Search results for: small bowel obstruction

Authors: Nguyen Dang Duc, Nguyen Phuong Sinh, Lam Nguyen Hong Anh

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Superior mesenteric artery (SMA) syndrome is a rare cause of high-section intestinal obstruction. SMA syndrome is characterized by compression of the third segment of the duodenum due to the narrowing of the distance between the superior mesenteric artery and the abdominal aorta. The main clinical signs of SMA syndrome are high intestinal obstruction, such as postprandial vomiting, epigastric pain, early feeling of abdominal fullness, and indigestion. Abdominal computed tomography plays an important role in diagnosis. There are two main methods of treating SMA syndrome that are conservative and surgical treatment. We report a clinical case of an 18-year-old male patient admitted to the hospital because of a Bungarus snake bit in the second hour, to the twelfth day of treatment, the patient developed diarrhea that lasted until the twenty-fourth day of treatment. On the twenty-fifth day of treatment, the patient lost 16 kilograms (from 56 down to 40). The patient had symptoms of vomiting after eating, indigestion, and epigastric pain. On abdominal computed tomography, the angle created by the superior mesenteric artery and the abdominal aorta was 17 degrees, the distance between the two arteries was 3.8 millimeters, light dilation and stagnation of the D1 and D2 segment of the duodenum with gas and watery level inside segment D3 and D4 of the duodenum and this segment was constricted. This patient was diagnosed with superior mesenteric artery syndrome with the Bungarus snake bites. Currently, the patient was treated with feeding through a jejunal tube each other intravenous nutrition. Finally, The patient was discharged and returned to his house on the forty-fifth day of treatment. We reported this clinical case to introduce clinical and paraclinical signs, diagnose, and methods treated for patient having SMA syndrome.

Keywords: superior mesenteric artery syndrome, Bungarus snake bites, loss weight

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Authors: R. R. Billones, N. Lukkahatai, L. N. Saligan

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Mindfulness based interventions (MBIs) have been used in medically unexplained symptoms (MUS). This systematic review describes the literature investigating the general effect of MBIs on MUS and identifies the effects of specific MBIs on specific MUS conditions. The preferred reporting items for systematic reviews and meta-analysis guidelines (PRISMA) and the modified Oxford quality scoring system (JADAD) were applied to the review, yielding an initial 1,556 articles. The search engines included PubMed, ScienceDirect, Web of Science, Scopus, EMBASE, and PsychINFO using the search terms: mindfulness, or mediations, or mindful or MBCT or MBSR and medically unexplained symptoms or MUS or fibromyalgia or FMS. A total of 24 articles were included in the final systematic review. MBIs showed large effects on socialization skills for chronic fatigue syndrome (d=0.65), anger in fibromyalgia (d=0.61), improvement of somatic symptoms (d=1.6) and sleep (d=1.12) for painful conditions, physical health for chronic back pain (d=0.51), and disease intensity for irritable bowel disease/syndrome (d=1.13). A manualized MBI that applies the four fundamental elements present in all types of interventions were critical to efficacy. These elements were psycho-education sessions specific to better understand the medical symptoms, the practice of awareness, the non-judgmental observance of the experience at the moment, and the compassion to ones’ self. The effectiveness of different mindfulness interventions necessitates giving attention to improve the gaps that were identified related to home-based practice monitoring, competency training of mindfulness teachers, and sound psychometric properties to measure the mindfulness practice.

Keywords: mindfulness-based interventions, medically unexplained symptoms, mindfulness-based cognitive therapy, mindfulness-based stress reduction, fibromyalgia, irritable bowel syndrome

Procedia PDF Downloads 142

Authors: Tan Dexian Arthur, James Wei Ming Kwek, Ian Loh, Lee Tee Sin

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Statement of the Problem: Mucoceles most commonly affect the frontal sinus, which results from chronic obstruction of the sinus ostium or cystic dilatation of mucous glands with ductal obstruction. They are known to cause bony erosion of the sinus walls, which can lead to large defects. These defects were typically managed by obliteration or cranialization of the frontal sinus. Although short term outcomes of conservative management of significant posterior table defects from fractures are promising, there have been no studies on the long-term outcomes of large dehiscences in the posterior wall of the frontal sinus. Methodology & Findings : Computed Tomography (CT) Paranasal Sinuses images were analyzed and found complete spontaneous osteogenesis of a large dehiscent frontal sinus posterior wall, secondary to a large mucocele, 9 years from functional endoscopic sinus surgery with the defect managed conservatively. Conclusion & Significance: The dura is well known for its osteogenic properties. Prior studies have showed that dura could induce osteogenesis in cutaneous tissue in the absence of other central nervous system structures. It was also demonstrated that osteogenesis and chondrogenesis were possible in zygomatic fractures by transplanting neonatal dura grafts to the bony defects in rats. Extrapolating from these studies, the authors postulate that the presence of dura beneath the bony deformity of the posterior frontal sinus wall had likely initiated the osteogenesis and restored the bony defect in the patient. In our literature review, we did not find any reports of spontaneous osteogenesis of large frontal sinus defects. While our experience is incidental, it reinforces the osteogenetic potential of an intact dura and further highlights that selected large defects of the posterior wall of the frontal sinus can be conservatively managed.

Keywords: paranasal sinus mucocele, mucocele, osteogenesis, dehiscence

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Authors: Tristan R. Fraser, Christopher D. Steadman, Christopher J. Boos

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Myopericarditis is an inflammation syndrome characterised by clinical diagnostic criteria for pericarditis, such as chest pain, combined with evidence of myocardial involvement, such as elevation of biomarkers of myocardial damage, e.g., troponins. It can rarely be a complication of therapeutics used for dysregulated immune-mediated diseases such as inflammatory bowel disease (IBD), for example, mesalazine. The infrequency of mesalazine-induced myopericarditis adds to the challenge in its recognition. Rapid diagnosis and the early introduction of treatment are crucial. This case report follows a 24-year-old professional footballer with a past medical history of ulcerative colitis, recently started on mesalazine for disease control. Three weeks after mesalazine was initiated, he was admitted with fever, shortness of breath, and chest pain worse whilst supine and on deep inspiration, as well as elevated venous blood cardiac troponin T level (cTnT, 288ng/L; normal: <13ng/L). Myocarditis was confirmed on initial inpatient cardiac MRI, revealing the presence of florid myocarditis with preserved left ventricular systolic function and an ejection fraction of 67%. This was a longitudinal case study following the progress of a single individual with myopericarditis over four acute hospital admissions over nine weeks, with admissions ranging from two to five days. Parameters examined included clinical signs and symptoms, serum troponin, transthoracic echocardiogram, and cardiac MRI. Serial measurements of cardiac function, including cardiac MRI and transthoracic echocardiogram, showed progressive deterioration of cardiac function whilst mesalazine was continued. Prior to cessation of mesalazine, transthoracic echocardiography revealed a small global pericardial effusion of < 1cm and worsening left ventricular systolic function with an ejection fraction of 45%. After recognition of mesalazine as a potential cause and consequent cessation of the drug, symptoms resolved, with cardiac MRI performed as an outpatient showing resolution of myocardial oedema. The patient plans to make a return to competitive sport. Patients suffering from myopericarditis are advised to refrain from competitive sport for at least six months in order to reduce the risk of cardiac remodelling and sudden cardiac death. Additional considerations must be taken in individuals for whom competitive sport is an essential component of their livelihood, such as professional athletes. Myopericarditis is an uncommon, however potentially serious medical condition with a wide variety of aetiologies, including viral, autoimmune, and drug-related causes. Management is mainly supportive and relies on prompt recognition and removal of the aetiological process. Mesalazine-induced myopericarditis is a rare condition; as such increasing awareness of mesalazine as a precipitant of myopericarditis is vital for optimising the management of these patients.

Keywords: myopericarditis, mesalazine, inflammatory bowel disease, professional athlete

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Authors: Jessica A. Hellings, Piyushkumar Jani

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Background: Systemic autoimmune disorders are increasingly implicated in neuropsychiatric illness, especially in the setting of treatment resistance in individuals of all ages. Gluten allergy in fullest extent results in celiac disease, affecting multiple organs including central nervous system (CNS). Clinicians often lack awareness of the association between neuropsychiatric illness and gluten allergy, partly since many such research studies are published in immunology and gastroenterology journals. Methods: Following a Pubmed literature search and online searches on celiac disease websites, 40 articles are critically reviewed in detail. This work reviews celiac disease, gluten intolerance and current evidence of their relationship to neuropsychiatric and systemic illnesses. The review also covers current work-up and diagnosis, as well as dietary interventions, gluten restriction outcomes, and future research directions. Results: Gluten allergy in susceptible individuals damages the small intestine, producing a leaky gut and malabsorption state, as well as allowing antibodies into the bloodstream, which attack major organs. Lack of amino acid precursors for neurotransmitter synthesis together with antibody-associated brain changes and hypoperfusion may result in neuropsychiatric illness. This is well documented; however, studies in neuropsychiatry are often small. In the large CATIE trial, subjects with schizophrenia had significantly increased antibodies to tissue transglutaminase (TTG), and antigliadin antibodies, both significantly greater gluten antibodies than in control subjects. On later follow up, TTG-6 antibodies were identified in these subjects’ brains but not in their intestines. Significant evidence mostly from small studies also exists for gluten allergy and celiac-related depression, anxiety disorders, attention-deficit/hyperactivity disorder, autism spectrum disorders, ataxia, and epilepsy. Dietary restriction of gluten resulted in remission in several published cases, including for treatment-resistant schizophrenia. Conclusions: Ongoing and larger studies are needed of the diagnosis and treatment efficacy of the gluten-free diet in neuropsychiatric illness. Clinicians should ask about the patient history of anemia, hypothyroidism, irritable bowel syndrome and family history of benefit from the gluten-free diet, not limited to but especially in cases of treatment resistance. Obtaining gluten antibodies by a simple blood test, and referral for gastrointestinal work-up in positive cases should be considered.

Keywords: celiac, gluten, neuropsychiatric, translational

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Authors: Eva Karaskova, Jana Volejnikova, Dusan Holub, Maria Velganova-Veghova, Michaela Spenerova, Dagmar Pospisilova

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Background: Hepcidin is the central regulator of iron metabolism. Its production is mainly affected by an iron deficiency and the presence of inflammatory activity in the body. The aim of this study was to compare serum hepcidin levels in paediatric patients with newly diagnosed inflammatory bowel disease and hepcidin levels during maintenance therapy, correlate changes of serum hepcidin levels with selected markers of iron metabolism and inflammation and type of provided treatment. Methods: Children with newly diagnosed Crohn's disease (CD) and ulcerative colitis (UC) were included in this prospective study. Blood and stool samples were collected before treatment (baseline). Serum hepcidin, hemoglobin levels, platelet counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-6 (IL 6), ferritin, iron, soluble transferrin receptors, and fecal calprotectin were assessed. The same parameters were measured and compared with the baseline levels in the follow-up period, during maintenance therapy (average of 39 months after diagnosis). Results: Patients with CD (n=30) had higher serum hepcidin levels (expressed as a median and interquartile range) at diagnosis than subjects with UC (n=13). These levels significantly decreased during the follow-up (from 36.5 (11.5-79.6) ng/ml to 2.1 (0.9-6.7) ng/ml). Contrarily, no significant serum hepcidin level changes were observed in UC (from 5.4 (3.4-16.6) ng/ml to 4.8 (0.9-8.1) ng/ml). While in children with CD hepcidin level dynamics correlated with disease activity and inflammatory markers (ESR, CRP), an only correlation with serum iron levels was observed in patients with UC. Conclusion: Children with CD had higher serum hepcidin levels at diagnosis compared to subjects with UC. Decrease of serum hepcidin in the CD group during anti-inflammatory therapy has been observed, whereas low hepcidin levels in children with UC have remained unchanged. Acknowledgment: This study was supported by grant MH CZ–DRO (FNOl, 00098892).

Keywords: children, Crohn's disease, ulcerative colitis, anaemia, hepcidin

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Authors: Jessada Monthasuwan, Charinsak Saetiaw, Chanchai Thongsopa

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This paper presents the development and design of the curved rectangular patch arrays antenna for small missile application. This design uses a 0.1mm flexible copper sheet on the front layer and back layer, and a 1.8mm PVC substrate on a middle layer. The study used a small missile model with 122mm diameter size with speed 1.1 Mach and frequency range on ISM 2.4 GHz. The design of curved antenna can be installation on a cylindrical object like a missile. So, our proposed antenna design will have a small size, lightweight, low cost, and simple structure. The antenna was design and analysis by a simulation result from CST microwave studio and confirmed with a measurement result from a prototype antenna. The proposed antenna has a bandwidth covering the frequency range 2.35-2.48 GHz, the return loss below -10 dB and antenna gain 6.5 dB. The proposed antenna can be applied with a small guided missile effectively.

Keywords: rectangular patch arrays, small missile antenna, antenna design and simulation, cylinder PVC tube

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Authors: Sanjeev Singh

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Background: Obstructed total anomalous pulmonary venous connection (OTAPVC) typically presents with severe cardiovascular decompensation and requires urgent surgical management. Pulmonary arterial hypertension (PAH) is a major risk factor affecting mortality. Perioperative management focuses on providing inotropic support and managing potential pulmonary hypertensive episodes. The aim of this study was to determine the outcome of patients with high pulmonary arterial pressure (PAP) with milrinone alone and a combination of milrinone and inhaled nitric oxide (INO). Material and Methods: After the approval of the ethical committee, this single-center prospective randomized and observational study was conducted over a period of two years among eighty-six patients with obstructed TAPVC repair with severe PAH. Group-I patients received milrinone, and Group-II patients received both milrinone (after aortic cross-clamp removal) and INO during the post-operative period at the cardiac care unit (CCU). Clinical outcomes such as ventilation time, length of stay (LOS) in the CCU, LOS in the hospital, complications, and hospital mortality were compared between the two groups. Result: The average ventilation time, LOS in CCU, and LOS in hospital for group I were 96.82 ± 19.46 hours, 10.91 ± 7.53 days, and 14.46 ± 7.58 days, respectively, and for group II, it was 85.14 ± 15.79 hours, 7.28 ± 3.68 days, and 10.21 ± 3.14 days, respectively, which was statistically significantly lower for group II. Reintubation, RV dysfunction, and hospital mortality were 16.3%, 37.2%, and 6.9% in group I, and 4.8%, 14.6%, and 2.4% in group II, respectively. The P value for each variable was significant < 0.05 (except mortality). Conclusion: Preoperative obstruction is a risk factor for postoperative obstruction, as 235 patients with obstructed TAPVC had severe PAH (39.98%) in this study. Management of severe PAH with a combination of milrinone and INO had a better outcome than milrinone alone.

Keywords: inhaled nitric oxide, milrinone, pulmonary artery hypertension, total anomalous pulmonary venous connection

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Authors: Mario C. Nierras

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This study aimed to determine the extension services’ needs of small farmers in Biliran province, Philippines. It also sought to find out other issues/concerns of the small farmers. Extension services’ needs of small farmers were gathered through personal interviewing and observational analysis of randomly-selected small farmers in Biliran, Philippines. Biliran small farmers extension services’ needs include: raising fruits, raising legumes, raising vegetables, raising swine, raising cattle, and raising chicken (as priority broad skills). For the specific skills, diagnosing symptoms on fertilizer deficiencies, controlling plant pests and diseases, diagnosing signs on specific pest and disease damage, controlling animal pests and diseases, and doing artificial insemination were the priority skills. They considered an on-farm trial of new technology as most needed to be coupled with industry and quality-orientedness, as positive behaviors needed in farming success. The farmers still adhere to the so-called wait-and-see attitude, thus they are more convinced to follow a particular technology if they see a concrete result of the introduced changes. Technical needs prioritization of Biliran small farmers showed that they have a real need for crop and animal production skills to include the other issues/concerns. Extension service program planning for small farmers should be patterned after their technical needs giving due attention to some issues/concerns so that extension work could deliver the right skills for the right needs of the farmers.

Keywords: extension, extension service, extension service needs, extension service program, farmers, small farmers, marginal farmers

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Authors: Rade M. Ciric, Nikola L. J. Rajakovic

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This paper presents a curriculum of the subject small power plants and renewable energy sources, dealing with the concept of distributed generation, renewable energy sources, hydropower, wind farms, geothermal power plants, cogeneration plants, biogas plants of agriculture and animal origin, solar power and fuel cells. The course is taught the manner of connecting small power plants to the grid, the impact of small generators on the distribution system, as well as economic, environmental and legal aspects of operation of distributed generators.

Keywords: distributed generation, renewable energy sources, energy policy, curriculum

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Authors: Sang-KeunBaik, Kyu-Soo Chong, Joon-Yeop Na

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This study attempts to reduce the wind load of road signs, improve roadside landscaping, and enhance the safety of road users by establishing criteria for the installation of small road signs. First, we derive the minimum font size that can be used on road signs according to the road’s design speed by considering the visibility and legibility of such road signs. We classify road junctions into eight types based on junction type (intersection, interchange, and expressway) and on the number of road lanes. Furthermore, we propose small sign alternatives, to which the minimum font size is applied, to be placed by each road junction. To verify the effects of the small signs, we implemented a 3D simulation road environment, to which the small road signs were applied, and performed experiments using the driving simulator targeting 50 drivers. The experiments compared and analyzed the effects, whether the driver proceeds to the desired exit and the average driving time, between the existing large road signs and the improved small road signs under the same road conditions and intersection type. We conducted a survey with the participants of the simulation experiment on the preference between graphical signs (large road signs) and exit-centric signs (small road signs). The results show that the participants prefer the exit-centric signs (60%) to the graphical signs (40%). We propose installation criteria for small road signs for intersections, interchanges, and expressways based on the results of the experiment and the survey.

Keywords: 3D simulation, driving simulator, legibility distance, minimum font size, small road signs

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Authors: R. Sadeghzadegan, S. A. Naeini, A. Mirzaii

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In this article, the results of a series of carefully conducted laboratory test program were represented to determine the small strain shear modulus of sand mixed with a range of kaolinite including zero to 30%. This was experimentally achieved using a triaxial cell equipped with bender element. Results indicate that small shear modulus tends to increase, while clay content decreases and effective confining pressure increases. The exponent of stress in the power model regression analysis was not sensitive to the amount of clay content for all sand clay mixtures, while coefficient A was directly affected by change in clay content.

Keywords: small shear modulus, bender element test, plastic fines, sand

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Authors: Karolina Siejka, Monika Piekarska, Monika Zbroja, Weronika Cyranka, Maryla Kuczynska, Magdalena Grzegorczyk, Malgorzata Nowakowska, Agnieszka Brodzisz, Magdalena Maria Wozniak

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Crohn’s disease is one of chronic inflammatory bowel diseases. It is increasing in prevalence worldwide, especially with young people. The disease usually occurs in the second to the fourth decade of life. Traditionally is diagnosed by clinical indicates, endoscopic, and histological findings. Magnetic Resonance Enterography (MRE) can demonstrate mural and extramural inflammatory signs and complications, which make it a valuable diagnostic modality. The study included 76 adults and 36 children diagnosed with Crohn’s disease. Each patient underwent MRE with intravenous administration of a contrast agent. All the studies were performed using Siemens Aera 1.5T scanner according to a local study protocol. Whenever applicable, MR Enterography findings were verified with endoscopy. Forty adults and all 36 children had an active phase of Crohn’s disease; five adults had a chronic phase of the disease; one adult had both chronic and active inflammatory features. Thirty adults have no sings of pathology. In both adult and pediatric groups the most commonly observed manifestation of active disease was thickened edematous ileum wall (26 adults and 36 children). Adults had Bauhin’s valve edema in 58% cases (n=23) and mesenteric changes in 34% cases (n=9). To compare, 32 children had Bauhin’s valve edema (89%) and, in 23 cases, was found inflammatory infiltration of the peri-intestinal fat (64%). The involvement of the large intestine was more common among children (100%). Complications of Crohn’s disease were found commonly in adults (40% of adults, 22% of children). There were observed 18 fistulas (14 adults, four children) and six abscesses (2 adults, four children). MRE is a reliable method in the evaluation of Crohn’s disease activity, especially of its complications. The lack of radiations makes MRE well-tolerated modality, which can be often repeated, particularly in young patients. The disease had different medical sings depending on age – children often had a more active inflammatory process, but there were more complications in the adult group.

Keywords: Crohn's disease, diagnostics, inflammatory bowel disease, magnetic resonance enterography, MRE

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Authors: Myunghoun Jang

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A survey of small-size contractors in Jeju was conducted to investigate college graduate's computer-aided design (CAD) competence. Most of small-size contractors use CAD software to review and update drawings submitted from an architect. This research analyzed the curriculum of the architectural engineering in several national universities. The CAD classes have 4 or 6 hours per week and use AutoCAD primarily. This paper proposes that a CAD class needs 6 hours per week, 2D drawing is the main theme in the curriculum, and exercises to make 3D models are also included in the CAD class. An improved method, for example Internet cafe and real time feedbacks using smartphones, to evaluate the reports and exercise results is necessary.

Keywords: CAD (Computer Aided Design), CAD education, education improvement, small-size contractor

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Authors: Pouya Karimi, Ramin Ghasemi Shayan

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Conclusions of the sort and setting of observational treatment for immunocompromised patients with fever are confused by the qualities of the hidden disease and the impacts of medications previously got, just as by changing microbiological examples and patterns in sedate obstruction at national and institutional levels. A few frameworks have been proposed to recognize patients who could profit by outpatient anti-infection treatment from patients who require hospitalization. Useful contemplations may choose whether the fundamental checking during the time of neutropenia can be accomplished.

Keywords: microbiology, infectious, neutropenia, epidemiology

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Authors: Sayyed Abdolmajid Jalaee Esfand Abadi, Sepideh Samimi

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Since one of the major difficulties to develop small manufacturing enterpriser in developing countries is the limitations of financing activities, this paper want to answer the question: “what is the role and status of micro finance in improving the labor productivity of small industries in Iran?” The results of panel data estimation show that micro finance in Iran has not yet been able to work efficiently and provide the required credit and investment. Also, reducing economy’s dependence on oil revenues reduced and increasing its reliance on domestic production and exports of industrial production can increase the productivity of workforce in Iranian small industries.

Keywords: microfinance, small manufacturing enterprises (SME), workforce productivity, Iran, panel data

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Authors: Medet K. Khamitov, Marat M. Ospanov, Vasiliy M. Lozovoy, Zhenis N. Sakuov, Dastan Z. Rustemov

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With a high rectosigmoid transitional zone in children with Hirschsprung’s disease, the upper rectal, sigmoid, left colon arteries are ligated during the pull-through of the descending part of the colon. As a result, the inferior mesenteric artery ceases to participate in the blood supply to the descending part of the colon. As a result, the reduced colon is supplied with blood only by the middle colon artery, which originates from the superior mesenteric artery. Insufficiency of blood supply to the reduced colon is the cause of the development of chronic hypoxia of the intestinal wall or necrosis of the reduced descending colon. Some surgeons prefer to preserve the left colon artery. However, it is possible to stretch the mesentery, which can lead to bowel retraction to anastomotic leaks and stenosis. Chronic hypoxia of the reduced colon, in turn, is the cause of acquired (secondary) aganglionosis. The highest frequency of anastomotic leaks is observed in children older than five years. The purpose is to reduce the risk of complications in the pull-through procedure of the descending part of the colon in patients with Hirschsprung’s disease by ensuring its sufficient mobility and maintaining blood supply to the lower mesenteric artery. Methodology and events. Two children aged 5 and 7 years with Hirschsprung’s disease were operated under the conditions of the hospital in Nur-Sultan. The diagnosis was made using x-ray contrast enema and histological examination. Operational technique. After revision of the left part of the colon and assessment of the architectonics of its blood vessels, parietal mobilization of the affected sigmoid and rectum was performed on laparotomy access, while maintaining the arterial and venous terminal arcades of the sigmoid vessels. Then, the descending branch of the left colon artery was crossed (if there is an insufficient length of the reduced intestine, the left colonic artery itself may also be crossed). This manipulation provides additional mobility of the pull-through descending part of the colon. The resulting "windows" in the mesentery of the reduced intestine were sutured to prevent the development of an internal hernia. Formed a full-blooded, sufficiently long transplant from the transverse loops of the splenic angle and the descending parts of the colon with blood supply from the upper and lower mesenteric artery, freely, without tension, is reduced to the rectal zone with the coloanal anastomosis 1.5 cm above the dentate line. Results. The postoperative period was uneventful. Patients were discharged on the 7th day. The observation was carried out for six months. In no case, there was a bowel retraction, anastomotic leak, anastomotic stenosis, or other complications. Conclusion. The presented technique of mobilization of the colon for the pull-through procedure in a high transitional rectosigmoid zone of Hirschsprung’s disease allows to maintain normal blood supply to the distal part of the colon and to avoid the tension of the colon. The technique allows reducing the risk of anastomotic leak, bowel necrosis, chronic ischemia, to exclude colon retraction and anastomotic stenosis.

Keywords: blood supply, children, colon mobilization, Hirschsprung's disease, pull-through

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Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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Authors: Dong-Hyun Ha, Young-Min Ko, Chang-Bin Ha, Hyoung-Kyu Song

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In Heterogeneous network (HetNet) can provide high quality of a service in a wireless communication system by composition of small cell networks. The composition of small cell networks improves cell coverage and capacity to the mobile users.Recently, various techniques using small cell networks have been researched in the wireless communication system. In this paper, the cooperative scheme obtaining high reliability is proposed in the small cell networks. The proposed scheme suggests a cooperative small cell system and the new signal transmission technique in the proposed system model. The new signal transmission technique applies a cyclic delay diversity (CDD) scheme based on the multiple input multiple output-orthogonal frequency division multiplexing (MIMO-OFDM) system to obtain improved performance. The improved performance of the proposed scheme is confirmed by the simulation results.

Keywords: adaptive transmission, cooperative communication, diversity gain, OFDM

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Authors: Jerzy Banski

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The basic aim of this study is to discuss and assess different classifications and research approaches to small towns that take their social and economic functions into account, as well as relations with surrounding areas. The subject literature typically includes three types of approaches to the classification of small towns: 1) the structural, 2) the location-related, and 3) the mixed. The structural approach allows for the grouping of towns from the point of view of the social, cultural and economic functions they discharge. The location-related approach draws on the idea of there being a continuum between the center and the periphery. A mixed classification making simultaneous use of the different approaches to research brings the most information to bear in regard to categories of the urban locality. Bearing in mind the approaches to classification, it is possible to propose a synthetic method for classifying small towns that takes account of economic structure, location and the relationship between the towns and their surroundings. In the case of economic structure, the small centers may be divided into two basic groups – those featuring a multi-branch structure and those that are specialized economically. A second element of the classification reflects the locations of urban centers. Two basic types can be identified – the small town within the range of impact of a large agglomeration, or else the town outside such areas, which is to say located peripherally. The third component of the classification arises out of small towns’ relations with their surroundings. In consequence, it is possible to indicate 8 types of small-town: from local centers enjoying good accessibility and a multi-branch economic structure to peripheral supra-local centers characterised by a specialized economic structure.

Keywords: small towns, classification, functional structure, localization

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Authors: Salman Piri

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In this study, a two-dimensional lattice Boltzmann method (LBM) was considered for the numerical simulation of fluid flow in a channel. Also, the Lagrangian method was used for particle tracking in one-way coupling. Three hundred spherical particles with specific diameters were released in the channel entry and an elliptical object was placed in the channel for flow obstruction. The effect of gravity, the drag force, the Saffman lift and the Brownian forces were evaluated in the particle motion trajectories. Also, the effect of the geometrical parameter, ellipse aspect ratio, and the flow characteristic or Reynolds number was surveyed for the transport and deposition of particles. Moreover, the influence of particle diameter between 0.01 and 10 µm was investigated. Results indicated that in small Reynolds, more inertial and gravitational trapping occurred on the obstacle surface for particles with larger diameters. Whereas, for nano-particles, influenced by Brownian diffusion and vortices behind the obstacle, the inertial and gravitational mechanisms were insignificant and diffusion was the dominant deposition mechanism. In addition, in Reynolds numbers larger than 400, there was no significant difference between the deposition of finer and larger particles. Also, in higher aspect ratios of the ellipse, more inertial trapping occurred for particles of larger diameter (10 micrometers), while in lower cases, interception and gravitational mechanisms were dominant.

Keywords: ellipse aspect elito, particle tracking diffusion, lattice boltzman method, larangain particle tracking

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Authors: E. Rak

Abstract:

The aim of the paper is to identify some of the specific characteristics of employee development, as observed in the practice of small enterprises in Poland. Results suggest that a sizeable percentage of employers are not interested in improving the development of their employee base. This aspect is often perceived as insignificant. In addition, many employers have no theoretical or practical knowledge of employee development methods. Lack of sufficient financial support is reported as third on the list of the most important barriers to employee development. Employees, on the other hand, typically offload the responsibility of initiating this type of activities onto the employer. Employee development plans are typically flexible and accommodating. The original value offered by this research comes in the form of a detailed characteristics of employee development in small enterprises, accompanied by identification of specificity of human resource development in Polish companies.

Keywords: employee development, human resources development, small enterprises, trainings

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Authors: H. D. Duong, J. I. Rhee

Abstract:

In this work, gold nanoparticles in star shape (called gold nanostars, GNS) were synthesized and coated by N-(3-aminopropyl) methacrylamide hydrochloride (PA) and mercaptopropionic acid (MPA) for functionalizing their surface by amine and carboxyl groups and then investigated for ROS production. The GNS with big size and multi-tips seem to be superior in singlet oxygen production as compared with that of small GNS and less tips. However, the functioned GNS in small size could also enhance efficiency of singlet oxygen production about double as compared with that of the intact GNS. In combination with methylene blue (MB+), the functioned GNS could enhance the singlet oxygen production of MB+ after 1h of LED750 irradiation and no difference between small size and big size in this reaction was observed. In combination with 5-aminolevulinic acid (ALA), only GNS coated PA could enhance the singlet oxygen production of ALA and the small size of GNS coated PA was a little higher effect than that of the bigger size. However, GNS coated MPA with small size had strong effect on hydroxyl radical production of ALA.

Keywords: 5-aminolevulinic acid, gold nanostars, methylene blue, ROS production

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Authors: E. O. Fakoya, B. G. Abiona, W. O. Oyediran, A. M. Omoare

Abstract:

This study examined the socio-economic effects of micro-credit on small scale poultry farmers’ livelihood in Ado Odo-Ota Local Government area of Ogun State. Purposive sampling method was used to select eighty (80) small scale poultry farmers that benefited in micro credit. Interview guide was used to obtain information on the respondents’ socio-economic characteristic, sources of micro-credit and the effects of micro-credit on their livelihood. The results revealed that most of the respondents (77.50 %) were males while half (40.00%) of the respondents were between the ages of 31-40 years. A high proportion (72.50%) of the respondents had formal education. The major sources of micro credit to small scale poultry farmers were cooperative society (47.50%) and personal savings (20.00%). The findings also revealed that micro-credit had positive effect on the assets and livelihoods of small scale poultry farmers’ livelihood. Results of t-test analysis showed a significant difference between the effects before and after micro-credit on small-scale poultry farmers’ Livelihood at p < 0.05. The study recommends that formal lending institution should be given necessary support by government to enable poultry farmers have access to credit facilities in the study area.

Keywords: micro-credit, effects, livelihood, poultry farmers, socio-economic, small scale

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Authors: Eno Jah Tabogo

Abstract:

The aim of this research is to identify and examine current deficiencies in entrepreneurial training in improving the performance of small businesses in sub Saharan Africa economies. This research achieves this by examining the course content, training methods, and profiles of trainers and trainees of small business service providers in Sub Saharan Africa (SSA) to identify training deficiencies in improving small businesses. Data was for the analysis was collected from a sample of four entrepreneurial training providers in SSA. These four providers served an average of 1,500 trainees. Questionnaire was used to collect data via face to face and through telephone. Face validity was determined by distributing the questionnaire among a group of colleagues, followed by a group discussion to strengthen the validity of the questionnaire. Interviews were also held with managers of training programs. Content and descriptive statistics was used to analyse the data collected. The results indicated only 25% of the training content were entrepreneurial. In terms of service provided, both business, entrepreneurial, technical and after-care services were identified. It was also discovered that owners of training firms had no formal entrepreneurship background. The paper contributes by advocating for a comprehensive entrepreneurship-training program for successful small business enterprises. Recommendations that could help sustain emerging small business enterprises and direction for further research are presented.

Keywords: entrepreneurship, emerging markets, small business, training

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Authors: Yun Zhang, Zhu Wang

Abstract:

Renewing ancient residential areas is an integral part of the sustainable development of modern cities. Compared with a metropolis, the old areas of small and medium-sized cities is more complicated to update, as the spatial form is more fragmented. In this context, the author takes as the research object, the ancient town of Changshu City, which is a small city representative in China with a history of more than 1,200 years. Through the analysis of urban research and update projects, the spatial evolution characteristics and renewal strategies of small ancient urban settlements are studied. On this basis, it is proposed to protect the residential area from the perspective of integrity and sustainability, strengthen the core public part, control the district building, and reshape the important interface. Renewing small and medium-sized urban areas should respect the rhythm of their own urban development and gradually complete the update, not blindly copying the experience of large cities.

Keywords: ancient residential area, Changshu, city renewal strategy, small and medium-sized cities

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Authors: Alexander Kelisek, Stanislava Strelcova

Abstract:

Developing of business in small and medium-sized enterprises (SMEs) is a specific especially for its flexibility and rapid adaptation to the conditions of turbulent market environment compared to large enterprises. Therefore, an importance of SMEs is growing rapidly in Slovakia but also in other EU countries. Small and medium enterprises are characterized by transparent organizational structure, as it allows the realization of direct management and information flow without significant negative aspects. In the national economy small and medium-sized enterprises represent a significant potential when performs a several important functions (e.g. social, economic, export-import, etc.) The significance of these enterprises is not only at national, but also at transnational level. Importance of SMEs is also aware of the EU, which declared this statement in a key document for SMEs called Small Business Act. In this document, SMEs are characterized, as the backbone of the EU economy and also as a key source of jobs opportunities. In addition to these aspects, SMEs attaches high innovation and development potential. The authors of the article are dealing with the current status of SMEs development in the Slovak Republic and highlight the current challenges that entrepreneurs face in their small and medium enterprises.

Keywords: small and medium enterprises (SMEs), business support, SMEs development, SMEs funding

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Authors: Tian Xia, Yuan Yan Tang

Abstract:

In order to obtain higher small target detection accuracy, this paper presents an effective algorithm inspired by the local contrast mechanism. The proposed method can enhance target signal and suppress background clutter simultaneously. In the first stage, a enhanced image is obtained using the proposed Weighted Laplacian of Gaussian. In the second stage, an adaptive threshold is adopted to segment the target. Experimental results on two changeling image sequences show that the proposed method can detect the bright and dark targets simultaneously, and is not sensitive to sea-sky line of the infrared image. So it is fit for IR small infrared target detection.

Keywords: small target detection, local contrast, human vision system, Laplacian of Gaussian

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Authors: Tugrul Oktay, Mehmet Konar, Mustafa Soylak, Firat Sal, Murat Onay, Orhan Kizilkaya

Abstract:

In this paper, autonomous performance of a small manufactured unmanned helicopter is tried to be increased. For this purpose, a small unmanned helicopter is manufactured in Erciyes University, Faculty of Aeronautics and Astronautics. It is called as ZANKA-Heli-I. For performance maximization, autopilot parameters are determined via minimizing a cost function consisting of flight performance parameters such as settling time, rise time, overshoot during trajectory tracking. For this purpose, a stochastic optimization method named as simultaneous perturbation stochastic approximation is benefited. Using this approach, considerable autonomous performance increase (around %23) is obtained.

Keywords: small helicopters, hierarchical control, stochastic optimization, autonomous performance maximization, autopilots

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Authors: Ewa Rak

Abstract:

This paper is part of a broader research project on employee development in small enterprises, financed by Polish National Science Centre. The project results will serve as basis for a doctoral dissertation. The paper utilises literature studies and qualitative research conducted in small enterprises operating in the Lower Silesia region of Poland. This paper aims to identify some of the factors that stimulate employee development in small companies operating in Poland. The great variety of business pursuits and applications represented by this sector makes it hard to determine a universal configuration of factors to offer best possible conditions for employee development. Research results suggest that each of the examined companies had one or two of such factors in focus, and serving as the basis for the entire pro-development system. These include: employment security (both for employee and entrepreneur) and extensive knowledge and experience of entrepreneurs, but only if it is combined with a willingness and ability to share it.

Keywords: employee development, factors that stimulate employee development, human resources development, Poland, small enterprises, training

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