Search results for: Enhanced Recovery after surgery

Authors: Manel Langar, Riad Bourguiba, Jaouhar Mouine

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In this paper, we propose the design and implementation of an enhanced wormhole virtual channel on chip router. It is a heart of a mesh NoC using the XY deterministic routing algorithm. It is characterized by its simple virtual channel allocation strategy which allows reducing area and complexity of connections without affecting the performance. We implemented our router on a Tezzaron process to validate its performances. This router is a basic element that will be used later to design a 3D mesh NoC.

Keywords: NoC, mesh, router, 3D NoC

Procedia PDF Downloads 549

Authors: Maatouk Mohamed, Nouira Mariem, Hamdi Kbir Gh, Mahjoubi M. F., Ben Moussa M.

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Background and aim: Preoperative biliary drainage (PBD) has been introduced to lower bilirubin levels and to control the negative effects of obstructive jaundice in patients with malignant obstructive jaundice undergoing pancreaticoduodenectomy (PD). The optimal time interval between PBD and PD is still not clear. Delaying surgery by 4 to 6 weeks is the commonly accepted practice. However, delayed PD has been shown to decrease the rate of resection and adversely affect the tumor grading and prognosis. Thus, the purpose of our systematic review and meta-analysis was to evaluate the optimal period for PBD prior to PD: short or prolonged in terms of postoperative morbidity and survival outcomes. Methods: Trials were searched in PubMed, Science Direct, Google Scholar, and Cochrane Library until November 2022. Studies using PBD in patients with malignant obstructive jaundice that compared short duration group (SDG) (surgery performed within 3-4 weeks) with prolonged duration group (PDG) (at least 3-4 weeks after PBD) were included in this study. The risk of bias was assessed using the Rob v2 and Robins-I tools. The priori protocol was published in PROSPERO (ID: CRD42022381405). Results: Seven studies comprising 1625 patients (SDG 870, PDG 882) were included. All studies were non-randomized, and only one was prospective. No significant differences were observed between the SDG and PDG in mortality (OR= 0.59; 95% CI [0.30, 1.17], p=0.13), major morbidity (Chi² = 30.28, p <0.00001; I² = 87%), pancreatic fistula (Chi² = 6.61, p = 0.25); I² = 24%), post pancreatectomy haemorrhage (OR= 1.16; 95% CI [0.67, 2.01], p=0.59), positive drainage culture (OR= 0.36; 95% CI [0.10, 1.32], p=0.12), septic complications (OR= 0.78; 95% CI [0.23, 2.72], p=0.70), wound infection (OR= 0.08, p=0.07), operative time (MD= 0.21; p=0.21). Conclusion: Early surgery within 3 or 4 weeks after biliary drainage is both safe and effective. Thus, it is reasonable to suggest early surgery following PBD for patients having resectable periampullary cancers.

Keywords: preoperative biliary drainage, pancreatic cancer, pancreatic surgery, complication

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Authors: Hussain Mustatab Wahedi, Sun You Kim

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Skin acts as a barrier against the harmful environmental factors. Integrity and timely recovery of the skin from injuries and harmful effects of radiations is thus very important. This study aimed to investigate the importance of Sirt1 in the recovery of skin from UVB-induced damage and cutaneous wounds by using natural and synthetic novel Sirt1 activators. Juglone, known as a natural Pin1 inhibitor, and NED416 a novel synthetic Sirt1 activator were checked for their ability to regulate the expression and activity of Sirt1 and hence photo-damage and wound healing in cultured skin cells (NHDF and HaCaT cells) and mouse model by using Sirt1 siRNA knockdown, cell migration assay, GST-Pulldown assay, western blot analysis, tube formation assay, and immunohistochemistry. Interestingly, Sirt1 knockdown inhibited skin cell migration in vitro. Juglone up regulated the expression of Sirt1 in both the cell lines under normal and UVB irradiated conditions, enhanced Sirt1 activity and increased the cell viability by reducing reactive oxygen species synthesis and apoptosis. Juglone promoted wound healing by increasing cell migration and angiogenesis through Cdc42/Rac1/PAK, MAPKs and Smad pathways in skin cells. NED416 upregulated Sirt1 expression in HaCaT and NHDF cells as well as increased Sirt1 activity. NED416 promoted the process of wound healing in early as well as later stages by increasing macrophage recruitment, skin cell migration, and angiogenesis through Cdc42/Rac1 and MAPKs pathways. So, both these compounds activated Sirt1 and promoted the process of wound healing thus pointing towards the possible role of Sirt1 in skin regeneration and wound healing.

Keywords: skin regeneration, wound healing, Sirt1, UVB light

Procedia PDF Downloads 168

Authors: Seon-Young Lee, Harkiran Sagoo, Katherine Whitehurst, Georgina Wellstead, Alexander Fowler, Riaz Agha, Dennis Orgill

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Introduction: Systematic reviews attempt to answer research questions by synthesising the data within primary papers. They are an increasingly important tool within evidence-based medicine, guiding clinical practice, future research and healthcare policy. We sought to determine the reporting quality of recent systematic reviews in plastic surgery. Methods: This systematic review was conducted in line with the Cochrane handbook, reported in line with the PRISMA statement and registered at the ResearchRegistry (UIN: reviewregistry18). MEDLINE and EMBASE databases were searched in 2013 and 2014 for systematic reviews by five major plastic surgery journals. Screening, identification and data extraction was performed independently by two teams. Results: From an initial set of 163 articles, 79 met the inclusion criteria. The median PRISMA score was 16 out of 27 items (59.3%; range 6-26, 95% CI 14-17). Compliance between individual PRISMA items showed high variability. It was poorest for items related to the use of review protocol (item 5; 5%) and presentation of data on risk of bias of each study (item 19; 18%), while being the highest for description of rationale (item 3; 99%) and sources of funding and other support (item 27; 95%), and for structured summary in the abstract (item 2; 95%). Conclusion: The reporting quality of systematic reviews in plastic surgery requires improvement. ‘Hard-wiring’ of compliance through journal submission systems, as well as improved education, awareness and a cohesive strategy among all stakeholders is called for.

Keywords: PRISMA, reporting quality, plastic surgery, systematic review, meta-analysis

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Authors: Md Y. Reja, Samuel D. Brody, Wesley E. Highfield, Galen D. Newman

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Historically, wetlands in the United States have been lost due to agriculture, anthropogenic activities, and rapid urbanization along the coast. Such losses of wetlands have resulted in high flooding risk for coastal communities over the period of time. In addition, alteration of wetlands via the Section 404 Clean Water Act permits can increase the flooding risk to future hurricane events, as the cumulative impact of this program is poorly understood and under-accounted. Further, recovery after hurricane events is acting as an encouragement for new development and reconstruction activities by converting wetlands under the wetland alteration permitting program. This study investigates the degree to which hurricane recovery activities in coastal communities are undermining the ability of these places to absorb the impacts of future storm events. Specifically, this work explores how and to what extent wetlands are being affected by the federal permitting program post-Hurricane Ike in 2008. Wetland alteration patterns are examined across three counties (Harris, Galveston, and Chambers County) along the Texas Gulf Coast over a 10-year time period, from 2004-2013 (five years before and after Hurricane Ike) by conducting descriptive spatial analyses. Results indicate that after Hurricane Ike, the number of permits substantially increased in Harris and Chambers County. The vast majority of individual and nationwide type permits were issued within the 100-year floodplain, storm surge zones, and areas damaged by Ike flooding, suggesting that recovery after the hurricane is compromising the ecological resiliency on which coastal communities depend. The authors expect that the findings of this study can increase awareness to policy makers and hazard mitigation planners regarding how to manage wetlands during a long-term recovery process to maintain their natural functions for future flood mitigation.

Keywords: ecological resiliency, Hurricane Ike, recovery, Section 404 Permitting, wetland alteration

Procedia PDF Downloads 235

Authors: Katherine van Kampen, Reva Qiu, Patricia Farrugia

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Orthopedic surgery has fallen behind when it comes to gender diversity despite medical school classes reaching gender parity. Studies have shown that orthopedic surgery would require 117 years to reach gender parity with the trainee population, the longest time than any other specialty, including neurosurgery, urology, and otolaryngology. The barriers that face women in orthopedic surgery have been well researched, with contributing factors being on-going stereotypes of the field, lack of women mentors, and gender roles outside of the hospital. Furthermore, women in orthopedic surgery face barriers to achieve promotion, publications, and leadership roles leading to a “leaky pipeline,” resulting in less and less women in key academic roles in the field. It is a complex topic with barriers and challenges faced in medical school, residency, and throughout employment. Our scoping review seeks to understand these challenges across a temporal timeline and to further characterize such barriers and the driving factors behind them. To this date, authors did not find a scoping review that seeks to look broadly at factors impacting the decreased amount of women entering orthopedics and the factors that cause women to hit a “glass ceiling”, the idea that women will not achieve the same success as men despite the same qualifications, upon entering the field. This scoping review is the first of its kind to attempt to summarize the large body of research focusing on women in orthopedic surgery from the preconceptions in medical school impacting their desire to pursue orthopedics all the way to employment, including challenges to academic success and financial success. Literature databases will be searched with the following key terms: women, gender inequity, workforce, orthopedics, and citations will be hand searched and collected. Articles included will discuss gender inequality within orthopedics with non-english, patient related articles excluded. Full-text review will seek to characterize the specific barriers faced by women across medical school, residency, and employment. Themes that are expected to be highlighted are workforce data, women in orthopedic leadership, medical student perspectives on the specialty, and gender bias and discrimination in the field.

Keywords: orthopedics, gender equity, workforce, women in surgery

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Authors: Hacer Y. Teke, Sultan Pehlivan, Mustafa Karapırlı, Asude Gökmen, Sait Özsoy

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The case is here presented of a patient with DMD with electrocardiograph findings within normal limits who underwent spinal surgery then developed the rarely seen complication of cardiac tamponade which resulted in death. A 17-year old male with DMD was admitted to hospital for spinal surgery. Due to a postoperative drop in hemoglobin, blood transfusion was administered to the patient, no complication developed and he was discharged on the third day. Four days after discharge, the patient worsened at home and an ambulance was called. Before the nearest hospital was reached, the patient died in the ambulance. An autopsy was performed. A fatal but rarely seen complication of Acute Myocardial Infarction (AMI) is myocardial rupture. 85% of ruptures occur in the first week of AMI but just as they can be seen on the day of the infarct, they can also be seen 2 weeks later. The case presented here had infarction findings related to different times and in different areas.

Keywords: duchenne muscular dystrophy, myocardial infarction, myocardial rupture, anesthesia

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Authors: I. A. Harris, J. M. Naylor

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Antibiotic guidelines are published in order to reduce the risk of perioperative infection in orthopaedics. We surveyed 20 orthopaedic hospitals in Australia to determine their protocols for antibiotic prophylaxis around joint replacement surgery. We tested the protocols against Australian guidelines. We found that less than half of all protocols adhered to Australian guidelines. This indicates that current practice may lead to increased infection rates and increased antibiotic resistance.

Keywords: antibiotics, practice guidelines, orthopaedic surgery, joint replacement

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Authors: Vidya Iyer, Suresh Babu Loganathan, Yuan Hwa Lee, Kwong Fah Koh

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Introduction: It has been recommended that every patient undergoes careful preoperative evaluation in a preoperative clinic to improve theatre utilization, reduce bed occupancy and avoid unnecessary cancellation due to inadequate optimisation, communication and administrative errors. It also gives an opportunity to counsel patients regarding different aspects of anaesthesia. Methodology: A retrospective audit of all the patients seen in preoperative assessment clinic, referral letters of all the patients postponed / referred to other sub specialities in the perioperative period from June 2012 - June 2013 was done. In our clinic, we retrieved patient records who were awaiting surgery pending clearance by other sub specialities. Those patients, who could continue with their scheduled date of surgery after having been referred, were not included in the file. We also studied details of same day cancellations from the data base, during the same study period. The reasons for cancellation were examined and defined as avoidable and unavoidable. Results: Less than 0.5% was postponed from the scheduled day of surgery. Less than 0.5% was cancelled on the day of surgery. Conclusions: Patients who undergo pre anaesthetic evaluation in a well-established clinic results in adequate preoperative patient optimisation, avoids unnecessary preoperative admission, efficient theatre utilisation and greater patient satisfaction. The benefits are the result of guidelines and timely update of them which are used by the junior doctors and trainees who run the clinic and a dedicated specialist to supervise them.

Keywords: preoperative assessment, clinic, referrals, cancellation

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Authors: Boshra Mozaffar, Iskandar Idris

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Taste change is a common complication after Bariatric surgery (BS). However, the cause of this is still not clear. Since zinc is important fortaste perception, zinc deficiency, which is common after BS, may play an important role for taste change after BS. In this review, we aimto collate evidence relating to taste change and zinc deficiencyin relation to BS; effects of zinc replacement on taste perception in general and thereafter discuss the possible role of zinc deficiency to induce taste change after BS. A literature search was conducted, using four electronic bibliographical databases—EMBASE, PubMed, AMED and MEDLINE. We identified all available and relevant articles published before 30th February 2021.In total, 33 studies were included. The total number of participants analysed was N= 3264. We showed that taste change is a frequent complication after BS, especially after Roux-en-Y gastric bypass RYGBP comparing to other types of procedures. Patients' taste sensitivity differs among studies, but the most important decline in taste preference was observed for sweet food. Twelve studies investigating zinc deficiency following BS showed a significant decrease in zinc levels at six months after surgery. Supplementation with 45–50 mg of zinc sulphate was effective in improving taste, except in cancer patients, who showed no improvement in taste following zinc supplementation. Zinc deficiency appears to be associated with taste change after BS. Supplementation with much higher levels of zinc, at 45–50 mg, was effective in taste change treatment for many cases of taste disorder. The currently recommended levels of zinc replacements currently prescribed to patients following BS were not effective for avoiding zinc deficiency after BS—and thus not effective for averting taste change. It is therefore suggested that taste change following BS is closely related to zinc deficiency induced by the surgery.

Keywords: taste change, taste disorder, bariatric surgery, zinc, zinc sulphate or Zn, deficiency, supplementation, and micro-nutrient deficiencies

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Authors: Tamas Bezsenyi, Noemi Katona

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Fighting Human Trafficking is a highly important issue worldwide that states need to deal with in international politics. In the EU combatting human trafficking is emphasized in international policy making and also in the work of international law enforcement, thus in the work of the EUROPOL. While the EU Directive against Human Trafficking prescribes how states should fight this transnational crime and also how victims should be assisted, the EUROPOL focuses on the effective cooperation between national law enforcement agencies. However, despite the aims of the common fight, human trafficking is regulated differently in the punitive law of various nation states. This deeply defines the work and possibilities of national law enforcement organizations. Among the manifold differences in this paper, we focus on the role of regulating asset recovery. We highlight that money, and the regulation and practice how the law enforcement deals with income gained from criminal activities, play essential role in combatting human trafficking. While doing research on the investigation of transnational human trafficking by the Hungarian Law Enforcement Agencies, we have found that the unfortunate regulation of asset recovery determines the lower effectiveness of eliminating criminal organizations. While i.e. in the Netherlands confiscation of property takes place in an early stage of the criminal procedure, in Hungary it can be conducted only if money laundering is also assumed. Our presentation builds on the comparison of criminal procedures which we analyse based on criminal files and interviews with coworkers of the National Bureau of Investigation.

Keywords: human trafficking, law enforcement, asset recovery, organized crime

Procedia PDF Downloads 267

Authors: Fan Wei, Tang Yipeng

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The outbreak of COVID-19 in early 2020 has been raging around the world, which has severely affected people's work and life. In today's post-pandemic era, although the pandemic has been effectively controlled, people still need to maintain social distancing at all times to prevent the further spread of the virus. Based on this, social distancing in the context of the pandemic has aroused widespread attention from scholars. At present, most studies exploring the influencing factors of social distancing are studying the negative impact of social distancing on the physical and mental state of special groups from the inter-individual level, and their more focus on the forced complete social distancing during the severe period of the pandemic. Few studies have focused on the impact of social distancing on working groups in the post-pandemic era from the within-individual level. In order to explore this problem, this paper constructs a cross-level moderating model based on resource conservation theory from the perspective of psychological resources. A total of 81 subjects were recruited to fill in the three-stage questionnaires each day for 10 working days, and 661valid questionnaires were finally obtained. Through the empirical tests, the following conclusions were finally obtained: (1) At the within-individual level, daily social distancing is positively correlated with the second day’s recovery, and the individual’s low sociability regulates the relationship between social distancing and recovery. The indirect effect of daily social distancing through recovery has positive relationship employees’ work engagement and work-goal progress only when the individual has low sociability. For individuals with high sociability, none of these paths are significant. (2) At the within-individual level, there is a significant relationship between individual's recovery and work engagement and work-goal progress, indicating that the recovery of resources can produce positive work outcomes. According to the results, this study believes that in the post-pandemic era, social distancing can not only effectively prevent and control the pandemic but also have positive impacts. Employees can use the time and energy originally saved for social activities through social distancing to invest in things that can provide resources and help them recover.

Keywords: social distancing, recovery, work engagement, work goal progress, sociability

Procedia PDF Downloads 115

Authors: Ratna Farida Soenarto, Anas Alatas, Made Ryan Kharmayani

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Background: Conventional ultrafiltration (CUF) system was shown to be helpful in reducing anti-inflammatory mediators for patients who underwent open heart surgery. Additionally, modified ultrafiltration (MUF) has been shown to reduce anti-inflammatory mediators further while reducing interstitial fluid volume at the same time. However, there has been minimal data concerning the efficacy of combining both ultrafiltration methods. This study aims to compare inflammation marker, vascular resistance, and cardiac index on CUF+MUF patients with CUF only patients undergoing open heart surgery. Method: This is a single blind randomized controlled trial on patients undergoing open heart surgery between June 2021 - October 2021 in CiptoMangunkusumo National Referral Hospital and Jakarta Heart Hospital. Patients wererandomized using block randomization into modified ultrafiltration following conventional ultrafiltration (CUF+MUF) and conventional ultrafiltration (CUF) only. Outcome assessed in this study were 24-hoursinterleukin-6 levels, systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), and cardiac index. Results: A total of 38patients were included (19 CUF+MUF and 19 CUF subjects). There was no difference in postoperative IL-6 level between groups (p > 0.05).No difference in PVR was observed between groups.Higher difference in SVR was observed in CUF+MUF group (-646 vs. -261dyn/s/cm-5, p < 0.05). Higher cardiac index was observed on CUF+MUF group (0.93 vs. 0.48, p < 0.05). Conclusion: Patients undergoing open heart surgery with modified ultrafiltration following conventional ultrafiltration had similar systemic inflammatory response and better cardiac response than those having conventional ultrafiltration.

Keywords: open-heart, CUF, MUF, SVR, PVR, IL-6

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Authors: Franky Michael Hamonangan Siagian, Affan Maulana, Himawan Tri Bayu Murti Petrus, Widi Astuti

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In this study, the feasibility of the direct electrowinning method was used to produce zero-valent iron from red mud. The bauxite residue sample came from the Tayan mine, Indonesia, which contains high hematite (Fe₂O₃). Before electrolysis, the samples were characterized by various analytical techniques (ICP-AES, SEM, XRD) to determine their chemical composition and mineralogy. The direct electrowinning method of red mud suspended in NaOH was introduced at low temperatures ranging from 30 - 110 °C. Variations of current density, red mud: NaOH ratio and temperature were carried out to determine the optimum operation of the direct electrowinning process. Cathode deposits and residues in electrochemical cells were analyzed using XRD, XRF, and SEM to determine the chemical composition and current recovery. The low-temperature electrolysis current efficiency on Redmud can reach 20% recovery at a current density of 920,945 A/m². The moderate performance of the process was investigated with red mud, which was attributed to the troublesome adsorption of red mud particles on the cathode, making the reduction far less efficient than that with hematite.

Keywords: red mud, electrochemical reduction, Iron production, hematite

Procedia PDF Downloads 56

Authors: Ya-Yi Yen

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The operating room is a medical environment full of high-risk, high-complexity and high-cost. In addition to assuring patient safety, the operating room should effort on the efficient and safe medical quality for the surgical patients of high risk, elders, and children. If the nursing staffs of operation room carry on the pre-operative visiting prior to surgery, the patient's anxiety and complications are expected to be alleviated, and the hospitalization days may also be shortened. Purpose: Applying the information system to enhance pre-operative visiting, case tracking, and effectiveness recording Method: (I) Application the information system to screen cases by integrating the operation scheduling, and linking the severe surgery codes, for to shorten the time to track cases of operative visiting. Through the improvement, the time required decreased to 1.5 minutes per day from 20 minutes per day, and nursing staffs’ satisfaction with satisfaction for tracking and visiting procedure of case increased to 86% from 54%. (II)The electronic establishment of the operative visiting record enhanced the integrity of the operative visiting record. The integrity rate was rise to 92% from 66%, while nursing staffs’ satisfaction with the visiting record increased to 82% from 61.3%. Since information technology continues evolving, the application of information technology is helpful to the integration of nursing information, simplification of processes, and saving of man-hours. This article introduces the application of information systems to simplify the processes and improve the effectiveness of operation visiting and tracking, including the saving of time, improving the integrity rate of record, and improving the satisfaction of nursing staffs.

Keywords: effectiveness, information system, perioperative nursing, pre-operative visiting

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Authors: E. K. Hardwick, L. B. Siwela, J. G. Falconer, M. E. Mathibela, W. Rolfe

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Lithium-ion battery (LiB) demand has increased with the advancement in technologies. The applications include electric vehicles, cell phones, laptops, and many more devices. Typical components of the cathodes include lithium, cobalt, nickel, and manganese. Recycling the spent LiBs is necessary to reduce the ecological footprint of their production and use and to have a secondary source of valuable metals. A hydrometallurgical method was investigated for the recovery of cobalt and nickel from LiB cathodes. The cathodes were leached using a chloride solution. Ion exchange was then used to recover the chloro-complexes of the metals. The aim of the research was to determine the efficiency of a chloride leach, as well as ion exchange operating capacities that can be achieved for LiB recycling, and to establish the optimal operating conditions (ideal pH, temperature, leachate and eluant, flowrate, and reagent concentrations) for the recovery of the cathode metals. It was found that the leaching of the cathodes could be hindered by the formation of refractory metal oxides of cathode components. A reducing agent was necessary to improve the leaching rate and efficiency. Leaching was achieved using various chloride-containing solutions. The chloro-complexes were absorbed by the ion exchange resin and eluted to produce concentrated cobalt, nickel, lithium, and manganese streams. Chromatographic separation of these elements was achieved. Further work is currently underway to determine the optimal operating conditions for the recovery by ion exchange.

Keywords: cobalt, ion exchange, leachate formation, lithium-ion batteries, manganese, nickel

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Authors: Cesar Vazquez-Gonzalez, Sophie Avila-Foucat, Leonardo Ortiz-Lozano, Patricia Moreno-Casasola, Alejandro Granados-Barba

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In the last twenty years, academic and scientific literature has been focused on understanding the processes and factors of coastal social-ecological systems vulnerability and resilience. Some scholars argue that resilience and vulnerability are isolated concepts due to their epistemological origin, while others note the existence of a strong resilience-vulnerability relationship. Here we present an ordinal logistic regression model based on the analytical framework about dynamic resilience-vulnerability interaction along adaptive cycle of complex systems and disasters process phases (during, recovery and learning). In this way, we demonstrate that 1) during the disturbance, absorptive capacity (resilience as a core of attributes) and external response capacity explain the probability of households capitals to diminish the damage, and exposure sets the thresholds about the amount of disturbance that households can absorb, 2) at recovery, absorptive capacity and external response capacity explain the probability of households capitals to recovery faster (resilience as an outcome) from damage, and 3) at learning, adaptive capacity (resilience as a core of attributes) explains the probability of households adaptation measures based on the enhancement of physical capital. As a result, during the disturbance phase, exposure has the greatest weight in the probability of capital’s damage, and households with absorptive and external response capacity elements absorbed the impact of floods in comparison with households without these elements. At the recovery phase, households with absorptive and external response capacity showed a faster recovery on their capital; however, the damage sets the thresholds of recovery time. More importantly, diversity in financial capital increases the probability of recovering other capital, but it becomes a liability so that the probability of recovering the household finances in a longer time increases. At learning-reorganizing phase, adaptation (modifications to the house) increases the probability of having less damage on physical capital; however, it is not very relevant. As conclusion, resilience is an outcome but also core of attributes that interacts with vulnerability along the adaptive cycle and disaster process phases. Absorptive capacity can diminish the damage experienced by floods; however, when exposure overcomes thresholds, both absorptive and external response capacity are not enough. In the same way, absorptive and external response capacity diminish the recovery time of capital, but the damage sets the thresholds in where households are not capable of recovering their capital.

Keywords: absorptive capacity, adaptive capacity, capital, floods, recovery-learning, social-ecological systems

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Authors: Takaaki Nemoto

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Case presentation: A 69-year-old Japanese man presented with a low-grade fever and fatigue that had persisted for one month. The patient had an aortic dissection on the aortic arch 13 years prior, an abdominal aortic aneurysm seven years prior, and an aortic dissection on the distal aortic arch one year prior, which were all treated with artificial blood-vessel replacement surgery. Laboratory tests revealed an inflammatory response (CRP 7.61 mg/dl), high serum creatinine (Cr 1.4 mg/dL), and elevated transaminase (AST 47 IU/L, ALT 45 IU/L). The patient was admitted to our hospital on suspicion of prosthetic vascular graft infection. Following further workups on the inflammatory response, an enhanced chest computed tomography (CT) and a non-enhanced chest DWI (MRI) were performed. The patient was diagnosed with a pulmonary fistula and a prosthetic vascular graft infection on the distal aortic arch. After admission, the patient was administered Ceftriaxion and Vancomycine for 10 days, but his fever and inflammatory response did not improve. On day 13 of hospitalization, a lung fistula repair surgery and an omental filling operation were performed, and Meropenem and Vancomycine were administered. The fever and inflammatory response continued, and therefore we took repeated blood cultures. M. fortuitum was detected in a blood culture on day 16 of hospitalization. As a result, we changed the treatment regimen to Amikacin (400 mg/day), Meropenem (2 g/day), and Cefmetazole (4 g/day), and the fever and inflammatory response began to decrease gradually. We performed a test of sensitivity for Mycobacterium fortuitum, and found that the MIC was low for fluoroquinolone antibacterial agent. The clinical course was good, and the patient was discharged after a total of 8 weeks of intravenous drug administration. At discharge, we changed the treatment regimen to Levofloxacin (500 mg/day) and Clarithromycin (800 mg/day), and prescribed these two drugs as a long life suppressive therapy. Discussion: There are few cases of prosthetic vascular graft infection caused by mycobacteria, and a standard therapy remains to be established. For prosthetic vascular graft infections, it is ideal to provide surgical and medical treatment in parallel, but in this case, surgical treatment was difficult and, therefore, a conservative treatment was chosen. We attempted to increase the treatment success rate of this refractory disease by conducting a susceptibility test for mycobacteria and treating with different combinations of antimicrobial agents, which was ultimately effective. With our treatment approach, a good clinical course was obtained and continues at the present stage. Conclusion: Although prosthetic vascular graft infection resulting from mycobacteria is a refractory infectious disease, it may be curative to administer appropriate antibiotics based on the susceptibility test in addition to surgical treatment.

Keywords: prosthetic vascular graft infection, lung fistula, Mycobacterium fortuitum, conservative treatment

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Authors: Vijayendra Anil Menon, Ashwath Narayan Murali

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The present day vehicles do not reuse the energy expelled in running the vehicle. The energy used to run the vehicle is expelled immediately.This has remained a constant for many decades. With all the vehicles running on non-renewable resources like fossil fuels, there is an urgent need to improve efficiency of the vehicles until a reliable replacement for fossil fuels is found.Our design is based on the concept of Kinetic energy recovery systems. Though our design lies in principle with the KERS, our design can be used in day-to-day driving. With our design, efficiency of vehicles increases and fuel conservation is possible thereby reducing the carbon footprint.

Keywords: KERS, Battery, Wheels, Efficiency.

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Authors: Hyun June Kim, Tailong Shi, Seden Akdagli, Sam Most, Yuling Yan

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Quantitative analysis of mouse whisker movement can be used to study functional recovery and regeneration of facial nerve after an injury. However, it is challenging to accurately track mouse whisker movements, and most whisker tracking methods require manual intervention, e.g. fixing the head of the mouse during a study. Here we describe a semi-automated image processing method that is applied to high-speed video recordings of free-moving mice to track whisker movements. We first track the head movement of a mouse by delineating the lower head contour frame-by-frame to locate and determine the orientation of its head. Then, a region of interest is identified for each frame, with subsequent application of the Hough transform to track individual whisker movements on each side of the head. Our approach is used to examine the functional recovery of damaged facial nerves in mice over a course of 21 days.

Keywords: mystacial macrovibrissae, whisker tracking, head tracking, facial nerve recovery

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Authors: Z. Herceg, V. Stulic, T. Vukusic, A. Rezek Jambrak

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High voltage electrical discharge plasmas are new nonthermal developing techniques used for water decontamination. To the full understanding of cell inactivation mechanisms, this study brings inactivation, recovery and cellular leakage of L. innocua cells before and after the treatment. Bacterial solution (200 mL) of L. innocua was treated in a glass reactor with a point-to-plate electrode configuration (high voltage electrode-titanium wire, was in the gas phase and grounded electrode was in the liquid phase). Argon was injected into the headspace of the reactor at the gas flow of 5 L/min. Frequency of 60, 90 and 120 Hz, time of 5 and 10 min, positive polarity and conductivity of media of 100 µS/cm were chosen to define listed parameters. With a longer treatment time inactivation was higher as well as the increase in cellular leakage. Despite total inactivation recovery of cells occurred probably because of a high leakage of proteins, compared to lower leakage of nucleic acids (DNA and RNA). In order to define mechanisms of inactivation further research is needed.

Keywords: Listeria innocua ATCC 33092, inactivation, gas phase plasma, cellular leakage, recovery of cells

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Authors: Sui Yan Wong, Keat Ping Yeoh, Chi Wai Hui

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In this study, supercritical steam is introduced to Combined Cycle Power Plant (CCPP) in an attempt to further optimize energy recovery. Subcritical steam is commonly used in the CCPP, operating at maximum pressures around 150-160 bar. Supercritical steam is an alternative to increase heat recovery during vaporization period of water. The idea of improvement using supercritical steam is further examined with the use of exergy, pinch analysis and Aspen Plus simulation.

Keywords: exergy, pinch, combined cycle power plant, supercritical steam

Procedia PDF Downloads 127

Authors: Estelle Démoulin, Dionysios Adamopoulos, Tornike Sologashvili, Mathieu Van Steenberghe, Jalal Jolou, Haran Burri, Christoph Huber, Mustafa Cikirikcioglu

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Background & objective: Mitral valve surgeries are mainly performed by median sternotomy with conventional direct atriotomy. Good exposure to the mitral valve is challenging, especially for acute pathologies, where left atrium dilation does not occur. Other atriotomies, such as transseptal or superior septal, are used as they allow better access and visualization. Peri- and postoperative outcomes of these three different left atriotomies were compared. Methods: Patients undergoing mitral valve surgery between January 2010 and December 2020 were included and divided into three groups: group 1 (conventional direct, n=115), group 2 (transseptal, n=33) and group 3 (superior septal, n=59). To improve the sampling size, all patients underwent mitral valve surgery with or without associated procedures (CABG, aortic-tricuspid surgery, Maze procedure). The study protocol was approved by SwissEthics. Results: No difference was shown for the etiology of mitral valve disease, except endocarditis, which was more frequent in group 3 (p = 0.014). Elective surgeries and isolated mitral valve surgery were more frequent in group 1 (p = 0.008, p = 0.011) and aortic clamping and cardiopulmonary bypass were shorter (p = 0.002, p<0.001). Group 3 had more emergency procedures (p = 0.011) and longer lengths of intensive care unit and hospital stay (p = 0.000, p = 0.003). There was no difference in permanent pacemaker implantation, postoperative complications and mortality between the groups. Conclusion: Mitral valve surgeries can be safely performed using those three left atriotomies. Conventional direct may lead to shorter aortic clamping and cardiopulmonary bypass times. Superior septal is mostly used for acute pathologies, and it does not increase postoperative arrhythmias and permanent pacemaker implantation. However, intensive care unit and hospital lengths of stay were found to be longer in this group. In our opinion, this outcome is more related to the pathology and type of surgery than the incision itself.

Keywords: Mitral valve surgery, cardiac surgery, atriotomy, Operative outcomes

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Authors: Homoud Bourisli, Haitham Safar

Abstract:

Oil is one of main resources of energy in the world. As conventional oil is drying out, oil recovery is crucial to maintain the same level of oil production. Since water injection is one of the commonly used methods to increase and maintain pressure in oil wells, oil-water separation processes of the water associated with oil production for water injection oil recovery is very essential. Therefore, Gas Flotation Units are used for oil-water separation to be able to re-inject the treated water back into the wells to increase pressure.

Keywords: Kuwait oil company, dissolved gas flotation unit, induced gas flotation unit, oil-water separation

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Authors: Nidhi S. Bisht

Abstract:

The study examines the role of work-home interference, on enhancing emotional exhaustion in the branch officers of private MFIs in India. Additionally, the moderating role of recovery experiences and technology-assisted supplemental work (TASW) were studied. With the increasing expectations to perform job related tasks at home, technology-assisted supplemental work (TASW) was hypothesized to positively moderate the relationship between work-home interference and emotional exhaustion. Further, it was expected that recovery experiences-psychological detachment, relaxation will help to recover and unwind from work and negatively moderate the relationship between work-home interference and emotional exhaustion. Results of SEM-analyses largely offered support for the hypotheses. These findings increase our insight in the processes leading to increased emotional exhaustion and suggest that employees can protect themselves from emotional exhaustion by keeping a tab on technology-assisted supplemental work and facilitating recovery experiences.

Keywords: emotional exhaustion, India, microfinance institutions (MFIs), work-home interference

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Authors: Yun-Tsuen Chen, Shih-Ting Huang, Pi-Fen Cheng, Heng-Hua Wang, Hui-Zhu Chen

Abstract:

This paper discusses the experience of caring for a patient diagnosed with breast cancer and later received total mastectomy during a 2nd trimester pregnancy. She was hospitalized from January 31 to February 4, 2018. Using 'Gordon’s 11 Functional Health Patterns' through physical exams and interviews, the researcher assessed the patient’s physical and mental health and determined the patient to have anxiety, acute pain, and body image disturbance. After establishing a strong relationship with the patient, the researcher helped the patient express her anxiety and personal feelings. A multi-specialist team was formed to evaluate both the patient and her unborn child, before, during, and after surgery. This individualized care allowed the patient and her child to optimize the post-operative results. Aside from medication, the patient also received non-medicinal treatment, including improvement of sleep quality with body positioning, diaphragmatic breathing exercises for pain and stress relief after surgery. Throughout hospitalization, the patient’s physical and emotional needs were addressed daily with listening sessions and empathy. The patient’s husband was also incorporated in the patient’s recovery by teaching both he and the patient how to change the sterile wound dressing, which may have the added benefit of improving marital relationships through shared activities of nurturing. The patient was also given advice about how to improve self-confidence through clothing. Lastly, the patient was encouraged to join a support group for breast cancer patients. Through the sharing of experience in groups and within the family, the patient was helped to adapt to the change of her appearance and re-establish her self-confidence. This level of care expedited the patient’s return to her family life and role of being a mother.

Keywords: anxiety, body image disturbance, breast cancer during pregnancy, multi-specialist team

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Authors: Hakan Duger, Alparslan Ersoy, Canan Ersoy

Abstract:

The improvement of surgical techniques in recent years has reduced the frequency of postoperative complications in kidney transplant recipients. Novel immunosuppressive agents have reduced rates of graft loss due to acute rejection to less than 1%. However, surgical complications may still lead graft loss and morbidity in recipients. Because of potent immunosuppression, impaired wound healing and complications are frequent after transplantation. We compared the frequency of post-operative surgical complications in diabetic and non-diabetic patients after kidney transplantation. Materials and Methods: This retrospective study conducted in consecutive patients (213 females, 285 males, median age 39 years) who underwent kidney transplant surgery at our center between December 2005 and October 2015. The patients were divided into two groups: diabetics (46 ± 10 year, 26 males, 16 females) and non-diabetics (39 ± 12 year, 259 males, 197 females). Characteristics of both groups were obtained from medical records. Results: We performed 225 living and 273 deceased donor transplantations. Renal replacement type was hemodialysis in 60.8%, peritoneal dialysis in 17.3% and preemptive in 12%. The mean body mass indexes of the recipients were 24 ± 4.6 kg/m², donor age was 48.6 ± 14.3 years, cold ischemic time was 11.3 ± 6.1 hours, surgery time was 4.9 ± 1.2 hours, and recovery time was 54±31 min. The mean hospitalization duration was 19.1 ± 13.5 days. The frequency of postoperative surgical complications was 43.8%. There was no significant difference between the ratios of post-operative surgical complications in non-diabetic (43.5%) and diabetic (47.4%) groups (p=0.648). Post-operative surgical complications were lymphocele (24.6% vs. 23.7%), delayed wound healing (13.2% vs. 7.6%), hematoma (7.8% vs.15.8 %), urinary leak (4.6% vs. 5.3%), hemorrhage (5.1% vs. 0%), hydronephrosis (2.2% vs. 0%), renal artery thrombosis (1.5% vs. 0%), renal vein thrombosis (1% vs. 2.6%), urinoma (0.7% vs. 0%), urinary obstruction (0.5% vs. 0%), ureteral stenosis (0.5% vs. 0%) and ureteral reflux (0.2% vs. 0%) in non-diabetic and diabetic groups, respectively (p > 0.05). Mean serum creatinine levels in non-diabetics and diabetics were 1.43 ± 0.81 and 1.61 ± 0.96 mg/dL at 1st month (p=0.198). At the 6th month, the mean graft and patient survival times in patients with post-operative surgical complications were significantly lower than in those who did not (162.9 ± 3.4 vs. 175.6 ± 1.5 days, p=0.008, and 171 ± 2.9 vs. 176.1 ± 1.6 days, p=0.047, respectively). However, patient survival durations of non-diabetic (173 ± 27) and diabetic (177 ± 13 day) groups were comparable (p=0.396). Conclusion: As a result, we concluded that surgical complications such as lymphocele and delayed wound healing were common and that frequency of these complications in diabetic recipients did not differ from non-diabetic one. All persons involved in the postoperative care of kidney transplant recipients be aware of the potential surgical complications for rapid diagnosis and treatment.

Keywords: kidney transplantation, diabetes mellitus, surgery, complication

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Authors: Franky Michael Hamonangan Siagian, Affan Maulana, Himawan Tri Bayu Murti Petrus, Panut Mulyono, Widi Astuti

Abstract:

In this study, the feasibility of the direct electrowinning method was used to produce zero-valent iron from red mud. The bauxite residue sample came from the Tayan mine, Indonesia, which contains high hematite (Fe₂O₃). Before electrolysis, the samples were characterized by various analytical techniques (ICP-AES, SEM, XRD) to determine their chemical composition and mineralogy. The direct electrowinning method of red mud suspended in NaOH was introduced at low temperatures ranging from 30 - 110 °C. Variations of current density, red mud: NaOH ratio and temperature were carried out to determine the optimum operation of the direct electrowinning process. Cathode deposits and residues in electrochemical cells were analyzed using XRD, XRF, and SEM to determine the chemical composition and current recovery. The low-temperature electrolysis current efficiency on Redmud can reach 20% recovery at a current density of 920,945 A/m². The moderate performance of the process was investigated with red mud, which was attributed to the troublesome adsorption of red mud particles on the cathode, making the reduction far less efficient than that with hematite.

Keywords: alumina, red mud, electrochemical reduction, iron production

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Authors: T. Malmir, U. Eicker

Abstract:

Landfilling of organic waste is still the predominant waste management method in the USA and Canada. Strategic plans for waste diversion from landfills are needed to increase material recovery and energy generation from waste. In this paper, we carried out a statistical survey on waste flow in the two cities New York and Montréal and estimated the energy recovery potential for each case. Data collection and analysis of the organic waste (food waste, yard waste, etc.), paper and cardboard, metal, glass, plastic, carton, textile, electronic products and other materials were done based on the reports published by the Department of Sanitation in New York and Service de l'Environnement in Montréal. In order to calculate the gas generation potential of organic waste, Buswell equation was used in which the molar mass of the elements was calculated based on their atomic weight and the amount of organic waste in New York and Montréal. Also, the higher and lower calorific value of the organic waste (solid base) and biogas (gas base) were calculated. According to the results, only 19% (598 kt) and 45% (415 kt) of New York and Montréal waste were diverted from landfills in 2017, respectively. The biogas generation potential of the generated food waste and yard waste amounted to 631 million m³ in New York and 173 million m³ in Montréal. The higher and lower calorific value of food waste were 3482 and 2792 GWh in New York and 441 and 354 GWh in Montréal, respectively. In case of yard waste, they were 816 and 681 GWh in New York and 636 and 531 GWh in Montréal, respectively. Considering the higher calorific value, this amount would mean a contribution of around 2.5% energy in these cities.

Keywords: energy recovery, organic waste, urban energy modelling with INSEL, waste flow

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Authors: Zhenyu Zhang, Hsi-Hsien Wei

Abstract:

Highway networks play a vital role in post-disaster recovery for disaster-damaged areas. Damaged bridges in such networks can disrupt the recovery activities by impeding the transportation of people, cargo, and reconstruction resources. Therefore, rapid restoration of damaged bridges is of paramount importance to long-term disaster recovery. In the post-disaster recovery phase, the key to restoration scheduling for a highway network is prioritization of bridge-repair tasks. Resilience is widely used as a measure of the ability to recover with which a network can return to its pre-disaster level of functionality. In practice, highways will be temporarily blocked during the downtime of bridge restoration, leading to the decrease of highway-network functionality. The failure to take downtime effects into account can lead to overestimation of network resilience. Additionally, post-disaster recovery of highway networks is generally divided into emergency bridge repair (EBR) in the response phase and long-term bridge repair (LBR) in the recovery phase, and both of EBR and LBR are different in terms of restoration objectives, restoration duration, budget, etc. Distinguish these two phases are important to precisely quantify highway network resilience and generate suitable restoration schedules for highway networks in the recovery phase. To address the above issues, this study proposes a novel resilience quantification method for the optimization of long-term bridge repair schedules (LBRS) taking into account the impact of EBR activities and restoration downtime on a highway network’s functionality. A time-dependent integer program with recursive functions is formulated for optimally scheduling LBR activities. Moreover, since uncertainty always exists in the LBRS problem, this paper extends the optimization model from the deterministic case to the stochastic case. A hybrid genetic algorithm that integrates a heuristic approach into a traditional genetic algorithm to accelerate the evolution process is developed. The proposed methods are tested using data from the 2008 Wenchuan earthquake, based on a regional highway network in Sichuan, China, consisting of 168 highway bridges on 36 highways connecting 25 cities/towns. The results show that, in this case, neglecting the bridge restoration downtime can lead to approximately 15% overestimation of highway network resilience. Moreover, accounting for the impact of EBR on network functionality can help to generate a more specific and reasonable LBRS. The theoretical and practical values are as follows. First, the proposed network recovery curve contributes to comprehensive quantification of highway network resilience by accounting for the impact of both restoration downtime and EBR activities on the recovery curves. Moreover, this study can improve the highway network resilience from the organizational dimension by providing bridge managers with optimal LBR strategies.

Keywords: disaster management, highway network, long-term bridge repair schedule, resilience, restoration downtime

Procedia PDF Downloads 131