Factor XI (FXI) deficiency is a rare inherited coagulation disorder associated with prolonged activated partial thromboplastin time. The severity of bleeding often does not correlate with plasma factor levels. We reviewed the medical and anesthetic records of 13 parturients with FXI deficiency that presented for delivery. Nine cases were managed with neuraxial anesthesia. (epidural, seven; spinal, one; combined spinal-epidural, one). Three received general anesthesia for cesarean delivery, and one had an unmedicated vaginal delivery. Baseline factor levels ranged from severe (<15%) to mild (near 50%) deficiency. Fresh frozen plasma was administered to correct activated partial thromboplastin time in most, but not all, cases. Hematology consultation was obtained for all. No hematological or anesthetic complications were noted. FXI deficiency is not an absolute contraindication to neuraxial anesthesia, provided appropriate hematology consultation has been obtained, and factor replacement is provided as guided by clinical and laboratory hemostatic evaluation.

No abstract

No abstract

Purpose.To report 22 patients who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation. Methods. Records of 6 women and 19 men aged 21 to 42 (mean, 28) years who underwent repair of compound Achilles tendon ruptures with peroneus brevis tendon augmentation were reviewed. All the wounds were transverse/oblique, minimally contaminated, and could be closed primarily. Patients were evaluated at months 3, 9, and 12, using the Foot and Ankle Outcome Score (FAOS) questionnaire. Results. Of the 22 patients, 3 developed superficial skin complications that healed gradually, and 2 developed a superficial discharging sinus and underwent minor debridement. No patient had a re-rupture of the Achilles tendon. At the one-year follow-up, all patients achieved good functional outcome in terms of the FAOS. Conclusion. Repair of Achilles tendon ruptures withRepair of Achilles tendon ruptures with peroneus brevis tendon augmentation Amarjeet Singh, Kushal Nag, Shuvendu P Roy, Ramesh Chandra Gupta, Vaibhav Gulati, Nikunj Agrawal

No abstract

No abstract

Abstract-The objective of this paper is to propose three modified versions of the Gravitational Search Algorithm for continuous optimization problems. Although the Gravitational Search Algorithm is a recently introduced promising memory-less heuristic but its performance is not so satisfactory in multimodal problems particularly during the later iterations. With a view to improve the exploration and exploitation capabilities of GSA, it is hybridized with well-known real coded genetic algorithm operators. The first version is the hybridization of GSA with Laplace Crossover which was initially designed for real coded genetic algorithms. The second version is the hybridization of GSA with Power Mutation which also was initially designed for real coded genetic algorithms. The third version hybridizes the GSA with both the Laplace Crossover and the Power mutation. The performance of the original GSA and the three proposed variants is investigated over a set of 23 benchmark problems considered in the original paper of GSA. Next, all the four variants are implemented on 30 rotated and shifted benchmark problems of CEC 2014. The extensive numerical, graphical and statistical analysis of the results show that the third version incorporating the Laplace Crossover and Power mutation is a definite improvement over the other variants.

No abstract