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Several tricuspid annuloplasty (TA) techniques are used for concomitant repair of functional tricuspid regurgitation (TR). This study compared the midterm clinical and valvular outcome among 3 annuloplasty techniques.TA was performed in 307 patients (aged 75.9 ± 10.4 years) with a rigid ring (RA) in 184, a flexible band (FA) in 80, or a suture annuloplasty (SA) in 43. Study end points were survival and recurrence of TRgrade 2 at 5 years.TA was performed concomitantly to mitral valve surgery in 136 patients (44.3%), aortic valve surgery in 18 (5.9%), coronary artery bypass grafting in 13 (4.2%), or a combined procedure in 140 (45.6%). Most had TRgrade 2 (78.5%), without significant differences between the TA groups (P = .878). Within a median follow-up of 3.4 years (interquartile range, 2.2-5.0 years), the 5-year survival was 80.1% ± 3.4% for RA, 83.5% ± 4.7% for FA, and 85.1% ± 6.5% for SA (P = .471). Independent risk factors for late mortality were renal impairment (hazard ratio [HR], 2.83; 95% CI, 1.16-6.89; P = .022), diabetes (HR, 2.10; 95% CI, 1.07-4.11; P = .030), and severe right ventricular dysfunction by tricuspid annulus plane systolic excursion10 mm (HR, 11.52; 95% CI, 4.98-26.66; P.001). Pulmonary hypertension was nearly significant (HR, 1.92; 95% CI, 0.98-3.74; P = .057). The cumulative incidence of TR recurrence at 5 years was 15.9%, 19.4%, and 21.1% for RA, FA, and SA, respectively (P = .342). Severe pulmonary hypertension (HR, 2.64; 95% CI, 1.38-5.07; P = .003), preoperative TR grade (HR, 1.82; 95% CI, 1.01-3.27; P = .046), and residual TRgrade 2 at discharge (HR, 3.38; 95% CI, 1.64-6.96; P = .001) were predictive for later TR recurrence, regardless of the annuloplasty technique.This study demonstrates that advanced pathophysiological right circulatory impairment, such as severe pulmonary hypertension and right ventricular dysfunction, affects the midterm survival and TR recurrence rate more than the annuloplasty technique used for concomitant repair of functional TR.

Introduction This study compares recurrence rates and functional outcomes of patients who underwent anterior arthroscopic synovectomy versus combined anterior arthroscopic/posterior open synovectomy for diffuse pigmented villonodular synovitis (DPVNS). Methods 41 patients were grouped by initial procedure and tracked for disease recurrence and functional outcomes (Lysholm Scale). Results 24 patients (58.5%) had disease recurrence [16 (57.1%) arthroscopic, 8 (61.5%) combined, chi-square test p = 0.81]. The combined procedure mean Lysholm Score (75.4) exceeded the arthroscopic (68.1) (two-sample t-test p = 0.25). Conclusions There is no statistical evidence that the combined procedure harms functionality more than arthroscopic only or that recurrence rates differ between treatment methods.

Microwave (MW)-hot air (HA) combined drying was applied to white sweet cherries besides solely HA drying at 50, 60 and 70°C in the presence of citric acid, sucrose and freezing pretreatment in this study. Single power level of MW (90 W) was chosen, and drying behavior of all samples was modelled by using eleven thin layer equations. Two-term, rational and sigmoid models were the most suitable models for describing drying phenomena. Effective moisture diffusivities (Deff) ranged from 1.724×10-10 to 5.173×10-10 m2/s in HA drying and from 4.260×10-10 to 1.805×10-9 m2/s in MW-HA drying. Activation energies (Ea) were between 2.785 and 30.541 kJ/mol and 6.929 and 42.101 kJ/mol for HA and MW-HA drying techniques, respectively. Total color change (ΔE) levels of the outer surface of dried cherries were generally higher than the ones of inner surface. Freezing pretreatment had a comparably lower enhancing effect on the total phenolic content (TPC) of HA dried white sweet cherries compared to fresh sample. The TPC of freezing pretreated and HA dried at 50°C and HA dried at 70°C control samples were 1.481 ± 0.398 mg gallic acid equivalent (GAE)/g dry matter (DM) and 6.181 ± 0.012 mg GAE/g DM as the minimum and maximum, respectively. These values were determined as 4.183 ± 1.728 and 8.240 ± 0.502 mg GAE/g DM that were belonged to MW-HA dried at 50°C control and freezing pretreated MW-HA dried at 70°C samples in combined procedure, respectively.

Aim: to improve the results of fistula treatment, to evaluate the effectiveness of the combined use of LIFT and FiLaC techniques.Patients and methods: the study included 35 patients with transsphincter fistulas of cryptopglandular etiology involved more than 1/3 of the sphincter. All patients underwent surgery with laser energy (the laser conductor speed is 1 mm per second, the wavelength is 1470 nm, the radiation output is 13 W) after the LIFT procedure.Results: the primary healing rate was 28/35 (80,0%). The patients who failed the combined procedure (cases of prolonged healing more than 3 months) underwent a second procedure ReFiLaC, which led to the closure of fistula in 2 of 3 patients. A median follow-up period was 10,2 months. No incontinence to solid and liquid stools was detected.Conclusion: preliminary results of the study permits to assess the potential of the combined low-invasive approach for anal fistulas as positive.

Lung transplantation is an established treatment for a variety of end-stage lung diseases; however, chest wall deformities such as an asymmetric pectus excavatum are often considered a contraindication for lung transplantation. Consequently, the published experience of lung transplants and simultaneous chest wall reconstruction is limited to a few case reports. This article aims to provide a detailed description of surgical steps as well as technical challenges and pitfalls of lung transplantation with a simultaneous modified Ravitch procedure. Exemplary technical aspects will be discussed for a pediatric patient in whom such a combined procedure resulted in an excellent outcome.

Zusammenfassung Hintergrund Laut aktueller Studienlage weist die einzeitige Augmentationsmastopexie (AM) geringe Komplikationen auf und ist mit einer niedrigeren Reoperationsrate verbunden, als wenn ein zweizeitiges Vorgehen erfolgt. Bei der AM kann sich die Brustdimension im Vergleich zu jenen Fällen ohne zusätzliche Straffungsindikation deutlich unterscheiden. Dabei blieben diese Unterschiede nur unzureichend untersucht. In der vorliegenden Studie sollen diese zunächst quantifiziert und im Anschluss die Auswirkung der Brustdimension auf die Implantatauswahl eruiert werden. Zudem soll der Einfluss der Mastopexie auf das Outcome von Augmentationen mit runden nanotexturierten Silikonimplantaten evaluiert werden. Patienten und Methoden Über einen Zweijahreszeitraum wurden alle Patientinnen mit primären Brustaugmentationen mit nanotexturierten Implantaten in die Studie eingeschlossen. Soziodemografische Daten, präoperative Brustmaße, Spezifikationen der eingesetzten Implantate und Komplikationen der Augmentationsgruppe ohne Straffung wurden mit jenen der Gruppe mit AM verglichen. Die Zufriedenheit der Patientinnen und der Operateure wurde mittels Likert-Skalen dokumentiert. Ergebnisse Insgesamt wurden 206 Brustaugmentationen bei n = 103 Patientinnen durchgeführt. Das mittlere Follow-up betrug 24,0 ± 4,3 Monate. Im Vergleich zur Augmentation ohne Straffungsindikation lagen bei der AM breitere Brustbasen und größere präoperative Körbchengrößen vor, p Schlussfolgerung Im Vergleich zu Augmentationen ohne Straffung führen präoperativ breitere Brustbasen und größere Brustvolumina zur Auswahl von signifikant unterschiedlichen Implantatdimensionen bei der AM. Nanotexturierte Implantate sind verbunden mit niedrigen Komplikationsraten, wobei ein erhöhtes Risiko für gewebebedingte Revisionen nach AM verbleibt. Weitere Studien sind notwendig, um eventuelle Vor- und Nachteile gegenüber etablierten Implantaten zu evaluieren.

Thermodynamic metabolic flux analysis (TMFA) can narrow down the space of steady-state flux distributions, but requires knowledge of the standard Gibbs free energy for the modelled reactions. The latter are often not available due to unknown Gibbs free energy change of formation $$, {\Delta }_{f} G^{0}$$ , Δ f G 0 , of metabolites. To optimize the usage of data on thermodynamics in constraining a model, reaction lumping has been proposed to eliminate metabolites with unknown $${\Delta }_{f} G^{0}$$ Δ f G 0 . However, the lumping procedure has not been formalized nor implemented for systematic identification of lumped reactions. Here, we propose, implement, and test a combined procedure for reaction lumping, applicable to genome-scale metabolic models. It is based on identification of groups of metabolites with unknown $${\Delta }_{f} G^{0}$$ Δ f G 0 whose elimination can be conducted independently of the others via: (1) group implementation, aiming to eliminate an entire such group, and, if this is infeasible, (2) a sequential implementation to ensure that a maximal number of metabolites with unknown $${\Delta }_{f} G^{0}$$ Δ f G 0 are eliminated. Our comparative analysis with genome-scale metabolic models of Escherichia coli, Bacillus subtilis, and Homo sapiens shows that the combined procedure provides an efficient means for systematic identification of lumped reactions. We also demonstrate that TMFA applied to models with reactions lumped according to the proposed procedure lead to more precise predictions in comparison to the original models. The provided implementation thus ensures the reproducibility of the findings and their application with standard TMFA.

Background and study aims Endoscopic balloon dilation (BD) and temporary stent placement for pancreaticojejunostomy anastomotic stricture (PJAS) achieves good short-term outcomes; however, stricture recurrences remain frequent. We examined the feasibility of performing radial incision and cutting (RIC) combined with BD for refractory PJAS. Patients and methods Five consecutive patients with refractory PJAS who underwent RIC with BD between 2015 and 2018 were retrospectively investigated. We evaluated the technical and clinical success, adverse event (AE), and recurrence rates associated with RIC with BD. Results In all five patients, technical and clinical success were achieved. Pancreatic stone removal was simultaneously performed in one patient. The mean procedure time was 18 minutes (range 12–23 minutes). There were no procedure-related AEs. All patients were followed for over 2 years, with a mean follow-up period of 33 months (range 24–40 months). During the follow-up period, none of the patients developed stricture recurrence and all anastomoses remained patent. Conclusions This is the first report of RIC with BD for the treatment of refractory PJAS, showing favorable results. This combined procedure might be a useful option for treating refractory PJAS.

CISG and arbitration are connected with each other. They may work through a combined or parallel procedure. Globalization of trade desires uniformity in trade. For uniformity of trade, we require uniform law. The arbitration may not work to make it uniform, but choosing any uniform law (i.e. CISG), it may lead to deal a particular arbitration in the international standard. The international standard may be maintained while considering the uniform law. Choosing uniform law (i.e. CISG), it may minimize the risk of wrong interpretation and put the arbitral parties on “equal footing”. Parties may consider CISG as the applicable law in their arbitral agreements. As of 13 February 2021, 94 states signed the United Nations Convention on Contracts for the International Sale of Goods 1980 (CISG). The frontline trading states like the USA, Australia, Israel, Canada, China, Germany, France, Russia, and Japan are contracting states of CISG. This research emphasizes providing guidelines as to how parties may apply CISG into their arbitral agreements by maintaining the international standard.

Purpose: To report the surgical outcomes of penetrating keratoplasty (PKP) and sutureless scleral fixation (SSF) using Carlevale Lens (Soleko) combined procedure to solve corneal failure and aphakia in vitrectomized eyes and discuss eventual advantages of this new approach. Methods: Two patients underwent primary wound repair and pars plana vitrectomy after a penetrating ocular trauma and were referred to the author’s clinic. The PKP and SSF-Carlevale lens implantation were performed under retrobulbar anesthesia. Intraoperative and postoperative complications were recorded, intraocular lens positioning was evaluated using anterior segment optical coherence tomography (AS-OCT) and endothelial cell density was determined using an endothelial microscope. Both patients completed 12 months follow-up. Results: The surgery was performed without intraoperative complications. After 1 month, the lens was fixed well, and the graft showed no sign of rejection. At the last visit after 12 months, the corneal graft remained transparent with good endothelial cell density in both cases; conjunctival scarring or inflammation and plugs externalization did not occur during follow-ups. Best-corrected visual acuity was 4/10 Snellen in the first case, while in the second case, we witnessed a limited visual recovery of 1/20 Snellen due to retinal issues. Conclusion: We report the feasibility of secondary IOL implantation using Carlevale with penetrating keratoplasty. The relative of ease of Carlevale lens implantation through the transscleral plugs reduces the open globe length resulting in a safer procedure, especially for vitrectomized eyes.

Background: Lateral column lengthening is currently the most attractive procedure to correct the deformity. In this study we aimed to evaluate the effect of lateral column lengthening as a single or combined procedure on the clinical and radiological outcome of symptomatic patients with flexible flatfoot. Aim of Study: This study aims was to evaluate the effect of lateral column lengthening as a single or combined proce-dure on the clinical and radiological outcome of symptomatic patients with flexible flatfoot. Prospective study. Patients and Methods: 24 pediatric patients with sympto-matic flexible flatfoot. Post-operative evaluation was done via AOFAS Ankle-hindfoot Scale. Results: There were significant improvements of the radiological alignment angles post-operatively. Also asignif-icant improvement of AOFAS score after 3 months post-operatively and the end of follow-up is noticed. Concerning complications, persistent pain (8.4%), delayed union (8.4%), graft site hematoma (4.2%), partial graft extrusion (4.2%) and wound dehiscence (4.2%). Conclusion: Lateral column lengthening in treatment of pediatric flexible flatfoot has a good clinical and radiological outcome. It is associated with few or minor post-operative complications.

Sacral neuromodulator (SNM) explantation is associated with higher cost and significant morbidity. The objectives were to investigate the incidence, reasons, and predictors of SNM explantation at our institution and evaluate whether combined versus staged procedures are associated with increased SNM explantation rates. A retrospective chart review of subjects with SNM implantation between Jan 2012 and Dec 2017 was performed. Explantation-free survival was estimated using the Kaplan-Meier method, and associations of demographic and clinical characteristics with time to explantation were assessed using Cox regression. One hundred three subjects were included in the final analysis. Of which, 39 underwent staged procedures and 64 received combined procedures. General surgeons implanted most SNMs (102/103) primarily for fecal incontinence (90.3%). The median follow-up time was 9.5 months (IQR 4.3, 30.0). Twelve subjects (11.7%) underwent explantation with an incidence rate of 0.006 per person-month (95% CI 0.003, 0.011). The mean time to explantation was 25 months (SD ± 16.9 months). The most common reason for explantation was loss of efficacy (58.3%). In univariable analyses, only age (HR 0.97(95%CI 0.93–1.00); p = .04) was significantly associated with explantation. Subjects that underwent staged procedures were more likely to undergo explantation at any given time compared with subjects that underwent combined procedures, however, it was not statistically significant (HR 2.91(95%CI 0.87–9.71); p = .08). Over a 6-year period, the incidence of SNM explantation was 0.006 per person-month at our institution. The most common reason for SNM explantation was loss of efficacy. Older subjects were more likely to get explantation. Compared to subjects who had a staged procedure, those who had a combined procedure did not have a significantly different rate of explantation in our population. Further prospective studies are warranted.

Background Acute left atrial ridge (LAR) lesions have been observed following atrial fibrillation (AF) ablation. However, LAR lesions had not yet been quantitatively evaluated and their influence on procedure combining cryoballoon (CB) ablation with left atrial appendage closure (LAAC) remained to be explored. Methods The profile of LAR lesions was measured by transesophageal echocardiography (TEE) in 117 consecutive nonvalvular AF patients, who underwent the combined procedure of CB ablation and LAAC. We thoroughly investigated how LAR lesions correlated with baseline variables and clinical outcomes. Results A total of 95 out of 96 available TEE images presented prominent acute LAR lesions. In terms of dimensions, there was a greater change in width (Δwidth = 3.6 ± 2.3 mm) than the thickness (Δthickness = 2.6 ± 3.5 mm), and the outer ostium was narrowed (Δouter ostium diameter = -3.4 ± 4.0 mm), while the inner ostium remained unchanged. A higher nadir temperature when freezing the left superior pulmonary vein (LSPV) led to an LAR lesion with a two times greater width (adjusted odds ratio = 1.16; 95% confidence interval, 1.02-1.31). In the evaluation of LAAC outcomes, four patients implanted with Watchman devices had minimal residual flow at the inferior border, while two implanted with LAmbre devices developed residual flow at the LAR side. Clinical outcomes were similar between groups divided by lesion size. Conclusion Acute LAR lesions frequently occurred following the CB ablation combined procedure, and lesion width positively correlates with LSPV nadir temperature. The presence of these lesions affects the measurement of pacifier devices but has little impact on that of occluder devices.

Aim: The purpose of this article is to prove the importance of autologous fat transfer (AFT) in scarring alopecia. Methods: We present a complete clinical report of 21 cases treated with a combined procedure of AFT and hair transplantation (HT) done in the last three years. Results: The main findings of this study are the constant, early and more predictable hair regrowth after the hair transplant done on a pre-treated scarring alopecia. Conclusion: Tissue regeneration through AFT can significantly improve hair growth in the area of scarring alopecia, underlining, once again, the tremendous potential of this approach. Future studies may need to be carried out.

The prevalence of concomitant abdominal aortic aneurysm (AAA) and severe aortic stenosis (AS) has been increasing in the elderly population. Both conditions have adverse outcomes, if not adequately managed. No clear recommendations are available in the literature until today, in regards of the management sequence making thus the decision-making challenging. We report 2 cases of AAA and significant AS treated with endovascular aortic repair (EVAR) and transcatheter aortic valve implantation (TAVI) during the same procedure and a review of the literature on this topic. Based on our experience, the combined procedure with TAVI followed by EVAR seems to be feasible, safe, and effective while detailed preoperative planning and a carefully tailored management strategy by a multidisciplinary team are essential.

Purpose: This retrospective audit aimed to evaluate the impact of combined iStent®Inject (iSI) and phacoemulsification on medication number in Australians with open-angle glaucoma. Secondary outcomes included intraocular pressure (IOP), best-corrected visual acuity, refraction and visual fields. Patients and Methods: Patients with glaucoma that received combined iSI and phacoemulsification by the same surgeon between 1 February 2016 and 1 February 2018 were audited for postoperative medication number, pressures after 1 day, 1 week, 4 weeks and 6, 12, 18 and 24 months, visual acuity, refraction and visual fields. These parameters were compared to baseline levels and with those from a separate cohort of patients without glaucoma that received standalone phacoemulsification. Results: Forty-one patients (63 eyes) received the combined procedure. Thirty-four patients (59 eyes) received standalone phacoemulsification. Four weeks after receiving combined iSI and phacoemulsification the mean medication number was significantly reduced by 1.3 (p < 0.001) for those on medication at baseline and by 0.5 (p = 0.002) overall. Mean IOP was significantly reduced from baseline after 6 months (-16%; p = 0.012; n = 35) and 12 months (-29%; p = 0.004; n = 16). Patients receiving standalone phacoemulsification had short-term reductions in IOP at 4 weeks (-8%; p < 0.001; n = 57) and 6 months (-16%; p < 0.001; n = 32). These patients without glaucoma had lower pressures overall compared to those with glaucoma that received the combined procedure (p = 0.019). There were no differences in final visual acuity or refractive outcomes between groups. Conclusion: This audit suggests that iSI and phacoemulsification are at least as effective in controlling IOP as medical therapy. It may have an important role in reducing the medication burden in Australians with cataract and glaucoma. This study is one of the first to confirm refractive stability in concomitant iSI and phacoemulsification.

Orthokeratology (Ortho-K) works to reshape cornea and is the only non-surgical way to enable vision without corrective aids. However, its effect is only temporary, and successful stabilization requires ongoing Ortho-K wear to maintain the reshaping effect. Corneal crosslinking (CXL) is a commonly-used technique in clinical practice to stabilize corneal shape in keratoconic eyes. However, whether or not CXL can stabilize corneal shape after Ortho-K in normal cornea has not been reported. Therefore, this proof-of-concept study using 2 rhesus monkeys aimed to determine the efficacy of the combined procedure. One monkey wore Ortho-K bilaterally for 24 hours, and the other from 6 pm to 8 am for 7 days. The left eyes of both monkeys underwent CXL after Ortho-K while the contralateral eye served as control. Results showed a gradual regression of corneal shape in all eyes with or without CXL. However, eyes underwent CXL regressed more slowly than the control eyes. The control eyes and the CXL treatment eye in the 7-day Ortho-K monkey regressed completely at last, while the CXL treatment eye in the 24 h Ortho-K monkey maintained a corneal flattening of −1.48 D 27 days after procedure. These findings suggest CXL can slow the regression of Ortho-K for a short duration, but cannot sustain its effect according to the current protocol.

In countries like India rheumatic heart disease (RHD) is still a common problem, and with improvements in diagnosis and treatment, the lifespan of these patients is increased. With increase in the lifespan, these patients may develop coronary artery disease (CAD) and present as acute coronary syndrome (ACS). In some cases especially RHD with severe mitral stenosis (MS), thrombus that develop in left atrium may embolize in one of the coronary arteries, leading to acute coronary syndrome. We report a case of 51 year old female who was a known case of rheumatic heart disease and now presented with acute coronary syndrome. Patient was hemodynamically unstable and underwent percutaneous balloon mitral valvotomy (PBMV) and percutaneous coronary intervention (PCI) simultaneously. We here discuss the possible complications that need to be addressed in such scenario and how can we approach such cases. This is first of such intervention at our institute and also there are very few such records available online. Patient tolerated the procedure well with significant clinical improvement.

Background Umbilical hernias (UH) are common in patients seeking abdominal contouring surgery and the question of simultaneous abdominoplasty and UH repair is raised. This presents, however, a risk to the umbilicus vascularization with possible umbilical necrosis. As a result, the umbilicus maintains its only blood supply from the underlying fascial attachments via the umbilical stalk. Abdominoplasty in the setting of a hernia repair can improve patients satisfaction, particularly appearance, hygiene, self-confidence and decrease the incidence of recurrence. Objective To assess the outcome of the combined procedure of abdominoplasty and repair of umbilical hernia. Patients and Methods This study Included 26 patients (18 females and 8 males) who were selected from those who presented to the department of general surgery at EL Demerdash University Hospital and Nasr city insurance hospital during the period between april2019 and october 2019. All patients had a physical examination of the UH and diastasis. Divided into two groups, each group formed of 13 patients. First group (group A) with patients underwent herniorrphy alone and the other group (group B) with patients underwent hernioplasty with combined abdominoplasty. Results It may be concluded that (1) during an abdominoplasty, midline fascial plication and ventral hernia repair can be performed in defects 3 cm, mesh reinforcement is indicated after suture hernia repair and midline plication,, yields lower recurrence of abdominal deformity and less refashioning procedures with minimal complications. Conclusion Finally, it may help to reduce the incidence of recurrence by enabling removal of a large pannus and the resultant weight on the anterior abdominal wall, though this has not been proven. Also it improves the quality of life and obtains patients satisfaction with this approach.

Tissue-engineering was important which combine medical applications and engineering materials. An extraction process was employed to remove the tissue and cellular molecules from porcine skin in this study via pretreatment of supercritical fluid a designed combined procedure of supercritical fluids of carbon dioxide and protease treatments at low temperatures. Varying porosities of the decellularized tissues were then created using protease reagent treatments. The author studied characterizations of the designed decellularized scaffolds derived from porcine skins via supercritical fluid and protease reagent treatments.

Purpose: To characterize changes in intraocular pressure (IOP), IOP-lowering medications, and visual acuity (VA) through 3 years of follow-up in patients undergoing combined phacoemulsification and excisional goniotomy with the Kahook Dual Blade (phaco-KDB), with simultaneous goniosynechialysis in cases of angle-closure glaucoma, by a single surgeon (A.H.) in King Fahd Hospital of the University, Dammam, Saudi Arabia.Methods: Prospective, non-comparative, uncontrolled, non-randomized interventional case series. Consecutive patients with medically-treated glaucoma and visually-significant cataract underwent combined surgery. Subgroup analysis of glaucoma subtypes was performed.Results: Fifty-seven eyes (48 patients) including 29 eyes with primary open-angle glaucoma, 15 with pseudoexfoliation glaucoma, and 13 with angle-closure glaucoma, were enrolled. Mean (standard error) baseline IOP was 20.3 (0.7) mmHg and through up to 36 months of follow-up (minimum 12 months, mean 26.2 [1.0] months) ranged from 13.5-14.0 mmHg (13.7 mmHg at Month 36); significant reductions (p<0.0002) of 23.6-29.9% were achieved at every time point. Medications were reduced from a mean of 3.3 (0.1) to 0.2-1.9 (reduction 51.4-94.7%; pConclusions: Phaco-KDB significantly improved VA, lowered IOP ~25-30%, and lowered medications by >50% through 36 months. This combined procedure provides meaningful long-term reductions in IOP and need for IOP-lowering medication without compromising visual rehabilitation in eyes with cataract and glaucoma.

ObjectiveThis study aimed to evaluate outcomes of the sequential one-stage combined procedure for treating bilateral developmental dysplasia of the hip (DDH) that was diagnosed after walking age.MethodsThirty-five patients (70 hips) with late-presenting bilateral DDH were treated with the sequential one-stage combined procedure. Hips were reclassified according to the operative time and divided into the first and the second operated hips. The outcomes were compared clinically and radiographically between the two sides preoperatively and postoperatively.ResultsThe mean interval time between the two procedures was 5.9 months (range: 2–9 months). The first operated hip achieved better results than did the second operated hip. A total of 68.6% (24/35) of the patients in our series had an asymmetric outcome.ConclusionsThe sequential one-stage combined procedure is a challenge, but a reasonable alternative surgery for bilateral DDH in children after walking age. An asymmetric outcome is a special complication of this procedure.

Experiments were carried out to determine the minimal extent of acceptable grinding allowance on case-hardened workpieces machined by combined procedure. The extent of acceptable or unacceptable allowance was determined by a “painting” method. After bore grinding tests for 2D roughness, roundness and 3D topography measurement were carried out. It was found that a 0.03 mm allowance in the bores of gearbox wheels of cars is satisfactory and also necessary to obtain the required level of topography when combined machining was applied and when no white layer formed in the turning procedure. This is a significant finding, because the usual allowances of 0.05 mm or higher (in many cases significantly higher) can be decreased to 0.33 mm and the machining time of bore grinding can be reduced in proportion to this extent. При шліфуванні швидкість видалення матеріалу значно збільшується завдяки застосуванню високошвидкісних методів. У верстатобудуванні робототехнічне обслуговування дозволяє здійснювати паралельну роботу більш ніж одного верстата. Однак існує сфера, яка недостатньо досліджена дослідницькими проектами - величина припуску на шліфування під час другої операції комбінованого методу. Визначення цього параметру базується на емпіричних даних, однак, дані експериментів свідчать про те, що часто застосовуються припуски на шліфуванняння, які значно перевищують вказані значення. Тому час обробки шліфуванням може бути значно збільшений і без особливих причин. У разі комбінованого методу, даних в літературі у визначенні операційного посібника, досить мало. Оскільки точіння на токарному верстаті в 4 або 5 разів продуктивніше, ніж шліфування при обробці отворів, і можна досягти кращої якості поверхні, в комбінованому методі досить видалити припуск на шліфування отвору, що дозволяє звести до нуля періодичність поверхні. В цих дослідженнях були проведені експерименти для визначення мінімального ступеню допустимого припуску матеріалу, що шліфується на оброблюваних деталях типу «корпус» комбінованим методом. Ступінь прийнятного або неприйнятного припуску визначали методом «розпису». Після шліфування проводили вимірювання 2D шорсткісті, округлості і 3D топографію. Було встановлено, що припуск 0,03 мм в отворах коліс коробки передач автомобілів є задовільним для отримання необхідного рівня рельєфу при застосуванні комбінованої обробки і при відсутності білого шару в процесі обробки. Це є досить значним висновком, оскільки звичайні припуски 0,05 мм або вище (у багатьох випадках значно вищі) можуть бути зменшені до 0,33 мм, а час обробки шліфуванням отворів може бути зменшено пропорційно до цієї величини.

Purpose: tо estimate the effectiveness of complete corneal ring (MyoRing) implantation compared with MyoRing implantation combined with corneal collagen crosslinking (CXL) for keratoconus treatment for 36 months follow-up. Patients and Methods. There were 101 patients (124 eyes) with progressing keratoconus aged 18–59 years in the study. Intracorneal rings were implanted in all patients. The patients were divided into 2 groups. MyoRing implantation was performed in a series of 59 patients (76 eyes) with keratoconus II–III Amsler classification, 42 patients (48 eyes) had MyoRing implantation combined with CXL. Implantation of a MyoRing in the corneal pocket was performed using a PocketMaker microkeratome and corneal intrastromal implantation system. Results. Keratometry was reduced in both groups; after MyoRing implantation for 8,45 D and MyoRing combined with CXL for 7,44 D, the spherical equivalent decreased for 7,72 and 6,29 D respectively, after 36 months. The cylinder decreased to 3,33 D with MyoRing alone and to 3,11 D with MyoRing combined with CXL. The smallest corneal thickness remained stable during 36 months after the procedure. There was an improvement in uncorrected and corrected visual acuity, and the difference in the CRF within the period of up to 12 months after the operation. It can be explained by the pseudochase formation in the group with a combined procedure. Conclusion. The implantation of the MyoRing IRC and the combination of MyoRing with CXL showed efficacy and safety in stabilizing keratoconus stabilization, as well as correction of comorbided ametropia 3 years after surgery. Both MyoRing implantation and MyoRing combined with CXL were effective in the stabilization of progressive keratoconus, as well as the correction of ametropia 3 years after surgery. There was no significant difference in MyoRing implantation and its combination with corneal crosslinking in visual and refractive results. The refractive power of the cornea was only one exeption. Long follow-up and randomized prospective studies with a large number of patients are needed.