Search results for: neck femur fracture

Authors: Anne N. Heirman, Song Duimel, Rob van Son, Lisette van der Molen, Richard Dirven, Gyorgi B. Halmos, Julia van Weert, Michiel W.M. van den Brekel

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Objectives: Treatments for head-neck cancer are drastic and often significantly impact the quality of life and appearance of patients. Shared decision-making (SDM) beholds a collaboration between patient and doctor in which the most suitable treatment can be chosen by integrating patient preferences, values, and medical information. SDM has a lot of advantages that would be useful in making difficult treatment choices. The objective of this study was to determine the current level of SDM among patients and head-and-neck surgeons. Methods: Consultations of patients with a non-cutaneous head-and-neck malignancy facing a treatment decision were selected and included. If given informed consent, the consultation was recorded with an audio recorder, and the patient and surgeon filled in a questionnaire immediately after the consultation. The SDM level of the consultation was scored objectively by independent observers who judged audio recordings of the consultation using the OPTION5-scale, ranging from 0% (no SDM) to 100% (optimum SDM), as well as subjectively by patients (using the SDM-Q-9 and Control preference scale) and clinicians (SDM-Q-Doc, modified control preference scale) percentages. Preliminary results: Five head-neck surgeons have each at least seven recorded conversations with different patients. One of them was trained in SDM. The other four had no experience with SDM. Most patients were male (74%), and oropharyngeal carcinoma was the most common diagnosis (41%), followed by oral cancer (33%). Five patients received palliative treatment of which two patients were not treated recording guidelines. At this moment, all recordings are scored by the two independent observers. Analysis of the results will follow soon. Conclusion: The current study will determine to what extent there is a discrepancy between the objective and subjective level of shared decision-making (SDM) during a doctor-patient consultation in Head-and-Neck surgery. The results of the analysis will follow shortly.

Keywords: head-and-neck oncology, patient involvement, physician-patient relations, shared decision making

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Authors: Akarsh Verma, Avinash Parashar

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The aim of this article is to study the effects of hydroxyl functional group on the mechanical strength and fracture toughness of graphene. This functional group forms the backbone of intrinsic atomic structure of graphene oxide (GO). Molecular dynamics-based simulations were performed in conjunction with reactive force field (ReaxFF) parameters to capture the mode-I fracture toughness of hydroxyl functionalised graphene. Moreover, these simulations helped in concluding that spatial distribution and concentration of hydroxyl functional group significantly affects the fracture morphology of graphene nanosheet. In contrast to literature investigations, atomistic simulations predicted a transition in the failure morphology of hydroxyl functionalised graphene from brittle to ductile as a function of its spatial distribution on graphene sheet.

Keywords: graphene, graphene oxide, ReaxFF, molecular dynamics

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Authors: Loredana G. Marcu, David Marcu, Sanda M. Filip

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Advanced head and neck cancers are aggressive tumours, which require aggressive treatment. Treatment efficiency is often hindered by cancer cell repopulation during radiotherapy, which is due to various mechanisms triggered by the loss of tumour cells and involves both stem and differentiated cells. The aim of the current paper is to present in silico simulations of radiotherapy schedules on a virtual head and neck tumour grown with biologically realistic kinetic parameters. Using the linear quadratic formalism of cell survival after radiotherapy, altered fractionation schedules employing various treatment breaks for normal tissue recovery are simulated and repopulation mechanism implemented in order to evaluate the impact of various cancer cell contribution on tumour behaviour during irradiation. The model has shown that the timing of treatment breaks is an important factor influencing tumour control in rapidly proliferating tissues such as squamous cell carcinomas of the head and neck. Furthermore, not only stem cells but also differentiated cells, via the mechanism of abortive division, can contribute to malignant cell repopulation during treatment.

Keywords: radiation, tumour repopulation, squamous cell carcinoma, stem cell

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Authors: Artitaya Sabangbal, Darawan Augsornwan, Palakorn Surakunprapha, Lalida Petphai

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Background: Srinagarind Hospital Ward 3C has about 180 cases of patients with head and neck cancer per year. Almost all of these patients suffer with pain, fatigue, low self image, swallowing problem and when the tumor is larger they will have breathing problem. Many of them have complication after operation such as pressure sore, pneumonia, deep vein thrombosis. Nursing activity is very important to prevent the complication especially promoting patients early ambulation. The objective of this study was to develop early ambulation protocol for patients with head and neck cancer undergoing operation. Method: this study is one part of nursing system development in patients undergoing operation in Ward 3C. It is a participation action research divided into 3 phases Phase 1 Situation review: In this phase we review the clinical outcomes, process of care, from document such as nurses note and interview nurses, patients and family about early ambulation. Phase 2 Searching nursing intervention about early ambulation from previous study then establish protocol . This phase we have picture package of early ambulation. Phase 3 implementation and evaluation. Result: Patients with head and neck cancer after operation can follow early ambulation protocol 100%, 85 % of patients can follow protocol within 2 days after operation and 100% can follow protocol within 3 days. No complications occur. Patients satisfaction in very good level is 58% and in good level is 42% Length of hospital stay is 6 days in patients with wide excision and 16 day in patients with flap coverage. Conclusion: The early ambulation protocol is appropriate for patients with head and neck cancer who undergo operation. This can restore physical health, reduce complication and increase patients satisfaction.

Keywords: nursing system, early ambulation, head and neck cancer, operation

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Authors: Yilin Ma, Zhaomiao Liu, Xiang Wang, Yan Pang

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Microscale droplets play an increasingly important role in various applications, including medical diagnostics, material synthesis, chemical engineering, and cell research due to features of high surface-to-volume ratio and tiny scale, which can significantly improve reaction rates, enhance heat transfer efficiency, enable high-throughput parallel studies as well as reduce reagent usage. As a mature technique to manipulate small amounts of liquids, droplet microfluidics could achieve the precise control of droplet parameters such as size, uniformity, structure, and thus has been widely adopted in the engineering and scientific research of multiple fields. Necking processes of the droplet in the cross junction microchannels are experimentally and theoretically investigated and dynamic mechanisms of the neck thinning in two different regimes are revealed. According to evolutions of the minimum neck width and the thinning rate, the necking process is further divided into different stages and the main driving force during each stage is confirmed. Effects of the flow rates and the cross-sectional aspect ratio on the necking process as well as the neck profile at different stages are provided in detail. The distinct features of the two regimes in the squeezing stage are well captured by the theoretical estimations of the effective flow rate and the variations of the actual flow rates in different channels are reasonably reflected by the channel width ratio. In the collapsing stage, the quantitative relation between the minimum neck width and the remaining time is constructed to identify the physical mechanism.

Keywords: cross junction, neck thinning, force analysis, inertial mechanism

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Authors: Nisha Nandlal Sharma, Julaluk Carmai, Saiprasit Koetniyom, Bernd Markert

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Whiplash Injuries are usually associated with car accidents. The sudden forward or backward jerk to head causes neck strain, which is the result of damage to the muscle or tendons. Neck pain and headaches are the two most common symptoms of whiplash. Symptoms of whiplash are commonly reported in studies but the Injury mechanism is poorly understood. Neck muscles are the most important factor to study the neck Injury. This study focuses on the development of finite element (FE) model of human neck muscle to study the whiplash injury mechanism and effect of active muscle contraction on occupant kinematics. A detailed study of Injury mechanism will promote development and evaluation of new safety systems in cars, hence reducing the occurrence of severe injuries to the occupant. In present study, an active human finite element (FE) model with 3D neck muscle model is developed. Neck muscle was modeled with a combination of solid tetrahedral elements and 1D beam elements. Muscle active properties were represented by beam elements whereas, passive properties by solid tetrahedral elements. To generate muscular force according to inputted activation levels, Hill-type muscle model was applied to beam elements. To simulate non-linear passive properties of muscle, solid elements were modeled with rubber/foam material model. Material properties were assigned from published experimental tests. Some important muscles were then inserted into THUMS (Total Human Model for Safety) 50th percentile male pedestrian model. To reduce the simulation time required, THUMS lower body parts were not included. Posterior to muscle insertion, THUMS was given a boundary conditions similar to experimental tests. The model was exposed to 4g and 7g rear impacts as these load impacts are close to low speed impacts causing whiplash. The effect of muscle activation level on occupant kinematics during whiplash was analyzed.

Keywords: finite element model, muscle activation, neck muscle, whiplash injury prevention

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Authors: Madhur Verma, Meena Rajput, Kamal Kishore

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Background: The general view that obesity is a problem of prosperous Western countries has been repealed with substantial evidence showing that middle-income countries like India are now at the heart of a fat explosion. Neck circumference has evolved as a promising index to measure obesity, because of the convenience of its use, even in culture sensitive population. Objectives: To determine whether neck circumference (NC) was associated with overweight and obesity and contributed to the prediction like other classical anthropometric indices. Methodology: Cross-sectional study consisting of 1080 adults (> 19 years) selected through Multi-stage random sampling between August 2013 and September 2014 using the pretested semi-structured questionnaire. After recruitment, the demographic and anthropometric parameters [BMI, Waist & Hip Circumference (WC, HC), Waist to hip ratio (WHR), waist to height ratio (WHtR), body fat percentage (BF %), neck circumference (NC)] were recorded & calculated as per standard procedures. Analysis was done using appropriate statistical tests. (SPSS, version 21.) Results: Mean age of study participants was 44.55+15.65 years. Overall prevalence of overweight & obesity as per modified criteria for Asian Indians (BMI ≥ 23 kg/m2) was 49.62% (Females-51.48%; Males-47.77%). Also, number of participants having high WHR, WHtR, BF%, WC & NC was 827(76.57%), 530(49.07%), 513(47.5%), 537(49.72%) & 376(34.81%) respectively. Variation of NC, BMI & BF% with age was non- significant. In both the genders, as per the Pearson’s correlational analysis, neck circumference was positively correlated with BMI (men, r=0.670 {p < 0.05}; women, r=0.564 {p < 0.05}), BF% (men, r=0.407 {p < 0.05}; women, r= 0.283 {p < 0.05}), WC (men, r=0.598{p < 0.05}; women, r=0.615 {p < 0.05}), HC (men, r=0.512{p < 0.05}; women, r=0.523{p < 0.05}), WHR (men, r= 0.380{p > 0.05}; women, r=0.022{p > 0.05}) & WHtR (men, r=0.318 {p < 0.05}; women, r=0.396{p < 0.05}). On ROC analysis, NC showed good discriminatory power to identify obesity with AUC (AUC for males: 0.822 & females: 0.873; p- value < 0.001) with maximum sensitivity and specificity at a cut-off value of 36.55 cms for males & 34.05cms for females. Conclusion: NC has fair validity as a community-based screener for overweight and obese individuals in the study context and has also correlated well with other classical indices.

Keywords: neck circumference, obesity, anthropometric indices, body fat percentage

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Authors: Ralene Sim, Stefan Mueller, N. Gopalakrishna Iyer, Ngian Chye Tan, Khee Chee Soo, R. Shetty Mahalakshmi, Hiang Khoon Tan

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Background: Regional failure in nasopharyngeal carcinoma (NPC) is managed by salvage treatment in the form of neck dissection. Radical neck dissection (RND) is preferred over modified radical neck dissection (MRND) since it is traditionally believed to offer better long-term disease control. However, with the advent of more advanced imaging modalities like high-resolution Magnetic Resonance Imaging, Computed Tomography, and Positron Emission Tomography-CT scans, earlier detection is achieved. Additionally, concurrent chemotherapy also contributes to reduced tumour burden. Hence, there may be a lesser need for an RND and a greater role for MRND. With this retrospective study, the primary aim is to ascertain whether MRND, as opposed to RND, has similar outcomes and hence, whether there would be more grounds to offer a less aggressive procedure to achieve lower patient morbidity. Methods: This is a retrospective study of 66 NPC patients treated at Singapore General Hospital between 1994 to 2016 for histologically proven regional recurrence, of which 41 patients underwent RND and 25 who underwent MRND, based on surgeon preference. The type of ND performed, primary treatment mode, adjuvant treatment, and pattern of recurrence were reviewed. Overall survival (OS) was calculated using Kaplan-Meier estimate and compared. Results: Overall, the disease parameters such as nodal involvement and extranodal extension were comparable between the two groups. Comparing MRND and RND, the median (IQR) OS is 1.76 (0.58 to 3.49) and 2.41 (0.78 to 4.11) respectively. However, the p-value found is 0.5301 and hence not statistically significant. Conclusion: RND is more aggressive and has been associated with greater morbidity. Hence, with similar outcomes, MRND could be an alternative salvage procedure for regional failure in selected NPC patients, allowing similar salvage rates with lesser mortality and morbidity.

Keywords: nasopharyngeal carcinoma, neck dissection, modified neck dissection, radical neck dissection

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Authors: Sang-Woo Kim, Young-Seon Lee

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An important concern in metal forming, even at elevated temperatures, is whether a desired deformation can be accomplished without any failure of the material. A detailed understanding of the critical condition for crack initiation provides not only the workability limit of a material but also a guide-line for process design. This paper describes the utilization of ductile fracture criteria in conjunction with the finite element method (FEM) for predicting the onset of fracture in warm metal working processes of magnesium alloy sheets. Critical damage values for various ductile fracture criteria were determined from uniaxial tensile tests and were expressed as the function of strain rate and temperature. In order to find the best criterion for failure prediction, Erichsen cupping tests under isothermal conditions and FE simulations combined with ductile fracture criteria were carried out. Based on the plastic deformation histories obtained from the FE analyses of the Erichsen cupping tests and the critical damage value curves, the initiation time and location of fracture were predicted under a bi-axial tensile condition. The results were compared with experimental results and the best criterion was recommended. In addition, the proposed methodology was used to predict the onset of fracture in non-isothermal deep drawing processes using an irregular shaped blank, and the results were verified experimentally.

Keywords: magnesium, AZ31 alloy, ductile fracture, FEM, sheet forming, Erichsen cupping test

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Authors: Patricia Shirley Almeida Prado, Selma Paixão Argollo, Maria De Fátima Teixeira Guimarães, Leticia Matos Sobrinho

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Skeletal differential diagnosis is essential in forensic anthropology in order to differentiate skeletal trauma from normal osseous variation and pathological processes. Thus, part of forensic anthropological field is differentiate skeletal criminal injuries from the normal skeletal variation (bone fusion or nonunion, transitional vertebrae and other non-metric traits), non-traumatic skeletal pathology (myositis ossificans, arthritis, bone metastasis, osteomyelitis) from traumatic skeletal pathology (myositis ossificans traumatic) avoiding misdiagnosis. This case shows the importance of effective pathological diagnosis in order to accelerate the identification process of skeletonized human remains. THE CASE: An unidentified skeletal remains at the medico legal institute Nina Rodrigues-Salvador, of a male young adult (29 to 40 years estimated) showing a massive heterotopic ossification on its right tibia at upper epiphysis and adjacent articular femur surface; an extensive ossification on the right clavicle (at the sternal extremity) also presenting an heterotopic ossification at right scapulae (upper third of scapulae lateral margin and infraglenoid tubercule) and at the head of right humerus at the shoulder joint area. Curiously, this case also shows an unusual porosity in certain vertebrae´s body and in some tarsal and carpal bones. Likewise, his left fifth metacarpal bones (right and left) showed a healed fracture which led both bones distorted. Based on identification, of pathological conditions in human skeletal remains literature and protocols these alterations can be misdiagnosed and this skeleton may present more than one pathological process. The anthropological forensic lab at Medico-legal Institute Nina Rodrigues in Salvador (Brazil) adopts international protocols to ancestry, sex, age and stature estimations, also implemented well-established conventions to identify pathological disease and skeletal alterations. The most compatible diagnosis for this case is hematogenous osteomyelitis due to following findings: 1: the healed fracture pattern at the clavicle showing a cloaca which is a pathognomonic for osteomyelitis; 2: the metacarpals healed fracture does not present cloaca although they developed a periosteal formation. 3: the superior articular surface of the right tibia shows an extensive inflammatory healing process that extends to adjacent femur articular surface showing some cloaca at tibia bone disease. 4: the uncommon porosities may result from hematogenous infectious process. The fractures probably have occurred in a different moments based on the healing process; the tibia injury is more extensive and has not been reorganized, while metacarpals and clavicle fracture is properly healed. We suggest that the clavicle and tibia´s fractures were infected by an existing infectious disease (syphilis, tuberculosis, brucellosis) or an existing syndrome (Gorham’s disease), which led to the development of osteomyelitis. This hypothesis is supported by the fact that different bones are affected in diverse levels. Like the metacarpals that do not show the cloaca, but then a periosteal new bone formation; then the unusual porosities do not show a classical osteoarthritic processes findings as the marginal osteophyte, pitting and new bone formation, they just show an erosive process without bone formation or osteophyte. To confirm and prove our hypothesis we are working on different clinical approaches like DNA, histopathology and other image exams to find the correct diagnostic.

Keywords: bone disease, forensic anthropology, hematogenous osteomyelitis, human identification, human remains

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Authors: Ashlesha Khanapure, Harsh Kashyap, Abhinav Anand, Sanjana Habib, Anupama Bidargaddi

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Technologies that are developing quickly are being developed daily in a variety of disciplines, particularly the medical field. For the purpose of detecting bone fractures in X-ray pictures of different body segments, our work compares the ResNet-50 and MobileNetV3 architectures. It evaluates accuracy and computing efficiency with X-rays of the elbow, hand, and shoulder from the MURA dataset. Through training and validation, the models are evaluated on normal and fractured images. While ResNet-50 showcases superior accuracy in fracture identification, MobileNetV3 showcases superior speed and resource optimization. Despite ResNet-50’s accuracy, MobileNetV3’s swifter inference makes it a viable choice for real-time clinical applications, emphasizing the importance of balancing computational efficiency and accuracy in medical imaging. We created a graphical user interface (GUI) for MobileNet V3 model bone fracture detection. This research underscores MobileNetV3’s potential to streamline bone fracture diagnoses, potentially revolutionizing orthopedic medical procedures and enhancing patient care.

Keywords: CNN, MobileNet V3, ResNet-50, healthcare, MURA, X-ray, fracture detection

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Authors: Nabil Abaab, Dhaou Akrout, Riadh Ahmadi, Mabrouk Montacer

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The study of fluid pressure and its evolution have a critical importance as they lead to understanding the tectonic history of the region. Therefore, the present work focuses on a microtectonic study of tectonic and hydraulic fracture at the anticline structure of Zemlet El Beidha (North Chott range). The study and the analysis of several stations of tectonic and hydraulic fracture allow revealing the witnesses of a paléosurpression in the deposits of Lower Cretaceous (Bouhedma Formation). In fact, we noticed that the overpressure is directly involved in the creation of various types of fractures as evidenced by the different measures and the stereographic projections. Thus, the orientations of fibers of mineralization that fills the Beefs type fracture have the same direction as the main constraint. Furthermore, we discussed the different overpressure build-up mechanisms. The results showed that tectonics is likely, responsible for this anomaly. This is confirmed by the description of the fibers and the projection of the different measurements of Beefs. The mineralization transformation from gypsum to anhydrite is heavily involved in this stress regime especially in the presence of all necessary conditions of dehydration of gypsum.

Keywords: Zemlet El Beidha, overpressure, tectonic fracture, hydraulic fracture, gypsum beefs

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Authors: Samir Lecheb, Ahmed Chellil, Hamza Mechakra, Brahim Safi, Houcine Kebir

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In this paper we studied fracture and dynamic behavior of vertical axis wind turbine blade, the VAWT is a historical machine, it has many properties, structure, advantage, component to be able to produce the electricity. We modeled the blade design then imported to Abaqus software for analysis the modes shapes, frequencies, stress, strain, displacement and stress intensity factor SIF, after comparison we chose the idol material. Finally, the CTS test of glass epoxy reinforced polymer plates to obtain the material fracture toughness Kc.

Keywords: blade, crack, frequency, material, SIF

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Authors: Brandtner-Hafner Martin

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Adhesives are increasingly being used in the construction sector. On the one hand, this concerns dowel reinforcements using chemical anchors. On the other hand, the sealing and repair of cracks in structural concrete components are still on the rise. In the field of bonding, the interface between the joined materials is the most critical area. Therefore, it is of immense importance to characterize and investigate this section sufficiently by fracture analysis. Since standardized mechanical test methods are not sufficiently capable of doing this, recourse is made to an innovative concept based on fracture energy. Therefore, a series of experimental tests were performed using the so-called GF-principle to study the interface bonding safety of adhesively bonded concrete joints. Several different structural adhesive systems based on epoxy, CA/A hybrid, PUR, MS polymer, dispersion, and acrylate were selected for bonding concrete substrates. The results show that stable crack propagation and prevention of uncontrolled failure in bonded concrete joints depend very much on the adhesive system used, and only fracture analytical evaluation methods can provide empirical information on this.

Keywords: interface bonding safety, adhesively bonded concrete joints, GF-principle, fracture analysis

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Authors: Hong Je Kang, Young Chae Choi, Jin Sung Park, Isac Kim

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Purpose: Osteoporotic fractures are an important among postmenopausal women. When osteoporotic distal radial fractures occur, osteoporosis must be treated to prevent the hip and spine fractures. Intravenous injection of Zoledronic acid is expected to improve preventing osteoporotic fractures. Many articles reported the effect of intravenous Zoledronic acid to BMD of the hip and spine fracture or non-fracture patients with low BMD. However, that with distal radial fractures has rarely been reported. Therefore, the authors decided to study the effect of Zoledronic acid in BMD score, bone union, and bone turnover markers in the patients who underwent volar plating due to osteoporotic distal radial fractures. Materials: From April 2018 to May 2022, postmenopausal women aged 55 years or older who had osteoporotic distal radial fractures and who underwent surgical treatment using volar plate fixation were included. Zoledronic acid (5mg) was injected intravenously between 3 and 5 days after surgery. BMD scores after 1 year of operation were compared with the initial scores. Bone turnover markers were measured before surgery, after 3 months, and after 1 year. Radiological follow-up was performed every 2 weeks until the bone union and at 1 year postoperatively. Clinical outcome indicators were measured one year after surgery, and the occurrence of side effects was observed. Result: Total of 23 patients were included, with a lumbar BMD T score of -2.89±0.2 before surgery to -2.27±0.3 one year after surgery (p=0.012) and a femoral neck BMD T score of -2.45±0.3 before surgery to -2.36±0.3 (p=0.041) after one year, and all were statistically significant. Measured as bone resorption markers, serum CTX-1 was 337.43±10.4 pg/mL before surgery, 160.86±8.7 pg/mL (p=0.022) after three months, and 250.12±12.7 pg/mL (p=0.031) after one year. Urinary NTX-1 was 39.24±2.2 ng/mL before surgery, 24.46±1.2 ng/mL (p=0.014) after three months and 30.35±1.6 ng/mL (p=0.042) after one year. Measured as bone formation markers, serum osteocalcin was 13.04±1.1 ng/mL before surgery, 8.84±0.7 ng/mL (p=0.037) after 3 months and 11.1±0.4 ng/mL (p=0.026) after one year. Serum bone-specific ALP was 11.24±0.9 IU/L before surgery, 8.25±0.9 IU/L (p=0.036) after three months, and 10.2±0.9 IU/L (p=0.027) after one year. All were statistically significant. All cases showed bone union within an average of 6.91±0.3 weeks without any signs of failure. Complications were found in 5 out of 23 cases (21.7%), such as headache, nausea, muscle pain, and fever. Conclusion: When Zoledronic acid was used, BMD was improved in both the spine and femoral neck. This may reduce the likelihood and subsequent morbidity of additional osteoporotic fractures. This study is meaningful in that there was no difference in the duration of bone union and radiological characteristics in patients with distal radial fractures administrated with intravenous BP early after the fractures, and improvement in BMD and bone turnover indicators was measured.

Keywords: zeoldreonic acid, BMD, osteoporosis, distal radius

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Authors: Brandtner-Hafner Martin

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Biocomposites have established themselves as a sustainable material class in the industry. Their advantages include lower density, lower price, and easier recycling compared to conventional materials. Now there are a variety of ways to measure their technical performance. One possibility is mechanical tests, which are widely used and standardized. However, these provide only very limited insights into damage capacity, which is particularly problematic under cracking conditions. To overcome such shortcomings, experimental tests were performed applying the fracture energetically GF-concept to study the structural safety of the interface under crack opening (mode-I loading). Two different types of biocomposites based on extruded henequen-fibers (NFRP) and wood-particles (WPC) in an HDPE matrix were evaluated. The results show that the fracture energy values obtained are higher than those given in the literature. This suggests that alternatives to previous linear elastic testing methods are needed to perform authentic safety evaluations of green plastics.

Keywords: biocomposites, structural safety, Gғ-concept, fracture analysis

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Authors: Farej Ahmed Emhmmed

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Fracture of duplex stainless steels (DSS) was investigated in air and in 3.5 wt % NaCl solution. Tow sets of fatigued specimens were heat treated at 475ºC for different times and pulled to failure either in air or after kept in 3.5% NaCl with polarization of -900 mV/ SCE. Fracture took place in general by ferrite cleavage and austenite ductile fracture in transgranular mode. Specimens measured stiffness (Ms) was affected by the aging time, with higher values measured for specimens aged for longer times. Microstructural features played a role in "blocking" the crack propagation process leading to lower the CTOD values specially for specimens aged for short times. Unbroken ligaments/ austenite were observed at the crack wake. These features may exerted a bridging stress, blocking effect, at the crack tip giving resistance to the crack propagation process i.e the crack mouth opening was reduced. Higher stress intensity factor Kıc values were observed with increased amounts of crack growth suggesting longer zone of unbroken ligaments in the crack wake. The bridging zone was typically several mm in length. Attempt to model the bridge stress was suggested to understand the role of ligaments/unbroken austenite in increasing the fracture toughness factor.

Keywords: stainless steels, fracture toughness, crack keying effect, ligaments

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Authors: Woei-Shyan Lee, Hao-Chien Kao

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The impact deformation and fracture behaviour of cobalt-based Haynes 188 superalloy are investigated by means of a split Hopkinson pressure bar. Impact tests are performed at strain rates ranging from 1×103 s-1 to 5×103 s-1 and temperatures between 25°C and 800°C. The experimental results indicate that the flow response and fracture characteristics of cobalt-based Haynes 188 superalloy are significantly dependent on the strain rate and temperature. The flow stress, work hardening rate and strain rate sensitivity all increase with increasing strain rate or decreasing temperature. It is shown that the impact response of the Haynes 188 specimens is adequately described by the Zerilli-Armstrong fcc model. The fracture analysis results indicate that the Haynes 188 specimens fail predominantly as the result of intensive localised shearing. Furthermore, it is shown that the flow localisation effect leads to the formation of adiabatic shear bands. The fracture surfaces of the deformed Haynes 188 specimens are characterised by dimple- and / or cleavage-like structure with knobby features. The knobby features are thought to be the result of a rise in the local temperature to a value greater than the melting point.

Keywords: Haynes 188 alloy, impact, strain rate and temperature effect, adiabatic shearing

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Authors: Vladyslav Povoroznyuk, Larysa Martynyuk, Iryna Syzonenko, Liliya Martynyuk

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Osteoporosis is one of the important problems in postmenopausal women due to an increased risk of sudden and unexpected fractures. This study is aimed to determine the connection between bone mineral density (BMD) and trabecular bone score (TBS) in Ukrainian women suffering from metabolic syndrome. Participating in the study, 566 menopausal women aged 50-79 year-old were examined and divided into two groups: Group A included 336 women with no obesity (BMI ≤ 29.9 kg/m²), and Group B – 230 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). Dual-energy X-ray absorptiometry was used for measuring of lumbar spine (L1-L4), femoral neck, total body and forearm BMD and bone quality indexes (last according to Med-Imaps installation). Data were analyzed using Statistical Package 6.0. A significant increase of lumbar spine (L1-L4), femoral neck, total body and ultradistal radius BMD was found in women with metabolic syndrome compared to those without obesity (p < 0.001) both in their totality and in groups of 50-59 years, 60-69 years, and 70-79 years. TBS was significantly higher in non-obese women compared to metabolic syndrome patients of 50-59 years and in the general sample (p < 0.05). Analysis showed significant positive correlation between body mass index (BMI) and BMD at all levels. Significant negative correlation between BMI and TBS (L1-L4) was established. Despite the fact that BMD indexes were significantly higher in women with metabolic syndrome, the frequency of vertebral and non-vertebral fractures did not differ significantly in the groups of patients.

Keywords: bone mineral density, trabecular bone score, metabolic syndrome, fracture

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Authors: Jianguo Chen, Fenggang Zang, Yu Yang, Liangang Zheng

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Reactor Pressure Vessel (RPV) is an important security barrier in nuclear power plant. Crack like defects may be produced on RPV during the whole operation lifetime due to the harsh operation condition and irradiation embrittlement. During the severe loss of coolant accident, thermal shock happened as the injection of emergency cooling water into RPV, which results in re-pressurization of the vessel and very high tension stress on the vessel wall, this event called Pressurized Thermal Shock (PTS). Crack on the vessel wall may propagate even penetrate the vessel, so the safety of the RPV would undergo great challenge. Many assumptions in structure integrity evaluation make the result of deterministic fracture mechanics very conservative, which affect the operation lifetime of the plant. Actually, many parameters in the evaluation process, such as fracture toughness and nil-ductility transition temperature, have statistical distribution characteristics. So it is necessary to assess the structural integrity of RPV subjected to PTS event by means of Probabilistic Fracture Mechanics (PFM). Structure integrity evaluation methods of RPV subjected to PTS event are summarized firstly, then evaluation method based on probabilistic fracture mechanics are presented by considering the probabilistic characteristics of material and structure parameters. A comprehensive analysis example is carried out at last. The results show that the probability of crack penetrates through wall increases gradually with the growth of fast neutron irradiation flux. The results give advice for reactor life extension.

Keywords: fracture toughness, integrity evaluation, pressurized thermal shock, probabilistic fracture mechanics, reactor pressure vessel

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Authors: Fadwa Jewilli

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A sudden leak of a 6-inch gas line pipe after being in service for one year was observed. The pipe had been designed to transport dry gas. The failure had taken place in 6 o’clock position at the stage discharge of the flow process. Laboratory investigations were conducted to find out the cause of the pipe rupture. Visual and metallographic observations confirmed that the pipe split was due to a crack initiated in circumferential and then turned into longitudinal direction. Sever wall thickness reduction was noticed on the internal pipe surface. Scanning electron microscopy observations at the fracture surface revealed features of ductile fracture mode. Corrosion product analysis showed the traces of iron carbonate and iron sulphate. The laboratory analysis resulted in the conclusion that the pipe failed due to the effect of wet fluid (condensate) caused severe wall thickness dissolution resulted in pipe could not stand the continuation at in-service working condition.

Keywords: gas line pipe, corrosion prediction ductile fracture, ductile fracture, failure analysis

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Authors: Rim Sghiri, Samia Al Shouli, Hana Benhassine, Nejla Elamri, Zahid Shakoor, Foued Slama, Adel Almogren, Hala Zeglaoui, Elyes Bouajina, Ramzi Zemni

Abstract:

Objectives: Little is known about genes predisposing to systemic bone loss (SBL) in rheumatoid arthritis (RA). Therefore, we examined the association between SBL and a variant of CD40 gene, which is known to play a critical role in both immune response and bone homeostasis among patients with RA. Methods: CD40 rs48104850 was genotyped in 176 adult RA patients. Bone mineral density (BMD) was measured using dual-energy X-ray absorptiometry (DXA). Results: Low BMD was observed in 116 (65.9%) patients. Among them, 60 (34.1%) had low femoral neck (FN) Z score, 72 (40.9%) had low total femur (TF) Z score, and 105 (59.6%) had low lumbar spine (LS) Z score. CD40 rs4810485 was found to be associated with reduced TF Z score with the CD40 rs4810485 T allele protecting against reduced TF Z score (OR = 0.40, 95% CI = 0.23-0.68, p = 0.0005). This association was confirmed in the multivariate logistic regression analysis (OR=0.31, 95% CI= 0.16-0.59, p=3.84 x 10₋₄). Moreover, median FN BMD was reduced among RA patients with CD40 rs4810485 GG genotype compared to RA patients harbouring CD40 rs4810485 TT and GT genotypes (0.788± 0.136 versus 0.826± 0.146g/cm², p=0.001). Conclusion: This study, for the first time ever, demonstrated an association between a CD40 genetic variant and SBL among patients with RA.

Keywords: rheumatoid arthritis, CD40 gene, bone mineral density, systemic bone loss, rs48104850

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Authors: Adel Edwar Waheeb Louka

Abstract:

Purpose AI-driven solutions are at the forefront of many pathology and medical imaging methods. Using algorithms designed to better the experience of medical professionals within their respective fields, the efficiency and accuracy of diagnosis can improve. In particular, X-rays are a fast and relatively inexpensive test that can diagnose diseases. In recent years, X-rays have not been widely used to detect and diagnose COVID-19. The under use of Xrays is mainly due to the low diagnostic accuracy and confounding with pneumonia, another respiratory disease. However, research in this field has expressed a possibility that artificial neural networks can successfully diagnose COVID-19 with high accuracy. Models and Data The dataset used is the COVID-19 Radiography Database. This dataset includes images and masks of chest X-rays under the labels of COVID-19, normal, and pneumonia. The classification model developed uses an autoencoder and a pre-trained convolutional neural network (DenseNet201) to provide transfer learning to the model. The model then uses a deep neural network to finalize the feature extraction and predict the diagnosis for the input image. This model was trained on 4035 images and validated on 807 separate images from the ones used for training. The images used to train the classification model include an important feature: the pictures are cropped beforehand to eliminate distractions when training the model. The image segmentation model uses an improved U-Net architecture. This model is used to extract the lung mask from the chest X-ray image. The model is trained on 8577 images and validated on a validation split of 20%. These models are calculated using the external dataset for validation. The models’ accuracy, precision, recall, f1-score, IOU, and loss are calculated. Results The classification model achieved an accuracy of 97.65% and a loss of 0.1234 when differentiating COVID19-infected, pneumonia-infected, and normal lung X-rays. The segmentation model achieved an accuracy of 97.31% and an IOU of 0.928. Conclusion The models proposed can detect COVID-19, pneumonia, and normal lungs with high accuracy and derive the lung mask from a chest X-ray with similarly high accuracy. The hope is for these models to elevate the experience of medical professionals and provide insight into the future of the methods used.

Keywords: artificial intelligence, convolutional neural networks, deeplearning, image processing, machine learningSarapin, intraarticular, chronic knee pain, osteoarthritisFNS, trauma, hip, neck femur fracture, minimally invasive surgery

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Authors: Rawan Masarwa, Merav Ben Natan, Yaron Berkovich

Abstract:

Background: Hip fracture repair surgery carries a certain mortality risk, yet evidence suggests that orthopedic surgeons often refrain from discussing this issue with patients prior to surgery. Aim: This study aims to examine whether orthopedic surgeons address the issue of one-year post-surgery mortality before hip fracture repair surgery and to explore the factors influencing this decision. Method: The study uses a cross-sectional design, administering validated digital questionnaires to 150 orthopedic surgeons. Results: A minority of orthopedic surgeons reported consistently informing patients about the risk of mortality in the year following hip fracture surgery. The primary reasons for not discussing this risk were a desire to avoid frightening patients, time constraints, and concerns about undermining patient hope. Surgeons reported a medium-high level of perceived self-efficacy, with higher self-efficacy linked to a reduced likelihood of discussing one-year mortality risk. In contrast, older age and holding a specialist status in orthopedic surgery were associated with a higher likelihood of discussing this risk with patients. Conclusions: The findings suggest a need for interventions to address communication barriers and ensure consistent provision of essential information to patients undergoing hip fracture surgery. Additionally, they emphasize the importance of considering individual factors such as self-efficacy, age, and expertise in developing strategies to enhance patient-provider communication in orthopedic care settings.

Keywords: orthopedic surgeons, hip fracture surgery, mortality risk communication, patient information

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Authors: F. C. Amadi, G. C. Enyi, G. G. Nasr

Abstract:

Hydraulic fracturing is one of the most important stimulation techniques available to the petroleum engineer to extract hydrocarbons in tight gas sandstones. It allows more oil and gas production in tight reservoirs as compared to conventional means. The main aim of the study is to optimize the hydraulic fracturing as technique and for this purpose three multi-zones layer formation is considered and fractured contemporaneously. The three zones are named as Zone1 (upper zone), Zone2 (middle zone) and Zone3 (lower zone) respectively and they all occur in shale rock. Simulation was performed with Mfrac integrated software which gives a variety of 3D fracture options. This simulation process yielded an average fracture efficiency of 93.8%for the three respective zones and an increase of the average permeability of the rock system. An average fracture length of 909 ft with net height (propped height) of 210 ft (average) was achieved. Optimum fracturing results was also achieved with maximum fracture width of 0.379 inches at an injection rate of 13.01 bpm with 17995 Mscf of gas production.

Keywords: hydraulic fracturing, optimisation, shale, tight reservoir

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Authors: Philippe Dillien, Patrice Forget, Harald Engel, Olivier Cornu, Marc De Kock, Jean Cyr Yombi

Abstract:

Introduction: Hip fracture precedes commonly death in elderly people. Identification of high-risk patients may contribute to target patients in whom optimal management, resource allocation and trials efficiency is needed. The aim of this study is to construct a predictive score of mortality after hip fracture on the basis of the objective prognostic factors available: Neutrophil-to-lymphocyte ratio (NLR), age, and sex. C-Reactive Protein (CRP), is also considered as an alternative to the NLR. Patients and methods: After the IRB approval, we analyzed our prospective database including 286 consecutive patients with hip fracture. A score was constructed combining age (1 point per decade above 74 years), sex (1 point for males), and NLR at postoperative day+5 (1 point if >5). A receiver-operating curve (ROC) curve analysis was performed. Results: From the 286 patients included, 235 were analyzed (72 males and 163 females, 30.6%/69.4%), with a median age of 84 (range: 65 to 102) years, mean NLR values of 6.47+/-6.07. At one year, 82/280 patients died (29.3%). Graphical analysis and log-rank test confirm a highly statistically significant difference (P<0.001). Performance analysis shows an AUC of 0.72 [95%CI 0.65-0.79]. CRP shows no advantage on NLR. Conclusion: We have developed a score based on age, sex and the NLR to predict the risk of mortality at one year in elderly patients after surgery for a hip fracture. After external validation, it may be included in clinical practice as in clinical research to stratify the risk of postoperative mortality.

Keywords: neutrophil-to-lymphocyte ratio, hip fracture, postoperative mortality, medical and health sciences

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Authors: Kim Kennedy, Daren Gibson, Stephanie Flukes, Chandra Diwakarla, Lisa Spalding, Leanne Pilkington, Andrew Redfern

Abstract:

Introduction: The mortality gap in Aboriginal Head and Neck Cancer is well known, but the reasons for poorer survival are not well established. Aim: We aimed to evaluate the locoregional and metastatic involvement, and stage at diagnosis, in Aboriginal compared with non-Aboriginal patients. Methods: We performed a retrospective cohort analysis of 320 HNC patients from a single centre in Western Australia, identifying 80 Aboriginal patients and 240 non-Aboriginal patients matched on a 1:3 ratio by sites, histology, rurality, and age. We collected data on the patient characteristics, tumour features, regions involved, stage at diagnosis, treatment history, and survival and relapse patterns, including sites of metastatic and locoregional involvement. Results: Aboriginal patients had a significantly higher incidence of lung metastases (26.3% versus 13.7%, p=0.009). Aboriginal patients also had a numerically but non-statistically significant higher incidence of thoracic nodal involvement (10% vs 5.8%) and malignant pleural effusions (3.8% vs 2.5%). Aboriginal patients also had a numerically but not statistically significantly higher incidence of adrenal and bony involvement. Interestingly, non-Aboriginal patients had an increased rate of cutaneous (2.1% vs 0%) and liver metastases (4.6% vs 2.5%) compared with Aboriginal patients. In terms of locoregional involvement, Aboriginal patients were more than twice as likely to have contralateral neck involvement (58.8% vs 24.2%, p<0.00001), and 30% more likely to have ipsilateral neck lymph node involvement (78.8% vs 60%, p=0.002) than non-Aboriginal patients. Aboriginal patients had significantly more advanced disease at diagnosis (p=0.008). Aboriginal compared with non-Aboriginal patients were less likely to present with stage I (7.5% vs 22.5%), stage II (11.3% vs 13.8%), or stage III disease (13.8% vs 17.1%), and more likely to present with more advanced stage IVA (42.5% vs 34.6%), stage IVB (15% vs 7.1%), or stage IVC (10% vs 5%) disease (p=0.008). Number of regions of disease involvement was higher in Aboriginal patients (median 3, mean 3.64, range 1-10) compared with non-Aboriginal patients (median 2, mean 2.80, range 1-12). Conclusion: Aboriginal patients had a significantly higher incidence of lung metastases, and significantly more frequent involvement of ipsilateral and contralateral neck lymph nodes. Aboriginal patients also had significantly more advanced disease at presentation with a higher stage at diagnosis. We are performing further analyses to investigate explanations for these findings.

Keywords: head and neck cancer, Aboriginal, metastases, locoregional, pattern of relapse, sites of disease

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Authors: Xianjia Meng, Chuanyong Qu

Abstract:

Compact bone produces fatigue damage under the inevitable physiological load. The accumulation of fatigue damage can change the bone’s micro-structure at different scales and cause the catastrophic failure eventually. However, most tests were limited to the macroscopic modulus of bone and there is a need to assess the microscopic modulus during fatigue progress. In this paper, nano-identation was used to investigate the bone specimen subjected to four point bending. The microscopic modulus of the same area were measured at different degrees of damage including fracture. So microscopic damage can be divided into three stages: first, the modulus decreased rapidly and then They fell slowly, before fracture the decline became fast again. After fracture, the average modulus decreased by 20%. The results of inner and outer planes explained the influence of compressive and tensile loads on modulus. Both the compressive and tensile moduli decreased with the accumulation of damage. They reached the minimum at ending and increased after fracture. The modulus evolution under different strains were revealed by the side. They all fell slowly and then fast with the accumulation of damage. The fractured results indicated that the elastic modulus decreased obviously at the high strain while decreased less at the low strain. During the fatigue progress, there was a significant difference in modulus at low degree of damage. However, the dispersed modulus tended to be similar at high degree of damage, but they became different again after the failure.

Keywords: fatigue damage, fracture, microscopic modulus, bone, nano-identation

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Authors: Anirudh Sharma

Abstract:

Introduction: The Covid-19 pandemic necessitated a change in the manner outpatient fracture clinics are conducted due to the need to reduce footfall in hospital. While studies regarding virtual fracture clinics have shown these to be useful and effective, they focus exclusively on remote consultations. However, our service was bespoke to the patient – either a face-to-face or telephone consultation depending on patient need – a ‘hybrid virtual clinic (HVC).’ We report patient satisfaction and outcomes with this novel service. Methods: Patients booked onto our fracture clinics during the first 2 weeks of national lockdown were retrospectively contacted to assess the mode of consultations (virtual, face-to-face, or hybrid), patient experience, and outcome. Patient experience was assessed using the net promoter (NPS), customer effort (CES) and customer satisfaction scores (CSS), and their likelihood of using the HVC in the absence of a pandemic. Patient outcomes were assessed using the components of the EQ5D score. Results: Of 269 possible patients, 140 patients responded to the questionnaire. Of these, 66.4% had ‘hybrid’ consultations, 27.1% had only virtual consultations, and 6.4% had only face-to-face consultations. The mean overall NPS, CES, and CSS (on a scale of 1-10) were 7.27, 7.25, and 7.37, respectively. The mean likelihood of patients using the HVC in the absence of a pandemic was 6.5/10. Patients who had ‘hybrid’ consultations showed better effort scores and greater overall satisfaction than those with virtual consultations only and also reported superior EQ5D outcomes (mean 79.27 vs. 72.7). Patients who did not require surgery reported increased satisfaction (mean 7.51 vs. 7.08) and were more likely to use the HVC in the absence of a pandemic. Conclusion: Our study indicates that a bespoke HVC has good overall patient satisfaction and outcomes and is a better format of fracture clinic service than virtual consultations alone. It may be the preferred mode for fracture clinics in similar situations in the future. Further analysis needs to be conducted in order to explore the impact on resources and clinician experience of HVC in order to appreciate this new paradigm shift.

Keywords: hybrid virtual clinic, coronavirus, COVID-19, fracture clinic, remote consultation

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Authors: El Sayed A. Sharara, A. Tsuji, K. Terada

Abstract:

Call centers have been expanding and they have influence on activation in various markets increasingly. A call center’s work is known as one of the most demanding and stressful jobs. In this paper, we propose the fatigue detection system in order to detect burnout of call center agents in the case of a neck pain and upper back pain. Our proposed system is based on the computer vision technique combined skin color detection with the Viola-Jones object detector. To recognize the gesture of hand poses caused by stress sign, the YCbCr color space is used to detect the skin color region including face and hand poses around the area related to neck ache and upper back pain. A cascade of clarifiers by Viola-Jones is used for face recognition to extract from the skin color region. The detection of hand poses is given by the evaluation of neck pain and upper back pain by using skin color detection and face recognition method. The system performance is evaluated using two groups of dataset created in the laboratory to simulate call center environment. Our call center agent burnout detection system has been implemented by using a web camera and has been processed by MATLAB. From the experimental results, our system achieved 96.3% for upper back pain detection and 94.2% for neck pain detection.

Keywords: call center agents, fatigue, skin color detection, face recognition

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