Search results for: plastic surgery

Authors: P. Panwalkar, K. Veravalli, M. Tofighi, A. Mofidi

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Introduction: Anterior femoral perforation or distal anterior nail position is a known complication of femoral nailing specifically in pertrochantric fractures fixed with cephalomedullary nail. This has been attributed to wrong entry point for the femoral nail, nail with large radius of curvature or malreduced fracture. Left alone anterior perforation of femur or abutment of nail on anterior femur will result in pain and risk stress riser at distal femur and periprosthetic fracture. There have been multiple techniques described to avert or correct this problem ranging from using different nail, entry point change, poller screw to deflect the nail position, use of shorter nail or use of curved guidewire or change of nail to ensure a nail with large radius of curvature Methods: We present this technique which we have used in order to centralise the femoral nail either when the nail has been put anteriorly or when the guide wire has been inserted too anteriorly prior to the insertion of the nail. This technique requires the use of femoral reduction spool from the nailing set. This technique was used by eight trainees of different level of experience under supervision. Results: This technique was easily reproducible without any learning curve without a need for opening of fracture site or change in the entry point with three different femoral nailing sets in twenty-five cases. The process took less than 10 minutes even when revising a malpositioned femoral nail. Conclusion: Our technique of using femoral reduction spool is easily reproducible and repeatable technique for avoidance of non-centralised femoral nail insertion and distal anterior perforation of femoral nail.

Keywords: femoral fracture, nailing, malposition, surgery

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Authors: Blanca Fatela Cantillo, Silvia Iglesias Cerrato, Guadalupe Garrido Ceca

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Purpose: Bleb dysfunction is a late complication following glaucoma filtration surgery. We describe our surgical technique for excision and reconstruction of a hypertrophic bleb complication using bovine pericardium patch graft (Tutopatch®) and amniotic membrane. Material and methods: The case report presents a hypertrophic bleb over the cornea with good intraocular pressure control. The hanging bleb without leak caused dysesthesia and high irregular astigmatism. Bleb reconstruction involved the excision of corneal fibrous material and avascular conjunctiva, preserving the original scleral and tennon. Bovine pericardium patch graft (Tutopatch®) was sited over these with fixed sutures, reinforcing the underlying scleral, and the conjunctiva advanced. The superior epithelium corneal defect was covered using an amniotic membrane. Conclusion: Repair of bleb dysfunction with varied techniques has been reported, including conjunctival advancement, use of scleral patch graft, dural patch graft, or pericardium. Additional use of amniotic membrane promotes epithelialization and exhibits anti-fibrotic and anti-inflammatory features. Reconstruction with bovine pericardium patch graft and amniotic membrane resulted in pain relief, visual rehabilitation, and good aesthetic results, with preservation of bleb function.

Keywords: reconstruction, hypertrophic bleb, bovine pericardium, amniotic membrane, dysesthesia of the bleb

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Authors: Arvan Prakash Ankitha, Madasamy Arockiasamy

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The increasing demand for adopting pile foundations in bridgeshas pointed towardsthe need to constantly improve the existing analytical techniques for better understanding of the behavior of such foundation systems. This study presents a simplistic approach using the energy-based method to assess the displacement responses of piles subjected to general loading conditions: Axial Load, Lateral Load, and a Bending Moment. The governing differential equations and the boundary conditions for a bridge pile embedded in multi-layered soil strata subjected to the general loading conditions are obtained using the Hamilton’s principle employing variational principles and minimization of energies. The soil non-linearity has been incorporated through simple constitutive relationships that account for degradation of soil moduli with increasing strain values.A simple power law based on published literature is used where the soil is assumed to be nonlinear-elastic and perfectly plastic. A Tresca yield surface is assumed to develop the soil stiffness variation with different strain levels that defines the non-linearity of the soil strata. This numerical technique has been applied to a pile foundation in a two - layered soil strata for a pier supporting the bridge and solved using the software MATLAB R2019a. The analysis yields the bridge pile displacements at any depth along the length of the pile. The results of the analysis are in good agreement with the published field data and the three-dimensional finite element analysis results performed using the software ANSYS 2019R3. The methodology can be extended to study the response of the multi-strata soil supporting group piles underneath the bridge piers.

Keywords: pile foundations, deep foundations, multilayer soil strata, energy based method

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Authors: Wooseok Byon, Eunyoung Kim, Junseong Kwon, Byung Joo Song, Chan Heun Park

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Background/Purpose: Previous preclinical and clinical data suggest that increased lymphocytic infiltration would be associated with good prognosis and benefit from immunogenic chemotherapy especially in triple-negative breast cancer (TNBC). We investigated a single-center experience of TNBC and relationship with lymphocytic infiltration. Methods: From January 2004 to December 2012, at the Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, we retrospectively reviewed 897 breast cancer patients-clinical outcomes, clinicopathological characteristics, breast cancer subtypes. And we reviewed lymphocytic infiltration of TNBC specimens by two pathologists. Statistical analysis of risk factors associated with recurrence was performed. Results: A total of 897 patients, 76 were TNBC (8.47%). Mean age of TNBC patients were 50.95 (SD10.42) years, mean follow-up periods was 40.06 months. We reviewed 49 slides, and there were 8 recurrent breast cancer patients (16.32%), and 4 patients were expired (8.16%). There were 9 lymphocytic predominant breast cancers (LPBC)-carcinomas with either intratumoral lymphocytes in >60% of tumor cell nests. 1 patient of LPBC was recurred and 8 were not. In multivariate logistic regression, the odds ratio of lymphocytic infiltration was 0.59 (p=0.643). Conclusion: In a single-center experience of TNBC, the lymphocytic infiltration in tumor cell nest might be a good trend on the prognosis but there was not statistically significant.

Keywords: tumor-infiltrating lymphocytes, triple negative breast cancer, medical and health sciences

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Authors: Pitchaporn Purngpiputtrakul, Suttasinee Petsakul, Sunisa Chatmongkolchart

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Nasogastric tube (NGT) insertion in anaesthetized and intubated patients can be challenging even for experienced anesthesiologists. Various techniques have been proposed to facilitate NGT insertion in these patients. This study aimed to compare the success rate and time required for NGT insertion between the GlideScope visualization and neck flexion with lateral neck pressure techniques. This randomized clinical trial was performed at a teaching hospital on 86 adult patients undergoing abdominal surgery under relaxant general anaesthesia who required intraoperative NGT insertion. The patients were randomized into two groups, the GlideScope group (group G) and the neck flexion with lateral neck pressure group (group F). The success rate of first and second attempts, duration of insertion, and complications were recorded. The total success rate was 79.1% in Group G compared with 76.7% in Group F (P=1) The median time required for NGT insertion was significantly longer in Group G, for both first and second attempts (97 vs 42 seconds P<0.001) and (70 vs 48.5 seconds P=0.015), respectively. Complications were reported in 23 patients (53.5%) in group G and 13 patients (30.2%) in group F. Bleeding and kinking were the most common complications in both techniques. Using GlideScope visualization to facilitate NGT insertion was comparable to neck flexion with lateral neck pressure technique in degree of success rate of insertion, while neck flexion with lateral neck pressure technique had fewer complications and was less time-consuming.

Keywords: anaesthesia, nasogastric tube, GlideScope, intubation

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Authors: Waqas Ahmad, Eisha Tahir, Shahper Aqeel, Imran Khalid Niazi, Amjad Iqbal

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Background: Breast conservation surgery applies a number of techniques for accurate localization of lesions. Wire localization remains the method of choice in non-palpable breast cancers post-neoadjuvant chemotherapy. Objective: The aim of our study was to determine the accuracy of wire localization procedures in our department and compare it with internationally set protocols as per the Royal College of Radiologists. Post wire mammography, as well as the margin status of the postoperative specimen, assessed the accuracy of the procedure. Methods: We retrospectively reviewed the data of 225 patients who presented to our department from May 2014 to June 2015 post neoadjuvant chemotherapy with non-palpable cancers. These patients are candidates for wire localized lumpectomies either under ultrasound or stereotactic guidance. Metallic marker was placed in all the patients at the time of biopsy. Post wire mammogram was performed in all the patients and the distance of the wire tip from the marker was calculated. The presence or absence of the metallic clip in the postoperative specimen, as well as the marginal status of the postoperative specimen, was noted. Results: 157 sonographic and 68 stereotactic wire localization procedures were performed. 95% of the wire tips were within 1 cm of the metallic marker. Marginal status was negative in 94% of the patients in histopathological specimen. Conclusion: Our audit report declares more than 95% accuracy of image guided wire localization in successful excision of non-palpable breast lesions.

Keywords: breast, cancer, non-palpable, wire localization

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Authors: Shikha Gupta, Suneet Kathuria, Supriya Sampley, Sunil Katyal

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Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anesthesia. The aim of this prospective, randomized, double‑blind study is to compare the effects of adding sufentanil or fentanyl to low dose bupivacaine in spinal anesthesia for endoscopic urological procedures. A total of 90 elective endoscopic urological surgery patients, 40‑80 years old, received spinal anesthesia with 7.5 mg hyperbaric bupivacaine 0.5% (Group A) or by adding sufentanil 10 μg (Group B) or fentanyl 25 μg (Group C) to 5 mg hyperbaric bupivacaine 0.5%. These groups were compared in terms of the quality of spinal anesthesia as well as analgesia. Analysis of variance and Chi‑square test were used for Statistical analysis. The onset of sensory and motor blockade was significantly rapid in Group A as compared with Groups B and C. The maximum upper level of sensory block was higher in Group A patients than Groups B and C patients. Quality of analgesia was significantly better and prolonged in sufentanil group as compared with other two groups. Motor block was more intense and prolonged in Group A as compared with Groups B and C patients. Request for post‑operative analgesic was significantly delayed in Group B patients. Hence in conclusions, spinal anesthesia for endoscopic urological procedures in elderly patients using low dose bupivacaine (5 mg) combined with 10 μg sufentanil is associated with a lower incidence of hemodynamic instability, better quality and prolonged duration as compared to that by adding 25 μg fentanyl.

Keywords: adjuvants, bupivacaine, fentanyl, intrathecal, low dose spinal, sufentanil

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Authors: Rachel P. Vasconcellos

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The Russian constructivism is usually enshrined in history as another ''modernist ism'', that is, as an artistic phenomenon related to the early twentieth century‘s zeitgeist. What we aim in this essay is to analyze the constructivist movement not over the Art History field neither through the aesthetic debate, but through a geographical critical theory, taking the main idea of construction in the concrete sense of production of space. Seen from the perspective of the critique of space, the constructivist production is presented as a plan of totality, designed as socialist society‘s spatiality, contemplating and articulating all its scalar levels: the objects of everyday life, the building, the city and the territory. The constructivist avant-garde manifests a geographical ideology, launching the foundation‘s basis of modern planning ideology. Taken in its political sense, the artistic avant-garde of the Russian Revolution intended to anticipate the forms of a social future already put in progress: their plastic research pointed to new formal expressions to revolutionary contents. With the foundation of new institutions under a new State, it was given to the specialized labor of artists, architects, and planners the task of designing the socialist society, based on the thesis of scientific socialism. Their projects were developed under the politico-economics imperatives to the Soviet modernization – that is: the structural needs of industrialization and inclusion of all people in the productive work universe. This context shapes the creative atmosphere of the constructivist avant-garde, which uses the methods of engineering to the transform everyday life. Architecture, urban planning, and state planning integrated must then operate as spatial arrangement morphologically able to produce socialist life. But due to the intrinsic contradictions of the process, the rational and geometric aesthetic of the City-Machine appears, finally, as an image of a scientific socialist utopia.

Keywords: city-machine, critique of space, production of space, soviet territorialization

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Authors: Carolina Payares-Asprino

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Dual-phase duplex stainless steel comprised of ferrite and austenite has shown high strength and corrosion resistance in many aggressive environments. Joining duplex alloys is challenging due to several embrittling precipitates and metallurgical changes during the welding process. The welding parameters strongly influence the quality of a weld joint. Therefore, it is necessary to quantify the weld bead’s integral properties as a function of welding parameters, especially when part of the weld bead is removed through a machining process due to aesthetic reasons or to couple the elements in the in-service structure. The present study uses the existing stress-strain model to predict the stress-strain curves for duplex stainless-steel welds under different welding conditions. Having mathematical expressions that predict the shape of the stress-strain curve is advantageous since it reduces the experimental work in obtaining the tensile test. In analysis and design, such stress-strain modeling simplifies the time of operations by being integrated into calculation tools, such as the finite element program codes. The elastic zone and the plastic zone of the curve can be defined by specific parameters, generating expressions that simulate the curve with great precision. There are empirical equations that describe the stress-strain curves. However, they only refer to the stress-strain curve for the stainless steel, but not when the material is under the welding process. It is a significant contribution to the applications of duplex stainless steel welds. For this study, a 3x3 matrix with a low, medium, and high level for each of the welding parameters were applied, giving a total of 27 weld bead plates. Two tensile specimens were manufactured from each welded plate, resulting in 54 tensile specimens for testing. When evaluating the four models used to predict the stress-strain curve in the welded specimens, only one model (Rasmussen) presented a good correlation in predicting the strain stress curve.

Keywords: duplex stainless steels, modeling, stress-stress curve, tensile test, welding

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Authors: Orod Zarrin, Mohesn Ramezan Shirazi, Hassan Moniri

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The use of pile foundations technique is developed to support structures and buildings on soft soil. The most important dynamic load that can affect the pile structure is earthquake vibrations. From the 1960s the comprehensive investigation of pile foundations during earthquake excitation indicate that, piles are subject to damage by affecting the superstructure integrity and serviceability. The main part of these research has been focused on the behavior of liquefiable soil and lateral spreading load on piles. During an earthquake, two types of stresses can damage the pile head, inertial load that is caused by superstructure and deformation which caused by the surrounding soil. Soil deformation and inertial load are associated with the acceleration developed in an earthquake. The acceleration amplitude at the ground surface depends on the magnitude of earthquakes, soil properties and seismic source distance. According to the investigation, the damage is between the liquefiable and non-liquefiable layers and also soft and stiff layers. This damage crushes the pile head by increasing the inertial load which is applied by the superstructure. On the other hand, the cracks on the piles due to the surrounding soil are directly related to the soil profile and causes cracks from small to large. And researchers have been listed the large cracks reason such as liquefaction, lateral spreading and inertial load. In the field of designing, elastic response of piles are always a challenge for designer in liquefaction soil, by allowing deflection at top of piles. Moreover, absence of plastic hinges in piles should be insured, because the damage in the piles is not observed directly. In this study, the performance and behavior of pile foundations during liquefaction and lateral spreading are investigated. And emphasize on the soil behavior in the liquefiable and non-liquefiable layers by different aspect of piles damage such as ranking, location and degree of damage are going to discuss.

Keywords: self-compacting concrete, fiber, tensile strength, post-cracking, direct and inverse technique

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Authors: Abdoon A.S., El Ashkar E.A., Kandil O.M., Wael H. Eisa, Shaban A.M., Khaled H.M., El Ashkar M.R., El Shaer M., Hussein H., Shaalan A.H., El Sayed M.

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Cancer is a major obstacle to human health and development worldwide. Conventional strategies for cancer intervention include surgery, chemotherapy, and radiation therapy. Recently, plasmon photothermal therapy (PPTT) was introduced as a promising treatment for the management of cancer and several non-cancerous diseases that are generally characterized by overgrowth of abnormal cells. The present work was conducted to evaluate the cytotoxic efficacy and toxicity of gold nanorods (AuNRs) in dogs and cats suffering from spontaneous mammary gland. AuNRs was injected intratumoral (IT, n=10, dose of 75 p.p.m/kg body weight) or by using spray method after surgical removal of cancer tissue (n=2) in dogs and cats. Then exposed to laser light after 60 min. Treated animals were observed every 2 days and the morphological changes in tumor size and shape were recorded. Blood samples were collected before and after treatment for checking CBC, liver and kidney functions. Results revealed that AuNRs successfully treat mammary gland tumor in dogs and cats (adenocarcinoma type 1 to IV). AuNRs induced sloughing of carcinogenic tissue within 5 to 15 days. AuNRs have no toxic effect on blood profile and the toxicity studies still under evaluation. Conclusion, AuNRs can be used for treatment of mammary gland carcinoma in dogs and cats.

Keywords: pet animals, mammary gland tumor, AuNRs, photothermal therapy, toxicity studies

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Authors: Mohammad Taghi Karbalaei Aghamolki, Mohd Khanif Yusop, Fateh Chand Oad, Hamed Zakikhani, Hawa Zee Jaafar, Sharifh Kharidah, Mohamed Hanafi Musa, Shahram Soltani

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The high temperatures during sensitive growth phases are changing rice morphology as well as influencing yield. In the glass house study, the treatments were: growing conditions [normal growing (32oC+2) and heat stress (38oC+2) day time and 22oC+2 night time], growth stages (booting, flowering and ripening) and four cultivars (Hovaze, Hashemi, Fajr, as exotic and MR219 as indigenous). The heat chamber was prepared covered with plastic, and automatic heater was adjusted at 38oC+2 (day) and 22oC+2 (night) for two weeks in every growth stages. Rice morphological and yield under the influence of heat stress during various growth stages showed taller plants in Hashsemi due to its tall character. The total tillers per hill were significantly higher in Fajr receiving heat stress during booting stage. In all growing conditions and growth stages, Hashemi recorded higher panicle exertion and flag leaf length. The flag leaf width in all situations was found higher in Hovaze. The total tillers per hill were more in Fajr, although heat stress was imposed during booting and flowering stages. The indigenous MR219 in all situations of growing conditions, growth stages recorded higher grain yield. However, its grain yield slightly decreased when heat stress was imposed during booting and flowering. Similar results were found in all other exotic cultivars recording to lower grain yield in the heat stress condition during booting and flowering. However, plants had no effect on heat stress during ripening stage.

Keywords: rice, growth, heat, temperature, stress, morphology, yield

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Authors: Sarra Haouala, Issam Doghri

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In this work, a multiscale computational strategy is proposed for the analysis of structures, which are described at a refined level both in space and in time. The proposal is applied to two-phase viscoelastic-viscoplastic (VE-VP) reinforced thermoplastics subjected to large numbers of cycles. The main aim is to predict the effective long time response while reducing the computational cost considerably. The proposed computational framework is a combination of the mean-field space homogenization based on the generalized incrementally affine formulation for VE-VP composites, and the asymptotic time homogenization approach for coupled isotropic VE-VP homogeneous solids under large numbers of cycles. The time homogenization method is based on the definition of micro and macro-chronological time scales, and on asymptotic expansions of the unknown variables. First, the original anisotropic VE-VP initial-boundary value problem of the composite material is decomposed into coupled micro-chronological (fast time scale) and macro-chronological (slow time-scale) problems. The former is purely VE, and solved once for each macro time step, whereas the latter problem is nonlinear and solved iteratively using fully implicit time integration. Second, mean-field space homogenization is used for both micro and macro-chronological problems to determine the micro and macro-chronological effective behavior of the composite material. The response of the matrix material is VE-VP with J2 flow theory assuming small strains. The formulation exploits the return-mapping algorithm for the J2 model, with its two steps: viscoelastic predictor and plastic corrections. The proposal is implemented for an extended Mori-Tanaka scheme, and verified against finite element simulations of representative volume elements, for a number of polymer composite materials subjected to large numbers of cycles.

Keywords: asymptotic expansions, cyclic loadings, inclusion-reinforced thermoplastics, mean-field homogenization, time homogenization

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Authors: Stephanie Hernández-Carreón, Judith Virginia Ríos-Arana

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Microplastics (MPs) are plastic particles smaller than 5 mm that has been detected in soil, air, organisms, and mostly water around the world. Most studies have focused on MPs detection in marine waters, and less so in freshwater, such is the case of Mexico, where studies about MPs in freshwaters are limited. One of the most important rivers in the country is The Rio Grande/Río Bravo, a natural border between Mexico and the United States. Its waters serve different purposes, such as fishing, habitat to endemic species, electricity generation, agriculture, and drinking water sources, among others. Despite its importance, the river’s waters have not been analyzed to determine the presence of MPs; therefore, the purpose of this research is to determine if the Rio Bravo/Rio Grande is polluted with microplastics. For doing so, three sites (Borderland, Casa de Adobe, and Guadalupe) along the El Paso-Juárez metroplex have been sampled: 30 L of water were filtered through a plankton net (64 µm) in each site and sediments-composed samples were collected. Water samples and sediments were 1) digested with a hydrogen peroxide solution (30%), 2) resuspended in a calcium chloride solution (1.5 g/cm3) to separate MPs, and 3) filtered through a 0.45 µm nitrocellulose membrane. Processed water samples were dyed with Nile Red (1 mg/ml ethanol) and analyzed by fluorescence microscopy. Two water samples have been analyzed until January 2023: Casa de Adobe and Borderland finding a concentration of 5.67 particles/L and 5.93 particles/L, respectively. Three types of particles were observed: fibers, fragments, and films, fibers being the most abundant. These data, as well as the data obtained from the rest of the samples, will be analyzed by an ANOVA (α=0.05). The concentrations and types of particles found in the Río Bravo correspond with other studies on rivers associated with urban environments and agricultural activities in China, where a range of 3.67—10.7 particles/L was reported in the Wei River. Even though we are in the early stages of the study, and three new sites will be sampled and analyzed in 2023 to provide more data about this issue in the river, this presents the first evidence of microplastic pollution in the Rio Grande.

Keywords: microplastics, fresh water, Rio Bravo, fluorescence microscopy

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Authors: Afzaal Bashir, Sunaina Afzaal

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Background: Facial contour deformities associated with pigmentary changes are of major concern for plastic surgeons, both being important and difficult in treating such issues. No definite ideal treatment option is available to simultaneously address both the contour defect as well as related pigmentation. Objectives: The aim of the current study is to compare the long-term effects of conventional adipose tissue grafting and ex-vivo expanded Mesenchymal Stem Cells enriched adipose tissue grafting for the treatment of contour deformities with pigmentary changes on the face. Material and Methods: In this study, eighty (80) patients with contour deformities of the face with hyperpigmentation were recruited after informed consent. Two techniques i.e., conventional fat grafting (C-FG) and fat grafts enriched with expanded adipose stem cells (FG-ASCs), were used to address the pigmentation. Both techniques were explained to patients, and enrolled patients were divided into two groups i.e., C-FG and FG-ASCS, per patients’ choice and satisfaction. Patients of the FG-ASCs group were treated with fat grafts enriched with expanded adipose stem cells, while patients of the C-FGs group were treated with conventional fat grafting. Patients were followed for 12 months, and improvement in face pigmentation was assessed clinically as well as measured objectively. Patient satisfaction was also documented as highly satisfied, satisfied, and unsatisfied. Results: Mean age of patients was 24.42(±4.49), and 66 patients were females. The forehead was involved in 61.20% of cases, the cheek in 21.20% of cases, the chin in 11.20% of cases, and the nose in 6.20% of cases. In the GF-ASCs group, the integrated color density (ICD) was decreased (1.08×10⁶ ±4.64×10⁵) as compared to the C-FG group (2.80×10⁵±1.69×10⁵). Patients treated with fat grafts enriched with expanded adipose stem cells were significantly more satisfied as compared to patients treated with conventional fat grafting only. Conclusion: Mesenchymal stem cell-enriched autologous fat grafting is a preferred option for improving the contour deformities related to increased pigmentation of face skin.

Keywords: hyperpigmentation, color density, enriched adipose tissue graft, fat grafting, contour deformities, Image J

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Authors: Mirzashahi Babak, Mansouri Pejman, Najafi Arvin, Farzan Mahmoud

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Introduction: There are several surgical treatment choices for cervical spondylotic myelopathy (CSM). The aim of this study is to evaluate clinical outcomes and surgical complications in patients with cervical disk degeneration (CDD) undergoing either anterior cervical discectomy with or without fusion or cervical laminectomy and fusion. Methods: This prospective case series study included 45 consecutive patients with cervical spondylotic myelopathy between January 2010 and November 2014. There were 28 males and 17 females, with a mean age of 47 (range 37-68) years. The mean clinical follow-up was 14 months (range 3-24 months). The Neck Disability Index (NDI), visual analog scale (VAS) neck and arm pain, Short Form-36 (SF-36) were used as the functional outcome measurements. All of the complications in our patients were recorded. Results: In our study group, 26 patients underwent only one or two level anterior cervical discectomy. Ten patients underwent anterior cervical discectomy and fusion (ACDF) and nine cases underwent posterior laminectomy and fusion. We have found a statistically significant improvement between mean preoperative (29, range 19-43) and postoperative (7, range 0-12) NDI scores following surgery (P < 0.05). Also, there was a statistically significant difference between pre and post-operative VAS and SF-36 score (p < 0.05). There was a 7% overall complication rate (n = 3). The only complication in our patients was surgical site cellulitis which has been managed with oral antibiotic therapy. Conclusion: Both anterior cervical discectomy with or without fusion or posterior laminectomy and fusion are safe and efficacious treatment options for the management of CSM. The clinical outcomes seem to be fairly reproducible.

Keywords: cervical, myelopathy, discectomy, fusion, laminectomy

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Authors: Roike Iwan Montolalu, Henny Adeleida Dien, Feny Mentang, Kristhina P. Rahael, Tomy Moga, Ayub Meko, Siegfried Berhimpon

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In the last 20 years, packaging materials derived from petrochemicals polymers were widely used as packaging materials. This due to various advantages such as flexible, strong, transparent, and the price is relatively cheap. However, the plastic polymer also has various disadvantages, such as the transmission monomer contamination into the material to be packed, and waste is non-biodegradable. Edible film (EF) is an up to date materials, generated after the biodegradable packaging materials. The advantages of the EF materials, is the materials can be eat together with food, and the materials can be applied as a coating materials for a widely kind of foods especially snack foods. The aims of this research are to produce and to analyze the characteristics of smoked EF made from carrageenan, myofibril and collagen of Black Marlin (Makaira indica) industrial waste. Smoked EF made with an addition of 0.8 % smoke liquid. Three biopolymers i.e. carrageenan, myofibril, and collagen were used as treatments, and homogenate for 1 hours at speed of 1500 rpm. The analysis carried out on the pH and physical properties i.e. thickness, solubility, tensile strength, % elongation, and water vapor transmission rate (WVTR), as well as on the sensory characteristics of texture i.e. wateriness, firmness, elasticity, hardness, and juiciness of the coated products. The result shown that the higher the concentration the higher the thickness of EF, where as for myofibril proteins appeared higher than carrageenan and collagen. Both of collagen and myofibril shown that concentration of 6% was most soluble, while for carrageenan were in concentration of 2 to 2.5%. For tensile strength, carrageenan was significantly higher than myofibril and collagen; while for elongation, collagen film more elastic than carragenan and myofibril protein. Water vapor transmission rate, shown that myofibril protein film lower than carrageenan and collagen film. From sensory assessment of texture, carrageenan has a high elasticity and juiciness, while collagen and myofibril have a high in firmness and hardness.

Keywords: edible film, collagen, myofibril, carrageenan

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Authors: Abraham J. Rizkalla, Joanne F. Irons, Christopher Q. Cao

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Purpose: Lobectomy was considered the standard of care for early-stage non-small lung cancer (NSCLC) after the Lung Cancer Study Group trial demonstrated increased locoregional recurrence for sublobar resections. However, there has been heightened interest in segmentectomies for selected patients with peripheral lesions ≤2cm, as investigated by the JCOG0802 and CALGB140503 trials. Minimally invasive robotic surgery facilitates segmentectomies with improved maneuverability and visualization of intersegmental planes using indocyanine green. We hereby present a patient who underwent robotic lingulectomy for an undiagnosed ground-glass opacity. Methodology: This video demonstrates a robotic portal lingulectomy using three 8mm ports and a 12mm port. Stereoscopic direct vision facilitated the identification of the lingula artery and vein, and intra-operative bronchoscopy was performed to confirm the lingula bronchus. The intersegmental plane was identified by indocyanine green and a near-infrared camera. Thorough lymph node sampling was performed in accordance with international standards. Results: The 18mm lesion was successfully excised with clear margins to achieve R0 resection with no evidence of malignancy in the 8 lymph nodes sampled. Histopathological examination revealed lepidic predominant adenocarcinoma, pathological stage IA. Conclusion: This video presentation exemplifies the standard approach for robotic portal lingulectomy in appropriately selected patients.

Keywords: lung cancer, robotic segmentectomy, indocyanine green, lingulectomy

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Authors: Azri Yamina Mounia, Zitouni Dalila, Aziza Majda, Tou Insaf, Sadi Meriem

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To confront the fossil fuel crisis and the consequences of global warning, many efforts were devoted to develop alternative electricity generation and attracted numerous researchers, especially in the microbial fuel cell field, because it allows generating electric energy and degrading multiple organics compounds at the same time. However, one of the main constraints on power generation is the slow rate of oxygen reduction at the cathode electrode. This paper describes the potential of algal biomass (Chlorella vulgaris) as photosynthetic cathodes, eliminating the need for a mechanical air supply and the use of often expensive noble metal cathode catalysts, thus improving the sustainability and cost-effectiveness of the MFC system. During polarizations, MFC power density using algal biomass was 0.4mW/m², whereas the MFC with mechanic aeration showed a value of 0.2mW/m². Chlorella vulgaris was chosen due to its fastest growing. C. vulgaris grown in BG11 medium in sterilized Erlenmeyer flask. C. vulgaris was used as a bio‐cathode. Anaerobic activated sludge from the plant of Beni‐Messous WWTP(Algiers) was used in an anodic compartment. A dual‐chamber reactor MFC was used as a reactor. The reactor has been fabricated in the laboratory using plastic jars. The cylindrical and rectangular jars were used as the anode and cathode chambers, respectively. The volume of anode and cathode chambers was 0.8 and 2L, respectively. The two chambers were connected with a proton exchange membrane (PEM). The plain graphite plates (5 x 2cm) were used as electrodes for both anode and cathode. The cyclic voltammetry analysis of oxygen reduction revealed that the cathode potential was proportional to the amount of oxygen available in the cathode surface electrode. In the case of algal aeration, the peak reduction value of -2.18A/m² was two times higher than in mechanical aeration -1.85A/m². The electricity production reached 70 mA/m² and was stimulated immediately by the oxygen produced by algae up to the value of 20 mg/L.

Keywords: Chlorella vulgaris, cyclic voltammetry, microbial fuel cell, oxygen reduction

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Authors: Saeed Wahass

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Objective: Obesity is epidemic, affecting all societies and cultures. Most serious medical illnesses are attributed to obesity. For this reason, all healthcare systems worldwide have focused on obesity for both intervention and prevention. However, there is scientific evidence supporting that obesity is treatable through implementing different modalities of interventions. They include biological interventions like medications and bariatric surgeries and behavioral interventions. It seems healthcare professionals may suggest the quick and the easiest interventions for obesity like surgery, ignoring other modesties that might require efforts from their sides and patients as well. Searching on the onset, progression and prevention, behavior plays a major role. As a result, psychological interventions have become increasingly core for intervention and prevention of obesity. They are effective and cost effective in dealing with obesity. Methods: A questionnaire describing the role of behavior on obesity and the way it can be prevented and treated was distributed to a group of health professionals who are dealing with obesity e.g. bariatric surgeons, bariatric physicians, psychologists, health educators, nurses and social workers. Results: 88% of healthcare professionals believed that behavior plays a major role on the onset and progression of obesity, 95% of them recognized that obesity can be prevented with consideration for behavior factors. A major proportion (87%) of the respondents see that psychological interventions are effective and cost effective in treating obesity. Conclusions: It optimistically appears that the majority of healthcare professionals believe that behavior is a key component in understanding, preventing and treating obesity. This outcome may help in developing specific training courses for healthcare professionals, who are dealing with obesity concerning the way they can treat patients behaviorally and, moreover, educating the community.

Keywords: behavior, obesity, healthcare provider, psychological interventions

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Authors: Ana Ferreira, Ines Costa, Patricia Polónia, Josué Pereira, Olinda Faria, Pedro Alberto Silva

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Introduction: Optical coherence tomography (OCT) and visual field tools are pivotal in evaluating neurological deficits and predicting potential visual improvement following surgical decompression in neurosurgical patients. Despite their clinical significance, a comprehensive understanding of their utility in this context is lacking in the literature. This study aims to elucidate the applications of OCT and visual field assessment, delineating distinct patterns of visual deficit presentations within the studied cohort. Methods: This retrospective analysis considered all adult patients who underwent a single surgery for pituitary adenoma or anterior skull base meningioma with optic nerve involvement, coupled with neuro-ophthalmology evaluation, between July 2020 and January 2023. A minimum follow-up period of 6 months was deemed essential. Results: A total of 24 patients, with a median age of 61, were included in the analysis. Three primary patterns emerged: 1) Low visual field involvement with compromised OCT, 2) High visual field involvement with relatively unaffected OCT, and 3) Significant compromise observed in both OCT and visual fields. Conclusion: This study delineates various findings in OCT and visual field assessments with illustrative examples. Based on the current findings, a prospective cohort will be systematically collected to further investigate and validate these patterns and their prognostic significance, enhancing our understanding of the utility of OCT and visual fields in neurosurgical patients.

Keywords: OCT, neurosurgery, visual field, optic nerve

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Authors: Sina Keyhanian, Abbas Ahmadi, Behrooz Karimi

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We present a multi-objective binary programming model which considers surgical cases are scheduling among operating rooms and the configuration of surgical instruments in limited capacity hospital trays, simultaneously. Many mathematical models have been developed previously in the literature addressing different challenges in health-care logistics such as assigning operating rooms, leveling beds, etc. But what happens inside the operating rooms along with the inventory management of required instruments for various operations, and also their integration with surgical scheduling have been poorly discussed. Our model considers the minimization of movements between trays during a surgery which recalls the famous cell formation problem in group technology. This assumption can also provide a major potential contribution to robotic surgeries. The tray configuration problem which consumes surgical instruments requirement plan (SIRP) and sequence of surgical procedures based on required instruments (SIRO) is nested inside the bin packing problem. This modeling approach helps us understand that most of the same-output solutions will not be necessarily identical when it comes to the rearrangement of surgeries among rooms. A numerical example has been dealt with via a proposed nested simulated annealing (SA) optimization approach which provides insights about how various configurations inside a solution can alter the optimal condition.

Keywords: health-care logistics, hospital tray configuration, off-line bin packing, simulated annealing optimization, surgical case scheduling

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Authors: Mohammad Abdullah Almalki

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Background: Despite the frequent usage of ankle arthroscopy, there is limited medical literature regarding its indications, patterns of admissions, surgical outcomes, and associated complicated at Saudi Arabia. Hence, this study would highlight the surgical outcomes of such surgical approach that will assist orthopedic surgeons to detect which surgical procedure needs to be done as well as to help them regarding their diagnostic workups. Methods: At the Orthopedic Division of King Abdul‑Aziz Medical City in Riyadh and through a cross‑sectional design and convenient sampling techniques, the present study had recruited 20 subjects who fulfill the inclusion and exclusion criteria between 2016 and 2018. Data collection was carried out by a questionnaire designed and revised by an expert panel of health professionals. Results: Twenty patients were reviewed (11M and 9F) with an average age of 40.1 ± 12.2. Only 30% of the patients (5M, 1F) have no comorbidity, but 70% of patients (7M, 8F) were having at least one comorbidity. The most common indications were osteochondritis dissecans (n = 7, 35%), ankle fracture without dislocation (n = 4, 20%), and tibiotalar impingement (n = 3, 15%). Patients recorded pain in all cases (100%). The top four symptoms after pain were instability (30%, n = 6), muscle weakness (15%, n = 3) swelling (15%, n = 3), and stiffness (5%, n = 1). Two‑third of cases reached to their full healthy status and toe‑touch weight‑bearing was seen in two patients (10%). Conclusion: Ankle arthroscopy improved the rehabilitation rates in our tertiary care center. In addition, the surgical outcomes are favorable in our hospital since it has a very short length of stay, unexpended surgery, and fewest physiotherapy sessions.

Keywords: ankle, arthroscopy, indications, patterns

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Authors: Caroline Correia, Stefani Perna, John Gaughan, Elizabeth Cerceo

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Introduction: The COVID-19 pandemic has brought unprecedented changes to how hospitals function on a daily basis. Increased personal protective equipment (PPE) usage and measures to pre-package, separate, and decontaminate have the potential to increase the waste load. However, limiting non-essential surgeries drastically reduces operating room (OR) waste, and restricting visitation policies to contain outbreaks may help conserve resources. The impact of these policy changes with increased disposable PPE usage on hospital production of waste is unknown. Methods: Waste produced in pounds (lbs) was measured for January through June during both 2019 and 2020 through Stericycle in Cooper University Hospital in Camden, NJ. This timeframe was selected since the pandemic began in January 2020 in the US. The total waste produced during this time was 328,623 lbs in 2019 and 306,454 lbs in 2020. Using Poisson counts (α=.05), less waste was produced in 2020 (p < 0.001). The amount of sharps and regulated medical waste (grossly bloody items) were both significantly decreased as well (p < 0.0001, p=0.0002), and these account for 10-15% of the total waste produced. Discussion: Despite the increased usage of disposable PPE, overall hospital waste was decreased during the pandemic as compared to prior. As surgeries are estimated to be responsible for up to one-half of waste produced by hospitals, it is possible that constraint on elective procedures contributed to the decreased waste in all three categories; estimates of a 35% decrease in surgical volume would be expected to impact waste production. The effects of the pandemic on waste production should continue to be monitored to understand the environmental impact as health systems resume backlogged surgeries at a higher volume.

Keywords: COVID-19, hospital, surgery, waste

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Authors: M. Ntšolo, D. Kalumba, N. Lefu, G. Letlatsa

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Rock mass damage due to shear tectonic activity has been investigated largely in geoscience where fluid transport is of major interest. However, little has been studied on the effect of shear zones on rock mass behavior and its impact on stability of rock slopes. At Letšeng Diamonds open pit mine in Lesotho, the shear zone composed of sheared kimberlite material, calcite and altered basalt is forming part of the haul ramp into the main pit cut 3. The alarming rate at which the shear zone is deteriorating has triggered concerns about both local and global stability of pit the walls. This study presents the numerical modelling of the open pit slope affected by shear zone at Letšeng Diamond Mine (LDM). Analysis of the slope involved development of the slope model by using a two-dimensional finite element code RS2. Interfaces between shear zone and host rock were represented by special joint elements incorporated in the finite element code. The analysis of structural geological mapping data provided a good platform to understand the joint network. Major joints including shear zone were incorporated into the model for simulation. This approach proved successful by demonstrating that continuum modelling can be used to evaluate evolution of stresses, strain, plastic yielding and failure mechanisms that are consistent with field observations. Structural control due to geological shear zone structure proved to be important in its location, size and orientation. Furthermore, the model analyzed slope deformation and sliding possibility along shear zone interfaces. This type of approach can predict shear zone deformation and failure mechanism, hence mitigation strategies can be deployed for safety of human lives and property within mine pits.

Keywords: numerical modeling, open pit mine, shear zone, slope stability

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Authors: Amessalu Atenafu Gelaw, Nele Rath

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Currently, laser hardening process is becoming among the most efficient and effective hardening technique due to its significant advantages. The source where heat is generated, the absence of cooling media, self-quenching property, less distortion nature due to localized heat input, environmental friendly behavior and less time to finish the operation are among the main benefits to adopt this technology. This day, a variety of injection machines are used in plastic, textile, electrical and mechanical industries. Due to the fast growing of composite technology, fiber reinforced polymer matrix becoming optional solution to use in these industries. Due, to the abrasion nature of fiber reinforced polymer matrix composite on the injection components, many parts are outdated before the design period. Niko, a company specialized in injection molded products, suffers from the short lifetime of the injection nozzles of the molds, due to the use of fiber reinforced and, therefore, more abrasive polymer matrix. To prolong the lifetime of these molds, hardening the susceptible component like the injecting nozzles was a must. In this paper, the laser hardening process is investigated on Unimax, a type of stainless steel. The investigation to get optimal results for the nozzle-case was performed in three steps. First, the optimal parameters for maximum possible hardenability for the investigated nozzle material is investigated on a flat sample, using experimental testing as well as thermal simulation. Next, the effect of an inclination on the maximum temperature is analyzed both by experimental testing and validation through simulation. Finally, the data combined and applied for the nozzle. This paper describes possible strategies and methods for laser hardening of the nozzle to reach hardness of at least 720 HV for the material investigated. It has been proven, that the nozzle can be laser hardened to over 900 HV with the option of even higher results when more precise positioning of the laser can be assured.

Keywords: absorptivity, fiber reinforced matrix, laser hardening, Nd:YAG laser

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Authors: Hannah Riva, Sarah Mazal, Jessica L. Marquez, Michael Rains

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A 70-year-old female with a Fitzpatrick skin phenotype II presented with a 13-year history of a scaly rash located on the left breast and bilateral pretibial regions. The patient’s past medical history was otherwise unremarkable, with the exception of surgery involving the left breast. Physical examination revealed infiltrative hyperpigmented scaly plaques and nodules located on the left breast and pretibial regions bilaterally. A negative systemic workup excluded organ involvement. A clinical diagnosis of cutaneous sarcoidosis was made. Prior treatments included triamcinolone 0.1% topical cream and clobetasol 0.05% ointment, which failed to show improvement. Full-body narrow-band UVB (NBUVB) treatment was performed on a tri-weekly basis for eight months. NBUVB dosage was slowly titrated from 300 mJ/cm2 to a final dose of 1800 mJ/cm2 to prevent discomfort and burning sensations. Throughout the duration of her treatment, the patient adhered to a regimen of clobetasol 0.05% topical ointment applied twice daily in two-week intervals. Improvement was noticed after two months, with continued improvement up to eight months. The patient is continuing NBUVB phototherapy treatments for maintenance. In our case, NBUVB phototherapy treatment demonstrated promising results with improvement after two months of treatment. Physicians should consider NBUVB phototherapy as an effective option for patients presenting with cutaneous sarcoidosis.

Keywords: dermatology, sarcoidosis, phototherapy, ultraviolet

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Authors: Olga Blagova, Yuliya Osipova, Evgeniya Kogan, Alexander Nedostup

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Purpose: to quantify the value of various clinical, laboratory and instrumental signs in the diagnosis of myocarditis in comparison with morphological studies of the myocardium. Methods: in 100 patients (65 men, 44.7±12.5 years) with «idiopathic» arrhythmias (n = 20) and dilated cardiomyopathy (DCM, n = 80) were performed 71 endomyocardial biopsy (EMB), 13 intraoperative biopsy, 5 study of explanted hearts, 11 autopsy with virus investigation (real-time PCR) of the blood and myocardium. Anti-heart antibodies (AHA) were also measured as well as cardiac CT (n = 45), MRI (n = 25), coronary angiography (n = 47). The comparison group included of 50 patients (25 men, 53.7±11.7 years) with non-inflammatory heart diseases who underwent open heart surgery. Results. Active/borderline myocarditis was diagnosed in 76.0% of the study group and in 21.6% of patients of the comparison group (p < 0.001). The myocardial viral genome was observed more frequently in patients of comparison group than in study group (group (65.0% and 40.2%; p < 0.01. Evaluated the diagnostic value of noninvasive markers of myocarditis. The panel of anti-heart antibodies had the greatest importance to identify myocarditis: sensitivity was 81.5%, positive and negative predictive value was 75.0 and 60.5%. It is defined diagnostic value of non-invasive markers of myocarditis and diagnostic algorithm providing an individual assessment of the likelihood of myocarditis is developed. Conclusion. The greatest significance in the diagnosis of latent myocarditis in patients with 'idiopathic' arrhythmias and DCM have AHA. The use of complex of noninvasive criteria allows estimate the probability of myocarditis and determine the indications for EMB.

Keywords: myocarditis, "idiopathic" arrhythmias, dilated cardiomyopathy, endomyocardial biopsy, viral genome, anti-heart antibodies

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Authors: Ihab Saad Ahmed

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Background For Siewert type I and II gastroesophageal junction tumor (GEJ) laparoscopic proximal gastrectomy can be performed. It is associated with several perioperative benefits compared with open proximal gastrectomy. The use of laparoscopic proximal gastrectomy (LPG) has become an increasingly popular approach for select tumors Methods We describe our technique for LPG, including the preoperative work-up, illustrated images of the main principle steps of the surgery, and our postoperative course. Results Thirteen pts (nine males, four female) with type I, II (GEJ) adenocarcinoma had laparoscopic radical proximal gastrectomy and D2 lymphadenectomy. All of our patient received neoadjuvant chemotherapy, eleven patients had intrathoracic anastomosis through mini thoracotomy (two hand sewn end to end anastomoses and the other 9 patient end to side using circular stapler), two patients with intrathoracic anastomosis had flap and wrap technique, two patients had thoracoscopic esophageal and mediastinal lymph node dissection with cervical anastomosis The mean blood loss 80ml, no cases were converted to open. The mean operative time 250 minute Average LN retrieved 19-25, No sever complication such as leakage, stenosis, pancreatic fistula ,or intra-abdominal abscess were reported. Only One patient presented with empyema 1.5 month after discharge that was managed conservatively. Conclusion For carefully selected patients, LPG in GEJ tumour type I and II is a safe and reasonable alternative for open technique , which is associated with similar oncologic outcomes and low morbidity. It showed less blood loss, respiratory infections, with similar 1- and 3-year survival rates.

Keywords: LPG(laparoscopic proximal gastrectomy, GEJ( gastroesophageal junction tumour), d2 lymphadenectomy, neoadjuvant cth

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Authors: Saba Atefyekta

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Aim: Control of bacterial bioburden in wounds is an important step for minimizing the risk of wound infection. An antimicrobial hydrogel wound dressing is developed out of soft polymeric hydrogels that contain antimicrobial peptides (AMPs). Such wound dressings can bind and kill all types of bacteria, even the resistance types at the wound site. Methods: AMPs are permanently bonded onto a soft nanostructured polymer via covalent attachment and physical entanglement. This improves stability, rapid antibacterial activity, and, most importantly, prevents the leaching of AMPs. Major Findings: Antimicrobial analysis of antimicrobial hydrogels using in-vitro wound models confirmed >99% killing efficiency against multiple bacterial trains, including MRSA, MDR, E. Coli. Furthermore, the hydrogel retained its antibacterial activity for up to 4 days when exposed to human serum. Tests confirmed no release of AMPs, and it was proven non-toxic to mammalian cells. An in-vivo study on human intact skin showed a significant reduction of bacteria for part of the subject’s skin treated with antibacterial hydrogels. A similar result was detected through a qualitative study in veterinary trials on different types of surgery wounds in cats, dogs, and horses. Conclusions: Antimicrobial hydrogels wound dressings developed by permanent attachment of AMPs can effectively and rapidly kill bacteria in contact. Such antibacterial hydrogel wound dressings are non-toxic and do not release any substances into the wound.

Keywords: antibacterial wound dressing, antimicrobial peptides, post-surgical wounds, infection

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