was to analyse opacification patterns in different IOLs. Therefore, this multicentre, retrospective, observational study was conducted at Ludwig-Maximilians-University, Munich, Germany and University-Hospital Basel, Switzerland.Methods and analysisIn this study, 75 opacified IOLs were identified and classified after extraction. Macroscopical photo documentation, light and electron microscopic analysis were done.Results68 acrylic-hydrophilic single-piece-IOLs, 1 acrylic-hydrophilic 3-piece-IOL, 6 acrylic-hydrophobic 3-piece-IOLs were extracted. The dataset comprised IOLs known for opacification and IOLs not having been reported yet. 67 IOLs showed a fine-granular and 8 IOLs a crust-like opacification pattern. According to literature, 62 of the fine-granular opacified IOLs were graded into type 1 (processing/packaging-induced primary opacification) and 13 into type 2 (secondary opacification of unknown aetiology). The anterior surface of the IOLs was affected in all 75 IOLs, the posterior surface only in 23 cases. Of all 67 fine-granular IOLs, 43 had a central defect and 21 had a zone without opacification (clear islet).ConclusionIn our series, the morphology of IOL opacification did not follow the existing pathogenetic classification that strictly discriminates between primary and secondary causes. Fine-granular IOL opacification occurs with similar patterns in both type 1 and type 2 IOL opacification, while a crust-like pattern was only detected in type 2 IOL opacifications. Consequently, susceptibility of an IOL to opacification is caused by a multifactorial combination of material and processing properties as well as individual (pathological) conditions of the patient., publishedVersion

The chapter presents the necessity of and reasoning behind large-scale fire tests. It describes in detail the construction of a model two-story wood-based building which was subjected to fire in such a test. The chapter contains basic technical documentation of the wooden building, partial photo documentation from the construction, and photos from the course of the fire. The temperature was graphically recorded in each location in the building and in individual elements of its construction.

The study deals with the economic function of Muslim organizations in Germany and Austria. Sales and services are a research topic that is associated not only with organized Muslims. Other included participants are individualized and cultural Muslims. The economic activities of these organizations also have an impact on customers from non-Muslim societies. The study is based on a critical reflection of expert discussion, non-participant observations conducted during field research, analysis of photo documentation obtained by the researcher, descriptions of the visited locations, as well as the self-presentation of communities. The economic function is interrelated with other activities of the associations. Primarily, it has an impact on the organization´s educational, leisure-oriented, social, and cultural activities. Financial resources gained from renting or operating shops or services are vital to secure the operation of an association and its development. Based on the analysis of the data obtained during field research, it is possible to design a basic typology of shops and establishments. The first sphere contains groceries, greengroceries, and butcher´s shops. Tea rooms differ from restaurants or cafés in their multifunctionality. The second sphere consists of travel agencies, bookshops, household goods, and textile shops. The third type contains services related to hair care. Last but not least, the paper deals with funeral services focused on Muslim clients. Among the key variables bearing an impact on the functioning of businesses are conveniently chosen business premises and adequately established working hours. Changes in the economic activities of Muslim associations in Germany and Austria show not only the transformation of the community itself but also its immediate surroundings.

A XX. század második felében megszületett nagy kiterjedésű víztározó, a Tisza-tó ma már kiemelt turisztikai fejlesztési térség része. Vonzerejét a természetközeli táj sokszínűsége jelenti, amely a horgászok számára is változatos lehetőségeket biztosít. Az egész évben horgászható tónál folyamatos fejlesztés alatt áll a horgászturisztikai infrastruktúra és a halállomány gyarapítása. A horgászidő legteljesebb kihasználása, a horgászhelyekhez való ragaszkodás, etetőhelyek védelme, valamint a spórolás a horgászokat a vízparton történő éjszakázásra készteti, azonban a területen a vadkempingezés jogszabályba ütköző. A Debreceni Egyetem Tájvédelmi és Környezetföldrajzi Tanszékén 2001-ben egy diplomamunka keretében elkészült egy vadkempingfelmérés, azonban a terület kezelői szerint a szemeteléssel együtt ez jelenleg is az egyik legnagyobb probléma a tározó partján. Ezért célul tűztük ki, hogy szakdolgozati kutatás keretében a felmérést megismételjük, illetve kibővítjük. 2019 nyarán elvégeztük a teljes Tisza-tó feltérképezését, vízen és szárazföldön. Ennek során minden helyszínen adatlap kitöltésére és fotódokumentációra került sor. Az illegális sátrazással érintett terület nagyságát, az ott található felépítmények, tűzrakóhelyek, mellékhelységek jellegét, valamint a hulladék mennyiségét egyaránt rögzítettük az adatbázisban, a pontok földrajzi koordinátáival együtt. Az adatok feldolgozásával egyrészt feltárjuk a jelenlegi helyzetet, lehetővé tesszük az egyes öblözetek összehasonlítását, és elemezzük a vadkempingezéssel érintett pontok legális infrastruktúrához való viszonyát. Másrészt a korábban készült felmérés térképeivel összevetve az elmúlt mintegy 20 év változásai is kimutathatóak lesznek. Jelen publikációban ennek a kutatásnak néhány eredményéről számolunk be. Az eredmények alapján elmondható, hogy összességében csökkent az illegális kempingezés és szemetelés. Azonban a megfelelő viselkedést elősegítő infrastruktuális fejlesztések és menedzsmentintézkedések ellenére a vártnál jóval kisebb mértékben.

The objective of this case report is to relate a malformation in a newborn male girolando breed bovine calf. The bovine presented craniofacial duplication and was sent to the Animal Diagnosis Center (CDA) at the Federal University of Rondônia (UNIR). The descriptive study of the main anatomical changes observed during the desiccation of the facial muscles and removal of the brain was performed. The anatomical parts were exposed on a board for photo documentation and description of the malformations. The diagnosis of incomplete diprosopia was made by observing the congenital lesions on the face and brain characterized through the craniofacial junction without total head separation; the animal presented triophthalmia, duplication of nasal and oral structures with lateral deviance of the right jaw side. The animal’s cerebellum was found in the opposite position and was united with the two brains through the cerebral peduncles in a caudal cranial orientation. In this case report, it was not possible to determine the malformation etiology, however, it emphasizes the importance of diprosopia in bovine and it suggests the need of further studies about the mechanism that produce cranial alterations. Este estudio tuvo como objetivo reportar un caso de malformación en un recién nacido, macho, gyrolando bovino que fue enviado al Centro de Diagnóstico Animal de la Universidad Federal de Rondônia con duplicación craneofacial. Luego, se realizó un estudio escriptivo de los principales cambios anatómicos observados durante la desecación de los músculos cara y la extirpación del cerebro. Las piezas anatómicas se exhibieron en un tablero para documentación fotográfica y descripción de las malformaciones. El diagnóstico de diprosopía incompleta e hizo observando la unión craneofacial sin separación total de la cabeza, con triophthalmos, duplicación de las estructuras nasal y oral con desviación lateral de la mandíbula en el lado derecho. El cerebelo estaba en una posición opuesta a la normal y unía los dos cerebros a través de los pedúnculos cerebrales en dirección caudal craneal. No fue posible determinar la etiología de la malformación, sin embargo, enfatizamos la importancia de la diprosopia en la especie bovina y la necesidad de investigaciones más detalhadas sobre los posibles mecanismos que conducen a cambios craneales. Este trabalho teve por objetivo relatar um caso de malformação em um bovino recém-nascido, macho, da raça girolando, encaminhado ao Centro de Diagnóstico Animal (CDA) da Universidade Federal de Rondônia (UNIR) com duplicação craniofacial. Em seguida, realizou-se um estudo descritivo das principais alterações anatômicas observadas durante a dessecação dos músculos da face e remoção do encéfalo. As peças anatômicas foram expostas numa prancha para foto documentação e descrição das malformações. O diagnóstico da diprosopia incompleta foi realizado pela observação das lesões congênitas da face e encéfalo, caracterizados pela junção craniofacial sem separação total da cabeça, apresentando trioftalmia, duplicação das estruturas nasal e bucal com desvio lateral da mandíbula do lado direito. O cerebelo encontrava-se em posição oposta ao normal e se unia aos dois cérebros através dos pedúnculos cerebrais no sentido caudal cranial. Não foi possível determinar a etiologia da malformação, no entanto, ressaltamos a importância da diprosopia na espécie bovina e a necessidade de investigações mais detalhadas sobre os possíveis mecanismos que levam a alterações cranianas.

While calls for cross-sectoral collaboration have become a recurrent motif in sustainability-oriented policymaking and research, the practical realization of such processes presents significant challenges. The hope for &ldquo, collaborative advantage&rdquo, often gets traded for the experience of &ldquo, collaborative impasse&rdquo, namely those moments in which collaboration gets stuck. To better understand the reasons underlying such impasses, the study focuses on the impact of facilitation artefacts&mdash, objects designed and used in collaborative practices. The study proposes an analytical heuristic of collaborative practices to investigate the data collected in an explorative study, tracing artefacts across three different communicative modes of deliberation. Detailed analysis of the case, grounded in audio&ndash, visual material, semi-structured interviews, photo documentation, and participatory observation, shows that such artefacts substantially influence the structure of the emerging interaction order in a given setting, and that unscripted and unsituated artefacts might contribute to reinforcing those communicative patterns that collaboration aims to contrast. The study identifies three relevant practices in facilitation work, in order to steer emerging interaction orders away from exclusionary dynamics: scripting, situating, and supervising. Although emerging from the micro-analysis of artefacts, these practices might apply to other spheres of collaboration and serve as orientation for successful collaborative processes.

Esophagogastroduodenoscopy (EGD) is generally a safe procedure, but adverse events often occur. This highlights the necessity of the quality control of EGD. Complete visualization and photo documentation of upper gastrointestinal (UGI) tracts are important measures in quality control of EGD. To evaluate these measures in large scale, we developed an AI-driven quality control system for EGD through convolutional neural networks (CNNs) using archived endoscopic images. We retrospectively collected and labeled images from 250 EGD procedures, a total of 2599 images from eight locations of the UGI tract, using the European Society of Gastrointestinal Endoscopy (ESGE) photo documentation methods. The label confirmed by five experts was considered the gold standard. We developed a CNN model for multi-class classification of EGD images to one of the eight locations and binary classification of each EGD procedure based on its completeness. Our CNN model successfully classified the EGD images into one of the eight regions of UGI tracts with 97.58% accuracy, 97.42% sensitivity, 99.66% specificity, 97.50% positive predictive value (PPV), and 99.66% negative predictive value (NPV). Our model classified the completeness of EGD with 89.20% accuracy, 89.20% sensitivity, 100.00% specificity, 100.00% PPV, and 64.94% NPV. We analyzed the credibility of our model using a probability heatmap. We constructed a CNN model that could be used in the quality control of photo documentation in EGD. Our model needs further validation with a large dataset, and we expect our model to help both endoscopists and patients by improving the quality of EGD procedures.

In this issue of the SAJS two perspectives are opined highlighting the medicolegal and tangible and intangible consequences of bile duct injury (BDI).1,2 We learn from both that, for patient and surgeon alike, a BDI is a traumatic experience that often results in significant personal, financial and medicolegal burdens. No surgeon performs a laparoscopic cholecystectomy (LC) with the intention of injuring the bile duct, but the reality is that it does happen and even though the incidence may have returned to open cholecystectomy rates, many would agree the number remains too high. With all the ramifications of laparoscopic BDI the most important question to ask ourselves is how can we prevent it? This editorial focuses on injury prevention through implementation of an operative team checklist that mandates photo documentation of the critical view of safety (CVS), assists in inculcating a culture of safety and aids in assessing competency in surgical trainees.

Objectives To examine whether early secondary repair of labial tears, 1st and 2nd degree perineal lacerations and episiotomies provided an anatomically acceptable result. Study design A retrospective analysis of 126 women undergoing an early secondary repair of birth lacerations not involving the sphincter complex within 21 days postpartum. Patients were included from 1 January 2014 to 11 August 2017 at Aarhus University Hospital, Denmark. Photo documentation of the wound was available just before the early secondary repair and at the follow-up visit after the repair. Photos were evaluated by two trained Urogynaecological Consultants. Main outcome measures Whether the anatomic result of the early secondary repair was acceptable based on photo documentation. Results Early secondary repair was performed by a specialised team of midwives in 94.4% and by doctors in 5.6% of the cases. In all, 72.2% were 2nd degree perineal lacerations. The most common indications for early secondary repair were wound dehiscence (55.3%) and suboptimal primary repair (34.1%). At the follow-up clinical examination seven days after the early secondary repair, the result was considered anatomically acceptable in 67.5% of the cases, not optimal in 22.2% and not possible to evaluate in 10.3% of the cases. In 7.9% of the cases, wound infection was suspected after the early secondary repair. Conclusions Based on photo documentation, early secondary repair of birth lacerations not involving the sphincter complex provides an anatomically acceptable result in the majority of cases without risk of serious complications.

Background: Total mesorectal excision has been gold standard since 1978. But standardization of surgery with quality assurance of total mesorectal excision specimen has been a challenging issue in developing countries. However, quality of macroscopic total mesorectal excision can be graded immediately by operating surgeon before specimen has been fixed in formalin and photographic documentation of gross specimen by surgeons is possible and practical.Objective: To grade macroscopic total mesorectal excision specimen by surgeon and document it photographically and compare it with reporting received from pathologist. Methods: A prospective observational study conducted from Jan 2014 to Jan 2016 at Department of Surgery, Kathmandu Medical College Teaching Hospital, Kathmandu, Nepal. All consecutive patients with rectal cancer (upper/middle and lower) without distant metastasis were included. Immediate after surgery, macroscopic specimen of TME were graded by operating surgeon and photo-documentation with one anterior, one posterior and two right and left lateral views of total mesorectal excision photos were taken and documented with printed form along with operative notes.Results: There were 40 patients with rectal cancer who underwent surgery during this period. Among those patients, the median age was 25 years of which 30% were females. Twenty-four patients underwent low anterior resection whereas thirteen had ultralow anterior resection and three had abdominal perineal resection. All patients had photo documentation. Complete mesorectal excision was seen in 36 patients and four patients had near complete total mesorectal excision when graded by surgeons. However, pathologist reported six (16.6%) patients having near complete mesorectum among those which had been graded as complete by surgeons.Conclusion: Grading of macroscopic total mesorectal excision specimen by surgeon is feasible and with use of photographic documentation, it can help to assess the quality of surgeons work and can be a good tool for feedback for surgeons to improve.

In medicine narcotic analgesics have long been used for therapeutic purposes, but their influence on the organs of the immune system is insufficiently studied. Aim of the work was the investigation of submicroscopic changes in the structural components of the thymus of white male rats in the dynamics of six weeks exposure of the nalbuphine to the body and one week after its abolition. Materials and methods. The study was conducted on 52 white male rats of reproductive age with an initial body weight of 140–150 g. The drug "Nalbuphine" was injected intramuscularly 1 time per day at 10–11 o’clock during 42 days, increasing the dose every 7 days. Experimental animals are divided into 8 groups: the first group – intact animals; opioid nalbuphine was daily injected intramuscularly at a dose of 8 mg/kg in the second group within 1 week; in the third group twithin 2 weeks nalbuphine dose increased to 15 mg/kg; in the fourth group within 3 weeks nalbuphine dose increased to 20 mg/kg; in the fifth group within 4 weeks nalbuphine dose increased to 25 mg/kg; in the sixth group within 5 weeks nalbuphine dose increased to 30 mg/kg; in the seventh group within 6 weeks nalbuphine dose increased to 35 mg/kg; in the eighth group material was taken one week after discontinuation of therapy. The material was collected in accordance with generally accepted rules. The slices were made on UMTP–6M ultramicrotome using diamond knife (DIATOM) and double-contrasted according to Reynolds and with uranyl acetate. The thymus sections were investigated using an electronic TEM–100 transmissive microscope. The photo documentation of studied material was carried out using SONY–H9 digital camera. Results. After one week of experiment, the intercellular space is expanded. Two weeks later, the contours of thymocyte nuclei are uneven, blurred. Three to four weeks there are destructive degenerative changes of thymocytes and epithelial reticular cells. Five to six weeks later, part of thymocytes and epithelial reticular cells have picnotic osmiofilic nuclei, an increase in the number of destructively altered thymocytes, epithelial reticular cells and macrophages with picnotial nuclei and in the state of apoptosis. One week after the discontinuation of nalbuphine, there are numerous destructively altered thymocytes and epithelial reticular cells and cells in the state of apoptosis, the nuclear membrane and plasmalemma have been damaged in some places. Conclusions. With a short-term effect of nalbuphine on the body for 2 weeks, there are no significant structural changes in the thymus. Under the action of nalbuphine for 3-4 weeks there are destructive-degenerative changes of the structural components of the thymus. With prolonged action of nalbuphine within 5-6 weeks, deep destructive degenerative changes occur, which are not restored even a week after discontinuation of the drug.

BACKGROUND Dermatologic surgeons have performed botulinum toxin type A injection to treat muscular calves, with different dosages and injection sites suggested. OBJECTIVE We investigated the use of individualized botulinum toxin type A injection protocols to treat hypertrophic calves in Asian women. MATERIALS AND METHODS A total of 294 calves were examined and their bulging areas divided into 4 units (Units 1, 2, 3, 4). The rare bulging area unit 5 was only seen in 1 case. Thirty-five cases were treated using botulinum toxin type A between September 2011 and May 2016, with the treatment protocol chosen according to the assessed bulging units. Standard photo documentation was performed at each clinical visit. RESULTS The average injection dose was 187 ± 10 U per patient. The average maximum calf circumference was significantly reduced 3 months postinjection, with that of the right leg reduced from 36.48 ± 0.57 to 34.87 ± 0.44 cm, and that of the left leg from 36.26 ± 0.61 to 34.71 ± 0.53 cm (both p < .01). The overall patient satisfaction rate was 73.08%. CONCLUSION A botulinum toxin type A injection protocol tailored to the shape of the hypertrophic calf muscle can effectively improve the contour of the lower leg.

The work analyses the historical roof of Derneburg Castle, in the municipality of Holle, Hildesheim’s district, Lower Saxony, Germany. The roof is assembled according to Laves Balken’s system (Laves beam’s system), developed by the architect Georg Ludwig Friedrich Laves (1788–1864). The system has the peculiarity to consist of beams that are split along the half of the cross section, and maintained diverged by wooden wedges, distributed along the length of the beam. The system increases the height of the beam, and elevates the bending capacity of it (Weber, 1964). The work has been developed in the frame of an interdisciplinary project in the fields of architecture, engineering and photogrammetry. Main aim of the project is the developing of a structural model to understand the load-carrying capacity of Laves Balken’s system from the laser-scanning model. For this reason, extensive surveys and photo documentation were collected on three areas of the roof construction, characterized by three peculiar usage of Laves Balken’s system. The work presents the survey of the pagoda-roof that covers the tower of the castle, and problems that can be encountered during the survey of very complex timber constructions.

The aim of photography in digestive endoscopy is to obtain adequate, relevant, and quality endoscopy pictures in order to record diagnosis and therapeutic findings. Photo documentation and video recording are mandatory for the following purposes: to provide a complete case record; as a quality measure of complete examination; to facilitate communication; as a useful teaching resource; and in some case to protect physician in medicolegal issue. Endoscopy is a procedure that allows the inspection of internal hollow organs. Gastrointestinal endoscopy is the examination of GI tract witch is performed for diagnosis and therapeutic purpose. In this chapter we describe the technical evolution of both digestive endoscopy and medical photography during the last 70 years, coming from fiberscopes to high-resolution endoscopes and from argentic photography to digital pictures. Nowadays photography is an integral part of digestive endoscopy in clinical practice.

BACKGROUND Temporary fixation with an external fixator is used for numerous indications in orthopedic trauma surgery. It is unclear whether primary wound healing or secondary open-wound healing after removal of the external fixator should be advocated for the pin site. This study compares primary wound closure with secondary wound healing for the pin site. The primary aim is to compare pin-site infection rates. The secondary aim is to compare time to wound healing and esthetic outcome. The hypothesis was that primary wound closure does not lead to more infections than secondary wound healing. METHODS AND DESIGN This is a prospective, randomized controlled, blinded, monocenter study based on a non-inferiority design. To obtain an equal patient population and groups, all pin-entry sites of the patients are treated alternately at the time of removal of the external fixator with primary wound closure and secondary wound healing. Patients are randomized according to whether the proximal pin-entry site is treated with wound closure or by secondary open-wound healing, from which the further sequence develops. The pre- and postoperative protocol is standardized for all pin-entry sites. A photo documentation of the pin-entry sites takes place 2 and 52 weeks postoperatively during the routine clinical follow-up visits. Further controls take place at 6, 12 and 26 weeks after pin removal. The primary outcome was to demonstrate the non-inferiority of primary wound closure compared to secondary wound healing in terms of postoperative wound infections according to the Center of Disease Control and Prevention (CDC) definitions. The secondary outcomes are time to complete wound healing (days) and esthetical outcome (subjective preference of patients and Vancouver Scar Scale score). DISCUSSION This study aims to answer how to deal with the pin site after removal of the external fixator. To date, no routine and generally accepted protocol exists for the management of pin sites after removal of the external fixator. This prospective, randomized controlled, blinded monocenter trial should determine whether primary wound closure or secondary wound healing should be advocated after removal of the external fixator. TRIAL REGISTRATION ClinicalTrials.gov, ID: NCT03842956. Registered retrospectively on 13 February 2019., + ID der Publikation: unilu_51615 + Sprache: Englisch + Letzte Aktualisierung: 2021-04-19 12:10:15

Palu City is the city that suffered the most damage and many casualties, effect from event Palu-Donggala earthquake on September 28, 2018. This earthquake triggered a tsunami, liquifaction and landslides which caused difficulties in determining a closest safe location for the temporary evacuation site in location affected disaster. The aftershocks that occurred after the main earthquake caused unrest for refugees and village government officials, because it was feared that the location to be used as a temporary evacuation site would run into the impact of an earthquake similar to other severe locations. To determine a safe location around the impact area destructive earthquake, information about the map of the minimum isoseismal distribution is very important. This study aims to map Minimum Isoseismal Distribution as the place that has the smallest disaster risk in areas affected by the earthquake, tsunami, liquefaction and landslides. The research methodology that be done are plotting and interpolate data from macroseismic surveys then were verified using satellite citra data and photo documentation of survey. The results showed that a minimum isoseismal distribution was found in 8 areas, located in the village: Kabonena, Lere, Kamonji, Siranindi, between Boyaoge and Nunu, Tawanjuka, Palupi and Tinggede.

In recent years, endoscopic image documentation has gained an important role in gastrointestinal (GI) endoscopic reporting and has become an integral aspect of quality control. Since 2001, several important guidelines and statements, some from major endoscopic societies, have been published to standardize endoscopic image documentation. Therefore, and according to the most recent recommendations of the European Society of Gastrointestinal Endoscopy, we propose a set of images to be routinely captured in upper and lower GI endoscopy. Systematic acquisition of 10 and 9 photographs of specific landmarks is recommended in upper-GI endoscopy and colonoscopy, respectively. In addition to photo documentation of the normal endoscopic features, imaging of pathologic findings is also advocated. Considering accurate and adequate image documentation as an essential part of endoscopic reporting, it should be systematically performed in upper and lower GI endoscopy. Nos últimos anos, a documentação por imagem tem adquirido um papel preponderante na elaboração do relatório em endoscopia digestiva, tornando-se num importante parâmetro no controlo de qualidade. Desde 2001, várias recomendações e vários comunicados, alguns de sociedades endoscópicas de relevo, têm sido publicados com o intuito de estandardizar a documentação por imagem em endoscopia. Por conseguinte, e de acordo com as mais recentes recomendações da European Society of Gastrointestinal Endoscopy, propomos um conjunto de imagens a serem capturadas por rotina em endoscopia digestiva alta e baixa. A aquisição sistemática de dez e de nove fotografias de locais de referência específicos é sugerida na endoscopia digestiva alta e na colonoscopia, respectivamente. Além da fotodocumentação de aspectos endoscópicos normais, é recomendada a obtenção de imagens de achados patológicos. Sendo considerada uma parte essencial do relatório em endoscopia, a adequada e rigorosa documentação por imagem, esta deve ser realizada de forma sistemática em endoscopia digestiva alta e baixa.

The aim of the research was to establish the influence of IPL treatment on skin ageing in the eye area.This study included 24 women, aged 38-63 years (mean age was 48.04) with Fitzpatrick skin type II and III who underwent five successive treatment sessions with an IPL in two-week intervals. The Cutometer (Courage + Khazaka electronic) reference test was an objective method for the assessment of the biomechanical properties of the skin. The measurements were made in three places around the eye. The photo documentation was used to compare state of skin before and after three months of treatments. Additionally, patients filled in a questionnaire, which contained questions concerning self-assessment of the procedure effects.Cutometric analysis showed significant improvement of skin elasticity (statistical significance level is mostly0.0001). The comparison of clinical changes in the therapy, based on photo documentation, showed a 25% improvement.This treatment was used in order to improve skin elasticity and decrease the amount and depth of wrinkles. It is a non-invasive treatment, with low risk of complications.

The aim of the study was to identify problematic situations in using zebra crossings. They were identified from photo documentations comprising film sequences and the perspectives of people with dementia. The aim was also to identify how they would understand, interpret and act in these problematic situations based on their previous experiences and linked to the film sequences. A qualitative grounded theory approach was used. Film sequences from five zebra crossings were analysed. The same film sequences were used as triggers in two focus group interviews with persons with dementia. Individual interviews with three informants were also performed. The core category, the hazard of meeting unfolding problematic traffic situations when only one layer at a time can be kept in focus, showed how a problematic situation as a whole consisted of different layers of problematic situations. The first category, adding layers of problematic traffic situations to each other, was characterized by the informants’ creation of a problematic situation as a whole. The different layers were described in the subcategories of layout of streets and zebra crossings, weather conditions, vehicles and crowding of pedestrians. The second category, actions used to meet different layers of problematic traffic situations, was characterized by avoiding problematic situations, using traffic lights as reminders and security precautions, following the flow at the zebra crossing and being cautious pedestrians. In conclusion, as community-dwelling people with dementia commonly are pedestrians, it is important that health care professionals and caregivers take their experiences and management of problematic traffic situations into account when providing support.

Mega-events are popular catalysts for launching area-based urban renewal. However, their built legacies are problematic due to a lack of planning. Besides a much-needed shift in mindset, legacy planning methodology holds the key. This chronic issue is gaining renewed attention with the recent rise of new-generation hosts such as China where massive event-led construction was fast-tracked in a top-down fashion. What remains less understood is the impact and implications of such a forceful paradigm on legacy planning and urban renewal. This paper aims to address this gap with an in-depth case study of Expo 2010 Shanghai China. The central theme is to investigate how this paradigm has been adopted to a previous dockland selected as the Expo 2010 site and a catalyst for city-branding oriented urban renewal. Data was sourced from 2004 to 2015 from personal observations, strategic policies, planning documents, photo documentation, and meetings and interviews. This study identifies both the merits and drawbacks of this controversial paradigm to caution about its mixed impact on mega-event built legacies. It is concluded that future event cities should shift their mindset from super-developers to guardians of built legacies, and strike a balance between the top-down and bottom-up thinking. A new categorization centering on the legacy planning process is proposed, with guidelines to improve legacy planning methodology for future event cities.

The research aims to formulate the government's assets disposal decision making and to determine its estimated value. The research type is descriptive analysis using primary data collected from direct observation in the field and secondary data sourced from Satuan Kerja Pelaksanaan Jalan Nasional Metropolitan I Surabaya. This research uses flowcharts, photo documentation, and asset valuation calculations using Depreciate Replacement Cost (DRC) method. The research object are five government vehicles. The results showed that from those five vehicles, three motorbikes and two cars that have various levels of damage, three motorbikes can be disposed and two cars can be repaired. The results of this study are expected to be used for planning the assets disposal and proposing the estimated value of the assets.&nbsp, Penelitian ini bertujuan untuk menyusun dasar pemikiran dalam pengambilan keputusan penghapusan aset BMN (Barang Milik Negara) dan menentukan besaran nilai taksir aset. Jenis penelitian ini adalah jenis penelitian yang bersifat deskriptif analitis dengan menggunakan data primer berupa observasi langsung ke lapangan dan data sekunder yang bersumber dari Satuan Kerja Pelaksanaan Jalan Nasional Metropolitan I Surabaya. Alat analisa data dengan menggunakan flow chart, dokumentasi foto serta perhitungan nilai taksir aset dengan pendekatan biaya yaitu metode Depreciate Replacement Cost (DRC). Objek penelitian ini adalah lima KDO (Kendaraan Dinas Operasional). Hasil penelitian menunjukkan bahwa dari kelima aset BMN berupa KDO tersebut, dengan rincian tiga sepeda motor dan dua mobil dengan tingkat kerusakan berbeda – beda maka didapatkan hasil tiga sepeda motor dapat dilakukan penghapusan dan dua mobil dilakukan perbaikan. Adapun hasil penelitian ini diharapkan dapat digunakan dalam pertimbangan perencanaan penghapusan aset serta usulan nilai taksir asetnya.

Water, sanitation and hygiene (WASH) is important to improve and maintain the quality of health care services. Improving and managing WASH services require strong and consistent monitoring mechanisms to measure progress and direct efforts where needs are greatest. Although several tools are available to assess WASH in health care facilities (HCFs), there is always a dilemma among the program managers to select an appropriate tool for the assessment of WASH. Thus, it was aimed to perform a descriptive review of all available WASH assessment tools and assist in reaching a consensus for an optimal tool to assess WASH in HCFs. For this descriptive review, PubMed, ScopeMed and Google Scholar were used to search all available tools for the assessment of WASH. All the tools available online since 1991 till July 2018 were included in the review. Globally, nine different WASH assessment tools were retrieved. The majority of them have their self-limitations on the basis of 11 selected indicators and were examined in all the retrieved tools. There are variability and overlapping components within the specific tools. Very few survey instruments including human resource (HR), supply, budget, patient/staff satisfaction and documentation for appropriateness of WASH were found to be neglected. The majority of instruments were based on the subjective assessment of WASH validating with microbiological surveillance and photo documentation. The descriptive review suggests that various tools are available for the assessment of WASH but none of them seem to be complete with all indicators and to have consensus for the elements. Therefore, there is a need to develop a robust and comprehensive tool for the assessment of WASH in HCFs.

Aims of the study Tongue lacerations are common in children, occurring mostly from falls or sports injuries. Optimal treatment of tongue lacerations is a challenge for paediatricians due to contradictory recommendations and a lack of current guidelines. It remains unclear which tongue lacerations should be sutured and which would benefit from spontaneous healing, which is a promising alternative. In recent years, the treatment of choice in our paediatric emergency department (ED) has shifted from generally suturing the wounds to more frequently advising secondary wound healing. The aim of this study was to analyse tongue lacerations treated at our ED in order to develop guidance for the optimal management of tongue lacerations in children. Methods This retrospective study was conducted to assess tongue lacerations at the ED of a University Children's Hospital Zurich from January 2010 to August 2015. All families were contacted for informed consent and photo documentation of the healed tongue. Clinical records of all the patients included were reviewed and different variables were defined and analysed. Results A total of 73 children with tongue lacerations were included (75.3% boys, mean age ± standard deviation 4.0 ± 2.6 years). The mean size of the lacerations was 12.4 ± 8.3 mm, with affected tongue borders in 51 cases (69.9%) and a through-and-through laceration in 23 patients (31.5%). A primary wound closure was performed in 12 children (16.4%). These wounds were significantly larger than those of the secondary wound healing group (21 ± 10 mm compared to 10.8 ± 6.8 mm), presented gaping wound edges with the tongue at rest more frequently (91.7% compared to 32.8%), and showed through-and-through lacerations more often (91.7% compared to 19.7%). The group with wound suturing needed longer to recover (median 13 days compared to 6.2 days) and had a higher rate of complications (25 vs 3.3%). Conclusions Suturing is not required in gaping tongue lacerations less than 2 cm long that do not involve the tip of the tongue. The Zurich Tongue Scheme was developed as a guide for clinicians when deciding which tongue lacerations need suturing.

The ability to accurately determine injury dimensions is an essential property of forensic documentation. The current standard for injury documentation is photography using a scale to approximate the injury dimensions in the image. The technical qualities of the photograph, such as orthogonality, depth of the field and sharpness of the desired area, are vital to obtaining a correct measurement. Adequate training of the forensic staff can reduce technical errors; nonetheless, there will always be some loss of information when visualizing an injury as a three-dimensional (3D) object on a two-dimensional (2D) photograph. The shortcomings of 2D photographs can be resolved by using 3D photogrammetry, which allows 3D documentation of persons and their injuries. A series of photographs has to be acquired and processed in photogrammetric software to create a photorealistic 3D model. In a prior study, a mannequin equipped with wound tattoos of known dimensions was documented with 3D photogrammetry using a multi-camera device. On the created 3D model, the dimensions of the injuries were then measured and compared to the dimensions approximated from standard forensic photographs. The results showed that the photogrammetric measurements in 3D are more accurate than the approximations performed with standard forensic photographs. In this subsequent study, the created 3D model was visualized and surveyed in virtual reality (VR), and the results were compared to the previous study. Our goal was to establish how accurately injuries can be measured in VR compared to the standard forensic photo documentation and photogrammetric method that is used on computer screens. We found that the measurements in VR are more accurate than the approximations from forensic photo documentation, but slightly less accurate than the photogrammetric measurements performed on a computer screen in dedicated software. In conclusion, photogrammetric software and virtual reality tools can both be used to make accurate size measurements of forensics-relevant injuries. Furthermore, 3D models can be visualized in varying ways allowing a much better understanding and review of injuries, even after the injury has healed.

Methodologies and procedures in processing gained data vary based on possibilities and needs of scientific projects. Technology moves ahead very fast. Application of different patents and remote control mechanisms has higher usage not only in military sector, but also in civil sector. These papers should help to get general overview in the choice of "small unmanned aircraft systems" (sUAS or commonly known as drones) for scientific purposes, for example remote sensing. Geomorphologic processes and the development of high mountain area are difficult for mapping and research with respect to accessibility of explored surface, slope of terrain, and mainly weather conditions that are rapidly changing. All high mountain areas in European countries are legislatively protected, and so various permissions and observation of strict procedures are needed, in order not to contaminate or not to have a negative influence on the environment. Nowadays several types of UAS and operating systems exist that could effectively help us in such protection, as well as in fully-fledged utilization when answering scientific questions.

BACKGROUND: Colonoscopy is one of the most powerful methods employed for early detection and prevention of colorectal cancer. Visualization of the cecum is significant as it indicates that a complete colonoscopy has been performed. Photo-documentation of the ileocecal valve has been utilized to document a complete colonoscopy. The effectiveness of this guideline as a screening tool used by endoscopists in the Saskatoon Health Region remains to be researched. AIMS: To determine the inter- and intra-rater reliability amongst endoscopists in regards to colonoscopy photodocumentation. METHODS: The endoscopic-photo at the moment when the endoscopist believes they have completed the colonoscopy (reached the ileocecal valve) was recorded. As well, endoscopists were instructed to get one photograph of the colon, not of the ileocecal valve but similar in appearance, for every 4 positive scopes. A total of 20 pictures were collected from 3 endoscopists and 10 pictures from 2 endoscopists. After the completion of all 80 colonoscopies, the photographs were compiled, randomized and presented to each of the 5 endoscopists. The endoscopists were required review all the 80 photographs, within a standardized time period, and grade whether the photo-documentation indicated that cecum had been reached or not. The data was recorded and a correlation coefficient was performed to analyze the intra-rater and inter-rater reliability. RESULTS: Overall agreement between stated image region that was taken and physician blinded review occurred in 365 of 400 reviews (91%). Among those images taken at the cecum/appendix, 297/320 reviews (93%) labeled these images as being from this region (sensitivity). Among those images not from the cecum/appendix, 68/80 reviews (85%) recognized these images as not begin from this region (specificity). As such 12/80 reviews (15%) of images taken prior to the cecum/appendix were mistakenly thought to be from the cecum/appendix (i.e. false positive). Overall positive and negative predictive values were 96% and 75% respectively. Overall agreement across multiple raters using Fleiss’s Kappa statistic = 0.69, suggesting substantial agreement beyond that occurring by chance. Of the 80 images assessed, 6 (8%) were not rated the same way when reassessed by the endoscopist who originally took the image. Three were falsely labeled as negative and three were falsely labeled as positive. CONCLUSIONS: Documenting colonoscopy with static images of the ileocecal valve is only partially successful as an objective measure if a total colonoscopy has been performed at the Saskatoon Health Region. Authors believe still photography of the ileocecal valve may not be convincing in all cases. A combination of photographs (involving the ileocecal valve and appendiceal orifice) or documentation of the terminal ileum could be more efficacious as an objective measure of a total colonoscopy. FUNDING AGENCIES: None

This article deals with the reasons for gear failure - Flank breakage on tooth of spur gears with helical and straight involute gears. Gear flank breakage can be observed on edge zone-hardened gears. The creation of flank and tooth breakage and FEM simulation of flank breakage on tooth are described in this article. In the article are also described and short photo documentation from real load tests on mechanically closed stand for testing of gearing with helical gears and different nitrided depth.

Background. Clinical forensic medicine is the practice of assessing the living condition of someone, either as victims of an assault or the alleged perpetrator of the offense. This publication shows the profile of clinical forensic medicine quality were reported on Visum et Repertum in Yogyakarta. Objective. The purpose of our study was to provide descriptive data on clinical forensic profile and Visum et Repertum quality in Yogyakarta 2011-2016. Method. Retrospective data were collected on all clinical forensic victims of five Regional Public Hospital in Yogyakarta, for asix-year period. Visum et Repertum quality was assessed by Herkutanto’s scoring method. Result. There were 2902 cases with male victims 50.7% and female 49.3%. Most cases were from Yogyakarta Regional Public Hospitals (72.6%). The most victims from18 to 30 years old (38.4%). The data from road traffic accidents (RTA), persecution, sexual violence, domestic violence, and poisoning cases were, 66.1%, 13.3%, 8.9%, 6.7%, and 5% respectively. The were no photo documentation in all hospitals. Blunt trauma was the highest number of trauma. While Almost hospitals have moderate quality in writing Visum et Repertum. Conclusion. Women victims in four Regional Public Hospitals (Sleman, Wonosari, Bantul, and Wates) were higher than men. The largest age group of the victims was a group of 18 to 30 years old. The most cases happened was road traffic accidents (RTA). For the type of trauma, blunt trauma was the highest proportion of trauma. All clinical forensic cases obtained were no photo documentation. Overall, Visum et Repertum scores for clinical forensic cases throughout Regional Public Hospitals in Yogyakarta province were in moderate category (range 50% - 75%).

To prove the concept that a dissolvable "on-command" tympanostomy tube placed into the tympanic membrane of a chinchilla can dissolve when a benign solution is applied and result in a well healed tympanic membrane without histologic evidence of injury.Prospective Randomized Single-Subject Controlled Trial.Prototype tympanostomy tubes were fabricated from poly(butyl methacrylate-co-(2-dimethylaminoethyl) methacrylate-co- methyl methacrylate) (PBM). "In vitro" dissolution studies were performed with applications of the benign chemical, hydrogen peroxide (HP). PBM tubes were placed into ten chinchilla tympanic membranes matched with standard plastic tubes placed into the contralateral side. All 20 tubes were exposed to HP for 21 days with serial endoscopic examinations. In vitro PBM tubes were weighed before and after interventions and compared to control tubes. In vivo photo documentation was used to show progression of dissolution and histologic slides were obtained to show the effect of the PBM on surrounding tissues.Compared to control tubes, all those exposed to hydrogen peroxide had a statistically significant reduction in weight (p 0.01). After placement into the tympanic membrane of chinchillas, all PBM tubes dissolved within 21 days of hydrogen peroxide treatment leaving behind histologically normal, intact tympanic membranes.Our PBM tubes dissolve "on-command" in a chinchilla model when exposed to treatment with a benign chemical. Dissolvable "on-command" tympanostomy tubes may reduce significant complications related to pediatric tympanostomy tube use.

The article is focused on renovation, rehabilitation and reinforcement of high ferroconcrete walls. It tries to point out the experience of experts in solving problems with high ferroconcrete walls. During a revitalization of buildings of a military accommodation facility in Brno with basement and connecting corridors of an average height of 25 m, degradation of concrete, locally missing reinforcement and poor-quality concrete mixtures, the strength class of which varied between C8/10–C10/12, were found in these corridors. Along the height of the pilasters, the structure also showed the signs of torsion and it was assessed the structure also needs to be strengthened/reinforced besides the rehabilitation. The reinforcement structure had to be built from the very foundation of the building, it is linked to the existing wall and has three cascade levels. For the first two parts, a construction pit has been created with a Berliner wall, and these parts reach below the modified terrain, are reinforced with concrete reinforcement according to the structural project, concreted with cast concrete, and the foundation is reinforced with deep-based construction. The second and the third parts of the cascade stretch from the modified terrain between the pilasters to the top and they are made with a two-stage shotcrete technique, the first one has inbuilt concrete reinforcement with welded wire mesh and the second one composite mesh anchored by helical reinforcement without static effect. In terms of the damage of the structure, carbon fibre wrapping technique or grouting of the existing ferroconcrete structure was also used in the affected areas. The article also includes photo documentation of the repairs and structural damage prior to them.

Introduction:In aesthetic medicine, the use of hardware technologies occupies an important place. Hardware action on skin includes microfocused ultrasound, radiowave, light and laser methods. The ultimate task of each method consists in improving the condition of skin and its rejuvenation. However, to enhance the clinical efficiency, combined actions have been suggested recently.Objective:To compare the effect of microfocused ultrasound as monotherapy and the combined application thereof with autologous blood cell factors.Methods:For assessing efficiency of the procedures undertaken, the data of ultrasonic scanning of skin were studied, photo documentation was performed, and adapted dermatological indices were used: the dermatological status index (DLQI) and WAM index (wellbeing, activity, mood).Results:According to the research results, ultrasonic skin scanning data were obtained which gave evidence about a more pronounced clinical effect in patients having received the combined application of microfocused ultrasound with autologous blood cell factors. The improvement of qualitative characteristics of skin in the form of a thicker dermal stratum and improved dermal coefficient was observed both in the patients having received monotherapy by microfocused ultrasound and in the group where patients underwent its combined application with autologous blood cell factors. However, the improvement of clinical effect was significantly higher in patients having received the combined application as compared to the microfocused ultrasound monotherapy group, which confirms the synergism of the hardware method and the use of factors of autologous blood cells (thrombocytes). Such manifestations as a significant increase of thickness of epidermis in 6 months in patients having received the microfocused ultrasound monotherapy gives an indirect evidence about the presence of compensated dehydration in reparative processes; this is a norm, but it curbs performance of other stimulations. Photo documentation and the analysis of dermatological indices also correlated with the data of US examination of skin. The pronounced clinical efficiency in the use of combined treatment confirms the synergism of the said two methods aimed at improving the quality of skin.Conclusion:The use of autologous blood cell factors significantly improves clinical results and allows employing other stimulation procedures in the integrated correction (laser technologies, radiofrequency methods) after microfocused ultrasound within the periods of up to 6 months after treatment.

The aim of the paper was to provide information about defects and causes of faults on the wooden facade of ThermoWood. The examined failure is the blackening of wooden elements on the entire area of the family house facade. The family house is now in a finished form and is therefore permanently used for housing people. Current damage does not jeopardize the stability of the object. A test sample of the blackened facade from the north-east side of the building at locations available and with a predominant blackening ratio was taken to determine the cause of the failure. The evaluation was based on general technical requirements for carrying out the work related to the implementation of the facade, technological details. Local examination of the facade revealed that the blackening occurs across the surface and shows signs of fungus. For this reason, a sample of the facade was taken from the north-eastern part and the opinion of the Czech Mycological Society was requested based on the photo documentation including the description of the impregnation used. At the end of the paper, we propose a comprehensive solution to the facade failure with the provision of the disposal and elimination of possible sources supporting the mold formation.

This brief discussion delves into current and future uses of digital imaging and photo documentation in the emergency department.

A failure investigation has been conducted on a piston rod end used in a hydraulic actuating cylinder of an aircraft landing gear. The failed piston rod end was found to be broken. An evaluation of the failed piston rod end was undertaken to assess its integrity that included a visual examination, photo documentation, chemical analysis, hardness measurement, tensile testing, and metallographic examination. The failure zones were examined with the help of a scanning electron microscope (SEM) equipped with EDX facility. A stress analysis is also carried out by the finite element technique for the determination of highly stressed regions on the piston rod end. The results indicated that the piston rod end failed by fatigue with cracks initiated at the surface close to the mechanically damaged region due to high stress concentrations. © 2013 Elsevier Ltd.

Objective:To compare the image quality provided by rigid laryngoscopes versus flexible distal-chip laryngoscopes when documenting the same laryngeal pathology.Methods:This paper reports a prospective single-blind study. Ten early stage glottic cancer cases were selected. Photographs of the pathologies were taken using both rigid and flexible distal-chip laryngoscopes (a total of 20 photographs). Nineteen clinicians were asked to review the laryngoscopic photographs; the clinicians were provided with a worksheet, which included questions regarding the clinical description, photograph quality and overall satisfaction with the images obtained. Clinicians' responses to the worksheet questions were then analysed.Results:The overall accuracy rate for lesion sidedness, anatomical sub-site involvement, anterior commissure involvement and tumour staging were 94.7 per cent, 46.6 per cent, 53.7 per cent and 47.1 per cent respectively. There were no statistically significant differences in terms of the accuracy rates, photograph quality or overall satisfaction with the photographs obtained by either modality.Conclusion:There were no statistically significant differences demonstrated in overall clinical accuracy or perceived image quality between the use of the rigid or flexible endoscopes when interpreting images of early glottic cancer.

Objective The endoscopic modified Lothrop procedure (EMLP) is an established approach for recalcitrant frontal sinus disease and anterior skull base exposure. However, in select cases, this technique may involve unnecessary resection of sinonasal structures. In this study, we propose a modification of the EMLP, termed the modified subtotal-Lothrop procedure (MSLP), to access the anterior skull base and complex frontal sinus disease for which access to the bilateral frontal sinus posterior table is required. Methods A cadaveric dissection with photo documentation was performed at an academic medical center on four cadaver heads using standard endoscopic techniques to demonstrate the MSLP and its feasibility. Results The endoscopic MSLP allowed ample access for instrumentation in each of the dissections using a 30- or 70-degree endoscope. Adequate bilateral access to the posterior table of the frontal sinus was gained in all cases without the need for dissection of the contralateral frontal sinus recess (FSR). Conclusion The MSLP appears to be a feasible technique for exposure of the anterior skull base and accessing complex frontal sinus pathology. This modification provides similar anterior skull base exposure and surgical maneuverability as the EMLP while limiting surgical dissection to one FSR, thereby preserving as much of the natural mucociliary drainage pathways as possible.

To present the experience of eye fundus photo documentation by using the plus 20 diopters spherical Volk lens and a smartphone with 4.2 Mpix camera and LED flash within the screening project of eye disorders in countries where the standard ophthalmology equipment is not available. Totally 241 patients underwent ophthalmology screening examination. The documentation of the eye fundus included patients with Burkitt lymphoma, Kala Azar, malnutrition with unknown etiology, tuberculosis, HIV positive patients, Usher syndrome and hypertension. This technique as an alternative way of screening will become a standard within examination of patients with eye disorders in outfield regions of developing countries.