Search results for: robotic mitral valve repair
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1005

Search results for: robotic mitral valve repair

75 Robots for the Elderly at Home: For Men Only

Authors: Christa Fricke, Sibylle Meyer, Gert G. Wagner

Abstract:

Our research focuses on the question of whether assistive and social robotics could pose a promising strategy to support the independent living of elderly people and potentially relieve relatives of any anxieties. To answer the question of how elderly people perceive the potential of robotics, we analysed the data from the Berlin Aging Study BASE-II (https://www.base2.mpg.de/de) (N=1463) and data from the German SYMPARTNER study (http://www.sympartner.de) (N=120) and compared those to a control group made up of people younger than 30 years (BASE II: N=241; SYMPARTNER: N=30). BASE-II is a cohort study of people living in Berlin, Germany. The sample covers more than 2200 cases; a questionnaire on the use and acceptance of assistive and social robots was carried out with a sub-sample of 1463 respondents in 2015. The SYMPARTNER study was done by SIBIS institute of Social Research, Berlin and included a total of 120 persons between the ages of 60 and 87 in Berlin and the rural German federal state of Thuringia. Both studies included a control group of persons between the ages of 20 and 35 (BASE II: N=241; SYMPARTNER: N=30). Additional data, representative for the whole population in Germany, will be surveyed in fall 2017 (Survey “Technikradar” [technology radar] by the National Academy of Science and Engineering). Since this survey is including some identical questions as BASE-II/SYMPARTNER, comparative results can be presented at 20th International Conference on Social Robotics in New York 2018. The complexity of the data gathered in BASE-II and SYMPARTNER, encompassing detailed socio-economic background characteristics as well as personality traits such as the personal attitude to risk taking, locus of control and Big Five, proves highly valuable and beneficial. Results show that participants’ expressions of resentment against robots are comparatively low. Participants’ personality traits play a role, however the effect sizes are small. Only 15 percent of participants received domestic robots with great scepticism. Participants aged older than 70 years expressed greatest rejection of the robotic assistant. The effect sizes however account for only a few percentage points. Overall, participants were surprisingly open to the robot and its usefulness. The analysis also shows that men’s acceptance of the robot is generally greater than that of women (with odds ratios of about 0.6 to 0.7). This applies to both assistive robots in the private household and in care environments. Men expect greater benefits of the robot than women. Women tend to be more sceptical of their technical feasibility than men. Interview results prove our hypothesis that men, in particular of the age group 60+, are more accustomed to delegate household chores to women. A delegation to machines instead of humans, therefore, seems palpable. The answer to the title question of this planned presentation is: social and assistive robots at home robots are not only accepted by men – but by fewer women than men.

Keywords: acceptance, care, gender, household

Procedia PDF Downloads 177
74 Radiation Induced DNA Damage and Its Modification by Herbal Preparation of Hippophae rhamnoides L. (SBL-1): An in vitro and in vivo Study in Mice

Authors: Anuranjani Kumar, Madhu Bala

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Ionising radiation exposure induces generation of free radicals and the oxidative DNA damage. SBL-1, a radioprotective leaf extract prepared from leaves Hippophae rhamnoides L. (Common name; Seabuckthorn), showed > 90% survival in mice population that was treated with lethal dose (10 Gy) of ⁶⁰Co gamma irradiation. In this study, early effects of pre-treatment with or without SBL-1 in blood peripheral blood lymphocytes (PBMCs) were investigated by cell viability assays (trypan blue and MTT). The quantitative in vitro study of Hoescht/PI staining was performed to check the apoptosis/necrosis in PBMCs irradiated at 2 Gy with or without pretreatment of SBL-1 (at different concentrations) up to 24 and 48h. Comet assay was performed in vivo, to detect the DNA strands breaks and its repair mechanism on peripheral blood lymphocytes at lethal dose (10 Gy). For this study, male mice (wt. 28 ± 2g) were administered radioprotective dose (30mg/kg body weight) of SBL-1, 30 min prior to irradiation. Animals were sacrificed at 24h and 48h. Blood was drawn through cardiac puncture, and blood lymphocytes were separated using histopaque column. Both neutral and alkaline comet assay were performed using standardized technique. In irradiated animals, alkaline comet assay revealed single strand breaks (SSBs) that showed significant (p < 0.05) increase in percent DNA in tail and Olive tail moment (OTM) at 24 h while at 48h the percent DNA in tail further increased significantly (p < 0.02). The double strands breaks (DSBs) increased significantly (p < 0.01) at 48 h in neutral assay, in comparison to untreated control. The animals pre-treated with SBL-1 before irradiation showed significantly (p < 0.05) less DSBs at 48 h treatment in comparison to irradiated group of animals. The SBL-1 alone treated group itself showed no toxicity. The antioxidant potential of SBL-1 were also investigated by in vitro biochemical assays such as DPPH (p < 0.05), ABTS, reducing ability (p < 0.09), hydroxyl radical scavenging (p < 0.05), ferric reducing antioxidant power (FRAP), superoxide radical scavenging activity (p < 0.05), hydrogen peroxide scavenging activity (p < 0.05) etc. SBL-1 showed strong free radical scavenging power that plays important role in the studies of radiation-induced injuries. The SBL-1 treated PBMCs showed significant (p < 0.02) viability in trypan blue assay at 24-hour incubation.

Keywords: radiation, SBL-1, SSBs, DSBs, FRAP, PBMCs

Procedia PDF Downloads 129
73 Multi-Criteria Evolutionary Algorithm to Develop Efficient Schedules for Complex Maintenance Problems

Authors: Sven Tackenberg, Sönke Duckwitz, Andreas Petz, Christopher M. Schlick

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This paper introduces an extension to the well-established Resource-Constrained Project Scheduling Problem (RCPSP) to apply it to complex maintenance problems. The problem is to assign technicians to a team which has to process several tasks with multi-level skill requirements during a work shift. Here, several alternative activities for a task allow both, the temporal shift of activities or the reallocation of technicians and tools. As a result, switches from one valid work process variant to another can be considered and may be selected by the developed evolutionary algorithm based on the present skill level of technicians or the available tools. An additional complication of the observed scheduling problem is that the locations of the construction sites are only temporarily accessible during a day. Due to intensive rail traffic, the available time slots for maintenance and repair works are extremely short and are often distributed throughout the day. To identify efficient working periods, a first concept of a Bayesian network is introduced and is integrated into the extended RCPSP with pre-emptive and non-pre-emptive tasks. Thereby, the Bayesian network is used to calculate the probability of a maintenance task to be processed during a specific period of the shift. Focusing on the domain of maintenance of the railway infrastructure in metropolitan areas as the most unproductive implementation process at construction site, the paper illustrates how the extended RCPSP can be applied for maintenance planning support. A multi-criteria evolutionary algorithm with a problem representation is introduced which is capable of revising technician-task allocations, whereas the duration of the task may be stochastic. The approach uses a novel activity list representation to ensure easily describable and modifiable elements which can be converted into detailed shift schedules. Thereby, the main objective is to develop a shift plan which maximizes the utilization of each technician due to a minimization of the waiting times caused by rail traffic. The results of the already implemented core algorithm illustrate a fast convergence towards an optimal team composition for a shift, an efficient sequence of tasks and a high probability of the subsequent implementation due to the stochastic durations of the tasks. In the paper, the algorithm for the extended RCPSP is analyzed in experimental evaluation using real-world example problems with various size, resource complexity, tightness and so forth.

Keywords: maintenance management, scheduling, resource constrained project scheduling problem, genetic algorithms

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72 Hardware Implementation for the Contact Force Reconstruction in Tactile Sensor Arrays

Authors: María-Luisa Pinto-Salamanca, Wilson-Javier Pérez-Holguín

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Reconstruction of contact forces is a fundamental technique for analyzing the properties of a touched object and is essential for regulating the grip force in slip control loops. This is based on the processing of the distribution, intensity, and direction of the forces during the capture of the sensors. Currently, efficient hardware alternatives have been used more frequently in different fields of application, allowing the implementation of computationally complex algorithms, as is the case with tactile signal processing. The use of hardware for smart tactile sensing systems is a research area that promises to improve the processing time and portability requirements of applications such as artificial skin and robotics, among others. The literature review shows that hardware implementations are present today in almost all stages of smart tactile detection systems except in the force reconstruction process, a stage in which they have been less applied. This work presents a hardware implementation of a model-driven reported in the literature for the contact force reconstruction of flat and rigid tactile sensor arrays from normal stress data. From the analysis of a software implementation of such a model, this implementation proposes the parallelization of tasks that facilitate the execution of matrix operations and a two-dimensional optimization function to obtain a vector force by each taxel in the array. This work seeks to take advantage of the parallel hardware characteristics of Field Programmable Gate Arrays, FPGAs, and the possibility of applying appropriate techniques for algorithms parallelization using as a guide the rules of generalization, efficiency, and scalability in the tactile decoding process and considering the low latency, low power consumption, and real-time execution as the main parameters of design. The results show a maximum estimation error of 32% in the tangential forces and 22% in the normal forces with respect to the simulation by the Finite Element Modeling (FEM) technique of Hertzian and non-Hertzian contact events, over sensor arrays of 10×10 taxels of different sizes. The hardware implementation was carried out on an MPSoC XCZU9EG-2FFVB1156 platform of Xilinx® that allows the reconstruction of force vectors following a scalable approach, from the information captured by means of tactile sensor arrays composed of up to 48 × 48 taxels that use various transduction technologies. The proposed implementation demonstrates a reduction in estimation time of x / 180 compared to software implementations. Despite the relatively high values of the estimation errors, the information provided by this implementation on the tangential and normal tractions and the triaxial reconstruction of forces allows to adequately reconstruct the tactile properties of the touched object, which are similar to those obtained in the software implementation and in the two FEM simulations taken as reference. Although errors could be reduced, the proposed implementation is useful for decoding contact forces for portable tactile sensing systems, thus helping to expand electronic skin applications in robotic and biomedical contexts.

Keywords: contact forces reconstruction, forces estimation, tactile sensor array, hardware implementation

Procedia PDF Downloads 162
71 iPSC-derived MSC Mediated Immunosuppression during Mouse Airway Transplantation

Authors: Mohammad Afzal Khan, Fatimah Alanazi, Hala Abdalrahman Ahmed, Talal Shamma, Kilian Kelly, Mohammed A. Hammad, Abdullah O. Alawad, Abdullah Mohammed Assiri, Dieter Clemens Broering

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Lung transplantation is a life-saving surgical replacement of diseased lungs in patients with end-stage respiratory malfunctions. Despite the remarkable short-term recovery, long-term lung survival continues to face several significant challenges, including chronic rejection and severe toxic side-effects due to global immunosuppression. Stem cell-based immunotherapy has been recognized as a crucial immunoregulatory regimen in various preclinical and clinical studies. Despite initial therapeutic outcomes, conventional stem cells face key limitations. The Cymerus™ manufacturing facilitates the production of a virtually limitless supply of consistent human induced pluripotent stem cell (iPSC)-derived mesenchymal stem cells, which could play a key role in selective immunosuppression and graft repair during rejection. Here, we demonstrated the impact of iPSC-derived human MSCs on the development of immune-tolerance and long-term graft survival in mouse orthotopic airway allografts. BALB/c→C57BL/6 allografts were reconstituted with iPSC-derived MSCs (2 million/transplant/ at d0), and allografts were examined for regulatory T cells (Tregs), oxygenation, microvascular blood flow, airway epithelium and collagen deposition during rejection. We demonstrated that iPSC-derived MSC treatment leads to significant increase in tissue expression of hTSG-6 protein, followed by an upregulation of mouse Tregs and IL-5, IL-10, IL-15 cytokines, which augments graft microvascular blood flow and oxygenation, and thereby maintained a healthy airway epithelium and prevented the subepithelial deposition of collagen at d90 post-transplantation. Collectively, these data confirmed that iPSC-derived MSC-mediated immunosuppression has potential to establish immune-tolerance and rescue allograft from sustained hypoxic/ischemic phase and subsequently limits long-term airway epithelial injury and collagen progression, which therapeutically warrant a study of Cymerus iPSC-derived MSCs as a potential management option for immunosuppression in transplant recipients.

Keywords: stem cell therapy, immunotolerance, regulatory T cells, hypoxia and ischemia, microvasculature

Procedia PDF Downloads 133
70 Application of the Carboxylate Platform in the Consolidated Bioconversion of Agricultural Wastes to Biofuel Precursors

Authors: Sesethu G. Njokweni, Marelize Botes, Emile W. H. Van Zyl

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An alternative strategy to the production of bioethanol is by examining the degradability of biomass in a natural system such as the rumen of mammals. This anaerobic microbial community has higher cellulolytic activities than microbial communities from other habitats and degrades cellulose to produce volatile fatty acids (VFA), methane and CO₂. VFAs have the potential to serve as intermediate products for electrochemical conversion to hydrocarbon fuels. In vitro mimicking of this process would be more cost-effective than bioethanol production as it does not require chemical pre-treatment of biomass, a sterile environment or added enzymes. The strategies of the carboxylate platform and the co-cultures of a bovine ruminal microbiota from cannulated cows were combined in order to investigate and optimize the bioconversion of agricultural biomass (apple and grape pomace, citrus pulp, sugarcane bagasse and triticale straw) to high value VFAs as intermediates for biofuel production in a consolidated bioprocess. Optimisation of reactor conditions was investigated using five different ruminal inoculum concentrations; 5,10,15,20 and 25% with fixed pH at 6.8 and temperature at 39 ˚C. The ANKOM 200/220 fiber analyser was used to analyse in vitro neutral detergent fiber (NDF) disappearance of the feedstuffs. Fresh and cryo-frozen (5% DMSO and 50% glycerol for 3 months) rumen cultures were tested for the retainment of fermentation capacity and durability in 72 h fermentations in 125 ml serum vials using a FURO medical solutions 6-valve gas manifold to induce anaerobic conditions. Fermentation of apple pomace, triticale straw, and grape pomace showed no significant difference (P > 0.05) in the effect of 15 and 20 % inoculum concentrations for the total VFA yield. However, high performance liquid chromatographic separation within the two inoculum concentrations showed a significant difference (P < 0.05) in acetic acid yield, with 20% inoculum concentration being the optimum at 4.67 g/l. NDF disappearance of 85% in 96 h and total VFA yield of 11.5 g/l in 72 h (A/P ratio = 2.04) for apple pomace entailed that it was the optimal feedstuff for this process. The NDF disappearance and VFA yield of DMSO (82% NDF disappearance and 10.6 g/l VFA) and glycerol (90% NDF disappearance and 11.6 g/l VFA) stored rumen also showed significantly similar degradability of apple pomace with lack of treatment effect differences compared to a fresh rumen control (P > 0.05). The lack of treatment effects was a positive sign in indicating that there was no difference between the stored samples and the fresh rumen control. Retaining of the fermentation capacity within the preserved cultures suggests that its metabolic characteristics were preserved due to resilience and redundancy of the rumen culture. The amount of degradability and VFA yield within a short span was similar to other carboxylate platforms that have longer run times. This study shows that by virtue of faster rates and high extent of degradability, small scale alternatives to bioethanol such as rumen microbiomes and other natural fermenting microbiomes can be employed to enhance the feasibility of biofuels large-scale implementation.

Keywords: agricultural wastes, carboxylate platform, rumen microbiome, volatile fatty acids

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69 Corrosion Analysis of Brazed Copper-Based Conducts in Particle Accelerator Water Cooling Circuits

Authors: A. T. Perez Fontenla, S. Sgobba, A. Bartkowska, Y. Askar, M. Dalemir Celuch, A. Newborough, M. Karppinen, H. Haalien, S. Deleval, S. Larcher, C. Charvet, L. Bruno, R. Trant

Abstract:

The present study investigates the corrosion behavior of copper (Cu) based conducts predominantly brazed with Sil-Fos (self-fluxing copper-based filler with silver and phosphorus) within various cooling circuits of demineralized water across different particle accelerator components at CERN. The study covers a range of sample service time, from a few months to fifty years, and includes various accelerator components such as quadrupoles, dipoles, and bending magnets. The investigation comprises the established sample extraction procedure, examination methodology including non-destructive testing, evaluation of the corrosion phenomena, and identification of commonalities across the studied components as well as analysis of the environmental influence. The systematic analysis included computed microtomography (CT) of the joints that revealed distributed defects across all brazing interfaces. Some defects appeared to result from areas not wetted by the filler during the brazing operation, displaying round shapes, while others exhibited irregular contours and radial alignment, indicative of a network or interconnection. The subsequent dry cutting performed facilitated access to the conduct's inner surface and the brazed joints for further inspection through light and electron microscopy (SEM) and chemical analysis via Energy Dispersive X-ray spectroscopy (EDS). Brazing analysis away from affected areas identified the expected phases for a Sil-Fos alloy. In contrast, the affected locations displayed micrometric cavities propagating into the material, along with selective corrosion of the bulk Cu initiated at the conductor-braze interface. Corrosion product analysis highlighted the consistent presence of sulfur (up to 6 % in weight), whose origin and role in the corrosion initiation and extension is being further investigated. The importance of this study is paramount as it plays a crucial role in comprehending the underlying factors contributing to recently identified water leaks and evaluating the extent of the issue. Its primary objective is to provide essential insights for the repair of impacted brazed joints when accessibility permits. Moreover, the study seeks to contribute to the improvement of design and manufacturing practices for future components, ultimately enhancing the overall reliability and performance of magnet systems within CERN accelerator facilities.

Keywords: accelerator facilities, brazed copper conducts, demineralized water, magnets

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68 Framework Proposal on How to Use Game-Based Learning, Collaboration and Design Challenges to Teach Mechatronics

Authors: Michael Wendland

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This paper presents a framework to teach a methodical design approach by the help of using a mixture of game-based learning, design challenges and competitions as forms of direct assessment. In today’s world, developing products is more complex than ever. Conflicting goals of product cost and quality with limited time as well as post-pandemic part shortages increase the difficulty. Common design approaches for mechatronic products mitigate some of these effects by helping the users with their methodical framework. Due to the inherent complexity of these products, the number of involved resources and the comprehensive design processes, students very rarely have enough time or motivation to experience a complete approach in one semester course. But, for students to be successful in the industrial world, it is crucial to know these methodical frameworks and to gain first-hand experience. Therefore, it is necessary to teach these design approaches in a real-world setting and keep the motivation high as well as learning to manage upcoming problems. This is achieved by using a game-based approach and a set of design challenges that are given to the students. In order to mimic industrial collaboration, they work in teams of up to six participants and are given the main development target to design a remote-controlled robot that can manipulate a specified object. By setting this clear goal without a given solution path, a constricted time-frame and limited maximal cost, the students are subjected to similar boundary conditions as in the real world. They must follow the methodical approach steps by specifying requirements, conceptualizing their ideas, drafting, designing, manufacturing and building a prototype using rapid prototyping. At the end of the course, the prototypes will be entered into a contest against the other teams. The complete design process is accompanied by theoretical input via lectures which is immediately transferred by the students to their own design problem in practical sessions. To increase motivation in these sessions, a playful learning approach has been chosen, i.e. designing the first concepts is supported by using lego construction kits. After each challenge, mandatory online quizzes help to deepen the acquired knowledge of the students and badges are awarded to those who complete a quiz, resulting in higher motivation and a level-up on a fictional leaderboard. The final contest is held in presence and involves all teams with their functional prototypes that now need to contest against each other. Prices for the best mechanical design, the most innovative approach and for the winner of the robotic contest are awarded. Each robot design gets evaluated with regards to the specified requirements and partial grades are derived from the results. This paper concludes with a critical review of the proposed framework, the game-based approach for the designed prototypes, the reality of the boundary conditions, the problems that occurred during the design and manufacturing process, the experiences and feedback of the students and the effectiveness of their collaboration as well as a discussion of the potential transfer to other educational areas.

Keywords: design challenges, game-based learning, playful learning, methodical framework, mechatronics, student assessment, constructive alignment

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67 Pixel Façade: An Idea for Programmable Building Skin

Authors: H. Jamili, S. Shakiba

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Today, one of the main concerns of human beings is facing the unpleasant changes of the environment. Buildings are responsible for a significant amount of natural resources consumption and carbon emissions production. In such a situation, this thought comes to mind that changing each building into a phenomenon of benefit to the environment. A change in a way that each building functions as an element that supports the environment, and construction, in addition to answering the need of humans, is encouraged, the way planting a tree is, and it is no longer seen as a threat to alive beings and the planet. Prospect: Today, different ideas of developing materials that can smartly function are realizing. For instance, Programmable Materials, which in different conditions, can respond appropriately to the situation and have features of modification in shape, size, physical properties and restoration, and repair quality. Studies are to progress having this purpose to plan for these materials in a way that they are easily available, and to meet this aim, there is no need to use expensive materials and high technologies. In these cases, physical attributes of materials undertake the role of sensors, wires and actuators then materials will become into robots itself. In fact, we experience robotics without robots. In recent decades, AI and technology advances have dramatically improving the performance of materials. These achievements are a combination of software optimizations and physical productions such as multi-materials 3D printing. These capabilities enable us to program materials in order to change shape, appearance, and physical properties to interact with different situations. nIt is expected that further achievements like Memory Materials and Self-learning Materials are also added to the Smart Materials family, which are affordable, available, and of use for a variety of applications and industries. From the architectural standpoint, the building skin is significantly considered in this research, concerning the noticeable surface area the buildings skin have in urban space. The purpose of this research would be finding a way that the programmable materials be used in building skin with the aim of having an effective and positive interaction. A Pixel Façade would be a solution for programming a building skin. The Pixel Facadeincludes components that contain a series of attributes that help buildings for their needs upon their environmental criteria. A PIXEL contains series of smart materials and digital controllers together. It not only benefits its physical properties, such as control the amount of sunlight and heat, but it enhances building performance by providing a list of features, depending on situation criteria. The features will vary depending on locations and have a different function during the daytime and different seasons. The primary role of a PIXEL FAÇADE can be defined as filtering pollutions (for inside and outside of the buildings) and providing clean energy as well as interacting with other PIXEL FACADES to estimate better reactions.

Keywords: building skin, environmental crisis, pixel facade, programmable materials, smart materials

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66 High Speed Motion Tracking with Magnetometer in Nonuniform Magnetic Field

Authors: Jeronimo Cox, Tomonari Furukawa

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Magnetometers have become more popular in inertial measurement units (IMU) for their ability to correct estimations using the earth's magnetic field. Accelerometer and gyroscope-based packages fail with dead-reckoning errors accumulated over time. Localization in robotic applications with magnetometer-inclusive IMUs has become popular as a way to track the odometry of slower-speed robots. With high-speed motions, the accumulated error increases over smaller periods of time, making them difficult to track with IMU. Tracking a high-speed motion is especially difficult with limited observability. Visual obstruction of motion leaves motion-tracking cameras unusable. When motions are too dynamic for estimation techniques reliant on the observability of the gravity vector, the use of magnetometers is further justified. As available magnetometer calibration methods are limited with the assumption that background magnetic fields are uniform, estimation in nonuniform magnetic fields is problematic. Hard iron distortion is a distortion of the magnetic field by other objects that produce magnetic fields. This kind of distortion is often observed as the offset from the origin of the center of data points when a magnetometer is rotated. The magnitude of hard iron distortion is dependent on proximity to distortion sources. Soft iron distortion is more related to the scaling of the axes of magnetometer sensors. Hard iron distortion is more of a contributor to the error of attitude estimation with magnetometers. Indoor environments or spaces inside ferrite-based structures, such as building reinforcements or a vehicle, often cause distortions with proximity. As positions correlate to areas of distortion, methods of magnetometer localization include the production of spatial mapping of magnetic field and collection of distortion signatures to better aid location tracking. The goal of this paper is to compare magnetometer methods that don't need pre-productions of magnetic field maps. Mapping the magnetic field in some spaces can be costly and inefficient. Dynamic measurement fusion is used to track the motion of a multi-link system with us. Conventional calibration by data collection of rotation at a static point, real-time estimation of calibration parameters each time step, and using two magnetometers for determining local hard iron distortion are compared to confirm the robustness and accuracy of each technique. With opposite-facing magnetometers, hard iron distortion can be accounted for regardless of position, Rather than assuming that hard iron distortion is constant regardless of positional change. The motion measured is a repeatable planar motion of a two-link system connected by revolute joints. The links are translated on a moving base to impulse rotation of the links. Equipping the joints with absolute encoders and recording the motion with cameras to enable ground truth comparison to each of the magnetometer methods. While the two-magnetometer method accounts for local hard iron distortion, the method fails where the magnetic field direction in space is inconsistent.

Keywords: motion tracking, sensor fusion, magnetometer, state estimation

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65 Scenario of Some Minerals and Impact of Promoter Hypermethylation of DAP-K Gene in Gastric Carcinoma Patients of Kashmir Valley

Authors: Showkat Ahmad Bhat, Iqra Reyaz, Falaque ul Afshan, Ahmad Arif Reshi, Muneeb U. Rehman, Manzoor R. Mir, Sabhiya Majid, Sonallah, Sheikh Bilal, Ishraq Hussain

Abstract:

Background: Gastric cancer is the fourth most common cancer and the second leading cause of worldwide cancer-related deaths, with a wide variation in incidence rates across different geographical areas. The current view of cancer is that a malignancy arises from a transformation of the genetic material of a normal cell, followed by successive mutations and by chain of alterations in genes such as DNA repair genes, oncogenes, Tumor suppressor genes. Minerals are necessary for the functioning of several transcriptional factors, proteins that recognize certain DNA sequences and have been found to play a role in gastric cancer. Material Methods:The present work was a case control study and its aim was to ascertain the role of minerals and promoter hypermethylation of CpG islands of DAP-K gene in Gastric cancer patients among the Kashmiri population. Serum was extracted from all the samples and mineral estimation was done by AAS from serum, DNA was also extracted and was modified using bisulphite modification kit. Methylation-specific PCR was used for the analysis of the promoter hypermethylation status of DAP-K gene. The epigenetic analysis revealed that unlike other high risk regions, Kashmiri population has a different promoter hypermethylation profile of DAP-K gene and has different mineral profile. Results: In our study mean serum copper levels were significantly different for the two genders (p<0.05), while as no significant differences were observed for iron and zinc levels. In Methylation-specific PCR the methylation status of the promoter region of DAP-K gene was as 67.50% (27/40) of the gastric cancer tissues showed methylated DAP-K promoter and 32.50% (13/40) of the cases however showed unmethylated DAP-K promoter. Almost all 85% (17/20) of the histopathologically confirmed normal tissues showed unmethylated DAP-K promoter except only in 3 cases where DAP-K promoter was found to be methylated. The association of promoter hypermethylation with gastric cancer was evaluated by χ2 (Chi square) test and was found to be significant (P=0.0006). Occurrence of DAP-K methylation was found to be unequally distributed in males and females with more frequency in males than in females but the difference was not statistically significant (P =0.7635, Odds ratio=1.368 and 95% C.I=0.4197 to 4.456). When the frequency of DAP-K promoter methylation was compared with clinical staging of the disease, DAP-K promoter methylation was found to be certainly higher in Stage III/IV (85.71%) compared to Stage I/ II (57.69%) but the difference was not statistically significant (P =0.0673). These results suggest that DAP-K aberrant promoter hypermethylation in Kashmiri population contributes to the process of carcinogenesis in Gastric cancer and is reportedly one of the commonest epigenetic changes in the development of Gastric cancer.

Keywords: gastric cancer, minerals, AAS, hypermethylation, CpG islands, DAP-K gene

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64 Hydroxyapatite Based Porous Scaffold for Tooth Tissue Engineering

Authors: Pakize Neslihan Taslı, Alev Cumbul, Gul Merve Yalcın, Fikrettin Sahin

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A key experimental trial in the regeneration of large oral and craniofacial defects is the neogenesis of osseous and ligamentous interfacial structures. Currently, oral regenerative medicine strategies are unpredictable for repair of tooth supporting tissues destroyed as a consequence of trauma, chronic infection or surgical resection. A different approach combining the gel-casting method with Hydroxy Apatite HA-based scaffold and different cell lineages as a hybrid system leads to successively mimic the early stage of tooth development, in vitro. HA is widely accepted as a bioactive material for guided bone and tooth regeneration. In this study, it was reported that, HA porous scaffold preparation, characterization and evaluation of structural and chemical properties. HA is the main factor that exists in tooth and it is in harmony with structural, biological, and mechanical characteristics. Here, this study shows mimicking immature tooth at the late bell stage design and construction of HA scaffolds for cell transplantation of human Adipose Stem Cells (hASCs), human Bone Marrow Stem Cells (hBMSCs) and Gingival Epitelial cells for the formation of human tooth dentin-pulp-enamel complexes in vitro. Scaffold characterization was demonstrated by SEM, FTIR and pore size and density measurements. The biological contraction of dental tissues against each other was demonstrated by mRNA gene expressions, histopatologic observations and protein release profile by ELISA tecnique. The tooth shaped constructs with a pore size ranging from 150 to 300 µm arranged by gathering right amounts of materials provide interconnected macro-porous structure. The newly formed tissue like structures that grow and integrate within the HA designed constructs forming tooth cementum like tissue, pulp and bone structures. These findings are important as they emphasize the potential biological effect of the hybrid scaffold system. In conclusion, this in vitro study clearly demonstrates that designed 3D scaffolds shaped as a immature tooth at the late bell stage were essential to form enamel-dentin-pulp interfaces with an appropriate cell and biodegradable material combination. The biomimetic architecture achieved here is providing a promising platform for dental tissue engineering.

Keywords: tooth regeneration, tissue engineering, adipose stem cells, hydroxyapatite tooth engineering, porous scaffold

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63 Stereological and Morphometric Evaluation of Wound Healing Burns Treated with Ulmo Honey (Eucryphia cordifolia) Unsupplemented and Supplemented with Ascorbic Acid in Guinea Pig (Cavia porcellus)

Authors: Carolina Schencke, Cristian Sandoval, Belgica Vasquez, Mariano Del Sol

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Introduction: In a burn injury, the successful repair requires not only the participation of various cells, such as granulocytes and fibroblasts, but also of collagen, which plays a crucial role as a structural and regulatory molecule of scar tissue. Since honey and ascorbic acid have presented a great therapeutic potential to cellular and structural level, experimental studies have proposed its combination in the treatment of wounds. Aim: To evaluate stereological and morphometric parameters of healing wounds, caused by burns, treated with honey Ulmo (Eucryphia cordifolia) unsupplemented, comparing its effect with Ulmo honey supplemented with ascorbic acid. Materials and Methods: Fifteen healthy adult guinea pigs (Cavia porcellus) were used, of both sexes, average weight 450 g from the Centro de Excelencia en Estudios Morfológicos y Quirúrgicos (CEMyQ) at the Universidad de La Frontera, Chile. The animals were divided at random into three groups: positive control (C+), honey only (H) and supplemented honey (SH) and were fed on pellets supplemented with ascorbic acid and water ad libitum, under ambient conditions controlled for temperature, ambient noise and a cycle of 12h light–darkness. The protocol for the experiment was approved by the Scientific Ethics Committee of the Universidad de La Frontera, Chile. The parameters measured were number density per area (NA), volume density (VV), and surface density (SV) of fibroblast; NA and VV of polymorphonuclear cells (PMN) and, evaluation of the content of collagen fibers in the scar dermis. One-way ANOVA was used for statistics analysis and its respective Post hoc tests. Results: The ANOVA analysis for NA, VV and SV of fibroblasts, NA and VV of PMN, and evaluation of collagen content, type I and III, showed that at least one group differs from other (P≤ 0.001). There were differences (P= 0.000) in NA of fibroblast between the groups [C+= 3599.560 mm-2 (SD= 764.461), H= 3355.336 mm-2 (SD= 699.443) and SH= 4253.025 mm-2 (SD= 1041.751)]. The VV and SV of fibroblast increased (P= 0.000) in the SH group [20.400% (SD= 5.897) and 100.876 mm2/mm3 (SD= 29.431), respectively], compared to the C+ [16.324% (SD= 7.719) and 81.676 mm2/mm3 (SD= 28.884), respectively). The mean values of NA and VV of PMN were higher (P= 0.000) in the H [756.875 mm-2 (SD= 516.489) and 2.686% (SD= 2.380), respectively) group. Regarding to the evaluation of the content of collagen fibers, type I and III, the one-way analysis of ANOVA showed a statistically significant difference (P< 0.05). The content of collagen fibers type I was higher in C+ (1988.292 μm2; SD= 1312.379), while the content of collagen fibers type III was higher in SH (1967.163 μm2; SD= 1047.944 μm2) group. Conclusions: The stereological results were correlated with the stage of healing observed for each group. These results suggest that the combination of honey with ascorbic acid potentiate the healing effect, where both participated synergistically.

Keywords: ascorbic acid, morphometry, stereology, Ulmo honey

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62 Design of a Low-Cost, Portable, Sensor Device for Longitudinal, At-Home Analysis of Gait and Balance

Authors: Claudia Norambuena, Myissa Weiss, Maria Ruiz Maya, Matthew Straley, Elijah Hammond, Benjamin Chesebrough, David Grow

Abstract:

The purpose of this project is to develop a low-cost, portable sensor device that can be used at home for long-term analysis of gait and balance abnormalities. One area of particular concern involves the asymmetries in movement and balance that can accompany certain types of injuries and/or the associated devices used in the repair and rehabilitation process (e.g. the use of splints and casts) which can often increase chances of falls and additional injuries. This device has the capacity to monitor a patient during the rehabilitation process after injury or operation, increasing the patient’s access to healthcare while decreasing the number of visits to the patient’s clinician. The sensor device may thereby improve the quality of the patient’s care, particularly in rural areas where access to the clinician could be limited, while simultaneously decreasing the overall cost associated with the patient’s care. The device consists of nine interconnected accelerometer/ gyroscope/compass chips (9-DOF IMU, Adafruit, New York, NY). The sensors attach to and are used to determine the orientation and acceleration of the patient’s lower abdomen, C7 vertebra (lower neck), L1 vertebra (middle back), anterior side of each thigh and tibia, and dorsal side of each foot. In addition, pressure sensors are embedded in shoe inserts with one sensor (ESS301, Tekscan, Boston, MA) beneath the heel and three sensors (Interlink 402, Interlink Electronics, Westlake Village, CA) beneath the metatarsal bones of each foot. These sensors measure the distribution of the weight applied to each foot as well as stride duration. A small microntroller (Arduino Mega, Arduino, Ivrea, Italy) is used to collect data from these sensors in a CSV file. MATLAB is then used to analyze the data and output the hip, knee, ankle, and trunk angles projected on the sagittal plane. An open-source program Processing is then used to generate an animation of the patient’s gait. The accuracy of the sensors was validated through comparison to goniometric measurements (±2° error). The sensor device was also shown to have sufficient sensitivity to observe various gait abnormalities. Several patients used the sensor device, and the data collected from each represented the patient’s movements. Further, the sensors were found to have the ability to observe gait abnormalities caused by the addition of a small amount of weight (4.5 - 9.1 kg) to one side of the patient. The user-friendly interface and portability of the sensor device will help to construct a bridge between patients and their clinicians with fewer necessary inpatient visits.

Keywords: biomedical sensing, gait analysis, outpatient, rehabilitation

Procedia PDF Downloads 259
61 Upper Jurassic to Lower Cretaceous Oysters (Bivalvia, Ostreoidea) from Siberia: Taxonomy and Variations of Carbon and Oxygen Isotopes

Authors: Igor N. Kosenko

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The present contribution is an analysis of more than 300 specimens of Upper Jurassic to Lower Cretaceous oysters collected by V.A. Zakharov during the 1960s and currently stored in the Trofimuk Institute of Geology and Geophysics SB RAS (Novosibirsk, Russia). They were sampled in the northwestern bounder of Western Siberia (Yatriya, Maurynia, Tol’ya and Lopsiya rivers) and the north of Eastern Siberia (Boyarka, Bolshaya Romanikha and Dyabaka-Tari rivers). During the last five years, they were examined with taxonomical and palaeoecological purposes. Based on carbonate material of oyster’s shells were performed isotopic analyses and associated palaeotemperatures. Taxonomical study consists on classical morphofunctional and biometrical analyses. It is completed by another large amount of Cretaceous oysters from Crimea as well as modern Pacific oyster - Crassostrea gigas. Those were studied to understand the range of modification variability between different species. Oysters previously identified as Liostrea are attributed now to four genera: Praeexogyra and Helvetostrea (Flemingostreidae), Pernostrea (Gryphaeidae) and one new genus (Gryphaeidae), including one species “Liostrea” roemeri (Quenstedt). This last is characterized by peculiar ethology, being attached to floating ammonites and morphology, outlined by a beak-shaped umbo on the right (!) valve. Endemic Siberian species from the Pernostrea genus have been included into the subgenus Boreiodeltoideum subgen. nov. Pernostrea and Deltoideum genera have been included into the tribe Pernostreini n. trib. from the Gryphaeinae subfamily. Model of phylogenetic relationships between species of this tribe has been proposed. Siberian oyster complexes were compared with complexes from Western Europe, Poland and East European Platform. In western Boreal and Subboreal Realm (England, northern France and Poland) two stages of oyster’s development were recognized: Jurassic-type and Cretaceous-type. In Siberia, Jurassic and Lower Cretaceous oysters formed a unique complex. It may be due to the isolation of the Siberian Basin toward the West during the Early Cretaceous. Seven oyster’s shells of Pernostrea (Pernostrea) uralensis (Zakharov) from the Jurassic/Cretaceous Boundary Interval (Upper Volgian – Lower Ryazanian) of Maurynia river were used to perform δ13C and δ18O isotopic analyses. The preservation of the carbonate material was controlled by: cathodoluminescence analyses; content of Fe, Mn, Sr; absence of correlation between δ13C and δ18O and content of Fe and Mn. The obtained δ13C and δ18O data were compared with isotopic data based on belemnites from the same stratigraphical interval of the same section and were used to trace palaeotemperatures. A general trend towards negative δ18O values is recorded in the Maurynia section, from the lower part of the Upper Volgian to the middle part of the Ryazanian Chetaites sibiricus ammonite zone. This trend was previously recorded in the Nordvik section. The higher palaeotemperatures (2°C in average) determined from oyster’s shells indicate that belemnites likely migrated laterally and lived part of their lives in cooler waters. This work financially supported by the Russian Foundation for Basic Researches (grant no. 16-35-00003).

Keywords: isotopes, oysters, Siberia, taxonomy

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60 A Case of Prosthetic Vascular-Graft Infection Due to Mycobacterium fortuitum

Authors: Takaaki Nemoto

Abstract:

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

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

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59 Biocompatibility Tests for Chronic Application of Sieve-Type Neural Electrodes in Rats

Authors: Jeong-Hyun Hong, Wonsuk Choi, Hyungdal Park, Jinseok Kim, Junesun Kim

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Identifying the chronic functions of an implanted neural electrode is an important factor in acquiring neural signals through the electrode or restoring the nerve functions after peripheral nerve injury. The purpose of this study was to investigate the biocompatibility of the chronic implanted neural electrode into the sciatic nerve. To do this, a sieve-type neural electrode was implanted at proximal and distal ends of a transected sciatic nerve as an experimental group (Sieve group, n=6), and the end-to-end epineural repair was operated with the cut sciatic nerve as a control group (reconstruction group, n=6). All surgeries were performed on the sciatic nerve of the right leg in Sprague Dawley rats. Behavioral tests were performed before and 1, 4, 7, 10, 14, and weekly days until 5 months following surgery. Changes in sensory function were assessed by measuring paw withdrawal responses to mechanical and cold stimuli. Motor function was assessed by motion analysis using a Qualisys program, which showed a range of motion (ROM) related to the joints. Neurofilament-heavy chain and fibronectin expression were detected 5 months after surgery. In both groups, the paw withdrawal response to mechanical stimuli was slightly decreased from 3 weeks after surgery and then significantly decreased at 6 weeks after surgery. The paw withdrawal response to cold stimuli was increased from 4 days following surgery in both groups and began to decrease from 6 weeks after surgery. The ROM of the ankle joint was showed a similar pattern in both groups. There was significantly increased from 1 day after surgery and then decreased from 4 days after surgery. Neurofilament-heavy chain expression was observed throughout the entire sciatic nerve tissues in both groups. Especially, the sieve group was showed several neurofilaments that passed through the channels of the sieve-type neural electrode. In the reconstruction group, however, a suture line was seen through neurofilament-heavy chain expression up to 5 months following surgery. In the reconstruction group, fibronectin was detected throughout the sciatic nerve. However, in the sieve group, the fibronectin was observed only in the surrounding nervous tissues of an implanted neural electrode. The present results demonstrated that the implanted sieve-type neural electrode induced a focal inflammatory response. However, the chronic implanted sieve-type neural electrodes did not cause any further inflammatory response following peripheral nerve injury, suggesting the possibility of the chronic application of the sieve-type neural electrodes. This work was supported by the Basic Science Research Program funded by the Ministry of Science (2016R1D1A1B03933986), and by the convergence technology development program for bionic arm (2017M3C1B2085303).

Keywords: biocompatibility, motor functions, neural electrodes, peripheral nerve injury, sensory functions

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58 The Influence of Human Movement on the Formation of Adaptive Architecture

Authors: Rania Raouf Sedky

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Adaptive architecture relates to buildings specifically designed to adapt to their residents and their environments. To design a biologically adaptive system, we can observe how living creatures in nature constantly adapt to different external and internal stimuli to be a great inspiration. The issue is not just how to create a system that is capable of change but also how to find the quality of change and determine the incentive to adapt. The research examines the possibilities of transforming spaces using the human body as an active tool. The research also aims to design and build an effective dynamic structural system that can be applied on an architectural scale and integrate them all into the creation of a new adaptive system that allows us to conceive a new way to design, build and experience architecture in a dynamic manner. The main objective was to address the possibility of a reciprocal transformation between the user and the architectural element so that the architecture can adapt to the user, as the user adapts to architecture. The motivation is the desire to deal with the psychological benefits of an environment that can respond and thus empathize with human emotions through its ability to adapt to the user. Adaptive affiliations of kinematic structures have been discussed in architectural research for more than a decade, and these issues have proven their effectiveness in developing kinematic structures, responsive and adaptive, and their contribution to 'smart architecture'. A wide range of strategies have been used in building complex kinetic and robotic systems mechanisms to achieve convertibility and adaptability in engineering and architecture. One of the main contributions of this research is to explore how the physical environment can change its shape to accommodate different spatial displays based on the movement of the user’s body. The main focus is on the relationship between materials, shape, and interactive control systems. The intention is to develop a scenario where the user can move, and the structure interacts without any physical contact. The soft form of shifting language and interaction control technology will provide new possibilities for enriching human-environmental interactions. How can we imagine a space in which to construct and understand its users through physical gestures, visual expressions, and response accordingly? How can we imagine a space whose interaction depends not only on preprogrammed operations but on real-time feedback from its users? The research also raises some important questions for the future. What would be the appropriate structure to show physical interaction with the dynamic world? This study concludes with a strong belief in the future of responsive motor structures. We imagine that they are developing the current structure and that they will radically change the way spaces are tested. These structures have obvious advantages in terms of energy performance and the ability to adapt to the needs of users. The research highlights the interface between remote sensing and a responsive environment to explore the possibility of an interactive architecture that adapts to and responds to user movements. This study ends with a strong belief in the future of responsive motor structures. We envision that it will improve the current structure and that it will bring a fundamental change to the way in which spaces are tested.

Keywords: adaptive architecture, interactive architecture, responsive architecture, tensegrity

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57 An Integrated Approach to Handle Sour Gas Transportation Problems and Pipeline Failures

Authors: Venkata Madhusudana Rao Kapavarapu

Abstract:

The Intermediate Slug Catcher (ISC) facility was built to process nominally 234 MSCFD of export gas from the booster station on a day-to-day basis and to receive liquid slugs up to 1600 m³ (10,000 BBLS) in volume when the incoming 24” gas pipelines are pigged following upsets or production of non-dew-pointed gas from gathering centers. The maximum slug sizes expected are 812 m³ (5100 BBLS) in winter and 542 m³ (3400 BBLS) in summer after operating for a month or more at 100 MMSCFD of wet gas, being 60 MMSCFD of treated gas from the booster station, combined with 40 MMSCFD of untreated gas from gathering center. The water content is approximately 60% but may be higher if the line is not pigged for an extended period, owing to the relative volatility of the condensate compared to water. In addition to its primary function as a slug catcher, the ISC facility will receive pigged liquids from the upstream and downstream segments of the 14” condensate pipeline, returned liquids from the AGRP, pigged through the 8” pipeline, and blown-down fluids from the 14” condensate pipeline prior to maintenance. These fluids will be received in the condensate flash vessel or the condensate separator, depending on the specific operation, for the separation of water and condensate and settlement of solids scraped from the pipelines. Condensate meeting the colour and 200 ppm water specifications will be dispatched to the AGRP through the 14” pipeline, while off-spec material will be returned to BS-171 via the existing 10” condensate pipeline. When they are not in operation, the existing 24” export gas pipeline and the 10” condensate pipeline will be maintained under export gas pressure, ready for operation. The gas manifold area contains the interconnecting piping and valves needed to align the slug catcher with either of the 24” export gas pipelines from the booster station and to direct the gas to the downstream segment of either of these pipelines. The manifold enables the slug catcher to be bypassed if it needs to be maintained or if through-pigging of the gas pipelines is to be performed. All gas, whether bypassing the slug catcher or returning to the gas pipelines from it, passes through black powder filters to reduce the level of particulates in the stream. These items are connected to the closed drain vessel to drain the liquid collected. Condensate from the booster station is transported to AGRP through 14” condensate pipeline. The existing 10” condensate pipeline will be used as a standby and for utility functions such as returning condensate from AGRP to the ISC or booster station or for transporting off-spec fluids from the ISC back to booster station. The manifold contains block valves that allow the two condensate export lines to be segmented at the ISC, thus facilitating bi-directional flow independently in the upstream and downstream segments, which ensures complete pipeline integrity and facility integrity. Pipeline failures will be attended to with the latest technologies by remote techno plug techniques, and repair activities will be carried out as needed. Pipeline integrity will be evaluated with ili pigging to estimate the pipeline conditions.

Keywords: integrity, oil & gas, innovation, new technology

Procedia PDF Downloads 51
56 Epigastric Pain in Emergency Room: Median Arcuate Ligament Syndrome

Authors: Demet Devrimsel Dogan, Ecem Deniz Kirkpantur, Muharrem Dogan, Ahmet Aykut, Ebru Unal Akoglu, Ozge Ecmel Onur

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Introduction: Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain due to external compression of the celiac trunk by a fibrous arch that unites diaphragmatic crura on each side of the aortic hiatus. While 10-24% of the population may suffer from compression of celiac trunk, it rarely causes patients to develop symptoms. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The diagnosis can be made using thin section multi-detector computed tomography (CT) scans which delineate the ligament and the compressed vessel. The treatment of MALS is aimed at relieving the compression of the celiac artery to restore adequate blood flow through the vessel and neurolysis to address chronic pain. Case: A 68-year-old male presented to our clinic with acute postprandial epigastric pain. This was patients’ first attack, and the pain was the worst pain of his life. The patient did not have any other symptoms like nausea, vomiting, chest pain or dyspnea. In his medical history, the patient has had an ischemic cerebrovascular stroke 5 years ago which he recovered with no sequel, and he was using 75 mg clopidogrel and 100 mg acetylsalicylic acid. He was not using any other medication and did not have a story of cardiovascular disease. His vital signs were stable (BP:113/72 mmHg, Spo2:97, temperature:36.3°C, HR:90/bpm). In his electrocardiogram, there was ST depression in leads II, III and AVF. In his physical examination, there was only epigastric tenderness, other system examinations were normal. Physical examination through his upper gastrointestinal system showed no bleeding. His laboratory results were as follows: creatinine:1.26 mg/dL, AST:42 U/L, ALT:17 U/L, amylase:78 U/L, lipase:26 U/L, troponin:10.3 pg/ml, WBC:28.9 K/uL, Hgb:12.7 gr/dL, Plt:335 K/uL. His serial high-sensitive troponin levels were also within normal limits, his echocardiography showed no segmental wall motion abnormalities, an acute myocardial infarction was excluded. In his abdominal ultrasound, no pathology was founded. Contrast-enhanced abdominal CT and CT angiography reported ‘thickened diaphragmatic cruras are compressing and stenosing truncus celiacus superior, this is likely compatible with MALS’. The patient was consulted to general surgery, and they admitted the patient for laparoscopic ligament release. Results: MALS is a syndrome that causes postprandial pain, nausea and vomiting as its most common symptoms. Affected patients are normally young, slim women between the ages of 30 and 50 who have undergone extensive examinations to find the source of their symptoms. To diagnose MALS, other underlying pathologies should initially be excluded. The gold standard is aortic angiography. Although diagnosis and treatment of MALS are unclear, symptom resolution has been achieved with multiple surgical modalities, including open, laparoscopic or robotic ligament release as well as celiac ganglionectomy, which often requires celiac artery revascularisation.

Keywords: differential diagnosis, epigastric pain, median arcuate ligament syndrome, celiac trunk

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55 Gender Specific Differences in Clinical Outcomes of Knee Osteoarthritis Treated with Micro-Fragmented Adipose Tissue

Authors: Tiffanie-Marie Borg, Yasmin Zeinolabediny, Nima Heidari, Ali Noorani, Mark Slevin, Angel Cullen, Stefano Olgiati, Alberto Zerbi, Alessandro Danovi, Adrian Wilson

Abstract:

Knee Osteoarthritis (OA) is a critical cause of disability globally. In recent years, there has been growing interest in non-invasive treatments, such as intra-articular injection of micro-fragmented fat (MFAT), showing great potential in treating OA. Mesenchymal stem cells (MSCs), originating from pericytes of micro-vessels in MFAT, can differentiate into mesenchymal lineage cells such as cartilage, osteocytes, adipocytes, and osteoblasts. Secretion of growth factor and cytokines from MSCs have the capability to inhibit T cell growth, reduced pain and inflammation, and create a micro-environment that through paracrine signaling, can promote joint repair and cartilage regeneration. Here we have shown, for the first time, data supporting the hypothesis that women respond better in terms of improvements in pain and function to MFAT injection compared to men. Historically, women have been underrepresented in studies, and studies with both sexes regularly fail to analyse the results by sex. To mitigate this bias and quantify it, we describe a technique using reproducible statistical analysis and replicable results with Open Access statistical software R to calculate the magnitude of this difference. Genetic, hormonal, environmental, and age factors play a role in our observed difference between the sexes. This observational, intention-to-treat study included the complete sample of 456 patients who agreed to be scored for pain (visual analogue scale (VAS)) and function (Oxford knee score (OKS)) at baseline regardless of subsequent changes to adherence or status during follow-up. We report that a significantly larger number of women responded to treatment than men: [90% vs. 60% change in VAS scores with 87% vs. 65% change in OKS scores, respectively]. Women overall had a stronger positive response to treatment with reduced pain and improved mobility and function. Pre-injection, our cohort of women were in more pain with worse joint function which is quite common to see in orthopaedics. However, during the 2-year follow-up, they consistently maintained a lower incidence of discomfort with superior joint function. This data clearly identifies a clear need for further studies to identify the cell and molecular biological and other basis for these differences and be able to utilize this information for stratification in order to improve outcome for both women and men.

Keywords: gender differences, micro-fragmented adipose tissue, knee osteoarthritis, stem cells

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54 The Gaps of Environmental Criminal Liability in Armed Conflicts and Its Consequences: An Analysis under Stockholm, Geneva and Rome

Authors: Vivian Caroline Koerbel Dombrowski

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Armed conflicts have always meant the ultimate expression of power and at the same time, lack of understanding among nations. Cities were destroyed, people were killed, assets were devastated. But these are not only the loss of a war: the environmental damage comes to be considered immeasurable losses in the short, medium and long term. And this is because no nation wants to bear that cost. They invest in military equipment, training, technical equipment but the environmental account yet finds gaps in international law. Considering such a generalization in rights protection, many nations are at imminent danger in a conflict if the water will be used as a mass weapon, especially if we consider important rivers such as Jordan, Euphrates and Nile. The top three international documents were analyzed on the subject: the Stockholm Convention (1972), Additional Protocol I to the Geneva Convention (1977) and the Rome Statute (1998). Indeed, some references are researched in doctrine, especially scientific articles, to substantiate with consistent data about the extent of the damage, historical factors and decisions which have been successful. However, due to the lack of literature about this subject, the research tends to be exhaustive. From the study of the indicated material, it was noted that international law - humanitarian and environmental - calls in some of its instruments the environmental protection in war conflicts, but they are generic and vague rules that do not define exactly what is the environmental damage , nor sets standards for measure them. Taking into account the mains conflicts of the century XX: World War II, the Vietnam War and the Gulf War, one must realize that the environmental consequences were of great rides - never deactivated landmines, buried nuclear weapons, armaments and munitions destroyed in the soil, chemical weapons, not to mention the effects of some weapons when used (uranium, agent Orange, etc). Extending the search for more recent conflicts such as Afghanistan, it is proven that the effects on health of the civilian population were catastrophic: cancer, birth defects, and deformities in newborns. There are few reports of nations that, somehow, repaired the damage caused to the environment as a result of the conflict. In the pitch of contemporary conflicts, many nations fear that water resources are used as weapons of mass destruction, because once contaminated - directly or indirectly - can become a means of disguised genocide side effect of military objective. In conclusion, it appears that the main international treaties governing the subject mention the concern for environmental protection, however leave the normative specifications vacancies necessary to effectively there is a prevention of environmental damage in armed conflict and, should they occur, the repair of the same. Still, it appears that there is no protection mechanism to safeguard natural resources and avoid them to become a mass destruction weapon.

Keywords: armed conflicts, criminal liability, environmental damages, humanitarian law, mass weapon

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53 Effect of Silica Nanoparticles on Three-Point Flexural Properties of Isogrid E-Glass Fiber/Epoxy Composite Structures

Authors: Hamed Khosravi, Reza Eslami-Farsani

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Increased interest in lightweight and efficient structural components has created the need for selecting materials with improved mechanical properties. To do so, composite materials are being widely used in many applications, due to durability, high strength and modulus, and low weight. Among the various composite structures, grid-stiffened structures are extensively considered in various aerospace and aircraft applications, because of higher specific strength and stiffness, higher impact resistance, superior load-bearing capacity, easy to repair, and excellent energy absorption capability. Although there are a good number of publications on the design aspects and fabrication of grid structures, little systematic work has been reported on their material modification to improve their properties, to our knowledge. Therefore, the aim of this research is to study the reinforcing effect of silica nanoparticles on the flexural properties of epoxy/E-glass isogrid panels under three-point bending test. Samples containing 0, 1, 3, and 5 wt.% of the silica nanoparticles, with 44 and 48 vol.% of the glass fibers in the ribs and skin components respectively, were fabricated by using a manual filament winding method. Ultrasonic and mechanical routes were employed to disperse the nanoparticles within the epoxy resin. To fabricate the ribs, the unidirectional fiber rovings were impregnated with the matrix mixture (epoxy + nanoparticles) and then laid up into the grooves of a silicone mold layer-by-layer. At once, four plies of woven fabrics, after impregnating into the same matrix mixture, were layered on the top of the ribs to produce the skin part. In order to conduct the ultimate curing and to achieve the maximum strength, the samples were tested after 7 days of holding at room temperature. According to load-displacement graphs, the bellow trend was observed for all of the samples when loaded from the skin side; following an initial linear region and reaching a load peak, the curve was abruptly dropped and then showed a typical absorbed energy region. It would be worth mentioning that in these structures, a considerable energy absorption was observed after the primary failure related to the load peak. The results showed that the flexural properties of the nanocomposite samples were always higher than those of the nanoparticle-free sample. The maximum enhancement in flexural maximum load and energy absorption was found to be for the incorporation of 3 wt.% of the nanoparticles. Furthermore, the flexural stiffness was continually increased by increasing the silica loading. In conclusion, this study suggested that the addition of nanoparticles is a promising method to improve the flexural properties of grid-stiffened fibrous composite structures.

Keywords: grid-stiffened composite structures, nanocomposite, three point flexural test , energy absorption

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52 Identifying the Needs for Renewal of Urban Water Infrastructure Systems: Analysis of Material, Age, Types and Areas: Case Study of Linköping in Sweden

Authors: Eman Hegazy, Stefan Anderberg, Joakim Krook

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Urban water infrastructure is crucial for efficient and reliable water supply in growing cities. With the growth of cities, the need for maintenance and renewal of these systems increases but often goes unfulfilled due to a variety of reasons, such as limited funding, political priorities, or lack of public awareness. Neglecting the renewal needs of these systems can lead to frequent malfunctions and reduced quality and reliability of water supply, as well as increased costs and health and environmental hazards. It is important for cities to prioritize investment in water infrastructure and develop long-term plans to address renewal needs. Drawing general conclusions about the rate of renewal of urban water infrastructure systems at an international or national level can be challenging due to the influence of local management decisions. In many countries, the responsibility for water infrastructure management lies with the municipal authorities, who are responsible for making decisions about the allocation of resources for repair, maintenance, and renewal. These decisions can vary widely based on factors such as local finances, political priorities, and public perception of the importance of water infrastructure. As a result, it is difficult to make generalizations about the rate of renewal across different countries or regions. In Sweden, the situation is not different, and the information from Svenskt Vatten indicates that the rate of renewal varies across municipalities and can be insufficient, leading to a buildup of maintenance and renewal needs. This study aims to examine the adequacy of the rate of renewal of urban water infrastructure in Linköping case city in Sweden. Using a case study framework, the study will assess the current status of the urban water system and the need for renewal. The study will also consider the role of factors such as proper identification processes, limited funding, competing for political priorities, and local management decisions in contributing to insufficient renewal. The study investigates the following questions: (1) What is the current status of water and sewerage networks in terms of length, age distribution, and material composition, estimated total water leakage in the network per year, damages, leaks, and outages occur per year, both overall and by district? (2) What are the main causes of these damages, leaks, and interruptions, and how are they related to lack of maintenance and renewal? (3) What is the current status of renewal work for the water and sewerage networks, including the renewal rate and changes over time, recent renewal material composition, and the budget allocation for renewal and emergency repairs? (4) What factors influence the need for renewal and what conditions should be considered in the assessment? The findings of the study provide insights into the challenges facing urban water infrastructure and identify strategies for improving the rate of renewal to ensure a reliable and sustainable water supply.

Keywords: case study, infrastructure, management, renewal need, Sweden

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51 The Architectural Conservation and Restoration Problems of Mevlevihanes

Authors: Zeynep Tanrıverdi, Ş. Barihüda Tanrıkorur

Abstract:

Mevlevihanes are the dervish lodges of the Mevlevi Sufi Order of dervishes, which was founded on the teachings of Mevlâna Jalaluddin Rumi (1207-1273) in the late 13th century in the Anatolian city of Konya, from which they were administered until 1925, when their activities together with all other sufi dervish orders, were legally prohibited after the founding of the Turkish Republic. On their closure in 1925 over 150 mevlevihane architectural complexes, which had functioned for over 600 years through the late Seljuk, Emirates, and Ottoman periods of Turkish history, were to be found in the geographic areas that had been once occupied by the Ottoman Empire. Unfortunately, because of the history of their prohibition and closure after 1925, the public developed confused negative reactions towards sufi dervish orders and their buildings occupied a nebulous political status so that their upkeep and restoration became neglected, they were used for different, inappropriate functions or were abandoned within the Turkish Republic, until a more socially objective, educated viewpoint developed in the late 1970’s and 80’s. The declaration of the Mevlevi Ayin-i Şerifi (the Ritual Whirling Ceremony of the Mevlevi Dervish Order) with its complex composed music and sema (whirling movements) performance, as a Masterpiece of the Intangible Heritage of Humanity in 2005 by UNESCO and 2007 as the International Year of Mevlâna, started an increase in studies about mevlevihanes and a wave of restorations, especially of their semahanes (the large assembly whirling halls where the Mevlevi Ritual Whirling Ceremony was performed). However, due to inadequacies in legal procedures, socio-cultural changes, economic incapacity, negative environmental factors, and faulty repair practices, the studies and applications for the protection of mevlevihanes have not reached the desired level. Within this historical perspective, this study aims to reveal the particular architectural conservation and restoration problems of mevlevihanes and propose solutions for them. Firstly, the categorization and components of mevlevihane architecture was evaluated through its historical process. Secondly, their basic architectural characteristics were explained. Thirdly, by examining recently restored examples like Manisa, Edirne, Bursa, Tokat, Gelibolu, and Çankırı Mevlevihanes, using archival documents, old maps, drawings, photos and reports, building survey method, mevlevihane architectural conservation and restoration application problems were analyzed. Finally, solution suggestions were proposed for the problems that threaten the proper restoration of mevlevihanes. It is hoped that this study will contribute to the preservation of Mevlevihanes which have played an important role in the architectural, cultural heritage of Turkey, and that their authentic values will be properly transmitted to future generations.

Keywords: conservation, cultural heritage, mevlevihane architecture, reastoration

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50 Shared Vision System Support for Maintenance Tasks of Wind Turbines

Authors: Buket Celik Ünal, Onur Ünal

Abstract:

Communication is the most challenging part of maintenance operations. Communication between expert and fieldworker is crucial for effective maintenance and this also affects the safety of the fieldworkers. To support a machine user in a remote collaborative physical task, both, a mobile and a stationary device are needed. Such a system is called a shared vision system and the system supports two people to solve a problem from different places. This system reduces the errors and provides a reliable support for qualified and less qualified users. Through this research, it was aimed to validate the effectiveness of using a shared vision system to facilitate communication between on-site workers and those issuing instructions regarding maintenance or inspection works over long distances. The system is designed with head-worn display which is called a shared vision system. As a part of this study, a substitute system is used and implemented by using a shared vision system for maintenance operation. The benefits of the use of a shared vision system are analyzed and results are adapted to the wind turbines to improve the occupational safety and health for maintenance technicians. The motivation for the research effort in this study can be summarized in the following research questions: -How can expert support technician over long distances during maintenance operation? -What are the advantages of using a shared vision system? Experience from the experiment shows that using a shared vision system is an advantage for both electrical and mechanical system failures. Results support that the shared vision system can be used for wind turbine maintenance and repair tasks. Because wind turbine generator/gearbox and the substitute system have similar failures. Electrical failures, such as voltage irregularities, wiring failures and mechanical failures, such as alignment, vibration, over-speed conditions are the common and similar failures for both. Furthermore, it was analyzed the effectiveness of the shared vision system by using a smart glasses in connection with the maintenance task performed by a substitute system under four different circumstances, namely by using a shared vision system, an audio communication, a smartphone and by yourself condition. A suitable method for determining dependencies between factors measured in Chi Square Test, and Chi Square Test for Independence measured for determining a relationship between two qualitative variables and finally Mann Whitney U Test is used to compare any two data sets. While based on this experiment, no relation was found between the results and the gender. Participants` responses confirmed that the shared vision system is efficient and helpful for maintenance operations. From the results of the research, there was a statistically significant difference in the average time taken by subjects on works using a shared vision system under the other conditions. Additionally, this study confirmed that a shared vision system provides reduction in time to diagnose and resolve maintenance issues, reduction in diagnosis errors, reduced travel costs for experts, and increased reliability in service.

Keywords: communication support, maintenance and inspection tasks, occupational health and safety, shared vision system

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49 How Restorative Justice Can Inform and Assist the Provision of Effective Remedies to Hate Crime, Case Study: The Christchurch Terrorist Attack

Authors: Daniel O. Kleinsman

Abstract:

The 2019 terrorist attack on two masjidain in Christchurch, New Zealand, was a shocking demonstration of the harm that can be caused by hate crime. As legal and governmental responses to the attack struggle to provide effective remedies to its victims, restorative justice has emerged as a tool that can assist, in terms of both meeting victims’ needs and discharging the obligations of the state under the International Covenant on Civil and Political Rights (ICCPR), arts 2(3), 26, 27. Restorative justice is a model that emphasizes the repair of harm caused or revealed by unjust behavior. It also prioritises the facilitation of dialogue, the restoration of equitable relationships, and the prevention of future harm. Returning to the case study, in the remarks of the sentencing judge, the terrorist’s actions were described as a hate crime of vicious malevolence that the Court was required to decisively reject, as anathema to the values of acceptance, tolerance and mutual respect upon which New Zealand’s inclusive society is based and which the country strives to maintain. This was one of the reasons for which the terrorist received a life sentence with no possibility of parole. However, in the report of the Royal Commission of Inquiry into the Attack, it was found that victims felt the attack occurred within the context of widespread racism, discrimination and Islamophobia, where hostile behaviors, including hate-based threats and attacks, were rarely recorded, analysed or acted on. It was also found that the Government had inappropriately concentrated intelligence resources on the risk of ‘Islamist’ terrorism and had failed to adequately respond to concerns raised about threats against the Muslim community. In this light, the remarks of the sentencing judge can be seen to reflect a criminal justice system that, in the absence of other remedies, denies systemic accountability and renders hate crime an isolated incident rather than an expression of more widespread discrimination and hate to be holistically addressed. One of the recommendations of the Royal Commission was to explore with victims the desirability and design of restorative justice processes. This presents an opportunity for victims to meet with state representatives and pursue effective remedies (ICCPR art 2(3)) not only for the harm caused by the terrorist but the harm revealed by a system that has exposed the minority Muslim community in New Zealand to hate in all forms, including but not limited to violent extremism. In this sense, restorative justice can also assist the state in discharging its wider obligations to protect all persons from discrimination (art 26) and allow ethnic and religious minorities to enjoy their own culture and profess and practice their own religion (art 27). It can also help give effect to the law and its purpose as a remedy to hate crime, as expressed in this case study by the sentencing judge.

Keywords: hate crime, restorative justice, minorities, victims' rights

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48 Histological and Ultrastructural Study on the Effect

Authors: Olfat Mohamed Hussien Yousef

Abstract:

Tamoxifen (TM) is a synthetic non-steroidal antiestrogen. It is one of the most effective drugs for treatment of estrogen-dependent cancer by binding to estrogen receptors, suppressing of epithelial proliferation and as a chemotherapeutic agent. Recently, more attention has been paid to the protective effects of natural antioxidants against toxicities induced by anti-cancer drugs involving free radical-mediated oxidative stress and tissue injury. Vitamin C is a potent antioxidant that has the ability to scavenge factors causing free radical formation in animals receiving tamoxifen. The present study aims at pinpointing the TM-induced histopathological and ultrastructural changes in the kidneys and to assess the possible chemoprotective role of vitamin C against such TM-induced microscopic changes. Thirty adult male CD-1 mice, 25-30 g in weight and 3 months old, were divided into three groups. The first group served as control. The second group received the therapeutic dose of TM at daily oral dose of 40 mg/kg body weight for 28 days. The third group received the therapeutic dose of vitamin C at a daily dose of 500 mg/kg body weight simultaneously with the therapeutic dose of TM used in group two for 28 days. Animals were sacrificed and kidney samples were obtained and processed for histological and ultrastructural examination. Histological changes induced by TM included damage of the renal corpuscles including obliteration of the subcapsular space, congestion of the glomerular blood capillaries, segmental mesangial cell proliferation with matrix expansion, capsular adhesions with the glomerular tuft especially at the urinary pole of the corpuscles. Moreover, some proximal and distal tubules suffered various degrees of degeneration in some lining cells. Haemorrhage and inflammatory cell infiltration were also observed in the intertubular spaces. Ultrastructural observations revealed damage of the parietal epithelium of Bowman’s capsule, fusion and destruction of the foot processes of podocytes and great increase of mesangial cells and mesangial matrix. The cells of the proximal convoluted tubules displayed marked destruction of the microvilli constituting the brush borders and degeneration of the mitochondria; besides, abundant lysosomes, numerous vacuoles and pyknotic nuclei were observed. The distal convoluted tubules displayed marked distruction of both the basal infolding and the mitochondria in some areas. Histological and ultrastructural results revealed that treatment of male mice with TM simultaneously with vitamin C led to apparent repair of the injured renal tissue. This might suggest that vitamin C (an antioxidant agent) can minimize the toxic effects of TM (an antiestrogen).

Keywords: tamoxifen, vitamin c, mammalian kidney, histology, ultrastructure

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47 Nigeria’s Terrorists RehabIlitation And Reintegration Policy: A Victimological Perspective

Authors: Ujene Ikem Godspower

Abstract:

Acts of terror perpetrated either by state or non-state actors are considered a social ill and impugn on the collective well-being of the society. As such, there is the need for social reparations, which is meant to ensure the healing of the social wounds resulting from the atrocities committed by errant individuals under different guises. In order to ensure social closure and effectively repair the damages done by anomic behaviors, society must ensure that justice is served and those whose rights and privileges have been denied and battered are given the necessary succour they deserve. With regards to the ongoing terrorism in the Northeast, the moves to rehabilitate and reintegrate Boko Haram members have commenced with the establishment of Operation Safe Corridor,1 and a proposed bill for the establishment of “National Agency for the Education, Rehabilitation, De-radicalisation and Integration of Repentant Insurgents in Nigeria”2. All of which Nigerians have expressed mixed feelings about. Some argue that the endeavor is lacking in ethical decency and justice and totally insults human reasoning. Terrorism and counterterrorism in Nigeria have been enmeshed in gross human rights violations both by the military and the terrorists, and this raises the concern of Nigeria’s ability to fairly and justiciably implement the deradicalization and reintegration efforts. On the other hand, there is the challenge of the community dwellers that are victims of terrorism and counterterrorism and their ability to forgive and welcome back their immediate-past tormentors even with the slightest sense of injustice in the process of terrorists reintegration and rehabilitation. With such efforts implemented in other climes, the Nigeria’s case poses a unique challenge and commands keen interests by stakeholders and the international community due to the aforementioned reasons. It is therefore pertinent to assess the communities’ level of involvement in the cycle of reintegration- hence, the objective of this paper. Methodologically as a part of my larger PhD thesis, this study intends to explore the three different local governments (Michika in Adamawa, Chibok in Borno, and Yunusari in Yobe), all based on the intensity of terrorists attacks. Twenty five in-depth interview will be conducted in the study locations above featuring religious leaders, Community (traditional) leaders, Internally displaced persons, CSOs management officials, and ex-Boko Haram insurgents who have been reintegrated. The data that will be generated from field work will be analyzed using the Nvivo-12 software package, which will help to code and create themes based on the study objectives. Furthermore, the data will be content-analyzed, employing verbatim quotations where necessary. Ethically, the study will take into consideration the basic ethical principles for research of this nature. It will strictly adhere to the principle of voluntary participation, anonymity, and confidentiality.

Keywords: boko haram, reintegration, rehabilitation, terrorism, victimology

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46 Bariatric Surgery Referral as an Alternative to Fundoplication in Obese Patients Presenting with GORD: A Retrospective Hospital-Based Cohort Study

Authors: T. Arkle, D. Pournaras, S. Lam, B. Kumar

Abstract:

Introduction: Fundoplication is widely recognised as the best surgical option for gastro-oesophageal reflux disease (GORD) in the general population. However, there is controversy surrounding the use of conventional fundoplication in obese patients. Whilst the intra-operative failure of fundoplication, including wrap disruption, is reportedly higher in obese individuals, the more significant issue surrounds symptom recurrence post-surgery. Could a bariatric procedure be considered in obese patients for weight management, to treat the GORD, and to also reduce the risk of recurrence? Roux-en-Y gastric bypass, a widely performed bariatric procedure, has been shown to be highly successful both in controlling GORD symptoms and in weight management in obese patients. Furthermore, NICE has published clear guidelines on eligibility for bariatric surgery, with the main criteria being type 3 obesity or type 2 obesity with the presence of significant co-morbidities that would improve with weight loss. This study aims to identify the proportion of patients who undergo conventional fundoplication for GORD and/or hiatus hernia, which would have been eligible for bariatric surgery referral according to NICE guidelines. Methods: All patients who underwent fundoplication procedures for GORD and/or hiatus hernia repair at a single NHS foundation trust over a 10-year period will be identified using the Trust’s health records database. Pre-operative patient records will be used to find BMI and the presence of significant co-morbidities at the time of consideration for surgery. This information will be compared to NICE guidelines to determine potential eligibility for the bariatric surgical referral at the time of initial surgical intervention. Results: A total of 321 patients underwent fundoplication procedures between January 2011 and December 2020; 133 (41.4%) had available data for BMI or to allow BMI to be estimated. Of those 133, 40 patients (30%) had a BMI greater than 30kg/m², and 7 (5.3%) had BMI >35kg/m². One patient (0.75%) had a BMI >40 and would therefore be automatically eligible according to NICE guidelines. 4 further patients had significant co-morbidities, such as hypertension and osteoarthritis, which likely be improved by weight management surgery and therefore also indicated eligibility for referral. Overall, 3.75% (5/133) of patients undergoing conventional fundoplication procedures would have been eligible for bariatric surgical referral, these patients were all female, and the average age was 60.4 years. Conclusions: Based on this Trust’s experience, around 4% of obese patients undergoing fundoplication would have been eligible for bariatric surgical intervention. Based on current evidence, in class 2/3 obese patients, there is likely to have been a notable proportion with recurrent disease, potentially requiring further intervention. These patient’s may have benefitted more through undergoing bariatric surgery, for example a Roux-en-Y gastric bypass, addressing both their obesity and GORD. Use of patient written notes to obtain BMI data for the 188 patients with missing BMI data and further analysis to determine outcomes following fundoplication in all patients, assessing for incidence of recurrent disease, will be undertaken to strengthen conclusions.

Keywords: bariatric surgery, GORD, Nissen fundoplication, nice guidelines

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