Myringoplasty is still the most performed otological surgery. Nevertheless, the underlay vs. overlay approaches have yet to be determined. The purpose of this study is to compare the surgical and audiological outcomes of underlay and overlay myringoplasty in perforated tympanic membrane patients. A systematic review and meta-analysis synthesizing randomized controlled trials (RCTs), which were retrieved by systematically searching of Web of Science, SCOPUS, PubMed, and Google Scholar until January 25th, 2023. RevMan version 5.4 software was used to pooled dichotomous outcomes using the risk ratio (RR) with the corresponding 95% confidence interval (CI). We registered our protocol in PROSPERO with ID: [CRD42023387432]. We included eight RCTs with 656 tympanic perforation membrane patients. Four RCTs had a low risk of overall bias, two had some concerns, and two had a high risk of bias. The underlay technique was significantly associated with a higher surgical success rate (n = 7 RCTs, RR: 1.21 with 95% CI [1.02, 1.43],  P = 0.03) and audiological success rate (n = 4 RCTs, RR: 1.31 with 95% CI [1.18, 1.44], P < 0.00001). This meta-analysis underscores the potential superiority of the underlay technique in managing tympanic membrane perforations, with significant implications for surgical and audiological outcomes. However, more investigations are still necessary to confirm this result.
UNASSIGNED: The online version contains supplementary material available at 10.1007/s12070-023-04425-6.

Mesh positioning is a commonly discussed detail in ventral hernia repair and is often cited as a major contributor to the outcome of the operation. However, there is a paucity of data that establishes one plane as superior to others. In this article, we will provide an overview of all potential planes to place prosthetic material and review the relevant literature supporting each option and the complications associated with accessing each anatomic plane.

High pressure, high-temperature events need to be quantified experimentally. Where fragmentation occurs, i.e. against personal protective equipment, there is a requirement for both a reliable and repeatable measurement of numerous experimental metrics. Typically, the most critical is calculating the energy absorbed by the target material, to characterize target performance. This is achieved by detonating a device and capturing a proportion of the fragmentation in a suitable material that can achieve successful recovery of all fragmentation produced. Therefore, allowing the estimation of the target\'s response using the depth of penetration within the capture material which allows the calculation of energy absorption. The current standardized fragmentation capture material used within the UK is known as strawboard. Although effective, this material is both expensive and limited in its availability. This study explores the classification of strawboard to provide a suitable baseline to compare against medium density fibreboard (MDF) and flooring underlay, which represent two more economically friendly alternatives on the openmarket. It was found that the uniformity of response for the MDF material was better than that of strawboard, due to its reproducibility between batches and velocity ranges. To further explore this phenomena, high explosive trials were conducted, further demonstrating MDF to be a viable, reliable and cheaper alternative. This article is part of the theme issue \'Exploring the length scales, timescales and chemistry of challenging materials (Part 2)\'.

The relentless expansion of communications services and applications in 5G networks and their further projected growth bring the challenge of necessary spectrum scarcity, a challenge which might be overcome using the concept of cognitive radio. Furthermore, an extremely high number of low-power devices are introduced by the concept of the Internet of Things (IoT), which also requires efficient energy usage and practically applicable device powering. Motivated by these facts, in this paper, we analyze a wirelessly powered underlay cognitive system based on a realistic case in which statistical channel state information (CSI) is available. In the system considered, the primary and the cognitive networks share the same spectrum band under the constraint of an interference threshold and a maximal tolerable outage permitted by the primary user. To adopt the system model in realistic IoT application scenarios in which network nodes are mobile, we consider the randomly moving cognitive user receiver. For the analyzed system, we derive the closed-form expressions for the outage probability, the outage capacity, and the ergodic capacity. The obtained analytical results are corroborated by an independent simulation method.

The aim of our study was to compare overlay and underlay techniques of myringoplasty in terms of time taken for surgery, graft uptake rate, Air-Bone (AB) Gap closure and surgical complications. The present prospective study was conducted in the Department of Otorhinolaryngology and Head and Neck Surgery, SMGS Hospital, Government Medical College, Jammu w.e.f. November 2018-October 2019. All symptomatic patients diagnosed with Chronic Inactive Mucosal Otitis Media on the basis of history, clinical examination and audiological evaluation, were included in this study and subjected to myringoplasty by overlay technique (Group I) or underlay technique (Group II). The mean time taken for surgery was more in Group I (36.83 ± 5.33 min) than Group II (30.17 ± 5.49 min).The graft uptake rate was better in Group II (90%) than Group I (86.6%).The mean AB Gap closure was more in Group II (3.04 ± 1.63 dB) than Group I (2.99 ± 1.67 dB).Complications from surgery were seen more in Group I (19.9%) than Group II (16.6%). According to our study, underlay technique of myringoplasty was better than overlay technique of myringoplasty in terms of time taken for surgery, graft uptake rate, AB gap closure and complications.

UNASSIGNED: To systematically review the results of inlay cartilage butterfly tympanoplasty and standard underlay temporal fascia tympanoplasty for anatomic and functional end points.
UNASSIGNED: PubMed, Embase, MEDLINE, and Virtual Health Library (VHL/Lilacs) databases were searched from inception through April 2, 2021. No restrictions on language, publication year, or publication status were applied.
UNASSIGNED: The meta-analysis included data from articles that met inclusion criteria and were extracted by 2 authors independently. The PRISMA statement was followed. Risk of Bias 2.0 and Newcastle-Ottawa Scale were used to assess risk of bias. The primary outcome was tympanic membrane closure rate. The secondary outcome was improvement of the air-bone gap.
UNASSIGNED: Ten studies were included, 9 cohort studies and 1 randomized clinical trial, with 577 patients. The graft take rate was 82.8% in the butterfly cartilage inlay tympanoplasty group and 85.2% in the temporal fascia underlay tympanoplasty group (relative risk, 1.01; 95% CI, 0.93-1.11; I 2 = 42%, P = .08). The air-bone gap reduction ranged from 6.1 to 11.28 in the butterfly cartilage inlay group and from 5.2 to 12.66 in the temporal fascia underlay group, with a mean difference between groups of -2.08 (95% CI, -3.23 to -0.94; I 2 = 58%, P = .04), favoring temporal fascia underlay.
UNASSIGNED: The 2 tympanoplasty techniques analyzed here produced similar results in terms of successful reconstruction of the tympanic membrane and reduction in the air-bone gap. Neither age nor follow-up length of time influenced outcomes.

Asphalt is a common material that is used extensively for roadways. Furthermore, bituminous mixes have been used in railways, both as asphalt and as mortar. Different agencies and research institutes have investigated and suggested various applications. These studies indicate the benefits of bituminous material under railways, such as improving a substructure\'s stiffness and bearing capacity; enhancing its dynamic characteristics and response, especially under high-speed train loads; waterproofing the subgrade; protecting the top layers against fine contamination. These potential applications can improve the overall track structure performance and lead to minimizing settlement under heavy loads. They can also guarantee an appropriate response under high-speed loads, especially in comparison to a rigid slab track. This review paper documents the literature related to the utilization of asphalt and bituminous mixes in railway tracks. This paper presents a critical review of the research in the application of asphalt and bituminous mixes in railway tracks. Additionally, this paper reviews the design and construction recommendations and procedures for asphalt and bituminous mixes in railway tracks as practiced in different countries. This paper also provides case studies of projects where asphalt and bituminous mixes have been utilized in railway tracks. It is anticipated that this review paper will facilitate (1) the exchange of ideas and innovations in the area of the design and construction of railway tracks and (2) the development of unified standards for the design and construction of railway tracks with asphalt and bituminous mixtures.

In this paper, we investigate the mode selection strategies for a new device-to-device (D2D) pair becoming active in a network with a number of existing D2D sensors or users coexisting with cellular users in a D2D-enabled heterogeneous network. Specifically, we propose two selection rules, the signal-to-interference-plus-noise-ratio (SINR)-based and the capacity-based, combined with two sets of different precoding schemes and discuss their impacts on the system under a variety of scenarios. While the cooperative block diagonalization (BD) among the cellular users combined with the zero-forcing (ZF) precoding among D2D users can eliminate interference observed at the new D2D receiving sensor, the maximum signal-to-leakage-and-noise-ratio (SLNR) precoding is often a preferred option due to low-complexity implementations and comparable performance. We note that the two selection rules, the SINR-based and the capacity-based, considered in this paper impact on the system differently, with interesting tradeoff from different perspectives. Finally, we provide insights by simulations into the best selection among the three modes depending on a variety of use cases in the network.

The endoscope has transformed the way we observe, understand, and treat chronic ear disease. Improved view, exclusive transcanal techniques, assessment of ventilation routes and mastoid tissue preservation have led to decreased morbidity and functional enhancement of minimally invasive reconstruction of the middle ear. The philosophical identity of endoscopic ear surgery is evolving; new research, long-term results, and widespread acknowledgement of its postulates will undoubtedly define its role in otology.

We describe a novel myringoplasty procedure. We placed a separated fascia graft descending from the scutum, combined with underlay myringoplasty, to support an anterosuperior perforation. We reviewed data from patients who underwent myringoplasty procedures to treat perforations extending into the anterosuperior quadrant of the pars tensa from October 2012 to June 2014. A total of 42 patients who were followed for a minimum of 1 year were enrolled. The same technique was used in all operations. The tympanomeatal flap was elevated from the neck of malleus up to the tip of the lateral process of malleus. The anterior mallear fold was incised to create an opening running from the neck of the malleus to the anterior tympanic spine. A separate temporal fascia graft (complementary graft) was next inserted through the opening and pushed down into the protympanum. The upper part of the fascia graft was placed over the superior bony wall of the canal. Underlay myringoplasty was then performed. The inferior part of the fascia graft was next spread out to cover the lateral surface of the underlying graft. We measured graft take rate and preoperative and postoperative hearing parameters. The graft success rate was 97.7 % (41/42 patients). The preoperative air-bone gap was 22.56 ± 18.12 dB, and the postoperative air-bone gap was 8.4 ± 10.05 dB. This difference was statistically significant (P < 0.001). We believe that this myringoplasty technique is a safe, suitable, and effective for cases with tympanic membrane perforations extending into the anterosuperior quadrant of the pars tensa.