Search results for: robotic bariatric surgery

Authors: Taehoon Kwon, Hyeongrae Cho, Dirk Henkensmeier, Youngjong Kang, Chong Min Koo

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Ionic polymer actuators have been of interest in the bio-inspired artificial muscle devices. However, the relatively slow response and low power density were the obstacles for practical applications. In this study, ionic polymer actuators are fabricated with ionic polymer composite membranes based on sulfonated poly(arylene ether sulfone) (SPAES) and copper(II) phthalocyanine tetrasulfonic acid (CuPCSA). CuPCSA is an organic filler with very high ion exchange capacity (IEC, 4.5 mmol H+/g) that can be homogeneously dispersed on the molecular scale into the SPAES membrane. SPAES/CuPCSA actuators show larger ionic conductivity, mechanical properties, bending deformation, exceptional faster response to electrical stimuli, and larger mechanical power density (3028 W m–3) than Nafion actuators. This outstanding actuation performance of SPAES/CuPCSA composite membrane actuators makes them attractive for next generation transducers with high power density, which are currently developed biomimetic devices such as endoscopic surgery.

Keywords: actuation performance, composite membranes, ionic polymer actuators, organic filler

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Authors: Freddy Patricio Moncayo-Matute, Pablo Gerardo Peña-Tapia, Vázquez-Silva Efrén, Paúl Bolívar Torres-Jara, Diana Patricia Moya-Loaiza, Gabriela Abad-Farfán

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This study describes a clinical case and the results on the application of additive manufacturing for the surgical planning in the removal of a cranial spheno-orbital meningioma. It is verified that the use of personalized anatomical models and cutting guides helps to manage the cranial anomalies approach. The application of additive manufacturing technology: Fused Deposition Modeling (FDM), as a low-cost alternative, enables the printing of the test anatomical model, which in turn favors the reduction of surgery time, as well the morbidity rate reduction too. And the printing of the personalized cutting guide, which constitutes a valuable aid to the surgeon in terms of improving the intervention precision and reducing the invasive effect during the craniotomy. As part of the results, post-surgical follow-up is included as an instrument to verify the patient's recovery and the validity of the procedure.

Keywords: surgical planning, additive manufacturing, rapid prototyping, fused deposition modeling, custom anatomical model

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Authors: Aparajita Bhattacharya, Mousumi Dutta, Zakir Husain, Dionne Sequeira, Asima Mukhopadhyay

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Background: Tata Medical Centre (TMC), Kolkata is a major cancer referral centre in Eastern India and neighbouring countries providing state of the art facilities; however, it is a non-profit organisation with patients requiring to pay at subsidised rates. Although a system for social assessment and applying for governmental/ non-governmental (NGO) funds is in place, access is challenging. Amongst gynaecological cancers (GC), ovarian cancer (OC) is associated with the highest treatment cost; majority of which is required at the beginning when complex surgery is performed and funding arrangements cannot be made in time. We therefore appointed a dedicated Medical Social Worker (MSW) in 2016, supported by NGO for GC patients in order to assist patients/family members to access/avail these funds more readily and assist in economic evaluation for both direct and opportunity costs. Objectives: To reflect on our experience and challenges in collecting data on economic evaluation of cancer patients and compare success rates in achieving fund mobilization after introduction of MSW. Methods: A Retrospective survey. Patients with OC and their relatives were seen by the MSW during the initial outpatients department visit and followed though till discharge from the hospital and during follow-up visits. Assistance was provided in preparing the essential documents/paperwork/contacts for the funding agencies including both governmental (Chief-Minister/Prime-Minister/President) and NGO sources. In addition, a detailed questionnaire was filled up for economic assessment of direct/opportunity costs during the entire treatment and 12 months follow up period which forms a part of the study called HEPTROC (Health economic evaluation of primary treatment for ovarian cancer) developed in collaboration with economics departments of Universities. Results: In 2015, 102 patients were operated for OC; only 16 patients (15.68 %) had availed funding of a total sum of INR 1640000 through the hospital system for social assessment. Following challenges were faced by majority of the relatives: 1. Gathering important documents/proper contact details for governmental funding bodies and difficulty in following up the current status 3. Late arrival of funds. In contrast in 2016, 104 OC patients underwent surgery; the direct cost of treatment was significantly higher (median, INR 300000- 400000) compared to other GCs (n=274). 98/104 (94.23%) OC patients could be helped to apply for funds and 90/104(86.56%) patients received funding amounting to a total of INR 10897000. There has been a tenfold increase in funds mobilized in 2016 after the introduction of dedicated MSW in GC. So far, in 2017 (till June), 46/54(85.18%) OC patients applied for funds and 37/54(68.51%) patients have received funding. In a qualitative survey, all patients appreciated the role of the MSW who subsequently became the key worker for patient follow up and the chief portal for patient reported outcome monitoring. Data collection quality for the HEPTROC study was improved when questionnaires were administered by the MSW compared to researchers. Conclusion: Introduction of cancer specific MSW can expedite the availability of funds required for cancer patients and it can positively impact on patient satisfaction and outcome reporting. The economic assessment will influence fund allocation and decision for policymaking in ovarian cancer. Acknowledgement: Jivdaya Foundation Dallas, Texas.

Keywords: economic evaluation, funding, medical social worker, ovarian cancer

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Authors: Ahmed Mudi, Bala Zakar

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The paper assesses the impact of safe motherhood initiative on maternal health of women in Gumel Local Government Area of Jigawa State. The work will specifically concentrate on the background on safe motherhood scheme and maternal health of women. The objective of this paper is to assess the level of safe motherhood scheme in Gumel local government area, to find out the level of maternal health in Gumel local government as well as to determine the impact of safe motherhood scheme on maternal health on women in Gumel Local Government Area Jigawa State. Various literature on the topic are reviewed, the paper adopts survey design and use questionnaire to collect data from the respondent. The study comprises 350 women selected from six rural communities in Gumel using random sampling techniques, and the data was analysed by simple frequency and percentage. The research concluded that safe motherhood initiative has a significant impact on the maternal health of women in Gumel Local Government Area of Jigawa State. Finally, suitable recommendations were given on how to improve the scheme to ensure better maternal health in the region.

Keywords: action, assessment, maternal health, safe motherhood, surgery

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Authors: Naraporn Taemaitree, Pruet Areesawangvong, Satchachon Changthom, Tanin Titipungul

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Adult intussusception, unlike childhood intussusception, is rare. Approximately 5-15% of cases are idiopathic without a lead point lesion. Secondary intussusception is caused by pathological conditions such as inflammatory bowel disease, postoperative adhesions, Meckel’s diverticulum, benign and malignant lesions, metastatic neoplasms, or even iatrogenically due to the presence of intestinal tubes, jejunostomy feeding tubes or after gastric surgery. Diagnosis can be delayed because of its longstanding, intermittent, and non-specific symptoms. Computed tomography is the most sensitive diagnostic modality and can help distinguish between intussusceptions with and without a lead point and lesion localization. This report presents the case of a 49-year-old man presented with increasing abdominal pain over the past three days, loss of appetite, constipation, and frequent vomiting. Computed tomography revealed distal small bowel obstruction at the right lower quadrant with thickened outer wall and internal non-dilated small bowel loop. Emergency exploratory laparotomy was performed to clear the obstruction, which upon inspection was caused by extremely long Taenia solium parasites.

Keywords: intussusception, tape worm, Taenia solium, abdominal pain

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Authors: Georgia Mills, Rachel Parsonage

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Thrombocytosis is a platelet count above the upper limit of the normal range. An urgent referral is advised for counts over 1000 x109 and if the count is between 600-1000 x109 with certain conditions/age. A non-urgent referral is warranted when the level is above 450 × 109/L (for more than 3 months) or over 600 × 109/L on at least two occasions (4–6 weeks apart) or within the range 450–600 × 109/L with other haematological abnormalities. The aim of this audit is the assess how well Roseneath's general practice has adhered to the National Institute for Health and Care Excellence (NICE) guidelines for investigations and management of high platelet counts. Through the filtering tool on Vision, all blood results in the surgery were filtered to only show those with a platelet count above 450 x 109 /L. These patients were then analyzed individually to see where they fall on the current NICE guidance pathway for management. The investigations and management of thrombocytosis were generally poor. 60% of those who needed an urgent referral did not have it done. 30% of those who needed a follow-up blood test did not have it done. 60% of those needing a routine referral from complete investigations did not have it done. To improve the knowledge of NICE guidelines within the practice, a teaching session was delivered. Percentages then reached 100% in the 2nd audit. There is a lack of awareness of guidelines and education on thrombocytosis in primary care. Teaching sessions will benefit outcomes greatly

Keywords: platelets, thrombocytosis, management, referral

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Authors: Maide Yesilyurt, Saide Faydalı

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Patients experience pain at different intensities in postoperative. The diagnosis of the pain, the assessment and the success of the treatment and care make the measurement of this finding compulsory. The aim of the study is to determine the evaluation differences numeric pain scales. The descriptive study was conducted with 360 patients with in postoperative. The data were obtained from questionnaires related to six numeric pain scales most preferred in clinical use, and a face-to-face interview technique was used by the researcher. Regarding to numeric pain scale, questions include forth positive and one negative statement. In evaluating the data; chi-square and Pearson correlation tests were used. For the study, the patients’ informed consents, the institution and the ethics committee received permission. In this study, patients' ages are between 18-80, 95.8% of the patients were not informed about pain assessment. Patients evaluated the 5-item numeric scale as the easy, can be answered quickly, accurate, and appropriate for clinical use and the 101 items numeric scale as complex than other scales. Regarding to numeric pain scales with positive statements between age, marital status, educational status, previous surgery, having chronic disease and getting information about pain assessment significant difference has been detected. All numeric pain scales are correlated to each other. As a result, it was determined that as the items in the numerical scales decreased, the patients were able to perceive the scales better, and the items in the scales increased, the patients were in trouble to understand.

Keywords: numeric pain scales, nurse, pain assessment, patient

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Authors: Andrey Boyko

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Nowadays, there is no consensus about the influence of urethral plate (UP) width on the surgical outcomes after distal hypospadias repair. The purpose of the research was to study the association between UP width and surgical outcomes after distal hypospadias repair in children. Materials and methods: The study included 138 patients with distal hypospadias. The mean age at the time of surgery was 4.6 years (6 months – 16 years). We measured UP width at the “midpoint within the glans” and used the HOSE scale to assess postoperative outcomes. The patients were divided into 2 groups: group 1 – the patients (107) with UP < 8mm, group 2 – patients (31) with UP > 8mm. All boys underwent TIP repair. Preincision means UP width after incision means UP width, and the UP ratio was analyzed. Statistical data were obtained using Statistica 10. Results: The findings were preincision mean UP width - 5.4 mm and 9.4 mm; after incision mean UP width - 13mm and 17.5 mm; UP ratio - 0.41 and 0.53 in group 1 and group 2, respectively. Most postoperative complications (fistula, meatal stenosis, and stricture) happened in patients with UP width < 8 mm versus ≥ 8 mm (7/107 versus 2/31, respectively). HOSE results were 15.77 (group 1), 15.65 (group 2). The follow up lasted up to 12 months. Statistical analysis proved the absence of correlation between UP width and postoperative complications. Conclusions: In conclusion, it should be noted that the success of surgical repair mostly depended on the surgical technique.

Keywords: children, distal hypospadias, tip repair, urethral plate width

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Authors: O. B. Iskender, K. V. Ling, V. Dubanchet, L. Simonini

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This paper discusses the recent advances and future prospects of spacecraft position and attitude control using Model Predictive Control (MPC). First, the challenges of the space missions are summarized, in particular, taking into account the errors, uncertainties, and constraints imposed by the mission, spacecraft and, onboard processing capabilities. The summary of space mission errors and uncertainties provided in categories; initial condition errors, unmodeled disturbances, sensor, and actuator errors. These previous constraints are classified into two categories: physical and geometric constraints. Last, real-time implementation capability is discussed regarding the required computation time and the impact of sensor and actuator errors based on the Hardware-In-The-Loop (HIL) experiments. The rationales behind the scenarios’ are also presented in the scope of space applications as formation flying, attitude control, rendezvous and docking, rover steering, and precision landing. The objectives of these missions are explained, and the generic constrained MPC problem formulations are summarized. Three key design elements used in MPC design: the prediction model, the constraints formulation and the objective cost function are discussed. The prediction models can be linear time invariant or time varying depending on the geometry of the orbit, whether it is circular or elliptic. The constraints can be given as linear inequalities for input or output constraints, which can be written in the same form. Moreover, the recent convexification techniques for the non-convex geometrical constraints (i.e., plume impingement, Field-of-View (FOV)) are presented in detail. Next, different objectives are provided in a mathematical framework and explained accordingly. Thirdly, because MPC implementation relies on finding in real-time the solution to constrained optimization problems, computational aspects are also examined. In particular, high-speed implementation capabilities and HIL challenges are presented towards representative space avionics. This covers an analysis of future space processors as well as the requirements of sensors and actuators on the HIL experiments outputs. The HIL tests are investigated for kinematic and dynamic tests where robotic arms and floating robots are used respectively. Eventually, the proposed algorithms and experimental setups are introduced and compared with the authors' previous work and future plans. The paper concludes with a conjecture that MPC paradigm is a promising framework at the crossroads of space applications while could be further advanced based on the challenges mentioned throughout the paper and the unaddressed gap.

Keywords: convex optimization, model predictive control, rendezvous and docking, spacecraft autonomy

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Authors: Elia Caldini, Cláudia N. Battlehner, Marcelo A. Ferreira, Rolf Gemperli, Nivaldo Alonso, Luiz P. Vana

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The advent of dermal regenerate templates has fostered major advances in the treatment of acute burns and their sequelae, in the last two decades. Both data on morphological aspects of the newly-formed tissue, and clinical trials comparing different templates, are still lacking. The goal of this study was to prospectively analyze the outcome of patients treated with two of the existing templates, followed by thin skin autograft. They are both made of bovine collagen, one includes a superficial silicone layer. Surgery was performed on patients with impaired mobility resulting from burn sequelae (n = 12 per template). Negative pressure therapy was applied post-surgically; patients were monitored for 12 months. Data on scar skin quality (Vancouver and POSAS evaluation scales), rate of joint mobility recovery, and graft contraction were recorded. Improvement in mobility and skin quality were demonstrated along with graft contraction, in all patients. The silicone-coupled template showed the best performance in all aspects.

Keywords: dermal regeneration template, artificial skin, skin quality, scar contracture

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Authors: Iddrisu Ibrahim, Joseph Atia Ayariga, Junhuan Xu, Daniel A. Abugri, Robertson K. Boakai, Olufemi S. Ajayi

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The recalcitrance of pathogenic bacteria indicates that millions of people who are at risk of infection arising from chronic diseases, surgery, organ transplant, diabetes, and several other debilitating diseases present an aura of potentially untreatable illness due to resistance development. Antimicrobial resistance has successfully become a global health menace, and resistances are often acquired by bacteria through health-care-related incidence (HRI) orchestrated by multi-drug resistant (MDR) and extended drug-resistant pathogens (EDRP). To understand the mechanisms S. Typhimurium uses to resist CDB, we study the abundance of LPS modification, Ergosterols, Mysristic palmitic resistance, Oleic acid resistance of susceptible and resistant S. Typhimurium. Using qPCR, we also analyzed the expression of selected genes known for enabling resistance in S. Typhimurium. We found high abundance of LPS, Ergosterols, Mysristic palmitic resistance, Oleic acid resistance of and high expression of resistant genes in S. Typhimurium compared to the susceptible strain. LPS modification, Ergosterols, Mysristic palmitic resistance, Oleic acid and genes such as Fims, integrons, blaTEM are important indicators of resistance development of S. typhimurium.

Keywords: antimicrobials, resistance, Cannabidiol, Salmonella, blaTEM, fimA, Lipopolysaccharide, Ergosterols

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Authors: Tery Nehemia Nugraha Joseph, J. D. P. Wisnubroto

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Thyroid cancer is a healthcare problem with high morbidity and mortality. Follicular adenoma and follicular carcinoma are thyroid tumors from the thyroid follicular cells differentiation with a microfollicular pattern that consists of follicular cuboidal cells. vascular endothelial growth factor (VEGF) is a potent and powerful mitogen for endothelial cells and increases vascular permeability. Therefore, due to an increase in thyroid-stimulating hormone (TSH), VEGF production is activated in the thyroid that leads to the end of mitogenic TSH stimulation and initiation of angiogenesis. The differences in VEGF levels in the follicular carcinoma of thyroid tissue with follicular adenoma thyroid can be used as a basis in differentiating the two types of neoplasms. This study aims to analyze VEGF in the serum so that it can be used to differentiate the types of thyroid carcinoma before surgery. This study uses a cross-sectional research design. Samples were carried out by taking serum samples, and the VEGF levels were calculated. Data were analyzed using the Mann-Whitney test. The results found a significant difference between VEGF levels in the follicular carcinoma thyroid group and VEGF levels in the follicular adenoma thyroid group with a value of p = 0.007 (p < 0.05). The results obtained are 560,427 ± 160,506 ng/mL in the type of follicular carcinoma thyroid and 320.943 ± 134.573 ng/mL in the type of follicular adenoma thyroid. VEGF levels between follicular adenoma and follicular carcinoma are different. VEGF levels are higher in follicular carcinoma thyroid than follicular adenoma thyroid.

Keywords: follicular adenoma thyroid, follicular carcinoma thyroid, thyroid, VEGF

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Authors: Zahra Tolou-Ghamari

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Introduction: After allogeneic organ transplantation, in order to lower the rate of rejectiontacrolimus is given. In fact, infection is reported as the most complication of tacrolimus that might be associated with higher susceptibility by its’ long term use. Aim: This study aims to review the association between the occurrence of infections after organ transplantation following the administration of tacrolims. Materials and Methods: Scientific literature on the pharmacotherapy of tacrolimus after organ transplantation and infections were searched using PUBMED.Gov (https://pubmed.ncbi.nlm.nih.gov/), Web of Science, and Scopus. Results: In order to prevent acute and chronic rejection, the potent immunosuppressive drug tacrolimus administered as a calcineurin inhibitor after organ transplantation. Its’ most frequent infectious complication is reported as urinary tract infection. Virulent strain of recombinant Literiamonocytogenes, in addition to an increase in bacterial burden in the liver and spleen tissues, was reported in the animal experimental study. The consequence of aggressive events and recipients total area under the cureve exposure to immunosuppressive could be as considered as surrogate markers for individual infection’s risk evaluation. Conclusion: Transplant surgery and duration of hospital stay could determinate the risk of infection during the first month of organ transplantation. Despite administration of antiviral drugs, opportunistic infection such as cytomegalovirus could increase the risk of infection during month 1 to year after transplantation.

Keywords: transplant, infection, tacrolimus, kidney

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Authors: Soheir Weheida, Amal E. Shehata, Samira E. Aboalizm

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The aim of this study was to examine the effect of surgical safety checklist on surgical team’s knowledge and performance in operating room. Subjects: A convenience sample 151 (48 head nurse, 45 nurse, 37 surgeon and 21 anesthesiologist) which available in operating room at two different hospitals was included in the study. Setting: The study was carried out at operating room in Menoufia University and Shebin Elkom Teaching Hospitals, Egypt. Tools: I: Surgical safety: Surgical team knowledge assessment structure interview schedule. II: WHO surgical safety observational Checklist. III: Post Surgery Culture Survey scale. Results: There was statistical significant improvement of knowledge mean score and performance about surgical safety especially in post and follow up than pre intervention, before patients entering the operating, before induction of anesthesia, skin incision and post skin closure and before patient leaves operating room, P values (P < 0.001). Improvement of communication post intervention than pre intervention between surgical team’s (4.74 ± 0.540). About two thirds (73.5 %) of studied sample strongly agreed on surgical safety in operating room. Conclusions: Implementation of surgical safety checklist has a positive effect on improving knowledge, performance and communication between surgical teams and these seems to have a positive effect on improve patient safety in the operating room.

Keywords: knowledge, operating room, performance, surgical safety checklist

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Authors: Habib Alah Dadgar, Nasim Norouzbeigi

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The precise definition margin of high and low-grade gliomas is crucial for treatment. We aimed to assess the feasibility of assessment of the resection legions with post-operative positron emission tomography (PET) using [18F]O-(2-[18F]-fluoroethyl)-L-tyrosine ([18F]FET). Four patients with the suspicion of high and low-grade were enrolled. Patients underwent post-operative [18F]FET-PET, pre-operative magnetic resonance imaging (MRI) and CT for clinical evaluations. In our study, three patients had negative response to recurrence and progression and one patient indicated positive response after surgery. [18F]FET-PET revealed a legion of increased radiotracer uptake in the dura in the craniotomy site for patient 1. Corresponding to the patient history, the study was negative for recurrence of brain tumor. For patient 2, there was a lesion in the right parieto-temporal with slightly increased uptake in its posterior part with SUVmax = 3.79, so the study was negative for recurrence evaluation. In patient 3 there was no abnormal uptake with negative result for recurrence of brain tumor. Intense radiotracer uptake in the left parietal lobe where in the MRI there was a lesion with no change in enhancement in the post-contrast image is indicated in patient 4. Assessment of the resection legions in high and low-grade gliomas with [18F]FET-PET seems to be useful.

Keywords: FET-PET, CT, glioma, MRI

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Authors: Efrain Rodriguez, Cristhian Riano, Alberto Alvares

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In recent years, robots manipulators with parallel architectures are used in additive manufacturing processes – 3D printing. These robots have advantages such as speed and lightness that make them suitable to help with the efficiency and productivity of these processes. Consequently, the interest for the development of parallel robots for additive manufacturing applications has increased. This article deals with the conceptual design and dimensional synthesis of the linear delta robot for additive manufacturing. Firstly, a methodology based on structured processes for the development of products through the phases of informational design, conceptual design and detailed design is adopted: a) In the informational design phase the Mudge diagram and the QFD matrix are used to aid a set of technical requirements, to define the form, functions and features of the robot. b) In the conceptual design phase, the functional modeling of the system through of an IDEF0 diagram is performed, and the solution principles for the requirements are formulated using a morphological matrix. This phase includes the description of the mechanical, electro-electronic and computational subsystems that constitute the general architecture of the robot. c) In the detailed design phase, a digital model of the robot is drawn on CAD software. A list of commercial and manufactured parts is detailed. Tolerances and adjustments are defined for some parts of the robot structure. The necessary manufacturing processes and tools are also listed, including: milling, turning and 3D printing. Secondly, a dimensional synthesis method applied on design of the linear delta robot is presented. One of the most important key factors in the design of a parallel robot is the useful workspace, which strongly depends on the joint space, the dimensions of the mechanism bodies and the possible interferences between these bodies. The objective function is based on the verification of the kinematic model for a prescribed cylindrical workspace, considering geometric constraints that possibly lead to singularities of the mechanism. The aim is to determine the minimum dimensional parameters of the mechanism bodies for the proposed workspace. A method based on genetic algorithms was used to solve this problem. The method uses a cloud of points with the cylindrical shape of the workspace and checks the kinematic model for each of the points within the cloud. The evolution of the population (point cloud) provides the optimal parameters for the design of the delta robot. The development process of the linear delta robot with optimal dimensions for additive manufacture is presented. The dimensional synthesis enabled to design the mechanism of the delta robot in function of the prescribed workspace. Finally, the implementation of the robotic platform developed based on a linear delta robot in an additive manufacturing application using the Fused Deposition Modeling (FDM) technique is presented.

Keywords: additive manufacturing, delta parallel robot, dimensional synthesis, genetic algorithms

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Authors: Jong Yeop Kim, Ji Eun Kim, Hyun Jeong Kwak, Sook Young Lee

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Background: This prospective, randomized, controlled study was performed to evaluate the usefulness of the McGrath VL compared to Macintosh laryngoscopy in children with expected normal airway during endotracheal intubation, by comparing the time to intubation and ease of intubation. Methods: Eighty-four patients, aged 1-10 years undergoing endotracheal intubation for elective surgery were randomly assigned to McGrath group (n = 42) or Macintosh group (n = 42). Anesthesia was induced with propofol 2.5-3.0 mg/kg and sevoflurane 5-8 vol%. Orotracheal intubation was performed 2 minutes after injection of rocuronium 0.6 mg/kg with McGrath VL or Macintosh laryngoscope. The primary outcome was time to intubation. The Cormack and Lehane glottic grade, intubation difficulty score (IDS), and success rate of intubation were assessed. Hemodynamic changes also were recorded. Results: Median time to intubation [interquartile range] was not different between the McGrath group and the Macintosh group (25.0 [22.8-28.3] s vs. 26.0 [24.0-29.0] s, p = 0.301). The incidence of grade I glottic view was significantly higher in theMcGrath group than in the Macintosh group (95% vs. 74%, p = 0.013). Median IDS was lower in the McGrath group than in the Macintosh group (0 [0-0] vs. 0 [0-1], p = 0.018). There were no significant differences in success rate on intubation or hemodynamics between the two groups. Conclusions: McGrath VL provides better laryngeal views and lower IDS, but similar intubation times and success rates compared to the Macintosh laryngoscope in children with the normal airway.

Keywords: intubation, Macintosh laryngoscopy, Mcgrath videolaryngoscopy, pediatrics

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Authors: Buse Bahitli, Samiye Mete

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The aim of the study was to evaluate the quality of sexual life of women with diagnosed gynecological cancer and receive treatment. The study was a descriptive and cross-sectional type, and it was carried out with 276 women. Information Form and Sexual Quality of Life Scale-Female (SQOL) form was used in the study. The data was evaluated using Mann-Whitney U and Kruskal-Wallis test. In the study, Sexual Quality of Life Scale-Female average score was 68.83 ± 21.17. The %43.1 of women was endometrial cancer, %30.8 was cervical cancer, %24.6 was ovarian cancer, and %1.4 was vulvar cancer. The average time to diagnosis of patients is 41.80 ± 47.64 months. There was no significant difference mean SQOL according to individual/sociodemographic characteristics like age, education. Gynecological cancer-related characteristics like gynaecological cancer type, treatment type, surgery type were found not to affect the mean score of SQOL. However, it was found that the difference was due to the higher SQOL score in the group with a diagnosis time of 25 months and over (X²KW= 6.356, p= 0.046). The reason of significant difference means SQOL according to diagnosis over time might be that women adapted to cancer diagnosis. While women with gynaecologic cancer are evaluating their sexual lives, it is necessary to evaluate them with good evaluation tools.

Keywords: gynecological cancers, sexuality, quality of sexual life, SQOL

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Authors: Öykü Barutçu, Mehmet Özgür Kuzdan

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Aim: Laparoscopy is very risky in patients undergoing, multiple open abdominal surgeries. The aim of this study, to define a safe method for the first trocar placement in children with a history of multiple open abdominal surgeries. Methods: Children who underwent laparoscopic surgery between March 2019 and April 2020 with a history of three or more open abdominal surgeries were included in the retrospective study. Patient information was obtained from the hospital automation system. Ultrasonography was used to determine the location of adhesions preoperatively. The first trocar was placed according to ultrasonography findings, using the Hasson technique to create an air pocket with finger dissection. The patient's preoperative, perioperative, and postoperative findings are reported. Results: A total of 10 patients were included in the study. The median number of operations before laparoscopy was three. The most common site for the first trocar entry was Palmer's point (40%). No mortality or morbidity was observed amongst any patients. The average number of adhesions detected by USG and observed on laparoscopy were significantly positively correlated. Conclusion: In children with a history of multiple abdominal surgeries, abdominal wall ultrasonography for visualization of adhesions and finger dissection for the formation of an air pocket appears to be a safe method for the first trocar insertion.

Keywords: abdominal wall, child, laparoscopy, ultrasonography

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Authors: Abhishek Sharma, Arnab Banerjee

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The research is intended to study the solar electric propulsion (SEP) technology for planetary missions. The main benefits of using solar electric propulsion for such missions are shorter flight times, more frequent target accessibility and the use of a smaller launch vehicle than that required by a comparable chemical propulsion mission. Energized by electric power from on-board solar arrays, the electrically propelled system uses 10 times less propellant than conventional chemical propulsion system, yet the reduced fuel mass can provide vigorous power which is capable of propelling robotic and crewed missions beyond the Lower Earth Orbit (LEO). The various thrusters used in the SEP are gridded ion thrusters and the Hall Effect thrusters. The research is solely aimed to study the ion thrusters and investigate the complications related to it and what can be done to overcome the glitches. The ion thrusters are used because they are found to have a total lower propellant requirement and have substantially longer time. In the ion thrusters, the anode pushes or directs the incoming electrons from the cathode. But the anode is not maintained at a very high potential which leads to divergence. Divergence leads to the charges interacting against the surface of the thruster. Just as the charges ionize the xenon gases, they are capable of ionizing the surfaces and over time destroy the surface and hence contaminate it. Hence the lifetime of thruster gets limited. So a solution to this problem is using substances which are not easy to ionize as the surface material. Another approach can be to increase the potential of anode so that the electrons don’t deviate much or reduce the length of thruster such that the positive anode is more effective. The aim is to work on these aspects as to how constriction of the deviation of charges can be done by keeping the input power constant and hence increase the lifetime of the thruster. Predominantly ring cusp magnets are used in the ion thrusters. However, the study is also intended to observe the effect of using solenoid for producing micro-solenoidal magnetic field apart from using the ring cusp magnetic field which are used in the discharge chamber for prevention of interaction of electrons with the ionization walls. Another foremost area of interest is what are the ways by which power can be provided to the Solar Electric Propulsion Vehicle for lowering and boosting the orbit of the spacecraft and also provide substantial amount of power to the solenoid for producing stronger magnetic fields. This can be successfully achieved by using the concept of Electro-dynamic tether which will serve as a power source for powering both the vehicle and the solenoids in the ion thruster and hence eliminating the need for carrying extra propellant on the spacecraft which will reduce the weight and hence reduce the cost of space propulsion.

Keywords: electro-dynamic tether, ion thruster, lifetime of thruster, solar electric propulsion vehicle

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Authors: K. P. v. R. de Silva, R. W. Senevirathna, M. M. A. J. Kumara, J. P. M. Kumarasinghe, R. L. Gunawardana, S. M. Uluwitiya, G. C. P. Jayawickrama, W. K. T. I. Madushani

Abstract:

Introduction: The limited literature supporting the utilization of mechanical bowel preparation (MBP) for patients undergoing laparoscopic anterior resection (LAR) remains a notable issue. This study was conducted to examine the clinical consequences of anastomosis in colorectal surgery with MBP compared to cases where MBP was not utilized (no-MBP) in the context of LAR. Methods: This was a retrospective comparative study conducted in the professorial surgical wards of the teaching hospital karapitiya (THK). Colorectal cancer patients(n=306) participated in the study, including 151 MBP patients and 155 no-MBP patients, where the postoperative complications and mortality rates were compared. Results: The anastomotic leakage rate was 2.6%(n=4) in the no-MBP group and 6.0%(n=9) in the MBP group (p=0.143). The postoperative paralytic ileus rate was 18.5%(n=28) and 5.8%(n=9) in the MBP group and no-MBP group, respectively, displaying a statistically significant difference (p=0.001). Wound infection, pneumonia, urinary tract infection, and cardiac complication rates also were higher in the MBP group. The overall mortality rate was 1.3%(n=3) in the no-MBP group and 2.0%(n=2) in the MBP group. Conclusions: The evidence concludes that MBP increases post-operative complications. Therefore, prophylactic MBP in LAR has not been proven to benefit patients. However, further research is necessary to understand the comparative effects of MBP versus no preparation comprehensively.

Keywords: MBP, anastomosis, LAR, paralytic ileus

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Authors: Anita Khadka, Gregory Epiphaniou, Carsten Maple

Abstract:

There is a dramatic surge in the adoption of machine learning (ML) techniques in many areas, including the nuclear industry (such as fault diagnosis and fuel management in nuclear power plants), autonomous systems (including self-driving vehicles), space systems (space debris recovery, for example), medical surgery, network intrusion detection, malware detection, to name a few. With the application of learning methods in such diverse domains, artificial intelligence (AI) has become a part of everyday modern human life. To date, the predominant focus has been on developing underpinning ML algorithms that can improve accuracy, while factors such as resiliency and robustness of algorithms have been largely overlooked. If an adversarial attack is able to compromise the learning method or data, the consequences can be fatal, especially but not exclusively in safety-critical applications. In this paper, we present an in-depth analysis of five adversarial attacks and three defence methods on a crack detection ML model. Our analysis shows that it can be dangerous to adopt machine learning techniques in security-critical areas such as the nuclear industry without rigorous testing since they may be vulnerable to adversarial attacks. While common defence methods can effectively defend against different attacks, none of the three considered can provide protection against all five adversarial attacks analysed.

Keywords: adversarial machine learning, attacks, defences, nuclear industry, crack detection

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Authors: Kave Moloudi, Heidi Abrahamse, Blassan P. George

Abstract:

Radiotherapy (RT) and photodynamic therapy (PDT) are both forms of cancer treatment that aim to kill cancer cells while minimizing damage to healthy tissue. The similarity between RT and PDT lies in their mechanism of action. Both treatments use energy to damage cancer cells. RT uses high-energy radiation to damage the DNA of cancer cells, while PDT uses light energy to activate a photosensitizing agent, which produces reactive oxygen species (ROS) that damage the cancer cells. Both treatments require careful planning and monitoring to ensure the correct dose is delivered to the tumor while minimizing damage to surrounding healthy tissue. They are also often used in combination with other treatments, such as surgery or chemotherapy, to improve overall outcomes. However, there are also significant differences between RT and PDT. For example, RT is a non-invasive treatment that can be delivered externally or internally, while PDT requires the injection of a photosensitizing agent and the use of a specialized light source to activate it. Additionally, the side effects and risks associated with each treatment can vary. In this review, we focus on generalizing the 6Rs of radiobiology in PDT, which can open a window for the clinical application of Radio-photodynamic therapy with minimum side effects. Furthermore, this review can open new insight to work on and design new radio-photosensitizer agents in Radio-photodynamic therapy.

Keywords: radiobiology, photodynamic therapy, radiotherapy, 6Rs in radiobiology, ROS, DNA damages, cellular and molecular mechanism, clinical application.

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Authors: Vesa Salminen, Esa Santakallio, Heikki Ruohomaa

Abstract:

Introduction: The city of Riihimäki has decided robotics on well-being, service and industry as the main focus area on their ecosystem strategy. Robotics is going to be an important part of the everyday life of citizens and present in the working day of the average citizen and employee in the future. For that reason, also education system and education programs on all levels of education from diaper age to doctorate have been directed to fulfill this ecosystem strategy. Goal: The objective of this activity has been to develop education continuity from diaper age to doctorate. The main target of the development activity is to create a unique robotics study entity that enables ongoing robotics studies from preprimary education to university. The aim is also to attract students internationally and supply a skilled workforce to the private sector, capable of the challenges of the future. Methodology: Education instances (high school, second grade, Universities on all levels) in a large area of Tavastia Province have gradually directed their education programs to support this goal. On the other hand, applied research projects have been created to make proof of concept- phases on areal real environment field labs to test technology opportunities and digitalization to change business processes by applying robotic solutions. Customer-oriented applied research projects offer for students in robotics education learning environments to learn new knowledge and content. That is also a learning environment for education programs to adapt and co-evolution. New content and problem-based learning are used in future education modules. Major findings: Joint robotics education entity is being developed in cooperation with the city of Riihimäki (primary education), Syria Education (secondary education) and HAMK (bachelor and master education). The education modules have been developed to enable smooth transitioning from one institute to another. This article is introduced a case study of the change of education of wellbeing education because of digitalization and robotics. Riihimäki's Elderly citizen's service house, Riihikoti, has been working as a field lab for proof-of-concept phases on testing technology opportunities. According to successful case studies also education programs on various levels of education have been changing. Riihikoti has been developed as a physical learning environment for home care and robotics, investigating and developing a variety of digital devices and service opportunities and experimenting and learn the use of equipment. The environment enables the co-development of digital service capabilities in the authentic environment for all interested groups in transdisciplinary cooperation.

Keywords: ecosystem strategy, digitalization and robotics, education continuity, learning environment, transdisciplinary co-operation

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Authors: Shantanu Vyas, Neerja Meena

Abstract:

Facial infiltrating lipomatosis is a rare lipomatous lesion, first described by Slavin in 1983. It is a benign pseudotumor pathology. It corresponds to a non-encapsulated collection of mature adipocytes infiltrating the local tissue and hyperplasia of underlying bone leading to a craniofacial deformity. Very few cases have been reported in the literature. We report the case of a 19-year-old female patient, who was consulted for a swelling of the right hemiface progressively evolving since birth. Physical examination revealed facial asymmetry. On palpation, the mass was soft, painless, not compressible, not pulsatile, not fluctuating. In view of the asymptomatic nature and slow progression of the lesion, a lipomatous tumour, namely lipoma, was suggested. CT scan image shows a hyperplastic subcutaneous fat on the right hemiface. On the right jugal and temporal areas, there is a subcutaneous formation of fatty density, poorly limited, with no detectable peripheral capsule. It merges with the adjacent fat. In the bone window, there was a hyperplasia of underlying bone. Facial lipomatosis infiltration of the face is a benign pseudotumor pathology. As a result, it can be confused with other disorders, in particular, hemifacial hyperplasia. Combination of physical and radiological findings can establish the diagnosis. Surgical treatment is done for cosmetic purposes.

Keywords: cosmetic correction and facial assemetry, aesthetic results, facial infiltration, surgery

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Authors: Ndje Ndje Mireille

Abstract:

The improvement in the physical aspects of hysterectomy has tended to make us forget the psychological burden of this operation for many women. African women closely associate fertility and femininity, and they fear that their desire will diminish, that they will be less desirable after having undergone a hysterectomy. Medicine may be tempted to trivialize this surgical intervention by relying on the evolution of current surgery that leaves little or no marks. It is possible to think that the uterus is useless for a nun who has decided to freely disregard her motherhood. We used the clinical research method for this study. Through a semi-directive interview guide, we collected the verbatims of an hysterectomized catholic nun. The verbatims were transcribed and analyzed with the thematic content analysis. This analysis shows that the medical reality does not always correspond to the subjective experience of women, for whom hysterectomy can imply strong symbolic damage. The uterus is not essential to life, but it is essential to give life, and this lack can reactivate a desire for motherhood. The experience of hysterectomy is unique for each woman in relation to her history. This operation will eliminate all hope of pregnancy; it will be felt as intimate mutilation and an attack on femininity, it will bring up concerns about sexuality. Even if a woman has past the age of having children, has gone through menopause, or has freely decided not to have children, she still find it difficult to accept this procedure. The lack of uterus make a woman feel useless.

Keywords: hysterectomy, symbolic damage, desire for motherhood, feminity, nun

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Authors: Mahmoud Tarek, Alaa Obeida, Mai Magdy, Khalid Hussein, Aly Shalaby

Abstract:

Background: More doctors are complaining of burnout than before, Burnout is a state of physical and mental exhaustion caused by the doctor’s lifestyle, unfortunately, Medical errors are also more likely in those suffering from burnout and these may result in malpractice suits. Methodology: It is a retrospective audit of burnout response on all neonatologists over a 9 months period. We gathered data using burnout questionnaire, it was obtained from 23 physicians, the physicians divided into 5 categories according to the final score of the 28 questions in the questionnaire. Category 1 with score from 28-38 with almost no work stress, category 2 with score (38-50) who express a low amount of job related stress, category 3 with score (51-70) with moderate amount of stress, category 4 with score (71-90) those express a high amount of job stress and begun to burnout, category 5 with score (91 and above) who are under a dangerous amount of stress and advanced stage of burnout. Results: 33 neonatologists have received the questionnaire, 23 responses were sent back with a response rate of 69.6%. The results showed that 61% of physicians fall in category 4, 31% of the physician in category 5, while 8% of physicians equally distributed between category 2 and 3 (4% each of them). On the other hand, there is no physician present in category 1. Conclusion: Burnout is prevalent in SNICUs, So interventions to minimize burnout prevalence may be of greater importance as this may be reflected indirectly on medical conditions of the patients and physicians, efforts should be done to decrease this high rate of burnout.

Keywords: Cairo, work overload, exhaustion, surgery, neonatal ICU

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Authors: Melliti Rihab, Zaeid Sonia, Khechine Wiem, Daldoul Amira

Abstract:

Introduction: Lung cancer is the leading cause of cancer death. Its incidence is increasing, and its prognosis remains pejorative. We present the clinical, pathological, and therapeutic characteristics of bronchopulmonary cancer (BPC) in Tunisia. Methods: Retrospective study including patients followed in the oncology department of the University Hospital of Monastir between April 2014 and December 2021 suffering from lung cancer. Results: These are 117 patients, including 86.3% men and 13.7% women (sex ratio 6.3). The average age was 64 years ± 9 (37-83), with 95.7% being over 50 years old. Patients were smokers in 82% of cases. The clinical signs were dominated by chest pain (27.5%) and dyspnea in 21.1% of cases. In 6 patients, an episode of COVID-19 infection revealed the diagnosis. Half of the patients had a PS between 0 and 1. Small cell lung cancer was present in 18 patients (15.4%). The majority of non small cell lung cancer was of the adenocarcinoma type (68.7%). The diagnosis was late (stage IV) in 62.4% of cases. BPC was metastatic to bone (52%), contralateral lung (25.9%), and brain (27.3%). Patients were oligometastatic in 26% of cases. Surgery and radiotherapy were performed respectively in 14.5% and 23.1% of cases. Three-quarters of the patients had had nutrition (75.2%). The ROS1 mutation was present in 1 patient. PDL-1 expression was >40% in 2 patients. Survival was mean eight months ± 7.4. Conclusion: Lung cancer is diagnosed at a late stage in Tunisia. The lack of molecular study for non-small cell PBC and the lack of marketing authorization for tyrosine kinase inhibitors in Tunisia make the management incomplete.

Keywords: SCLC, NCSLC, ROS1, PDL1

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Authors: Kelechi Emmanuel, Kyaw Thein Aung, William Burch

Abstract:

Introduction: Although rewarding in more ways than one, rural medicine can be challenging. The factors that lead to the challenges experienced in rural medicine include but are not limited to scarcity of resources, poor patient education inadequately trained professionals. This is the first single center study done on the challenges of and ways to improve diagnosis in rural medicine. Materials and Methods: Questionnaires were given to providers in a single hospital in rural Tennessee USA. In which providers were asked the question ‘In the past six months, what measures have you taken to improve your diagnostic accuracy given limited resources. Results: The questionnaire was passed to ten physicians working in a two hundred and twentyfive hospital bed. Physicians who participated included physicians in hospital medicine, emergency medicine, surgery, cardiology and gastroenterology. The study found that improved physical examination skills, access to specialist especially via telemedicine and affiliation to centers with more experienced professionals improved diagnosis and overall patient outcome in rural medicine. Conclusion: From this single center study, there is evidence to show that in addition to honing physical examination skills and having access to immediate results of testing done; hospital collaborations and access to highly trained specialist via telemedicine does improve diagnosis in rural medicine.

Keywords: rural medicine, diagnostic accuracy, diagnosis, telemedicine

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Authors: Maneka Marianne Britto, Hansraj Riteesh Bookun

Abstract:

The ability of a junior doctor to deliver complex multi-disciplinary care to patients in a paradigm of respect and collaboration requires a multitude of interpersonal skills and competencies. A short survey was used to explore the perspective of allied health staff on the desirable attributes of a junior doctor which are conducive to good teamwork. 23 allied health professionals (14 nurses, 4 physiotherapists, 2 dietitians, 1 occupational therapist, 1 speech therapist and 1 audiologist) responded to this 17-item survey. There were 17 females. The mean age of the respondents was 34.9 ± 10.1 years. The salient findings of our survey are that 95% of our respondents rated friendliness and non-clinical small talk with average importance or greater. 45% of them viewed these 2 items as very important or absolutely essential. A single respondent viewed these 2 items with little importance. The other criteria which were rated with high levels of importance were the acknowledgment of allied health suggestions and good ward organizational skills. Training these collaborative skills is challenging, and an enhanced understanding of interprofessional perspectives will help a junior doctor to achieve better clinical outcomes. It is hoped that this paper will further stimulate discussion in this area and will encourage junior doctors to engage in non-clinical conversations with allied health staff in the spirit of promoting effective teamwork.

Keywords: allied health, collaboration, doctor, medicine, surgery

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