Search results for: nerve and tendon transfer surgery

Authors: Chana Pavneet

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Background: In more recent years in dentistry, a greater emphasis has been placed on competency-based education (CBE) programmes. Undergraduate and postgraduate curriculums have been reformed to reflect these changes, and adopting a CBE approach has shown to be beneficial to trainees and places an emphasis on continuous lifelong learning. The literature is vast; however, very little work has been done specifically to the assessment of competence in dentistry and even less so in oral surgery. The majority of the literature tends to opinion pieces. Some small-scale studies have been undertaken in this area researching assessment tools which can be used to assess competence in oral surgery. However, there is a lack of general consensus on the preferable assessment methods. The aim of this review is to identify the assessment methods available and their usefulness. Methods: Electronic databases (Medline, Embase, and the Cochrane Database of systematic reviews) were searched. PRISMA guidelines were followed to identify relevant papers. Abstracts of studies were reviewed, and if they met the inclusion criteria, they were included in the review. Papers were reviewed against the critical appraisal skills programme (CASP) checklist and medical education research quality instrument (MERQSI) to assess their quality and identify any bias in a systematic manner. The validity and reliability of each assessment method or tool were assessed. Results: A number of assessment methods were identified, including self-assessment, peer assessment, and direct observation of skills by someone senior. Senior assessment tended to be the preferred method, followed by self-assessment and, finally, peer assessment. The level of training was shown to affect the preferred assessment method, with one study finding peer assessment more useful in postgraduate trainees as opposed to undergraduate trainees. Numerous tools for assessment were identified, including a checklist scale and a global rating scale. Both had their strengths and weaknesses, but the evidence was more favourable for global rating scales in terms of reliability, applicability to more clinical situations, and easier to use for examiners. Studies also looked into trainees’ opinions on assessment tools. Logbooks were not found to be significant in measuring the competence of trainees. Conclusion: There is limited literature exploring the methods and tools which assess the competence of oral surgery trainees. Current evidence shows that the most favourable assessment method and tool may differ depending on the stage of training. More research is required in this area to streamline assessment methods and tools.

Keywords: competence, oral surgery, assessment, trainees, education

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Authors: Nuha Alamro

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Besides achieving of weight loss, Bariatric surgery (BS) shown metabolic improvement including reduction of cardiovascular disease, insulin resistance and diabetes. This study aimed to measure BS effects on Framingham Risk Score (FRS) and metabolic syndrome (MetS) among patients who underwent BS. Additionally, to determine the effect of BS on TSH among euthyroid obese patients. A Retrospective follow-up study was conducted in King Abdullah Medical City. A total of 160 participants who underwent BS and completed one year of follow ups. Medical history, biochemical, anthropometric, and hormonal parameters were evaluated at baseline and 3-12 months after BS. International Diabetes Federation (IDF) criteria were used to diagnose MetS pre and postoperative. The mean age of participants was 41.9 ± 10.6 with Body Mass Index (BMI) of 48.8 ± 7.3. After 3 months, Systolic, Diastolic blood pressure (SBP, DBP), glycated haemoglobin (HBA1C), Low-density lipoprotein (LDL), cholesterol, triglycerides and Thyroid stimulating hormone (TSH) were significantly decrease (P < 0.001). Significant decrease was seen in Mets, BMI, FRS, SBP, DBP, HBA1C, LDL, triglycerides, cholesterol, liver enzyme, with significant increase in high-density lipoprotein (HDL) level 12 months post-op (P < 0.001). After 1 year, the prevalence of MetS, DM, HTN, FRS were significantly decrease from 72.5%, 43.1%, 78.1%, 11.4 to 16.3%, 9.4%, 22.5% and 5.4, respectively. Besides achieving substantial weight loss, MetS resolution was linked to improvement in cardiovascular risk profile.

Keywords: bariatric surgery, cardiovascular disease, metabolic syndrome, thyroid stimulating hormone

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Authors: Rehan Ali Shah, A. M. Siddiqui, T. Haroon

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Slip boundary value problem in wire coating analysis with heat transfer is examined. The fluid is assumed to be viscoelastic PTT (Phan-Thien and Tanner). The rheological constitutive equation of PTT fluid model simulates various polymer melts. Therefore, the current consequences are valuable in a number of realistic situations. Effects of slip parameter γ as well as εDec^2 (viscoelastic index) on the axial velocity, shear stress, normal stress, average velocity, volume flux, thickness of coated wire, shear stress, force on the total wire and temperature distribution profiles have been investigated. A new direction is explored to analyze the flow with the slip parameter. The slippage at the boundaries plays an important role in thickness of coated wire. It is noted that as the slip parameter increases the flow rate and thickness of coated wire increases while, temperature distribution decreases. The results reduce to no slip when the slip parameter is vanished. Furthermore, we can obtain the results for Maxwell and viscous model by setting ε and λ equal to zero respectively.

Keywords: wire coating, straight annular die, PTT fluid, heat transfer, slip boundary conditions

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Authors: R. Pardo, P. Menendez, MA Gil-Olarte, S. Sanchez, E. García, R. Quintana, J. Martín

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Introduction : Within oncoplastic breast techniques there is increased interest in immediate partial breast reconstruction. The volume resected is greater than that of conventional conservative techniques. Central tumours of the breast have classically been treated with a mastectomy with regard to oncological safety and cosmetic secondary effects after wide central resection of the nipple and breast tissue beneath. Oncological results for central quadrantectomy have a recurrence level, disease- free period and survival identical to mastectomy. Grissoti flap is an oncoplastic surgical technique that allows the surgeon to perform a safe central quadrantectomy with excellent cosmetic results. Material and methods: The Grissoti flap is a glandular cutaneous advancement rotation flap that can fill the defect in the central portion of the excised breast. If the inferior border is affected by tumour and further surgery is decided upon at the Multidisciplinary Team Meeting, it will be necessary to perform a mastectomy. All patients with a Grisotti flap undergoing surgery since 2009 were reviewed obtaining the following data: age, hystopathological diagnosis, size, operating time, volume of tissue resected, postoperative admission time, re-excisions due to positive margins affected by tumour, wound dehiscence, complications and recurrence. Analysis and results of sentinel node biopsy were also obtained. Results: 12 patients underwent surgery between 2009-2015. The mean age was 54 years (34-67) . All had a preoperative diagnosis of ductal infiltrative carcinoma of less than 2 cm,. Diagnosis was made with Ultrasound, Mamography or both . Magnetic resonance was used in 5 cases. No patients had preoperative positive axilla after ultrasound exploration. Mean operating time was 104 minutes (84-130). Postoperative stay was 24 hours. Mean volume resected was 159 cc (70-286). In one patient the surgical border was affected by tumour and a further procedure with resection of the affected border was performed as ambulatory surgery. The sentinel node biopsy was positive for micrometastasis in only two cases. In one case lymphadenectomy was performed in 2009. In the other, treated in 2015, no lymphadenectomy was performed as the patient had a favourable histopathological prognosis and the multidisciplinary team meeting agreed that lymphadenectomy was not required. No recurrence has been diagnosed in any of the patients who underwent surgery and they are all disease free at present. Conclusions: Conservative surgery for retroareolar central tumours of the breast results in good local control of the disease with free surgical borders, including resection of the nipple areola complex and pectoral major muscle fascia. Reconstructive surgery with the inferior Grissoti flap adequately fills the defect after central quadrantectomy with creation of a new cutaneous disc where a new nipple areola complex is reconstructed with a local flap or micropigmentation. This avoids the need for contralateral symmetrization. Sentinel Node biopsy can be performed without added morbidity. When feasible, the Grissoti flap will avoid skin-sparing mastectomy for central breast tumours that will require the use of an expander, prosthesis or myocutaneous flap, with all the complications of a more complex operation.

Keywords: Grisotti flap, oncoplastic surgery, central tumours, breast

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Authors: Mingmei Zhang, Xinyong Li

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AgInS₂/SnS₂ (AIS) nanocomposites were synthesized by a simple hydrothermal method. The morphology and composition of the fabricated AIS nanocomposites were investigated by field-emission scanning electron microscopy (SEM), X-ray diffraction (XRD), high resolution transmission electron microscopy (HRTEM) and X-ray photoelectron spectroscopy (XPS). Moreover, the as-prepared AIS photocatalysts exhibited excellent photocatalytic activities for the degradation of Norfloxacin (NOR), mainly due to its high optical absorption and separation efficiency of photogenerated electron-hole pairs, as evidenced by UV–vis diffusion reflection spectra (DRS) and Surface photovoltage (SPV) spectra. Furthermore, the interfacial charges transfer mechanism was also discussed by DFT calculations.

Keywords: AIS nanocomposites, electron-hole pairs, charges transfer, DFTcaculations

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Authors: E. Esra Kasapbaşı, Büşra Yıldırım

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Weak oxidizing radicals, such as alkyl peroxyl derivatives, react with carotenoids through hydrogen atom transfer to form neutral carotenoid radicals. Using the DFT method, it has been observed that s-cis-β-carotene is more stable than all-transforms. In the context of this study, an attempt is made to explain the reaction mechanism of the isomers of β-carotene, which exhibits antioxidant properties, with n-pentyl peroxide, one of the alkyl peroxyl molecules, using the Density Functional Theory (DFT) method. The cis and transforms of β-carotene are used in the study to determine which form is more reactive. For this purpose, Natural Bond Orbital (NBO) charges of all optimized structures are calculated, and electron transfer is determined by examining electron transitions between Highest Occupied Molecular Orbital (HOMO) and Lowest Unoccupied Molecular Orbital (LUMO). Additionally, the radical character and reaction mechanism of β-carotene in a radical environment are attempted to be explained based on the calculations. The theoretical inclination of whether β-carotene in cis or transforms is more active in reaction is also discussed. All these calculations are performed in the gas phase using the Integral Equation Formalism Polarizable Continuum Model IEFPCM method with dichloromethane as the solvent.

Keywords: β-carotene, n-pentyl peroxyl radical, DFT, TD-DFT

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Authors: Seung Cho Yang, Jae Sung Lee, Se Hee Park

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This study suggests the analysis method to predict the damages of tunnel concrete caused by fires. The result obtained from the analyses of concrete temperatures at a fire in a tunnel using ABAQUS was compared with the test result. After the reliability of the analysis method was verified, the temperatures of a tunnel at a real fire and those of concrete during the fire were estimated to predict fire damages. The temperatures inside the tunnel were estimated by FDS, a CFD model. It was deduced that the fire performance of tunnel lining and the fire damages of the structure at an actual fire could be estimated by the analysis method.

Keywords: fire resistance, heat transfer, numerical analysis, tunnel fire

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Authors: Hossein Shokouhmand, Seyyed Mostafa Saadat

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In this paper, the effect of thermal dispersion on the performance of plate heat exchangers (PHEs) with sinusoidal plates is investigated. In this regard, the PHE is considered as a porous medium. The important property of a porous medium is porosity that is defined as the total fluid volume divided by the total volume occupied by the solid and fluid. A 2D array of parallel sinusoidal plates with laminar periodically developed forced convection and single-phase constant property flows and conduction in a homogenous solid phase in two directions is considered. The array of flows is counter and the flows heat capacities are equal. Numerical study of conjugate heat transfer and axial conduction in the solid phase with different plate thicknesses showed that there is an optimal porosity in which the efficiency of heat transfer is up to 4% more than the time when the porosity is near one. It is shown that the optimal porosity at zero angle of inclination depends both on Reynolds number and the aspect ratio. The optimal porosity increased while either the Reynolds number or waviness of plates increased.

Keywords: plate heat exchanger, optimal porosity, efficiency, aspect ratio

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Authors: Stephanie Cheng, Benjamin Poh, Vivyan Tay, Sachin Mathur

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Aim: Diabetes mellitus (DM) is a worldwide pandemic affecting 500 million people. It is known to be associated with increased susceptibility to soft tissue infections (STI). Despite being a major public health burden, the literature relating the effects of DM and the presentation, severity and healing of STIs in general surgical patients remain limited. Methods: We conducted a retrospective review of all patients admitted with STI in a tertiary teaching hospital over a 12-month period. Patient demographics and surgical outcomes were collected and analyzed. Results: During the study period, 1059 patients were admitted for STIs, of which 936 (88%) required surgical intervention. Diabetic patients were presented with a higher body-mass index (BMI) (28 vs 26), larger abscess size (24 vs 14 cm²) and a longer length of stay (LOS)(4.4 days vs 2.9 days). They also underwent a higher proportion of wide debridement as well as application of negative pressure wound therapy (NPWT) (42% vs 35%). More diabetic patients underwent subsequent re-operation within the same sitting (8 vs 4). There were no differences in re-admission rates within 30 days nor subsequent abscess formation in those followed for 6 months. Conclusion: The incidence of STIs among DM patients represents a significant disease burden; surgeons should consider intensive patient counseling and partnering with primary care providers in order to help reduce the incidence of future STI admissions based on lifestyle modification and glucose control.

Keywords: general surgery, emergency general surgery, acute care surgery, soft tissue infections, diabetes mellitus

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Authors: Bimrisha Mali

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The present study investigates the type of errors English as a second language (ESL) learners produce using the definite article ‘the’. The participants were provided a questionnaire on the learner's ability test. The questionnaire consists of three cloze tests and two free composition tests. Each participant's response was received in the form of written data. A total of 78 participants from three government schools participated in the study. The participants are high-school students from Rural Assam. Assam is a north-eastern state of India. Their age ranged between 14-15. The medium of instruction and the communication among the students take place in the local language, i.e., Assamese. Pit Corder’s steps for conducting error analysis have been followed for the analysis procedure. Four types of errors were found (1) deletion of the definite article, (2) use of the definite article as modifiers as adjectives, (3) incorrect use of the definite article with singular proper nouns, (4) substitution of the definite article by the indefinite article ‘a’. Classifiers in Assamese that express definiteness is used with nouns, adjectives, and numerals. It is found that native language (L1) transfer plays a pivotal role in the learners’ errors. The analysis reveals the learners' inability to acquire the semantic connotation of definiteness in English due to native language (L1) interference.

Keywords: definite article error, l1 transfer, error analysis, ESL

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Authors: Yuri Seu, Seong-Kyu Choi, Hyun Jin Park, Jin Seo Park, HongtaeKim, Mi-Sun Hur

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The aim of this study was to clarify the attachments of the distal oblique membrane (DOM) and distal oblique bundle (DOB) of the interosseous membrane of the forearm. The distal oblique membrane was investigated in the 21 specimens of 11 Korean cadavers. The muscles in the forearms were removed to observe the DOB. The DOB was found in 13 of 21 specimens (61.9 %). The DOB was attached to the distal radioulnar joint capsule and the septum between the tendons of the extensor digiti minimi (EDM) and extensor carpi ulnaris (ECU) as well as the radius and ulna. In the cases that the DOB was absent, a part of the DOM extended to the distal radioulnar joint capsule and the septum between the tendons of the EDM and ECU, as well as the radius and ulna in all specimens (100%). The DOM, including the DOB, was arranged obliquely in the anteroposterior direction, whereas the intermediate part of the interosseous membrane was arranged in the same plane between the radius and ulna. The extension of the DOM and DOB to the wrist region may stabilize the distal radioulnar joint during supination and pronation. These data will be useful when performing reconstructive surgeries.

Keywords: distal oblique membrane, distal oblique bundle, distal radioulnar joint capsule, interosseous membrane

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Authors: Amritanshu Sandilya, M. V. Shah

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Collapsible soils such as loess are a common geotechnical challenge due to their potential to undergo sudden and severe settlement under certain loading conditions. The need for filling engineering to increase developing land has grown significantly in recent years, which has created several difficulties in managing soil strength and stability during compaction. Numerous engineering problems, such as roadbed subsidence and pavement cracking, have been brought about by insufficient fill strength. Therefore, strict control of compaction parameters is essential to reduce these distresses. Accurately measuring the degree of compaction, which is often represented by compactness is an important component of compaction control. For credible predictions of how collapsible soils will behave under complicated loading situations, the accuracy of laboratory studies is essential. Therefore, this study aims to investigate the energy transfer in collapsible soils during laboratory Proctor compaction tests to provide insights into how energy transfer can be optimized to achieve more accurate and reliable results in compaction testing. The compaction characteristics in terms of energy of loess soil have been studied at moisture content corresponding to dry of optimum, at the optimum and wet side of optimum and at different compaction energy levels. The hammer impact force (E0) and soil bottom force (E) were measured using an impact load cell mounted at the bottom of the compaction mould. The variation in energy consumption ratio (E/ E0) was observed and compared with the compaction curve of the soil. The results indicate that the plot of energy consumption ratio versus moisture content can serve as a reliable indicator of the compaction characteristics of the soil in terms of energy.

Keywords: soil compaction, proctor compaction test, collapsible soil, energy transfer

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Authors: Diane Ghanem, Oscar Covarrubias, Michael Raad, Dawn LaPorte, Babar Shafiq

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Introduction: Standardized exams have long been considered a cornerstone in measuring cognitive competency and academic achievement. Their fixed nature and predetermined scoring methods offer a consistent yardstick for gauging intellectual acumen across diverse demographics. Consequently, the performance of artificial intelligence (AI) in this context presents a rich, yet unexplored terrain for quantifying AI's understanding of complex cognitive tasks and simulating human-like problem-solving skills. Publicly available AI language models such as ChatGPT have demonstrated utility in text generation and even problem-solving when provided with clear instructions. Amidst this transformative shift, the aim of this study is to assess ChatGPT’s performance on the orthopaedic surgery in-training examination (OITE). Methods: All 213 OITE 2021 web-based questions were retrieved from the AAOS-ResStudy website. Two independent reviewers copied and pasted the questions and response options into ChatGPT Plus (version 4.0) and recorded the generated answers. All media-containing questions were flagged and carefully examined. Twelve OITE media-containing questions that relied purely on images (clinical pictures, radiographs, MRIs, CT scans) and could not be rationalized from the clinical presentation were excluded. Cohen’s Kappa coefficient was used to examine the agreement of ChatGPT-generated responses between reviewers. Descriptive statistics were used to summarize the performance (% correct) of ChatGPT Plus. The 2021 norm table was used to compare ChatGPT Plus’ performance on the OITE to national orthopaedic surgery residents in that same year. Results: A total of 201 were evaluated by ChatGPT Plus. Excellent agreement was observed between raters for the 201 ChatGPT-generated responses, with a Cohen’s Kappa coefficient of 0.947. 45.8% (92/201) were media-containing questions. ChatGPT had an average overall score of 61.2% (123/201). Its score was 64.2% (70/109) on non-media questions. When compared to the performance of all national orthopaedic surgery residents in 2021, ChatGPT Plus performed at the level of an average PGY3. Discussion: ChatGPT Plus is able to pass the OITE with a satisfactory overall score of 61.2%, ranking at the level of third-year orthopaedic surgery residents. More importantly, it provided logical reasoning and justifications that may help residents grasp evidence-based information and improve their understanding of OITE cases and general orthopaedic principles. With further improvements, AI language models, such as ChatGPT, may become valuable interactive learning tools in resident education, although further studies are still needed to examine their efficacy and impact on long-term learning and OITE/ABOS performance.

Keywords: artificial intelligence, ChatGPT, orthopaedic in-training examination, OITE, orthopedic surgery, standardized testing

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Authors: Ritesh Verma, Manisha Rathi, Chand Singh Dhull, Sumit Sachdeva, Jitender Phogat

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Temporal trabeculectomy with the Ologen implant was done in a 66-year-old lady with uveitic glaucoma. Serial IOP measurement was done to assess the efficacy of ologen implant in uveitic glaucoma. The patient had an IOP of 4mmhg day 1 postoperatively and Ologen implant was in place with a well-formed bleb. On follow up patient had an IOP of 14mmhg and unaided visual acuity of 6/12 on day 10 postoperatively. After 12 weeks of Trabeculectomy with Ologen implant, the IOP of the patient was 14 mmHg, the vision was 6/6 with -1.25 DS and -1.25 DC at 90 degrees. Trabeculectomy performed in patients with uveitic glaucoma has a higher chance of failure due to increased inflammation and fibrosis. Trabeculectomy with ologen implant done in a patient of uveitic glaucoma provides excellent postoperative results and the patient has a well-controlled IOP even after 56 weeks of surgery and a best corrected visual acuity of 6/6. Trabeculectomy with the ologen implant is superior to other surgeries in cases of secondary glaucoma with increased inflammation.

Keywords: glaucoma surgery, ologen implant, temporal trabeculectomy, uveitic glaucoma

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Authors: Nur Irmawati, H. A. Mohammed

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In the present study, mixed convection in a horizontal rectangular duct using Al2O3 is numerically investigated. The effects of different Rayleigh number, Reynolds number and radiation on flow and heat transfer characteristics were studied in detail. This study covers Rayleigh number in the range of 2×106≤Ra≤2×107 and Reynolds number in the range of 100≤Re≤1100. Results reveal that the Nusselt number increases as Reynolds and Rayleigh numbers increase. It was also found that the dimensionless temperature distribution increases as Rayleigh number increases.

Keywords: numerical simulation, mixed convection, horizontal rectangular duct, nanofluids

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Authors: Shehu Aliyu

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This study investigated the effects of instructional materials on academic achievement among senior secondary school students on the concept of Heat Transfer in physics in Fagge Educational Zone, Kano State Nigeria. The population consisted of SSII students from 10 public schools. Out of this, 87 students were randomly selected from which 24 males and 22 females formed the experimental group and 41 students as control group. A quasi experiential design with pretest and post-test for both the groups was adopted. Two research questions and null hypotheses guided the conduct of the study. The experimental group was exposed to teaching using instructional materials while the control group was taught using the normal lecture mode. Head Transfer Performance Test (HTPT) was used for data collection. The instrument was validated by experts in the science education field. A Pearson Product Moment Correlation (PPMC) was used to determine the reliability co-efficient and was found to be r=0.83. The research questions were answered using descriptive statistics while the hypotheses were tested at p≤ 0.05 level of significance using t-test. The result obtained from the data analysis showed that students in experimental group performed significantly better than those in the control group and that there was no significant difference in the academic performance between male and female students in the experimental group. Based on the findings of this study, it was recommended among others that the physics teachers should be receiving regular training on the importance of using instructional materials whether ready made or improved in their teaching.

Keywords: heat transfer, physics, instructional materials, academic performance

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Authors: Christy M. Moen, Richard B. Townsley

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Introduction: Metastasis to the frontal bone in thyroid cancer is extremely rare. A literature review found only six cases of thyroid cancer that metastasised to the frontal bone, with two of those involving further bone sites. Case Report: The patient was originally referred to the Oral and Maxillofacial Surgery team with an isolated mass on her forehead. Biopsies were performed, which showed this was likely a metastatic deposit from thyroid cancer. CT-PET scan showed this was an isolated lesion. The patient had a total thyroidectomy, and the forehead lesion was managed with radiotherapy. On interval scanning, the patient’s bony lesion had increased in size and had new lung nodules, which likely represented further metastasis. Conclusion: Isolated bony metastases to the frontal bone are rare. An important clinical principle to remember is that a bony metastasis from an unknown primary is more likely than primary bone cancer.

Keywords: cancer, thyroid, head and neck, surgery

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Authors: Sayyed Mostafa Ahmadi, Neda Raeesi

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Background and Objectives: Cervical spondylosis is a common problem that affects the adult spine and is the most common cause of radiculopathy and myelopathy in older patients. Anterior discectomy and fusion is a well-known technique in degenerative cervical disc disease. However, one of the late undesirable complications is adjacent disc degeneration, which affects about 91% of patients in ten years. Many factors can be effective in causing this complication, but some are still debatable. Discovering these risk factors and eliminating them can improve the quality of life. Methods: This is a retrospective cohort study. All patients who underwent anterior discectomy and fusion surgery in the neurosurgery ward of Imam Khomeini Hospital between 2013 and 2016 were evaluated. Their demographic information was collected. All patients were visited and examined for radiculopathy, myelopathy, and muscular force. At the same visit, all patients were asked to have a facelift, and neck profile, as well as a neck MRI(General Tesla 3). Preoperative graphs were used to measure the diameter of the cervical canal(Pavlov ratio) and to evaluate sagittal alignment(Cobb Angle). Preoperative MRI of patients was reviewed for anterior and posterior longitudinal ligament calcification. Result: In this study, 57 patients were studied. The mean age of patients was 50.63 years, and 49.1% were male. Only 3.5% of patients had anterior and posterior longitudinal ligament calcification. Symptomatic ASD was observed in 26.6%. The X-rays and MRIs showed evidence of 80.7% radiological ASD. Among patients who underwent one-level surgery, 20% had symptomatic ASD, but among patients who underwent two-level surgery, the rate of ASD was 50%.In other words, the higher the number of surfaces that are operated and fused, the higher the probability of symptomatic ASD(P-value <0.05). The X-rays and MRIs showed 80.7% of radiological ASD. Among patients who underwent surgery at one level, 78% had radiological ASD, and this number was 92% among patients who underwent two-level surgery(P-value> 0.05). Demographic variables such as age, sex, height, weight, and BMI did not have a significant effect on the incidence of radiological ASD(P-value> 0.05), but sex and height were two influential factors on symptomatic ASD(P-value <0.05). Other related variables such as family history, smoking and exercise also have no significant effect(P-value> 0.05). Radiographic variables such as Pavlov ratio and sagittal alignment were also unaffected by the incidence of radiological and symptomatic ASD(P-value> 0.05). The number of surgical surfaces and the incidence of anterior and posterior longitudinal ligament calcification before surgery also had no statistically significant effect(P-value> 0.05). In the study of the ability of the neck to move in different directions, none of these variables are statistically significant in the two groups with radiological and symptomatic ASD and the non-affected group(P-value> 0.05). Conclusion: According to the findings of this study, this disease is considered to be a multifactorial disease. The incidence of radiological ASD is much higher than symptomatic ASD (80.7% vs. 26.3%) and sex, height and number of fused surfaces are the only factors influencing the incidence of symptomatic ASD and no variable influences radiological ASD.

Keywords: risk factors, anterior neck disectomy and fusion, adjucent segment degeneration, complication

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Authors: Z. Aziz, S. Terkhi, Y. Sefir, R. Djelti, S. Bentata

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The effect of a uniform electric field across multibarrier systems (InAs/InxGa1-xAs) is exhaustively explored by a computational model using exact airy function formalism and the transfer-matrix technique. In the case of biased DFHBSL structure a strong reduction in transmission properties was observed and the width of the miniband structure linearly decreases with the increase of the applied bias. This is due to the confinement of the states in the miniband structure, which becomes increasingly important (Wannier-Stark Effect).

Keywords: dimer fibonacci height barrier superlattices, singular extended state, exact airy function, transfer matrix formalism

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Authors: Ji Jiazheng, Wang Jingrao, Jin Xin, Zhang Hong

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Diabetes mellitus is a metabolic disease characterized by high blood sugar. A long-standing hyperglycemic state can lead to various tissue damage. Diabetic retinopathy is the most common and widely studied ocular complication and has become the leading cause of blindness in my country. At the same time, diabetes has profound clinically relevant effects on the cornea, leading to keratopathy and vision-threatening. The cornea is an avascular tissue and is sensitive to hyperglycemia, Keratopathy caused by diabetes is usually chronic, they are called diabetic keratopathy or diabetic neurotrophic keratopathy, leading to several diabetic corneal complications including delayed epithelial wound healing, recurrent erosions, neuropathy, loss of sensitivity. Corneal stem cell dysfunction in diabetic patients as an important influencing factor of diabetic keratopathy. The consequences of this condition are often underestimated. The limbus is located between the cornea and the sclera tissue. The limbal stroma consists of a series of radial elevations with fibrovascular centers known as palisades of Vogt (POV). Previous studies have shown that palisades of Vogt (POV), as the main site of limbal stem cells, plays an important role in the homeostasis of the corneal epithelium. Therefore, POV plays a vital role in the healing of corneal epithelial surgery and postoperative evaluation. IVCM can observe the condition of the corneal epithelium at the cellular level. It has profound significance and guidance for the evaluation of limbal and limbal stem cells. We have previously observed structural changes in POV in HSK and HZO patients on IVCM. At present, there have been reports involving limbal stem cell dysfunction in diabetic patients, but the specific pathogenesis is still unclear. However, there are no studies on POV morphological changes in patients with DM. Therefore, we performed statistics and compared the correlation between POV morphological changes and corneal epithelial basal cell density, corneal nerves, and length of disease in DM patients and normal humans using IVCM studies. At the same time, fundoscopy was used to observe the correlation between the thickness of RNFL and the thickness of GCC and POV in diabetic patients. And to observe the correlation between SVD, DVD and POV for research.

Keywords: confocal microscopy, fundus, limbal stem cells, diabetes

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Authors: Nagesh Vangala, Rayudu Mannam

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Soft switching has attracted the interest of various researchers constantly. Many techniques are in vogue to achieve soft switching (ZVS and/or ZCS) in Boost converters. These techniques utilize an auxiliary switch to incorporate the ZCS/ZVS. Such schemes require additional control circuit and induce complexity in design. This paper proposes an elegant fly back approach which guarantees zero current switching of the main Switch without the need for any additional active device. A simple flyback transformer scheme is implemented which absorbs the initial turn ON energy (or the Reverse recovery energy of Boost diode) and delivers to the output.

Keywords: boost converter, complete energy transfer, flyback, zero current switching

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Authors: John Joseph S. Martis, Rohanchandra R. Gatty, Aaron Jose Fernandes, Rahul P. Nambiar

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Introduction: Surgery for breast cancer is either mastectomy or breast conservation surgery. The most commonly used incision for modified radical mastectomy is the transverse Stewart incision. But this incision may have the disadvantage of causing disparity between the closure lines of superior and inferior skin flaps in mastectomy and can cause overhanging of soft tissue below and behind the axilla. The curvizigzag incision, on principle, may help in this regard and can prevent scar migration beyond the anterior axillary line. This study aims to compare the two incisions in this regard. Methods: 100 patients with cancer of breast were included in the study after satisfying inclusion and exclusion criteria. They underwent surgery at Father Muller Medical College, Mangalore, India, between November 2019 to September 2021. The patients were divided into two groups. Group A patients were subjected to modified radical mastectomy with curvizigzag incision and group B patients with transverse Stewart incision. Results: Seroma on postoperative day1, day 2 was 0% in both the groups. Seroma on postoperative day 30 was present in 14% of patients in group B. 60% of patients in group B had sag of soft tissue below and behind the axilla, and none of the patients in group A had this problem. In 64% of the patients in group B, the incision crossed the anterior axillary fold, 64% of the patients in group B had tension in the incision site while approximation of the skin flaps. Conclusion: Curvizigzag incision is statistically better with lesser complications when compared to the transverse Stewart incision for modified radical mastectomy for carcinoma breast.

Keywords: breast cancer, curvizigzag incision, transverse Stewart incision, seroma, modified radical mastectomy

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Authors: Yasemin Akar, Jan G. Wissink, Herlina Herlina

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The effect of various levels of contamination on the interfacial air–water gas transfer velocity is studied by Direct Numerical Simulation (DNS). The interfacial gas transfer is driven by isotropic turbulence, introduced at the bottom of the computational domain, diffusing upwards. The isotropic turbulence is generated in a separate, concurrently running the large-eddy simulation (LES). The flow fields in the main DNS and the LES are solved using fourth-order discretisations of convection and diffusion. To solve the transport of dissolved gases in water, a fifth-order-accurate WENO scheme is used for scalar convection combined with a fourth-order central discretisation for scalar diffusion. The damping effect of the surfactant contamination on the near surface (horizontal) velocities in the DNS is modelled using horizontal gradients of the surfactant concentration. An important parameter in this model, which corresponds to the level of contamination, is ReMa⁄We, where Re is the Reynolds number, Ma is the Marangoni number, and We is the Weber number. It was previously found that even small levels of contamination (ReMa⁄We small) lead to a significant drop in the interfacial gas transfer velocity KL. It is known that KL depends on both the Schmidt number Sc (ratio of the kinematic viscosity and the gas diffusivity in water) and the surface divergence β, i.e. K_L∝√(β⁄Sc). Previously it has been shown that this relation works well for surfaces with low to moderate contamination. However, it will break down for β close to zero. To study the validity of this dependence in the presence of surface contamination, simulations were carried out for ReMa⁄We=0,0.12,0.6,1.2,6,30 and Sc = 2, 4, 8, 16, 32. First, it will be shown that the scaling of KL with Sc remains valid also for larger ReMa⁄We. This is an important result that indicates that - for various levels of contamination - the numerical results obtained at low Schmidt numbers are also valid for significantly higher and more realistic Sc. Subsequently, it will be shown that - with increasing levels of ReMa⁄We - the dependency of KL on β begins to break down as the increased damping of near surface fluctuations results in an increased damping of β. Especially for large levels of contamination, this damping is so severe that KL is found to be underestimated significantly.

Keywords: contamination, gas transfer, surfactants, turbulence

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Authors: L. Torchane

Abstract:

This study is devoted to defining the optimal conditions for the nitriding of pure iron at atmospheric pressure by using NH3-Ar-C3H8 gas mixtures. After studying the mechanisms of phase formation and mass transfer at the gas-solid interface, a mathematical model is developed in order to predict the nitrogen transfer rate in the solid, the ε-carbonitride layer growth rate and the nitrogen and carbon concentration profiles. In order to validate the model and to show its possibilities, it is compared with thermogravimetric experiments, analyses and metallurgical observations (X-ray diffraction, optical microscopy and electron microprobe analysis). Results obtained allow us to demonstrate the sound correlation between the experimental results and the theoretical predictions.

Keywords: gaseous nitrocarburizing, kinetic model, diffusion, layer growth kinetic

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Authors: Yoshio Kurosawa

Abstract:

To reduce the interior noise of cars in high-frequency region, sound proof materials are laminated with the body panels and the interior trims. Therefore, sound proof properties of the laminates play an important role for the efficient acoustical design. A program code which predicts both sound absorption properties and sound insulation properties of the laminates are developed. This program code is used for transfer matrix method by Biot theory. This report described the outline of this program code, and the calculation results almost agreed with the experimental results.

Keywords: porous media, transmission loss, Biot theory, transfer matrix method

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Authors: Lingyu Ding, Hongxia Hua, Hanfei Zhu, Jinling Lu, Qin Xu

Abstract:

Background: Postoperative pain is a prevalent problem leading to many adverse outcomes in surgical patients. Virtual reality (VR) is an emerging non-pharmacological method of postoperative pain relief, but the effects of it are not clear. This review aimed to explore the effects of VR on relieving postoperative pain. Methods: We searched PubMed, Embase, Web of Science, and other databases from inception to November 2019 to get the eligible studies. Meta-analyses were conducted to compare VR and usual care for relieving postoperative pain. Subgroup analyses and sensitivity analyses were performed to explain the heterogeneity. Results: Overall, 8 randomized control trials (RCTs) enrolling 723 participants were included. Our results demonstrated that the patients receiving the VR intervention had lower postoperative pain scores than those receiving the usual care. One subgroup analysis revealed that VR could relieve postoperative pain both in minor surgery and major surgery. Another subgroup analysis demonstrated a significant reduction in postoperative pain among patients receiving VR during the intraoperative and the postoperative periods. However, there was no significant postoperative pain relief when receiving VR during the preoperative period. Additionally, significant improvements in postoperative satisfaction were reported in two studies. However, another two studies included found that VR could not affect physiological parameters related to pain. Conclusion: Applying VR can relieve postoperative pain effectively. The type of surgery and timing of using VR are the main sources of heterogeneity. More rigorous studies about the relationship between VR and postoperative pain relief will be needed.

Keywords: meta-analysis, postoperative pain, systematic review, virtual reality

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Authors: Jenee Gooden, Kevin Vasquez-monterroso, Lady Paula Dejesus, Sandra Wainwright, Daniel Kim, Mackenzie Walker

Abstract:

Introduction: Pyoderma gangrenosum (PG) is a rare, rapidly progressive, neutrophilic ulcerative colitis condition with an incidence of 3 to 10 cases per year ¹ ². Due to the similar appearance, PG is often misdiagnosed as a diabetic ulcer in diabetic patients. Though they may clinically appear similar in appearance, the treatment protocol and diagnostic criteria differ. Also, end-stage renal disease (ESRD) is often a condition seen in diabetic patients, which can have a significant impact on wound healing due to the wide range of uremic toxins³. This case study demonstrates a multidisciplinary team and multimodal treatment approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine for an uncontrolled diabetic with pyoderma gangrenosum of a significant circumferential wound, covering almost the entire right lower extremity. Methods:56 y.o male presents with multiple PG ulcerations, including the chest, right posterior lower extremity and sacrum. All ulcerations were previously managed by the same wound care specialist. His chief complaint was worsening PG ulcerations accompanied by a fever of 103 °F . This case study focuses on the wound to his RLE. Past medical history significant for diabetes mellitus type 2 with hemoglobin A1c of 10% and end stage renal disease (ESRD) on hemodialysis. A multidisciplinary team approach by podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine was successfully used to perform right lower extremity limb salvage. The patient was managed by rheumatology for the continuation of prior medication, as well as the mutual agreement with wound care for the addition of dapsone. A coronary CT angiogram was performed by interventional cardiology, but no significant disease was noted, and no further vascular workup was necessary. Multiple surgical sharp wide excisional debridements with application of allografts and split thickness skin grafts for the circumferential ulceration that encompassed almost the entire right lower extremity were performed by both podiatric surgery and general surgery. Wound cultures and soft tissue biopsies were performed, and infectious disease managed antibiotic therapy. Hyperbaric oxygen therapy and wound vac therapy by wound care were also completed as adjunct management. Results: Prevention of leg amputation by limb salvage of the RLE was accomplished by a multidisciplinary team approach, with the wound size decreasing over a total of 29 weeks from 600 cm² to 12.0 x 3.5 x 0.2 cm. Our multidisciplinary team included podiatric surgery, general surgery, rheumatology, infectious disease, interventional cardiology, wound care and hyperbaric medicine. Discussion: Wound healing, in general, can have its challenges, and those challenges are only magnified when accompanied by multiple systemic illnesses. Though the negative impact of diabetes on wound healing is well known, the compound impact of being a diabetic with ESRD and having pyoderma gangrenosum is not. This case demonstrates the necessity for a multidisciplinary team approach with a wide array of treatment modalities to optimize wound healing and perform limb salvage with prevention of lower extremity amputation.

Keywords: diabetes, podiatry, pyoderma gangrenosum, end stage renal disease

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Authors: Sitti Rahmawati

Abstract:

Payment system of cataract surgery implemented by professional attendant of doctor and nurse has been increasing, through health insurance program and this has become one of the factors that affects a lot of government in the budget establishment. This system has been implemented in purpose of quality and expenditure control, i.e., controlling health overpayment to obtain benefit (moral hazard) by the user of insurance or health service provider. The increasing health cost becomes the main issue that hampers the society to receive required health service in cash payment-system. One of the efforts that should be taken by the government in health payment is by securing health insurance through society's health insurance. The objective of the study is to learn the capability of a patient to pay cataract eye operation for the elders. Method of study sample population in this study was patients who obtain health insurance board card for the society that was started in the first of tri-semester (January-March) 2015 and claimed in Indonesian software-Case Based Group as a purposive sampling of 40 patients. Results of the study show that total unit cost analysis of surgery service unit was obtained $75 for unit cost without AFC and salary of nurse and doctor. The operation tariff that has been implemented today at Anutapura hospitals in eye department is tariff without AFC and the salary of the employee is $80. The operation tariff of the unit cost calculation with double distribution model at $65. Conclusion, the calculation result of actual unit cost that is much greater causes incentive distribution system provided to an ophthalmologist at $37 and nurse at $20 for one operation. The surgery service tariff is still low; consequently, the hospital receives low revenue and the quality of health insurance in eye operation department is relatively low. In purpose of increasing the service quality, it requires adequately high cost to equip medical equipment and increase the number of professional health attendant in serving patients in cataract eye operation at hospital.

Keywords: economic evaluation, cataract operation, health attendant, health insurance system

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Authors: Cristian Patrascioiu, Loredana Negoita

Abstract:

This paper is focused on modeling and simulation of the tubular heaters. The paper is structured in four parts: the structure of the tubular convection section, the heat transfer model, the adaptation of the mathematical model and the solving model. The main hypothesis of the heat transfer modeling is that the heat exchanger of the convective tubular heater is a lumped system. In the same time, the model uses the heat balance relations, Newton’s law and criteria relations. The numerical program achieved allows for the estimation of the burn gases outlet temperature and the heated flow outlet temperature.

Keywords: heat exchanger, mathematical modelling, nonlinear equation system, Newton-Raphson algorithm

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Authors: Jitendra Jain, Cassandra Hidajat, Hansraj Riteesh Bookun

Abstract:

Graft patency underpins long-term prognosis after coronary artery bypass grafting surgery (CABG). The benefits of the combined use of only the left internal mammary artery and radial artery, referred to as total arterial revascularisation (TAR), on long-term clinical outcomes and quality of life are relatively unknown. The aim of this study was to identify whether there were differences in long term clinical outcomes between recipients of TAR compared to a cohort of mostly arterial revascularization involving the left internal mammary, at least one radial artery and at least one saphenous vein graft. A retrospective analysis was performed on all patients who underwent TAR or were re-vascularized with supplementary saphenous vein graft from February 1996 to December 2004. Telephone surveys were conducted to obtain clinical outcome parameters including major adverse cardiac and cerebrovascular events (MACCE) and Short Form (SF-36v2) Health Survey responses. A total of 176 patients were successfully contacted to obtain postop follow up results. The mean follow-up length from time of surgery in our study was TAR 12.4±1.8 years and conventional 12.6±2.1. PCS score was TAR 45.9±8.8 vs LIMA/Rad/ SVG 44.9±9.2 (p=0.468) and MCS score was TAR 52.0±8.9 vs LIMA/Rad/SVG 52.5±9.3 (p=0.723). There were no significant differences between groups for NYHA class 3+ TAR 9.4% vs. LIMA/Rad/SVG 6.6%; or CCS 3+ TAR 2.35% vs. LIMA/Rad/SVG 0%.

Keywords: CABG; MACCEs; quality of life; total arterial revascularisation

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