PURPOSE: Non-operative management (NOM) has been validated for blunt liver and splenic injuries. Literature on continuous intra-abdominal pressure (IAP) monitoring as a part of NOM remains to be equivocal. The study aimed to find any correlation between clinical parameters and IAP, and their effect on the NOM of patients with blunt liver and splenic injury. METHOD: A prospective cross-sectional study conducted at a level I trauma center from October 2018 to January 2020 including 174 patients who underwent NOM following blunt liver and splenic injuries. Hemodynamically unstable patients or those on ventilators were excluded, as well as patients who suffered significant head, spinal cord, and/or bladder injuries. The study predominantly included males (83.9%) with a mean age of 32.5 years. IAP was monitored continuously and the relation of IAP with various parameters, interventions, and outcomes were measured. Data were summarized as frequency (percentage) or mean ± SD or median (Q₁, Q₃) as indicated. χ² or Fisher's exact test was used for categorical variables, while for continuous variables parametric (independent t-test) or nonparametric tests (Wilcoxon rank sum test) were used as appropriate. Clinical and laboratory correlates of IAP < 12 with p < 0.200 in the univariable logistic regression analysis were included in the multivariable analysis. A p < 0.05 was used to indicate statistical significance. RESULTS: Intra-abdominal hypertension (IAH) was seen in 19.0% of the study population. IAH was strongly associated with a high injury severity score (p < 0.001), and other physiological parameters like respiratory rate (p < 0.001), change in abdominal girth (AG) (p < 0.001), and serum creatinine (p < 0.001). IAH along with the number of solid organs involved, respiratory rate, change in AG, and serum creatinine was associated with the intervention, either operative or non-operative (p = 0.001, p = 0.002, p < 0.001, p < 0.001, p = 0.013, respectively). On multivariable analysis, IAP (p = 0.006) and the mean change of AG (p = 0.004) were significantly associated with the need for intervention. CONCLUSION As a part of NOM, IAP should be monitored as a continuous vital. However, the decision for any intervention, either operative or non-operative cannot be guided by IAP values alone.
Humans ; Male ; Adult ; Female ; Wounds, Nonpenetrating/physiopathology* ; Spleen/injuries* ; Prospective Studies ; Cross-Sectional Studies ; Liver/injuries* ; Middle Aged ; Monitoring, Physiologic/methods* ; Pressure ; Abdominal Injuries/physiopathology* ; Intra-Abdominal Hypertension ; Young Adult

Arthroscopic rotator cuff repair is the gold standard for treatment, but current techniques have shortcomings, especially for larger tears. Single-row repairs often fail to fully restore the footprint, leading to high retear rates. Although triple-row and double-row repairs show promise, concerns regarding retear persist. Biomechanical studies favor triple-row repair for better coverage and pressure distribution. Techniques such as linked double-row and double-pulley methods enhance strength. Secondary cuff failures near the musculotendinous junction are commonly caused by stress concentration. To address these challenges, novel methods have employed linked, knotless, and bridging constructs. Our approach, the double pulley-triple row, aims to minimize retears, especially at the musculotendinous junction, and provides uniform pressure distribution, which is particularly beneficial for large tears. The surgical steps involve standard arthroscopic procedures with specific instruments. Despite these challenges, our method combines proven techniques for optimized outcomes and promising improved results in rotator cuff repair.

Rotator cuff tears are common shoulder injuries that often necessitate surgical intervention, particularly when nonoperative treatments fail. Arthroscopic rotator cuff repair is the current gold standard; however, challenges, such as high retear rates, especially in large tears, persist. Traditional techniques, such as single-row and double-row repairs, have limitations in fully restoring the anatomical footprint and ensuring optimal healing. This review examines the novel double pulley-triple row technique, which aims to overcome these limitations by enhancing the footprint contact area, load distribution, and tendon healing. By evaluating the double pulley-triple row method in comparison to established techniques, this study explores the potential advantages, limitations, and future directions of rotator cuff repair.

Arthroscopic rotator cuff repair is the gold standard for treatment, but current techniques have shortcomings, especially for larger tears. Single-row repairs often fail to fully restore the footprint, leading to high retear rates. Although triple-row and double-row repairs show promise, concerns regarding retear persist. Biomechanical studies favor triple-row repair for better coverage and pressure distribution. Techniques such as linked double-row and double-pulley methods enhance strength. Secondary cuff failures near the musculotendinous junction are commonly caused by stress concentration. To address these challenges, novel methods have employed linked, knotless, and bridging constructs. Our approach, the double pulley-triple row, aims to minimize retears, especially at the musculotendinous junction, and provides uniform pressure distribution, which is particularly beneficial for large tears. The surgical steps involve standard arthroscopic procedures with specific instruments. Despite these challenges, our method combines proven techniques for optimized outcomes and promising improved results in rotator cuff repair.

Rotator cuff tears are common shoulder injuries that often necessitate surgical intervention, particularly when nonoperative treatments fail. Arthroscopic rotator cuff repair is the current gold standard; however, challenges, such as high retear rates, especially in large tears, persist. Traditional techniques, such as single-row and double-row repairs, have limitations in fully restoring the anatomical footprint and ensuring optimal healing. This review examines the novel double pulley-triple row technique, which aims to overcome these limitations by enhancing the footprint contact area, load distribution, and tendon healing. By evaluating the double pulley-triple row method in comparison to established techniques, this study explores the potential advantages, limitations, and future directions of rotator cuff repair.

Objectives: The integration of large language models (LLMs), particularly those based on the generative pre-trained transformer (GPT) architecture, has begun to revolutionize various fields, including dentistry. Despite these promising applications, the use of GPT in dentistry presents several challenges. Ongoing research and the development of robust ethical frameworks are essential to mitigate these issues and enhance the responsible deployment of GPT technologies in clinical settings. Hence, this systematic review aims to explore the trends, applications, strengths, and challenges associated with the use of GPT in dentistry. Methods: Articles were selected if they contained detailed information on the application of GPT in dentistry. The search strategy used in systematic reviews follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search of databases and other sources yielded a total of 704 studies. After removing duplicates and conducting a full-text screening, 16 articles were included in the review. The methodological quality of the research was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. Results: Out of a total of 91 articles published on GPT in dentistry, 20 were editorials and 11 were narrative reviews; these were excluded, leaving 60 original research articles for further analysis. The articles were assessed based on the type of results they provided. Ultimately, 16 articles that reported positive findings with robust methodology were included in this review Conclusions The results highlight mixed responses; therefore, further research on integration into clinical workflows must be conducted with extensive methodological rigor.

Arthroscopic rotator cuff repair is the gold standard for treatment, but current techniques have shortcomings, especially for larger tears. Single-row repairs often fail to fully restore the footprint, leading to high retear rates. Although triple-row and double-row repairs show promise, concerns regarding retear persist. Biomechanical studies favor triple-row repair for better coverage and pressure distribution. Techniques such as linked double-row and double-pulley methods enhance strength. Secondary cuff failures near the musculotendinous junction are commonly caused by stress concentration. To address these challenges, novel methods have employed linked, knotless, and bridging constructs. Our approach, the double pulley-triple row, aims to minimize retears, especially at the musculotendinous junction, and provides uniform pressure distribution, which is particularly beneficial for large tears. The surgical steps involve standard arthroscopic procedures with specific instruments. Despite these challenges, our method combines proven techniques for optimized outcomes and promising improved results in rotator cuff repair.

Rotator cuff tears are common shoulder injuries that often necessitate surgical intervention, particularly when nonoperative treatments fail. Arthroscopic rotator cuff repair is the current gold standard; however, challenges, such as high retear rates, especially in large tears, persist. Traditional techniques, such as single-row and double-row repairs, have limitations in fully restoring the anatomical footprint and ensuring optimal healing. This review examines the novel double pulley-triple row technique, which aims to overcome these limitations by enhancing the footprint contact area, load distribution, and tendon healing. By evaluating the double pulley-triple row method in comparison to established techniques, this study explores the potential advantages, limitations, and future directions of rotator cuff repair.

Depression is a common mental health problem that is associated with significant disability and mortality. Electroconvulsive therapy (ECT) has been demonstrated to be effective at resolving expression of suicidal intent in patients with depression. In less acute situations, patients are usually referred for ECT after several medication trials. Neuromuscular blocking agents (NMBAs) are used to block tonic-clonic motor activity and associated physical harm during the delivery of ECT. Succinylcholine (Sch), with its rapid onset of muscle relaxation, short self-terminating duration of action, and rapid subsequent return of spontaneous ventilation, is the NMBA of choice for ECT. However, the use of Sch is problematic or contraindicated is some situations. Although non-depolarizing NMBAs can be used, the variable time to onset of adequate muscle relaxation and prolonged duration of action have limited their widespread acceptance as alternatives to Sch. Recently, however, with the widespread availability of sugammadex, a chemically modified γ-cyclodextrin that rapidly and predictably reverses the effect of non-depolarizing NMBAs, the muscle relaxation achieved by rocuronium can predictably and effectively be reversed. In situations where Sch is contraindicated or otherwise problematic, rocuronium, followed by pharmacological antagonism with sugammadex, can provide a safe and effective muscle relaxation approach comparable to that of Sch in terms of duration of action. This review provides a summary of the current state of evidence for the use of sugammadex during ECT, which should lend support to further acceptance and future studies of sugammadex in the context of ECT.

Objectives: The integration of large language models (LLMs), particularly those based on the generative pre-trained transformer (GPT) architecture, has begun to revolutionize various fields, including dentistry. Despite these promising applications, the use of GPT in dentistry presents several challenges. Ongoing research and the development of robust ethical frameworks are essential to mitigate these issues and enhance the responsible deployment of GPT technologies in clinical settings. Hence, this systematic review aims to explore the trends, applications, strengths, and challenges associated with the use of GPT in dentistry. Methods: Articles were selected if they contained detailed information on the application of GPT in dentistry. The search strategy used in systematic reviews follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search of databases and other sources yielded a total of 704 studies. After removing duplicates and conducting a full-text screening, 16 articles were included in the review. The methodological quality of the research was evaluated using the Critical Appraisal Skills Programme (CASP) checklist. Results: Out of a total of 91 articles published on GPT in dentistry, 20 were editorials and 11 were narrative reviews; these were excluded, leaving 60 original research articles for further analysis. The articles were assessed based on the type of results they provided. Ultimately, 16 articles that reported positive findings with robust methodology were included in this review Conclusions The results highlight mixed responses; therefore, further research on integration into clinical workflows must be conducted with extensive methodological rigor.