Search results for: nasolacrimal duct obstruction

Authors: Abraham J. Rizkalla, Tristan D. Yan

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Atrial myxoma is the most common primary cardiac tumor, and can result in cardiac failure secondary to obstruction, or systemic embolism due to fragmentation. Traditionally, excision of atrial an myxoma has been performed through median sternotomy, however the robotic approach offers several advantages including less pain, improved cosmesis, and faster recovery. Here, we highlight the less well recognized advantages and technical aspects to robotic myxoma resection. This video-presentation demonstrates the resection of a papillary subtype left atrial myxoma using the DaVinci© Xi surgical robot. The 10x magnification and 3D vision allows for the interface between the tumor and the interatrial septum to be accurately dissected, without the need to patch the interatrial septum. Several techniques to avoid tumor fragmentation and embolization are demonstrated throughout the procedure. The tumor was completely excised with clear margins. There was no atrial septal defect or mitral valve injury on post operative transesophageal echocardiography. The patient was discharged home on the fourth post-operative day. This video-presentation highlights the advantages of the robotic approach in atrial myxoma resection compared with sternotomy, as well as emphasizing several technical considerations to avoid potential complications.

Keywords: cardiac surgery, left atrial myxoma, cardiac tumour, robotic resection

Procedia PDF Downloads 48

Authors: H. H. Goh, K. C. Goh, T. W. Seow, N. S. Said, S. E. P. Ang

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Malaysia is rich with historic buildings, particularly in Penang and Malacca states. Restoration activities are increasingly important as these states are recognized under UNESCO World Heritage Sites. Restoration activities help to maintain the uniqueness and value of a heritage building. However, increasing in restoration activities has resulted in large quantities of waste. To cope with this problem, the 3R concept (reduce, reuse and recycle) is introduced. The 3R concept is one of the waste management hierarchies. This concept is still yet to apply in the building restoration industry compared to the construction industry. Therefore, this study aims to promote the 3R concept in the heritage building restoration industry. This study aims to examine the importance of 3R concept and to identify challenges in applying the 3R concept in the heritage building restoration industry. This study focused on contractors and consultants who are involved in heritage restoration projects in Penang. Literature review and interviews helps to reach the research objective. Data that obtained is analyzed by using content analysis. For the research, application of 3R concept is important to conserve natural resources and reduce pollution problems. However, limited space to organise waste is the obstruction during the implementation of this concept. In conclusion, the 3R concept plays an important role in promoting environmental conservation and helping in reducing the construction waste

Keywords: 3R Concept, heritage building, restoration activities, building science

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Authors: Raana Babadi Fathipour

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Nourishment nanotechnology is an range of rising intrigued and opens up a entirety universe of modern conceivable outcomes for the nourishment industry. The essential categories of nanotechnology applications and functionalities right now within the improvement of nourishment bundling incorporate: the enhancement of plastic materials obstructions, the consolidation of dynamic components that can convey utilitarian properties past those of customary dynamic bundling, and the detecting and signaling of significant data. Nano nourishment bundling materials may amplify nourishment life, move forward nourishment security, alarm buyers that nourishment is sullied or ruined, repair tears in bundling, and indeed release preservatives to expand the life of the nourishment within the bundle. Nanotechnology applications within the nourishment industry can be utilized to identify microbes in bundling, or produce stronger flavors and color quality, and security by expanding the obstruction properties. Nanotechnology holds extraordinary guarantee to supply benefits not fair inside nourishment items but too around nourishment items. In reality, nanotechnology presents modern chances for advancement within the nourishment industry at monstrous speed, but instability and wellbeing concerns are moreover developing. EU/WE/global enactment for the direction of nanotechnology in nourishment are scanty. Besides, current enactment shows up unacceptable to nanotechnology specificity.

Keywords: nano technology, nano foods, food packaging, nano participle

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Authors: Bao Liu, Maarten Vanierschot, Frank Buysschaert

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The present work examines the wake dynamics of a rim-driven thruster (RDT) with Computational Fluid Dynamics (CFD). Unsteady Reynolds-averaged Navier-Stokes (URANS) equations were solved in the commercial solver ANSYS Fluent in combination with the SST k-ω turbulence model. The application of the moving reference frame (MRF) and sliding mesh (SM) approach to handling the rotational movement of the propeller were compared in the transient simulations. Validation and verification of the numerical model was performed to ensure numerical accuracy. Two representative scenarios were considered, i.e., the bollard condition (J=0) and a very light loading condition(J=0.7), respectively. From the results, it’s confirmed that compared to the SM method, the MRF method is not suitable for resolving the unsteady flow features as it only gives the general mean flow but smooths out lots of characteristic details in the flow field. By evaluating the simulation results with the SM technique, the instantaneous wake flow field under both conditions is presented and analyzed, most notably the helical vortex structure. It’s observed from the results that the tip vortices, blade shed vortices, and hub vortices are present in the wake flow field and convect downstream in a highly non-linear way. The shear layer vortices shedding from the duct displayed a strong interaction with the distorted tip vortices in an irregularmanner.

Keywords: computational fluid dynamics, rim-driven thruster, sliding mesh, wake dynamics

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Authors: Xi-Wen Xiao, Tzy-Rong Lin, Chien-Hao Liu

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Ventilated acoustic metamaterials have attracted considerable research attention due to their low-frequency absorptions and efficient fluid ventilations. In this research, a wideband acoustic metamaterial with auditory filtering ability and efficient ventilation capacity were proposed. In contrast to a conventional Fano-like resonator, a Fano-like resonator composed of a resonant unit and two nonresonant units with a large opening area of 68% for fluid passages was developed. In addition, the coupling mechanism to improve the narrow bandwidths of conventional Fano-resonance-based meta-materials was included. With a suitable design, the output sound waves of the resonant and nonresonant states were out of phase to achieve sound absorptions in the far fields. Therefore, three-element and five-element coupled Fano-like metamaterials were designed and simulated with the help of the finite element software to obtain the filtering fractional bandwidths of 42.5% and 61.8%, respectively. The proposed approach can be extended to multiple coupled resonators for obtaining ultra-wide bandwidths and can be implemented with 3D printing for practical applications. The research results are expected to be beneficial for sound filtering or noise reductions in duct applications and limited-volume spaces.

Keywords: fano resonance, noise reduction, resonant coupling, sound filtering, ventilated acoustic metamaterial

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Authors: Rong-Terng Juang

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Autonomous vehicles offer the possibility of significant benefits to social welfare. However, fully automated cars might not be going to happen in the near further. To speed the adoption of the self-driving technologies, many governments worldwide are passing laws requiring data recorders for the testing of autonomous vehicles. Currently, the self-driving vehicle, (e.g., shuttle bus) has to be monitored from a remote control center. When an autonomous vehicle encounters an unexpected driving environment, such as road construction or an obstruction, it should request assistance from a remote operator. Nevertheless, large amounts of data, including images, radar and lidar data, etc., have to be transmitted from the vehicle to the remote center. Therefore, this paper proposes a data compression method of in-vehicle networks for remote monitoring of autonomous vehicles. Firstly, the time-series data are rearranged into a multi-dimensional signal space. Upon the arrival, for controller area networks (CAN), the new data are mapped onto a time-data two-dimensional space associated with the specific CAN identity. Secondly, the data are sampled based on differential sampling. Finally, the whole set of data are encoded using existing algorithms such as Huffman, arithmetic and codebook encoding methods. To evaluate system performance, the proposed method was deployed on an in-house built autonomous vehicle. The testing results show that the amount of data can be reduced as much as 1/7 compared to the raw data.

Keywords: autonomous vehicle, data compression, remote monitoring, controller area networks (CAN), Lidar

Procedia PDF Downloads 133

Authors: P. Deepak Kumar, P. R. Maiti

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In recent years, sediment scour near bridge piers and abutment is a serious problem which causes nationwide concern because it has resulted in more bridge failures than other causes. Scour is the formation of scour hole around the structure mounted on and embedded in erodible channel bed due to the erosion of soil by flowing water. The formation of scour hole around the structures depends upon shape and size of the pier, depth of flow as well as angle of attack of flow and sediment characteristics. The flow characteristics around these structures change due to man-made obstruction in the natural flow path which changes the kinetic energy of the flow around these structures. Excessive scour affects the stability of the foundation of the structure by the removal of the bed material. The accurate estimation of scour depth around bridge pier is very difficult. The foundation of bridge piers have to be taken deeper and to provide sufficient anchorage length required for stability of the foundation. In this study, computational model simulations using a 3D Computational Fluid Dynamics (CFD) model were conducted to examine the mechanism of scour around a cylindrical pier. Subsequently, the flow characteristics around these structures are presented for different flow conditions. Mechanism of scouring phenomenon, the formation of vortex and its consequent effect is discussed for a straight channel. Effort was made towards estimation of scour depth around bridge piers under different flow conditions.

Keywords: bridge pier, computational fluid dynamics, multigrid, pier shape, scour

Procedia PDF Downloads 262

Authors: Sarwan Hasan

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This article is to investigate the main forms and causes of corruption and provides anti-corruption policies. It is significant to find out how both interact and affect each other. The research focuses particularly on the case study of Iraq from 2003 to 2023. In this way, the main methods of analysis will be the system approach to analyze the relationship of different elements of the political system of Iraq in the context of corruption, the process-tracing method to explain the reasons for corruption, and content analysis of the official documents important for the research topic. Moreover, the SWOT analysis will be used in the part about the anti-corruption policies. This article concludes that the main causes behind corruption in Iraq are power distribution based on muhassasa tayifiya (power apportionment based on ethno-sectarianism), decentralized political system, sectarian division, Iran, and socio-cultural structure. The main forms of corruption in the country are illegal enrichment, using public positions for sectarian agenda, criminal corruption, bribery, political patronage, clientelism, cronyism, nepotism, embezzlement, kickback, extortion, money laundry, speed money, theft, and justice obstruction. The main anti-corruption policies in Iraq are establishing the Commission of Integrity, Board of Supreme Audit, Inspectors General and Parliamentary Committee, Internalization (assistance from foreign actors), economic adjustment and financial reform, and the new anti-corruption program of the new Prime Minister (Mohamed Shiyah al-Sudani).

Keywords: anti-corruption, corruption, Iraq, anti-corruption policies

Procedia PDF Downloads 46

Authors: Jonathan Andres Pullas Navarrete, Ernesto Hale de la Torre Chauvin

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In this work, the antibacterial effect of activated carbon fibers (ACF) impregnated with ionic silver particles was studied. ACF were prepared from samples of cotton woven wastes (cotton based fabrics 5x10 cm) by applying a chemical activation procedure with H3PO4. This treatment was performed using several H3PO4: Cotton based fabrics weight ratios (1:2–2:1), temperatures (600–900 ºC) and activation times (0.5–2 h). The ACF obtained under the best activation conditions showed BET surface area of 1103 m2/g; this result along with iodine index demonstrated the microporous nature of the fibers herein obtained. Then, the obtained fibers were impregnated with ionic silver particles by immersion in 0.1 and 0.5 M AgNO3 solutions followed by drying and thermal decomposition in order to fix the silver particles in the structure of ACF. It was determined that the presence of Ag ions lowered the BET surface area of the ACF in approximately 17 % due to the obstruction of the porosities along the carbonized structure. Finally, the antibacterial effect of the ACF impregnated with silver was studied through direct counting method for coliforms. The antibacterial activity of the impregnated fibers was demonstrated, and it was attributed to the strongly inhibition of bacteria growth because of chemical properties of the particles of silver inside the ACF. This behavior was demonstrated at concentrations of silver as low as 0.035 % w/w.

Keywords: activated carbon, adsorption, antibacterial activity, coliforms, surface area

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Authors: Jake Tempo, Stephen Brough

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Introduction and Objectives: Urine cytology has a role in the diagnosis of urothelial cancer when used alongside cystoscopy and imaging, according to the European Association of Urology guidelines. It also has a role in the surveillance post-treatment of urothelial carcinoma. Collecting and analysing urine cytology is costly and time-consuming. We investigated the use of urine cytology in an Australian regional hospital to determine whether clinicians are following international guidelines. Materials and Methods: We analysed all urine cytology requests performed in an Australian regional hospital between 1st January 2017 and 31st December 2018. We reviewed the indication for urine cytology and the patients’ case notes to determine whether urine cytology changed management. Results: During the two-year study period, 153 patients had urine cytology analysed for a variety of indications. In no cases did cytology change the outcome of patient management significantly. In total, 69 of 153 (41%) urine cytology requests were not supported by urological society guidelines. Fifty requests were for haematuria, and twenty requests were for urothelial cancer surveillance. Seven were analysed for follow-up from previous urological investigations. Nine samples were sent for ureteric obstruction of unknown origin. Conclusion: Urine cytology, even when positive, did not significantly change management for the investigation of potential urothelial cancer, and therefore, its use as a diagnostic tool for this purpose should be reconsidered. Many cytology tests are expensive, unnecessary, and not supported by urological society guidelines.

Keywords: cytology, bladder cancer, urine, urothelial carcinoma

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Authors: Salman Piri

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

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

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Authors: Liaqat Ali, Khalid Farooq, Shafieullah Khan, Nasir Orakzai, Qudratullah

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Objectives: To determine the risk factors for high resistance of ciprofloxacin in complicated urinary tract infections. Materials and Methods: It is an analytical study that was conducted in the department of Urology (Team ‘C’) at Institute of Kidney Diseases Hayatabad Peshawar from 1st June 2012 till 31st December 2012. Total numbers of 100 patients with complicated UTI was selected in the study. Multivariate analysis and linear regression were performed for the detection of risk factors. All the data was recorded on structured Proforma and was analyzed on SPSS version 17. Results: The mean age of the patient was 55.6 years (Range 3-82 years). 62 patients were male while 38 patients were female. 66 isolates of E-Coli were found sensitive to ciprofloxacin while 34 isolates were found Resistant for ciprofloxacin. Using multivariate analysis and linear regression, an increasing age above 50 (p=0.002) History of urinary catheterization especially for bladder outflow obstruction (p=0.001) and previous multiple use of ciprofloxacin (p=0.001) and poor brand of ciprofloxacin were found to be independent risk factors for high resistance of ciprofloxacin. Conclusion: UTI is common illness across the globe with increasing trend of antimicrobial resistance for ciprofloxacin against E Coli in complicated UTI. The risk factors for emerging resistance are increasing age, urinary catheterization and multiple use and poor brand of ciprofloxacin.

Keywords: urinary tract infection, ciprofloxacin, urethral catheterization, antimicrobial resistance

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Authors: Dimitri Bigot, Bruno Malet-Damour, Jérôme Vigneron

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Many studies have been made about using bio-based materials in buildings. The goal is to reduce its environmental footprint by analyzing its life cycle. This can lead to minimize the carbon emissions or energy consumption. A previous work proposed to numerically study the feasibility of using wood chips to regulate relative humidity inside a building. This has shown the capability of a wood chips bed to regulate humidity inside the building, to improve thermal comfort, and so potentially reduce building energy consumption. However, it also shown that some physical parameters of the wood chips must be identified to validate the proposed model and the associated results. This paper presents an experimental setup able to study such a wood chips bed with different solicitations. It consists of a simple duct filled with wood chips and crossed by an air flow with variable temperature and relative humidity. Its main objective is to study the thermal behavior of the wood chips bed by controlling temperature and relative humidity of the air that enters into it and by observing the same parameters at the output. First, the experimental set up is described according to previous results. A focus is made on the particular properties that have to be characterized. Then some case studies are presented in relation to the previous results in order to identify the key physical properties. Finally, the feasibility of the proposed technology is discussed, and some model validation paths are given.

Keywords: wood chips bed, experimental set-up, bio-based material, desiccant, relative humidity, water content, thermal behaviour, air treatment

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Authors: Lian Wu, Mervyn Merrilees

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Chronic Obstructive Pulmonary Disease (COPD) is a worldwide problem, characterized by irreversible and progressive airflow obstruction. In New Zealand, it is currently the 4th commonest cause of death and exacerbations of COPD are a frequent cause of admission to hospital. Serum levels of Clara cell secretory protein-16 (CC-16) are believed to represent Clara cell toxicity. More recently, CC-16 has been found to be associated with smoker COPD. It is produced almost exclusively by non-ciliated Clara cells in the airways, and its primary function is to protect the lungs against oxidative stress and carcinogenesis. After acute exposure to cigarette smoke, serum levels of CC-16 become elevated. CC16 is a potent natural immune-suppressor and anti-inflammatory agent. In vitro, CC16 inhibits both monocyte and polymorphonuclear neutrophils chemotaxis and phagocytosis. CC16 also inhibits fibroblast chemotaxis. However, the role of CC-16 in non-smoking related COPD is still not clear. In this study, we investigated serum CC-16 levels in non-smoking related COPD. Methods: We compared non-smoker patients with COPD (FEV1<60% of predicted, FEV1/FVC <0.7, n=100) and individuals with normal lung function FEV1≥ 80% of predicted and FEV1/FVC≥ 0.7, n=80). All subjects had no smoking history. CC-16 was measured by ELISA. Results and conclusion: Serum CC-16 levels are reduced in individuals with non-smoking related COPD, and there is a weak correlation with disease severity in non-smoking related COPD group compared to non-smoker controls.

Keywords: COPD, CC-16, ELISA, non-smoking-related COPD

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Authors: Pratibha, Jyoti Kori

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Particles in industry, harvesting, coal mines, etc. may not necessarily be spherical in shape. In general, it is difficult to find perfectly spherical particle. The prediction of movement and deposition of non spherical particle in distinct airway generation is much more difficult as compared to spherical particles. Moreover, there is extensive inflexibility in deposition between ducts of a particular generation and inside every alveolar duct since particle concentrations can be much bigger than the mean acinar concentration. Consequently, a large number of particles fail to be exhaled during expiration. This study presents a mathematical model for the movement and deposition of those non-spherical particles by using particle aspect ratio and shape factor. We analyse the pulsatile behavior underneath sinusoidal wall oscillation due to periodic breathing condition through a non-Darcian porous medium or inside pulmonary region. Since the fluid is viscous and Newtonian, the generalized Navier-Stokes equation in two-dimensional coordinate system (r, z) is used with boundary-layer theory. Results are obtained for various values of Reynolds number, Womersley number, Forchsheimer number, particle aspect ratio and shape factor. Numerical computation is done by using finite difference scheme for very fine mesh in MATLAB. It is found that the overall air velocity is significantly increased by changes in aerodynamic diameter, aspect ratio, alveoli size, Reynolds number and the pulse rate; while velocity is decreased by increasing Forchheimer number.

Keywords: deposition, interstitial lung diseases, non-Darcian medium, numerical simulation, shape factor

Procedia PDF Downloads 152

Authors: Jake Tempo, Jack Crozier, Huay Ann Chia, Philip Tan

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Purpose: A prospective study was performed to determine whether temporary ureteric catheterization should be eliminated as a prophylactic method for preventing ureteric obstruction after uncomplicated ureteropyeloscopic lithotripsy. Material and Methods: From 2010 to 2014, 227 patients underwent uncomplicated ureteroscopic and/or pyeloscopic lithotripsy. Three patient-groups based on postoperative drainage method were analysed: temporary uretericcatheter (TUC), -ureteric JJ stent, and no-stent groups. Exclusion criteria included urosepsis, ureteric injury, and non-surgical complications delaying hospital-discharge. Outcome measures included parenteral analgesic requirements, prolonged hospitalization ≥2 days due to postoperative-pain, and readmissions rate. Results: Delayed discharge was reported in 14.5%(9 of 62) patients in the TUC group compared to 3.4%(4 of 119) in theureteric JJ stent group and 8.7%(4 of 46) in the no-drainage-group (p=0.02). Odds ratio for delayed-discharge between catheter- versus-ureteric JJ stent is 4.9 (95% CI = 1.6-15.0; p < 0.01). Parenteral analgesic requirements in the TUC group (12.9%) was also significantly higher than theureteric JJ stent group (1.7%; p=0.003). Readmissions were negligible between groups. Conclusions: Patients with ureteric catheters after uncomplicated ureteroscopy have a prolonged hospital stay with increased pain and parenteral analgesic requirements. There is a 7.6-fold increased requirement for parenteral analgesia and a 4.2-fold increased risk of delayed-discharge compared to a patient with a ureteric JJ stent.

Keywords: ureteric catheter, ureteric stent, ureteroscopy, pyeloscopy

Procedia PDF Downloads 115

Authors: Ru-Yin Yang, Chi Wu, Cheng-Yu Tsai, Yin-Tzu Lin, Wen-Te Liu

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Background: Sleep breathing disorder (SDB) is a condition demonstrated by recurrent episodes of the airway obstruction leading to intermittent hypoxia and quality fragmentation during sleep time. However, the procedures for SDB severity examination remain complicated and costly. Objective: The objective of this study is to establish a simplified examination method for SDB by the respiratory impendence pattern sensor combining the signal processing and machine learning model. Methodologies: We records heart rate variability by the electrocardiogram and respiratory pattern by impendence. After the polysomnography (PSG) been done with the diagnosis of SDB by the apnea and hypopnea index (AHI), we calculate the episodes with the absence of flow and arousal index (AI) from device record. Subjects were divided into training and testing groups. Neuron network was used to establish a prediction model to classify the severity of the SDB by the AI, episodes, and body profiles. The performance was evaluated by classification in the testing group compared with PSG. Results: In this study, we enrolled 66 subjects (Male/Female: 37/29; Age:49.9±13.2) with the diagnosis of SDB in a sleep center in Taipei city, Taiwan, from 2015 to 2016. The accuracy from the confusion matrix on the test group by NN is 71.94 %. Conclusion: Based on the models, we established a prediction model for SDB by means of the wearable sensor. With more cases incoming and training, this system may be used to rapidly and automatically screen the risk of SDB in the future.

Keywords: sleep breathing disorder, apnea and hypopnea index, body parameters, neuron network

Procedia PDF Downloads 118

Authors: F. A. Gdhaidh, K. Hussain, H. S. Qi

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A numerical study of natural convection heat transfer in water filled cavity has been examined in 3D for single phase liquid cooling system by using an array of parallel plate fins mounted to one wall of a cavity. The heat generated by a heat source represents a computer CPU with dimensions of 37.5×37.5 mm mounted on substrate. A cold plate is used as a heat sink installed on the opposite vertical end of the enclosure. The air flow inside the computer case is created by an exhaust fan. A turbulent air flow is assumed and k-ε model is applied. The fins are installed on the substrate to enhance the heat transfer. The applied power energy range used is between 15- 40W. In order to determine the thermal behaviour of the cooling system, the effect of the heat input and the number of the parallel plate fins are investigated. The results illustrate that as the fin number increases the maximum heat source temperature decreases. However, when the fin number increases to critical value the temperature start to increase due to the fins are too closely spaced and that cause the obstruction of water flow. The introduction of parallel plate fins reduces the maximum heat source temperature by 10% compared to the case without fins. The cooling system maintains the maximum chip temperature at 64.68℃ when the heat input was at 40 W which is much lower than the recommended computer chips limit temperature of no more than 85℃ and hence the performance of the CPU is enhanced.

Keywords: chips limit temperature, closed enclosure, natural convection, parallel plate, single phase liquid

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Authors: S. Teksin, S. Yayla

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The aim of the present study was to investigate details of flow structure in downstream of a circular cylinder base mounted on a flat surface in a rectangular duct with the dimensions of 8000 x 1000 x 750 mm in deep water flow for the Reynolds number 2500, 5000 and 7500. A flexible strip was attached to behind the cylinder and compared the bare body. Also, it was analyzed that how boundary layer affects the structure of flow around the cylinder. Diameter of the cylinder was 60 mm and the length of the flexible splitter plate which had a certain modulus of elasticity was 150 mm (L/D=2.5). Time-averaged velocity vectors, vortex contours, streamwise and transverse velocity components were investigated via Particle Image Velocimetry (PIV). Velocity vectors and vortex contours were displayed through the sections in which boundary layer effect was not present. On the other hand, streamwise and transverse velocity components were monitored for both cases, i.e. with and without boundary layer effect. Experiment results showed that the vortex formation occured in a larger area for L/D=2.5 and the point where the vortex was maximum from the base of the cylinder was shifted. Streamwise and transverse velocity component contours were symmetrical with reference to the center of the cylinder for all cases. All Froud numbers based on the Reynolds numbers were quite smaller than 1. The flow characteristics of velocity component values of attached circular cylinder arrangement decreased approximately twenty five percent comparing to bare cylinder case.

Keywords: partical image velocimetry, elastic plate, cylinder, flow structure

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Authors: Diego Carrasco, Catarina Freitas, Hugo Rio Tinto, Ricardo Rio Tinto, Nuno Couto, Joaquim Gago, Carlos Carvalho

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Introduction: Endoscopic ultrasound-guided choledochoduodenostomy (EUS-CD) to drain the gallbladder can be a palliative care procedure for non-surgical oncologic patients with cholelithiasis and cholangitis process. Case description: A 59-years old Caucasian male diagnosed with extrahepatic cholangiocarcinoma with multiple liver, lung and peritoneum metastasis, unresponsive to treatment with gemcitabine/cisplatin, presented in the institution with fever, hypotension, and severe upper right abdominal pain secondary to cholelithiasis and cholangitis process. The patient was admitted and started on large spectrum antibiotics plus fluid-challenge. Afterward, a percutaneous transhepatic biliary drainage (PTBD) was performed to drain the gallbladder. This procedure temporarily stabilized the patient. However, the definitive solution required gallbladder removal. Since the patient exhibited an advanced oncologic disease and poor response to the chemotherapy, he was not a candidate for surgical intervention. Diagnostic Pathways: A self-expanding metal stent was placed from the duodenum into the bile duct by endoscopic ultrasound-guided. The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure. Conclusion and Discussion: The stent allowed efficient drainage of the contrast from the gallbladder at the end of the endoscopic procedure and successfully reversed the cholangitis process. EUS-CD is an effective and safe technique and can be used as a palliative care procedure for non-surgical oncologic patients.

Keywords: palliative care, cholangiocarcinoma, choledochoduodenostomy, endoscopic ultrasound-guided

Procedia PDF Downloads 156

Authors: Payam Haghparast, Mikhail V. Sorin, Hakim Nesreddine

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The complex oblique shock phenomenon can be simply assumed as a normal shock at the constant area section to simulate a sharp pressure increase and velocity decrease in 1-D thermodynamic models. The assumed normal shock location is one of the greatest sources of error in ejector thermodynamic models. Most researchers consider an arbitrary location without justifying it. Our study compares the effect of normal shock place on ejector dimensions in 1-D models. To this aim, two different ejector experimental test benches, a constant area-mixing ejector (CAM) and a constant pressure-mixing (CPM) are considered, with different known geometries, operating conditions and working fluids (R245fa, R141b). In the first step, in order to evaluate the real value of the efficiencies in the different ejector parts and critical back pressure, a CFD model was built and validated by experimental data for two types of ejectors. These reference data are then used as input to the 1D model to calculate the lengths and the diameters of the ejectors. Afterwards, the design output geometry calculated by the 1D model is compared directly with the corresponding experimental geometry. It was found that there is a good agreement between the ejector dimensions obtained by the 1D model, for both CAM and CPM, with experimental ejector data. Furthermore, it is shown that normal shock place affects only the constant area length as it is proven that the inlet normal shock assumption results in more accurate length. Taking into account previous 1D models, the results suggest the use of the assumed normal shock location at the inlet of the constant area duct to design the supersonic ejectors.

Keywords: 1D model, constant area-mixing, constant pressure-mixing, normal shock location, ejector dimensions

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Authors: Bing-Fang Lee, Srinivasan Periasamy, Ming-Yie Liu

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Shift work sleep disorder is a common problem in industrialized world. It is a type of circadian rhythmic sleep disorders characterized by insomnia and sleep deprivation. Lack of sleep in workers may lead to poor health conditions such as hepatic dysfunction. Melatonin is a hormone secreted by the pineal gland to alleviate insomnia. Moreover, it is a powerful antioxidant and may prevent acute liver injury. Therefore, workers take in melatonin to deal with sleep-related health is an important issue. The aim of this study was to investigate the effect of melatonin on an acute hepatic injury model sinusoidal obstruction syndrome (SOS) in mice. Male C57BL/6 mice were injected with a single dose (500 mg/kg) of monocrotaline (MCT) to induce SOS. Melatonin (1, 3, 10 and 30 mg/kg) was injected 1 h before MCT treatment. After 24 h of MCT treatment, mice were sacrificed. The blood and liver were collected. Organ damage was evaluated by serum biochemistry, hematology analyzer, and histological examination. Low doses of melatonin (1 and 3 mg/kg) had no protective effect on SOS. However, high doses (10 and 30 mg/kg) exacerbated SOS. In addition, it not only increased serum glutamate oxaloacetate transaminase (GOT), glutamate pyruvate transaminase (GPT) and extended liver damage indicated by histological examination but also decreased platelet levels, lymphocyte ratio, and glutathione level; it had no effect on malondialdehyde and nitric oxide level in SOS mice. To conclude, melatonin may exacerbate MCT-induced SOS in mice. Furthermore, melatonin might have a synergistic action with SOS. Usage of melatonin for insomnia by people working in long shift must be cautioned; it might cause acute hepatic injury.

Keywords: acute liver injury, melatonin, shift work, sleep deprivation

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Authors: Ying Zhu, Ning Wu, Hai-Dong Huang, Yu-Chao Dong, Qin-Ying Sun, Wei Zhang, Qin Wang, Qiang Li

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Background and study aims: Tracheobronchopathia osteochondroplastica (TO) is an uncommon disease of the tracheobronchial system that leads to narrowing of the airway lumen from cartilaginous and/or osseous submucosal nodules. The aim of this study is to perform a detailed review of this rare disease in a large cohort of patients with TO proven by fiberoptic bronchoscopy from China. Patients and Methods: Retrospective chart review was performed on 41,600 patients who underwent bronchoscopy in the Department of Respiratory Medicine of Changhai Hospital between January 2005 and December 2012. Cases of TO were identified based on characteristic features during bronchoscopic examination. Results: 22 cases of bronchoscopic TO were identified. Among whom one-half were male and the mean age was 47.45 ±10.91 years old. The most frequent symptoms at presentation were chronic cough (n=14) and increased sputum production (n=10). Radiographic abnormalities were observed in 3/18 patients and findings on computed tomography consistent with TO such as beaded intraluminal calcifications and/or increased luminal thickenings were observed in 18/22 patients. Patients were classified into the following categories based on the severity of bronchoscopic findings: Stage I (n=2), Stage II (n=6) and Stage III(n=14). The result that bronchoscopic improvement was observed in 2 patients administered with inhaled corticosteroids suggested that resolution of this disease is possible. Conclusions: TO is a benign disease with slow progression, which could be roughly divided into 3 stages on the basis of the characteristic endoscopic features and histopathologic findings. Chronic inflammation was thought to be more important than the other existing plausible hypotheses in the course of TO. Inhaled corticosteroids might have some impact on patients at Stage I/II.

Keywords: airway obstruction, bronchoscopy, etiology, Tracheobronchopathia osteochondroplastica (TO), treatment

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

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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: Chutamas Thepmalee, Aussara Panya, Mutita Junking, Jatuporn Sujjitjoon, Nunghathai Sawasdee, Pa-Thai Yenchitsomanus

Abstract:

Cholangiocarcinoma (CCA) is an aggressive malignancy of bile duct epithelial cells in which the standard treatments, including surgery, radiotherapy, chemotherapy, and targeted therapy are partially effective. Many solid tumors including CCA escape host immune responses by creating tumor microenvironment and generating immunosuppressive cytokines such as interleukin-10 (IL-10) and transforming growth factor-β (TGF-β). These cytokines can inhibit dendritic cell (DC) differentiation and function, leading to decreased activation and response of effector CD4+ and CD8+ T cells for cancer cell elimination. To overcome the effects of these immunosuppressive cytokines and to increase ability of DC to activate effector CD4+ and CD8+ T cells, we generated self-differentiated DCs (SD-DCs) with down-regulation of IL-10 and TGF-β receptors for activation of effector CD4+ and CD8+ T cells. Human peripheral blood monocytes were initially transduced with lentiviral particles containing the genes encoding GM-CSF and IL-4 and then secondly transduced with lentiviral particles containing short-hairpin RNAs (shRNAs) to knock-down mRNAs of IL-10 and TGF-β receptors. The generated SD-DCs showed up-regulation of MHC class II (HLA-DR) and co-stimulatory molecules (CD40 and CD86), comparable to those of DCs generated by convention method. Suppression of IL-10 and TGF-β receptors on SD-DCs by specific shRNAs significantly increased levels of IFN-γ and also increased cytolytic activity of DC-activated effector T cells against CCA cell lines (KKU-213 and KKU-100), but it had little effect to immortalized cholangiocytes (MMNK-1). Thus, SD-DCs with down-regulation of IL-10 and TGF-β receptors increased activation of effector T cells, which is a recommended method to improve DC function for the preparation of DC-activated effector T cells for adoptive T-cell therapy.

Keywords: cholangiocarcinoma, IL-10 receptor, self-differentiated dendritic cells, TGF-β receptor

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Authors: R. M. Kashim

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The study investigated primary school teachers’ conceptual and procedural knowledge of rational numbers and its effects on pupil’s achievement in rational numbers. Specifically, primary school teachers’ level of conceptual knowledge about rational numbers, primary school teachers’ level of procedural knowledge about rational numbers, and the effects of teachers conceptual and procedural knowledge on their pupils understanding of rational numbers in primary schools is investigated. The study was carried out in Bauchi metropolis in the Bauchi state of Nigeria. The design of the study was a multi-stage design. The first stage was a descriptive design. The second stage involves a pre-test, post-test only quasi-experimental design. Two instruments were used for the data collection in the study. These were Conceptual and Procedural knowledge test (CPKT) and Rational number achievement test (RAT), the population of the study comprises of three (3) mathematics teachers’ holders of Nigerian Certificate in Education (NCE) teaching primary six and 210 pupils in their intact classes were used for the study. The data collected were analyzed using mean, standard deviation, analysis of variance, analysis of covariance and t- test. The findings indicated that the pupils taught rational number by a teacher that has high conceptual and procedural knowledge understand and perform better than the pupil taught by a teacher who has low conceptual and procedural knowledge of rational number. It is, therefore, recommended that teachers in primary schools should be encouraged to enrich their conceptual knowledge of rational numbers. Also, the superiority performance of teachers in procedural knowledge in rational number should not become an obstruction of understanding. Teachers Conceptual and procedural knowledge of rational numbers should be balanced so that primary school pupils will have a view of better teaching and learning of rational number in our contemporary schools.

Keywords: conceptual, procedural knowledge, rational number, pupils

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Authors: A. Zecchin, E. Vallicella, I. Alberi, A. Dalle Carbonare, A. Festi, F. Galeone, S. Garzon, R. Raffaelli, P. Pomini, M. Franchi

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Introduction: Severe endometriosis is a multiorgan disease, that involves bowel in 31% of cases. Disabling symptoms and deep infiltration can lead to bowel obstruction: surgical bowel treatment may be needed. In these cases, colorectal segment resection is usually performed by inferior mesenteric artery ligature, as radically as for oncological surgery. This study was made on surgery based on intestinal vascular axis’ preservation. It was assessed postoperative complications risks (mainly rate of dehiscence of intestinal anastomoses), and results were compared with the ones found in literature about classical colorectal resection. Materials and methods: This was a retrospective study based on 62 patients with deep infiltrating endometriosis of the bowel, which undergo segmental resection with intestinal vascular axis preservation, between 2013 and 2016. It was assessed complications related to the intervention both during hospitalization and 30-60 days after resection. Particular attention was paid to the presence of anastomotic dehiscence. 52 patients were finally telephonically interviewed in order to investigate the presence or absence of intestinal constipation. Results and Conclusion: Segmental intestinal resection performed in this study ensured a more conservative vascular approach, with lower rate of anastomotic dehiscence (1.6%) compared to classical literature data (10.0% to 11.4% ). No complications were observed regarding spontaneous recovery of intestinal motility and bladder emptying. Constipation in some patients, even after years of intervention, is not assessable in the absence of a preoperative constipation state assessment.

Keywords: anastomotic dehiscence, deep infiltrating endometriosis, colorectal resection, vascular axis preservation

Procedia PDF Downloads 176

Authors: Thinakar Mani Balusamy, Ratnakar S. Kini, Bharat Narasimhan, Venkateswaran A. R, Pugazhendi Thangavelu, Mohammed Ali, Prem Kumar K., Kani Sheikh M., Sibi Thooran Karmegam, Radhakrishnan N., Mohammed Noufal

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Introduction: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining nine presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed nonoperatively. Nine patients had a severe injury ( > grade 3) – of which four underwent endotherapy, three had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed nonoperatively, three underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Keywords: endotherapy, non-operative management, surgery, traumatic pancreatic injury

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods: This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare, and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results: There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for the population was 182 per 100,000; this increased by 9.578 per year during the study period (95% CI = 8.431- 10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year. (95% CI = 0.654- 1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95% CI = 0.510 -0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions: Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Keywords: ventral, incisional, hernia, trends

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Authors: Guoqiang Yu, Mehrana Mohtasebi, Jinghong Sun, Thomas Pittman

Abstract:

Malignant glioma (MG) is the most common type of primary malignant brain tumor. Surgical resection of MG remains the cornerstone of therapy, and the extent of resection correlates with patient survival. A limiting factor for resection, however, is the difficulty in differentiating the tumor from normal tissue during surgery. Fluorescence imaging is an emerging technique for real-time intraoperative visualization of MGs and their boundaries. However, most clinical-grade neurosurgical operative microscopes with fluorescence imaging ability are hampered by low adoption rates due to high cost, limited portability, limited operation flexibility, and lack of skilled professionals with technical knowledge. To overcome the limitations, we innovatively integrated miniaturized light sources, flippable filters, and a recording camera to the surgical eye loupes to generate a wearable fluorescence eye loupe (FLoupe) device for intraoperative imaging of fluorescent MGs. Two FLoupe prototypes were constructed for imaging of Fluorescein and 5-aminolevulinic acid (5-ALA), respectively. The wearable FLoupe devices were tested on tumor-simulating phantoms and patients with MGs. Comparable results were observed against the standard neurosurgical operative microscope (PENTERO® 900) with fluorescence kits. The affordable and wearable FLoupe devices enable visualization of both color and fluorescence images with the same quality as the large and expensive stationary operative microscopes. The wearable FLoupe device allows for a greater range of movement, less obstruction, and faster/easier operation. Thus, it reduces surgery time and is more easily adapted to the surgical environment than unwieldy neurosurgical operative microscopes.

Keywords: fluorescence guided surgery, malignant glioma, neurosurgical operative microscope, wearable fluorescence imaging device

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