Search results for: minimal invasive surgical technique

Authors: Neha Thakur, Pravin S. More

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The interaction of CO, H2 and LPG with Cu-dosed SnO2 catalysts was studied by means of Fourier transform infrared spectroscopy (FTIR). With increasing Cu loading, pronounced and progressive red shifts of the C–O stretching frequency associated with molecular CO adsorbed on the Cu/SnO2 component were observed. This decrease in n(CO) correlates with enhancement of CO dissociation at higher temperatures on Cu promoted SnO2 catalysts under conditions, where clean Cu is almost ineffective. In the conclusion, the capability of our technique is discussed, and a technique for enhancing the sensitivity in our technique is proposed.

Keywords: FTIR, spectroscopic, dissociation, n(CO)

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Authors: Yamina Boukari, Nashiru Billa, Andrew Morris, Stephen Doughty, Kevin Shakesheff

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Poly (lactic-co-glycolic) acid (PLGA) is a synthetic polymer that can be used in bone tissue engineering with the aim of creating a scaffold in order to support the growth of cells. The formation of microspheres from this polymer is an attractive strategy that would allow for the development of an injectable system, hence avoiding invasive surgical procedures. The aim of this study was to develop a microsphere delivery system for use as an injectable scaffold in bone tissue engineering and evaluate various formulation parameters on its properties. Porous and lysozyme-containing PLGA microspheres were prepared using the double emulsion solvent evaporation method from various molecular weights (MW). Scaffolds were formed by sintering to contain 1 -3mg of lysozyme per gram of scaffold. The mechanical and physical properties of the scaffolds were assessed along with the release of lysozyme, which was used as a model protein. The MW of PLGA was found to have an influence on microsphere size during fabrication, with increased MW leading to an increased microsphere diameter. An inversely proportional relationship was displayed between PLGA MW and mechanical strength of formed scaffolds across loadings for low, intermediate and high MW respectively. Lysozyme release from both microspheres and formed scaffolds showed an initial burst release phase, with both microspheres and scaffolds fabricated using high MW PLGA showing the lowest protein release. Following the initial burst phase, the profiles for each MW followed a similar slow release over 30 days. Overall, the results of this study demonstrate that lysozyme can be successfully incorporated into porous PLGA scaffolds and released over 30 days in vitro, and that varying the MW of the PLGA can be used as a method of altering the physical properties of the resulting scaffolds.

Keywords: bone, microspheres, PLGA, tissue engineering

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Authors: Ching-Yi Yiu, Hui-Chen Hsu

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Objectives: Obstructive sleep apnea syndrome (OSAS) is a popular problem in the modern society. It usually leads to sleep disorder, excessive daytime sleepiness and associated with cardiovascular diseases, cognitive dysfunction and even death. The nonsurgical therapies include continuous positive airway pressure (CPAP), diet and oral appliances. The surgical approaches have nasal surgery, tonsillectomy, adenoidectomy, uvulopalatopharyngoplasty (UPPP) and transoral robotic surgery (TORS).We compare the impact of surgical treatments on these kinds of patients. Methods: Between January 2018 to September 2022, We have enrolled 125 OSAS patients including 82 male and 43 female in Chi Mei Medical Center, Liouying, Taiwan. The age distribution from 6 to 71 years old (y/o) with mean age 36.1 y/o. The averaged body mass index (BMI) is 25 kg/m2 in male and 25.5 kg/m2 in female. In this cohort, we evaluated their upper airway obstruction sites with nasopharyngoscopy and scheduled a planned surgery. Some of cases received polysomnography (PSG) preoperatively, the averaged apnea-hypopnea index (AHI) is 37.7 events/hour. We have 68 patients received tonsillectomy, 9 received UPPP, 42 received UPPP and septomeatoplasty (SMP) and 6 received adenoidectomy and tonsillectomy (A and T). The subjective daytime sleepiness was evaluated with the Epworth sleepiness scale (ESS). Results: In the 68 tonsillectomy group, the averaged BMI is 24.9 kg/m2. In the UPPP group, the averaged BMI is 28.9 kg/m2. In UPPP and SMP group, the averaged BMI is 27.9 kg/m2. In the A and T group, the averaged BMI is 17.2 kg/m2. The reduction of AHI less than 20 is 58% postoperatively. The ESS reduced from 10.9 to 4.9 after surgery. Conclusion: Obstructive sleep apnea syndrome is a common upper airway disturbance in the general population. The prevalence rate is ranging high depending on different regions, age, sex and race. It leads to severe morbidity and mortality including car accident, stroke, nocturnal desaand sudden death and should be considered to be a major public health problem. The CPAP is effective to improve daytime sleepiness but the long-term compliance is low. The surgical treatment with different modalities can produce 50% decrease in AHI and ESS after surgery in the 6 to 12 months short-term period.

Keywords: apnea-hypopnea index, obstructive sleep apnea syndrome, polysomnography, uvulopalatopharyngoplasty

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Authors: Saimir Heta, Ilma Robo, Nevila Alliu, Tea Meta

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Background: Plasma levels of inflammatory markers are the expression of the infectious wastes of existing periodontitis, as well as of existing inflammation everywhere in the body. Materials and Methods: The study consists of the clinical part of the measurement of inflammatory markers of 23 patients diagnosed with chronic periodontitis and the recording of parental periodontal parameters of patient periodontal status: hemorrhage index and probe values, before and 7-10 days after non-surgical periodontal treatment. Results: The level of fibrinogen drops according to the categorization of disease progression, active and passive, with the biggest % (18%-30%) at the fluctuation 10-20 mg/d. Fluctuations in fibrinogen level according to the age of patients in the range 0-10 mg/dL under 40 years and over 40 years was 13%-26%, in the range 10-20 mg/dL was 26%-22%, in the 20-40 mg/dL was 9%-4%. Conclusions: Non-surgical periodontal treatment significantly reduces the level of non-inflammatory markers in the blood. Oral health significantly reduces the potential source for periodontal bacteria, with the potential of promoting thromboembolism, through interaction between thrombocytes.

Keywords: chronic periodontitis, atherosclerosis, risk factor, inflammatory markers

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Authors: Ilma Robo, Saimir Heta, Emela Dalloshi, Nevila Alliu, Vera Ostreni

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The dental whitening process, beyond the fact that it is a mini-invasive dental treatment, has effects on the dental structure, or on the pulp of the tooth, where it is applied. The electronic search was performed using keywords to find articles published within the last 10 years about side effects, assessed as such, of minimally invasive dental bleaching treatment. Methodology: In selected articles, the other aim of the study was to evaluate the side effects of bleaching based on the percentage and type of solution used, where the latter was evaluated on the basic solution used for bleaching. Results: The side effects of bleaching are evaluated in selected articles depending on the method of bleaching application, which means it is carried out with recommended solutions, or with mixtures of alternative solutions or substances based on Internet information. Short conclusion: The dental bleaching process has side effects which have not yet been definitively evaluated, experimentally in large samples of individuals or animals (mice or cattle) to arrive at accurate numerical conclusions. The trend of publications about this topic is increasing in recent years, as long as the trend for aesthetic facial treatments, including dental ones, is increasing.

Keywords: teeth whitening, side effects, permanent teeth, formed dental apex

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Authors: Aji Budi Rinekso

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There are some common problems that are often faced by students in writing. The problems are related to macro and micro skills of writing, such as incorrect spellings, inappropriate diction, grammatical errors, random ideas, and irrelevant supporting sentences. Therefore, it is needed a teaching technique that can solve those problems. Dictogloss technique is a teaching technique that involves listening practices. So, it is a suitable teaching technique for students with auditory learning style. Dictogloss technique comprises of four basic steps; (1) warm up, (2) dictation, (3) reconstruction and (4) analysis and correction. Warm up is when students find out about topics and do some preparatory vocabulary works. Then, dictation is when the students listen to texts read at normal speed by a teacher. The text is read by the teacher twice where at the first reading the students only listen to the teacher and at the second reading the students listen to the teacher again and take notes. Next, reconstruction is when the students discuss the information from the text read by the teacher and start to write a text. Lastly, analysis and correction are when the students check their writings and revise them. Dictogloss offers some advantages in relation to the efforts of improving writing skills. Through the use of dictogloss technique, students can solve their problems both on macro skills and micro skills. Easier to generate ideas and better writing mechanics are the benefits of dictogloss.

Keywords: auditory learners, writing skills, dictogloss technique, second language learning

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Authors: Nicole Ramlachan, Samuel Mark West

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Lung cancer is the leading cause of cancer-associated deaths in North America, with the vast majority being non-small cell lung cancer (NSCLC), with a five-year survival rate of only 24%. Non-invasive discovery of biomarkers associated with early-diagnosis of NSCLC can enable precision oncology efforts using liquid biopsy-based multiomics profiling of plasma. Although tissue biopsies are currently the gold standard for tumor profiling, this method presents many limitations since these are invasive, risky, and sometimes hard to obtain as well as only giving a limited tumor profile. Blood-based tests provides a less-invasive, more robust approach to interrogate both tumor- and non-tumor-derived signals. We intend to examine 30 stage III-IV NSCLC patients pre-surgery and collect plasma samples.Cell-free DNA (cfDNA) will be extracted from plasma, and next-generation sequencing (NGS) performed. Through the analysis of tumor-specific alterations, including single nucleotide variants (SNVs), insertions, deletions, copy number variations (CNVs), and methylation alterations, we intend to identify tumor-derived DNA—ctDNA among the total pool of cfDNA. This would generate data to be used as an accurate form of cancer genotyping for diagnostic purposes. Using liquid biopsies offer opportunities to improve the surveillance of cancer patients during treatment and would supplement current diagnosis and tumor profiling strategies previously not readily available in Trinidad and Tobago. It would be useful and advantageous to use this in diagnosis and tumour profiling as well as to monitor cancer patients, providing early information regarding disease evolution and treatment efficacy, and reorient treatment strategies in, timethereby improving clinical oncology outcomes.

Keywords: genomics, multiomics, clinical genetics, genotyping, oncology, diagnostics

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Authors: Leanda Denise Mason, Philip William Bateman, Grant Wardell-Johnson

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Ecological traps attract biota to low-quality habitats. Landscape traps are zones caught in a vortex of spiraling degradation. Here, we demonstrate how short-range endemic traits may make such taxa vulnerable to ecological and landscape traps. Three short-range endemic mygalomorph spider species were used in this study. Mygalomorphs can be long-lived ( > 40 years) and select sites for permanent burrows in their early dispersal phase. Spiderlings from two species demonstrated choice for microhabitats that correspond to where adults typically occur. An invasive veldt grass microhabitat was selected almost exclusively by spiderlings of the third species. Habitat dominated by veldt grass has lower prey diversity and abundance than undisturbed habitats and therefore acts as an ecological trap for this species. Furthermore, as a homogenising force, veldt grass can spread to form a landscape trap in naturally heterogeneous ecosystems. Selection of specialised microhabitats of short-range endemics may explain high extinction rates in old, stable landscapes undergoing (human-induced) rapid change.

Keywords: biotic homogenization, invasive species, mygalomorph, short-range endemic

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Authors: R. W. Walker, J. M. Lynch, K. Anderson, R. G. Middleton

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Hip and knee arthritis are two of the commonest conditions that result in elective orthopaedic outpatient referral. At clinic appointments advice given regarding lifestyle modifications or treatment options may not be fully understood by patients. The majority of patients now use the internet to research their condition and use this to inform their decision about treatments. This study assessed the quality of patient information regarding hip and knee arthritis. To assess the quality of patient information regarding knee and hip arthritis available on the internet. Two internet searches were carried out one month apart using the search terms “knee arthritis” and “hip arthritis” on Google, a search engine that accounts for over 90% or internet searches in the UK. Sites were evaluated using the DISCERN instrument, a validated tool for measuring the quality of consumer health information. The first 50 results for each search were analysed by two different observers and discrepancies in scores were reviewed by both observers together and a score was agreed upon. In total 200 search result websites were assessed, of which 84 fulfilled the inclusion criteria. 53% (n=44) were funded directly by commercial healthcare businesses and of these, 70% (n=31) were funded by a surgeon/hospital promoting end-user purchase of surgical intervention. Overall 35% (n=29) websites were “for-profit” information websites where funding was from advertising revenues from pharmaceutical and prosthesis companies. 81% (n=67) offered information about surgical treatments however only 43% (n=36) mentioned the risk of complications of surgery. 67% (n=56) did not have any reference to sources for the information they detailed and 57% (n=47) had no apparent date for the production of the information they offered. Overall 17% (n=14) of websites were judged as being of high quality, with 29% (n=24) being of moderate quality and 54% (n=45) being of low quality. The quality of health information regarding hip and knee arthritis on the internet is highly variable and the majority of websites assessed were of poor quality. A preponderance of websites were funded by a commercial surgical service offering athroplasty at consumer cost, with a further third being funded indirectly via advertising revenues from commercial businesses. The vast majority of websites only mentioned surgery as a treatment and nearly half of all websites did not mention the risks or complications of surgical intervention at all. This has implications for the consent process. As such, Clinicians should be aware of the heterogeneous nature of patient information on the internet and be prepared to advise their patients about good quality websites where further reliable information can be sought.

Keywords: hip osteoarthritis, informed consent, knee osteoarthritis, patient information

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Authors: Samira-Sadat JamaliDinan, Haidar Almohri, Mohammad-Reza Nazem-Zadeh

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Lateralization of temporal lobe epilepsy (TLE) is very important for positive surgical outcomes. We propose a machine learning framework to ultimately identify the epileptogenic hemisphere for temporal lobe epilepsy (TLE) cases using magnetoencephalography (MEG) coherence source imaging (CSI) and diffusion tensor imaging (DTI). Unlike most studies that use classification algorithms, we propose an effective clustering approach to distinguish between normal and TLE cases. We apply the famous Minkowski weighted K-Means (MWK-Means) technique as the clustering framework. To overcome the problem of poor initialization of K-Means, we use particle swarm optimization (PSO) to effectively select the initial centroids of clusters prior to applying MWK-Means. We demonstrate that compared to K-means and MWK-means independently, this approach is able to improve the result of a benchmark data set.

Keywords: temporal lobe epilepsy, machine learning, clustering, magnetoencephalography

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Authors: Maria Amelia V. C. Araujo, Billy J. Araujo, Brian Greenwood

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The flow over a backward-facing step is characterized by the presence of flow separation, recirculation and reattachment, for a simple geometry. This type of fluid behaviour takes place in many practical engineering applications, hence the reason for being investigated. Historically, fluid flows over a backward-facing step have been examined in many experiments using a variety of measuring techniques such as laser Doppler velocimetry (LDV), hot-wire anemometry, particle image velocimetry or hot-film sensors. However, some of these techniques cannot conveniently be used in separated flows or are too complicated and expensive. In this work, the applicability of the acoustic Doppler velocimetry (ADV) technique is investigated to such type of flows, at various Reynolds numbers corresponding to different flow regimes. The use of this measuring technique in separated flows is very difficult to find in literature. Besides, most of the situations where the Reynolds number effect is evaluated in separated flows are in numerical modelling. The ADV technique has the advantage in providing nearly non-invasive measurements, which is important in resolving turbulence. The ADV Nortek Vectrino+ was used to characterize the flow, in a recirculating laboratory flume, at various Reynolds Numbers (Reh = 3738, 5452, 7908 and 17388) based on the step height (h), in order to capture different flow regimes, and the results compared to those obtained using other measuring techniques. To compare results with other researchers, the step height, expansion ratio and the positions upstream and downstream the step were reproduced. The post-processing of the AVD records was performed using a customized numerical code, which implements several filtering techniques. Subsequently, the Vectrino noise level was evaluated by computing the power spectral density for the stream-wise horizontal velocity component. The normalized mean stream-wise velocity profiles, skin-friction coefficients and reattachment lengths were obtained for each Reh. Turbulent kinetic energy, Reynolds shear stresses and normal Reynolds stresses were determined for Reh = 7908. An uncertainty analysis was carried out, for the measured variables, using the moving block bootstrap technique. Low noise levels were obtained after implementing the post-processing techniques, showing their effectiveness. Besides, the errors obtained in the uncertainty analysis were relatively low, in general. For Reh = 7908, the normalized mean stream-wise velocity and turbulence profiles were compared directly with those acquired by other researchers using the LDV technique and a good agreement was found. The ADV technique proved to be able to characterize the flow properly over a backward-facing step, although additional caution should be taken for measurements very close to the bottom. The ADV measurements showed reliable results regarding: a) the stream-wise velocity profiles; b) the turbulent shear stress; c) the reattachment length; d) the identification of the transition from transitional to turbulent flows. Despite being a relatively inexpensive technique, acoustic Doppler velocimetry can be used with confidence in separated flows and thus very useful for numerical model validation. However, it is very important to perform adequate post-processing of the acquired data, to obtain low noise levels, thus decreasing the uncertainty.

Keywords: ADV, experimental data, multiple Reynolds number, post-processing

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Authors: Muhammad Tahir Khalily

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Aim: The purpose of the present study was to examine the effectiveness of alpha-theta brainwave Neuro feedback treatment for the internal self-exploration of individuals with conversion disorder. Method: A Purposive sample technique was used and data collected from Kalsoom International Hospital Islamabad and Al-Malik Medical Center Rawalpindi. 123 participants were examined, Male child = 5, female child = 6, male adult = 64, female adult = 48. This study retrospectively examined the symptomatic changes in clients with a range of psychiatric disorders particularly 13 (Male = 3, Female = 10) conversion disorder clients who have received Neuro feedback treatment. Results: Our results indicated a significant improvement (P < .001) in the amelioration of our clients’ symptoms which have enabled them to bring their emotional memories into conscious awareness for the peaceful resolution without self-detachment. Conclusion: Majority of the clients improved their psychiatric symptoms including the symptoms of conversion disorder and was discharged from therapy with the accomplishment of therapeutic goals.

Keywords: EEG, neurofeedback, conversion, therapy

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Authors: S. Sudhakar, Geetha Manjunath, Siva Teja Kakileti, Himanshu Madhu

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Diagnosis of breast cancer at early stages has seen better clinical and survival outcomes. Survival rates in developing countries like India are very low due to accessibility and affordability issues of screening tests such as Mammography. In addition, Mammography is not much effective in younger women with dense breasts. This leaves a gap in current screening methods. Thermalytix is a new technique for detecting breast abnormality in a non-contact, non-invasive way. It is an AI-enabled computer-aided diagnosis solution that automates interpretation of high resolution thermal images and identifies potential malignant lesions. The solution is low cost, easy to use, portable and is effective in all age groups. This paper presents the results of a retrospective comparative analysis of Thermalytix over Mammography and Clinical Breast Examination for breast cancer screening. Thermalytix was found to have better sensitivity than both the tests, with good specificity as well. In addition, Thermalytix identified all malignant patients without palpable lumps.

Keywords: breast cancer screening, radiology, thermalytix, artificial intelligence, thermography

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Authors: Awais Naeem, Osama Shakeel, Aamir Ali Syed, Shahid Khattak

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Introduction: Laparoscopic right hemicolectomy is an advanced cancer surgery in today's era. The aim of this study was to evaluate the surgical and initial oncological outcomes after curative, laparoscopic resection of right sided colonic tumors. Also to compare our results with those of previous randomized trials. Methods And Procedures: We retrospectively analyzed the medical record files of all the patients who presented to our hospital with the diagnosis of right sided colon carcinoma from January 2012 to December 2017 and underwent laparoscopic right hemicolectomy. Demographics, operative findings and histopathological reports were all recorded on a preformed data sheet. All the analysis was performed on SPSS 20. Results: Total of 48 patients were included. There were 37 male and 11 female patients with mean age of 49.7 (range from 25 – 82). Mean hospital stay was 8.25 ± 3.17 days. Blood loss was 80mls and operative mean time was 240 minutes. Eighteen patients had extended right hemicolectomy. Median length of the specimen retrieved was 31cm (range, 14-59cm). Mean size of tumor was 6.44cm + 2.53. Total number of lymph nodes removed was 20.5 + 8.3. All had R0 resection. Post-operatively 2 patients had pelvic collection and there was no 30 day mortality. In 33 patients there was T3 disease, 5 had T2 and 10 had T4 disease. There was distant recurrence in 4 patients with peritoneal metastasis in 3 and liver metastasis in 1 patient. Forty-six patients are still alive and 44 are disease free. The mean follow-up period was 25.31 (12 to 60) months. Conclusion: Our early experience with Laparascopic Right hemicolectomy as a safe and oncologically feasible surgical option. We attained comparable surgical results with curative intent.

Keywords: right hemicolectomy, right sided colonic tumors, laparoscopic, curative intent

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Authors: Ke Lin, Steve Wu Qing Yang, Zhang Nan

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The medicine and drugs has in the past been manufactured to the final products and then used laboratory analysis to verify their quality. However the industry needs crucially a monitoring technique for the final batch to batch quality check. The introduction of process analytical technology (PAT) provides an incentive to obtain real-time information about drugs on the production line, with the following optical techniques being considered: near-infrared (NIR) spectroscopy, Raman spectroscopy and imaging, mid-infrared spectroscopy with the use of chemometric techniques to quantify the final product. However, presents problems in that the spectra obtained will consist of many combination and overtone bands of the fundamental vibrations observed, making analysis difficult. In this work, we describe a non-destructive system and method for capsule and liquid medicine identification, more particularly, using terahertz time-domain spectroscopy and/or designed terahertz portable system for identifying different types of medicine in the package of capsule or in liquid medicine bottles. The target medicine can be detected directly, non-destructively and non-invasively.

Keywords: terahertz, non-destructive, non-invasive, chemical identification

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Authors: Yun-Shan Tsai, Si-Ping Lin, En-Chieh Lin, Xin-Hong Chen, Shin-Yun Ho, Shin-Hong Huang, Ching-ju Hsieh

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Background and significance: Uncorrected refractive errors and cataracts are the main visually debilitating ophthalmological abnormalities in adult participants with intellectual disability (ID). However, not all adult participants with ID may receive a regular and timely ophthalmological assessment. Consequently, some of the ocular diseases may not be diagnosed until late, thereby causing unnecessary ocular morbidity. In addition, recent clinical practice and researches have also suggested that eye-care services for this group are neglected. Purpose: To investigate the unmet need for eye care services, clinical characteristics of cataract, visual function, surgical outcome and prognostic predictors in adult participants with ID at Taipei City Hospital in Taiwan. Methods: This is a one-year prospective clinical study. We recruited about 120 eyes of 60 adult participants with ID who were received cataract surgery. Caregivers of all participants received a questionnaire on current eye care services. Clinical demographic data, such as age, gender, and associated systemic diseases or syndromes, were collected. All complete ophthalmologic examinations were performed 1 month preoperatively and 3 months postoperatively, including ocular biometry, visual function, refractive status, morphology of cataract, associated ocular features, anesthesia methods, surgical types, and complications. Morphology of cataract, visual and surgical outcome was analyzed. Results: A total of 60 participants with mean age 43.66 ± 13.94 years, including 59.02% male and 40.98% female, took part in comprehensive eye-care services. The prevalence of unmet need for eye care services was high (about 70%). About 50% of adult participants with ID have bilateral cataracts at the time of diagnosis. White cataracts were noted in about 30% of all adult participants with ID at the time of presentation. Associated ocular disorders were included myopic maculopathy (4.54%), corneal disorders (11.36%), nystagmus (20.45%), strabismus (38.64%) and glaucoma (2.27%). About 26.7% of adult participants with ID underwent extracapsular cataract extraction whereas a phacoemulsification was performed in 100% of eyes. Intraocular lens implantation was performed in all eyes. The most common postoperative complication was posterior capsular opacification (30%). The mean best-corrected visual acuity was significantly improved from preoperatively (mean log MAR 0.48 ± 0.22) to at 3 months postoperatively (mean log MAR 0.045 ± 0.22) (p < .05). Conclusions: Regular follow up will help address the need for eye-care services in participants with ID. A high incidence of bilateral cataracts, as well as white cataracts, was observed in adult participants with ID. Because of early diagnosis and early intervention of cataract, the visual and surgical outcomes of cataract are good, but the visual outcomes are suboptimal due to associated ocular comorbidities.

Keywords: adult participants with intellectual disability, cataract, cataract surgery

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Authors: Ahmed Abdallatif

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Background: Patients with malignant germ cell tumors have age distribution in two peaks, with the first one during infancy and the second after the onset of puberty. Gonadal germ cell tumors are the most common malignant ovarian tumor in females aged below twenty years. Sacrococcygeal and retroperitoneal abdominal tumors usually presents in a large size before the onset of symptoms. Methods: Patients with pediatric germ cell tumors presenting to Children’s Cancer Hospital Egypt and National Cancer Institute Egypt from January 2008 to June 2011 Patients underwent stratification according to risk into low, intermediate and high risk groups according to children oncology group classification. Objectives: Assessment of the clinicopathologic features of all cases of pediatric germ cell tumors and classification of malignant cases according to their stage, and the primary site to low, intermediate and high risk patients. Evaluation of surgical management in each group of patients focusing on surgical approach, the extent of surgical resection according to each site, ability to achieve complete surgical resection and perioperative complications. Finally, determination of the three years overall and disease-free survival in different groups and the relation to different prognostic factors including the extent of surgical resection. Results: Out of 131 cases surgically explored only 26 cases had re exploration with 8 cases explored for residual disease 9 cases for remote recurrence or metastatic disease and the other 9 cases for other complications. Patients with low risk kept under follow up after surgery, out of those of low risk group (48 patients) only 8 patients (16.5%) shifted to intermediate risk. There were 20 patients (14.6%) diagnosed as intermediate risk received 3 cycles of compressed (Cisplatin, Etoposide and Bleomycin) and all high risk group patients 69patients (50.4%) received chemotherapy. Stage of disease was strongly and significantly related to overall survival with a poorer survival in late stages (stage IV) as compared to earlier stages. Conclusion: Overall survival rate at 3 three years was (76.7% ± 5.4, 3) years EFS was (77.8 % ±4.0), however 3 years DFS was much better (89.8 ± 3.4) in whole study group with ovarian tumors had significantly higher Overall survival (90% ± 5.1). Event Free Survival analysis showed that Male gender was 3 times likely to have bad events than females. Patients who underwent incomplete resection were 4 times more than patients with complete resection to have bad events. Disease free survival analysis showed that Patients who underwent incomplete surgery were 18.8 times liable for recurrence compared to those who underwent complete surgery, and patients who were exposed to re-excision were 21 times more prone to recurrence compared to other patients.

Keywords: extragonadal, germ cell tumors, gonadal, pediatric

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Authors: Lubomir Vecera, Tomas Gabrhelik, Benjamin Tolmaci, Josef Srovnal, Emil Berta, Petr Prasil, Petr Stourac

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Cancer is the second leading cause of death worldwide and colon cancer is the second most common type of cancer. Currently, there are only a few studies evaluating the effect of postoperative analgesia on the prognosis of patients undergoing radical colon cancer surgery. Postoperative analgesia in patients undergoing colon cancer surgery is usually managed in two ways, either with strong opioids (morphine, piritramide) or epidural analgesia. In our prospective study, we evaluated the effect of postoperative analgesia on the presence of circulating tumor cells or minimal residual disease after colon cancer surgery. A total of 60 patients who underwent radical colon cancer surgery were enrolled in this prospective, randomized, two-center study. Patients were randomized into three groups, namely piritramide, morphine and postoperative epidural analgesia. We evaluated the presence of carcinoembryonic antigen (CEA) and cytokeratin 20 (CK-20) mRNA positive circulating tumor cells in peripheral blood before surgery, immediately after surgery, on postoperative day two and one month after surgery. The presence of circulating tumor cells was assessed by quantitative real-time reverse transcriptase-polymerase chain reaction (qRT-PCR). In the priritramide postoperative analgesia group, the presence of CEA mRNA positive cells was significantly lower on a postoperative day two compared to the other groups (p=0.04). The value of CK-20 mRNA positive cells was the same in all groups on all days. In all groups, both types of circulating tumor cells returned to normal levels one month after surgery. Demographic and baseline clinical characteristics were similar in all groups. Compared with morphine and epidural analgesia, piritramide significantly reduces the amount of CEA mRNA positive circulating tumor cells after radical colon cancer surgery.

Keywords: cancer progression, colon cancer, minimal residual disease, perioperative analgesia.

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Authors: Michelle Roesler, Ian Glendon, Francis O'Callaghan

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This study expands on recent findings and offers a new perspective on recovery from injury and return to work (RTW) after an acute traumatic occupational hand injury. Recovery is a complex medical and psychosocial process. A number of predictor variables were studied simultaneously to identify the bio-psychosocial variables that impede recovery. An unexpected phenomenon to emerge from this study was the high incidence of complications within the hand-injured patient sample. Twenty six percent (n = 71) of the total sample (N = 263) required a second operation due to complications. This warranted further investigation. Results confirmed that complications not only significantly delayed the RTW outcome but also had a profound psychological impact on the individuals affected. Research has found that surgical complications are usually the result of incorrect early assessment and management. A strategic plan needs to be implemented to ensure the optimal level of surgical care is provided for managing acute traumatic hand injuries to avoid such complications.

Keywords: occupational hand trauma, psychological recovery, return to work, psychology

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Authors: T. K. Tee, M. N. A. Azman, S. Mohamed, M. Muhammad, M. M. Mohamad, J. Md Yunos, M. H. Yee, W. Othman

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Buzan mind mapping is an efficient system of note-taking that makes revision a fun thing to do for students. Tony Buzan has been teaching children all over the world for the past thirty years and has proved that mind maps are the magic formula in the classroom for everyone. The purpose of this paper is to discuss the importance of Buzan mind mapping as a note-taking technique for the secondary school students. This paper also examines the mind mapping technique, advantages and disadvantages of hand-drawn mind maps. Samples of students’ mind maps were presented and discussed.

Keywords: Buzan mind mapping, note-taking technique, hand-drawn, mind maps

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Authors: Andriana Purnama, Reno Rudiman, Kezia Christy

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Anal stenosis which develops due to anoderm scarring usually caused by secondary to surgical trauma, has become common, causing significant decrease patient’s quality of life. Even though mild anal stenosis was treated with non-surgical treatment, but surgical reconstruction in unavoidable for moderate to severe anal stenosis that cause distressing, severe anal pain and inability to defecate. In our study, we intend to share our result with the use of diamond flap in treatment of anal stenosis. This case report illustrates a 57-year-old male patient who presented with difficulty and discomfort in defecation caused by anal stenosis after 2 years of open hemorrhoidectomy surgery. At physical examination, there was requirement of forceful dilatation when the index finger was inserted or precisely 6mm as measured by hegar dilator (moderate anal stenosis). Blood test result was within normal limits. The patient underwent anal repair and diamond flap where the scar tissue at 6 and 9 o’clock directions was excised and diamond graft was incised carefully while paying attention to the vascular supply. Finally, the graft was fixated without any tension to the anal canal, resulting in diameter of 2 cm after operation. After 2 days post operation, the patient was in stable condition, without any complication, and discharged. There was no abnormality concerning the stool. Ten days after the operation, diamond flap was in normal condition and without any complication. He was scheduled for futher follow up at the Digestive Surgery Department. Anal stenosis due to overzealous hemorrhoidectomy is a complication that is preventable when performed in experienced hands. Diamond flap was one of the options for the anal stenosis treatment with less complication.

Keywords: anal stenosis, diamond flap, post hemorrhoidectomy, anal repair

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Authors: Siraa Ben Ftima, Mourad Talbi, Tahar Ezzedine

Abstract:

In this paper, we present a technique of secure watermarking of grayscale and color images. This technique consists in applying the Singular Value Decomposition (SVD) in LWT (Lifting Wavelet Transform) domain in order to insert the watermark image (grayscale) in the host image (grayscale or color image). It also uses signature in the embedding and extraction steps. The technique is applied on a number of grayscale and color images. The performance of this technique is proved by the PSNR (Pick Signal to Noise Ratio), the MSE (Mean Square Error) and the SSIM (structural similarity) computations.

Keywords: lifting wavelet transform (LWT), sub-space vectorial decomposition, secure, image watermarking, watermark

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Authors: Mohamed El Horri, Amine Mouden, Reda Messaoudi, Mohamed Chekkal, Driss Benlaldj, Malika Baghdadi, Lahcene Benmahdi, Fatima Seghier

Abstract:

Background/aim: Recently, the Von Willebrand factor antigen (vWF-Ag)has been identified as a new marker of portal hypertension (PH) and its complications. Few studies talked about its role in the prediction of esophageal varices. VWF-Ag is considered a non-invasive approach, In order to avoid the endoscopic burden, cost, drawbacks, unpleasant and repeated examinations to the patients. In our study, we aimed to evaluate the ability of this marker in the prediction of another complication of portal hypertension, which is portal hypertensive gastropathy (PHG), the one that is diagnosed also by endoscopic tools. Patients and methods: It is about a prospective study, which include 124 cirrhotic patients with no history of bleeding who underwent screening endoscopy for PH-related complications like esophageal varices (EVs) and PHG. Routine biological tests were performed as well as the VWF-Ag testing by both ELFA and Immunoturbidimetric techniques. The diagnostic performance of our marker was assessed using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and receiver operating characteristic curves. Results: 124 patients were enrolled in this study, with a mean age of 58 years [CI: 55 – 60 years] and a sex ratio of 1.17. Viral etiologies were found in 50% of patients. Screening endoscopy revealed the presence of PHG in 20.2% of cases, while for EVsthey were found in 83.1% of cases. VWF-Ag levels, were significantly increased in patients with PHG compared to those who have not: 441% [CI: 375 – 506], versus 279% [CI: 253 – 304], respectively (p <0.0001). Using the area under the receiver operating characteristic curve (AUC), vWF-Ag was a good predictor for the presence of PHG. With a value higher than 320% and an AUC of 0.824, VWF-Ag had an 84% sensitivity, 74% specificity, 44.7% positive predictive value, 94.8% negative predictive value, and 75.8% diagnostic accuracy. Conclusion: VWF-Ag is a good non-invasive low coast marker for excluding the presence of PHG in patients with liver cirrhosis. Using this marker as part of a selective screening strategy might reduce the need for endoscopic screening and the coast of the management of these kinds of patients.

Keywords: von willebrand factor, portal hypertensive gastropathy, prediction, liver cirrhosis

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Authors: H. N. Alyaseen, S. E. Alalawi, T. Cordoba, É. Delisle, C. Cordoba, A. Odobescu

Abstract:

Sternal dehiscence is defined as the persistent separation of sternal bones that are often complicated with mediastinitis. Etiologies that lead to sternal dehiscence vary, with cardiovascular and thoracic surgeries being the most common. Early diagnosis in susceptible patients is crucial to the management of such cases, as they are associated with high mortality rates. A recent meta-analysis of more than four hundred thousand patients concluded that deep sternal wound infections were the leading cause of mortality and morbidity in patients undergoing cardiac procedures. Long-term complications associated with sternal dehiscence include increased hospitalizations, cardiac infarctions, and renal and respiratory failures. Numerous osteosynthesis methods have been described in the literature. Surgical materials offer enough rigidity to support the sternum and can be flexible enough to allow physiological breathing movements of the chest; however, these materials fall short when managing patients with extensive bone loss, osteopenia, or general poor bone quality, for such cases, flaps offer a better closure system. Early utilization of flaps yields better survival rates compared to delayed closure or to patients treated with sternal rewiring and closed drainage. The utilization of pectoralis major flaps, rectus abdominus, and latissimus muscle flaps have all been described in the literature as great alternatives. Flap selection depends on a variety of factors, mainly the size of the sternal defect, infection, and the availability of local tissues. Free fibular flaps are commonly harvested flaps utilized in reconstruction around the body. In cases regarding sternal reconstruction with free fibular flaps, the literature exclusively discussed the flap applied vertically to the chest wall. We present a different technique applying the free fibular triple barrel flap oriented in a transverse manner, in parallel to the ribs. In our experience, this method could have enhanced results and improved prognosis as it contributes to the normal circumferential shape of the chest wall.

Keywords: sternal dehiscence, management, free fibular flaps, novel surgical techniques

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Authors: Palak V. Patel, Jessica Pixley, Steven R. Feldman

Abstract:

Introduction: Basal cell carcinoma (BCC) is the most common skin cancer worldwide and requires substantial resources to treat. When choosing between indicated therapies, providers consider their associated adverse effects, efficacy, cosmesis, and function preservation. The patient’s tumor burden, infiltrative risk, and risk of tumor recurrence are also considered. Treatment cost is often left out of these discussions. This can lead to financial toxicity, which describes the harm and quality of life reductions inflicted by high care costs. Methods: We studied the guidelines set forth by the American Academy of Dermatology for the treatment of BCC. A PubMed literature search was conducted to identify the costs of each recommended therapy. We discuss costs alongside treatment efficacy and side-effect profile. Results: Surgical treatment for BCC can be cost-effective if the appropriate treatment is selected for the presenting tumor. Curettage and electrodesiccation can be used in low-grade, low-recurrence tumors in aesthetically unimportant areas. The benefits of cost-conscious care are not likely to be outweighed by the risks of poor cosmesis or tumor return ($471 BCC of the cheek). When tumor burden is limited, MMS offers better cure rates and lower recurrence rates than surgical excision, and with comparable costs (MMS $1263; SE $949). Surgical excision with permanent sections may be indicated when tumor burden is more extensive or if molecular testing is necessary. The utility of surgical excision with frozen sections, which costs substantially more than MMS without comparable outcomes, is less clear (SE with frozen sections $2334-$3085). Less data exists on non-surgical treatments for BCC. These techniques cost less, but recurrence-risk is high. Side-effects of nonsurgical treatment are limited to local skin reactions, and cosmesis is good. Cryotherapy, 5-FU, and MAL-PDT are all more affordable than surgery, but high recurrence rates increase risk of secondary financial and psychosocial burden (recurrence rates 21-39%; cost $100-270). Radiation therapy offers better clearance rates than other nonsurgical treatments but is associated with similar recurrence rates and a significantly larger financial burden ($2591-$3460 BCC of the cheek). Treatments for advanced or metastatic BCC are extremely costly, but few patients require their use, and the societal cost burden remains low. Vismodegib and sonidegib have good response rates but substantial side effects, and therapy should be combined with multidisciplinary care and palliative measures. Expert-review has found sonidegib to be the less expensive and more efficacious option (vismodegib $128,358; sonidegib $122,579). Platinum therapy, while not FDA-approved, is also effective but expensive (~91,435). Immunotherapy offers a new line of treatment in patients intolerant of hedgehog inhibitors ($683,061). Conclusion: Dermatologists working within resource-compressed practices and with resource-limited patients must prudently manage the healthcare dollar. Surgical therapies for BCC offer the lowest risk of recurrence at the most reasonable cost. Non-surgical therapies are more affordable, but high recurrence rates increase the risk of secondary financial and psychosocial burdens. Treatments for advanced BCC are incredibly costly, but the low incidence means the overall cost to the system is low.

Keywords: nonmelanoma skin cancer, basal cell skin cancer, squamous cell skin cancer, cost of care

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Authors: Garg Ramneesh, Uppal Sanjeev, Mittal Rajinder, Shah Sheerin, Jain Vikas, Singla Bhupinder

Abstract:

Introduction: Despite advances in trauma care, a classification system for soft tissue injuries of the face still needs to be objectively defined. Aim: To develop a classification system for soft tissue injuries of the face; that is objective, easy to remember, reproducible, universally applicable, aids in surgical management and helps to develop a structured data that can be used for future use. Material and Methods: This classification system includes those patients that need surgical management of facial injuries. Associated underlying bony fractures have been intentionally excluded. Depending upon the severity of soft tissue injury, these can be graded from 0 to IV (O-Abrasions, I-lacerations, II-Avulsion injuries with no skin loss, III-Avulsion injuries with skin loss that would need graft or flap cover, and IV-complex injuries). Anatomically, the face has been divided into three zones (Zone 1/2/3), as per aesthetic subunits. Zone 1e stands for injury of eyebrows; Zones 2 a/b/c stand for nose, upper eyelid and lower eyelid respectively; Zones 3 a/b/c stand for upper lip, lower lip and cheek respectively. Suffices R and L stand for right or left involved side, B for presence of foreign body like glass or pellets, C for extensive contamination and D for depth which can be graded as D 1/2/3 if depth is still fat, muscle or bone respectively. I is for damage to facial nerve or parotid duct. Results and conclusions: This classification system is easy to remember, clinically applicable and would help in standardization of surgical management of soft tissue injuries of face. Certain inherent limitations of this classification system are inability to classify sutured wounds, hematomas and injuries along or against Langer’s lines.

Keywords: soft tissue injuries, face, avulsion, classification

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Authors: Reem Al-Shidhani, Isabelle S. R. Storer, Michael J. Bromley, Lydia Tabernero

Abstract:

Invasive fungal diseases are an increasing global health concern that contributes to the high mortality rates in immunocompromised patients. The rising of antifungal resistance severely lowers the efficacy of the limited antifungal agents available. New antifungal drugs that target new mechanisms are necessary to tackle the current shortfalls. Amongst post- modifications, phosphorylation is a predominant and an outstanding protein alteration in all eukaryotes. In fungi, protein phosphorylation plays a vital role in many signal transduction pathways, including cell cycle, cell growth, metabolism, transcription, differentiation, proliferation, and virulence. The investigation of Aspergillus fumigatus phosphatases revealed seven genes essential for viability. Inhibiting one of these phosphatases is a new interesting route to develop novel antifungal drugs. In this study, we carried out an early drug discovery process targeting oneessential phosphatase, GlcA. Here, we report the identification of new GlcA inhibitors that show antifungal activity. These important finding open a new avenue to the development of novel antifungals to expand the current narrow arsenal of clinical candidates.

Keywords: invasive fungal diseases, phosphatases, GlcA, competitive inhibitors

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Authors: Saghar Karimi, Mohammad Saeed Ahrari Khafi, Amin Abolhasani Foroughi

Abstract:

In recent decades, keeping exotic species as pet animals has become widespread. Turtles are exotic species from chelonians, which are interested by many people. Caspian pond and European pond turtles from Emydidea family are commonly kept as pets in Iran. Presence of the shell in turtles makes achievement to a comprehensive clinical examination impossible. Respiratory system is one of the most important structures to be examined completely. Presence of the air in the respiratory system makes radiography the first modality to think of; however, image quality would be affected by the shell. Computed tomography (CT) as a radiography-based and non-invasive technique provides cross-sectional scans with little superimposition. The aim of this study was to depict normal computed tomographic anatomy of the respiratory system in Caspian Pond Turtle. Five adult Caspian pond turtle were scanned using a 16-detector CT machine. Our results showed that computed tomography is able to well illustrated different parts of respiratory system in turtle and can be used for detecting abnormalities and disorders.

Keywords: anatomy, computed tomography, respiratory system, turtle

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Authors: Davina Von Hagt, Genevieve Gibbons, Matt Henderson, Tom Bowles

Abstract:

Purpose: Food bolus obstructions are common emergency surgical presentations, but there is no established management guideline in a rural setting. Intervention usually involves endoscopic removal after initial medical management has failed. Within a rural setting, this falls upon the general surgeon. There are varied endoscopic techniques that may be used. Methodology: A review of the past fifty cases of food bolus obstruction managed at Albany Health Campus was retrospectively reviewed to assess endoscopic findings and techniques. Operation notes, histopathology, imaging, and patient notes were reviewed. Results: 50 patients underwent gastroscopy for food bolus obstruction from August 2017 to March 2021. Ages ranged from 11 months to 95 years, with the majority of patients aged between 30-70 years. 88% of patients were male. Meat was the most common bolus (20% unspecified, 20% steak, 10% chicken, 6% lamb, 4% sausage, 2% pork). At endoscopy, 12% were found not to have a food bolus obstruction. Two patients were found to have oesophageal cancer, and four patients had a stricture and required dilatation. A variety of methods were used to relieve oesophageal obstruction ranging from pushing through to stomach (24 patients), using an overtube (10 patients), raptor (13 patients), and less common instruments such as Roth net, basket, guidewire, and pronged grasper. One patient had an unsuccessful endoscopic retrieval and required theatre for laparoscopic assisted removal with rendezvous endoscopic piecemeal removal via oesophagus and gastrostomy. Conclusion: Food bolus obstruction is a common emergency presentation. Within the rural setting, management requires innovation and teamwork within the safety of the local experience.

Keywords: food bolus obstruction, regional hospital, surgical management, innovative surgical treatment

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Authors: Vasuki Rayapati, Bhanu Duggal

Abstract:

Trans catheter aortic valve replacement (TAVR) is the recommended treatment over surgical aortic valve replacement (SAVR) for high-risk groups, patients >75 years of age with severe symptomatic Aortic stenosis (AS). In high income countries TAVR is more cost effective because of – i) Reduction in total length of stay including less number of days in ICU ii) Non-procedural costs like cost of general anaesthesia are higher for SAVR. In India, there are two kinds of hospitals – Public and Private. Most patients visit public sector hospitals than private sector hospitals. In a LMIC like India, especially in the Public health sector cost of TAVR is prohibitive. In a small study from three (public) hospitals in India, it was envisaged that cost of TAVR should decrease at least by 2/3 to be a cost effective option in Public health sector for severe AS.

Keywords: cost effectiveness, TAVR vs SAVR, LMIC, HTA

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