Search results for: bone repair
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 1273

Search results for: bone repair

1093 Self-Inflating Soft Tissue Expander Outcome for Alveolar Ridge Augmentation a Randomized Controlled Clinical and Histological Study

Authors: Alaa T. Ali, Nevine H. Kheir El Din, Ehab S. Abdelhamid, Ahmed E. Amr

Abstract:

Objective: Severe alveolar bone resorption is usually associated with a deficient amount of soft tissues. soft tissue expansion is introduced to provide an adequate amount of soft tissue over the grafted area. This study aimed to assess the efficacy of sub-periosteal self-inflating osmotic tissue expanders used as preparatory surgery before horizontal alveolar ridge augmentation using autogenous onlay block bone graft. Methods: A prospective randomized controlled clinical trial was performed. Sixteen partially edentulous patients demanding horizontal bone augmentation in the anterior maxilla were randomly assigned to horizontal ridge augmentation with autogenous bone block grafts harvested from the mandibular symphysis. For the test group, soft tissue expanders were placed sub-periosteally before horizontal ridge augmentation. Impressions were taken before and after STE, and the cast models were optically scanned and superimposed to be used for volumetric analysis. Horizontal ridge augmentation was carried out after STE completion. For the control group, a periosteal releasing incision was performed during bone augmentation procedures. Implants were placed in both groups at re-entry surgery after six months period. A core biopsy was taken. Histomorphometric assessment for newly formed bone surface area, mature collagen area fraction, the osteoblasts count, and blood vessel count were performed. The change in alveolar ridge width was evaluated through bone caliper and CBCT. Results: Soft tissue expander successfully provides a Surplus amount of soft tissues in 5 out of 8 patients in the test group. Complications during the expansion period were perforation through oral mucosa occurred in two patients. Infection occurred in one patient. The mean soft tissue volume gain was 393.9 ± 322mm. After 6 months. The mean horizontal bone gains for the test and control groups were 3.14 mm and 3.69 mm, respectively. Conclusion: STE with a sub-periosteal approach is an applicable method to achieve an additional soft tissue and to reduce bone block graft exposure and wound dehiscence.

Keywords: soft tissue expander, ridge augmentation, block graft, symphysis bone block

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1092 Age Estimation and Sex Determination by CT-Scan Analysis of the Hyoid Bone: Application on a Tunisian Population

Authors: N. Haj Salem, M. Belhadj, S. Ben Jomâa, R. Dhouieb, S. Saadi, M. A. Mesrati, A. Chadly

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Introduction: The hyoid bone is considered as one of many bones used to identify a missed person. There is a specificity of each population group in human identifications. Objective: To analyze the relationship between age, sex and metric parameters of hyoid bone in Tunisian population sample, using CT-scan. Materials and Methods: A prospective study was conducted in the Department of Forensic Medicine of FattoumaBourguiba Hospital of Monastir-Tunisia during 4 years. A total of 240 samples of hyoid bone were studied. The age of cases ranged from 18 days to 81 years. The specimens were collected only from the deceased of known age. Once dried, each hyoid bone was scanned using CT scan. For each specimen, 10 measurements were taken using a computer program. The measurements consisted of 6 lengths and 4 widths. A regression analysis was used to estimate the relationship between age, sex, and different measurements. For age estimation, a multiple logistic regression was carried out for samples ≤ 35 years. For sex determination, ROC curve was performed. Discriminant value finally retained was based on the best specificity with the best sensitivity. Results: The correlation between real age and estimated age was good (r²=0.72) for samples aged 35 years or less. The unstandardised canonical function equation was estimated using three variables: maximum length of the right greater cornua, length from the middle of the left joint space to the middle of the right joint space and perpendicular length from the centre point of a line between the distal ends of the right and left greater cornua to the centre point of the anterior view of the body of the hyoid bone. For sex determination, the ROC curve analysis reveals that the area under curve was at 81.8%. Discriminant value was 0.451 with a specificity of 73% and sensibility of 79%. The equation function was estimated based on two variables: maximum length of the greater cornua and maximum length of the hyoid bone. Conclusion: The findings of the current study suggest that metric analysis of the hyoid bone may predict the age ≤ 35 years. Sex estimation seems to be more reliable. Further studies dealing with the fusion of the hyoid bone and the current study could help to achieve more accurate age estimation rates.

Keywords: anthropology, age estimation, CT scan, sex determination, Tunisia

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1091 Barrier Membrane Influence Histology of Guided Bone Regenerations: A Systematic Review and Meta-Analysis

Authors: Laura Canagueral-Pellice, Antonio Munar-Frau, Adaia Valls-Ontanon, Joao Carames, Federico Hernandez-Alfaro, Jordi Caballe-Serrano

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Objective: Guided bone regeneration (GBR) aims to replace the missing bone with a new structure to achieve long-term stability of rehabilitations. The aim of the present systematic review and meta-analysis is to determine the effect of barrier membranes on histological outcomes after GBR procedures. Moreover, the effect of the grafting material and tissue gain were analyzed. Materials & methods: Two independent reviewers performed an electronic search in Pubmed and Scopus, identifying all eligible publications up to March 2020. Only randomized controlled trials (RCTs) assessing a histological analysis of augmented areas were included. Results: A total of 6 publications were included for the present systematic review. A total of 110 biopsied sites were analysed; 10 corresponded to vertical bone augmentation procedures, whereas 100 analysed horizontal regeneration procedures. A mean tissue gain of 3 ± 1.48mm was obtained for horizontal defects. Histological assessment of new bone formation, residual particle and sub-epithelial connective tissue (SCT) was reported. The four main barrier membranes used were natural collagen membranes, e-PTFE, polylactic resorbable membranes and acellular dermal matrix membranes (AMDG). The analysis demonstrated that resorbable membranes result in higher values of new bone formation and lower values of residual particles and SCT. Xenograft resulted in lower new bone formation compared to allograft; however, no statistically significant differences were observed regarding residual particle and SCT. Overall, regeneration procedures adding autogenous bone, plasma derivate or growth factors achieved in general greater new bone formation and tissue gain. Conclusions: There is limited evidence favoring the effect of a certain type of barrier membrane in GBR. Data needs to be evaluated carefully; however, resorbable membranes are correlated with greater new bone formation values, especially when combined with allograft materials and/or the addition of autogenous bone, platelet reach plasma (PRP) or growth factors in the regeneration area. More studies assessing the histological outcomes of different GBR protocols and procedures testing different biomaterials are needed to maximize the clinical and histological outcomes in bone regeneration science.

Keywords: barrier membrane, graft material, guided bone regeneration, implant surgery, histology

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1090 Proposal for Knowledge-Based Virtual Community System (KBVCS) for Enhancing Knowledge Sharing in Mechatronics System Diagnostic and Repair

Authors: Adetoba B. Tiwalola, Adedeji W. Oyediran, Yekini N. Asafe, Akinwole A. Kikelomo

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Mechatronics is synergistic integration of mechanical engineering, with electronics and intelligent computer control in the design and manufacturing of industrial products and processes. Automobile (auto car, motor car or car is a wheeled motor vehicle used for transporting passengers, which also carries its own engine or motor) is a mechatronic system which served as major means of transportation around the world. Virtually all community has a need for automobile. This makes automobile issues as related to diagnostic and repair interesting to all communities. Consequent to the diversification of skill in diagnosing automobile faults and approaches in solving some problems and innovation in automobile industry. It is appropriate to say that repair and diagnostic of automobile will be better enhanced if community has opportunity of sharing knowledge and idea globally. This paper discussed the desirable elements in automobile as mechatronics system and present conceptual framework of virtual community model for knowledge sharing among automobile users.

Keywords: automobile, automobile users, knowledge sharing, mechatronics system, virtual community

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1089 Synthesis and in vitro Characterization of a Gel-Derived SiO2-CaO-P2O5-SrO-Li2O Bioactive Glass

Authors: Mehrnaz Aminitabar, Moghan Amirhosseinian, Morteza Elsa

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Bioactive glasses (BGs) are a group of surface-reactive biomaterials used in clinical applications as implants or filler materials in the human body to repair and replace diseased or damaged bone. Sol-gel technique was employed to prepare a SiO2-CaO-P2O5 glass with nominal composition of 58S BG with the addition of Sr and Li modifiers which imparts special properties to the BG. The effect of simultaneous addition of Sr and Li on bioactivity and biocompatibility, proliferation, alkaline phosphatase (ALP) activity of osteoblast cell line MC3T3-E1 and antibacterial property against methicillin-resistant Staphylococcus aureus (MRSA) bacteria were examined. BGs were characterized by X-ray diffraction, Fourier transform infrared spectroscopy, scanning electron microscopy before and after soaking the samples in the simulated body fluid (SBF) for different time intervals to characterize the formation of hydroxyapatite (HA) formed on the surface of BGs. Structural characterization indicated that the simultaneous presence of 5% Sr and 5% Li in 58S-BG composition not only did not retard HA formation because of opposite effect of Sr and Li of the dissolution of BG in the SBF but also, stimulated the differentiation and proliferation of MC3T3-E1s. Moreover, the presence of Sr and Li on dissolution of the ions resulted in an increase in the mean number of DAPI-labeled nuclei which was in good agreement with live/dead assay. The result of antibacterial tests revealed that Sr and Li-substituted 58S BG exhibited a potential antibacterial effect against MRSA bacteria. Because of optimal proliferation and ALP activity of MC3T3-E1cells, proper bioactivity and high antibacterial potential against MRSA, BG-5/5 is suggested as a multifunctional candidate for bone tissue engineering.

Keywords: antibacterial activity, bioactive glass, sol-gel, strontium

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1088 Mini-Open Repair Using Ring Forceps Show Similar Results to Repair Using Achillon Device in Acute Achilles Tendon Rupture

Authors: Chul Hyun Park

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Background:Repair using the Achillon deviceis a representative mini-open repair technique;however, the limitations of this technique includethe need for special instruments and decreasedrepair strength.A modifiedmini-open repair using ring forcepsmight overcome these limitations. Purpose:This study was performed to compare the Achillon device with ring forceps in mini-open repairsof acute Achilles tendon rupture. Study Design:This was a retrospective cohort study, and the level of evidence was3. Methods:Fifty patients (41 men and 9 women), withacute Achilles tendon rupture on one foot, were consecutively treated using mini-open repair techniques. The first 20 patients were treated using the Achillon device (Achillon group) and the subsequent 30 patients were treated using a ring forceps (Forcep group). Clinical, functional, and isokinetic results,and postoperative complications were compared between the two groups at the last follow-up. Clinical evaluations wereperformed using the American Orthopedic Foot and Ankle Society (AOFAS) score, Achilles tendon Total Rupture Score (ATRS), length of incision, and operation time. Functional evaluationsincludedactive range of motion (ROM) of the ankle joint, maximum calf circumference (MCC), hopping test, and single limb heel-rise (SLHR) test. Isokinetic evaluations were performed using the isokinetic test for ankle plantar flexion. Results:The AOFAS score (p=0.669), ATRS (p=0.753), and length of incision (p=0.305) were not significantly different between the groups. Operative times in the Achillon group were significantly shorter than that in the Forcep group (p<0.001).The maximum height of SLHR (p=0.023) and number of SLHRs (p=0.045) in the Forcep group were significantly greater than that in the Achillon group. No significant differences in the mean peak torques for plantar flexion at angular speeds of 30°/s (p=0.219) and 120°/s (p=0.656) were detected between the groups. There was no significant difference in the occurrence of postoperative complications between the groups (p=0.093). Conclusion:The ring forceps technique is comparable with the Achillon technique with respect to clinical, functional, and isokinetic results and the postoperative complications. Given that no special instrument is required, the ring forceps technique could be a better option for acute Achilles tendon rupture repair.

Keywords: achilles tendon, acute rupture, repair, mini-open

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1087 Self-Regenerating, Vascularizing Hybrid Scaffold-Hydrogel For Bone Tissue Engineering

Authors: Alisha Gupta

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Osteoarthritis (OA) is the most common form of arthritis which is a degenerative joint disease causing joints to begin to break down and underlying bones to change. This “wear and tear” most frequently affects hands, hips, and knees. This is important because OA pain is considered to be a leading cause of mobility impairment in older adults, with hip and knee OA ranked 11th highest contributors to global disability. Bone tissue engineering utilizing polymer scaffolds and hydrogels is an emerging field for treating osteoarthritis. Polymer scaffolds provide a three-dimensional structure for tissue growth, and hydrogels can be used to deliver drugs and growth factors. The combination of the two materials creates a hybrid structure that can better withstand physiological and mechanical demands while also providing a more controlled environment for drug and nutrient delivery. I think using bone tissue engineering for making scaffold-hydrogel composites that are self-regenerating and vascularizing might be useful in solving this problem. Successful implementation can reconstruct healthy, simulated bone tissue on deficient applicants.

Keywords: tissue engineering, regenerative medicine, scaffold-hydrogel composites, osteoarthritis

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1086 Serum Vitamin D and Carboxy-Terminal TelopeptideType I Collagen Levels: As Markers for Bone Health Affection in Patients Treated with Different Antiepileptic Drugs

Authors: Moetazza M. Al-Shafei, Hala Abdel Karim, Eitedal M. Daoud, Hassan Zaki Hassuna

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Epilepsy is a common neurological disorder affecting all age groups. It is one of the world's most prevalent non-communicable diseases. Increased evidence suggesting that long term usage of anti-epileptic drugs can have adverse effects on bone mineralization and bone molding .Aiming to study these effects and to give guide lines to support bone health through early intervention. From Neurology Out-Patient Clinic kaser Elaini University Hospital, 60 Patients were enrolled, 40 patients on antiepileptic drugs for at least two years and 20 controls matched with age and sex, epileptic but before starting treatment both chosen under specific criteria. Patients were divided into four groups, three groups with monotherapy treated with either Phynetoin, Valporic acid or Carbamazipine and fourth group treated with both Valporic acid and Carbamazipine. Estimation of serum Carboxy-Terminal Telopeptide of Type I- Collagen(ICTP) bone resorption marker, serum 25(OH )vit D3, calcium ,magnesium and phosphorus were done .Results showed that all patients on AED had significant low levels of 25(OH) vit D3 (p<0.001) ,with significant elevation of ICTP (P<0.05) versus controls. In group treated with Phynotoin highly significant elevation of (ICTP) marker and decrease of both serum 25(OH) vit D3 (P<0, 0001) and serum calcium(P<0.05)versus control. Double drug group showed significant decrease of serum 25(OH) vit D3 (P<0.0001) and decrease in Phosphorus (P<0.05) versus controls. Serum magnesium showed no significant differences between studied groups. We concluded that Anti- epileptic drugs appears to be an aggravating factor on bone mineralization ,so therapeutically it can be worth wile to supplement calcium and vitamin D even before initiation of antiepileptic therapy. ICTP marker can be used to evaluate change in bone resorption before and during AED therapy.

Keywords: antiepileptic drugs, bone minerals, carboxy teminal telopeptidetype-1-collagen bone resorption marker, vitamin D

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1085 Management of Tibial Bone Defects Following Grade Three Injury in Adults

Authors: Rajendra Kumar Kanojia

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Background; Massive bone gaps are common following road side accidents and injury to the tibia, specially open grade three fractures. It has been seen that the diaphyseal fractures in the tibia are prone to non-union, there are certain reasons known very well, like less soft tissues around the lower third tibia, less vascularity, less options of fixation of the fractures after trauma and prolonged surgical time, operation theatre time and special surgical means. Aim of study; To know the suitability of the ilizarov ring fixators in staged treatment of the fracture of the both bones leg, including tibia, we wish to see the role of ilizarov in management of open grade three fractures which have been operated and debrided, for getting the length use of ilizaorv ring in a tertiary canter is the aim of the study.

Keywords: open fracture, staged management, ilizarov, bone grafting, lengthening

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1084 Change of Bone Density with Treatments of Intravenous Zoledronic Acid in Patients with Osteoporotic Distal Radial Fractures

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

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

Keywords: zeoldreonic acid, BMD, osteoporosis, distal radius

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1083 The Effect of Improvement Programs in the Mean Time to Repair and in the Mean Time between Failures on Overall Lead Time: A Simulation Using the System Dynamics-Factory Physics Model

Authors: Marcel Heimar Ribeiro Utiyama, Fernanda Caveiro Correia, Dario Henrique Alliprandini

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The importance of the correct allocation of improvement programs is of growing interest in recent years. Due to their limited resources, companies must ensure that their financial resources are directed to the correct workstations in order to be the most effective and survive facing the strong competition. However, to our best knowledge, the literature about allocation of improvement programs does not analyze in depth this problem when the flow shop process has two capacity constrained resources. This is a research gap which is deeply studied in this work. The purpose of this work is to identify the best strategy to allocate improvement programs in a flow shop with two capacity constrained resources. Data were collected from a flow shop process with seven workstations in an industrial control and automation company, which process 13.690 units on average per month. The data were used to conduct a simulation with the System Dynamics-Factory Physics model. The main variables considered, due to their importance on lead time reduction, were the mean time between failures and the mean time to repair. The lead time reduction was the output measure of the simulations. Ten different strategies were created: (i) focused time to repair improvement, (ii) focused time between failures improvement, (iii) distributed time to repair improvement, (iv) distributed time between failures improvement, (v) focused time to repair and time between failures improvement, (vi) distributed time to repair and between failures improvement, (vii) hybrid time to repair improvement, (viii) hybrid time between failures improvements, (ix) time to repair improvement strategy towards the two capacity constrained resources, (x) time between failures improvement strategy towards the two capacity constrained resources. The ten strategies tested are variations of the three main strategies for improvement programs named focused, distributed and hybrid. Several comparisons among the effect of the ten strategies in lead time reduction were performed. The results indicated that for the flow shop analyzed, the focused strategies delivered the best results. When it is not possible to perform a large investment on the capacity constrained resources, companies should use hybrid approaches. An important contribution to the academy is the hybrid approach, which proposes a new way to direct the efforts of improvements. In addition, the study in a flow shop with two strong capacity constrained resources (more than 95% of utilization) is an important contribution to the literature. Another important contribution is the problem of allocation with two CCRs and the possibility of having floating capacity constrained resources. The results provided the best improvement strategies considering the different strategies of allocation of improvement programs and different positions of the capacity constrained resources. Finally, it is possible to state that both strategies, hybrid time to repair improvement and hybrid time between failures improvement, delivered best results compared to the respective distributed strategies. The main limitations of this study are mainly regarding the flow shop analyzed. Future work can further investigate different flow shop configurations like a varying number of workstations, different number of products or even different positions of the two capacity constrained resources.

Keywords: allocation of improvement programs, capacity constrained resource, hybrid strategy, lead time, mean time to repair, mean time between failures

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1082 Unreliable Production Lines with Simultaneously Unbalanced Operation Time Means, Breakdown, and Repair Rates

Authors: Sabry Shaaban, Tom McNamara, Sarah Hudson

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This paper investigates the benefits of deliberately unbalancing both operation time means (MTs) and unreliability (failure and repair rates) for non-automated production lines.The lines were simulated with various line lengths, buffer capacities, degrees of imbalance and patterns of MT and unreliability imbalance. Data on two performance measures, namely throughput (TR) and average buffer level (ABL) were gathered, analyzed and compared to a balanced line counterpart. A number of conclusions were made with respect to the ranking of configurations, as well as to the relationships among the independent design parameters and the dependent variables. It was found that the best configurations are a balanced line arrangement and a monotone decreasing MT order, coupled with either a decreasing or a bowl unreliability configuration, with the first generally resulting in a reduced TR and the second leading to a lower ABL than those of a balanced line.

Keywords: unreliable production lines, unequal mean operation times, unbalanced failure and repair rates, throughput, average buffer level

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1081 Photocrosslinkable Nanocomposite Ink for Printing of Strong, Biodegradable and Bioactive Bone Graft

Authors: Xin Zhao

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3D printing is used in creating bone grafts of various architectures by printing materials in a layer-by-layer manner. Traditionally, to make materials printable, heating up or dissolving materials in organic solvents have been used, compromising their capability in loading biomolecules. Photocrosslinkable materials which are initially liquid and printable, and solidified upon light exposure are therefore developed. However, the existing photocrosslinkable materials are either too soft to bear load or non-degradable with potential long-term biocompatibility problems. Here, photocrosslinkable nanocomposite ink is developed composed of poly (lactide-co-propylene glycol-co-lactide) dimethacrylate (PmLnDMA) and hydroxyethyl methacrylate-functionalized hydroxyapatite nanoparticles (nHAMA) mimicking the hairy setae of gecko that can strongly interact with its surroundings to bear high load. Incorporation of nHAMA into PmLnDMA endows the nanocomposite ink with several advantages in (1) improved organic/inorganic interfacial compatibility to increase mechanical strength, (2) readily modulated rheological behaviors, wettability, and biodegradation, (3) enhanced osteoconductivity and osteoinductivity. Moreover, the ink can be rapidly crosslinked upon light exposure, load, and long-term release growth factors, and be printed into 3D bone scaffolds of various shapes and structures according to the patients’ needs. Altogether, this innovation will benefit patients all over the world who suffer from bone fractures, tumors, infections.

Keywords: photocrosslinkable nanocomposite, 3D printing, bone ink, personalized medicine

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1080 Development and Evaluation of a Calcium Rich Plant-Based Supplement on Bone Turnover of Peri and Post Menopausal Women

Authors: Gayathri.G, Hemamalini.A.J, Chandrasekaran.A

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Problem statement: Nutritional deficiency, especially calcium, may lead to poor bone formation and mineralization. Although there are plenty of synthetic supplements available, it is essential to make a calcium rich food supplement accessible to combat calcium deficiency that could be readily prepared at the household level. Thus the current study aimed to formulate and standardize an indigenous low-cost calcium-rich food supplement and to study the impact of supplementation on the bone resorption and formation markers. Methods: A Randomized controlled trial was conducted with 60 subjects distributed equally in control and experimental groups, including perimenopausal and postmenopausal women. A plant-based calcium-rich product was developed and supplemented in form of balls as a midmorning and evening snack by addition of optimized proportions of leaves of Sesbania Grandiflora, seeds of Sesamum indicum, Eleusine coracana, Glycine max, Vigna mungo for a period of 6 months. Postmenopausal and perimenopausal women received 1200mg and 800mg of calcium per day from the supplemented, respectively. Outcome measures like serum calcium; betacrosslaps (bone resorption marker) and total P1NP (bone absorption marker) were assessed after 3 months and after 6 months. Results: There were no significant changes seen in the serum calcium and total P1NP levels (bone formation marker) among the subjects during the supplementation period. The bone resorption marker (betacrosslaps) reduced in all the groups and the reduction (0.32 ± 0.130 ng/ml to 0.25 ± 0.130 ng/ml) was found to be statistically highly significant (p < 0.01) in experimental group of perimenopausal subjects and significant (p < 0.05) in experimental group of postmenopausal subjects (1.11 ± 0.290 ng/ml to 0.42 ± 0.263 ng/ml). Conclusion: With the current severe calcium deficiency in the Indian population, integrating low-cost, calcium-rich native foods that could be readily prepared at household level would be useful in raising the nutritional consumption of calcium, which would, in turn, decrease bone turnover.

Keywords: calcium, sesbania grandiflora, sesamum indicum, eleusine coracana, glycine max, vigna mungo, postmenopause, perimenopause, bone resorption, bone absorption, betacrosslaps, total P1NP

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1079 Growth and Bone Health in Children following Liver Transplantation

Authors: Faris Alkhalil, Rana Bitar, Amer Azaz, Hisham Natour, Noora Almeraikhi, Mohamad Miqdady

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Background: Children with liver transplantation are achieving very good survival and so there is now a need to concentrate on achieving good health in these patients and preventing disease. Immunosuppressive medications have side effects that need to be monitored and if possible avoided. Glucocorticoids and calcineurin inhibitors are detrimental to bone and mineral homeostasis in addition steroids can also affect linear growth. Steroid sparing regimes in renal transplant children has shown to improve children’s height. Aim: We aim to review the growth and bone health of children post liver transplant by measuring bone mineral density (BMD) using dual energy X-ray absorptiometry (DEXA) scan and assessing if there is a clear link between poor growth and impaired bone health and use of long term steroids. Subjects and Methods: This is a single centre retrospective Cohort study, we reviewed the medical notes of children (0-16 years) who underwent a liver transplantation between November 2000 to November 2016 and currently being followed at our centre. Results: 39 patients were identified (25 males and 14 females), the median transplant age was 2 years (range 9 months - 16 years), and the median follow up was 6 years. Four patients received a combined transplant, 2 kidney and liver transplant and 2 received a liver and small bowel transplant. The indications for transplant included, Biliary Atresia (31%), Acute Liver failure (18%), Progressive Familial Intrahepatic Cholestasis (15%), transplantable metabolic disease (10%), TPN related liver disease (8%), Primary Hyperoxaluria (5%), Hepatocellular carcinoma (3%) and other causes (10%). 36 patients (95%) were on a calcineurin inhibitor (34 patients were on Tacrolimus and 2 on Cyclosporin). The other three patients were on Sirolimus. Low dose long-term steroids was used in 21% of the patients. A considerable proportion of the patients had poor growth. 15% were below the 3rd centile for weight for age and 21% were below the 3rd centile for height for age. Most of our patients with poor growth were not on long term steroids. 49% of patients had a DEXA scan post transplantation. 21% of these children had low bone mineral density, one patient had met osteoporosis criteria with a vertebral fracture. Most of our patients with impaired bone health were not on long term steroids. 20% of the patients who did not undergo a DEXA scan developed long bone fractures and 50% of them were on long term steroid use which may suggest impaired bone health in these patients. Summary and Conclusion: The incidence of impaired bone health, although studied in limited number of patients; was high. Early recognition and treatment should be instituted to avoid fractures and improve bone health. Many of the patients were below the 3rd centile for weight and height however there was no clear relationship between steroid use and impaired bone health, reduced weight and reduced linear height.

Keywords: bone, growth, pediatric, liver, transplantation

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1078 Bone Mineral Density and Frequency of Low-Trauma Fractures in Ukrainian Women with Metabolic Syndrome

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

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

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

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1077 Data Driven Infrastructure Planning for Offshore Wind farms

Authors: Isha Saxena, Behzad Kazemtabrizi, Matthias C. M. Troffaes, Christopher Crabtree

Abstract:

The calculations done at the beginning of the life of a wind farm are rarely reliable, which makes it important to conduct research and study the failure and repair rates of the wind turbines under various conditions. This miscalculation happens because the current models make a simplifying assumption that the failure/repair rate remains constant over time. This means that the reliability function is exponential in nature. This research aims to create a more accurate model using sensory data and a data-driven approach. The data cleaning and data processing is done by comparing the Power Curve data of the wind turbines with SCADA data. This is then converted to times to repair and times to failure timeseries data. Several different mathematical functions are fitted to the times to failure and times to repair data of the wind turbine components using Maximum Likelihood Estimation and the Posterior expectation method for Bayesian Parameter Estimation. Initial results indicate that two parameter Weibull function and exponential function produce almost identical results. Further analysis is being done using the complex system analysis considering the failures of each electrical and mechanical component of the wind turbine. The aim of this project is to perform a more accurate reliability analysis that can be helpful for the engineers to schedule maintenance and repairs to decrease the downtime of the turbine.

Keywords: reliability, bayesian parameter inference, maximum likelihood estimation, weibull function, SCADA data

Procedia PDF Downloads 38
1076 Bone Fracture Detection with X-Ray Images Using Mobilenet V3 Architecture

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

Abstract:

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

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

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1075 WILCKO-PERIO, Periodontally Accelerated Orthodontics

Authors: Kruttika Bhuse

Abstract:

Aim: Synergism between periodontists and orthodontists (periodontal accelerated osteogenic orthodontics- PAOO) creates crucial opportunities to enhance clinical outcomes of combined therapies regarding both disciplines and has made adult orthodontics a reality. Thus, understanding the biomechanics of bone remodelling may increase the clinical applications of corticotomy facilitated orthodontics with or without alveolar augmentation. Wilckodontics can be an attractive treatment option and be a “win-win” situation for both the dental surgeon and patient by reducing the orthodontic treatment time in adults. Materials and methods: In this review, data related to the clinical aspects, steps of procedure, biomechanics of bone, indications and contraindications and final outcome of wilckodontic shall be discussed. 50 supporting articles from various international journals and 70 clinical cases were reviewed to get a better understanding to design this wilckodontic - meta analysis. Various journals like the Journal Of Clinical And Diagnostic Research, Journal Of Indian Society Of Periodontology, Journal Of Periodontology, Pubmed, Boston Orthodontic University Journal, Good Practice Orthodontics Volume 2, have been referred to attain valuable information on wilckodontics which was then compiled in this single review study. Result: As a promising adjuvant technique based on the transient nature of demineralization-remineralisation process in healthy tissues, wilckodontics consists of regional acceleratory phenomenon by alveolar corticotomy and bone grafting of labial and palatal/lingual surfaces, followed by orthodontic force. The surgical wounding of alveolar bone potentiates tissue reorganization and healing by a way of transient burst of localized hard and soft tissue remodelling.This phenomenon causes bone healing to occur 10-50 times faster than normal bone turnover. Conclusion: This meta analysis helps understanding that the biomechanics of bone remodelling may increase the clinical applications of corticotomy facilitated orthodontics with or without alveolar augmentation. The main benefits being reduced orthodontic treatment time, increased bone volume and post-orthodontic stability.

Keywords: periodontal osteogenic accelerated orthodontics, alveolar corticotomy, bone augmentation, win-win situation

Procedia PDF Downloads 359
1074 Macroscopic Anatomy of the Nutrient Foramina of Human Scaphoid Bone

Authors: B. V. Murlimanju

Abstract:

Background: Scaphoid bone is commonly fractured among all the bones of the wrist. The fracture can damage the arteries and would cause avascular necrosis of the scaphoid. In this present study, the goal was to study the topography and number of nutrient foramina in the scaphoid bones of South Indian population. Methods: We studied 46 human scaphoid bones, among them 20 were left sided and 26 belonged to the right side. The scaphoid bones were available at the department of anatomy of our institution. The scaphoid bones were macroscopically observed for the topography and number of nutrient foramina. The data was collected, tabulated and analyzed. Results: The nutrient foramina were observed in all the scaphoid bones (100%). The locations of the foramina were over the non-articular surfaces in all these scaphoids. They were distributed over the palmar and dorsal surfaces. The foramina were found proximal as well as distal to the mid waist of the scaphoid bone. Their number ranged between 9 and 54 in each scaphoid bone. The number ranged between 2-24 over the palmar surface and 7-36 over the dorsal surface. They ranged between 2-24 proximal to the waist and 3-39 distal to the waist. Conclusion: The knowledge of arterial supply, topography of nutrient foramen and their number is essential to understand the concepts of avascular necrosis of scaphoid bone. It will be enlightening to understand the non-union of the fracture of waist of the scaphoid. The morphological data is required to the operating hand surgeon. We do believe that the present study has provided additional information about the topography and number of nutrient foramina of the human scaphoid bones.

Keywords: avascular necrosis, nutrient foramen, scaphoid, vascular

Procedia PDF Downloads 244
1073 Seismic Behavior and Loss Assessment of High–Rise Buildings with Light Gauge Steel–Concrete Hybrid Structure

Authors: Bing Lu, Shuang Li, Hongyuan Zhou

Abstract:

The steel–concrete hybrid structure has been extensively employed in high–rise buildings and super high–rise buildings. The light gauge steel–concrete hybrid structure, including light gauge steel structure and concrete hybrid structure, is a new–type steel–concrete hybrid structure, which possesses some advantages of light gauge steel structure and concrete hybrid structure. The seismic behavior and loss assessment of three high–rise buildings with three different concrete hybrid structures were investigated through finite element software, respectively. The three concrete hybrid structures are reinforced concrete column–steel beam (RC‒S) hybrid structure, concrete–filled steel tube column–steel beam (CFST‒S) hybrid structure, and tubed concrete column–steel beam (TC‒S) hybrid structure. The nonlinear time-history analysis of three high–rise buildings under 80 earthquakes was carried out. After simulation, it indicated that the seismic performances of three high–rise buildings were superior. Under extremely rare earthquakes, the maximum inter–storey drifts of three high–rise buildings are significantly lower than 1/50. The inter–storey drift and floor acceleration of high–rise building with CFST‒S hybrid structure were bigger than those of high–rise buildings with RC‒S hybrid structure, and smaller than those of high–rise building with TC‒S hybrid structure. Then, based on the time–history analysis results, the post-earthquake repair cost ratio and repair time of three high–rise buildings were predicted through an economic performance analysis method proposed in FEMA‒P58 report. Under frequent earthquakes, basic earthquakes and rare earthquakes, the repair cost ratio and repair time of three high-rise buildings were less than 5% and 15 days, respectively. Under extremely rare earthquakes, the repair cost ratio and repair time of high-rise buildings with TC‒S hybrid structure were the most among three high rise buildings. Due to the advantages of CFST-S hybrid structure, it could be extensively employed in high-rise buildings subjected to earthquake excitations.

Keywords: seismic behavior, loss assessment, light gauge steel–concrete hybrid structure, high–rise building, time–history analysis

Procedia PDF Downloads 155
1072 Behavioral Study Circumferential and Longitudinal Cracks in a Steel Pipeline X65 and Repair Patch

Authors: Sadok Aboubakr

Abstract:

The mechanical behavior of cracks from several manufacturing defect in an oil pipeline, is characterized by the fact that defects'm taking several forms: circumferential, longitudinal and inclined crack that evolve over time. Increased lifetime of the constructions and in particular cylindrical tubes under internal pressure requires knowledge improving these defects during loading. From this study we simulated various forms of cracking and also their pipeline repair patch.

Keywords: stress intensity factor, pressure, Young's modulus, Poisson's ratio, Shear modulus, Longueur du pipeline, the angle of crack, crack length

Procedia PDF Downloads 338
1071 The Nutrient Foramen of the Scaphoid Bone – A Morphological Study

Authors: B. V. Murlimanju, P. J. Jiji, Latha V. Prabhu, Mangala M. Pai

Abstract:

Background: The scaphoid is the most commonly fractured bone of the wrist. The fracture may disrupt the vessels and end up as the avascular necrosis of the bone. The objective of the present study was to investigate the morphology and number of the nutrient foramina in the cadaveric dried scaphoid bones of the Indian population. Methods: The present study included 46 scaphoid bones (26 right sided and 20 left sided) which were obtained from the gross anatomy laboratory of our institution. The bones were macroscopically observed for the nutrient foramina and the data was collected with respect to their number. The tabulation of the data and analysis were done. Results: All of our specimens (100%) exhibited the nutrient foramina over the non-articular surfaces. The foramina were observed only over the palmar and dorsal surfaces of the scaphoid bones. The foramina were observed both proximal and distal to the mid waist of the scaphoid bone. The foramen ranged between 9 and 54 in each scaphoid bone. The foramina over the palmar surface ranged between, 2-24 in number. The foramina over the dorsal surface ranged between, 7-36 in number. The foramina proximal to the waist ranged between 2 and 24 in number and distal to the waist ranged between 3 and 39. Conclusion: We believe that the present study has provided additional data about the nutrient foramina of the scaphoid bones. The data is enlightening to the orthopedic surgeon and would help in the hand surgeries. The morphological knowledge of the vasculature, their foramina of entry and their number is required to understand the concepts in the avascular necrosis of the proximal scaphoid and non-union of the fracture at the waist of the scaphoid.

Keywords: avascular necrosis, nutrient, scaphoid, vascular

Procedia PDF Downloads 308
1070 Investigation on 3D Printing of Calcium silicate Bioceramic Slurry for Bone Tissue Engineering

Authors: Amin Jabbari

Abstract:

The state of the art in major 3D printing technologies, such as powder-based and slurry based, has led researchers to investigate the ability to fabricate bone scaffolds for bone tissue engineering using biomaterials. In addition, 3D printing technology can simulate mechanical and biological surface properties and print with high precision complex internal and external structures that match their functional properties. Polymer matrix composites reinforced with particulate bioceramics, hydrogels reinforced with particulate bioceramics, polymers coated with bioceramics, and non-porous bioceramics are among the materials that can be investigated for bone scaffold printing. Furthermore, it was shown that the introduction of high-density micropores into the sparingly dissolvable CSiMg10 and dissolvable CSiMg4 shell layer inevitably leads to a nearly 30% reduction in compressive strength, but such micropores can easily influence the ion release behavior of the scaffolds. Also, biocompatibility tests such as cytotoxicity, hemocompatibility and genotoxicity were tested on printed parts. The printed part was tested in vitro, and after 24-26 h for cytotoxicity, and 4h for hemocompatibility test, the CSiMg4@CSiMg10-p scaffolds were found to have significantly higher osteogenic capability than the other scaffolds of implantation. Overall, these experimental studies demonstrate that 3D printed, additively-manufactured bioceramic calcium (Ca)-silicate scaffolds with appropriate pore dimensions are promising to guide new bone ingrowth.

Keywords: AM, 3D printed implants, bioceramic, tissue engineering

Procedia PDF Downloads 54
1069 Maximum Power and Bone Variables in Young Adult Men

Authors: Anthony Khawaja, Jacques Prioux, Ghassan Maalouf, Rawad El Hage

Abstract:

The regular practice of physical activities characterized by significant mechanical stresses stimulates bone formation and improves bone mineral density (BMD) in the most solicited sites. The purpose of this study was to explore the relationships between maximum power and bone variables in a group of young adult men. Identification of new determinants of BMD, bone mineral content (BMC) and hip geometric indices in young adult men, would allow screening and early management of future cases of osteopenia and osteoporosis. Fifty-three young adult men (18 – 35yr) voluntarily participated in this study. Weight and height were measured, and body mass index was calculated. Body composition, BMC and BMD were determined for each individual by Dual-energy X-ray absorptiometry (DXA; GE Healthcare, Madison, WI) at whole body (WB), lumbar spine (L1-L4), total hip (TH), and femoral neck (FN). FN cross-sectional area (CSA), strength index (SI), buckling ratio (BR), FN section modulus (Z), cross-sectional moment of inertia (CSMI) and L1-L4 TBS were also evaluated by DXA. The vertical jump was evaluated using a field test (sargent test). Two main parameters were retained: vertical jump performance (cm) and power (w). The subjects performed three jumps with 2 minutes of recovery between jumps. The highest vertical jump was selected. Maximum power (P max, in watts) was calculated. Maximum power was positively correlated to WB BMD (r = 0.41; p < 0.01), WB BMC (r = 0.65; p < 0.001), L1-L4 BMC (r = 0.54; p < 0.001), FN BMC (r = 0.35; p < 0.01), TH BMC (r = 0.50; p < 0.001), CSMI (r = 0.50; p < 0.001), CSA (r = 0.33; p < 0.05). Vertical jump was positively correlated to WB BMC (r = 0.31; p < 0.05), L1-L4 BMC (r = 0.40; p < 0.01), CSMI (r = 0.29; p < 0.05). The current study suggests that maximum power is a positive determinant of BMD, BMC and hip geometric indices in young adult men. In addition, it shows also that maximum power is a stronger positive determinant of bone variables than vertical jump in this population. Implementing strategies to increase maximum power in young adult men may be useful for preventing osteoporotic fractures later in life.

Keywords: bone variables, maximum power, osteopenia, osteoporosis, vertical jump, young adult men

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1068 Design and Fabrication of a Scaffold with Appropriate Features for Cartilage Tissue Engineering

Authors: S. S. Salehi, A. Shamloo

Abstract:

Poor ability of cartilage tissue when experiencing a damage leads scientists to use tissue engineering as a reliable and effective method for regenerating or replacing damaged tissues. An artificial tissue should have some features such as biocompatibility, biodegradation and, enough mechanical properties like the original tissue. In this work, a composite hydrogel is prepared by using natural and synthetic materials that has high porosity. Mechanical properties of different combinations of polymers such as modulus of elasticity were tested, and a hydrogel with good mechanical properties was selected. Bone marrow derived mesenchymal stem cells were also seeded into the pores of the sponge, and the results showed the adhesion and proliferation of cells within the hydrogel after one month. In comparison with previous works, this study offers a new and efficient procedure for the fabrication of cartilage like tissue and further cartilage repair.

Keywords: cartilage tissue engineering, hydrogel, mechanical strength, mesenchymal stem cell

Procedia PDF Downloads 271
1067 The Effect of Simultaneous Doping of Silicate Bioglass with Alkaline and Alkaline-Earth Elements on Biological Behavior

Authors: Tannaz Alimardani, Amirhossein Moghanian, Morteza Elsa

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Bioactive glasses (BGs) are a group of surface-reactive biomaterials used in clinical applications as implants or filler materials in the human body to repair and replace diseased or damaged bone. Sol-gel technique was employed to prepare a SiO₂-CaO-P₂O₅ glass with a nominal composition of 58S BG with the addition of Sr and Li modifiers which imparts special properties to the BG. The effect of simultaneous addition of Sr and Li on bioactivity and biocompatibility, proliferation, alkaline phosphatase (ALP) activity of osteoblast cell line MC3T3-E1 and antibacterial property against methicillin-resistant Staphylococcus aureus (MRSA) bacteria were examined. BGs were characterized by X-ray diffraction, Fourier transform infrared spectroscopy and scanning electron microscopy before and after soaking the samples in the simulated body fluid (SBF) for different time intervals to characterize the formation of hydroxyapatite (HA) formed on the surface of BGs. Structural characterization indicated that the simultaneous presence of 5% Sr and 5% Li in 58S-BG composition not only did not retard HA formation because of the opposite effect of Sr and Li of the dissolution of BG in the SBF, but also stimulated the differentiation and proliferation of MC3T3-E1s. Moreover, the presence of Sr and Li on the dissolution of the ions resulted in an increase in the mean number of DAPI-labeled nuclei which was in good agreement with the live/dead assay. The result of antibacterial tests revealed that Sr and Li-substituted 58S bioactive glass exhibited a potential antibacterial effect against MRSA bacteria. Because of optimal proliferation and ALP activity of MC3T3-E1cells, proper bioactivity and high antibacterial potential against MRSA, BG-5/5 is suggested as a multifunctional candidate for bone tissue engineering.

Keywords: alkaline, alkaline earth, bioglass, co-doping, ion release

Procedia PDF Downloads 183
1066 Associations between Metabolic Syndrome and Bone Mineral Density and Trabecular Bone Score in Postmenopausal Women with Non-Vertebral Fractures

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

Abstract:

Medical, social, and economic relevance of osteoporosis is caused by reducing quality of life, increasing disability and mortality of the patients as a result of fractures due to the low-energy trauma. This study is aimed to examine the associations of metabolic syndrome components, bone mineral density (BMD) and trabecular bone score (TBS) in menopausal women with non-vertebral fractures. 1161 menopausal women aged 50-79 year-old were examined and divided into three groups: A included 419 women with increased body weight (BMI - 25.0-29.9 kg/m2), B – 442 females with obesity (BMI >29.9 kg/m2)i and C – 300 women with metabolic syndrome (diagnosis according to IDF criteria, 2005). BMD of lumbar spine (L1-L4), femoral neck, total body and forearm was investigated with usage of dual-energy X-ray absorptiometry. The bone quality indexes were measured according to Med-Imaps installation. All analyses were performed using Statistical Package 6.0. BMD of lumbar spine (L1-L4), femoral neck, total body, and ultradistal radius was significant higher in women with obesity and metabolic syndrome compared to the pre-obese ones (p<0.001). TBS was significantly higher in women with increased body weight compared to obese and metabolic syndrome patients. Analysis showed significant positive correlation between waist circumference, triglycerides level and BMD of lumbar spine and femur. Significant negative association between serum HDL level and BMD of investigated sites was established. The TBS (L1-L4) indexes positively correlated with HDL (high-density lipoprotein) level. Despite the fact that BMD indexes were better in women with metabolic syndrome, the frequency of non-vertebral fractures was significantly higher in this group of patients.

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

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1065 Transperineal Repair Is Ideal for the Management of Rectocele with Faecal Incontinence

Authors: Tia Morosin, Marie Shella De Robles

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Rectocele may be associated with symptoms of both obstructed defecation and faecal incontinence. Currently, numerous operative techniques exist to treat patients with rectocele; however, no single technique has emerged as the optimal approach in patients with post-partum faecal incontinence. The purpose of this study was to evaluate the clinical outcome in a consecutive series of patients who underwent transperineal repair of rectocele for patients presenting with faecal incontinence as the predominant symptom. Twenty-three consecutive patients from April 2000 to July 2015 with symptomatic rectocele underwent transperineal repair by a single surgeon. All patients had a history of vaginal delivery, with or without evidence of associated anal sphincter injury at the time. The median age of the cohort was 53 years (range 21 to 90 years). The median operating time and length of hospital stay were 2 hours and 7 days, respectively. Two patients developed urinary retention post-operatively, which required temporary bladder catheterization. One patient had wound dehiscence, which was managed by absorbent dressing applied by the patient and her carer. There was no operative mortality. In all patients with rectocele, there was a concomitant anal sphincter disruption. All patients had satisfactory improvement with regard to faecal incontinence on follow-up. This study suggests this method provides excellent anatomic and physiologic results with minimal morbidity. However, because none of the patients gained full continence postoperatively, pelvic floor rehabilitation might be also needed to achieve better sphincter function in patients with incontinence.

Keywords: anal sphincter defect, faecal incontinence, rectocele, transperineal repair

Procedia PDF Downloads 106
1064 Evaluation of Bone and Body Mineral Profile in Association with Protein Content, Fat, Fat-Free, Skeletal Muscle Tissues According to Obesity Classification among Adult Men

Authors: Orkide Donma, Mustafa M. Donma

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Obesity is associated with increased fat mass as well as fat percentage. Minerals are the elements, which are of vital importance. In this study, the relationships between body as well as bone mineral profile and the percentage as well as mass values of fat, fat-free portion, protein, skeletal muscle were evaluated in adult men with normal body mass index (N-BMI), and those classified according to different stages of obesity. A total of 103 adult men classified into five groups participated in this study. Ages were within 19-79 years range. Groups were N-BMI (Group 1), overweight (OW) (Group 2), first level of obesity (FLO) (Group 3), second level of obesity (SLO) (Group 4) and third level of obesity (TLO) (Group 5). Anthropometric measurements were performed. BMI values were calculated. Obesity degree, total body fat mass, fat percentage, basal metabolic rate (BMR), visceral adiposity, body mineral mass, body mineral percentage, bone mineral mass, bone mineral percentage, fat-free mass, fat-free percentage, protein mass, protein percentage, skeletal muscle mass and skeletal muscle percentage were determined by TANITA body composition monitor using bioelectrical impedance analysis technology. Statistical package (SPSS) for Windows Version 16.0 was used for statistical evaluations. The values below 0.05 were accepted as statistically significant. All the groups were matched based upon age (p > 0.05). BMI values were calculated as 22.6 ± 1.7 kg/m2, 27.1 ± 1.4 kg/m2, 32.0 ± 1.2 kg/m2, 37.2 ± 1.8 kg/m2, and 47.1 ± 6.1 kg/m2 for groups 1, 2, 3, 4, and 5, respectively. Visceral adiposity and BMR values were also within an increasing trend. Percentage values of mineral, protein, fat-free portion and skeletal muscle masses were decreasing going from normal to TLO. Upon evaluation of the percentages of protein, fat-free portion and skeletal muscle, statistically significant differences were noted between NW and OW as well as OW and FLO (p < 0.05). However, such differences were not observed for body and bone mineral percentages. Correlation existed between visceral adiposity and BMI was stronger than that detected between visceral adiposity and obesity degree. Correlation between visceral adiposity and BMR was significant at the 0.05 level. Visceral adiposity was not correlated with body mineral mass but correlated with bone mineral mass whereas significant negative correlations were observed with percentages of these parameters (p < 0.001). BMR was not correlated with body mineral percentage whereas a negative correlation was found between BMR and bone mineral percentage (p < 0.01). It is interesting to note that mineral percentages of both body as well as bone are highly affected by the visceral adiposity. Bone mineral percentage was also associated with BMR. From these findings, it is plausible to state that minerals are highly associated with the critical stages of obesity as prominent parameters.

Keywords: bone, men, minerals, obesity

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