Search results for: knee replacement surgery

Authors: Jason Hoellwarth, Atiya Oomatia, Anuj Chavan, Kevin Tetsworth, Munjed Al Muderis

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Introduction: Percutaneous EndoProsthetic Osseointegration for Limbs (PEPOL) facilitates improved quality of life (QOL) and objective mobility for most amputees discontent with their traditional socket prosthesis (TSP) experience. Some amputees desiring PEPOL have residual bone much shorter than the currently marketed press-fit implant lengths of 14-16 cm, potentially a risk for failure to integrate. We report on the techniques used, complications experienced, the management of those complications, and the overall mobility outcomes of seven patients who had femur distraction osteogenesis (DO) with a Freedom nail followed by PEPOL. Method: Retrospective evaluation of a prospectively maintained database identified nine patients (5 females) who had transfemoral DO in preparation for PEPOL with two years of follow-up after PEPOL. Six patients had traumatic causes of amputation, one had perinatal complications, one was performed to manage necrotizing fasciitis and one was performed as a result of osteosarcoma. Result: The average age at which DO commenced was 39.4±15.9 years, and seven patients had their amputation more than ten years prior (average 25.5±18.8 years). The residual femurs, on average, started at 102.2±39.7 mm and were lengthened 58.1±20.7 mm, 98±45% of the goal (99±161% of the original bone length). Five patients (56%) had a complication requiring additional surgery: four events of inadequate regeneration were managed with continued lengthening to the desired goal followed by autograft placement harvested from contralateral femur reaming; one patient had the cerclage wires break, which required operative replacement. All patients had osseointegration performed at 355±123 days after the initial lengthening nail surgery. One patient had K-level >2 before DO, at a mean of 3.4±0.6 (2.6-4.4) years following osseointegration. Six patients had K-level >2. The 6-Minute Walk Test remained unchanged (267±56 vs. 308 ± 117 meters). Patient self-rating of prosthesis function, problems, and amputee situation did not significantly change from before DO to after osseointegration. Six patients required additional surgery following osseointegration: six to remove fixation plates placed to maintain distraction osteogenesis length at osseointegration; two required irritation and debridement for infection. Conclusion: Extremely short residual femurs, which make TSP use troublesome, can be lengthened with externally controlled telescoping nails and successfully achieve osseointegration. However, it is imperative to counsel patients that additional surgery to address inadequate regeneration or to remove painful hardware used to maintain fixation may be necessary. This may improve the amputee’s expectations before beginning a potentially arduous process.

Keywords: osseointegration, limb lengthening, quality of life, amputation

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Authors: Imran Altaf Wasil, Dinesh Ganvir

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Due to a scarcity of virgin aggregates, the use of reclaimed asphalt pavement (RAP) as a substitute for natural aggregates has gained popularity. Despite the fact that RAP is recycled in asphalt pavement, there is still excess RAP, and its use in concrete pavements has expanded in recent years. According to a survey, 98 percent of India's pavements are flexible. As a result, the maintenance and reconstruction of such pavements generate RAP, which can be reused in concrete pavements as well as surface course, base course, and sub-base of flexible pavements. Various studies on the properties of reclaimed asphalt pavement and its optimal requirements for usage in concrete has been conducted throughout the years. In this study a total of four different mixes were prepared by partially replacing natural aggregates by RAP in different proportions. It was found that with the increase in the replacement level of Natural aggregates by RAP the mechanical and durability properties got reduced. In order to increase the mechanical strength of mixes 40% Glass Granulated Blast Furnace Slag (GGBS) was used and it was found that with replacement of cement by 40% of GGBS, there was an enhancement in the mechanical and durability properties of RAP inclusive PQC mixes. The reason behind the improvement in the properties is due to the processing technique used in order to remove the contaminant layers present in the coarse RAP aggregates. The replacement level of Natural aggregate with RAP was done in proportions of 20%, 40% and 60% along with the partial replacement of cement by 40% GGBS. It was found that all the mixes surpassed the design target value of 40 MPa in compression and 4.5 MPa in flexure making it much more economical and feasible.

Keywords: reclaimed asphalt pavement, pavement quality concrete, glass granulated blast furnace slag, mechanical and durability properties

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Authors: Arun C. Gulani, Aaishwariya A. Gulani, Amanda Southall

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Background: Laser Corneoplastique™ as a least interventional, visually promising technique for patients with vision disability from corneal scars of varied causes has been retrospectively reviewed and proves to cause a paradigm shift in mindset and approach towards corneal scars as a Refractive surgery aiming for emmetropic, unaided vision of 20;/20 in most cases. Three decades of work on this technique has been compiled in this 15-year study. Subject and Methods: The objective of this study was to determine the success of Laser Corneoplastique™ surgery as a treatment of corneal scar cases. A survey of corneal scar cases caused by various medical histories that had undergone Laser Corneoplastique™ surgery over the past twenty years by a single surgeon Arun C. Gulani, M.D. were retrospectively reviewed. The details of each of the cases were retrieved from their medical records and analyzed. Each patient had been examined thoroughly at their preoperative appointments for stability of refraction and vision, depth of scar, pachymetry, topography, pattern of the scar and uncorrected and best corrected vision potential, which were all taken into account in the patients' treatment plans. Results: 64 eyes of 53 patients were investigated for scar etiology, keratometry, visual acuity, and complications. There were 25 different etiologies seen, with the most common being a Herpetic scar. The average visual acuity post-op was, on average, 20/23.55 (±7.05). Laser parameters used were depth and pulses. Overall, the mean Laser ablation depth was 30.67 (±19.05), ranging from 2 to 73 µm. Number of Laser pulses averaged 191.85 (±112.02). Conclusion: Refractive Laser Corneoplastique™ surgery, when practiced as an art, can address all levels of ametropia while reversing complex corneas and scars from refractive surgery complications back to 20/20 vision.

Keywords: corneal scar, refractive surgery, corneal transplant, laser corneoplastique

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Authors: Beloulou Mohamed Lamine, Fedili Benamar, Meliani Walid, Chaid Dalila

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Introduction: The risk factors for the chronicization of postoperative pain are numerous and often intricately intertwined. Among these, the severity of acute postoperative pain is currently recognized as one of the most determining factors. Mastectomy and thoracotomy are described as among the most painful surgeries and the most likely to lead to chronic post-surgical pain (CPSP). Objective: To examine the aspects of acute postoperative pain potentially involved in the development of chronic pain following breast and thoracic surgery. Patients and Methods: A prospective study involving 164 patients was conducted over a six-month period. Postoperative pain (during mobilization) was assessed using a Visual Analog Scale (VAS) at various time points after surgery: Day 0, 1st, 2nd, 5th days, 1st and 6th months. Moderate to severe pain was defined as a VAS score ≥ 4. A comparative analysis (univariate analysis) of postoperative pain intensities at different evaluation phases was performed on patients with and without CPSP to identify potential associations with the risk of chronicization six months after surgery. Results: At the 6th month post-surgery, the incidence of CPSP was 43.0%. Moderate to severe acute postoperative pain (in the first five days) was observed in 64% of patients. The highest pain scores were reported among thoracic surgery patients. Comparative measures revealed a highly significant association between the presence of moderate to severe acute pain, especially lasting for ≥ 48 hours, and the occurrence of CPSP (p-value <0.0001). Likewise, the persistence of subacute pain (up to 4 to 6 weeks after surgery), especially of moderate to severe intensity, was significantly associated with the risk of chronicization at six months (p-value <0.0001). Conclusion: CPSP after breast and thoracic surgery remains a fairly common morbidity that profoundly affects the quality of life. Severe acute postoperative pain, especially if it is prolonged and/or with a slow decline in intensity, can be an important predictive factor for the risk of chronicization. Therefore, more effective and intensive management of acute postoperative pain, as well as longitudinal monitoring of its trajectory over time, should be an essential component of strategies for preventing chronic pain after surgery.

Keywords: chronic post-surgical pain, acute postoperative pain, breast and thoracic surgery, subacute postoperative pain, pain trajectory, predictive factor

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Authors: Muhammad Rizwan Akram, Saim Raza, Hamza Hanif Chauhan

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This paper describes the aim of research to evaluate the performance of ordinary Portland concretes containing cement replacement materials in both binary and ternary system. Blocks of concrete were prepared to have a constant water-binder ratio of 0.30. The test variables included the type and the amount of the supplementary cementious materials (SCMs) such as class of Silica Fume (SF) and ground granulated blast furnace slag (GGBS). Portland cement was replaced with Silica Fume (SF) upto 7.5% and GGBS up to a level of 50%. Then physical properties are assessed from the compressive strength and permeability tests.

Keywords: silica fume, GGBS, compressive strength, permeability

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Authors: R. Sonda, F. Pellini, A. Invento, S. Mirandola, F. Riolfatti, D. Grigolato, G. P. Pollini

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The purpose of study is to assess utility of 18F-FDG PET/CT in patients with breast heteroplasia and possibility of changing the surgery/therapeutic treatment. Among these "under fourty-five" candidated for NAC, the prevalence of change in therapeutic approach in comparison with first and second level exams has been: 43.75%, while by 22% among the "over forty-five". The surgical timing according to first-level exams have been deferred in 31.46% cases; PET/CT has led to a change in therapeutic treatment of 48.31% on the previous given; then the addition of MRI has led to a similar variation. For all the total patients, the prevalent choice was found to the debulking approach by increasing from a prevalence of 12.92% to 15.17%, resulting in a reduction of conservative one.The present study set itself the objective to demonstrate how the FDG PET/CT could improve on breast imaging according to a more appropriate surgery.

Keywords: breast cancer, FGD PET/CT, preoperative staging, surgical approach

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Authors: P. Parthiban, J. Karthikeyan

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This paper deals with the performance of semi-light weight concrete, prepared by using wood ash pellets as coarse aggregates which were improved by partial replacement of cement with alccofine. Alccofine is a mineral admixture which contains high glass content obtained through the process of controlled granulation. This is finer than cement which carries its own pozzolanic property. Therefore, cement could be replaced by alccofine as 0%, 5%, 10%, 15%, 20%, 25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, and 70% to enhance the strength and durability properties of concrete. High range water reducing admixtures (HRWA) were used in these mixes which were dosed up to 1.5% weight of the total cementitious content (alccofine & cement). It also develops the weaker transition zone into more impermeable layer. Specimens were subjected in both the accelerated curing method as well as conventional curing method. Experimental results were compared and reported, in that the maximum compressive strength of 32.6 MPa was achieved on 28^th day with 30% replacement level in a density of 2200 kg/m³ to a conventional curing, while in the accelerated curing, maximum compressive strength was achieved at 40% replacement level. Rapid chloride penetration test (RCPT) output results for the conventional curing method at 0% and 70% give 3296.7 and 545.6 coulombs.

Keywords: Alccofine, compressive strength, RCPT, wood ash pellets

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Authors: O. O. Onafowokan, K. Anderson, M. R. Norton, R. G. Middleton

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Revision total hip arthroplasty (THA) is known to be a challenging procedure with potential for poor outcomes. Due to its lack of metaphyseal encroachment, hip resurfacing arthroplasty (HRA) is classified as a bone conserving procedure. Although the literature postulates that this is an advantage at time of revision surgery, there is no evidence to either support or refute this claim. We identified 129 hips that had undergone HRA and 129 controls undergoing first revision THA. We recorded the clinical assessment and survivorship of implants in a multi-surgeon, single centre, retrospective case control series for both arms. These were matched for age and sex. Data collected included demographics, indications for surgery, Oxford Hip Score (OHS), length of surgery, length of hospital stay, blood transfusion, implant complexity and further surgical procedures. Significance was taken as p < 0.05. Mean follow up was 7.5 years (1 to 15). There was a significant 6 point difference in postoperative OHS in favour of the revision resurfacing group (p=0.0001). The revision HRA group recorded 48 minutes less length of surgery (p<0.0001), 2 days less in length of hospital stay (p=0.018), a reduced need for blood transfusion (p=0.0001), a need for less complexity in revision implants (p=0.001) and a reduced probability of further surgery being required (P=0.003). Whilst we acknowledge the limitations of this study our results suggest that, in contrast to THA, the bone conservation element of HRA may make for a less traumatic revision procedure with better functional outcomes. Use of HRA has seen a dramatic decline as a result of concerns regarding metallosis. However, this information remains of relevance when counselling young active patients about their arthroplasty options and may become pertinent in the future if the promise of ceramic hip resurfacing is ever realized.

Keywords: hip resurfacing, metallosis, revision surgery, total hip arthroplasty

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Authors: Melissa Mattos, Camila Lima, Ibraim Castro, Augusto Carioca, Saulo Magalhães, Paula Freitas, Keciany Oliveira

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Obesity is a chronic, multifactorial, relapsing disease that has increased dramatically over the years. Its control is considered a public health issue, and more and more treatments and interventions are being studied to reduce its prevalence. When interventions in lifestyle and the use of drugs do not generate lasting results, bariatric procedures emerge as a resource for obesity control. The main guidelines for the treatment of obesity emphasize the need for pre-procedure and post-procedure nutritional monitoring to avoid nutritional deficiencies that may occur. The individual who undergoes bariatric surgery needs to understand the changes that will be necessary for life in view of the intense anatomical and metabolic changes that result from surgical techniques. To assess the nutritional profile of patients who undergo bariatric surgery, we analyzed data from the medical records of all people who underwent sleeve-type bariatric surgery from January to June 2022 at a clinic in the City of Fortaleza. 38 patients were analyzed, 32 women and 6 men in the pre-surgical period, 6 and 12 months after surgery. The data showed an average weight loss of 24.45% at 6 months and 30.85% at 12 months, with a reduction of 21.32% and 30.41%, respectively, in the fat percentage, also indicating that 13.15% used drugs for weight loss during this period, leading to reflection on the isolated long-term efficacy of bariatric surgery, requiring multidisciplinary follow-up for a change in lifestyle. Only 12 individuals, corresponding to 31.57%, reached eutrophic BMI 12 months after surgery, 20 individuals remained overweight, corresponding to 52.63% of the sample, and 6 individuals (15.78%) remained in the BMI obese class I. As for body composition, there was a 52.39% reduction in fat mass and a 12.82% reduction in muscle mass, and 21% of individuals underwent cholecystectomy. Sleeve-type bariatric surgery promoted significant weight loss after 1 year of the procedure, with a reduction in body fat percentage and fat mass. Most patients were still overweight and had a significant reduction in muscle mass.

Keywords: bariatric surgery, sleeve gastrectomy, obesity, sleeve

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Authors: D. Lepe-Cervantes, E. Leon-Becerril, J. Gomez-Romero, O. Garcia-Depraect, A. Lopez-Lopez

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In this study, raw coffee wastewater (CWW) was used as a complex substrate for anaerobic digestion. The inoculum adaptation stage, microbial diversity analysis and biomethane potential (BMP) tests were performed. A fast inoculum adaptation stage was used by the replacement of vinasse to CWW in an anaerobic sequential batch reactor (AnSBR) operated at mesophilic conditions. Illumina MiSeq sequencing was used to analyze the microbial diversity. While, BMP tests using inoculum adapted to CWW were carried out at different inoculum to substrate (I/S) ratios (2:1, 3:1 and 4:1, on a VS basis). Results show that the adaptability percentage was increased gradually until it reaches the highest theoretical value in a short time of 10 d; with a methane yield of 359.10 NmL CH₄/g COD-removed; Methanobacterium beijingense was the most abundant microbial (75%) and the greatest specific methane production was achieved at I/S ratio 4:1, whereas the lowest was obtained at 2:1, with BMP values of 320 NmL CH₄/g VS and 151 NmL CH₄/g VS, respectively. In conclusion, gradual replacement of substrate was a feasible method to adapt the inoculum in a short time even using complex raw substrates, whereas in the BMP tests, the specific methane production was proportional to the initial amount of inoculum.

Keywords: anaerobic digestion, biomethane potential test, coffee wastewater, fast inoculum adaptation

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Authors: Isyaka Abdulkadir, Egbe-Ngu Ntui Ogork

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This research aims to investigate the effect of Rice Husk Ash (RHA) on Scrap Tyre Steel Fiber Reinforced High Performance Concrete (STSFRHPC). RHA was obtained by control burning of rice husk in a kiln to a temperature of 650-700oC and when cooled sieved through 75µm sieve and characterized. The effect of RHA were investigated on grade 50 STSFRHPC of 1:1.28:1.92 with water cement ratio of 0.39 at additions of Scrap Tyre Steel Fiber (STSF) of 1.5% by volume of concrete and partial replacement of cement with RHA at percentages of 0, 5, 10, 15 and 20. The fresh concrete was tested for slump while the hardened concrete was tested for compressive and splitting tensile strengths respectively at curing ages of 3, 7, 28 and 56 days in accordance with standard procedure. Results of RHA-STSFRHPC indicated a reduction in slump and compressive strength with increase in RHA content, while splitting tensile strength increased with RHA replacement up to 10% and reduction in strength above 10% RHA content. The 28 days compressive strength of RHA-STSFRHPC with up to 10% RHA attained the desired characteristic strength of 50N/mm2 and therefore up to 10% RHA is considered as the optimum replacement dosage in STSFRHPC-RHA.

Keywords: compressive strength, high performance concrete, rice husk ash, scrap tyre steel fibers

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Authors: Ana Miguel

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Purpose: Glaucoma is the second cause of worldwide blindness and the first cause of irreversible blindness. Trabeculectomy, the standard glaucoma surgery, has a success rate between 36.0% and 98.0% at three years and a high complication rate, leading to the development of different surgeries, micro-invasive glaucoma surgeries (MIGS). MIGS devices are diverse and have various indications, risks, and effectiveness. We intended to review MIGS’ surgical techniques, indications, contra-indications, and IOP effect. Methods: We performed a literature review of MIGS to differentiate the devices and their reported effectiveness compared to traditional surgery (tubes and blebs). We also conducted a video review of the last 1000 glaucoma surgeries of the author (including MIGS, but also trabeculectomy, deep sclerectomy, and tubes of Ahmed and Baerveldt) performed at glaucoma and advanced anterior segment fellowship in Canada and France, to describe preferred surgical techniques for each. Results: We present the videos with surgical techniques and pearls for each surgery. Glaucoma surgeries included: 1- bleb surgery (namely trabeculectomy, with releasable sutures or with slip knots, deep sclerectomy, Ahmed valve, Baerveldt tube), 2- MIGS with bleb, also known as MIBS (including XEN 45, XEN 63, and Preserflo), 3- MIGS increasing supra-choroidal flow (iStar), 4-MIGS increasing trabecular flow (iStent, gonioscopy-assisted transluminal trabeculotomy - GATT, goniotomy, excimer laser trabeculostomy -ELT), and 5-MIGS decreasing aqueous humor production (endocyclophotocoagulation, ECP). There was also needling (ab interno and ab externo) performed at the operating room and irido-zonulo-hyaloïdectomy (IZHV). Each technique had different indications and contra-indications. Conclusion: MIGS are valuable in glaucoma surgery, such as traditional surgery with trabeculectomy and tubes. All glaucoma surgery can be combined with phacoemulsification (there may be a synergistic effect on MIGS + cataract surgery). In addition, some MIGS may be combined for further intraocular pressure lowering effect (for example, iStents with goniotomy and ECP). A good surgical technique and postoperative management are fundamental to increasing success and good practice in all glaucoma surgery.

Keywords: glaucoma, migs, surgery, video, review

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Authors: Shirin Jalili, Ramin Ghasemi

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Lumbar microdiscectomy is the most commonly performed spinal surgery strategy; it is regularly performed to lighten the indications and signs of sciatica within the lower back and leg caused by a lumbar disc herniation. This surgery aims to progress leg pain, reestablish function, and enable a return to ordinary day-by-day exercises. Rates of lumbar disc surgery show critical geographic varieties recommending changing treatment criteria among working specialists. Few population-based considers have investigated the hazard of reoperation after disc surgery, and regional or inter specialty varieties within the reoperations are obscure. The conventional approach to recouping from lumbar microdiscectomy has been to restrain bending, lifting, or turning for a least 6 weeks in arrange to anticipate the disc from herniating once more. Traditionally, patients were exhorted to limit post-operative action, which was accepted to decrease the hazard of disc herniation and progressive insecurity. In modern hone, numerous specialists don't limit understanding of postoperative action due to the discernment this practice is pointless. There's a need of thinks about highlighting the result by distinctive scores or parameters after surgery for repetitive circle herniations of the lumbar spine at the starting herniation location. This study will evaluate the quality of life after surgical treatment of recurrent herniations with distinctive standardized approved result instruments.

Keywords: post-operative activity, disc, quality of life, treatment, movements

Procedia PDF Downloads 57

Authors: Raymond Puijk, Rachid Rassir, Inger N. Sierevelt, Anneke Spekenbrink-Sporen, Bart G. C. W. Pijls, Rob G. H. H. Nelissen, Peter A. Nolte

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Background: Among uncemented total knee arthroplasty (TKA), a wide variety of metal surface structures (MSS) and coatings exist to enhance implants' biological properties (i.e., bone ingrowth). This study explores the variety of MSS-coating combinations and compares their mid-long-term survivorships with cemented TKAs, by using data from the Dutch Arthroplasty Register. Methods: A total of 235,500 cemented and 11,132 uncemented primary TKAs with a median follow-up of 5.1 years were included. MSS-coating combinations were (1) Porous-uncoated (n=8986), (2) Beaded-hydroxyapatite (HA)(n=1093), (3) Matte-uncoated (n=846), (4) Matte-Titanium-nitride (TiN) (n=207). Five- and 10-year revision-free survival for all-cause revisions, and aseptic loosening of the tibial component, were calculated and compared by using Kaplan-Meier, Log-rank tests, and multivariable Cox proportional hazard regression analyses. Results: Ten-year survival rates with all-cause revisions as an endpoint, were 94.2% for cement, and 94.7%, 96.3%, 92.1%, and 79.0% for porous-uncoated, beaded-HA, matte-uncoated, and Matte-TiN, respectively (p<0.01). Rates for aseptic loosening were 98.8% for cemented, and 98.7%, 99.8%, 97.2%, and 94.9% for the uncemented, respectively (p<0.01).The beaded-HA implants were half the risk for an all-cause revision compared to cemented implants (p<0.01). Matte-uncoated and matte-TiN implants were at more risk of an all-cause revision than cemented implants (p=0.01, p<0.01). Proportions of revisions for aseptic loosening were comparable among most groups. Conclusion: Based on Dutch registry data, four main MSS-coating combinations among uncemented TKAs were found. survivorships for all-cause revisions and aseptic release differed widely between groups. Beaded-HA and porous-uncoated implants had the best survival rates among the uncemented TKAs and were non-inferior to the cemented TKAs.

Keywords: total knee arthroplasty, cement, uncemented, cementless;, metal surface structure, coating

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Authors: F. A. Olutoge, O.R. Olulope, M. O. Odelola

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This study investigates the strength potentials of groundnut husk ash as partial cement replacement in mortar and also develops a predictive model using Artificial Neural Network. Groundnut husks sourced from Ogbomoso, Nigeria, was sun dried, calcined to ash in a furnace at a controlled temperature of 600⁰ C for a period of 6 hours, and sieved through the 75 microns. The ash was subjected to chemical analysis and setting time test. Fine aggregate (sand) for the mortar was sourced from Ado Ekiti, Nigeria. The cement: GHA constituents were blended in ratios 100:0, 95:5, 90:10, 85:15 and 80:20 %. The sum of SiO₂, Al₂O₃, and Fe₂O₃ content in GHA is 26.98%. The compressive strength for mortars PC, GHA5, GHA10, GHA15, and GHA20 ranged from 6.3-10.2 N/mm² at 7days, 7.5-12.3 N/mm² at 14 days, 9.31-13.7 N/mm² at 28 days, 10.4-16.7 N/mm² at 56days and 13.35- 22.3 N/mm² at 90 days respectively, PC, GHA5 and GHA10 had competitive values up to 28 days, but GHA10 gave the highest values at 56 and 90 days while GHA20 had the lowest values at all ages due to dilution effect. Flexural strengths values at 28 days ranged from 1.08 to 1.87 N/mm² and increased to a range of 1.53-4.10 N/mm² at 90 days. The ANN model gave good prediction for compressive strength of the mortars. This study has shown that groundnut husk ash as partial cement replacement improves the strength properties of mortar.

Keywords: compressive strength, groundnut husk ash, mortar, pozzolanic index

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Authors: Ahmed Mohamed El-Shamy, Akram Abbas El-Awady, Mahmoud Taha Eldestawy

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Background: The present study was to evaluate clinically and radiographically the combined effect of split crest technique by ultrasonic bone surgery and platelet concentrates in implant site development. Methods: Forty patients with narrow ridge were participated in this study. Patients were assigned randomly into one of the following four groups according to treatment: Group 1: Patients received split-crest technique by ultrasonic bone surgery with implant placement. Group 2: Patients received split-crest technique by ultrasonic bone surgery with implant placement and PRF. Group 3: Patients received split-crest technique by ultrasonic bone surgery with implant placement and PRP. Group 4: Patients received split-crest technique by ultrasonic bone surgery with implant placement and collagen membrane. Modified plaque index, modified sulcus bleeding index, and implant stability were recorded as a baseline and measured again at 3 and 6 months. CBCT scans were taken immediately after surgery completion and at 9 months to evaluate bone density at the bone-implant interface. Results after 6 months; collagen group showed statistically significantly lower mean modified bleeding index than the other groups. After 3 months, the PRF group showed statistically significantly higher mean implant stability with ostell ISQ units' than the other groups. After 6 months, the PRF group showed statistically significantly higher mean implant stability with ostell ISQ units' than the other groups. After 6 months, the PRF group showed statistically significantly higher mean bone density than the collagen group. Conclusion: Ultrasonic bone surgery in split-crest technique can be a successful option for increasing implant stability values throughout the healing period. The use of a combined technique of ultrasonic bone surgery with PRF and simultaneous implant placement potentially improves osseointegration (bone density). PRF membranes represent advanced technology for the stimulation and acceleration of bone regeneration.

Keywords: dental implants, split-crest, PRF, PRP

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Authors: Shirin Jalili, Ramin Ghasemi Shayan

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Atrial fibrillation is the foremost common arrhythmia around the world, with expanding recurrence famous with age. Thromboembolic occasions and strokes are the number one cause of mortality and morbidity. For patients who don't react to restorative treatment for rate and beat control, the maze method offers an elective treatment mediation. pharmaco-medical treatment for atrial fibrillation is pointed at the control of rate or cadence, intrusive treatment for atrial fibrillation is pointed at cadence control. An obtrusive approach may comprise of percutaneous catheter treatment, surgery, or a crossover approach. Since the maze method is recognized as the foremost successful way to dispense with AF, combining the maze strategy amid major cardiac surgeries has been received in clinical hone. the maze strategy, moreover known as Cox¬maze iii or the ‘cut¬and¬sew’ method, involves making different incisions within the atria to make an arrangement of scars that dispose of each potential zone of re¬entry. The electrical drive is constrained through a maze of scars that coordinates the electrical drive from the sinus node to the av node. By settling the headstrong period between ranges of scar, re¬entry is disposed of. in this article, we evaluate the Maze surgery method that's the surgical method of choice for the treatment of restorative atrial fibrillation.

Keywords: atrial fibrillation, congenital heart disease, procedure, maze surgery, treatment

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Authors: V. Churkin, M. Lopatin

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The purpose of the paper is to estimate the US small wind turbines market potential and forecast the small wind turbines sales in the US. The forecasting method is based on the application of the Bass model and the generalized Bass model of innovations diffusion under replacement purchases. In the work an exponential distribution is used for modeling of replacement purchases. Only one parameter of such distribution is determined by average lifetime of small wind turbines. The identification of the model parameters is based on nonlinear regression analysis on the basis of the annual sales statistics which has been published by the American Wind Energy Association (AWEA) since 2001 up to 2012. The estimation of the US average market potential of small wind turbines (for adoption purchases) without account of price changes is 57080 (confidence interval from 49294 to 64866 at P = 0.95) under average lifetime of wind turbines 15 years, and 62402 (confidence interval from 54154 to 70648 at P = 0.95) under average lifetime of wind turbines 20 years. In the first case the explained variance is 90,7%, while in the second - 91,8%. The effect of the wind turbines price changes on their sales was estimated using generalized Bass model. This required a price forecast. To do this, the polynomial regression function, which is based on the Berkeley Lab statistics, was used. The estimation of the US average market potential of small wind turbines (for adoption purchases) in that case is 42542 (confidence interval from 32863 to 52221 at P = 0.95) under average lifetime of wind turbines 15 years, and 47426 (confidence interval from 36092 to 58760 at P = 0.95) under average lifetime of wind turbines 20 years. In the first case the explained variance is 95,3%, while in the second –95,3%.

Keywords: bass model, generalized bass model, replacement purchases, sales forecasting of innovations, statistics of sales of small wind turbines in the United States

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Authors: A. K. Jain, M. C. Paliwal

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The production of cement leads to the emission of large amounts of carbon-dioxide gas into the atmosphere which is a major contributor for the greenhouse effect and the global warming; hence it is mandatory either to quest for another material or partly replace it with some other material. According to the practical demonstrations and reports, Egg Shell Powder (ESP) can be used as a binding material for different field applications as it contains some of the properties of lime. It can partially replace the cement and further; it can be used in different proportion for enhancing the performance of cement. It can be used as a first-class alternative, for material reuse and waste recycling practices. Eggshell is calcium rich and analogous to limestone in chemical composition. Therefore, use of eggshell waste for partial replacement of cement in concrete is feasible. Different studies reveal that plasticity index of the soil can be improved by adding eggshell wastes in all the clay soil and it has wider application in construction projects including earth canals and earthen dams. The scarcity of aggregates is also increasing nowadays. Utilization of industrial waste or secondary materials is increasing in different construction applications. Coconut shell was successfully used in the construction industry for partial or full replacement for coarse aggregates. The use of coconut shell gives advantage of using waste material to partially replace the coarse aggregate. Studies carried on coconut shell indicate that it can partially replace the aggregate. It has good strength and modulus properties along with the advantage of high lignin content. It absorbs relatively low moisture due to its low cellulose content. In the paper, study carried out on eggshell powder and coconut shell will be discussed. Optimum proportions of these materials to be used for partial replacement of cement and aggregate will also be discussed.

Keywords: greenhouse, egg shell powder, binding material, aggregates, coconut shell, coarse aggregates

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Authors: Amiya Kumar Thakur, Dinesh Ganvir, Prem Pal Bansal

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Industrial by product utilization has been encouraged due to environment and economic factors. Since electric arc furnace slag aggregate is a by-product of steel industry and its storage is a major concern hence it can be used as a replacement of natural aggregate as its physical and mechanical property are comparable or better than the natural aggregates. The present study investigates the effect of partial and full replacement of natural coarse aggregate with coarse EAF slag aggregate and partial replacement of cement with ground granulated blast furnace slag (GGBFS) on the mechanical and durability properties of roller compacted concrete pavement (RCCP).The replacement level of EAF slag aggregate were at five levels (i.e. 0% ,25% ,50%,75% & 100%) and of GGBFS was (0 % & 30%).The EAF slag aggregate was stabilized by exposing to outdoor condition for several years and the volumetric expansion test using steam exposure device was done to check volume stability. Soil compaction method was used for mix proportioning of RCCP. The fresh properties of RCCP investigated were fresh density and modified vebe test was done to measure the consistency of concrete. For investigating the mechanical properties various tests were done at 7 and 28 days (i.e. Compressive strength, split tensile strength, flexure strength modulus of elasticity) and also non-destructive testing was done at 28 days (i.e. Ultra pulse velocity test (UPV) & rebound hammer test). The durability test done at 28 days were water absorption, skid resistance & abrasion resistance. The results showed that with the increase in slag aggregate percentage there was an increase in the fresh density of concrete and also slight increase in the vebe time but with the 30 % GGBFS replacement the vebe time decreased and the fresh density was comparable to 0% GGBFS mix. The compressive strength, split tensile strength, flexure strength & modulus of elasticity increased with the increase in slag aggregate percentage in concrete when compared to control mix. But with the 30 % GGBFS replacement there was slight decrease in mechanical properties when compared to 100 % cement concrete. In UPV test and rebound hammer test all the mixes showed excellent quality of concrete. With the increase in slag aggregate percentage in concrete there was an increase in water absorption, skid resistance and abrasion resistance but with the 30 % GGBFS percentage the skid resistance, water absorption and abrasion resistance decreased when compared to 100 % cement concrete. From the study it was found that the mix containing 30 % GGBFS with different percentages of EAF slag aggregate were having comparable results for all the mechanical and durability property when compared to 100 % cement mixes. Hence 30 % GGBFS can be used as cement replacement with 100 % EAF slag aggregate as natural coarse aggregate replacement.

Keywords: durability properties, electric arc furnace slag aggregate, GGBFS, mechanical properties, roller compacted concrete pavement, soil compaction method

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Authors: Mengying Wang, Xiaohui Wang, Chun Deng, Bei Liu, Changyu Sun, Guangjin Chen, Mahmoud El-Halwagi

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Significant amounts of natural gas hydrates (NGHs) are considered potential new sustainable energy resources in the future. However, common used methods for methane gas recovery from hydrate sediments require high investment but with low gas production efficiency, and may cause potential environment and security problems. Therefore, there is a need for effective gas production from hydrates. The natural gas hydrate production method by CO₂/H₂ replacement coupling steam methane reforming can improve the replacement effect and reduce the cost of gas separation. This paper develops a simulation model of the gas production process integrated with steam reforming and membrane separation. The process parameters (i.e., reactor temperature, pressure, H₂O/CH₄ ratio) and the composition of CO₂ and H₂ in the feed gas are analyzed. Energy analysis is also conducted. Two design scenarios with different composition of CO₂ and H₂ in the feed gas are proposed and evaluated to assess the energy efficiency of the novel system. Results show that when the composition of CO₂ in the feed gas is between 43 % and 72 %, there is a certain composition that can meet the requirement that the flow rate of recycled gas is equal to that of feed gas, so as to ensure that the subsequent production process does not need to add feed gas or discharge recycled gas. The energy efficiency of the CO₂ in feed gas at 43 % and 72 % is greater than 1, and the energy efficiency is relatively higher when the CO₂ mole fraction in feed gas is 72 %.

Keywords: Gas production, hydrate, process integration, steam reforming

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Authors: Raouf Mbarki, Fadi Al Khatib, Malek Adouni

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Knee collateral ligaments play a significant role in restraining excessive frontal motion (varus/valgus rotations). In this investigation, a multiscale frame was developed based on structural hierarchies of the collateral ligaments starting from the bottom (tropocollagen molecule) to up where the fibred reinforced structure established. Experimental data of failure tensile test were considered as the principal driver of the developed model. This model was calibrated statistically using Bayesian calibration due to the high number of unknown parameters. Then the model is scaled up to fit the real structure of the collateral ligaments and simulated under realistic boundary conditions. Predications have been successful in describing the observed transient response of the collateral ligaments during tensile test under pre- and post-damage loading conditions. Collateral ligaments maximum stresses and strengths were observed near to the femoral insertions, a results that is in good agreement with experimental investigations. Also for the first time, damage initiation and propagation were documented with this model as a function of the cross-link density between tropocollagen molecules.

Keywords: multiscale model, tropocollagen, fibrils, ligaments commas

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Authors: Anuoluwapo S. Taiwo, David S. Ayre, Morteza Khorami, Sameer S. Rahatekar

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This investigation aims to characterize the effect of Corn Cob (CC), an agricultural waste, for potential use as a filler material, reducing cement in natural fibre-reinforced cement composite boards used for building applications in low-cost housing estates in developing countries. The corn cob, an agro-waste, is readily and abundantly available in many West African States. However, this agricultural waste product has not been put to any effective use. Hence, the objective of the current research is to convert this massive agro-waste resource into a potential material for use as partial cement replacement in fibre-cement board production. Kraft pulp fibre-reinforced cement composite boards were developed with the incorporation of the corn cob at a varying percentage of 1 - 4 wt.% as partial cement replacement using a laboratory-simulated Hatschek process. The mechanical properties of the developed cement boards were characterized through a three-point bending test, while the fractured morphology of the cement boards was examined through a scanning electron microscope (SEM). Results revealed that the flexural strength of the composite board improved significantly with an optimum enhancement of 40% when compared to the reference sample without corn cob replacement; however, the flexural behaviour (toughness) of the composite board was slightly affected by the addition of the corn cob. SEM observation of the fractured surfaces revealed good bonding at the fibre-matrix interface as well as a ductile-to-brittle fracture mechanism. Overall, the composite board incorporated with 2 wt.% corn cob replacement for cement had the optimum properties, which satisfied the minimum requirements of relevant standards for fibre cement flat sheets.

Keywords: agricultural waste, building applications, fibre-cement board, kraft pulp fibre, sustainability

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Authors: Md. Jahidul Islam, A. K. M. Rakinul Islam, M. Salamah Meherier

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This study investigates the suitability of using plastic, such as polyethylene terephthalate (PET), as a partial replacement of natural coarse and fine aggregates (for example, brick chips and natural sand) to produce lightweight concrete for load bearing structural members. The plastic coarse aggregate (PCA) and plastic fine aggregate (PFA) were produced from melted polyethylene terephthalate (PET) bottles. Tests were conducted using three different water–cement (w/c) ratios, such as 0.42, 0.48, and 0.57, where PCA and PFA were used as 50% replacement of coarse and fine aggregate respectively. Fresh and hardened properties of concrete have been compared for natural aggregate concrete (NAC), PCA concrete (PCC) and PFA concrete (PFC). The compressive strength of concrete at 28 days varied with the water–cement ratio for both the PCC and PFC. Between PCC and PFC, PFA concrete showed the highest compressive strength (23.7 MPa) at 0.42 w/c ratio and also the lowest compressive strength (13.7 MPa) at 0.57 w/c ratio. Significant reduction in concrete density was mostly observed for PCC samples, ranging between 1977–1924 kg/m³. With the increase in water–cement ratio PCC achieved higher workability compare to both NAC and PFC. It was found that both the PCA and PFA contained concrete achieved the required compressive strength to be used for structural purpose as partial replacement of the natural aggregate; but to obtain the desired lower density as lightweight concrete the PCA is most suited.

Keywords: polyethylene terephthalate, plastic aggregate, concrete, fresh and hardened properties

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Authors: T. N. Goh, M. Hashmi, O. Hussain

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Temporomandibular joint (TMJ) dysfunction (TMD) is a condition that may affect patients via restricted mouth opening, significant pain during normal functioning, and/or reproducible joint noise. TMD includes myofascial pain, TMJ functional derangements (internal derangement, dislocation), and TMJ degenerative/inflammatory joint disease. Internal derangement (ID) is the most common cause of TMD-related clicking and locking. These patients are managed in a stepwise approach, from patient education (homecare advice and analgesia), splint therapy, physiotherapy, botulinum toxin treatment, to arthrocentesis. Arthrotomy is offered when the aforementioned treatment options fail to alleviate symptoms and improve quality of life. The aim of this prospective study was to review the outcomes of jaw joint open surgery in TMD patients. Patients who presented from 2015-2022 at the Oral and Maxillofacial Surgery Department in the Doncaster NHS Foundation Trust, UK, with a Wilkes classification of III -V were included. These patients underwent either i) discopexy with bone-anchoring suture (9); ii) intrapositional temporalis flap (ITF) with bone-anchoring suture (3); iii) eminoplasty and discopexy with suturing to the capsule (3); iii) discectomy + ITF with bone-anchoring suture (1); iv) discoplasty + bone-anchoring suture (1); v) ITF (1). Maximum incisal opening (MIO) was assessed pre-operatively and at each follow-up. Pain score, determined via the visual analogue scale (VAS, with 0 being no pain and 10 being the worst pain), was also recorded. A total of 18 eligible patients were identified with a mean age of 45 (range 22 - 79), of which 16 were female. The patients were scored by Wilkes Classification as III (14), IV (1), or V (4). Twelve patients had anterior disc displacement without reduction (66%) and six had degenerative/arthritic changes (33%) to the TMJ. The open joint procedure resulted in an increase in MIO and reduction in pain VAS and for the majority of patients, across all Wilkes Classifications. Pre-procedural MIO was 22.9 ± 7.4 mm and VAS was 7.8 ± 1.5. At three months post-procedure there was an increase in MIO to 34.4 ± 10.4 mm (p < 0.01) and a decrease in the VAS to 1.5 ± 2.9 (p < 0.01). Three patients were lost to follow-up prior to six months. Six were discharged at six month review and five patients were discharged at 12 months review as they were asymptomatic with good mouth opening. Four patients are still attending for annual botulinum toxin treatment. Two patients (Wilkes III and V) subsequently underwent TMJ replacement (11%). One of these patients (Wilkes III) had improvement initially to MIO of 40 mm, but subsequently relapsed to less than 20 mm due to lack of compliance with jaw rehabilitation device post-operatively. Clinical improvements in 89% of patients within the study group were found, with a return to near normal MIO range and reduced pain score. Intraoperatively, the operator found bone-anchoring suture used for discopexy/discoplasty more secure than the soft tissue anchoring suturing technique.

Keywords: bone anchoring suture, open temporomandibular joint surgery, temporomandibular joint, temporomandibular joint dysfunction

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Authors: Jared Cheves, Amanda DeChent, Joyce Pan

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Total knee replacements (TKAs) are one of the most common but painful surgical procedures performed in the United States. Currently, the gold standard for postoperative pain management is the utilization of opioids. However, in the wake of the opioid epidemic, the healthcare system is attempting to reduce opioid consumption by trialing innovative opioid sparing analgesic techniques such as continuous peripheral nerve blocks (CPNB) and continuous periarticular infiltration (CPAI). The alleviation of pain, particularly during the first 72 hours postoperatively, is of utmost importance due to its association with delayed recovery, impaired rehabilitation, immunosuppression, the development of chronic pain, the development of rebound pain, and decreased patient satisfaction. While both CPNB and CPAI are being used today, there is limited evidence comparing the two to the current standard of care or to each other. An extensive literature review was performed to explore the safety profiles and effectiveness of CPNB and CPAI in reducing reported pain scores and decreasing opioid consumption. The literature revealed the usage of CPNB contributed to lower pain scores and decreased opioid use when compared to opioid-only control groups. Additionally, CPAI did not improve pain scores or decrease opioid consumption when combined with a multimodal analgesic (MMA) regimen. When comparing CPNB and CPAI to each other, neither unanimously lowered pain scores to a greater degree, but the literature indicates that CPNB decreased opioid consumption more than CPAI. More research is needed to further cement the efficacy of CPNB and CPAI as standard components of MMA in TKA procedures. In addition, future research can also focus on novel catheter-free applications to reduce the complications of continuous catheter analgesics.

Keywords: total knee arthroplasty, continuous peripheral nerve blocks, continuous periarticular infiltration, opioid, multimodal analgesia

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Authors: Farajallah Adibhashemi

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A retrospective study on causes, surgery findings, results and the follow up of 30 horses with colic in Tehran, Iran. Colic is the main problem horse industry.The causes of colic are related to management like food, sport and medical care. In this study that has been done between 2012-2015 for 30 horses referred to teaching hospital of veterinary medicine faculty of the University of Tehran. Seventy percent of causes was related to management of feeding and twenty percent was for malsporting. The rest of causes was from the anti parasite in bad root. The surgery findings were as follows: 60% displacement of dorsal right and left colon, 20% in impaction of pelvic flexure,10% impaction of the cecum, and 10% impaction of the stomach.

Keywords: horse, colic, Tehran, Iran

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Authors: Abdolrasoul Daneshjoo

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Soccer is a game which draws more attention in different countries especially in Brazil. Kicking among different skills in soccer and soccer players is an excellent role for the success and preference of a team. The way of point gaining in this game is passing the ball over the goal lines which are gained by shoot skill in attack time and or during the penalty kicks.Regarding the above assumption, identifying the effective factors in instep kicking in different distances shoot with maximum force and high accuracy or pass and penalty kick, may assist the coaches and players in raising qualitative level of performing the skill.The aim of the present study was to study of a few kinematical parameters in instep kicking from 5 and 7 meter distance among the male and female elite soccer players.24 right dominant lower limb subjects (12 males and 12 females) among Tehran elite soccer players with average and the standard deviation (22.5 ± 1.5) & (22.08± 1.31) years, height of (179.5 ± 5.81) & (164.3 ± 4.09) cm, weight of (69.66 ± 4.09) & (53.16 ± 3.51) kg, %BMI (21.06 ± .731) & (19.67 ± .709), having playing history of (4 ± .73) & (3.08 ± .66) years respectively participated in this study. They had at least two years of continuous playing experience in Tehran soccer league.For sampling player's kick; Kinemetrix Motion analysis with three cameras with 1000 Hz was used. Five reflective markers were placed laterally on the kicking leg over anatomical points (the iliac crest, major trochanter, lateral epicondyle of femur, lateral malleolus, and lateral aspect of distal head of the fifth metatarsus). Instep kick was filmed, with one step approach and 30 to 45 degrees angle from stationary ball. Three kicks were filmed, one kick selected for further analyses. Using Kinemetrix 3D motion analysis software, the position of the markers was analyzed. Descriptive statistics were used to describe the mean and standard deviation, while the analysis of variance, and independent t-test (P < 0.05) were used to compare the kinematic parameters between two genders.Among the evaluated parameters, the knee acceleration, the thigh angular velocity, the angle of knee proportionately showed significant relationship with consequence of kick. While company performance on 5m in 2 genders, significant differences were observed in internal – external displacement of toe, ankle, hip and the velocity of toe, ankle and the acceleration of toe and the angular velocity of pelvic, thigh and before time contact . Significant differences showed the internal – external displacement of toe, the ankle, the knee and the hip, the iliac crest and the velocity of toe, the ankle and acceleration of ankle and angular velocity of the pelvic and the knee.

Keywords: biomechanics, kinematics, instep kicking, soccer

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Authors: Muhammad Yasir Tarar

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Background: Intraarticular steroid injections are an effective option in alleviating the symptoms of conditions like osteoarthritis, rheumatoid arthritis, crystal arthropathy, and rotator cuff tendinopathy. Most of these injections are conducted in the elderly who are on polypharmacy, including anticoagulants at times. Up to 6% of patients aged 80-84 years have been reported to be taking Warfarin. The literature availability on safety quotient for patients undergoing intraarticular injections on Warfarin is scarce. It has remained debatable over the years which approach is safe for these patients. Continuing warfarin has a theoretical bleeding risk, and stopping it can lead to even severe life-threatening thromboembolic events in high-risk patients. Objectives: To evaluate the risk of bleeding complications in patients on warfarin undergoing intraarticular injections or arthrocentesis. Study Design & Methods: A literature search of MEDLINE (1946 to present), EMBASE (1974 to present), and Cochrane CENTRAL (1988 to present) databases were conducted using any combination of the keywords, Injection, Knee, Shoulder, Joint, Intraarticular, arthrocentesis, Warfarin, and Anticoagulation in November 2020 for articles published in any language with no publication year limit. The study inclusion criteria included reporting on the rate of bleeding complications following injection of the knee or shoulder in patients on warfarin treatment. Randomized control trials and prospective and retrospective study designs were included. An electronic standardized Performa for data extraction was made. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) the methodology was used. The articles were appraised using the methodological index for nonrandomized studies. The Cochrane Risk of Bias Tool used to assess the risk of bias in included RCTs and the MINORS tool for assessment of bias in observational studies. Results: The search of databases resulted in a total of 852 articles. Relevant articles as per the inclusion criteria were shortlisted, 7 articles deemed suitable to be include. A total of 1033 joints sample size was undertaken with specified knee and shoulder joints of a total of 820. Only 6 joints had bleeding complications, 5 early bleeding at the time of injection or aspiration, and one late bleeding complication with INR of 5, additionally, 2 patients complained of bruising, 3 of pain, and 1 managed for infection. Conclusions: The results of the metanalysis show that it is relatively safe to perform intraarticular injections in patients on Warfarin regardless of the INR range.

Keywords: arthrocentesis, warfarin, bleeding, injection

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Authors: Nooshin Salari, Viliam Makis, Jane Doe

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This paper presents a maintenance policy for a system consisting of two units. Unit 1 is gradually deteriorating and is subject to soft failure. Unit 2 has a general lifetime distribution and is subject to hard failure. Condition of unit 1 of the system is monitored periodically and it is considered as failed when its deterioration level reaches or exceeds a critical level N. At the failure time of unit 2 system is considered as failed, and unit 2 will be correctively replaced by the next inspection epoch. Unit 1 or 2 are preventively replaced when deterioration level of unit 1 or age of unit 2 exceeds the related preventive maintenance (PM) levels. At the time of corrective or preventive replacement of unit 2, there is an opportunity to replace unit 1 if its deterioration level reaches the opportunistic maintenance (OM) level. If unit 2 fails in an inspection interval, system stops operating although unit 1 has not failed. A mathematical model is derived to find the preventive and opportunistic replacement levels for unit 1 and preventive replacement age for unit 2, that minimize the long run expected average cost per unit time. The problem is formulated and solved in the semi-Markov decision process (SMDP) framework. Numerical example is provided to illustrate the performance of the proposed model and the comparison of the proposed model with an optimal policy without opportunistic maintenance level for unit 1 is carried out.

Keywords: condition-based maintenance, opportunistic maintenance, preventive maintenance, two-unit system

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