Search results for: lower mekong river basin

Authors: S. Altmeyer, B. Hof, F. Marques, J. M. Lopez

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We present numerical simulations concerning the reversal of spiraling vortices in short highly counter-rotating cylinders. Increasing the differential cylinder rotation results in global flow-inversion is which develops various different and complex flow dynamics of several quasi-periodic solutions that differ in their number of vortex cells in the bulk. The dynamics change from being dominated of the inner cylinder boundary layer with ’passive’ only responding outer one to be dominated by the outer cylinder boundary layer with only responding inner one. Solutions exist on either two or three tori invariant manifolds whereby they appear as symmetric or asymmetric states. We find for either moderate and high inner cylinder rotation speed the quasiperiodic flow to consist of only two vortex cells but differ as the vortices has opposite spiraling direction. These both flows live on 2-tori but differ in number of symmetries. While for the quasi-periodic flow (q^a_2) at lower rotation speed a pair of symmetrically related 2-tori T2 exists the quasi-periodic flow (q^s_2) at higher rotation speeds is symmetric living on a single 2-torus T2. In addition these both flows differ due to their dominant azimuthal m modes. The first is dominated by m=1 whereas for the latter m=3 contribution is largest. The 2-tori states are separated by a further quasi-periodic flow (q^a_3) living on pair of symmetrically related 3-tori T3. This flow offers a ’periodical’ competition between a two and three vortex cell states in the bulk. This flow is also an m=1 solution as for the quasiperiodic flows living on the pair of symmetrically-related 2-tori states. Moreover we find hysteresis resulting in coexisting regions of different quasiperiodic flows q^s_2 and q^a_3 with increasing and decreasing the differential rotation.

Keywords: transition, bifurcation, torus, symmetries

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Authors: Pedro Cabrales, Scott Caroen, Tony R. Reid, Bryan Oronsky

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Introduction and Purpose RRx-001 is an NLRP3 inhibitor and Nrf2 agonist in Phase 3 trials for the treatment of cancer. The purpose of this study was to examine whether treatment with RRx-001, given itsanti-inflammatory and antioxidant properties, improvedexercise and skeletal muscle oxidative capacity in mice on the generalpremiss that better health outcomes correlatewith more activity. Material and Methods Male and female adult mice (n=6 per group) were subjected to an endurance exercise capacity (EEC)test until exhaustion on a motorized treadmill after 3 once weekly doses of either RRx-001 5 mg/kg, RRx-001 2 mg/kg, or vehicle. The EEC protocol consisted of a treadmill velocity of 30meters per min at an uphill inclination (slope of 10%) until the mice reached fatigue, which was defined as the inability of the mice to maintain the appropriate pace despitecontinuous hand stimulation for 1 min. The concentration of malondialdehyde (MDA), an indicator of lipid peroxidation, and creatine kinase (CK), an indicator of muscle damage, in the blood samples collected immediately after the acute exercise was determined with a commercial ELISA assay kit. ResultsThe exhaustive exercise times of the RRx-001 groups were significantly longer than that of the vehicle group (p<0.05) by weeks 2 and 3. In addition, MDA levels in the gastrocnemius, soleus, and extensor digitorum longus muscles were significantly lower than those of the vehicle group were (p<0.05), as were the serum CK levels(p<0.05). ConclusionsIn conclusion, this study found that RRx-001 has anti-fatigue properties, as evidenced by an increase in exercise capacity with RRx-001 treatment, and protects against strenuous exercise-induced muscle damage and lipid peroxidation. This data potentially supports the use of RRx-001 in the clinic to improve exercise performance and reduce physical fatigue.

Keywords: RRx-001, anti-fatigue, muscle protection, increased exercise tolerance, lipid peroxidation

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Authors: Seyede Sanaz Seyedebrahimi, Shima Rahimi, Shohreh Fakhari, Ali Jalili

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Background: CXCR4, as a chemokine receptor, plays well-known roles in various types of cancers. Several studies have been conducted to overcome CXCR4 axis acts in multiple myeloma (MM) pathogenesis and progression. Dexamethasone, a standard treatment for multiple myeloma, has been shown to increase CXCR4 levels in multiple myeloma cell lines. Herein, we focused on the effects of metformin and dexamethasone on CXCR4 at the cellular level and the migration rate of cell lines after exposure to a combination compared to single-agent models. Materials and Method: Multiple myeloma cell lines (U266 and RPMI8226) were cultured with different metformin and dexamethasone concentrations in single-agent and combination models. The simultaneous combination doses were calculated by CompuSyn software. Cell surface and mRNA expression of CXCR4 were determined using flow cytometry and the quantitative reverse transcription-polymerase chain reaction (qRT-PCR) assay, respectively. The Transwell cell migration assay evaluated the migration ability. Results: In concurred with previous studies, our results showed a dexamethasone up-regulation effect on CXCR4 in a dose-dependent manner. Although, the metformin single-agent model could reduce CXCR4 expression of U266 and RPMI8226 in cell surface and mRNA expression level. Moreover, the administration of metformin and dexamethasone simultaneously exerted a higher suppression effect on CXCR4 expression than the metformin single-agent model. The migration rate through the combination model's matrigel membrane was remarkably lower than the metformin and dexamethasone single-agent model. Discussion: According to our findings, the combination of metformin and dexamethasone effectively inhibited dexamethasone-induced CXCR4 expression in multiple myeloma cell lines. As a result, metformin may be counted as an alternative medicine combined with other chemotherapies to combat multiple myeloma. However, more research is required.

Keywords: CXCR4, dexamethasone, metformin, migration, multiple myeloma

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Authors: Chetan Gupta, Ramesh Gupta

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Unmanned aerial vehicles, of all sizes, are prime targets of the wing morphing concept as their lightweight structures demand high aerodynamic stability while traversing unsteady atmospheric conditions. In this research study, a hybrid morphing technology is developed to aid the trailing edge of the aircraft wing to alter its camber as a monolithic element rather than functioning as conventional appendages like flaps. Kinematic tailoring, actuation techniques involving shape memory alloys (SMA), piezoelectrics – individually fall short of providing a simplistic solution to the conundrum of morphing aircraft wings. On the other hand, the feature of negligible hysteresis while actuating using compliant mechanisms has shown higher levels of applicability and deliverability in morphing wings of even large aircrafts. This research paper delves into designing a wing section model with a periodic, multi-stable compliant structure requiring lower orders of topological optimization. The design is sub-divided into three smaller domains with external hyperelastic connections to achieve deflections ranging from -15° to +15° at the trailing edge of the wing. To facilitate this functioning, a hybrid actuation system by combining the larger bandwidth feature of piezoelectric macro-fibre composites and relatively higher work densities of shape memory alloy wires are used. Finite element analysis is applied to optimize piezoelectric actuation of the internal compliant structure. A coupled fluid-surface interaction analysis is conducted on the wing section during morphing to study the development of the velocity boundary layer at low Reynold’s numbers of airflow.

Keywords: compliant mechanism, hybrid morphing, piezoelectrics, shape memory alloys

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Authors: Eric Noe Hernandez Rodriguez, Cristian Esneider Penuela Cruz

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Magnesium is a biocompatible and biodegradable material that has gained increased interest for application in resorbable orthopedic implants. However, to date, much research is being conducted to overcome the main disadvantage: its low corrosion resistance. In this work, we report our findings on the development and application of TiO₂-MgO coatings to improve and modulate the corrosion resistance of magnesium pieces. The plasma electrolytic oxidation (PEO) technique was employed to obtain the TiO₂-MgO coatings. The effect of the experimental parameters on the modulation of the TiO₂:MgO ratio was investigated. The most critical parameters were the chemical composition of the precursor electrolytic solution and the current density. According to scanning electron microscopy (SEM) observations, the coatings were porous; however, they become more compact as the current density increases. XRD measurements showed that the coatings are formed by a composite consisting of TiO₂ and MgO oxides, whose ratio can be changed by the experimental conditions. TiO₂ had the anatase crystalline structure, while the MgO had the FCC crystalline structure. The corrosion resistance was evaluated through the corrosion current (Icorr) measured at room temperature by the polarization technique (Tafel). For doing it, Hank's solution was used in order to simulate the body fluids. Also, immersion tests were conducted. Tafel curves showed an improvement of the corrosion resistance at some coated magnesium pieces in contrast to control pieces (uncoated). Corrosion currents were lower, and the corrosion potential changed to positive values. It was observed that the experimental parameters allowed to modulate the protective capacity of the coatings by changing the TiO₂:MgO ratio. Coatings with a higher content of TiO₂ (measured by energy dispersive spectroscopy) showed higher corrosion resistance. Results showed that TiO₂-MgO coatings can be successfully applied to improve the corrosion resistance of Mg pieces in simulated body fluid; even more, the corrosion resistance can be tuned by changing the TiO₂:MgO ratio.

Keywords: biomaterials, PEO, corrosion resistance, magnesium

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Authors: Mohammed H. Karim, Bestoon M. Faraj

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Introduction: This study aimed to compare the effectiveness of a Dynamic Navigation System (DNS) and a three-dimensional microscope in retrieving broken rotary NiTi files when using trepan burs and the extractor system. Materials and Methods: Thirty maxillary first bicuspids with sixty separate roots were split into two comparable groups based on a comprehensive Cone-Beam Computed Tomography (CBCT) analysis of the root length and curvature. After standardized access opening, glide paths, and patency attainment with the K file (sizes 10 and 15), the teeth were arranged on 3D models (three per quadrant, six per model). Subsequently, controlled-memory heat-treated NiTi rotary files (#25/0.04) were notched 4 mm from the tips and fractured at the apical third of the roots. The C-FR1 Endo file removal system was employed under both guidance to retrieve the fragments, and the success rate, canal aberration, treatment time and volumetric changes were measured. The statistical analysis was performed using IBM SPSS software at a significance level of 0.05. Results: The microscope-guided group had a higher success rate than the DNS guidance, but the difference was insignificant (p > 0.05). In addition, the microscope-guided drills resulted in a substantially lower proportion of canal aberration, required less time to retrieve the fragments and caused minimal change in the root canal volume (p < 0.05). Conclusion: Although dynamically guided trephining with the extractor can retrieve separated instruments, it is inferior to three-dimensional microscope guidance regarding treatment time, procedural errors, and volume change.

Keywords: separated instruments retrieval, dynamic navigation system, 3D video microscope, trephine burs, extractor

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Authors: Dada. O.Akinola, Uche. I. Ebele, Bamiro .A.Rafatu, Akinbami A. Akinsegun, Dada O. Adeyemi, Adeyemi. O. Ibukun, Okunowo O.Bolanle, Abdulateef O. Kareem, Ibrahim.N. Ismaila, Dosu Rihanat

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Background: Hyperglycaemia alters qualitatively and quantitatively all the full blood count parameters. The alterations among other factors are responsible for the macrovascular and microvascular complications associated with diabetes mellitus (DM). This study is aimed at correlating haematological parameters in DM subjects with their fasting blood glucose (FBG) and anthropometric parameters. Materials and Methods: This was a cross-sectional study of participants attending DM clinic of Lagos State University Teaching Hospital (LASUTH), Ikeja. The study recruited one hundred and two (102) DM subjects and one hundred (100) non-DM controls. Venous blood samples were collected for full blood count (FBC) assay while FBG was done, structured questionnaires were administered, and anthropometric measurements of all participants were done. Data were analyzed with Statistical Package for Social Science (SPSS) version 23. P was set at ≤0.05. Results: The mean age of DM patients was 64.32± 11.31 years. Using a haemoglobin concentration cut-off of 11g/dl, 39.2%, and 13% DM and control participants respectively had values lower than 11g/dl. A total of 22.5% and 3% of DM and controls respectively gave a history of previous blood transfusion.White blood cells count and platelet count means were (6.12±1.60 and 5.30±7.52,p=0.59) and (213.31±73.58 and 228.91±73.21,p = 0.26) *109/L in DM subjects and controls respectively. FBG and all the anthropometric data in DM subjects were significantly higher than in controls. Conclusions: The prevalence of anaemia in DM subjects was three times higher than in controls. The white blood cell count was higher but not statistically significant in DM compared with controls. But platelet count was higher but not statistically significant in controls compared with DM subjects.

Keywords: haematological profile, diabetes mellitus, anthropometric data, fasting blood glucose

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Authors: Ali Kassem, Mohamed Alsenbasy, Ahmed Nagaah

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Background: Diabetic foot is one of the often neglected complications of diabetes mellitus It was reported that patients of diabetic foot ulcer (DFU) have considerable morbidity and mortality. Due to arterial abnormalities, diabetic neuropathy, as well as the tendency to delayed wound healing, foot infection and or gangrene is relatively common in diabetic patients. Foot related problems are responsible for up to 50% of diabetic related hospital admissions. Aim of work: The aim of the present study is to assess the risk factors for DFU in diabetic patients attending Sohag University Hospitals (Upper Egypt) Material and methods: The present study includes 100 diabetic foot patients attending the diabetic outpatient clinic of Sohag University Hospitals. For all of the studied patients the following were done: Full medical history and clinical examination; thorough foot examination; Laboratory tests including: Blood glucose level, HBA1c, serum lipids and renal function tests, ECG and Echocardiography, Doppler study on the lower limbs. Results: Sixty eight percent of the affected patients were males versus 32 % female patients. All male patients and none of the female were smoker. Seventy nine percent of patients were living in rural areas versus 14 % in urban areas. Duration of diabetes was more than 12 years in 74%, less than 12 years in 26% of patients. Fifty percent of patients have associated hypertension, 46% have dyslipidemia, 18% have ischemic heart disease or old myocardial infarction and 8% have impaired renal function. History of previous foot ulcers was reported in 11 % and foot amputation in 2% of patients. Conclusion: Male gender, low socioeconomic status, smoking, long duration of diabetes, other cardiovascular risk factors particularly hypertension and previous history of foot ulceration are the major risk factors for diabetic foot in our locality.

Keywords: diabetic foot, diabetic neuropathy, foot gangrene, risk factors for diabetic complications

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Authors: E. Bittar, A. Quiñonez, F. Mencia, E. Aguero, M. Delgado, V. Arriola, R. López

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In the western region of Paraguay, the poor condition of the roads has negatively affected the development of this zone, where the absence of petrous material has led engineers to opt for the stabilization of soils with lime or cement as the main structure for bases and subbases of these roads. In several areas of this region, high sulfate contents have been found both in groundwater and in soils, which, when reacted with lime or cement, generate a new problem instead of solving it. On the other hand, the use of industrial waste as granulated slag and fly ash proved to be a sustainable practice widely used in the manufacture of cement, and now also, in the stabilization of soils worldwide. Works related to soils containing sulfates stabilized either with granulated slag or fly ash and lime shown a good performance in their mechanical behaviour. This research seeks to evaluate the mechanical behaviour of soils with high contents of sulfates stabilized with lime by curing them both, at the normalized temperature (23 ± 2 °C) and at 40 ± 2 °C. Moreover, it attempts to asses if the addition of rice husk ash has a positive influence on the new geomaterial. The 40 ± 2 °C curing temperature was selected trying to simulate the average local temperature in summer and part of spring session whereas rice husk ash is an affordable waste produced in the region. An extensive experimental work, which includes unconfined compression, durability and free swell tests were carried out considering different dry unit weights, lime content and the addition of 20% of rice husk ash. The results showed that the addition of rice husk ash increases the resistance and durability of the material and decreases the expansion of this, moreover, the specimens cured at a temperature of 40 ± 2 °C showed higher resistance, better durability and lower expansion compared to those cured at the normalized temperature of 23 ± 2 °C.

Keywords: durability, expansion, lime stabilization, rice husk ash, sulfate

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Authors: Maria C. Proença, Maria T. Rebelo, Maria J. Alves, Sofia Cunha

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Vector-borne diseases are transmitted to humans by mosquitos, sandflies, bugs, ticks, and other vectors. Some are re-transmitted between vectors, if the infected human has a new contact when his levels of infection are high. The vector is infected for lifetime and can transmit infectious diseases not only between humans but also from animals to humans. Some vector borne diseases are very disabling and globally account for more than one million deaths worldwide. The mosquitoes from the complex Culex pipiens sl. are the most abundant in Portugal, and we dispose in this moment of a data set from the surveillance program that has been carried on since 2006 across the country. All mosquitos’ species are included, but the large coverage of Culex pipiens sl. and its importance for public health make this vector an interesting candidate to assess risk of disease amplification. This work focus on ports and airports identified as key areas of high density of vectors. Mosquitoes being ectothermic organisms, the main factor for vector survival and pathogen development is temperature. Minima and maxima local air temperatures for each area of interest are averaged by month from data gathered on a daily basis at the national network of meteorological stations, and interpolated in a geographic information system (GIS). The range of temperatures ideal for several pathogens are known and this work shows how to use it with the meteorological data in each port and airport facility, to focus an efficient implementation of countermeasures and reduce simultaneously risk transmission and mitigation costs. The results show an increased alert with decreasing latitude, which corresponds to higher minimum and maximum temperatures and a lower amplitude range of the daily temperature.

Keywords: human health, risk assessment, risk management, vector-borne diseases

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Authors: David B. Tsuanyo, Didier Aussel, Yao Azoumah, Pierre Neveu

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An innovative concept called “Flexy-Energy”is developing at 2iE. This concept aims to produce electricity at lower cost by smartly mix different available energies sources in accordance to the load profile of the region. With a higher solar irradiation and due to the fact that Diesel generator are massively used in sub-Saharan rural areas, PV/Diesel hybrid systems could be a good application of this concept and a good solution to electrify this region, provided they are reliable, cost effective and economically attractive to investors. Presentation of the developed approach is the aims of this paper. The PV/Diesel hybrid system designed consists to produce electricity and/or heat from a coupling between Diesel gensets and PV panels without batteries storage, while ensuring the substitution of gasoil by bio-fuels available in the area where the system will be installed. The optimal design of this system is based on his technical performances; the Life Cycle Cost (LCC) and Levelized Cost of Energy are developed and use as economic criteria. The Net Present Value (NPV), the internal rate of return (IRR) and the discounted payback (DPB) are also evaluated according to dual electricity pricing (in sunny and unsunny hours). The PV/Diesel hybrid system obtained is compared to the standalone Diesel gensets. The approach carried out in this paper has been applied to Siby village in Mali (Latitude 12 ° 23'N 8 ° 20'W) with 295 kWh as daily demand. This approach provides optimal physical characteristics (size of the components, number of component) and dynamical characteristics in real time (number of Diesel generator on, their load rate, fuel specific consumptions, and PV penetration rate) of the system. The system obtained is slightly cost effective; but could be improved with optimized tariffing strategies.

Keywords: investments criteria, optimization, PV hybrid, sizing, rural electrification

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Authors: Marcin Jakiel, Maria Kurek, Karolina Gutkowska, Sylwia Sanakiewicz, Dominika Stolarczyk, Jakub Batko, Rafał Jakiel, Mateusz K. Hołda

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The geometry of RVOT is extremely complicated. It is an irregular block with an ellipsoidal cross-section, whose dimensions decrease toward the pulmonary valve and measure 33.82 (IQR 30,51-39,36), 28.82 (IQR 26,11-32,22), 27.95 ± 4,11 for width [mm] and 33.41 ± 6,14, 26.99 ± 4,41, 26.91 ± 4,00 [mm] for depth, in the basal, middle and subpulmonary parts, respectively. In a sagittal section view, the RVOT heads upward and slightly backward. Its anterior perimeter has an average length of 41.96 mm and inclines to the transverse plane at an angle of 50.77° (IQR 46,53°-58,70°). In the posterior region, the RVOT is shorter (18.17mm) and flexes anteriorly. Therefore, the slope of the upper part of the rear wall to the transverse plane is an acute angle (open toward the rear) of 44,58° (IQR 37,30°-51,25°), while in the lower part it is an angle close to a right angle of 94,30°±15,44°. In addition, the thickness of the RVOT wall in the diastolic phase, at the posterior perimeter at the base, in the middle of the length and subpulmonary measure 3,80 mm ± 0,88 mm, 3,56 mm ± 0,73 mm, 3,56 mm ± 0,65 mm, respectively. In frontal cross-section, the RVOT rises on the interventricular septum, which makes it possible to distinguish the septal and supraseptal parts on its left periphery. The angles (facing the vertices to the right) of the inclination of these parts to the transverse plane are 75.5° (IQR 66,44°-81,11°) and 107.01° (IQR 99,09 – 115,23°), respectively, which allows us to conclude that the direction of the RVOT long axis changes from left to right. The above analysis shows that there is no single RVOT axis. Two axes can be distinguished, the one for the upper RVOT being more backward and leftward. The aforementioned forward deflection of the posterior wall and the RVOT's elevation over the interventricular septum, suggest that access to the subpulmonary region may be difficult. It should be emphasized that this area is often the target for ablation of ventricular arrhythmias. The small thickness of the RVOT posterior wall, with its difficult geometry, may favor its perforation into the pericardium or ascending aorta.

Keywords: angle, geometry, operation access, position, RVOT, shape

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Authors: Minho Kwak, Suhwan Yun, Choonsoo Park

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Nose shape optimizations of high-speed train are performed for the improvement of aerodynamic characteristics. Based on the commercial train, KTX-Sancheon, multi-objective optimizations are conducted for the improvement of the side wind stability and the micro-pressure wave following the optimization for the reduction of aerodynamic drag. 3D nose shapes are modelled by the Vehicle Modeling Function. Aerodynamic drag and side wind stability are calculated by three-dimensional compressible Navier-Stokes solver, and micro pressure wave is done by axi-symmetric compressible Navier-Stokes solver. The Maxi-min Latin Hypercube Sampling method is used to extract sampling points to construct the approximation model. The kriging model is constructed for the approximation model and the NSGA-II algorithm was used as the multi-objective optimization algorithm. Nose length, nose tip height, and lower surface curvature are design variables. Because nose length is a dominant variable for aerodynamic characteristics of train nose, two optimization processes are progressed respectively with and without the design variable, nose length. Each pareto set was obtained and each optimized nose shape is selected respectively considering Honam high-speed rail line infrastructure in South Korea. Through the optimization process with the nose length, when compared to KTX Sancheon, aerodynamic drag was reduced by 9.0%, side wind stability was improved by 4.5%, micro-pressure wave was reduced by 5.4% whereas aerodynamic drag by 7.3%, side wind stability by 3.9%, micro-pressure wave by 3.9%, without the nose length. As a result of comparison between two optimized shapes, similar shapes are extracted other than the effect of nose length.

Keywords: aerodynamic characteristics, design variable, multi-objective optimization, train nose shape

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Authors: Emineh Tsegahun Gedif

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Zinc oxide nanoparticles (ZnO NPs) have garnered significant attention due to their diverse applications encompassing catalytic, optical, photonic, and antibacterial properties. In this study, we successfully synthesized zinc oxide nanoparticles using a rapid, environmentally benign, and cost-effective method. Neem (Azadirachta indica) leaf extract served as the reducing agent for Zn (NO₃)₂.6H2O solution under optimized conditions (pH = 9). Qualitative screening techniques and FT-IR Spectroscopy confirmed the presence of active biomolecules such as flavonoids, phenolic groups, alkaloids, terpenoids, and tannins within the Neem leaf extract, both before and after reduction. The formation of ZnO NPs was visually evident through a distinct color change from colorless to light yellow. The biosynthesized nanoparticles underwent comprehensive characterization through UV-visible, FT-IR, and XRD spectroscopies. The reduction process proved to be straightforward and user-friendly, with UV-visible spectroscopy demonstrating a surface plasmon resonance (SPR) at 321 nm, unequivocally confirming the ZnO NP formation. X-ray diffraction analysis elucidated the crystal structure, revealing an average particle size of approximately 20 nm using Scherrer's equation based on the line width of the plane. Furthermore, the synthesized zinc oxide nanoparticles were evaluated for their antimicrobial properties against both Gram-positive and Gram-negative bacteria. The results showcased significant inhibitory activity, with the highest zone of inhibition observed against Escherichia coli (15 mm) and comparatively lower activity against Staphylococcus aureus. This research underscores the potential of Neem leaf extract-mediated synthesis of ZnO NPs as an eco-friendly and effective approach for various applications, including antibacterial agents.

Keywords: zinc oxide nanoparticles (ZnO NPs), bioreducing agent, green synthesis, antibacterial activity

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Authors: Akram Rasheed

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Background: Simulation in the health care field has been increasingly used over the last years in the training of resuscitation and life support practices. It has shown the advantage of improving the decision-making and technical skills through deliberate practice and return demonstration. Local Problem: This article reports on the integration of simulation-based training (SBT) in the training program about proper team dynamics and leadership skills during cardiopulmonary resuscitation (CPR) in the intensive care unit (ICU). Method and Intervention: Training of 180 critical care nurses was conducted using SBT between 1st January and 30th 2020. We had conducted 15 workshops, with the integration of SBT using high fidelity manikins and using demonstration and return-demonstration approach to train the nursing staff about proper team dynamics and leadership skills during CPR. Results: After completing the SBT session, all 180 nurses completed the evaluation form. The majority of evaluation items were rated over 95% for the effectiveness of the education; four items were less than 95% (88–94%). Lower rated items considered training and practice time, improved competency, and commitment to apply to learn. The team dynamics SBT was evaluated as an effective means to improve team dynamics and leadership skills during CPR in the intensive care unit (ICU). Conclusion: The use of simulation-based training to improve team dynamics and leadership skills is an effective method for better patient management during CPR. Besides skills competency, closed-loop communication, clear messages, clear roles, and assignments, knowing one’s limitations, knowledge sharing, constructive interventions, re-evaluating and summarizing, and mutual respect are all important concepts that should be considered during team dynamics training. However, participants reported the need for a repeated practice opportunity to build competency.

Keywords: cardiopulmonary resuscitation, high fidelity manikins, simulation-based training, team dynamics

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Authors: N. Piwpuan, J. Tosalee, N. Phonkerd

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Malachite green (MG), a synthetic dye, is used in industries and aquaculture and also disposed in the effluent. Use of wastewater in irrigation increases due to water shortage. However, wastewater containing dyes, MG, are toxic to biological systems. Therefore, effects of MG on growth of vegetables were evaluated in order to utilize dye-contaminated wastewater for irrigation. In this study, Pak choy (Brassica chinensis) and Chinese convolvulus (Ipomoea aquatica) were grown in growing material (mixture of soil, coconut fiber, and compost) for four weeks and afterward kept watering with 200 ml of tap water containing MG at the concentrations of 0 (control), 1, 2, 10, and 20 mg/L. At harvest, number of leaf and shoot and root dry weight of the treated plants were measured and compared with control. For both species, their biomass values were similar among treatments and did not differ from the control plants (dry weight were 0.6-1.0 and 1.1-1.7 g/plant for B. chinensis and I. aquatica, respectively). B. chinensis treated with 2, 10, and 20 mg/L of MG produced lower number of new leaf and had smaller and shorter leaf compared to control and treatment of 1 mg/L. These results indicate the different responses between plant species, which B. chinensis is more sensitive to contaminant compared to I. aquatica. There was no sign of MG and leucomalachite green (LMG) detected in root and shoot tissues of plants treated with MG at 20 mg/L, tested by thin layer chromatography. After plant harvest, toxicity of the growing material from all treatments was tested on mung beans. Percent germination (83-97%), seedling fresh weight (0.3-0.5 g/plant), and shoot length (11-12.5 cm) were similar to the control. These indicated that contaminant in growing material did not pose detrimental effect on mung beans. Based on these results, the water contaminated with low concentration of MG, such as discharge from aquaculture, may serve as ferti-irrigation water to compensate water shortage.

Keywords: ferti-irrigation, soil toxicity, triphenylmethane dye, wastewater reuse

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Authors: Yu-Ching Liu

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Background: Family numbers usually take responsibility for taking care of their elderly relatives, especially parents. Caring for a patient with chronic diseases is a stressful experience, which makes carers suffer physical and mental health stress, difficulties maintaining family relationships and issues in participating in the labor market, which may lower their quality of life (QoL). The issue of providing care to relatives with chronic illness has been widely explored in Taiwan, but most studies focus on the need for full-time caregivers. Objective: The main goal of this study was to examine the topic of working carers involved in the decision-making process of LTC services and to explore what affects working carers considering when they choose the care services for their disabled, elderly relatives. Method: A total of 7 working caregivers were enrolled in this study. A face-to-face and semi-structured in-depth qualitative interview study were conducted to explore the caregivers' perspectives. Results: Working carers have a positive experience of using LTC service because it allows them to kill two birds with one stone, continue employment, and care for an elderly disabled relative. However, working carers have still been struggling to find friendly community-based LTC services. There were no longer available community services that could be used with the illness condition of patients getting worse. As such, patients have to be cared for at home, which might increase the caregiver burden of carers. Conclusion: Working family caregivers suffer from heavy physical and psychological burdens as they not only have to maintain their employment but care for elderly disabled relatives; however, the current support provided is insufficient. The design of services should consider working carers' employment situation and need rather than the only caring situation of patients at home.

Keywords: family caregiver, Long-term care, work-life balance, decision-making

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Authors: Saud S. AL Oud

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Soil contamination can have dire consequences, such as loss of ecosystem and agricultural productivity, diminished food chain quality, tainted water resources, economic loss, and human and animal illness. In recent years, attention has focused on the development of in situ immobilization methods that are generally less expensive and disruptive to the natural landscape, hydrology, and ecosystems than are conventional excavation treatments, and disposal methods. Soft, inexpensive, and efficient agents were used in the present research to immobilize Pb in polluted sandy soil. Five agents, either naturally occurring or chemically prepared, were used for this purpose. These agents include; iron ore (72% Fe2O3), cement, a mixture of calcite and shale rich in aluminum (CASH), and two chemically prepared amorphous materials of Al- and Fe-gel. These agents were selected due to their ability to specifically adsorb heavy metals onto their surface OH functional groups, which provide permanent immobilization of metal pollutants and reduce the fraction that is potentially mobile or bioavailable. The efficiency of these agents in immobilizing Pb were examined in a laboratory experiment, in which two rates (0.5 and 1.0 %) of tested agents were added to the polluted soils containing total contents of Pb ranging from 17.4-49.8 mg/kg. The results show that all immobilizing agents were succeed in minimizing the mobile form of Pb as extracted by 0.5 N HNO3. The extracted Pb decreased with increasing addition rate of immobilizing agents. At addition rate of 0.5%, HNO3 extractable-Pb varied widely depending on the agents type and were found to represent 21-67% of the initial values. All agents were able to reduce mobile Pb to levels lower than that (2.0 mg/kg) reported for non polluted soil, particularly for soils had initials of mobile Pb less than 10 mg/kg. Both iron oxide and CASH had the highest efficiency in immobilizing Pb, followed by cement, then amorphous materials of Fe and Al hydroxides.

Keywords: soil, synthetic chemical, lead, immobilization, polluted

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Authors: Murali Aarthy, Sanjeev Kumar Singh

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High risk human papillomaviruses are highly associated with the carcinoma of the cervix and the other genital tumors. Cervical cancer develops through the multistep process in which increasingly severe premalignant dysplastic lesions called cervical intraepithelial neoplastic progress to invasive cancer. The oncoprotein E7 of human papillomavirus expressed in the lower epithelial layers drives the cells into S-phase creating an environment conducive for viral genome replication and cell proliferation. The replication of the virus occurs in the terminally differentiating epithelium and requires the activation of cellular DNA replication proteins. To date, no suitable drug molecule is available to treat HPV infection whereas identification of potential drug targets and development of novel anti-HPV chemotherapies with unique mode of actions are expected. Hence, our present study aimed to identify the potential inhibitors analogous to EGCG, a green tea molecule which is considered to be safe to use for mammalian systems. A 3D similarity search on the natural small molecule library from natural product database using EGCG identified 11 potential hits based on their similarity score. The structure based docking strategies were implemented in the potential hits and the key interacting residues of protein with compounds were identified through simulation studies and binding free energy calculations. The conformational changes between the apoprotein and the complex were analyzed with the simulation and the results demonstrated that the dynamical and structural effects observed in the protein were induced by the compounds and indicated the dominance to the oncoprotein. Overall, our study provides the basis for the structural insights of the identified potential hits and EGCG and hence, the analogous compounds identified can be potent inhibitors against the HPV 16 E7 oncoprotein.

Keywords: EGCG, oncoprotein, molecular dynamics simulation, analogues

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Authors: Soo-Bi Lee, Jun Young Jeong, Zehgn Lin, Chenminxi

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Background: In South Korea, a problematic phenomenon has recently arisen whereby adult children continue to receive parentalcaregivingin some cases. These phenomena has been shown to affect the mental health of mothers. Study Goals: The purposes of this study are to verify whether the mediating effects of stress on the relationship between a woman’s care burden for their adult children and depression are moderated by their satisfaction about their husbands’ sharing of the caregiving. Methodology: This study analyzed 3,053 married women with adult children using the most recent data from the “Korean Longitudinal Survey of Women & Families 7th(2018)" conducted at the national level. The analysis was conducted using the SPSS Process Macro Model 7 to verify the moderated mediating effects and subsequently confirm their significance based on the bootstrapping method. Results and Implications: (1) Stress was identified a mediating factor in the relationship between the care burden for adult children and depression; and (2) the mediating effects of stress on depression from the burden of caring for adult children are modulated by the woman's satisfaction with her husband’s sharing of the care burden. In other words, the higher the caring burden of adult children, the higher the mother's stress, which increases depression. At this time, the higher the their satisfaction with the husband's share of care in the path of mother's care burden and stress, the lower the mother's stress and, ultimately, the depression be alleviated. Conclusion: Programs that promote the mental health of married women heavily with the caring burden for their adult children, as well as those that improve social awareness regarding husbands' sharing of the care burden, should be implemented. Also, social welfare policy alternatives are needed at the national level to reduce the caring burden caused by adult children.

Keywords: married women, adult children care burden, stress, depression, satisfaction with husbands sharing of the care

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Authors: Ririt Aprilin Sumarsono

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Composite member (concrete and steel) has been widely advanced for structural utilization due to its best performance in resisting load, reducing the total weight of the structure, increasing stiffness, and other available advantages. On the other hand, the environment load such as corrosion (e.g. chloride ingress) creates significant time-dependent degradation for steel. Analysis performed in this paper is mainly considered uniform corrosion for evaluating the composite beam without examining the pit corrosion as the initial corrosion formed. Corrosion level in terms of weight loss is modified in yield stress and modulus elasticity of steel. Those two mechanical properties are utilized in this paper for observing the stresses due to corrosion attacked. As corrosion level increases, the effective width of the composite beam in the concrete section will be wider. The position of a neutral axis of composite section will indicate the composite action due to corrosion of composite beam so that numerous shear connectors provided must be reconsidered. Flexure capacity quantification provides stresses, and shear capacity calculation derives connectors needed in overcoming the shear problem for composite beam under corrosion. A model of simply supported composite beam examined in this paper under uniform corrosion where the stresses as the focus of the evaluation. Principal stress at the first stage of composite construction decline as the corrosion level incline, parallel for the second stage stress analysis where the tension region held by the steel undergoes lower capacity due to corrosion. Total stresses of the composite section for steel to be born significantly decreases particularly in the outermost fiber of tension side. Whereas, the available compression side is smaller as the corrosion level increases so that the stress occurs on the compression side shows reduction as well. As a conclusion, the increment of corrosion level will degrade both compression and tension side of stresses.

Keywords: composite beam, modulus of elasticity, stress analysis, yield strength, uniform corrosion

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Authors: Joseph A. Bentil, Anders Thygesen, Lene Langea, Moses Mensah, Anne Meyer

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The study investigated the saccharification potential of in-house enzymes produced from a white-rot basidiomycete strain, Polyporus ciliatus CBS 366.74. The in-house enzymes were produced by growing the fungus on mono and composite substrates of cocoa pod husk (CPH) and green seaweed (GS) (Ulva lactuca sp.) with and without the addition of 25mM ammonium nitrate at 4%w/v substrate concentration in submerged condition for 144 hours. The crude enzyme extracts preparations (CEE 1-5 and CEE 1-5+AN) obtained from the fungal cultivation process were sterile-filtered and used as enzyme sources for enzymatic hydrolysis of hydrothermally pretreated corn stover using a commercial cocktail enzyme, Cellic Ctec3, as benchmark. The hydrolysis was conducted at 50ᵒC with 50mM sodium acetate buffer, pH 5 based on enzyme dosages of 5 and 10 CMCase Units/g biomass at 1%w/v dry weight substrate concentration at time points of 6, 24, and 72 hours. The enzyme activity profile of the in-house enzymes varied among the growth substrates with the composite substrates (50-75% GS and AN inclusion), yielding better enzyme activities, especially endoglucanases (0.4-0.5U/mL), β-glucosidases (0.1-0.2 U/mL), and xylanases (3-10 U/mL). However, nitrogen supplementation had no significant effect on enzyme activities of crude extracts from 100% GS substituted substrates. From the enzymatic hydrolysis, it was observed that the in-house enzymes were capable of hydrolysing the pretreated corn stover at varying degrees; however, the saccharification yield was less than 10%. Consequently, theoretical glucose yield was ten times lower than Cellic Ctec3 at both dosage levels. There was no linear correlation between glucose yield and enzyme dosage for the in-house enzymes, unlike the benchmark enzyme. It is therefore recommended that the in-house enzymes are used to complement the dosage of commercial enzymes to reduce the cost of biomass saccharification.

Keywords: enzyme production, hydrolysis yield, feedstock, enzyme blend, Polyporus ciliatus

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Authors: T. Goldstein, E. Serok, J. D. Kark

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Background and Aim: The prevalence of obesity is increasing worldwide and in Israel. To meet this challenge, our study tests a new educational approach through a controlled school-based trial to achieve an improvement in eating habits, aerobic activity, and reduced obesity in Grades 2-3. Methods and Design: A cluster randomized controlled trial allocated 4 elementary schools (3rd and 2nd-grade classes each) to intervention or control groups. This allocation was switched with the next cohort of children. Recruitment was in first grade, randomization at the beginning of second grade, evaluation of results at the end of second grade and the beginning of third grade — intervention: 5 joint parent-children classroom activities on health topics and 5 educational workshops for parents only. Alfred Adler's concepts were guiding principles. Subjects: Of 743 children in 23-second grade classes, parents provided informed consent for 508 (68%). Information of retention health habits continued for third grade. Additional parental approvals were required. Parents provided informed consent for third-grade follow-up for 432. Results: At the end of 2nd grade, the amount of aerobic activity increased in the intervention group in comparison with the control group, the difference being marginally statistically significant (p=0.061). There is a significant difference between the groups in the percentage of "no activity being done" reported at the end of second grade when in the experimental group, the percentage is lower than the control. There are differences between genders in the percentage of aerobic activity at the end of second grade (p=0.044) and in the third grade (p < 0.0001). Height increased significantly (p=0.030 ), and waist circumference declined significantly (p=0.021) in the intervention compared with the control group. There were no significant between-group differences in BMI and weight. Conclusion: There were encouraging changes in aerobic activity and in anthropometric measurements. To maintain changes over longer periods, refreshing these nutrition and activity themes annually in school using the model is required.

Keywords: aerobic activity, child obesity, Alfred Adler, schoolchildren

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Authors: Alokananda Ghosh, Shraban Sarkar

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The study aims to identify suitable sites for new hospitals with critical obstetric care facilities in Birbhum, one of the vulnerable and underserved districts of Eastern India, considering six main and 14 sub-criteria, using GIS-based Analytic Hierarchy Process (AHP) and Multi-Attribute Utility Theory (MAUT) approach. The criteria were identified through field surveys and previous literature. After collecting expert decisions, a pairwise comparison matrix was prepared using the Saaty scale to calculate the weights through AHP. On the contrary, objective weighting methods, i.e., Entropy and Criteria Importance through Interaction Correlation (CRITIC), were used to perform the MAUT. Finally, suitability maps were prepared by weighted sum analysis. Sensitivity analyses of AHP were performed to explore the effect of dominant criteria. Results from AHP reveal that ‘maternal death in transit’ followed by ‘accessibility and connectivity’, ‘maternal health care service (MHCS) coverage gap’ were three important criteria with comparatively higher weighted values. Whereas ‘accessibility and connectivity’ and ‘maternal death in transit’ were observed to have more imprint in entropy and CRITIC, respectively. While comparing the predictive suitable classes of these three models with the layer of existing hospitals, except Entropy-MAUT, the other two are pointing towards the left-over underserved areas of existing facilities. Only 43%-67% of existing hospitals were in the moderate to lower suitable class. Therefore, the results of the predictive models might bring valuable input in future planning.

Keywords: hospital site suitability, analytic hierarchy process, multi-attribute utility theory, entropy, criteria importance through interaction correlation, multi-criteria decision analysis

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Authors: Arfan Ali, Muhammad Shahzad Iqbal, Idrees Ahmad Nasir

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Potato (Solanum tuberosum L.) is ranked among the top leading staple foods in the world. Salinity adversely affects potato crop yield and quality. Therefore, increased level of salt tolerance is a key factor to ensure high yield. The present study focused on the Agrobacterium-mediated transformation of Atriplex canescens betaine aldehyde dehydrogenase (BADH) gene, using single, double and triple CAMV35s promoter to improve salt tolerance in potato. Detection of seven potato lines harboring BADH gene, followed by identification of T-DNA insertions, determination of transgenes copies no through Southern Hybridization and quantification of BADH protein through Enzyme Linked Immunosorbent Assay were considered in this study. The results clearly depict that the salt tolerance of potato was found to be promoter-dependent, as the potato transgenic lines with triple promoter showed 4.4 times more glycine betaine production which consequently leads towards high resistance to salt stress as compared to transgenic potato lines with single and double promoters having least production of glycine betaine. Moreover, triple promoter transgenic potato lines have also shown lower levels of H2O2, malondialdehyde (MDA), relative electrical conductivity, high proline and chlorophyll content as compared other two lines having a single and double promoter. Insilco analysis also confirmed that Atriplex canescens BADH has the tendency to interact with sodium ions and water molecules. Taken together these facts it can be concluded that over-expression of BADH under triple CAMV35s promoter with more glycine betaine, chlorophyll & MDA contents, high relative quantities of other metabolites results in an enhanced level of salt tolerance in potato.

Keywords: Atriplex canescens, BADH, CAMV35s promotor, potato, Solanum tubersum

Procedia PDF Downloads 277

Authors: Karimeh Alnuaimi, Manal Kassab, Reem Ali, Khitam Mohammad, Kholoud Shattnawi

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Aim: To compare pregnancy outcomes of Syrian refugee women and Jordanian women. Background and introduction: The current conflict in Syria continues to displace thousands to neighboring countries, including Jordan. Pregnant refugee women are therefore facing many difficulties are known to increase the prevalence of poor reproductive health outcomes and antenatal complications. However, there is very little awareness of whether Syrian refugee women have different risks of pregnancy outcomes than Jordanian women. Methods: Using a retrospective cohort design, we examined pregnancy outcomes for Syrian refugee (N = 616) and Jordanian women (N = 644) giving birth at two governmental Hospitals in the north of Jordan, between January 1, 2014, and December 31, 2014. A checklist of 13 variables was utilized. The primary outcome measures were delivery by Caesarean section, maternal complications, low birth weight (< 2500 g), Apgar score and preterm delivery (< 37 weeks' gestational age). Results: Statistical analysis revealed that refugee mothers had a significant increase in the rate of cesarean section and the higher rate of anemia, a lower neonates’ weight, and Apgar scores when compared to their Jordanian counterparts. Discussion and Conclusion: Results were congruent with findings from other studies in the region and worldwide. Minimizing inequalities in pregnancy outcomes between Syrian refugees and Jordan women is a healthcare priority. Implications for nursing and health policy: The findings could guide the planning and development of health policies in Jordan that would help to alleviate the situation regarding refugee populations. The action is required by the policy makers, specifically targeting public and primary health care services, to address the problem of adequately meeting the need for antenatal care of this vulnerable population.

Keywords: pregnancy, Syrian refugee, Jordanian women, comparative study

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Authors: Siddhant Srivastav, Soumyaranjan Mishra, Sumanta Kumar Meher

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Researchers are attempting to develop extremely efficient electrochemical energy storage technologies as a result of the phenomenal advancement of portable electronic devices. Because of their improved electrical conductivity and narrower band gap, transition metal selenide-based nanostructures have piqued the interest of many researchers in this field. Based on this concept, we present a simple anion exchange hydrothermal synthesis method for synthesizing manganese and nickel based selenide (Mn/NiSe2) nanostructure for use in all-solid-state asymmetric supercapacitors. According to the comprehensive physicochemical characterizations, the material has lowly crystalline properties, a distinct porous microstructure, and a significant bonding contact between the metal and the selenium. The electrochemical investigations of the Mn/NiSe2 electrode material revealed supercapacitive charge discharge properties, excellent electro-kinetic reversibility, and minimal charge transfer resistance (Rct). Furthermore, the all-solid-state asymmetric supercapacitor device assembled using Mn/NiSe2 as positive electrode, nitrogen doped reduced graphene oxide (N-rGO) as negative electrode, and PVA-KOH gel as electrolyte/separator exhibit good redox behaviour, excellent charge-discharge properties with negligible voltage (IR) drop, and lower impedance characteristics. The solid state asymmetric supercapacitor device (Mn/NiSe2||N-rGO) demonstrated the power density of ultra-capacitors and the energy density of rechargeable batteries. Conclusively, the Mn/NiSe2 has been proposed as a potential outstanding electrode material for the next generation of all-solid-state asymmetric supercapacitors.

Keywords: anion exchange, asymmetric supercapacitor, supercapacitive charge-discharge, voltage drop

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Authors: Chia-Wen Yeh, Ting-Sheng Lin, Chih-Han Chang

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Pressure garment has been used to prevent and treat the hypertrophic scars following serious burns since 1970s. The use of pressure garment is believed to hasten the maturation process and decrease the highness of scars. Pressure garment is custom made by reducing circumferential measurement of the patient by 10%~20%, called Reduction Factor. However the exact reducing value used depends on the subjective judgment of the therapist and the feeling of patients throughout the try and error process. The Laplace Law can be applied to calculate the pressure from the dimension of the pressure garment by the circumferential measurements of the patients and the tension profile of the fabrics. The tension profile currently obtained neglects the stress relaxation and hysteresis effect within most elastic fabrics. The purpose of this study was to investigate the influence of the tension attenuation, from stress relaxation and hysteresis effect of the fabrics. Samples of pressure garment were obtained from Sunshine Foundation Organization, a nonprofit organization for burn patients in Taiwan. The wall tension profile of pressure garments were measured on a material testing system. Specimens were extended to 10% of the original length, held for 1 hour for the influence of the stress relaxation effect to take place. Then, specimens were extended to 15% of the original length for 10 seconds, then reduced to 10% to simulate donning movement for the influence of the hysteresis effect to take place. The load history was recorded. The stress relaxation effect is obvious from the load curves. The wall tension is decreased by 8.5%~10% after 60mins of holding. The hysteresis effect is obvious from the load curves. The wall tension is increased slightly, then decreased by 1.5%~2.5% and lower than stress relaxation results after 60mins of holding. The wall tension attenuation of the fabric exists due to stress relaxation and hysteresis effect. The influence of hysteresis is more than stress relaxation. These effect should be considered in order to design and evaluate the pressure of pressure garment more accurately.

Keywords: hypertrophic scars, hysteresis, pressure garment, stress relaxation

Procedia PDF Downloads 512

Authors: Hussain M. Al-foudari, Weizhong Chen, James M. Bishop

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Correlations between oceanographic variables and monthly catch rates of total shrimp and those of each of the major species (Penaeus semisulcatus, Metapenaeus affinis and Parapenaeopsis stylifera) showed significant differences for particular conditions. Catches of P. semisulcatus were basically positively correlated with temperature, i.e., the higher the temperature, the higher the catch rate, while those of M. affinis and P. stylifera were negatively correlated with temperature, i.e., high catch rates occurred in the low temperature waters. Thus, during the months January and April, P. semisulcatus preferred waters with high temperature, usually the offshore and southern areas, while M. affinis and P. stylifera preferred waters with low temperature, usually inshore and northern areas. The relationships between the catch rate of P. semisulcatus and salinity were not so clear. Results indicated that although salinity was one of the factors affecting the distribution of P. semisulcatus, it was not the principal factor, and impacts from other variables, such as temperature, might overshadow the correlation between the catch rates of P. semisulcatus and salinity. The relationship between shrimp catch rates and dissolved oxygen (DO) also showed mixed results. The catch rates of M. affinis increased with a decrease of surface DO in November 2013, but decreased with lower bottom DO in December. These results indicated that DO might be a factor affecting distributions of the shrimp; however; the true correlation between catch rate and DO might be easily overshadowed by other environmental variables. Catch rates of P. semisulcatus did not show any relationship with depth. P. semisulcatus is a migratory species and widely distributed in Kuwait's waters.During the shrimp season from July through December, P. semisulcatus occurs in almost all areas in Kuwait's waters irrespective of water depth. The catch rates of M. affinis and P. stylifera, however, showed clear relationships with depth. Both species had significantly higher catch rates in shallower waters, indicative of their restricted distribution.

Keywords: Kuwait, Penaeus semisulcatus, Metapenaeus affinis, Parapenaeopsis stylifera, Arabian gulf

Procedia PDF Downloads 490

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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