Search results for: minimally invasive surgery

Authors: Elham Alaee, Mousa Shamsi, Hossein Ahmadi, Soroosh Nazem, Mohammadhossein Sedaaghi

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Human face has a fundamental role in the appearance of individuals. So the importance of facial surgeries is undeniable. Thus, there is a need for the appropriate and accurate facial skin segmentation in order to extract different features. Since Fuzzy CMeans (FCM) clustering algorithm doesn’t work appropriately for noisy images and outliers, in this paper we exploit Possibilistic CMeans (PCM) algorithm in order to segment the facial skin. For this purpose, first, we convert facial images from RGB to YCbCr color space. To evaluate performance of the proposed algorithm, the database of Sahand University of Technology, Tabriz, Iran was used. In order to have a better understanding from the proposed algorithm; FCM and Expectation-Maximization (EM) algorithms are also used for facial skin segmentation. The proposed method shows better results than the other segmentation methods. Results include misclassification error (0.032) and the region’s area error (0.045) for the proposed algorithm.

Keywords: Facial image, segmentation, PCM, FCM, skin error, facial surgery.

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Authors: Eric Sitorus, Septian Prahastudhi, Turgod Nainggolan, Erwin Riyanto

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Mining by block or panel caving is a mining method that takes advantage of fractures within an ore body, coupled with gravity, to extract material from a predetermined column of ore. The caving column is weakened from beneath through the use of undercutting, after which the ore breaks up and is extracted from below in a continuous cycle. The nature of this method induces cyclical stresses on the pillars of excavations as stress is built up and released over time, which has a detrimental effect on both the installed ground support and the rock mass itself. Ground support capacity, especially on the production where excavation void ratio is highest, is subjected to heavy loading. Strain above threshold of the elongation of support capacity can yield resulting in damage to excavations. Geotechnical engineers must evaluate not only the remnant capacity of ground support systems but also investigate depth of rock mass yield within pillars, backs and floors. Ground Penetrating Radar (GPR) is a geophysical method that has the ability to evaluate rock mass damage using electromagnetic waves. This paper illustrates a case study from the Grasberg mining complex where non-invasive information on the depth of damage and condition of the remaining rock mass was required. GPR with 100 MHz antenna resolution was used to obtain images of the subsurface to determine rehabilitation requirements prior to recommencing production activities. The GPR surveys were used to calibrate the reflection coefficient response of varying rock mass conditions to known Rock Quality Designation (RQD) parameters observed at the mine. The calibrated GPR survey allowed site engineers to map subsurface conditions and plan rehabilitation accordingly.

Keywords: Block caving, ground penetrating radar, reflectivity, RQD.

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Authors: Ehsan Firouzfar, Maryam Attaran

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Heat pipes are two-phase heat transfer devices with high effective thermal conductivity. Due to the high heat transport capacity, heat exchanger with heat pipes has become much smaller than traditional heat exchangers in handling high heat fluxes. With the working fluid in a heat pipe, heat can be absorbed on the evaporator region and transported to the condenser region where the vapour condenses releasing the heat to the cooling media. Heat pipe technology has found increasing applications in enhancing the thermal performance of heat exchangers in microelectranics, energy saving in HVAC systems for operating rooms,surgery centers, hotels, cleanrooms etc, temperature regulation systems for the human body and other industrial sectors. Development activity in heat pipe and thermosyphon technology in asia in recent years is surveyed. Some new results obtained in Australia and other countries are also included.

Keywords: Heat pipe heat exchanger, Thermosyphone, effectiveness, HVAC system, energy saving, temperature regulation.

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Authors: W. Kaowumpai, D. Koolpiruck, K. Viravaidya

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Female breast cancer is the second in frequency after cervical cancer. Surgery is the most common treatment for breast cancer, followed by chemotherapy as a treatment of choice. Although effective, it causes serious side effects. Controlled-release drug delivery is an alternative method to improve the efficacy and safety of the treatment. It can release the dosage of drug between the minimum effect concentration (MEC) and minimum toxic concentration (MTC) within tumor tissue and reduce the damage of normal tissue and the side effect. Because an in vivo experiment of this system can be time-consuming and labor-intensive, a mathematical model is desired to study the effects of important parameters before the experiments are performed. Here, we describe a 3D mathematical model to predict the release of doxorubicin from pluronic gel to treat human breast cancer. This model can, ultimately, be used to effectively design the in vivo experiments.

Keywords: Breast Cancer, Doxorubicin, Controlled ReleaseSystem, Diffusion and Convection Equation.

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Authors: L. Bikulciene, E. Venskaityte, G. Jarusevicius

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Nonstationary and nonlinear signals generated by living complex systems defy traditional mechanistic approaches, which are based on homeostasis. Previous our studies have shown that the evaluation of the interactions of physiological signals by using special analysis methods is suitable for observation of physiological processes. It is demonstrated the possibility of using deep physiological model, based on the interpretation of the changes of the human body’s functional states combined with an application of the analytical method based on matrix theory for the physiological signals analysis, which was applied on high risk cardiac patients. It is shown that evaluation of cardiac signals interactions show peculiar for each individual functional changes at the onset of hemodynamic restoration procedure. Therefore, we suggest that the alterations of functional state of the body, after patients overcome surgery can be complemented by the data received from the suggested approach of the evaluation of functional variables’ interactions.

Keywords: Cardiac diseases, Complex systems theory, ECG analysis, matrix analysis.

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: Critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team.

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Authors: Shaival Dalal, Nilesh Shah, Dinshaw Pardiwala, David Rajan, Satyen Sanghavi, Charul Bhanji

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Autologous Chondrocyte Implantation (ACI) is used worldwide since 1998 to treat cartilage defect. GEL based ACI is a new tissue-engineering technique to treat full thickness cartilage defect with fibrin and thrombin as scaffold for chondrocytes. Purpose of this study is to see safety and efficacy of gel based ACI for knee cartilage defect in multiple centres with different surgeons. Gel-based Autologous Chondrocyte Implantation (GACI) has shown effectiveness in treating isolated cartilage defect of knee joint. Long term results are still needed to be studied. This study was followed-up up to two years and showed benefit to patients. All enrolled patients with a mean age of 28.5 years had an average defect size of3 square centimeters, and were grade IV as per ICRS grading. All patients were followed up several times and at several intervals at 6th week, 8th week, 11th week, 17th week, 29th week, 57th week after surgery. The outcomes were measured based on the IKDC (subjective and objective) and MOCART scores.

Keywords: Knee, chondrocyte, autologous chondrocyte implantation, gel.

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Authors: Rashima Mahajan, Dipali Bansal, Shweta Singh

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Real time non-invasive Brain Computer Interfaces have a significant progressive role in restoring or maintaining a quality life for medically challenged people. This manuscript provides a comprehensive review of emerging research in the field of cognitive/affective computing in context of human neural responses. The perspectives of different emotion assessment modalities like face expressions, speech, text, gestures, and human physiological responses have also been discussed. Focus has been paid to explore the ability of EEG (Electroencephalogram) signals to portray thoughts, feelings, and unspoken words. An automated workflow-based protocol to design an EEG-based real time Brain Computer Interface system for analysis and classification of human emotions elicited by external audio/visual stimuli has been proposed. The front end hardware includes a cost effective and portable Emotiv EEG Neuroheadset unit, a personal computer and a set of external stimulators. Primary signal analysis and processing of real time acquired EEG shall be performed using MATLAB based advanced brain mapping toolbox EEGLab/BCILab. This shall be followed by the development of MATLAB based self-defined algorithm to capture and characterize temporal and spectral variations in EEG under emotional stimulations. The extracted hybrid feature set shall be used to classify emotional states using artificial intelligence tools like Artificial Neural Network. The final system would result in an inexpensive, portable and more intuitive Brain Computer Interface in real time scenario to control prosthetic devices by translating different brain states into operative control signals.

Keywords: Brain Computer Interface (BCI), Electroencephalogram (EEG), EEGLab, BCILab, Emotiv, Emotions, Interval features, Spectral features, Artificial Neural Network, Control applications.

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Authors: P. V. Pramila, V. Mahesh

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Pulmonary Function Tests are important non-invasive diagnostic tests to assess respiratory impairments and provides quantifiable measures of lung function. Spirometry is the most frequently used measure of lung function and plays an essential role in the diagnosis and management of pulmonary diseases. However, the test requires considerable patient effort and cooperation, markedly related to the age of patients resulting in incomplete data sets. This paper presents, a nonlinear model built using Multivariate adaptive regression splines and Random forest regression model to predict the missing spirometric features. Random forest based feature selection is used to enhance both the generalization capability and the model interpretability. In the present study, flow-volume data are recorded for N= 198 subjects. The ranked order of feature importance index calculated by the random forests model shows that the spirometric features FVC, FEF25, PEF, FEF25-75, FEF50 and the demographic parameter height are the important descriptors. A comparison of performance assessment of both models prove that, the prediction ability of MARS with the `top two ranked features namely the FVC and FEF25 is higher, yielding a model fit of R2= 0.96 and R2= 0.99 for normal and abnormal subjects. The Root Mean Square Error analysis of the RF model and the MARS model also shows that the latter is capable of predicting the missing values of FEV1 with a notably lower error value of 0.0191 (normal subjects) and 0.0106 (abnormal subjects) with the aforementioned input features. It is concluded that combining feature selection with a prediction model provides a minimum subset of predominant features to train the model, as well as yielding better prediction performance. This analysis can assist clinicians with a intelligence support system in the medical diagnosis and improvement of clinical care.

Keywords: FEV1, Multivariate Adaptive Regression Splines Pulmonary Function Test, Random Forest.

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Authors: Y.K. Kim, Y.S. Jang, H.H. Park, J.H. Ji, I.S. Park, T.S. Bae, M.H. Lee

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Magnesium is used implant material potentially for non-toxicity to the human body. Due to the excellent bio-compatibility, Mg alloys is applied to implants avoiding removal second surgery. However, it is found commercial magnesium alloys including aluminum has low corrosion resistance, resulting subcutaneous gas bubbles and consequently the approach as permanent bio-materials. Generally, Aluminum is known to pollution substance, and it raises toxicity to nervous system. Therefore especially Mg-35Zn-3Ca alloy is prepared for new biodegradable materials in this study. And the pulsed power is used in constant-current mode of DC power kinds of anodization. Based on the aforementioned study, it examines corrosion resistance and biocompatibility by effect of current and frequency variation. The surface properties and thickness were compared using scanning electronic microscopy. Corrosion resistance was assessed via potentiodynamic polarization and the effect of oxide layer on the body was assessed cell viability. Anodized Mg-35Zn-3Ca alloy has good biocompatibility in vitro by current and frequency variation.

Keywords: Biodegradable material, Mg, anodization, osteoblast cell, pulse power.

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Authors: Santhosh K. S. Annayappa, Nupur Pruthi

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The region of dentate nucleus is a common site for various pathologies like hematomas, tumours, etc. We aimed to study in detail the relationship of this region with the vermis, especially the pyramid using microscopic fibre dissection technique. To achieve this aim, 20 cerebellar hemispheres were studied from the 11 cerebellums. Dissection was performed using wooden spatulas and micro dissectors under a microscope following Klingler’s preservation technique. The relationship between the pyramid of vermis and the dentate nucleus was studied in detail. A similar relationship was studied on the MRI of randomly selected trigeminal neuralgia patients and correlated with anatomical findings. Results show the mean distance of the lateral margin of the dentate nucleus from the midline on anatomic specimens was 21.4 ± 1.8 mm (19-25 mm) and 23.4 ± 3.4 mm (15-29 mm) on right and left side, respectively. Similar measurements made on the MRI were 22.97 ± 2.0 mm (20.03-26.15 mm) on the right side and 23.98 ± 2.1 mm (21.47-27.67 mm) on the left side. The amount of white matter dissection required to reach the dentate nucleus at the pyramidal attachment area was 7.3 ± 1.0 mm (6-9 mm) on the right side and 6.8 ± 1.4 mm (5-10 mm) on the left side. It was concluded that the pyramid of vermis has a constant relationship with the dentate nucleus and can be used as an excellent landmark during surgery to localise the dentate nucleus on the suboccipital surface.

Keywords: Fiber dissection, micro neurosurgery, dentate nucleus of cerebellum, pyramid of vermis.

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Authors: Anita Khadka, Gregory Epiphaniou, Carsten Maple

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There is a dramatic surge in the adoption of Machine Learning (ML) techniques in many areas, including the nuclear industry (such as fault diagnosis and fuel management in nuclear power plants), autonomous systems (including self-driving vehicles), space systems (space debris recovery, for example), medical surgery, network intrusion detection, malware detection, to name a few. Artificial Intelligence (AI) has become a part of everyday modern human life. To date, the predominant focus has been developing underpinning ML algorithms that can improve accuracy, while factors such as resiliency and robustness of algorithms have been largely overlooked. If an adversarial attack is able to compromise the learning method or data, the consequences can be fatal, especially but not exclusively in safety-critical applications. In this paper, we present an in-depth analysis of five adversarial attacks and two defence methods on a crack detection ML model. Our analysis shows that it can be dangerous to adopt ML techniques without rigorous testing, since they may be vulnerable to adversarial attacks, especially in security-critical areas such as the nuclear industry. We observed that while the adopted defence methods can effectively defend against different attacks, none of them could protect against all five adversarial attacks entirely.

Keywords: Resilient Machine Learning, attacks, defences, nuclear industry, crack detection.

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Authors: V. Thulasi Bai, Srivatsa S. K.

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Deaths from cardiovascular diseases have decreased substantially over the past two decades, largely as a result of advances in acute care and cardiac surgery. These developments have produced a growing population of patients who have survived a myocardial infarction. These patients need to be continuously monitored so that the initiation of treatment can be given within the crucial golden hour. The available conventional methods of monitoring mostly perform offline analysis and restrict the mobility of these patients within a hospital or room. Hence the aim of this paper is to design a Portable Cardiac Telemedicine System to aid the patients to regain their independence and return to an active work schedule, there by improving the psychological well being. The portable telemedicine system consists of a Wearable ECG Transmitter (WET) and a slightly modified mobile phone, which has an inbuilt ECG analyzer. The WET is placed on the body of the patient that continuously acquires the ECG signals from the high-risk cardiac patients who can move around anywhere. This WET transmits the ECG to the patient-s Bluetooth enabled mobile phone using blue tooth technology. The ECG analyzer inbuilt in the mobile phone continuously analyzes the heartbeats derived from the received ECG signals. In case of any panic condition, the mobile phone alerts the patients care taker by an SMS and initiates the transmission of a sample ECG signal to the doctor, via the mobile network.

Keywords: WET, ECG analyzer, Bluetooth, mobilecellular network, high risk cardiac patients.

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Authors: Adilson M. Enes, Juliana A. Fracarolli, Inácio M. Dal Fabbro, Silvestre Rodrigues

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This research work proposed a study of fruit bruise detection by means of a biospeckle method, selecting the papaya fruit (Carica papaya) as testing body. Papaya is recognized as a fruit of outstanding nutritional qualities, showing high vitamin A content, calcium, carbohydrates, exhibiting high popularity all over the world, considering consumption and acceptability. The commercialization of papaya faces special problems which are associated to bruise generation during harvesting, packing and transportation. Papaya is classified as climacteric fruit, permitting to be harvested before the maturation is completed. However, by one side bruise generation is partially controlled once the fruit flesh exhibits high mechanical firmness. By the other side, mechanical loads can set a future bruise at that maturation stage, when it can not be detected yet by conventional methods. Mechanical damages of fruit skin leave an entrance door to microorganisms and pathogens, which will cause severe losses of quality attributes. Traditional techniques of fruit quality inspection include total soluble solids determination, mechanical firmness tests, visual inspections, which would hardly meet required conditions for a fully automated process. However, the pertinent literature reveals a new method named biospeckle which is based on the laser reflectance and interference phenomenon. The laser biospeckle or dynamic speckle is quantified by means of the Moment of Inertia, named after its mechanical counterpart due to similarity between the defining formulae. Biospeckle techniques are able to quantify biological activities of living tissues, which has been applied to seed viability analysis, vegetable senescence and similar topics. Since the biospeckle techniques can monitor tissue physiology, it could also detect changes in the fruit caused by mechanical damages. The proposed technique holds non invasive character, being able to generate numerical results consistent with an adequate automation. The experimental tests associated to this research work included the selection of papaya fruit at different maturation stages which were submitted to artificial mechanical bruising tests. Damages were visually compared with the frequency maps yielded by the biospeckle technique. Results were considered in close agreement.

Keywords: Biospeckle, papaya, mechanical damages, vegetable bruising.

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Authors: Benjawan Saengwichian, Alasdair E. Charles, Philip J. Hyde

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Magnetically controlled growing rods (MCGRs) have been used to stabilise and correct spinal curvature in children to support non-invasive scoliosis adjustment. Although the encapsulated driving components are intended to be isolated from body fluid contact, in vivo corrosion was observed on these components due to sealing mechanism damage. Consequently, a corrosion circuit is created with the body fluids, resulting in malfunction of the lengthening mechanism. Particularly, the chloride ions in blood plasma or cerebrospinal fluid (CSF) may corrode the MCGR alloys, possibly resulting in metal ion release in long-term use. However, there is no data available on the corrosion resistance of spinal implant alloys in CSF. In this study, an in vitro immersion configuration was designed to simulate in vivo corrosion of 440C SS-Ti6Al4V couples. The 440C stainless steel (SS) was heat-treated to investigate the effect of tempering temperature on intergranular corrosion (IGC), while crevice and galvanic corrosion were studied by limiting the clearance of dissimilar couples. Tests were carried out in a neutral artificial cerebrospinal fluid (ACSF) and phosphate-buffered saline (PBS) under aeration and deaeration for 2 months. The composition of the passive films and metal ion release were analysed. The effect of galvanic coupling, pH, dissolved oxygen and anion species on corrosion rates and corrosion mechanisms are discussed based on quantitative and qualitative measurements. The results suggest that ACSF is more aggressive than PBS due to the combination of aggressive chlorides and sulphate anions, while phosphate in PBS acts as an inhibitor to delay corrosion. The presence of Vivianite on the SS surface in PBS lowered the corrosion rate (CR) more than 5 times for aeration and nearly 2 times for deaeration, compared with ACSF. The CR of 440C is dependent on passive film properties varied by tempering temperature and anion species. Although the CR of Ti6Al4V is insignificant, it tends to release more Ti ions in deaerated ACSF than under aeration, about 6 µg/L. It seems the crevice-like design has more effect on macroscopic corrosion than combining the dissimilar couple, whereas IGC is dominantly observed on sensitized microstructure.

Keywords: Cerebrospinal fluid, crevice corrosion, intergranular corrosion, magnetically controlled growing rods.

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Authors: Md. Zahangir Alom, Mei-Lan Piao, Md. Shariful Islam, Nam Kim, Jae-Hyeung Park

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The evaluation and measurement of human body dimensions are achieved by physical anthropometry. This research was conducted in view of the importance of anthropometric indices of the face in forensic medicine, surgery, and medical imaging. The main goal of this research is to optimization of facial feature point by establishing a mathematical relationship among facial features and used optimize feature points for age classification. Since selected facial feature points are located to the area of mouth, nose, eyes and eyebrow on facial images, all desire facial feature points are extracted accurately. According this proposes method; sixteen Euclidean distances are calculated from the eighteen selected facial feature points vertically as well as horizontally. The mathematical relationships among horizontal and vertical distances are established. Moreover, it is also discovered that distances of the facial feature follows a constant ratio due to age progression. The distances between the specified features points increase with respect the age progression of a human from his or her childhood but the ratio of the distances does not change (d = 1 .618 ) . Finally, according to the proposed mathematical relationship four independent feature distances related to eight feature points are selected from sixteen distances and eighteen feature point-s respectively. These four feature distances are used for classification of age using Support Vector Machine (SVM)-Sequential Minimal Optimization (SMO) algorithm and shown around 96 % accuracy. Experiment result shows the proposed system is effective and accurate for age classification.

Keywords: 3D Face Model, Face Anthropometrics, Facial Features Extraction, Feature distances, SVM-SMO

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Authors: L. Siva Rama Krishna, Sriram Venkatesh, M. Sastish Kumar, M. Uma Maheswara Chary

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Rapid Prototyping (RP) is a technology that produces models and prototype parts from 3D CAD model data, CT/MRI scan data, and model data created from 3D object digitizing systems. There are several RP process like Stereolithography (SLA), Solid Ground Curing (SGC), Selective Laser Sintering (SLS), Fused Deposition Modeling (FDM), 3D Printing (3DP) among them SLS and FDM RP processes are used to fabricate pattern of custom cranial implant. RP technology is useful in engineering and biomedical application. This is helpful in engineering for product design, tooling and manufacture etc. RP biomedical applications are design and development of medical devices, instruments, prosthetics and implantation; it is also helpful in planning complex surgical operation. The traditional approach limits the full appreciation of various bony structure movements and therefore the custom implants produced are difficult to measure the anatomy of parts and analyze the changes in facial appearances accurately. Cranioplasty surgery is a surgical correction of a defect in cranial bone by implanting a metal or plastic replacement to restore the missing part. This paper aims to do a comparative study on the dimensional error of CAD and SLS RP Models for reconstruction of cranial defect by comparing the virtual CAD with the physical RP model of a cranial defect.

Keywords: Rapid Prototyping, Selective Laser Sintering, Cranial defect, Dimensional Error.

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Authors: L. M. Ben Ali

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A retrospective study was undertaken to record the occurrence and pattern of fractures in small animals (dogs and cats) from year 2005 to 2010. A total of 650 cases were presented in small animal surgery unit out of which of 116 (dogs and cats) were presented with history of fractures of different bones. A total of 17.8% (116/650) cases were of fractures which constituted dogs 67% while cats were 23%. The majority of animals were intact. Trauma in the form of road side accident was the principal cause of fractures in dogs whereas as in cats it was fall from height. The ages of the fractured dog ranged from 4 months to 12 years whereas in cat it was from 4 weeks to 10 years. The femoral fractures represented 37.5% and 25% respectively in dogs and cats. Diaphysis, distal metaphyseal and supracondylar fractures were the most affected sites in dog and cats. Tibial fracture in dogs and cats represented 21.5% and 10% while humoral fractures were 7.9% and 14% in dogs and cats respectively. Humoral condyler fractures were most commonly seen in puppies aged 4 to 6 months. Fractured radius-ulna incidence was 19% and 14% in dogs and cats respectively. Other fractures recorded were of lumbar vertebrae, mandible and metacarpals etc. The management comprised of external and internal fixation in both the species. The most common internal fixation technique employed was Intramedullary fixation in long followed by other methods like stack or cross pinning, wiring etc as per findings in the cases. The cast bandage was used majorly as mean for external coaptation. The paper discusses the outcome of the case as per the technique employed.

Keywords: Animal, Fracture, Incidence, Occurrence.

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Authors: A. Razavykia, A. Esmaeilzadeh, S. Iranmanesh

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Many orthopedic implants like proximal humerus cases require lower surface roughness and almost immediate/short lead time surgery. Thus, rapid response from the manufacturer is very crucial. Tool path strategy of milling process has a direct influence on the surface roughness and lead time of medical implant. High-speed milling as promised process would improve the machined surface quality, but conventional or super-abrasive grinding still required which imposes some drawbacks such as additional costs and time. Currently, many CAD/CAM software offers some different tool path strategies to milling free form surfaces. Nevertheless, the users must identify how to choose the strategies according to cutting tool geometry, geometry complexity, and their effects on the machined surface. This study investigates the effect of different tool path strategies for milling a proximal humerus head during finishing operation on stainless steel 316L. Experiments have been performed using MAHO MH700 S vertical milling machine and four machining strategies, namely, spiral outward, spiral inward, and radial as well as zig-zag. In all cases, the obtained surfaces were analyzed in terms of roughness and dimension accuracy compared with those obtained by simulation. The findings provide evidence that surface roughness, dimensional accuracy, and machining time have been affected by the considered tool path strategy.

Keywords: CAD/CAM software, milling, orthopedic implants, tool path strategy.

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Authors: Hai Ming Wong, Kuen Wai Ma, Lavender Yu Xin Yang, Yanqi Yang

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Objectives: In recent years, the Faculty of Dentistry of the University of Hong Kong have extended the implementation of 3D electronic models (e-models) into problem-based learning (PBL) of the Bachelor of Dental Surgery (BDS) curriculum, aiming at mutual enhancement of PBL teaching quality and the students’ skills in using e-models. This study focuses on the effectiveness of e-models serving as a tool to enhance the students’ skills and competences in PBL. Methods: The questionnaire surveys are conducted to measure 50 fourth-year BDS students’ attitude change between beginning and end of blended PBL tutorials. The response rate of this survey is 100%. Results: The results of this study show the students’ agreement on enhancement of their learning experience after e-model implementation and their expectation to have more blended PBL courses in the future. The potential of e-models in cultivating students’ self-learning skills reduces their dependence on others, while improving their communication skills to argue about pros and cons of different treatment options. The students’ independent thinking ability and problem solving skills are promoted by e-model implementation, resulting in better decision making in treatment planning. Conclusion: It is important for future dental education curriculum planning to cope with the students’ needs, and offer support in the form of software, hardware and facilitators’ assistance for better e-model implementation.

Keywords: Problem-Based learning, curriculum, dental education, 3-D electronic models.

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Authors: Khaled M. Ali, M. A. Abdel-Hamid, Ayman A. Mostafa

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Objective: Safety and efficacy of Ahmed glaucoma valve implantation for the management of uveitis induced glaucoma evaluated on the five dogs with uncontrollable glaucoma. Materials and Methods: Ahmed Glaucoma Valve (AGV®; New World Medical, Rancho Cucamonga, CA, USA) is a flow restrictive, nonobstructive self-regulating valve system. Preoperative ocular evaluation included direct ophthalmoscopy and measurement of the intraocular pressure (IOP). The implant was examined and primed prior to implantation. The selected site of the valve implantation was the superior quadrant between the superior and lateral rectus muscles. A fornix-based incision was made through the conjunectiva and Tenon’s capsule. A pocket is formed by blunt dissection of Tenon’s capsule from the episclera. The body of the implant was inserted into the pocket with the leading edge of the device around 8-10 mm from the limbus. Results: No post-operative complications were detected in the operated eyes except a persistent corneal edema occupied the upper half of the cornea in one case. Hyphaema was very mild and seen only in two cases which resolved quickly two days after surgery. Endoscopical evaluation for the operated eyes revealed a normal ocular fundus with clearly visible optic papilla, tapetum and retinal blood vessels. No evidence of hemorrhage, infection, adhesions or retinal abnormalities was detected. Conclusion: Ahmed glaucoma valve is safe and effective implant for treatment of uveitic glaucoma in dogs.

Keywords: Ahmed valve, endoscopy, glaucoma, ocular fundus.

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Authors: Reza Yousefian, Michael A. Kia, Mehrdad Hosseini Zadeh

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The blood ducts must be occluded to avoid loss of blood from vessels in laparoscopic surgeries. This paper presents a locking mechanism to be used in a ligation laparoscopic procedure (LigLAP I), as an alternative solution for a stapling procedure. Currently, stapling devices are being used to occlude vessels. Using these devices may result in some problems, including injury of bile duct, taking up a great deal of space behind the vessel, and bile leak. In this new procedure, a two-layer suture occludes a vessel. A locking mechanism is also required to hold the suture. Since there is a limited space at the device tip, a Shape Memory Alloy (SMA) actuator is used in this mechanism. Suitability for cleanroom applications, small size, and silent performance are among the advantages of SMA actuators in biomedical applications. An experimental study is conducted to examine the function of the locking mechanism. To set up the experiment, a prototype of a locking mechanism is built using nitinol, which is a nickel-titanium shape memory alloy. The locking mechanism successfully locks a polymer suture for all runs of the experiment. In addition, the effects of various surface materials on the applied pulling forces are studied. Various materials are mounted at the mechanism tip to compare the maximum pulling forces applied to the suture for each material. The results show that the various surface materials on the device tip provide large differences in the applied pulling forces.

Keywords: Laparoscopic surgery, ligation process, locking mechanism, Shape Memory Alloy (SMA) actuator.

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Authors: Duan Huanyun, Xu Rui, Li Jianchang, Yuan Yage, Wang Qiuxia, Nomana Intekhab Hadi

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BioEnergy is an archetypal appropriate technology and alternate source of energy in rural areas of China, and can meet the basic need for cooking fuel in rural areas. The paper introduces with an alternate mean of research that can accelerate the biogas energy production. Tithonia diversifolia or the Tree marigold can be hailed as mesophillic anaerobic digestion to increase the production of more Bioenergy. Tithonia diversifolia is very native to Mexico and Central America, which can be served as ornamental plants- green manure and can prevent soil erosion. Tithonia diversifolia is widely grown and known to Asia, Africa, America and Australia as well. Nowadays, Considering China’s geographical condition it is found that Tithonia diversifolia is widely growing plant in the many tropical and subtropical regions of southern Yunnan- which can have great usage in accelerating and increasing the Bioenergy production technology. The paper discussed aiming at proving possibility that Tithonia diversifolia can be applied in biogas fermentation and its biogas production potential, the research carried experiment on Tithonia diversifolia biogas fermentation under the mesophilic condition (35 Celsius Degree). The result revealed that Tithonia diversifolia can be used as biogas fermentative material, and 6% concentration can get the best biogas production, with the TS biogas production rate 656mL/g and VS biogas production rate 801mL/g. It is well addressed that Tithonia diversifolia grows wildly in 53 Counties and 9 cities of Yunnan Province, which mainly grows in form of the road side plants, the edge of the field, countryside, forest edge, open space; of which demersum-natures can form dense monospecific beds -causing serious harm to agricultural production landforms threatening the ecological system as a potentially harmful exotic plant. There are also found the three types of invasive daisy alien plants -Eupatorium adenophorum, Eupatorium Odorata and Tithonia diversifolia in Yunnan Province of China-among them the Tithonia diversifolia is responsible for causing serious harm to agricultural production. In this paper we have designed the experimental explanation of Biogas energy production that requires anaerobic environment and some microbes; Tithonia diversifolia plant has been taken into consideration while carrying experiments and with successful resulting of generating more BioEnergy emphasizing on the practical applications of Tithonia diversifolia. This paper aims at- to find a new mechanism to provide a more scientific basis for the development of this plant herbicides in Biogas energy and to improve the utilization throughout the world as well.

Keywords: Biogas Energy Production, Tithonia diversifolia, Energy Development, Ecological Agriculture, Eupatorium adenophorum, Eupatorium odorata, Anaerobic Fermentation, Biogas Production Potential, Mesopilic Fermentation.

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Authors: H. M. Haytham, E. A. Azza, E.S. Mohamed, E. G. Nesreen

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Thoracotomy is a great surgery that has serious pulmonary complications, so purpose of this study was to determine the response of diaphragmatic excursion to inspiratory muscle trainer post thoracotomy. Thirty patients of both sexes (16 men and 14 women) with age ranged from 20 to 40 years old had done thoracotomy participated in this study. The practical work was done in cardiothoracic department, Kasr-El-Aini hospital at faculty of medicine for individuals 3 days Post operatively. Patients were assigned into two groups: group A (study group) included 15 patients (8 men and 7 women) who received inspiratory muscle training by using inspiratory muscle trainer for 20 minutes and routine chest physiotherapy (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Group B (control group) included 15 patients (8 men and 7 women) who received the routine chest physiotherapy only (deep breathing, cough and early ambulation) twice daily, 3 days per week for one month. Ultrasonography was used to evaluate the changes in diaphragmatic excursion before and after training program. Statistical analysis revealed a significant increase in diaphragmatic excursion in the study group (59.52%) more than control group (18.66%) after using inspiratory muscle trainer post operatively in patients post thoracotomy. It was concluded that the inspiratory muscle training device increases diaphragmatic excursion in patients post thoracotomy through improving inspiratory muscle strength and improving mechanics of breathing and using of inspiratory muscle trainer as a method of physical therapy rehabilitation to reduce post-operative pulmonary complications post thoracotomy.

Keywords: Diaphragmatic excursion, inspiratory muscle trainer, ultrasonography, thoracotomy.

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Authors: Saimir Heta, Kastriot Haxhirexha, Virtut Velmishi, Nevila Alliu, Ilma Robo

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Background: Testicular rotation can occur at any age. The possibility to save the testicle is the fastest possible surgical intervention which is indicated by the presence of acute pain even at rest. The time element is more important to diagnose and proceed further with surgical intervention. Testicular damage is a consequence which mainly depends on the moment of onset of symptoms, at the time when the symptoms are diagnosed, the earliest action to be performed is surgical intervention. Sometimes medical tests are needed to confirm a diagnosis, or to help identify another cause for symptoms; for example, the urine test, that is used to check for infection, associated with the scrotal ultrasound test. Control of blood flow to the longitudinal supply vessels of the testicles is indicated. The sign that indicates testicular rotation is a reduction in blood flow. This is the element which is distinguished from ultrasound examination. Surgery may be needed to determine if the patient’s symptoms are caused by the rotation of the testis or any other condition. Discussion: As a surgical intervention of the emergency, the torsion of the test depends very much on the duration of the torsion, as the success in the life of the testicle depends on the fastest surgical intervention. From the previous clinic, it is noted that in any case presented to the pediatric patient diagnosed with testicular rotation, there is always a link with personal history that the patient refers to the presence of a previous episode of testicular trauma. Literature supports this fact very logically. Conclusions: Salvation without testicular atrophy depends closely on establishing the diagnosis of testicular rotation as soon as possible. Following the logic above, it can be said that the diagnosis for rotation should be performed as soon as possible, to avoid consequences that will not be favorable for the patient.

Keywords: Acute scrotum, testicular torsion, newborns, infants, clinical presentation.

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Authors: Pricillia Priska Sianita

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An aesthetic facial profile is one of the goals in Orthodontics treatment. However, this is not easily achieved, especially in patients with Class II Division 1 malocclusion who have the clinical characteristics of convex profile and significant skeletal discrepancy due to mandibular growth deficiency. Malocclusion with skeletal problems require proper treatment timing for growth stimulation, and it must be done in early age and in need of good cooperation from the patient. If this is not done and the patient has passed the growth period, the ideal treatment is orthognathic surgery which is more complicated and more painful. The growth stimulation of skeletal malocclusion requires a careful cephalometric evaluation ranging from diagnosis to determine the parts that require stimulation to post-treatment evaluation to see the success achieved through changes in the measurement of the skeletal parameters shown in the cephalometric analysis. This case report aims to describe skeletal changes cephalometrically that were achieved through orthodontic treatment in growing period. Material and method: Lateral Cephalograms, pre-treatment, and post-treatment of cases of Class II Division 1 malocclusion is selected from a collection of cephalometric radiographic in a private clinic. The Cephalogram is then traced and measured for the skeletal parameters. The result is noted as skeletal condition data of pre-treatment and post-treatment. Furthermore, superimposition is done to see the changes achieved. The results show that growth stimulation through orthodontic treatment can solve the skeletal problem of Class II Division 1 malocclusion and the skeletal changes that occur can be verified through cephalometric analysis. The skeletal changes have an impact on the improvement of patient's facial profile. To sum up, the treatment timing on a skeletal malocclusion is very important to obtain satisfactory results for the improvement of the aesthetic facial profile, and skeletal changes can be verified through cephalometric evaluation of pre- and post-treatment.

Keywords: Cephalometric evaluation, Class II Division 1 malocclusion, growth stimulation, skeletal changes, skeletal problems.

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Authors: Jochen Nelles, Susanne Kohns, Julia Spies, Friederike Schmitz-Buhl, Roland Thietje, Christopher Brandl, Alexander Mertens, Christopher M. Schlick

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Industrial robots as part of highly automated manufacturing are recently developed to cooperative (light-weight) robots. This offers the opportunity of using them as assistance robots and to improve the participation in professional life of disabled or handicapped people such as tetraplegics. Robots under development are located within a cooperation area together with the working person at the same workplace. This cooperation area is an area where the robot and the working person can perform tasks at the same time. Thus, working people and robots are operating in the immediate proximity. Considering the physical restrictions and the limited mobility of tetraplegics, a hands-free robot control could be an appropriate approach for a cooperative assistance robot. To meet these requirements, the research project MeRoSy (human-robot synergy) develops methods for cooperative assistance robots based on the measurement of head movements of the working person. One research objective is to improve the participation in professional life of people with disabilities and, in particular, mobility impaired persons (e.g. wheelchair users or tetraplegics), whose participation in a self-determined working life is denied. This raises the research question, how a human-robot cooperation workplace can be designed for hands-free robot control. Here, the example of a library scenario is demonstrated. In this paper, an empirical study that focuses on the impact of head movement related stress is presented. 12 test subjects with tetraplegia participated in the study. Tetraplegia also known as quadriplegia is the worst type of spinal cord injury. In the experiment, three various basic head movements were examined. Data of the head posture were collected by a motion capture system; muscle activity was measured via surface electromyography and the subjective mental stress was assessed via a mental effort questionnaire. The muscle activity was measured for the sternocleidomastoid (SCM), the upper trapezius (UT) or trapezius pars descendens, and the splenius capitis (SPL) muscle. For this purpose, six non-invasive surface electromyography sensors were mounted on the head and neck area. An analysis of variance shows differentiated muscular strains depending on the type of head movement. Systematically investigating the influence of different basic head movements on the resulting strain is an important issue to relate the research results to other scenarios. At the end of this paper, a conclusion will be drawn and an outlook of future work will be presented.

Keywords: Assistance robot, human-robot-interaction, motion capture, stress-strain-concept, surface electromyography, tetraplegia.

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Authors: Ren-Jy Ben, Jo-Chi Jao, Chiu-Ya Liao, Ya-Ru Tsai, Lain-Chyr Hwang, Po-Chou Chen

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Cancer is still one of the serious diseases threatening the lives of human beings. How to have an early diagnosis and effective treatment for tumors is a very important issue. The animal carcinoma model can provide a simulation tool for the studies of pathogenesis, biological characteristics, and therapeutic effects. Recently, drug delivery systems have been rapidly developed to effectively improve the therapeutic effects. Liposome plays an increasingly important role in clinical diagnosis and therapy for delivering a pharmaceutic or contrast agent to the targeted sites. Liposome can be absorbed and excreted by the human body, and is well known that no harm to the human body. This study aimed to compare the therapeutic effects between encapsulated (doxorubicin liposomal, Lipodox) and un-encapsulated (doxorubicin, Dox) anti-tumor drugs using magnetic resonance imaging (MRI). Twenty-four New Zealand rabbits implanted with VX2 carcinoma at left thighs were classified into three groups: control group (untreated), Dox-treated group, and LipoDox-treated group, 8 rabbits for each group. MRI scans were performed three days after tumor implantation. A 1.5T GE Signa HDxt whole body MRI scanner with a high resolution knee coil was used in this study. After a 3-plane localizer scan was performed, three-dimensional (3D) fast spin echo (FSE) T2-weighted Images (T2WI) was used for tumor volumetric quantification. Afterwards, two-dimensional (2D) spoiled gradient recalled echo (SPGR) dynamic contrast-enhanced (DCE) MRI was used for tumor perfusion evaluation. DCE-MRI was designed to acquire four baseline images, followed by contrast agent Gd-DOTA injection through the ear vein of rabbit. A series of 32 images were acquired to observe the signals change over time in the tumor and muscle. The MRI scanning was scheduled on a weekly basis for a period of four weeks to observe the tumor progression longitudinally. The Dox and LipoDox treatments were prescribed 3 times in the first week immediately after the first MRI scan; i.e. 3 days after VX2 tumor implantation. ImageJ was used to quantitate tumor volume and time course signal enhancement on DCE images. The changes of tumor size showed that the growth of VX2 tumors was effectively inhibited for both LipoDox-treated and Dox-treated groups. Furthermore, the tumor volume of LipoDox-treated group was significantly lower than that of Dox-treated group, which implies that LipoDox has better therapeutic effect than Dox. The signal intensity of LipoDox-treated group is significantly lower than that of the other two groups, which implies that targeted therapeutic drug remained in the tumor tissue. This study provides a radiation-free and non-invasive MRI method for therapeutic monitoring of targeted liposome on an animal tumor model.

Keywords: Doxorubicin, dynamic contrast-enhanced MRI, lipodox, magnetic resonance imaging, VX2 tumor model.

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Authors: Mohammad Emran, Colton Wayne, Shannon M Koehler, P. Stephen Almond, Haroon Patel

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Purpose: Assessment of anastomotic perfusion in Hirschsprung disease using Indocyanine Green (ICG)-near-infrared (NIR) fluorescence angiography. Introduction: Anastomotic stricture and leak are well-known complications of Hirschsprung pull-through procedures. Complications are due to tension, infection, and/or poor perfusion. While a surgeon can visually determine and control the amount of tension and contamination, assessment of perfusion is subject to surgeon determination. Intraoperative use of ICG-NIR enhances this decision-making process by illustrating perfusion intensity and adequacy in the pulled-through bowel segment. This technique, proven to reduce anastomotic stricture and leak in adults, has not been studied in children to our knowledge. ICG, an FDA approved, nontoxic, non-immunogenic, intravascular (IV) dye, has been used in adults and children for over 60 years, with few side effects. ICG-NIR was used in this report to demonstrate the adequacy of perfusion during transanal pullthrough for Hirschsprung’s disease. Method: 8 patients with Hirschsprung disease were evaluated with ICG-NIR technology. Levels of affected area ranged from sigmoid to total colonic Hirschsprung disease. After leveling, but prior to anastomosis, ICG was administered at 1.25 mg (< 2 mg/kg) and perfusion visualized using an NIR camera, before and during anastomosis. Video and photo imaging was performed and perfusion of the bowel was compared to surrounding tissues. This showed the degree of perfusion and demarcation of perfused and non-perfused bowel. The anastomosis was completed uneventfully and the patients all did well. Results: There were no complications of stricture or leak. 5 of 8 patients (62.5%) had modification of the plan based on ICG-NIR imaging. Conclusion: Technologies that enhance surgeons’ ability to visualize bowel perfusion prior to anastomosis in Hirschsprung’s patients may help reduce post-operative complications. Further studies are needed to assess the potential benefits.

Keywords: Colonic anastomosis, fluorescence angiography, Hirschsprung disease, pediatric surgery, SPY, ICG, NIR.

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Authors: Shende Suraj Balu, A. B. Deoghare, K. M. Pandey

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The human middle ear (ME) is a delicate and vital organ. It has a complex structure that performs various functions such as receiving sound pressure and producing vibrations of eardrum and propagating it to inner ear. It consists of Tympanic Membrane (TM), three auditory ossicles, various ligament structures and muscles. Incidents such as traumata, infections, ossification of ossicular structures and other pathologies may damage the ME organs. The conditions can be surgically treated by employing prosthesis. However, the suitability of the prosthesis needs to be examined in advance prior to the surgery. Few decades ago, this issue was addressed and analyzed by developing an equivalent representation either in the form of spring mass system, electrical system using R-L-C circuit or developing an approximated CAD model. But, nowadays a three-dimensional ME model can be constructed using micro X-Ray Computed Tomography (μCT) scan data. Moreover, the concern about patient specific integrity pertaining to the disease can be examined well in advance. The current research work emphasizes to develop the ME model from the stacks of μCT images which are used as input file to MIMICS Research 19.0 (Materialise Interactive Medical Image Control System) software. A stack of CT images is converted into geometrical surface model to build accurate morphology of ME. The work is further extended to understand the dynamic behaviour of Harmonic response of the stapes footplate and umbo for different sound pressure levels applied at lateral side of eardrum using finite element approach. The pathological condition Cholesteatoma of ME is investigated to obtain peak to peak displacement of stapes footplate and umbo. Apart from this condition, other pathologies, mainly, changes in the stiffness of stapedial ligament, TM thickness and ossicular chain separation and fixation are also explored. The developed model of ME for pathologies is validated by comparing the results available in the literatures and also with the results of a normal ME to calculate the percentage loss in hearing capability.

Keywords: Computed tomography, human middle ear, harmonic response, pathologies, tympanic membrane.

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