Search results for: tarsal coalition resection

Authors: Thampi Rawther, Sean O’Brien, Kamala Kanta Das

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Background: Intussusception in the adult is rarely from a benign cause and is almost always pathological. Causes include carcinomas, polyps, Meckel's diverticulum, or colonic diverticulum. Common symptoms include abdominal pain, intestinal obstruction, palpable abdominal mass, GI bleeding, and anemia. Sarcomatoid carcinoma is a rare type of small intestinal malignancy exhibiting carcinomatous and sarcomatous features. It primarily affects older patients, mean age 57, and is 1.5 times more prevalent in men. Method: This is an interesting case report of a patient presenting with intussusception secondary to a sarcomatoid tumor of the small bowel. Conclusion: Surgery is the treatment of choice in adults with intussusception due to the high malignancy potential. Furthermore, surgical resection of the affected bowel is the definitive form of therapy as small bowel sarcomatoid tumors are not responsive to chemotherapy and radiotherapy. Early surgical intervention helps reduce mortality as it allows for early staging, treatment, and monitoring of the tumor. The patient was fortunate to have presented with intussusception, facilitating early surgical intervention, and was found to have a low disease stage.

Keywords: general surgery, small bowel tumour, imaging, unique

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Authors: Ghada Esheba, Bayan Hafiz, Ashwaq Al-Qarni, Abdulelah AlMalki, Esraa Kaheel

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Hydatid disease is caused by genus Echinococcus, it is transmitted to human through sheep and cattle. People who lived in an endemic area should be suspected to have the disease. Pulmonary hydatid disease can be presented by respiratory manifestations as in our case. We report a case of child, 13 years old, who was presented by shortness of breath and non-productive cough 2 months ago. The patient had an attack of hemoptysis 3 months ago but there is no history of fever, other constitutional symptoms or any medical illness. The patient has had a close contact with a horse. On examination, the patient was oriented and vitally stable. Both side of chest were moving equally with decrease air entry on the left side of the chest. Cervical lymph node enlargement was also detected. The case was provisionally diagnosed as tuberculosis. The x-ray was normal, while CT scan showed two cysts in the left side. The patient was treated surgically with resection of both cysts without lobectomy. Broncho-alveolar lavage was done and together with plural effusion and both cysts were sent for histopathology. The patient received the following medication: albendazole 200MG/BID/Orally for 30 days and Cefuroxime 250MG/Q12H/Orally for 10 days.

Keywords: Echinococcus granulosus, hydatid disease, pediatrics, pulmonary hydatid cyst

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Authors: Luxi Chen

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The land finance in China in recent years has propelled urban renewals in the name of historical conservation and led to massive gentrification and compulsory relocation. Such inequalities cause insurgence. Drawing on public planning information, ethnographic field notes, and online interview data about Guangzhou's Enninglu Area, this paper aims to present how such insurgence has been contained and put down gradually through depoliticization narratives represented by "improving living conditions," "conserving historical culture," and "public participation”. This paper's findings include that 1) Besides economic growth, maintaining social stability in alignment with the central government are equally important to local government, reveals the latter efforts to mediate the growth coalition, residents, media, and academics so as to reconstruct the interface between state and society; 2) To empower the insurgence, the media and academics use public interests for propaganda, that diverts attention away from its political dimension; 3) In response, the government introduces improved regulations and planning, turning social inequalities into technical inadequacy so as to become the defender of public interests, which justifies the incoming renewal and prevents public questioning. By comparing regime changes among governments, developers, residents, media, and academics caused by renewal policies, this paper presents the depoliticized narrative as a counter-insurgence strategy to contain social conflicts and to boost inner-city renewal.

Keywords: inner city renewal, depoliticization, historical conservation, public participation

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Authors: Dainius Genys, Vylius Leonavicius, Ricardas Krikstolaitis

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Energy security problems in Lithuania are analyzed on a regular basis; however, there is no comprehensive research on the very issue of the concept of public energy security. There is a lack of attention not only to social determinants of perception of energy security, but also a lack of a deeper analysis of the public opinion. This article aims to research the Lithuanian public perception of energy security. Complex tasks were set during the sociological study. Survey questionnaire consisted of different sets of questions: view of energy security (risk perception, political orientation, and energy security; comprehensiveness and energy security); view of energy risks and threats (perception of energy safety factors; individual dependence and burden; disobedience and risk); view of the activity of responsible institutions (energy policy assessment; confidence in institutions and energy security), demographic issues. In this article, we will focus on two aspects: a) We will analyze public opinion on the most important aspects of energy security and social factors influencing them; The hypothesis is made that public perception of energy security is related to value orientations: b) We will analyze how public opinion on energy policy executed by the government and confidence in the government are intertwined with the concept of energy security. Data of the survey, conducted on May 10-19 and June 7-17, 2013, when Seimas and the government consisted of the coalition dominated by Social Democrats with Labor, Order and Justice Parties and the Electoral Action of Poles, were used in this article. It is important to note that the survey was conducted prior to Russia’s occupation of the Crimea.

Keywords: energy security, public opinion, risk, energy threat, energy security policy

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Authors: Jeong Hwan Joo, Keun Pil Kim

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During meiosis, meiotic recombination is initiated by Spo11-mediated DSB formation and exonuclease-mediated DSB resection occurs to expose single stranded DNA formation. RPA is further required to inhibit secondary structure formation of ssDNA that can be formed Watson-Crick pairing. Rad51-Dmc1, RecA homologs in eukaryote and their accessory factors involve in searching homolog templates to mediate strand exchange. In this study, we investigate the recombinational roles of replication protein A (RPA), which is heterotrimeric protein that is composed of RPA1, RPA2, and RPA3. Here, we investigated meiotic recombination using DNA physical analysis at the HIS4LEU2 hot spot. In rfa1-119 (K45E, N316S) cells, crossover (CO) and non-crossover (NCO) products reduced than WT. rfa1-119 delayed in single end invasion-to-double holiday junction (SEI-to-dHJ) transition and exhibits a defect in second-end capture that is also modulated by Rad52. In the further experiment, we observed that in rfa1-119 mutant, RPA could not be released in timely manner. Furthermore, rfa1-119 exhibits failure in the second end capture, implying reduction of COs and NCOs. In this talk, we will discuss more detail how RPA involves in chromatin axis association via formation of axis-bridge and why RPA is required for Rad52-mediated second-end capture progression.

Keywords: homolog interaction, meiotic recombination, replication protein A, RPA1

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Authors: Nadine Abuqtaish

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Females’ participation in athletic sports events has increased in the last decades, and the discovery of eating disorders and menstrual dysfunction has been evident since the early 1980s. The term “Female athlete triad” was initially defined by the Task Force on Women’s Issues of the American College of Sports Medicine (ACSM) in 1992. Menstrual irregularities have been prevalent in competitive female athletes, especially in their adolescence and early adulthood age. Nutritional restrictions to maintain a certain physique and lean look are sought to be advantageous in female athletes such as gymnastics, cheerleading, or weight-sensitive sports such as endurance sports (cycling and marathoners). This stress places the female at risk of irregularities in their menstrual cycle which can lead them to lose their circadian estrogen levels. Estrogen is an important female reproductive hormone that plays a role in maintaining bone mass. Bone mineral density peaks by the age 25. Inadequate estrogen due to missed menstrual cycle or amenorrhea has been estimated to cause a yearly loss of 2% of bone mass, increasing the risk of osteoporosis in the postmenopausal phase. This paper is intended to have a better depth understanding of whether female athletes are being monitored by their official entities or coaches. A qualitative research method through online search engines and keywords “females, athletes, triad, amenorrhea, anorexia, osteoporosis” were used to collect the available primary sources from official public library databases. The latest consensus was published in 2014 by the Female Athlete Triad Coalition and the need for further research and emphasis on this issue is still lacking.

Keywords: female, athlete, triad, amenorrhea, anorexia, bone loss

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Authors: Sara Shuger Fox, Oscar Reynaga

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This session explains the process and lessons learned as Central College (USA) faculty and staff developed undergraduate research opportunities within the model of a short-term faculty-led study abroad program in Costa Rica. The program in Costa Rica increases access to research opportunities across the disciplines and was developed by faculty from English, Biology, and Exercise Science. Session attendees will benefit from learning how faculty and staff navigated the program proposal process at a small liberal arts college and, in particular, how the program was built to be inclusive of departments with lower enrollment, like those currently seen in the humanities. Vital to this last point, presenters will explain how they negotiated issues of research supervision and disciplinary authority in such a way that the program is open to students from multiple disciplines without forcing the program budget to absorb costs for multiple faculty supervisors traveling and living in-country. Additionally, session attendees will learn how scouting laid the groundwork for mutually beneficial relationships between the program and the communities with which it collaborates. Presenters will explain how they built a coalition of students, faculty advisors, study abroad staff and local research hosts to support the development of research questions that are of value not just to the students, but to the community in which the research will take place. This program also incorporates principles of fair-trade learning by intentionally reporting research findings to local community members, as well as encouraging students to proactively share their research as a way to connect with local people.

Keywords: Costa Rica, research, sustainability, transdisciplinary

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Authors: Ahmed Mostafa, Mohamed Mahmoud, Nesreen H. Hafez, Mohamed Fahim

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This retrospective study includes 60 patients with pre-invasive breast cancer. Aim of the study: Evaluation of premalignant lesions of the breast (DCIS), different treatment methods and outcome. Patients and methods: 60 patients with DCIS were studied from the period between 2005 to 2012, for 38 patients the primary surgical method was wide local resection (WLE) (63.3%) and the other cases (22 patients, 36.7%) had mastectomy, fourteen cases from those who underwent local excision received radiotherapy, while no adjuvant radiotherapy was given for those who underwent mastectomy. In case of hormonal receptor positive DCIS lesions hormonal treatment (Tamoxifen) was given after local control. Results: No difference in overall survival between mastectomy & breast conserving therapy (wide local excision and adjuvant radiotherapy), however local recurrence rate is higher in case of breast conserving therapy, also no role of Axillary evacuation in case of DCIS. The use of hormonal therapy decreases the incidence of local recurrence by about 98%. Conclusion: The main management of DCIS is local treatment (wide local excision and radiotherapy) with hormonal treatment in case of hormone receptor positive lesions.

Keywords: ductal carcinoma in situ, surgical treatment, radiotherapy, breast conserving therapy, hormonal treatment

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Authors: Ahmad Khoirul Umam, Iin Mayasari

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Indonesia is blessed with rich natural resources and frequently dubbed as the 6th richest country in the world in terms of mining resources, including minerals and coal. Mining can contribute to the socio-economic development by generating state revenue for development, elevating poverty through employment, opening and developing remote areas, putting in basic infrastructure and creating new centres of developments. However, favouritism and rent-seeking behaviour committed by government officials, politicians, and business players in licensing and permit giving in mining and forestry sectors have resisted reforms. Even though Indonesia’s Corruption Eradication Commission (KPK) successfully targeted untouchable actors, public criticism continues to focus on questions of why corruption apparently remains systemic in mining industry in the country? This paper revealed that structural anomalies, as well as legacies of the Soeharto era’s power inequities, have severely inhibited Indonesia’s bureaucratic arrangements that continue to influence adversely the elements of transparency and accountability in mining industry governance. In the more liberalized and decentralized political system, the deficiencies have gradually assisted vested interest groups to band together, thus creating a coalition that can challenge, resist, and contain anti-graft actions. Therefore, Indonesia needs much more serious anti-corruption actions that would require eliminating the monopoly over power, enhancing competition, limiting discretion, and clarifying the rules of business and political competition in the mining sector in the country.

Keywords: anti-corruption, public integrity, private integrity, mining industry, democratization

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Authors: B. Shukir, L. Szivos, D. Kis, P. Barzo

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Glioblastoma is the most malignant brain tumor. In general, the survival rate varies between (14-18) months. Glioblastoma consists a solid and infiltrative part. The standard therapeutic management of glioblastoma is maximum safe resection followed by chemo-radiotherapy. It’s hypothesized that the pretumoral hyperintense region in fluid attenuated inversion recovery (FLAIR) images includes both vasogenic edema and infiltrated tumor cells. In our study, we aimed to define the sensitivity and specificity of hyperintense FLAIR images preoperatively to examine how well it can define the true extent of glioblastoma. (16) glioblastoma patients included in this study. Hyperintense FLAIR region were delineated preoperatively as tumor mask. The infiltrative part of glioblastoma considered the regions where the tumor recurred on the follow up MRI. The recurrence on the CE-T1 images was marked as the recurrence masks. According to (AAL3) and (JHU white matter labels) atlas, the brain divided into cortical and subcortical regions respectively. For calculating specificity and sensitivity, the FLAIR and the recurrence masks overlapped counting how many regions affected by both . The average sensitivity and specificity was 83% and 85% respectively. Individually, the sensitivity and specificity varied between (31-100)%, and (100-58)% respectively. These results suggest that despite FLAIR being as an effective radiologic imaging tool its prognostic value remains controversial and probabilistic tractography remain more reliable available method for identifying the true extent of glioblastoma.

Keywords: brain tumors, glioblastoma, MRI, FLAIR

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Authors: Divya SY. Ang, Mark B. Tan, Nicholas EM. Yeo, Siti RB. Sudirman, Khong Yik Chew

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Introduction: The importance of the amalgamation of technological and engineering advances with surgical principles of reconstruction cannot be overemphasized. With earlier detection of cancer, consequences of high-speed living and neglect, like traumatic injuries and infection, resulting in increasingly younger patients with bone defects. This may result in malformations and suboptimal function that is more noticeable and palpable in the younger, active demographic. Our team proposes a technique that encapsulates a mesh of multidisciplinary effort, tissue engineering and reconstructive principles. Methods/Materials: Our patient was a young competitive footballer in his early 30s who was diagnosed with submandibular adenoid cystic carcinoma with bony involvement. He was thus counselled for a right hemi mandibulectomy, the floor of mouth resection, right selective neck dissection, tracheostomy, and free fibular flap reconstruction of his mandible and required post-operative radiotherapy. Being young and in his prime sportsman years, he was unable to accept the morbidities associated with using his fibula to reconstruct his mandible despite it being the gold standard reconstructive option. The fibula is an ideal vascularized bone flap because it’s reliable and easily shaped with relatively minimal impact on functional outcomes. The fibula contributes to 30% of weightbearing and is the attachment for the lateral compartment muscles; it is stronger in footballers concerning lateral bending. When harvesting the fibula, the distal 6-8cm and up to 10% of the total length is preserved to maintain the ankle’s stability, thus, minimizing the impact on daily activities. There are studies that have noted gait variability post-operatively. Therefore, returning to a premorbid competitive level may be doubtful. To improve his functional outcomes, the decision was made to try and restore the fibula's form and function. Using the concept of Fused Deposition Modelling (FDM), our team comprising of Plastics, Otolaryngology, Orthopedics and Radiology, worked with Osteopore to design a 3D bioresorbable implant to regenerate the fibula defect (14.5cm). Bone marrow was harvested via reaming the contralateral hip prior to the wide resection. 30mls of his blood was obtained for extracting platelet rich plasma. These were packed into the Osteopore 3D-printed bone scaffold. This was then secured into the fibula defect with titanium plates and screws. The flexor hallucis longus and soleus were anchored along the construct and intraosseous membrane, done in a single setting. Results: He was reviewed closely as an outpatient over 10 months post operatively. He reported no discernable loss or difference in ankle function. He is satisfied and back in training and our team has video and photographs that substantiate his progress. Conclusion: FDM allows regeneration of long bone defects. However, we aimed to also restore his eversion and inversion that is imperative for footballers and hence reattached his previously dissected muscles along the length of the Osteopore implant. We believe that the reattachment of the muscle stabilizes not only the construct but allows optimum muscle tensioning when moving his ankle. This is a simple but effective technique in restoring complete function and form in a young patient whose minute muscle control is imperative to life.

Keywords: fused deposition modelling, functional reconstruction, lower limb bony defects, regenerative surgery, 3D printing, tissue engineering

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Authors: Lamia Bensissaid

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Goals: Endometriosis affects 6 to 10% of women of childbearing age. 17 to 44% of them have ovarian endometriomas. Medical and surgical treatments represent the two therapeutic axes with which PMA can be associated. Laparoscopic intraperitoneal ovarian cystectomy is described as the reference technique in the management of endometriomas by learned societies (CNGOF, ESHRE, NICE). However, it leads to a significant short-term reduction in the AMH level and the number of antral follicles, especially in cases of bilateral cystectomy, large cyst size or cystectomy after recurrence. Often, the disease is at an advanced stage with several surgical patients. Most have adhesions, which increase the risk of surgical complications and suboptimal resection and, therefore recurrence of the cyst. These results led to a change of opinion towards a conservative approach. Sclerotherapy is an old technique which acts by fibrinoid necrosis. It consists of injecting a sclerosing agent into the cyst cavity. Results : Recurrence was less than 15% for a 12-month follow-up; these rates are comparable to those of surgery. It does not seem to have a negative impact on ovarian reserve, but this is not sufficiently evaluated. It has an advantage in IVF pregnancy rates compared to cystectomy, particularly in cases of recurrent endometriomas. It has the advantages: · To be done on an outpatient basis. · To be inexpensive. · To avoid sometimes difficult and iterative surgery: · To allow an increase in pregnancy rates and the preservation of the ovarian reserve compared to iterative surgery. · of great interest in cases of bilateral endometriomas (kissing ovaries) or recurrent endometriomas. Conclusions: Ethanol sclerotherapy could be a good alternative to surgery.

Keywords: Endometrioma, Sclerotherapy, infertility, Ethanol

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Authors: Jules Selles

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The Atlantic and Mediterranean bluefin tuna fishery have been considered as the archetype of an overfished and mismanaged fishery. This crisis has demonstrated the role of public awareness and the importance of the interactions between science and management about scientific uncertainties. This work aims at investigating the policy making process associated with a regional fisheries management organization. We propose a contextualized computer-based experimental approach, in order to explore the effects of key factors on the cooperation process in a complex straddling stock management setting. Namely, we analyze the effects of the introduction of a socio-economic tipping point and the uncertainty surrounding the estimation of the resource level. Our approach is based on a Gordon-Schaefer bio-economic model which explicitly represents the decision making process. Each participant plays the role of a stakeholder of ICCAT and represents a coalition of fishing nations involved in the fishery and decide unilaterally a harvest policy for the coming year. The context of the experiment induces the incentives for exploitation and collaboration to achieve common sustainable harvest plans at the Atlantic bluefin tuna stock scale. Our rigorous framework allows testing how stakeholders who plan the exploitation of a fish stock (a common pool resource) respond to two kinds of effects: i) the inclusion of a drastic shift in the management constraints (beyond a socio-economic tipping point) and ii) an increasing uncertainty in the scientific estimation of the resource level.

Keywords: economic experiment, fisheries management, game theory, policy making, Atlantic Bluefin tuna

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Authors: Anupam Sibal

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Whatever is measured tends to improve. With a view to objectively measuring and improving clinical quality across the Apollo Group Hospitals, the initiative of ACE @ 25 (Apollo Clinical Excellence@25) was launched on Jan 09. ACE @ 25 is a clinically balanced scorecard incorporating 25 clinical quality parameters involving complication rates, mortality rates, one-year survival rates and average length of stay after major procedures like liver and renal transplant, CABG, TKR, THR, TURP, PTCA, endoscopy, large bowel resection and MRM covering all major specialties. Also included are hospital acquired infection rates, pain satisfaction and medication errors. Benchmarks have been chosen from the world’s best hospitals. There are weighted scores for outcomes color coded green, orange and red. The cumulative score is 100. Data is reported monthly by 43 Group Hospitals online on the Lighthouse platform. Action taken reports for parameters falling in red are submitted quarterly and reviewed by the board. An audit team audits the data at all locations every six months. Scores are linked to appraisal of the medical head and there is an “ACE @ 25” Champion Award for the highest scorer. Scores for different parameters were variable from green to red at the start of the initiative. Most hospitals showed an improvement in scores over the last four years for parameters where they had showed scores in red or orange at the start of the initiative. The overall scores for the group have shown an increase from 72 in 2010 to 81 in 2015.

Keywords: benchmarks, clinical quality, lighthouse, platform, scores

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Authors: Rameesha Javaid

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Balochistan, the largest landmass named after and dominated by the 55% Baloch population, which has had a difficult anti-center history like their brothers the Kurds of Middle East, reluctantly acceded to Pakistan in 1947. The region, which attained the status of a province after two decades of accession, has lagged behind in social development and economic growth as compared to the other three federating units. The province has seen the least financial autonomy and administrative decentralization both in autocratic and democratic dispensations under geostrategic and security considerations. Significant corrections have been recently made in the policy framework through changing the formula for intra-provincial National Finance Award, curtailing the number of subjects under federal control, and reactivating the Council of Common Interests. Yet policymaking remains overwhelmingly bureaucratic under a weak parliamentary oversight. The provincial coalition governments are unwieldy and directionless. The government machinery has much less than the optimal capability, character, integrity, will, and opportunity to perform. Decentralization further loses its semblance in the absence of local governments for long intervals and with the hold of hereditary tribal chiefs. Increased allocations failed to make an impact in the highest per capita cost environment due to long distances and scattered settlements. Decentralization, the basic ingredient of federalism has remained mortgaged to geo-strategic factors, internal security perceptions, autocratic and individualistic styles of governments, bureaucratic policymaking structures, bad governance, non-existent local governments, and feudalistic tribal lords. This suboptimal federalism speaks for the present underdevelopment in Balochistan and will earmark the milestones in the future.

Keywords: Balochistan, economic development, federalism, political economy

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Authors: Sidney A. Lima, Hermann J. H. Kux, Elcio H. Shiguemori

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The Unmanned Aircraft Systems (UAS) usually navigate through the Global Navigation Satellite System (GNSS) associated with an Inertial Navigation System (INS). However, GNSS can have its accuracy degraded at any time or even turn off the signal of GNSS. In addition, there is the possibility of malicious interferences, known as jamming. Therefore, the image navigation system can solve the autonomy problem, because if the GNSS is disabled or degraded, the image navigation system would continue to provide coordinate information for the INS, allowing the autonomy of the system. This work aims to evaluate the accuracy of the positioning though photogrammetry concepts. The methodology uses orthophotos and Digital Surface Models (DSM) as a reference to represent the object space and photograph obtained during the flight to represent the image space. For the calculation of the coordinates of the perspective center and camera attitudes, it is necessary to know the coordinates of homologous points in the object space (orthophoto coordinates and DSM altitude) and image space (column and line of the photograph). So if it is possible to automatically identify in real time the homologous points the coordinates and attitudes can be calculated whit their respective accuracies. With the methodology applied in this work, it is possible to verify maximum errors in the order of 0.5 m in the positioning and 0.6º in the attitude of the camera, so the navigation through the image can reach values equal to or higher than the GNSS receivers without differential correction. Therefore, navigating through the image is a good alternative to enable autonomous navigation.

Keywords: autonomy, navigation, security, photogrammetry, remote sensing, spatial resection, UAS

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

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

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

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Authors: Janis Zarins, Kristaps Blums, Oskars Radzins, Renars Deksnis, Atis Svare, Santa Salaka

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Wide tumor resection remains the first choice method for tumors of the oral cavity. Nevertheless, remained tissue defect impacts patients functional and aesthetical outcome, which could be improved using microvascular tissue transfers. Mandibular reconstruction is challenging due to the complexity of composite tissue defects and occlusal relationships for normal eating, chewing, and pain free jaw motions. Individual 3-D virtual planning would provide better symmetry and functional outcome. The main goal of preoperative planning is to develop a customized surgical approach with patient specific cutting guides of the mandible, osteotomy guides of the fibula, pre-bended osteosynthesis plates to perform more precise reconstruction, to decrease the surgery time and reach the best outcome. Our study is based on the analysis of 32 patients operated on between 2019 to 2021. All patients underwent mandible reconstruction with vascularized fibula flaps. Patients characteristics, surgery profile, survival, functional outcome, and quality of life was evaluated. Preoperative planning provided a significant decrease of surgery time and the best arrangement of bone closely similar as before the surgery. In cases of bone asymmetry, deformity and malposition, a new mandible was created using 3D planning to restore the appearance of lower jaw anatomy and functionality.

Keywords: mandibular, 3D planning, cutting guides, fibula flap, reconstruction

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Authors: Alka Yadav, Mayank Jain, Rajan Saxena, Niraj Kumari, Narendra Krishnani, Ashok Kumar

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Purpose: To study the mismatch repair (MMR) protein expression and its clinicopathological correlation in colorectal cancer patients in North India. Methods: A prospective study was conducted on histologically proven 52 (38 males and 14 females) patients with adenocarcinoma of colorectum. MMR protein loss was determined by using immunohistochemistry for MLH1, MSH2, PMS2 and MSH6. Results: 52 patients (38 males and 14 females) underwent resection for colorectal cancer with the median age of 52 years (16-81 years). 35% of the patients (n=18) were younger than 50 years of the age. 3 patients had associated history of malignancy in the family. 29 (56%) patients had right colon cancer, 9 (17%) left colon cancer and 14 (27%) rectal cancer. 2 patients each had synchronous and metachronous cancer. Histology revealed well-differentiated tumour in 16, moderately differentiated in 10 and poorly differentiated tumour in 26 patients. MMR protein loss was seen in 15 (29%) patients. Seven (46%) of these patients were less than 50 years of age. Combined loss of MSH2 and MSH6 was seen most commonly and it was found in 6 patients. 12 (80%) patients with MMR protein loss had tumour located proximal to the splenic flexure compared to 3 (20%) located distal to the splenic flexure. There was no difference in MMR protein loss based on patients' age, gender, degree of tumour differentiation, stage of the disease and tumour histological characteristics. Conclusions: This study revealed that there was less than 30% MMR protein loss in colorectal cancer patients. The loss was most commonly seen in right sided colon cancer than left. A larger study is further required to validate these findings.

Keywords: colorectal cancer, mismatch repair protein, immunohitochemistry, clinicopathological correlation

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Authors: Reem Saad Alqahtani

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Drawing on minority literature, this research highlights the role of three contemporary Arab American writers, considering the significance of the historical and cultural contexts of the brutal attacks of 9/11. The focus of the research is to draw attention to the poetry of Samuel Hazo, Nathalie Handal, and Naomi Shihab Nye as representatives of the identity crisis, whose experiences left them feeling marginalized and alienated in both societies, and reflected as one of the ethnic American minority groups, as demonstrated in their poetry, with a special focus on hybridity, resistance, identity, and empowerment. The study explores the writers’ post-9/11 experience, affected by the United States’ long history of marginalization and discrimination against people of colour, placing Arab American literature with that of other ethnic American groups who share the same experience and contribute to composing literature characterized by the aesthetics of cultural hybridity, cultural complexity, and the politics of minorities to promote solidarity and coalition building. Indeed, the three selected Arab American writers have found a link between their narration and the identity of the exiled by establishing an identity that is a kind of synthesis of diverse identities of Western reality and Eastern nostalgia. The approaches applied in this study will include historical/biographical, postcolonial, and discourse analysis. The first will be used to emphasize the influence of the biographical aspects related to the community, identity, and resistance of the three poets on their poetry. The second is used to investigate the effects of postcolonialism on the poets and their responses to it, while the third understand the sociocultural, political, and historical dimensions of the texts, establishing these poets as representative of the Arab American experience. This study is significant because it will help shed light on the importance of the Arabic hybrid identity in creating resistance to minority communities within American society.

Keywords: Arab American, identity, hybridity, post-9/11

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Authors: Seember Susan Aondoakura

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This paper examines the international legal framework established to address the challenges women and girls experience in situations of violent conflict. The United Nations (UN) women, peace, and security agenda (hereafter WPS agenda, the Agenda) aspire to make wars safer for women. It recognizes women's agency in armed conflict and their victimization and formulates measures for their protection. The Agenda also acknowledges women's participation in conflict transformation and post-conflict reconstruction. It also calls for the involvement of women in conflict transformation, encourages the protection of women from sex and gender-based violence (SGBV), and provides relief and recovery from conflict-related SGBV. Using Third World Critical Feminist Theory, this paper argues that the WPS agenda overly focus on the protection of women from SGBV occurring in the less developed and conflict-ridden states in the global south, obscures the complicity of western states and economies to the problem, and silences the privileges that such states derive from war economies that continue to fuel conflict. This protectionist approach of the UN also obliterates other equally pressing problems in need of attention, like the high rates of economic degradation in conflict-ravaged societies of the global south. Prioritising protection also 'others' the problem, obliterating any sense of interconnections across geographical locations and situating women in the less developed economies of the global south as the victims and their men as the perpetrators. Prioritising protection ultimately situates western societies as saviours of Third World women with no recourse to their role in engendering and sustaining war. The paper demonstrates that this saviour mentality obliterates chances of any meaningful coalition between the local and the international in framing and addressing the issue, as solutions are formulated from a specific lens—the white hegemonic lens.

Keywords: conflict, protection, security, SGBV

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Authors: Abdullah Saeidi, Aydin Gülses, Christan Flörke

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Skin cancer of the face region is the most common type of malignancy and surgical excision is the preferred approach. However, the clinical long term results reported in the literature are still controversial. Objectives: To describe; 1. Demographical characteristics 2. Affected site, distribution and TNM classification regarding tumor type 3. Surgical aspects • Surgical removal: excision principles, safety margins, the need for secondary resection, primary reconstruction/ defect closure, anesthesia protocol, duration of hospital stay (if any) • Secondary intervention for defect closure/reconstruction: Flap technique, anesthesia protocol, duration of hospital stay (if any), postoperative wound management etc. 4. Tumor recurrences 5. Clinical outcomes 6. Studying the possible therapy approach throw Biostatistical relation and correlation between multiple Histological, diagnostics and clinical Faktors. following surgical ablation of the skin cancer of the head and neck region. Methods: Selection and statistical analysis of medical records of patients who had admitted to the Department of Oral and Maxillofacial Surgery, Universitätsklinikum Schleswig Holstein, Campus Kiel during the period of 2015-2019 will be retrospectively evaluated. Data will be collected via ORBIS Information-Management-System (ORBIS AG, Saarbrücken, Germany).

Keywords: non melanoma skin cancer, face skin cancer, skin reconstruction, non melanoma skin cancer recurrence, non melanoma skin cancer metastases

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Authors: Riddhi Chopra

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While China’s friendship with a number of countries has waxed and waned over the decades, Sino-Pak relationship is said to have withstood the vicissitudes of larger international politics as well as changes in regional and domestic currents. Pakistan, one of the first countries to recognize the People’s Republic of China, thus providing China with a corridor into the energy rich Muslim states which was reciprocated with a continual stream of no-strings-attached military hardware and defense-related assistance from Beijing. The joint enmity towards India also provided the initial thrust to a burgeoning Sino-Pak friendship. This paper intends to provide a profound analysis of the strategic relation between China-Pakistan and examine India as a determining factor. The Pakistan-China strategic relationship has been conventionally viewed by India as a zero sum game, wherein any gains accrued by Pakistan or China through their partnership is seen as a direct detriment to the evolution of India-Pakistan or India-China relation. The paper evaluates various factors which were crucial for the synthesis of such a strong relation and presents a comprehensive study of the various policies and programs that have been undertaken by the two countries to tie India to South Asia and reduce its sphere of influence. The geographic dynamics is said to breed a natural coalition, dominating the strategic ambitions of both Beijing and Islamabad hence directing their relationship. In addition to the obvious geopolitical factors, there are several dense collaborations between the two nations knitting a relatively close partnership. Moreover, an attempt has been made to assess the irritants in China-Pak relations and the initiatives taken by the two to further strengthen it. Current trends in diplomatic, economic and defense cooperation – along with the staunch affinity rooted in history and consistent geo-strategic interests – points to a strong and strengthening relationship, significant in directing India’s foreign and security policies. This paper seeks to analyze the changing power dynamics of the China-Pak nexus with external actors such as US and India with an ulterior motive of their own and predict the change in power dynamics between the four countries.

Keywords: China, Pakistan, India, strategy

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Authors: Choppala Pratheek, Vineet Ahuja

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Background: Crohn's disease (CD) recurrence following surgery is a common challenge, and current detection methods rely on risk factors identified in Western populations. This study aimed to investigate the risk factors and rates of postoperative CD recurrence in a tuberculosis-endemic region like India. Retrospective data was collected from a structured database from a specialty IBD clinic by reviewing case files from January 2005 to December 2021. Inclusion criteria involved CD patients diagnosed based on the ECCO-ESGAR consensus guidelines, who had undergone at least one intestinal resection and had a minimum follow-up period of one year at the IBD clinic. Results: A total of 90 patients were followed up for a median period of 45 months (IQR, 20.75 - 72.00). Out of the 90 patients, 61 received ATT prior to surgery, with a mean delay in diagnosis of 2.5 years, although statistically non-significant (P=0.078). Clinical recurrence occurred in 50% of patients, with the cumulative rate increasing from 13.3% at one year to 40% at three years. Among 63 patients who underwent endoscopy, 65.7% showed evidence of endoscopic recurrence, with the cumulative rate increasing from 31.7% at one year to 55.5% at four years. Smoking was identified as a significant risk factor for early endoscopic recurrence (P=0.001) by Cox regression analysis, but no other risk factors were identified. Initiating post-operative medications prior to clinical recurrence delayed its onset (P=0.004). Subgroup analysis indicated that endoscopic monitoring aided in the early identification of recurrence (P=0.001). The findings contribute to enhancing post-operative CD management strategies in such regions where the disease burden is escalating.

Keywords: crohns, post operative, tuberculosis-endemic, risk factors

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Authors: Waseem Al-Talalwah

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The superior vesical artery usually arises directly from the anterior division of the internal iliac artery. It may arise from the umbilical artery as three or four branches to supply the upper and middle parts of bladder. Current study focuses on the different origins of the superior vesical artery to provide a sufficient data for surgeons to disease iatrogenic fault. The superior vesical artery arises directly from the anterior division of the internal iliac artery in 24.5% whereas it arises indirectly as from umbilical artery in 83.7%. Further, it may arise from any branch of the anterior division as from the utrine and obturator arteries in 6.1% and in 6.3% respectively. It also shares the origin of the internal pudendal and inferior glutyeal artery as it arises from the gluteopudendal trunk in 4.1%. The superior vesical artery arises as a single, double, triple and quadruple in 69.4%, 20.4%, 8.2% and 2% respectively. In case of cystectomy for bladder cancer, surgeons have to be aware of the origin variability of superior vesical artery to prevent post-surgical complication such as intra-pelvic bleeding. Also, the as intra-pelvic bleeding has to be expected in case of hysterectomy therefore a great caution of the vesical branches arising from uterine artery has to be considered. In case of aneurysm resection of inferior gluteal artery arising from the gluteopudendal trunk, the surgeons have to be careful of the vascular supply of urinary bladder coming from above and below this common trunk as from superior and inferior vesical arteries respectively. Therefore, present study increases the awareness of clinical significance of superior vesical artery origin for surgeons to minimise the iatroginc errors.

Keywords: superior vesical artery, anterior division, internal iliac, internal pudendal, inferior glutyeal, intra-pelvic bleeding, hysterectomy, cystectomy

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Authors: Francis Zerd, Brian E. Moore, Atuganile E. Malango, Patrick W. Hosokawa, Kevin O. Lillehei, Laurence Lemery Mchome, D. Ryan Ormond

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Introduction: Since neuropathologic diagnosis in the developing world is hampered by limitations in technical infrastructure, trained laboratory personnel, and subspecialty-trained pathologists, the use of telepathology for diagnostic support, second-opinion consultations, and ongoing training holds promise as a means of addressing these challenges. This research aims to assess the utility of static teleneuropathology in improving neuropathologic diagnoses in low- and middle-income countries. Methods: Consecutive neurosurgical biopsy and resection specimens obtained at Muhimbili National Hospital in Tanzania between July 1, 2018, and June 30, 2019, were selected for retrospective, blinded static-image neuropathologic review followed by on-site review by an expert neuropathologist. Results: A total of 75 neuropathologic cases were reviewed. The agreement of static images and on-site glass diagnosis was 71% with strict criteria and 88% with less stringent criteria. This represents an overall improvement in diagnostic accuracy from 36% by general pathologists to 71% by a neuropathologist using static telepathology (or 76% to 88% with less stringent criteria). Conclusions: Telepathology offers a suitable means of providing diagnostic support, second-opinion consultations, and ongoing training to pathologists practicing in resource-limited countries. Moreover, static digital teleneuropathology is an uncomplicated, cost-effective, and reliable way to achieve these goals.

Keywords: neuropathology, resource-limited settings, static image, Tanzania, teleneuropathology

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Authors: Dina Tawfic, Robert Hassan

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The current chapter addresses Al-Azhar's strategy to counter extremism in tandem with reflecting on the ideology of the Islamic establishment itself. The topic is motivated by the fact that some of the Western governments have been relying on Al-Azhar to counter the ideology of Islamist radicalism and violent extremism, in particular during the rise of the Islamic State in Syria and Iraq (known as ISIS/ ISIL/ Daesh) in 2014/2015. In his visit to Egypt in June 2016, Brett McGurk, the then U.S. envoy for the global coalition to counter ISIS, commended Al-Azhar’s “intellectual and reforming role” in refuting the ideology of extremism. On the other hand, Egyptian liberal intellectuals, such as Farag Fouda (1945- 1992) and Nasr Hamed Abu Zeid (1943-2010), had always questioned the ideological capability of Al-Azhar to counter extremism, citing the rigidity and resistance of the Islamic establishment to carry out genuine reformation. This chapter aims to discuss the following research questions: what is the strategy of Al-Azhar to counter extremism? Does Al-Azhar have a solid strategy to combat online propaganda produced by violent extremist groups? Is it applicable to identify Al-Azhar ideological identity? and is it capable of countering extremism? To answer these questions, I conducted intensive interviews with seven senior scholars and officials at Al-Azhar and the Endowments ministry from September to December 2020. Using a qualitative approach as a backdrop, this project uses semi-structured interviews to collect data. Participants were briefed on the purpose of the study and consented to be interviewed and to record their interviews. Some of the participants chose to conceal their names. All the interviews were conducted in Arabic via Zoom. The researcher then transcribed and translated the interviews into English. A purposive sample is used to select the seven interviewees, based on their prominence and experience in the field of counter-extremism and Al-Azhar affairs. The researcher uses a snowball sample to select the sample, in which a personal contact recommends other officials within the establishment.

Keywords: Al-Azhar, Egypt, Counter-Extremism, Political Islam, Ideology

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Authors: Metrek Almetrek, Naser Alqahtani, Eisa Ghazwani, Mona Asiri, Mohammed Alqahtani, Magboolah Balobaid

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Background: Advocacy of potential for community coalitions to positively address social determinants of health and quality of life, little is known about the views of stakeholders involved in such efforts. This study sought to assess the provinces leaders’ perspectives about social determinants related to the Health Neighborhood Initiative (HNI), a new county effort to support community coalitions. Method and Subjects: We used a descriptive, qualitative study using personal interviews in 2022. We conducted it in the community coalition's “main cities committees” set across service planning areas that serve vulnerable groups located in the seven registered healthy cities to WHO (Abha, Tareeb, Muhayel, Balqarn, Alharajah, Alamwah, and Bisha). We conducted key informant interviews with 76 governmental, profit, non-profit, and community leaders to understand their perspectives about the HNI. As part of a larger project, this study focused on leaders’ views about social determinants of health related to the HNI. All interviews were audio-recorded and transcribed. An inductive approach to coding was used, with text segments grouped by social determinant categories. Results: Provinces leaders described multiple social determinants of health and quality of life that were relevant to the HNI community coalitions: housing and safety, community violence, economic stability, city services coordination and employment and education. Leaders discussed how social determinants were interconnected with each other and the need for efforts to address multiple social determinants simultaneously to effectively improve health and quality of life. Conclusions: Community coalitions have an opportunity to address multiple social determinants of health and quality of life to meet the social needs of vulnerable groups. Future research should examine how community coalitions, like those in the HNI, can actively engage with community members to identify needs and then deliver evidence-based care.

Keywords: social determinants, health and quality of life, vulnerable groups, qualitative research

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Authors: Libia Jiménez Chávez

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This is a study of freedom riders and their courageous journey for civil rights, but the year was not 1961. It was 2003. This paper chronicles the emergence of a new civil rights movement for immigrant rights through an oral history of the 2003 U.S. Immigrant Workers Freedom Ride (IWFR). During the height of the post-9/11 immigrant repression, a bloc of organizations inspired by the Civil Rights Movement of the 1960s mobilized 900 multinational immigrants and their allies in the fight for legal status, labor protections, family reunification, and civil rights. The activists visited over 100 U.S. cities, met with Congressional leaders in the nation’s capital, and led a rally of over 50,000 people in New York City. This unified effort set the groundwork for the national May Day immigration protests of 2006. Movements can be characterized in two distinct ways: physical movement and social movements. In the past, historians have considered immigrants both as people and as participants in social movements. In contrast, studies of recent migrants tend to say little about their involvement in immigrant political mobilizations. The dominant literature on immigration portrays immigrants as objects of exclusion, border enforcement, detention, and deportation instead of strategic political actors. This paper aims to change this perception. It considers the Freedom Riders both as immigrants who were literally on the move and as participants in a social movement. Through interviews with participants and archival video footage housed at the University of California Los Angeles, it is possible to study this mobile protest as a movement. This contemporary immigrant struggle is an opportunity to explore the makeup and development of a heterogenous immigrant coalition and consider the relationship between population movements and social justice. In addition to oral histories and archival research, the study will utilize social movement literature, U.S. immigration and labor history, and Undocumented Critical Theory to expand the historiography of immigrant social movements in America.

Keywords: civil rights, immigrant social movements, undocumented communities, undocumented critical theory

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Authors: Chew Zhao Hong

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Since the transition of power in 2018, the Malaysian political landscape has experienced substantial shifts and complexities. The decline of the longstanding ruling party, United Malays National Organization (UMNO), following the party rotation, has given rise to splinter parties such as the Indigenous Unity Party (Bersatu), along with the enduring presence of the Pan-Malaysian Islamic Party (PAS) in the northern region of the Malay Peninsula. However, the "Sheraton Move" in 2020 led to the fall of the Pakatan Harapan government and the emergence of Perikatan Nasional, signifying the ascent of a third political force. The 2022 general elections marked Malaysia's entry into a hung parliament, culminating in an intricate negotiation that resulted in a coalition government formed by Pakatan Harapan, Barisan Nasional, and the Sarawak parties alliance (GPS), collectively governing the Malaysian federal administration. During the 2023 state elections, Pakatan Harapan and Barisan Nasional formed an unprecedented alliance, yet the media framing benefited Perikatan Nasional, even securing substantial support from UMNO's traditional constituencies. In the era of converging new media, Malaysia’s democratization faces new challenges: first, political leaders leveraging media to cultivate unfiltered personas risk inducing populism; second, under the influence of agenda-setting and two-step flow theories, media contributes to polarization; lastly, Malaysia's multi-party system is no longer effectively moderate extreme ideologies into the political center. This study examines the role of media framing and its impact on the democratization process within Malaysia's consociational democracy under a multi-party system and analyzes media discourse before and after the 2023 Malaysian state elections to explore how different parties shape public opinion and political discourse, and how political messages may be amplified or distorted in the process.

Keywords: multi-party system, democratization, elections, political polarization, Malaysia, media framing

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