Search results for: ventricular septal defect
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 509

Search results for: ventricular septal defect

359 Smart Defect Detection in XLPE Cables Using Convolutional Neural Networks

Authors: Tesfaye Mengistu

Abstract:

Power cables play a crucial role in the transmission and distribution of electrical energy. As the electricity generation, transmission, distribution, and storage systems become smarter, there is a growing emphasis on incorporating intelligent approaches to ensure the reliability of power cables. Various types of electrical cables are employed for transmitting and distributing electrical energy, with cross-linked polyethylene (XLPE) cables being widely utilized due to their exceptional electrical and mechanical properties. However, insulation defects can occur in XLPE cables due to subpar manufacturing techniques during production and cable joint installation. To address this issue, experts have proposed different methods for monitoring XLPE cables. Some suggest the use of interdigital capacitive (IDC) technology for online monitoring, while others propose employing continuous wave (CW) terahertz (THz) imaging systems to detect internal defects in XLPE plates used for power cable insulation. In this study, we have developed models that employ a custom dataset collected locally to classify the physical safety status of individual power cables. Our models aim to replace physical inspections with computer vision and image processing techniques to classify defective power cables from non-defective ones. The implementation of our project utilized the Python programming language along with the TensorFlow package and a convolutional neural network (CNN). The CNN-based algorithm was specifically chosen for power cable defect classification. The results of our project demonstrate the effectiveness of CNNs in accurately classifying power cable defects. We recommend the utilization of similar or additional datasets to further enhance and refine our models. Additionally, we believe that our models could be used to develop methodologies for detecting power cable defects from live video feeds. We firmly believe that our work makes a significant contribution to the field of power cable inspection and maintenance. Our models offer a more efficient and cost-effective approach to detecting power cable defects, thereby improving the reliability and safety of power grids.

Keywords: artificial intelligence, computer vision, defect detection, convolutional neural net

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358 Defect Identification in Partial Discharge Patterns of Gas Insulated Switchgear and Straight Cable Joint

Authors: Chien-Kuo Chang, Yu-Hsiang Lin, Yi-Yun Tang, Min-Chiu Wu

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With the trend of technological advancement, the harm caused by power outages is substantial, mostly due to problems in the power grid. This highlights the necessity for further improvement in the reliability of the power system. In the power system, gas-insulated switches (GIS) and power cables play a crucial role. Long-term operation under high voltage can cause insulation materials in the equipment to crack, potentially leading to partial discharges. If these partial discharges (PD) can be analyzed, preventative maintenance and replacement of equipment can be carried out, there by improving the reliability of the power grid. This research will diagnose defects by identifying three different defects in GIS and three different defects in straight cable joints, for a total of six types of defects. The partial discharge data measured will be converted through phase analysis diagrams and pulse sequence analysis. Discharge features will be extracted using convolutional image processing, and three different deep learning models, CNN, ResNet18, and MobileNet, will be used for training and evaluation. Class Activation Mapping will be utilized to interpret the black-box problem of deep learning models, with each model achieving an accuracy rate of over 95%. Lastly, the overall model performance will be enhanced through an ensemble learning voting method.

Keywords: partial discharge, gas-insulated switches, straight cable joint, defect identification, deep learning, ensemble learning

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357 Development of Partial Discharge Defect Recognition and Status Diagnosis System with Adaptive Deep Learning

Authors: Chien-kuo Chang, Bo-wei Wu, Yi-yun Tang, Min-chiu Wu

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This paper proposes a power equipment diagnosis system based on partial discharge (PD), which is characterized by increasing the readability of experimental data and the convenience of operation. This system integrates a variety of analysis programs of different data formats and different programming languages and then establishes a set of interfaces that can follow and expand the structure, which is also helpful for subsequent maintenance and innovation. This study shows a case of using the developed Convolutional Neural Networks (CNN) to integrate with this system, using the designed model architecture to simplify the complex training process. It is expected that the simplified training process can be used to establish an adaptive deep learning experimental structure. By selecting different test data for repeated training, the accuracy of the identification system can be enhanced. On this platform, the measurement status and partial discharge pattern of each equipment can be checked in real time, and the function of real-time identification can be set, and various training models can be used to carry out real-time partial discharge insulation defect identification and insulation state diagnosis. When the electric power equipment entering the dangerous period, replace equipment early to avoid unexpected electrical accidents.

Keywords: partial discharge, convolutional neural network, partial discharge analysis platform, adaptive deep learning

Procedia PDF Downloads 47
356 Cardiac Protective Effect of Olive Oil against Ischemia Reperfusion- Induced Cardiac Arrhythmias in Isolated Diabetic Rat Hearts

Authors: Ishfaq A. Bukhari, Bassem Yousef Sheikh, Abdulrahman Almotrefi, Osama Yousaf, Amer Mahmood

Abstract:

Olive oil is the primary source of fat in the Mediterranean diet which is associated with a low mortality for cardiovascular disease. Olive oil is rich in monounsaturated fatty acids, and has been reported for variety of beneficial cardiovascular effects including blood pressure lowering, anti-platelet, anti-diabetic and anti-inflammatory effects. Growing number evidences from preclinical and clinical studies have shown that olive oil improves insulin resistance, decrease vessels stiffness and prevent thromboembolism. We evaluated the effects of olive against streptozotocin-induced physiological disorders in the animal models of diabetes and ischemia and reperfusion (I/R)- induced cardiac arrhythmias. Diabetes was induced in male rats with a single intraperitoneal injection of streptozotocin (60 mg/kg), rats were treated for two months with olive oil (1 ml/kg p.o). Control animals received saline. Blood glucose, body weight were monitored every 14 days. At the end of the treatment rats were sacrificed hearts were isolated for mounting on langedorff’s apparatus. The blood glucose and body weight was not significantly different in the control and olive treated animals. The control diabetic animals exhibited 100% incidence of I/R –induced ventricular fibrillation which was reduced to 0% with olive oil, treatment. The duration of ventricular fibrillation reduced from 98.8± 2.3 (control) to 0 seconds in the olive oil treated group. Diltiazem, a calcium channel blocker (1 µm/L) showed similar results and protected the I/R-induced cardiac disorders. The biochemical analysis of the cardiac tissues showed that diabetes and I/R produce marked pathological changes in the cardiomyocytes including decreased glutathione (GSH) and increased oxidative stress (Malondialdehyde; MDA). Pretreatment of animals with olive oil (1 ml/kg p.o) increased GSH and MDA levels. Olive oil also improved the diabetic-induced histopathological changes in the cardiomyocytes. These finding indicates that olive possesses cardiac protective properties. Further studies are under way in our lab to explore the mechanism of the cardio-protective effect of olive oil.

Keywords: diabeties, ischemia-reperfusion, olive oil, rats heart

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355 Detection of Defects in CFRP by Ultrasonic IR Thermographic Method

Authors: W. Swiderski

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In the paper introduced the diagnostic technique making possible the research of internal structures in composite materials reinforced fibres using in different applications. The main reason of damages in structures of these materials is the changing distribution of load in constructions in the lifetime. Appearing defect is largely complicated because of the appearance of disturbing of continuity of reinforced fibres, binder cracks and loss of fibres adhesiveness from binders. Defect in composite materials is usually more complicated than in metals. At present, infrared thermography is the most effective method in non-destructive testing composite. One of IR thermography methods used in non-destructive evaluation is vibrothermography. The vibrothermography is not a new non-destructive method, but the new solution in this test is use ultrasonic waves to thermal stimulation of materials. In this paper, both modelling and experimental results which illustrate the advantages and limitations of ultrasonic IR thermography in inspecting composite materials will be presented. The ThermoSon computer program for computing 3D dynamic temperature distribuions in anisotropic layered solids with subsurface defects subject to ulrasonic stimulation was used to optimise heating parameters in the detection of subsurface defects in composite materials. The program allows for the analysis of transient heat conduction and ultrasonic wave propagation phenomena in solids. The experiments at MIAT were fulfilled by means of FLIR SC 7600 IR camera. Ultrasonic stimulation was performed with the frequency from 15 kHz to 30 kHz with maximum power up to 2 kW.

Keywords: composite material, ultrasonic, infrared thermography, non-destructive testing

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354 A Review: Detection and Classification Defects on Banana and Apples by Computer Vision

Authors: Zahow Muoftah

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Traditional manual visual grading of fruits has been one of the agricultural industry’s major challenges due to its laborious nature as well as inconsistency in the inspection and classification process. The main requirements for computer vision and visual processing are some effective techniques for identifying defects and estimating defect areas. Automated defect detection using computer vision and machine learning has emerged as a promising area of research with a high and direct impact on the visual inspection domain. Grading, sorting, and disease detection are important factors in determining the quality of fruits after harvest. Many studies have used computer vision to evaluate the quality level of fruits during post-harvest. Many studies have used computer vision to evaluate the quality level of fruits during post-harvest. Many studies have been conducted to identify diseases and pests that affect the fruits of agricultural crops. However, most previous studies concentrated solely on the diagnosis of a lesion or disease. This study focused on a comprehensive study to identify pests and diseases of apple and banana fruits using detection and classification defects on Banana and Apples by Computer Vision. As a result, the current article includes research from these domains as well. Finally, various pattern recognition techniques for detecting apple and banana defects are discussed.

Keywords: computer vision, banana, apple, detection, classification

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353 Molecular Dynamics Simulation of Irradiation-Induced Damage Cascades in Graphite

Authors: Rong Li, Brian D. Wirth, Bing Liu

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Graphite is the matrix, and structural material in the high temperature gas-cooled reactor exhibits an irradiation response. It is of significant importance to analyze the defect production and evaluate the role of graphite under irradiation. A vast experimental literature exists for graphite on the dimensional change, mechanical properties, and thermal behavior. However, simulations have not been applied to the atomistic perspective. Remarkably few molecular dynamics simulations have been performed to study the irradiation response in graphite. In this paper, irradiation-induced damage cascades in graphite were investigated with molecular dynamics simulation. Statistical results of the graphite defects were obtained by sampling a wide energy range (1–30 KeV) and 10 different runs for every cascade simulation with different random number generator seeds to the velocity scaling thermostat function. The chemical bonding in carbon was described using the adaptive intermolecular reactive empirical bond-order potential (AIREBO) potential coupled with the standard Ziegler–Biersack–Littmack (ZBL) potential to describe close-range pair interactions. This study focused on analyzing the number of defects, the final cascade morphology and the distribution of defect clusters in space, the length-scale cascade properties such as the cascade length and the range of primary knock-on atom (PKA), and graphite mechanical properties’ variation. It can be concluded that the number of surviving Frenkel pairs increased remarkably with the increasing initial PKA energy but did not exhibit a thermal spike at slightly lower energies in this paper. The PKA range and cascade length approximately linearly with energy which indicated that increasing the PKA initial energy will come at expensive computation cost such as 30KeV in this study. The cascade morphology and the distribution of defect clusters in space mainly related to the PKA energy meanwhile the temperature effect was relatively negligible. The simulations are in agreement with known experimental results and the Kinchin-Pease model, which can help to understand the graphite damage cascades and lifetime span under irradiation and provide a direction to the designs of these kinds of structural materials in the future reactors.

Keywords: graphite damage cascade, molecular dynamics, cascade morphology, cascade distribution

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352 Hypocalcaemia Inducing Heart Failure: A Rare Presentation

Authors: A. Kherraf, M. Bouziane, L. Azzouzi, R. Habbal

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Introduction: Hypocalcaemia is a rare cause of heart failure. We report the clinical case of a young patient with reversible dilated cardiomyopathy secondary to hypocalcaemia in the context of hyperparathyroidism. Clinical case: We report the clinical case of a 23-year-old patient with a history of thyroidectomy for papillary thyroid carcinoma 3 years previously, who presented to the emergency room with a progressive onset dyspnea and edema of the lower limbs. Clinical examination showed hypotension at 90/70 mmHg, tachycardia at 102 bpm, and edema of the lower limbs. The ECG showed a regular sinus rhythm with a prolonged corrected QT interval to 520ms. The chest x-ray showed cardiomegaly. Echocardiography revealed dilated cardiomyopathy with biventricular dysfunction and a left ventricular ejection fraction of 45%, as well as moderate mitral insufficiency by restriction of the posterior mitral leaflet, moderate tricuspid insufficiency, and a dilated inferior vena cava with a pulmonary arterial pressure estimated at 46 mmHg. Blood tests revealed severe hypocalcemia at 38 mg / l with normal albumin and thyroxine levels, as well as hyperphosphatemia and increased TSH. The patient received calcium intake and vitamin D supplementation and was treated with beta blockers, ACE inhibitors, and diuretics with good progress and progressive normalization of cardiac function. Discussion: The cardiovascular manifestations of hypocalcaemia usually appear with deeply low serum calcium levels. This can lead to hypotension, arrhythmias, ventricular fibrillation, prolonged QT interval, or even heart failure. Heart failure is a rare and serious complication of hypocalcemia but most often characterized by complete normalization of myocardial function after treatment. The etiology of the hypocalcaemia, in this case, was probably related to accidental parathyroid removal during thyroidectomy. This is why careful monitoring of calcium levels is recommended after surgery. Conclusion: Hypocalcemic heart failure is rare but reversible heart disease. Systematic monitoring of serum calcium should be performed in all patients after thyroid surgery to avoid any complications related to hypoparathyroidism.

Keywords: hypocalcemia, heart failure, thyroid surgery, hypoparathyroidism

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351 The Yield of Neuroimaging in Patients Presenting to the Emergency Department with Isolated Neuro-Ophthalmological Conditions

Authors: Dalia El Hadi, Alaa Bou Ghannam, Hala Mostafa, Hana Mansour, Ibrahim Hashim, Soubhi Tahhan, Tharwat El Zahran

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Introduction: Neuro-ophthalmological emergencies require prompt assessment and management to avoid vision or life-threatening sequelae. Some would require neuroimaging. Most commonly used are the CT and MRI of the Brain. They can be over-used when not indicated. Their yield remains dependent on multiple factors relating to the clinical scenario. Methods: A retrospective cross-sectional study was conducted by reviewing the electronic medical records of patients presenting to the Emergency Department (ED) with isolated neuro-ophthalmologic complaints. For each patient, data were collected on the clinical presentation, whether neuroimaging was performed (and which type), and the result of neuroimaging. Analysis of the performed neuroimaging was made, and its yield was determined. Results: A total of 211 patients were reviewed. The complaints or symptoms at presentation were: blurry vision, change in the visual field, transient vision loss, floaters, double vision, eye pain, eyelid droop, headache, dizziness and others such as nausea or vomiting. In the ED, a total of 126 neuroimaging procedures were performed. Ninety-four imagings (74.6%) were normal, while 32 (25.4%) had relevant abnormal findings. Only 2 symptoms were significant for abnormal imaging: blurry vision (p-value= 0.038) and visual field change (p-value= 0.014). While 4 physical exam findings had significant abnormal imaging: visual field defect (p-value= 0.016), abnormal pupil reactivity (p-value= 0.028), afferent pupillary defect (p-value= 0.018), and abnormal optic disc exam (p-value= 0.009). Conclusion: Risk indicators for abnormal neuroimaging in the setting of neuro-ophthalmological emergencies are blurred vision or changes in the visual field on history taking. While visual field irregularities, abnormal pupil reactivity with or without afferent pupillary defect, or abnormal optic discs, are risk factors related to physical testing. These findings, when present, should sway the ED physician towards neuroimaging but still individualizing each case is of utmost importance to prevent time-consuming, resource-draining, and sometimes unnecessary workup. In the end, it suggests a well-structured patient-centered algorithm to be followed by ED physicians.

Keywords: emergency department, neuro-ophthalmology, neuroimaging, risk indicators

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350 Laser Ultrasonic Imaging Based on Synthetic Aperture Focusing Technique Algorithm

Authors: Sundara Subramanian Karuppasamy, Che Hua Yang

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In this work, the laser ultrasound technique has been used for analyzing and imaging the inner defects in metal blocks. To detect the defects in blocks, traditionally the researchers used piezoelectric transducers for the generation and reception of ultrasonic signals. These transducers can be configured into the sparse and phased array. But these two configurations have their drawbacks including the requirement of many transducers, time-consuming calculations, limited bandwidth, and provide confined image resolution. Here, we focus on the non-contact method for generating and receiving the ultrasound to examine the inner defects in aluminum blocks. A Q-switched pulsed laser has been used for the generation and the reception is done by using Laser Doppler Vibrometer (LDV). Based on the Doppler effect, LDV provides a rapid and high spatial resolution way for sensing ultrasonic waves. From the LDV, a series of scanning points are selected which serves as the phased array elements. The side-drilled hole of 10 mm diameter with a depth of 25 mm has been introduced and the defect is interrogated by the linear array of scanning points obtained from the LDV. With the aid of the Synthetic Aperture Focusing Technique (SAFT) algorithm, based on the time-shifting principle the inspected images are generated from the A-scan data acquired from the 1-D linear phased array elements. Thus the defect can be precisely detected with good resolution.

Keywords: laser ultrasonics, linear phased array, nondestructive testing, synthetic aperture focusing technique, ultrasonic imaging

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349 Bionaut™: A Minimally Invasive Microsurgical Platform to Treat Non-Communicating Hydrocephalus in Dandy-Walker Malformation

Authors: Suehyun Cho, Darrell Harrington, Florent Cros, Olin Palmer, John Caputo, Michael Kardosh, Eran Oren, William Loudon, Alex Kiselyov, Michael Shpigelmacher

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The Dandy-Walker malformation (DWM) represents a clinical syndrome manifesting as a combination of posterior fossa cyst, hypoplasia of the cerebellar vermis, and obstructive hydrocephalus. Anatomic hallmarks include hypoplasia of the cerebellar vermis, enlargement of the posterior fossa, and cystic dilatation of the fourth ventricle. Current treatments of DWM, including shunting of the cerebral spinal fluid ventricular system and endoscopic third ventriculostomy (ETV), are frequently clinically insufficient, require additional surgical interventions, and carry risks of infections and neurological deficits. Bionaut Labs develops an alternative way to treat Dandy-Walker Malformation (DWM) associated with non-communicating hydrocephalus. We utilize our discreet microsurgical Bionaut™ particles that are controlled externally and remotely to perform safe, accurate, effective fenestration of the Dandy-Walker cyst, specifically in the posterior fossa of the brain, to directly normalize intracranial pressure. Bionaut™ allows for complex non-linear trajectories not feasible by any conventional surgical techniques. The microsurgical particle safely reaches targets in the lower occipital section of the brain. Bionaut™ offers a minimally invasive surgical alternative to highly involved posterior craniotomy or shunts via direct fenestration of the fourth ventricular cyst at the locus defined by the individual anatomy. Our approach offers significant advantages over the current standards of care in patients exhibiting anatomical challenge(s) as a manifestation of DWM, and therefore, is intended to replace conventional therapeutic strategies. Current progress, including platform optimization, Bionaut™ control, and real-time imaging and in vivo safety studies of the Bionauts™ in large animals, specifically the spine and the brain of ovine models, will be discussed.

Keywords: Bionaut™, cerebral spinal fluid, CSF, cyst, Dandy-Walker, fenestration, hydrocephalus, micro-robot

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348 Evaluation of Compressive Mechanical Properties of the Radial Bone Defect Treated with Selected Bone Graft Substitute Materials in Rabbit

Authors: Omid Gholipoor Bashiri, Ghafur Mosavi, Aliasghar Behnamghader, Seyed Mahmood Rabiee

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Objective: To determine the effect of selected bone graft on the compression properties of radial bone in rabbit. Design-Experimental in vivo study. Animals: A total of 45 adult male New Zealand white rabbits. Procedures: The rabbits were anesthetized and a one-cm-full thickness piece of radial bone was removed using oscillating saw in the all rabbit. The rabbits were divided into 5 groups on the basis of the material used to fill the bone defect: group 1: the paste of bone cement calcium phosphate; group II: the paste of calcium phosphate mixture with type I collagen; group III: tricalcium phosphate mixed with hydroxyapatite (TCP & HP) with 5% porosity; group IV: the same scaffold as group III with 10% porosity; and group V: the same scaffold as group III and IV with 20% porosity, with 9 rabbits in each group. Subsequently subdivided into 3 subgroups of 3 rabbits each. Results: There was a significant increase in compression properties of radial bone in the group II and V in 2nd and 3rd months as compared with groups I, III and IV. The mean endurable crack-strength in group II and V were slightly higher than that of normal radius (P<0.05). Conclusion and clinical relevance: Application of calcium phosphate paste with type I collagen and scaffold of tricalcium phosphate with hydroxyapatite having 20% porosity indicated to have positive effect in integral formation of qualitative callus at the site of fracture and early re-organization of callus to regain mechanical strength too.

Keywords: calcium phosphate, tricalcium phosphate, hydroxyapatite, radial bone, compressive properties, porosity, type i collagen, rabbit

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347 Angiomotin Regulates Integrin Beta 1-Mediated Endothelial Cell Migration and Angiogenesis

Authors: Yuanyuan Zhang, Yujuan Zheng, Giuseppina Barutello, Sumako Kameishi, Kungchun Chiu, Katharina Hennig, Martial Balland, Federica Cavallo, Lars Holmgren

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Angiogenesis describes that new blood vessels migrate from pre-existing ones to form 3D lumenized structure and remodeling. During directional migration toward the gradient of pro-angiogenic factors, the endothelial cells, especially the tip cells need filopodia to sense the environment and exert the pulling force. Of particular interest are the integrin proteins, which play an essential role in focal adhesion in the connection between migrating cells and extracellular matrix (ECM). Understanding how these biomechanical complexes orchestrate intrinsic and extrinsic forces is important for our understanding of the underlying mechanisms driving angiogenesis. We have previously identified Angiomotin (Amot), a member of Amot scaffold protein family, as a promoter for endothelial cell migration in vitro and zebrafish models. Hence, we established inducible endothelial-specific Amot knock-out mice to study normal retinal angiogenesis as well as tumor angiogenesis. We found that the migration ratio of the blood vessel network to the edge was significantly decreased in Amotec- retinas at postnatal day 6 (P6). While almost all the Amot defect tip cells lost migration advantages at P7. In consistence with the dramatic morphology defect of tip cells, there was a non-autonomous defect in astrocytes, as well as the disorganized fibronectin expression pattern correspondingly in migration front. Furthermore, the growth of transplanted LLC tumor was inhibited in Amot knockout mice due to fewer vasculature involved. By using MMTV-PyMT transgenic mouse model, there was a significantly longer period before tumors arised when Amot was specifically knocked out in blood vessels. In vitro evidence showed that Amot binded to beta-actin, Integrin beta 1 (ITGB1), Fibronectin, FAK, Vinculin, major focal adhesion molecules, and ITGB1 and stress fibers were distinctly induced by Amot transfection. Via traction force microscopy, the total energy (force indicater) was found significantly decreased in Amot knockdown cells. Taken together, we propose that Amot is a novel partner of the ITGB1/Fibronectin protein complex at focal adhesion and required for exerting force transition between endothelial cell and extracellular matrix.

Keywords: angiogenesis, angiomotin, endothelial cell migration, focal adhesion, integrin beta 1

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346 Solventless C−C Coupling of Low Carbon Furanics to High Carbon Fuel Precursors Using an Improved Graphene Oxide Carbocatalyst

Authors: Ashish Bohre, Blaž Likozar, Saikat Dutta, Dionisios G. Vlachos, Basudeb Saha

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Graphene oxide, decorated with surface oxygen functionalities, has emerged as a sustainable alternative to precious metal catalysts for many reactions. Herein, we report for the first time that graphene oxide becomes super active for C-C coupling upon incorporation of multilayer crystalline features, highly oxidized surface, Brønsted acidic functionalities and defect sites on the surface and edges via modified oxidation. The resulting improved graphene oxide (IGO) demonstrates superior activity to commonly used framework zeolites for upgrading of low carbon biomass furanics to long carbon chain aviation fuel precursors. A maximum 95% yield of C15 fuel precursor with high selectivity is obtained at low temperature (60 C) and neat conditions via hydroxyalkylation/alkylation (HAA) of 2-methylfuran (2-MF) and furfural. The coupling of 2-MF with carbonyl molecules ranging from C3 to C6 produced the precursors of carbon numbers 12 to 21. The catalyst becomes inactive in the 4th cycle due to the loss of oxygen functionalities, defect sites and multilayer features; however, regains comparable activity upon regeneration. Extensive microscopic and spectroscopic characterization of the fresh and reused IGO is presented to elucidate high activity of IGO and to establish a correlation between activity and surface and structural properties. Kinetic Monte Carlo (KMC) and density functional theory (DFT) calculations are presented to further illustrate the surface features and the reaction mechanism.

Keywords: methacrylic acid, itaconic acid, biomass, monomer, solid base catalyst

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345 Retrospective Analysis of Facial Skin Cancer Patients Treated in the Department of Oral and Maxillofacial Surgery Kiel

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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344 Neutron Irradiated Austenitic Stainless Steels: An Applied Methodology for Nanoindentation and Transmission Electron Microscopy Studies

Authors: P. Bublíkova, P. Halodova, H. K. Namburi, J. Stodolna, J. Duchon, O. Libera

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Neutron radiation-induced microstructural changes cause degradation of mechanical properties and the lifetime reduction of reactor internals during nuclear power plant operation. Investigating the effects of neutron irradiation on mechanical properties of the irradiated material (hardening, embrittlement) is challenging and time-consuming. Although the fast neutron spectrum has the major influence on microstructural properties, the thermal neutron effect is widely investigated owing to Irradiation-Assisted Stress Corrosion Cracking firstly observed in BWR stainless steels. In this study, 300-series austenitic stainless steels used as material for NPP's internals were examined after neutron irradiation at ~ 15 dpa. Although several nanoindentation experimental publications are available to determine the mechanical properties of ion irradiated materials, less is available on neutron irradiated materials at high dpa tested in hot-cells. In this work, we present particular methodology developed to determine the mechanical properties of neutron irradiated steels by nanoindentation technique. Furthermore, radiation-induced damage in the specimens was investigated by High Resolution - Transmission Electron Microscopy (HR-TEM) that showed the defect features, particularly Frank loops, cavity microstructure, radiation-induced precipitates and radiation-induced segregation. The results of nanoindentation measurements and associated nanoscale defect features showed the effect of irradiation-induced hardening. We also propose methodologies to optimized sample preparation for nanoindentation and microscotructural studies.

Keywords: nanoindentation, thermal neutrons, radiation hardening, transmission electron microscopy

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343 Comparison of Anterolateral Thigh Flap with or without Acellular Dermal Matrix in Repair of Hypopharyngeal Squamous Cell Carcinoma Defect: A Retrospective Study

Authors: Yaya Gao, Bing Zhong, Yafeng Liu, Fei Chen

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Aim: The purpose of this study was to explore the difference between acellular dermal matrix (ADM) combined with anterolateral thigh (ALT) flap and ALT flap alone. Methods: HSCC patients were treated and divided into group A (ALT) and group B (ALT+ADM) between January 2014 and December 2018. We compared and analyzed the intraoperative information and postoperative outcomes of the patients. Results: There were 21 and 17 patients in group A and group B, respectively. The operation time, blood loss, defect size and anastomotic vessel selection showed no significant difference between two groups. The postoperative complications, including wound bleeding (n=0 vs. 1, p=0.459), wound dehiscence (n=0 vs. 1, p=0.459), wound infection (n=5vs.3, p=0.709), pharyngeal fistula (n=5vs.4, p=1.000) and hypoproteinemia (n=11 vs. 12, p=0.326) were comparable between the groups. Dysphagia at 6 months (number of liquid diets=0vs. 0; number of partial tube feedings=1vs. 1; number of total tube feedings=1vs. 0, p=0.655) also showed no significant differences. However, significant differences was observed in dysphagia at 12 months (number of liquid diets=0vs. 0; number of partial tube feedings=3 vs. 1; number of total tube feedings=10vs. 1, p=0.006). Conclusion: For HSCC patients, the use of the ALT flap combined ADM, compared to ALT treatment, showed better swallowing function at 12 months. The ALT flap combined ADM may serve as a safe and feasible alternative for selected HSCC patients.

Keywords: hypopharyngeal squamous cell carcinoma, anterolateral thigh free flap, acellular dermal matrix, reconstruction, dysphagia

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342 Theoretical Study of Gas Adsorption in Zirconium Clusters

Authors: Rasha Al-Saedi, Anthony Meijer

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The progress of new porous materials has increased rapidly over the past decade for use in applications such as catalysis, gas storage and removal of environmentally unfriendly species due to their high surface area and high thermal stability. In this work, a theoretical study of the zirconium-based metal organic framework (MOFs) were examined in order to determine their potential for gas adsorption of various guest molecules: CO2, N2, CH4 and H2. The zirconium cluster consists of an inner Zr6O4(OH)4 core in which the triangular faces of the Zr6- octahedron are alternatively capped by O and OH groups which bound to nine formate groups and three benzoate groups linkers. General formula is [Zr(μ-O)4(μ-OH)4(HCOO)9((phyO2C)3X))] where X= CH2OH, CH2NH2, CH2CONH2, n(NH2); (n = 1-3). Three types of adsorption sites on the Zr metal center have been studied, named according to capped chemical groups as the ‘−O site’; the H of (μ-OH) site removed and added to (μ-O) site, ‘–OH site’; (μ-OH) site removed, the ‘void site’ where H2O molecule removed; (μ-OH) from one site and H from other (μ-OH) site, in addition to no defect versions. A series of investigations have been performed aiming to address this important issue. First, density functional theory DFT-B3LYP method with 6-311G(d,p) basis set was employed using Gaussian 09 package in order to evaluate the gas adsorption performance of missing-linker defects in zirconium cluster. Next, study the gas adsorption behaviour on different functionalised zirconium clusters. Those functional groups as mentioned above include: amines, alcohol, amide, in comparison with non-substitution clusters. Then, dispersion-corrected density functional theory (DFT-D) calculations were performed to further understand the enhanced gas binding on zirconium clusters. Finally, study the water effect on CO2 and N2 adsorption. The small functionalized Zr clusters were found to result in good CO2 adsorption over N2, CH4, and H2 due to the quadrupole moment of CO2 while N2, CH4 and H2 weakly polar or non-polar. The adsorption efficiency was determined using the dispersion method where the adsorption binding improved as most of the interactions, for example, van der Waals interactions are missing with the conventional DFT method. The calculated gas binding strengths on the no defect site are higher than those on the −O site, −OH site and the void site, this difference is especially notable for CO2. It has been stated that the enhanced affinity of CO2 of no defect versions is most likely due to the electrostatic interactions between the negatively charged O of CO2 and the positively charged H of (μ-OH) metal site. The uptake of the gas molecule does not enhance in presence of water as the latter binds to Zr clusters more strongly than gas species which attributed to the competition on adsorption sites.

Keywords: density functional theory, gas adsorption, metal- organic frameworks, molecular simulation, porous materials, theoretical chemistry

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341 Suicide Prevention through Spiritual Practice

Authors: Jayant Balaji Athavale, Sean Clarke

Abstract:

Background: According to the WHO, every year, more than 700,000 people die by suicide, which is one person around every 45 seconds. Suicide is the fourth leading cause of death among 15 to 29-year-olds globally. The most common situations or life events that might cause suicidal thoughts are financial problems/unemployment, rejections, relationship breakups, sexual/substance abuse and mental illnesses. Mental/psychological weakness caused due to defects in one’s personality is one of the main reasons why people feel they cannot cope in such situations and contemplate suicide. A WHO Mental Health Action Plan 2013–2020 lists a 4-point strategy to enhance mental health by ‘implementing strategies for promotion and prevention in mental health.’ Methodology: With 40 years of spiritual research background, the team at the Maharshi University of Spirituality has studied the spiritual root causes that can significantly affect one’s mental health and the solutions to improve it. Results/Findings: According to spiritual science, the time and nature of death are mostly due to spiritual reasons. A person would mostly contemplate and attempt suicide when he is spiritually most vulnerable. Spiritual practice, as per universal principles, helps in protecting a person spiritually and prevents him from getting such thoughts of self-harm or acting upon them by controlling such impulses. The University has had much success in helping people to overcome the defects in their personalities, including those with suicidal thoughts, through spiritual practices such as chanting the Name of God and the Personality Defect Removal (PDR) process developed by the Author. Conclusion: If such techniques were taught in educational institutions, they could be simple yet effective self-help tools to prevent thoughts of suicide and enhance mental health and well-being.

Keywords: suicide, mental health, abuse, suicide prevention, personality defect removal

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340 Ulnar Parametacarpal Flap for Coverage of Fifth Finger Defects: Propeller Flap Concept

Authors: Ahmed M. Gad, Ahmed S. Hweidi

Abstract:

Background: Defects of the little finger and adjacent areas are not uncommon. It could be a traumatic, post-burn, or after contracture release. Different options could be used for resurfacing these defect, including skin grafts, local or regional flaps. Ulnar para-metacarpal flap described by Bakhach in 1995 based on the distal division of the dorsal branch of the ulnar artery considered a good option for that. In this work, we applied the concept of propeller flap for better mobilization and in-setting of the ulnar para-metacarpal flap. Methods: The study included 15 cases with 4 females and 11 male patients. 10 of the patients had severe post-burn contractures of little finger, and 5 had post-traumatic little finger defects. Contractures were released and resulting soft tissue defects were reconstructed with propeller ulnar para-metacarpal artery flap. The flap based on two main perforators communicating with the palmar system, it was raised based on one of them depending on the extent of the defect and rotated 180 degrees after judicious dissection of the perforator. Results: 13 flaps survived completely, one of the cases developed partial skin loss, which healed by dressing, another flap was completely lost and covered later by a full-thickness skin graft. Conclusion: Ulnar para-metacarpal flap is a reliable option to resurface the little finger as well as adjacent areas. The application of the propeller flap concept based on whether the proximal or distal communicating branch makes the rotation and in-setting of the flap easier.

Keywords: little finger defects, propeller flap, regional hand defects, ulnar parametacarpal flap

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339 Insights and Observation for Optimum Work Roll Cooling in Flat Hot Mills: A Case Study on Shape Defect Elimination

Authors: Uday S. Goel, G. Senthil Kumar, Biswajit Ghosh, V. V. Mahashabde, Dhirendra Kumar, H. Manjunath, Ritesh Kumar, Mahesh Bhagwat, Subodh Pandey

Abstract:

Tata Steel Bhushan Steel Ltd.(TSBSL)’s Hot Mill at Angul , Orissa , India, was facing shape issues in Hot Rolled (HR) coils. This was resulting in a defect called as ‘Ridge’, which was appearing in subsequent cold rolling operations at various cold mills (CRM) and external customers. A collaborative project was undertaken to resolve this issue. One of the reasons identified was the strange drop in thermal crown after rolling of 20-25 coils in the finishing mill (FM ) schedule. On the shop floor, it was observed that work roll temperatures in the FM after rolling were very high and non uniform across the work roll barrel. Jammed work roll cooling nozzles, insufficient roll bite lubrication and inadequate roll cooling water quality were found to be the main reasons. Regular checking was initiated to check roll cooling nozzles health, and quick replacement done if found jammed was implemented. Improvements on roll lubrication, especially flow rates, was done. Usage of anti-peeling headers and inter stand descaling was enhanced. A subsequent project was also taken up for improving the quality of roll cooling water. Encouraging results were obtained from the project with a reduction in rejection due to ridge at CRM’s by almost 95% of the pre project start levels. Poor profile occurrence of HR coils at HSM was also reduced from a high of 32% in May’19 to <1% since Apr’20.

Keywords: hot rolling flat, shape, ridge, work roll, roll cooling nozzle, lubrication

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338 Characterization of Coronary Artery Obstruction and Related Findings in Ischemic Heart Patients Using Cardiac Scintigraphy

Authors: Yousif Mohamed Y. Abdallah, Eltayeb Wagi Allah Eltayeb, Mohamed E. Gar-elnabi, Mohamed Ahmed Ali

Abstract:

To characterize coronary artery obstruction and related findings in ischemic heart patients using cardiac scintigraphy for the identification of myocardial ischemia, 146 patients were studied at basal conditions and also asked for fasting after night till the intravenous injection of the radiopharmaceutical. After the injection time about 15 to 20 minutes, the patient should eat a fatty meal and chocolate for the good excretion of the gall bladder, to evaluate the performance and regional wall motion of the left ventricle (LV). The results showed that the body mass index percentage in this sample was in range of 43.05 to 61.05. The number of patients who were catheter candidates were 56 with 43% and the patients that were not candidate to cathode were 74 patients with 57% of all patients. For the group of patients where type of ischemia was assessed, 29.5% of patients had reversible posterior and inferior wall, 15.1% of patients had fixed large from apex to base, 9.6% of patients had mild basal inferior wall, 4.8 % of patients had mild anterior wall, 6.2% of patients had antro-septal and 34.9% of patients had moderate ischemia.

Keywords: myocardial ischemia, myocardial scintigraphy, contrast ventriculography, coronary artery obstruction

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337 Literature Review on the Controversies and Changes in the Insanity Defense since the Wild Beast Standard in 1723 until the Federal Insanity Defense Reform Act of 1984

Authors: Jane E. Hill

Abstract:

Many variables led to the changes in the insanity defense since the Wild Beast Standard of 1723 until the Federal Insanity Defense Reform Act of 1984. The insanity defense is used in criminal trials and argued that the defendant is ‘not guilty by reason of insanity’ because the individual was unable to distinguish right from wrong during the time they were breaking the law. The issue that surrounds whether or not to use the insanity defense in the criminal court depends on the mental state of the defendant at the time the criminal act was committed. This leads us to the question of did the defendant know right from wrong when they broke the law? In 1723, The Wild Beast Test stated that to be exempted from punishment the individual is totally deprived of their understanding and memory and doth not know what they are doing. The Wild Beast Test became the standard in England for over seventy-five years. In 1800, James Hadfield attempted to assassinate King George III. He only made the attempt because he was having delusional beliefs. The jury and the judge gave a verdict of not guilty. However, to legal confine him; the Criminal Lunatics Act was enacted. Individuals that were deemed as ‘criminal lunatics’ and were given a verdict of not guilty would be taken into custody and not be freed into society. In 1843, the M'Naghten test required that the individual did not know the quality or the wrongfulness of the offense at the time they committed the criminal act(s). Daniel M'Naghten was acquitted on grounds of insanity. The M'Naghten Test is still a modern concept of the insanity defense used in many courts today. The Irresistible Impulse Test was enacted in the United States in 1887. The Irresistible Impulse Test suggested that offenders that could not control their behavior while they were committing a criminal act were not deterrable by the criminal sanctions in place; therefore no purpose would be served by convicting the offender. Due to the criticisms of the latter two contentions, the federal District of Columbia Court of Appeals ruled in 1954 to adopt the ‘product test’ by Sir Isaac Ray for insanity. The Durham Rule also known as the ‘product test’, stated an individual is not criminally responsible if the unlawful act was the product of mental disease or defect. Therefore, the two questions that need to be asked and answered are (1) did the individual have a mental disease or defect at the time they broke the law? and (2) was the criminal act the product of their disease or defect? The Durham courts failed to clearly define ‘mental disease’ or ‘product.’ Therefore, trial courts had difficulty defining the meaning of the terms and the controversy continued until 1972 when the Durham rule was overturned in most places. Therefore, the American Law Institute combined the M'Naghten test with the irresistible impulse test and The United States Congress adopted an insanity test for the federal courts in 1984.

Keywords: insanity defense, psychology law, The Federal Insanity Defense Reform Act of 1984, The Wild Beast Standard in 1723

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336 A Comparison of Implant Stability between Implant Placed without Bone Graft versus with Bone Graft Using Guided Bone Regeneration (GBR) Technique: A Resonance Frequency Analysis

Authors: R. Janyaphadungpong, A. Pimkhaokham

Abstract:

This prospective clinical study determined the insertion torque (IT) value and monitored the changes in implant stability quotient (ISQ) values during the 12 weeks healing period from implant placement without bone graft (control group) and with bone graft using the guided bone regeneration (GBR) technique (study group). The relationship between the IT and ISQ values of the implants was also assessed. The control and study groups each consisted of 6 patients with 8 implants per group. The ASTRA TECH Implant System™ EV 4.2 mm in diameter was placed in the posterior mandibular region. In the control group, implants were placed in bone without bone graft, whereas in the study group implants were placed simultaneously with the GBR technique at favorable bone defect. IT (Ncm) of each implant was recorded when fully inserted. ISQ values were obtained from the Osstell® ISQ at the time of implant placement, and at 2, 4, 8, and 12 weeks. No difference in IT was found between groups (P = 0.320). The ISQ values in the control group were significantly higher than in the study group at the time of implant placement and at 4 weeks. There was no significant association between IT and ISQ values either at baseline or after the 12 weeks. At 12 weeks of healing, the control and study groups displayed different trends. Mean ISQ values for the control group decreased over the first 2 weeks and then started to increase. ISQ value increases were statistically significant at 8 weeks and later, whereas mean ISQ values in the study group decreased over the first 4 weeks and then started to increase, with statistical significance after 12 weeks. At 12 weeks, all implants achieved osseointegration with mean ISQ values over the threshold value (ISQ>70). These results indicated that implants, in which guided bone regeneration technique was performed during implant placement for treating favorable bone defects, were as predictable as implants placed without bone graft. However, loading in implants placed with the GBR technique for correcting favorable bone defects should be performed after 12 weeks of healing to ensure implant stability and osseointegration.

Keywords: dental implant, favorable bone defect, guided bone regeneration technique, implant stability

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335 Surface Defect-engineered Ceo₂−x by Ultrasound Treatment for Superior Photocatalytic H₂ Production and Water Treatment

Authors: Nabil Al-Zaqri

Abstract:

Semiconductor photocatalysts with surface defects display incredible light absorption bandwidth, and these defects function as highly active sites for oxidation processes by interacting with the surface band structure. Accordingly, engineering the photocatalyst with surface oxygen vacancies will enhance the semiconductor nanostructure's photocatalytic efficiency. Herein, a CeO2₋ₓ nanostructure is designed under the influence of low-frequency ultrasonic waves to create surface oxygen vacancies. This approach enhances the photocatalytic efficiency compared to many heterostructures while keeping the intrinsiccrystal structure intact. Ultrasonic waves induce the acoustic cavitation effect leading to the dissemination of active elements on the surface, which results in vacancy formation in conjunction with larger surface area and smaller particle size. The structural analysis of CeO₂₋ₓ revealed higher crystallinity, as well as morphological optimization, and the presence of oxygen vacancies is verified through Raman, X-rayphotoelectron spectroscopy, temperature-programmed reduction, photoluminescence, and electron spinresonance analyses. Oxygen vacancies accelerate the redox cycle between Ce₄+ and Ce₃+ by prolongingphotogenerated charge recombination. The ultrasound-treated pristine CeO₂ sample achieved excellenthydrogen production showing a quantum efficiency of 1.125% and efficient organic degradation. Ourpromising findings demonstrated that ultrasonic treatment causes the formation of surface oxygenvacancies and improves photocatalytic hydrogen evolution and pollution degradation. Conclusion: Defect engineering of the ceria nanoparticles with oxygen vacancies was achieved for the first time using low-frequency ultrasound treatment. The U-CeO₂₋ₓsample showed high crystallinity, and morphological changes were observed. Due to the acoustic cavitation effect, a larger surface area and small particle size were observed. The ultrasound treatment causes particle aggregation and surface defects leading to oxygen vacancy formation. The XPS, Raman spectroscopy, PL spectroscopy, and ESR results confirm the presence of oxygen vacancies. The ultrasound-treated sample was also examined for pollutant degradation, where 1O₂was found to be the major active species. Hence, the ultrasound treatment influences efficient photocatalysts for superior hydrogen evolution and an excellent photocatalytic degradation of contaminants. The prepared nanostructure showed excellent stability and recyclability. This work could pave the way for a unique post-synthesis strategy intended for efficient photocatalytic nanostructures.

Keywords: surface defect, CeO₂₋ₓ, photocatalytic, water treatment, H₂ production

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334 A Proposed Treatment Protocol for the Management of Pars Interarticularis Pathology in Children and Adolescents

Authors: Paul Licina, Emma M. Johnston, David Lisle, Mark Young, Chris Brady

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Background: Lumbar pars pathology is a common cause of pain in the growing spine. It can be seen in young athletes participating in at-risk sports and can affect sporting performance and long-term health due to its resistance to traditional management. There is a current lack of consensus of classification and treatment for pars injuries. Previous systems used CT to stage pars defects but could not assess early stress reactions. A modified classification is proposed that considers findings on MRI, significantly improving early treatment guidance. The treatment protocol is designed for patients aged 5 to 19 years. Method: Clinical screening identifies patients with a low, medium, or high index of suspicion for lumbar pars injury using patient age, sport participation and pain characteristics. MRI of the at-risk cohort enables augmentation of existing CT-based classification while avoiding ionising radiation. Patients are classified into five categories based on MRI findings. A type 0 lesion (stress reaction) is present when CT is normal and MRI shows high signal change (HSC) in the pars/pedicle on T2 images. A type 1 lesion represents the ‘early defect’ CT classification. The group previously referred to as a 'progressive stage' defect on CT can be split into 2A and 2B categories. 2As have HSC on MRI, whereas 2Bs do not. This distinction is important with regard to healing potential. Type 3 lesions are terminal stage defects on CT, characterised by pseudarthrosis. MRI shows no HSC. Results: Stress reactions (type 0) and acute fractures (1 and 2a) can heal and are treated in a custom-made hard brace for 12 weeks. It is initially worn 23 hours per day. At three weeks, patients commence basic core rehabilitation. At six weeks, in the absence of pain, the brace is removed for sleeping. Exercises are progressed to positions of daily living. Patients with continued pain remain braced 23 hours per day without exercise progression until becoming symptom-free. At nine weeks, patients commence supervised exercises out of the brace for 30 minutes each day. This allows them to re-learn muscular control without rigid support of the brace. At 12 weeks, bracing ceases and MRI is repeated. For patients with near or complete resolution of bony oedema and healing of any cortical defect, rehabilitation is focused on strength and conditioning and sport-specific exercise for the full return to activity. The length of this final stage is approximately nine weeks but depends on factors such as development and level of sports participation. If significant HSC remains on MRI, CT scan is considered to definitively assess cortical defect healing. For these patients, return to high-risk sports is delayed for up to three months. Chronic defects (2b and 3) cannot heal and are not braced, and rehabilitation follows traditional protocols. Conclusion: Appropriate clinical screening and imaging with MRI can identify pars pathology early. In those with potential for healing, we propose hard bracing and appropriate rehabilitation as part of a multidisciplinary management protocol. The validity of this protocol will be tested in future studies.

Keywords: adolescents, MRI classification, pars interticularis, treatment protocol

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333 Acute Cartilage Defects of the Knee Treated With Chondral Restoration Procedures and Patellofemoral Stabilisation

Authors: John Scanlon, Antony Raymond, Randeep Aujla, Peter D’Alessandro, Satyen Gohil

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Background: The incidence of significant acute chondral injuries with patella dislocation is around 10-15%. It is accepted that chondral procedures should only be performed in the presence of joint stability Methods:Patients were identified from surgeon/hospital logs. Patient demographics, lesion size and location, surgical procedure, patient reported outcome measures, post-operative MR imaging, and complications were recorded. PROMs and patient satisfaction was obtained. Results:20 knees (18 patients) were included. Mean age was 18.6 years (range; 11-39), and the mean follow-up was 16.6 months (range; 2-70). The defect locations were the lateral femoral condyle (9/20; 45%), patella (9/20; 45%), medial femoral condyle (1/20; 5%) and the trochlea (1/20; 5%). The mean defect size was 2.6cm2. Twelve knees were treated with cartilage fixation, 5 with microfracture, and 3 with OATS. At follow up, the overall mean Lysholm score was 77.4 (± 17.1), with no chondral regenerative procedure being statistically superior. There was no difference in Lysholm scores between those patients having acute medial patellofemoral ligament reconstruction versus medial soft tissue plication (p=0.59). Five (25%) knees required re-operation (one arthroscopic arthrolysis; one patella chondroplasty; two removal of loose bodies; one implant adjustment). Overall, 90% responded as being satisfied with surgery. Conclusion: Our aggressive pathway to identify and treat acute cartilage defects with early operative intervention and patella stabilisation has shown high rates of satisfaction and Lysholm scores. The full range of chondral restoration options should be considered by surgeons managing these patients.

Keywords: patella dislocation, chondral restoration, knee, patella stabilisation

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332 Spontaneous Reformation of Dehiscent Frontal Sinus Wall after Endoscopic Removal of Mucocele

Authors: Tan Dexian Arthur, James Wei Ming Kwek, Ian Loh, Lee Tee Sin

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Statement of the Problem: Mucoceles most commonly affect the frontal sinus, which results from chronic obstruction of the sinus ostium or cystic dilatation of mucous glands with ductal obstruction. They are known to cause bony erosion of the sinus walls, which can lead to large defects. These defects were typically managed by obliteration or cranialization of the frontal sinus. Although short term outcomes of conservative management of significant posterior table defects from fractures are promising, there have been no studies on the long-term outcomes of large dehiscences in the posterior wall of the frontal sinus. Methodology & Findings : Computed Tomography (CT) Paranasal Sinuses images were analyzed and found complete spontaneous osteogenesis of a large dehiscent frontal sinus posterior wall, secondary to a large mucocele, 9 years from functional endoscopic sinus surgery with the defect managed conservatively. Conclusion & Significance: The dura is well known for its osteogenic properties. Prior studies have showed that dura could induce osteogenesis in cutaneous tissue in the absence of other central nervous system structures. It was also demonstrated that osteogenesis and chondrogenesis were possible in zygomatic fractures by transplanting neonatal dura grafts to the bony defects in rats. Extrapolating from these studies, the authors postulate that the presence of dura beneath the bony deformity of the posterior frontal sinus wall had likely initiated the osteogenesis and restored the bony defect in the patient. In our literature review, we did not find any reports of spontaneous osteogenesis of large frontal sinus defects. While our experience is incidental, it reinforces the osteogenetic potential of an intact dura and further highlights that selected large defects of the posterior wall of the frontal sinus can be conservatively managed.

Keywords: paranasal sinus mucocele, mucocele, osteogenesis, dehiscence

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331 Cardiac Arrest after Cardiac Surgery

Authors: Ravshan A. Ibadov, Sardor Kh. Ibragimov

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Objective. The aim of the study was to optimize the protocol of cardiopulmonary resuscitation (CPR) after cardiovascular surgical interventions. Methods. The experience of CPR conducted on patients after cardiovascular surgical interventions in the Department of Intensive Care and Resuscitation (DIR) of the Republican Specialized Scientific-Practical Medical Center of Surgery named after Academician V. Vakhidov is presented. The key to the new approach is the rapid elimination of reversible causes of cardiac arrest, followed by either defibrillation or electrical cardioversion (depending on the situation) before external heart compression, which may damage sternotomy. Careful use of adrenaline is emphasized due to the potential recurrence of hypertension, and timely resternotomy (within 5 minutes) is performed to ensure optimal cerebral perfusion through direct massage. Out of 32 patients, cardiac arrest in the form of asystole was observed in 16 (50%), with hypoxemia as the cause, while the remaining 16 (50%) experienced ventricular fibrillation caused by arrhythmogenic reactions. The age of the patients ranged from 6 to 60 years. All patients were evaluated before the operation using the ASA and EuroSCORE scales, falling into the moderate-risk group (3-5 points). CPR was conducted for cardiac activity restoration according to the American Heart Association and European Resuscitation Council guidelines (Ley SJ. Standards for Resuscitation After Cardiac Surgery. Critical Care Nurse. 2015;35(2):30-38). The duration of CPR ranged from 8 to 50 minutes. The ARASNE II scale was used to assess the severity of patients' conditions after CPR, and the Glasgow Coma Scale was employed to evaluate patients' consciousness after the restoration of cardiac activity and sedation withdrawal. Results. In all patients, immediate chest compressions of the necessary depth (4-5 cm) at a frequency of 100-120 compressions per minute were initiated upon detection of cardiac arrest. Regardless of the type of cardiac arrest, defibrillation with a manual defibrillator was performed 3-5 minutes later, and adrenaline was administered in doses ranging from 100 to 300 mcg. Persistent ventricular fibrillation was also treated with antiarrhythmic therapy (amiodarone, lidocaine). If necessary, infusion of inotropes and vasopressors was used, and for the prevention of brain edema and the restoration of adequate neurostatus within 1-3 days, sedation, a magnesium-lidocaine mixture, mechanical intranasal cooling of the brain stem, and neuroprotective drugs were employed. A coordinated effort by the resuscitation team and proper role allocation within the team were essential for effective cardiopulmonary resuscitation (CPR). All these measures contributed to the improvement of CPR outcomes. Conclusion. Successful CPR following cardiac surgical interventions involves interdisciplinary collaboration. The application of an optimized CPR standard leads to a reduction in mortality rates and favorable neurological outcomes.

Keywords: cardiac surgery, cardiac arrest, resuscitation, critically ill patients

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330 Superficial Temporal Artery Pseudoaneurysm Post Blepharoplasty: Case Report

Authors: Asaad Alhabsi, Alyaqdan Algafri

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Aim: Reporting 83 years old man with history of left upper eyelid swelling post 4-lids blepharoplasty diagnosed based on clinical presentation and Radiological imaging with pseudoaneurysm of frontal branch of Superficial Temporal Artery post blepharoplasty. METHODS: 83 years old who presented to a Tertiary ophthalmic center with painless left upper eyelids swelling for 2 months post 4-lids blepharoplasty. Left subcutaneous, sub-brow lesion, in the supertemporal pre-septal area, large mass found and excised surgically. Then he developed recurrent larger mass twice first time treated with aspiration of blood, second time diagnosed with superficial temporal artery (STA) pseudoaneurysm of frontal branch treated with endovascular embolization. RESULTS: Pseudoaneurysm of superficial temporal artery (STA) is a rare, presenting usual post head or face trauma .literature reported few cases of such conditions post operatively, and no reported cases post blepharoplasty. CONCLUSIONS: Surgical intervention is the gold standard of treatment either directly by dissecting the aneurysmal sac and ligate both ends, or endovascular method of injecting thrombin or embolization which was done in this patient by interventional radiologist.

Keywords: superficial temporal artery, pseudoaneurysm, blepharoplasty, Oculoplasty

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