Search results for: pediatric surgery

Authors: Naima Nur, Safa Islam, Saeema Islam, Md. Faridul Alam

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The study addresses the increasing challenge of pediatric presumptive tuberculosis, emphasizing the need to understand the factors associated with it. The research aims to determine the proportion of presumptive TB and factors associated with it among suspected pediatric tuberculosis patients. A cross-sectional study was conducted at ICDDR-Bangladesh, collecting specimens from suspected pediatric patients and using logistic regression for data analysis. The study found a high proportion of presumptive TB (85.7%) but no statistically significant differences between presumptive and non-presumptive TB. Theoretical importance of the study highlights the importance of identifying factors associated with presumptive TB for better control and management strategies. Specimens were collected from 84 suspected pediatric patients diagnosed with TB based on clinical symptoms/radiological findings. Microbiological tests like smear-microscopy, culture, and GeneXpert were used to isolate presumptive TB and confirmed TB. The proportion of presumptive TB was 85.7% among suspected pediatric TB patients. Among various factors that were not found to be associated with the presumptive TB. The study concludes that despite a high proportion of presumptive TB, no significant differences were found between presumptive and non-presumptive TB cases.

Keywords: Presumptive tuberculosis, confirmed tuberculosis, patient's characteristics, diagnosis.

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Authors: Jagmohan Mago, Parvinder S. Sandhu, Neeru Chawla

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In this paper, a Bayesian Network (BN) based system is presented for providing clinical decision support to healthcare practitioners in rural or remote areas of India for young infants or children up to the age of 5 years. The government is unable to appoint child specialists in rural areas because of inadequate number of available pediatricians. It leads to a high Infant Mortality Rate (IMR). In such a scenario, Intelligent Pediatric System provides a realistic solution. The prototype of an intelligent system has been developed that involves a knowledge component called an Intelligent Pediatric Assistant (IPA); and User Agents (UA) along with their Graphical User Interfaces (GUI). The GUI of UA provides the interface to the healthcare practitioner for submitting sign-symptoms and displaying the expert opinion as suggested by IPA. Depending upon the observations, the IPA decides the diagnosis and the treatment plan. The UA and IPA form client-server architecture for knowledge sharing.

Keywords: Network, Based Intelligent, Pediatric System

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Authors: Dimas T. Anantyo, Zsa-Zsa A. Laksmi, Adhie N. Radityo, Arsita E. Rini, Gatot I. Sarosa

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A six-point-two-magnitude earthquake rocked Mamuju District, West Sulawesi Province, Indonesia, on 15 January 2021, causing significant health issues for the affected community, particularly among vulnerable populations such as neonates and children. The aim of this study is to examine and describe the diseases diagnosed in the pediatric population in Mamuju 14 days after the earthquake. This study uses a prospective observational study of the pediatric population presenting at West Sulawesi Regional Hospital, Mamuju Regional Public Hospital, and Bhayangkara Hospital for the period of 14 days after the earthquake. Demographic and clinical information was recorded. 153 children were admitted to the health center. Children younger than six years old were the highest proportion (78%). Out of 153 children, 82 of them were male (54%). The most frequently diagnosed disease during the first and second weeks after the earthquake was respiratory problems, followed by gastrointestinal problems that showed an increase in incidence in the second week. This study found that age has a correlation with common disease in children after an earthquake. Respiratory and gastrointestinal problems were found to be the most common diseases among the pediatric population in Mamuju after the earthquake.

Keywords: Health outcomes, pediatric population, earthquake, Mamuju.

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Authors: O. Benaziz, A. Dorbane, S. Djeraba

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The objective of this work is to formulate a dry dispersible form of furosemide in the context of pediatric dose adjustment. To achieve this, we have produced a set of formulas that will be tested in process and after compression. The formula with the best results will be improved to optimize the final shape of the product. Furosemide is the most widely used pediatric diuretic because of its low toxicity. The manufacturing process was chosen taking into account all the data relating to the active ingredient and the excipients used and complying with the specifications and requirements of dispersible tablets. The process used to prepare these tablets was wet granulation. Different excipients were used: lactose, maize starch, magnesium stearate and two superdisintegrants. The mode of incorporation of super-disintegrant changes with each formula. The use of super-disintegrant in the formula allowed optimization of the disintegration time. Prepared tablets were evaluated for weight, content uniformity, hardness, disintegration time, friability and in vitro dissolution test. 

Keywords: Formulation, dispersible tablets, wet granulation, superdisintegrants, disintegration.

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Authors: Sangram A. Sathe, Neha A. Madgulkar, Shruti S. Raut, S. P. Wadkar

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Transforaminal lumbar interbody fusion (TLIF) surgeries have nowadays became popular for treatment of degenerated spinal disorders. The interbody fusion technique like TLIF maintains load bearing capacity of the spine and a suitable disc height. Currently many techniques have been introduced to cure Spondylolisthesis. This surgery provides greater rehabilitation of degenerative spines. While performing this TLIF surgery existing methods use guideway, which is a troublesome surgery technique as the use of two separate instruments is required to perform this surgery. This paper presents a concept which eliminates the use of guideway. This concept also eliminates problems that occur like reverting the cage. The concept discussed in this paper also gives high accuracy while performing surgery.

Keywords: Degenerative disc diseases, pedicle screw, spine, spondylolisthesis, transforaminal lumbar interbody fusion.

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Authors: Ramon Sancibrian, Carlos Redondo-Figuero, Maria C. Gutierrez-Diez, Esther G. Sarabia, Maria A. Benito-Gonzalez, Jose C. Manuel-Palazuelos

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In this paper, the design and evaluation of a handle for laparoscopic surgery is presented. The design of the handle is based on ergonomic principles and tries to avoid awkward postures for surgeons. The handle combines the so-called power-grip and accurate-grip in order to provide strength and accuracy in the performance of surgery. The handle is tested using both objective and subjective approaches. The objective approach uses motion capture techniques to obtain the angles of forearm, arm, wrist and hand. The muscular effort is obtained with electromyography electrodes. On the other hand, a subjective survey has been carried out using questionnaires. Results confirm that the handle is preferred by the majority of the surgeons.

Keywords: Laparoscopic Surgery, Ergonomics, Mechanical Design, Biomechanics.

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Authors: K. Bensafia, A. Mansour, G. Le Maillot, B. Clement, O. Reynet, P. Ariès, S. Haddab

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This paper presents a system designed for wireless acquisition, the recording of electrocardiogram (ECG) signals and the monitoring of the heart’s health during surgery. This wireless recording system allows us to visualize and monitor the state of the heart’s health during a surgery, even if the patient is moved from the operating theater to post anesthesia care unit. The acquired signal is transmitted via a Bluetooth unit to a PC where the data are displayed, stored and processed. To test the reliability of our system, a comparison between ECG signals processed by a conventional ECG monitoring system (Datex-Ohmeda) and by our wireless system is made. The comparison is based on the shape of the ECG signal, the duration of the QRS complex, the P and T waves, as well as the position of the ST segments with respect to the isoelectric line. The proposed system is presented and discussed. The results have confirmed that the use of Bluetooth during surgery does not affect the devices used and vice versa. Pre- and post-processing steps are briefly discussed. Experimental results are also provided.

Keywords: Electrocardiography, monitoring, surgery, wireless system.

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Authors: M. Ovinis, D. Kerr, K. Bouazza-Marouf, M. Vloeberghs

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The use of machine vision to inspect the outcome of surgical tasks is investigated, with the aim of incorporating this approach in robotic surgery systems. Machine vision is a non-contact form of inspection i.e. no part of the vision system is in direct contact with the patient, and is therefore well suited for surgery where sterility is an important consideration,. As a proof-of-concept, three primary surgical tasks for a common neurosurgical procedure were inspected using machine vision. Experiments were performed on cadaveric pig heads to simulate the two possible outcomes i.e. satisfactory or unsatisfactory, for tasks involved in making a burr hole, namely incision, retraction, and drilling. We identify low level image features to distinguish the two outcomes, as well as report on results that validate our proposed approach. The potential of using machine vision in a surgical environment, and the challenges that must be addressed, are identified and discussed.

Keywords: Visual inspection, machine vision, robotic surgery.

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Authors: Mustafa M. Donma, Orkide Donma

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Pediatric overweight and obesity need attention because they may cause morbid obesity, which may develop metabolic syndrome (MetS). Criteria used for the definition of adult MetS cannot be applied for pediatric MetS. Dynamic physiological changes that occur during childhood and adolescence require the evaluation of each parameter based upon age intervals. The aim of this study is to investigate the distribution of blood pressure (BP) values within diverse pediatric age intervals and the possible use and clinical utility of a recently introduced Diagnostic Obesity Notation Model Assessment Tension (DONMA tense) Index derived from systolic BP (SBP) and diastolic BP (DBP) [SBP+DBP/200]. Such a formula may enable a more integrative picture for the assessment of pediatric obesity and MetS due to the use of both SBP and DBP. 554 children, whose ages were between 6-16 years participated in the study; the study population was divided into two groups based upon their ages. The first group comprises 280 cases aged 6-10 years (72-120 months), while those aged 10-16 years (121-192 months) constituted the second group. The values of SBP, DBP and the formula (SBP+DBP/200) covering both were evaluated. Each group was divided into seven subgroups with varying degrees of obesity and MetS criteria. Two clinical definitions of MetS have been described. These groups were MetS3 (children with three major components), and MetS2 (children with two major components). The other groups were morbid obese (MO), obese (OB), overweight (OW), normal (N) and underweight (UW). The children were included into the groups according to the age- and sex-based body mass index (BMI) percentile values tabulated by WHO. Data were evaluated by SPSS version 16 with p < 0.05 as the statistical significance degree. Tension index was evaluated in the groups above and below 10 years of age. This index differed significantly between N and MetS as well as OW and MetS groups (p = 0.001) above 120 months. However, below 120 months, significant differences existed between MetS3 and MetS2 (p = 0.003) as well as MetS3 and MO (p = 0.001). In comparison with the SBP and DBP values, tension index values have enabled more clear-cut separation between the groups. It has been detected that the tension index was capable of discriminating MetS3 from MetS2 in the group, which was composed of children aged 6-10 years. This was not possible in the older group of children. This index was more informative for the first group. This study also confirmed that 130 mm Hg and 85 mm Hg cut-off points for SBP and DBP, respectively, are too high for serving as MetS criteria in children because the mean value for tension index was calculated as 1.00 among MetS children. This finding has shown that much lower cut-off points must be set for SBP and DBP for the diagnosis of pediatric MetS, especially for children under-10 years of age. This index may be recommended to discriminate MO, MetS2 and MetS3 among the 6-10 years of age group, whose MetS diagnosis is problematic.

Keywords: Blood pressure, children, index, metabolic syndrome, obesity.

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Authors: M. Mottaghi, F. Ghalichi, H. Badri Ghavifekr, H. Niroomand Oskui

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This paper presents design and characterization of a microaccelerometer designated for integration into cataract surgical probe to detect hardness of different eye tissues during cataract surgery. Soft posterior lens capsule of eye can be easily damaged in comparison with hard opaque lens since the surgeon can not see directly behind cutting needle during the surgery. Presence of microsensor helps the surgeon to avoid rupturing posterior lens capsule which if occurs leads to severe complications such as glaucoma, infection, or even blindness. The microsensor having overall dimensions of 480 μm x 395 μm is able to deliver significant capacitance variations during encountered vibration situations which makes it capable to distinguish between different types of tissue. Integration of electronic components on chip ensures high level of reliability and noise immunity while minimizes space and power requirements. Physical characteristics and results on performance testing, proves integration of microsensor as an effective tool to aid the surgeon during this procedure.

Keywords: Cataract surgery, MEMS, Microsensor, Phacoemulsification.

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Authors: Ege Can Onal, Enver Ersen, Meltem Elitas

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Laparoscopy is a surgical operation, well known as keyhole surgery. The operation is performed through small holes, hence, scars of a patient become much smaller, patients can recover in a short time and the hospital stay becomes shorter in comparison to an open surgery. Several tools are used at laparoscopic operations; among them, the laparoscope has a crucial role. It provides the vision during the operation, which will be the main focus in here. Since the operation area is very small, motion of the surgical tools might be limited in laparoscopic operations compared to traditional surgeries. To overcome this limitation, most of the laparoscopic tools have become more precise, dexterous, multi-functional or automated. Here, we present a robotic-assisted laparoscope that is controlled with pedals directly by a surgeon. Thus, the movement of the laparoscope might be controlled better, so there will not be a need to calibrate the camera during the operation. The need for an assistant that controls the movement of the laparoscope will be eliminated. The duration of the laparoscopic operation might be shorter since the surgeon will directly operate the camera.

Keywords: Laparoscope, laparoscopy, low-cost, minimally invasive surgery, robotic-assisted surgery.

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Authors: M. Ovinis, D. Kerr, K. Bouazza-Marouf, M. Vloeberghs

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In this paper, the feasibility of using machine vision to assess task completion in a surgical intervention is investigated, with the aim of incorporating vision based inspection in robotic surgery systems. The visually rich operative field presents a good environment for the development of automated visual inspection techniques in these systems, for a more comprehensive approach when performing a surgical task. As a proof of concept, machine vision techniques were used to distinguish the two possible outcomes i.e. satisfactory or unsatisfactory, of three primary surgical tasks involved in creating a burr hole in the skull, namely incision, retraction, and drilling. Encouraging results were obtained for the three tasks under consideration, which has been demonstrated by experiments on cadaveric pig heads. These findings are suggestive for the potential use of machine vision to validate successful task completion in robotic surgery systems. Finally, the potential of using machine vision in the operating theatre, and the challenges that must be addressed, are identified and discussed.

Keywords: Machine vision, robotic surgery, visual inspection.

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Authors: J. Bouchard, B. Prosperi, G. Bavre, M. Daudé, E. Jeandupeux

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Young patients suffering from Cerebral Palsy are facing difficult choices concerning heavy surgeries. Diagnosis settled by surgeons can be complex and on the other hand decision for patient about getting or not such a surgery involves important reflection effort. Proposed software combining prediction for surgeries and post surgery kinematic values, and from 3D model representing the patient is an innovative tool helpful for both patients and medicine professionals. Beginning with analysis and classification of kinematics values from Data Base extracted from gait analysis in 3 separated clusters, it is possible to determine close similarity between patients. Prediction surgery best adapted to improve a patient gait is then determined by operating a suitable preconditioned neural network. Finally, patient 3D modeling based on kinematic values analysis, is animated thanks to post surgery kinematic vectors characterizing the closest patient selected from patients clustering.

Keywords: Cerebral Palsy, Clustering, Crouch Gait, 3-D Modeling.

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Authors: Vikas Pandey, T. L. Joshy, Vyshak Vijayan, N. Babu

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A new and cost effective robotic device was designed for remote tele surgery using dual tone multi frequency technology (DTMF). Tele system with Dual Tone Multiple Frequency has a large capability in sending and receiving of data in hardware and software. The robot consists of DC motors for arm movements and it is controlled manually through a mobile phone through DTMF Technology. The system enables the surgeon from base station to send commands through mobile phone to the patient’s robotic system which includes two robotic arms that translate the input into actual instrument manipulation. A mobile phone attached to the microcontroller 8051 which can activate robot through relays. The Remote robot-assisted tele surgery eliminates geographic constraints for getting surgical expertise where it is needed and allows an expert surgeon to teach or proctor the performance of surgical technique by real-time intervention.

Keywords: Robot, Microcontroller, DTMF, Tele surgery.

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Authors: T. Kero, R. Söderberg, M. Andersson, L. Lindkvist

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Within dental-guided surgery, there has been a lack of analytical methods for optimizing the treatment of the rehabilitation concepts regarding geometrical variation. The purpose of this study is to find the source of the greatest geometrical variation contributor and sensitivity contributor with the help of virtual variation simulation of a dental drill- and implant-guided surgery process using a methodical approach. It is believed that lower geometrical variation will lead to better patient security and higher quality of dental drill- and implant-guided surgeries. It was found that the origin of the greatest contributor to the most variation, and hence where the foci should be set, in order to minimize geometrical variation was in the assembly category (surgery). This was also the category that was the most sensitive for geometrical variation.

Keywords: Variation Simulation, Process Optimization, Guided Surgeries, Dental Prosthesis.

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Authors: Lubna M. Zakaryia Mahmoud, Mohammed A. Dawood, Doaa A. Heiba

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A prospective double-blind placebo controlled trial carried out on 60 children known to be asthmatic who presented to the emergency department at Alexandria University of Children’s Hospital at El-Shatby with acute asthma exacerbations to assess the efficacy of adding inhaled magnesium sulfate to β-agonist, compared with β-agonist in saline, in the management of acute asthma exacerbations in children. The participants in the study were divided in two groups; Group A (study group) received inhaled salbutamol solution (0.15 ml/kg) plus isotonic magnesium sulfate 2 ml in a nebulizer chamber. Group B (control group): received nebulized salbutamol solution (0.15 ml/kg) diluted with placebo (2 ml normal saline). Both groups received inhaled solution every 20 minutes that was repeated for three doses. They were evaluated using the Pediatric Asthma Severity Score (PASS), oxygen saturation using portable pulse oximetry and peak expiratory flow rate using a portable peak expiratory flow meter at initially recorded as zero-minute assessment and every 20 minutes from the end of each nebulization (nebulization lasts 5-10 minutes) recorded as 20, 40 and 60-minute assessments. Regarding PASS, comparison showed non-significant difference with p-value 0.463, 0.472, 0.0766 at 20, 40 and 60 minutes. Regarding oxygen saturation, improvement was more significant towards group A starting from 40 min with significant p-value=0.000. At 60 min p-value=0.000. Although mean PEFR significantly improved from zero-min in both groups; however, improvement was more significant in group A with significant p-value = 0.015, 0.001, 0.001 at 20 min, 40 min and 60 min, respectively. The conclusion this study suggests is that inhaled magnesium sulfate is an efficient add on drug to standard β- agonist inhalation used in the treatment of moderate to severe asthma exacerbations.

Keywords: Nebulized, magnesium sulfate, acute asthma, pediatric.

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Authors: Ç. Erdoğan, T. Turan

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Pediatric cancer patients experience multiple distressing, challenges, physical symptom such as fatigue, pain, sleep disturbance, and balance impairment that continue years after treatment completion. In recent years, yoga is often used in children with cancer to cope with these symptoms. Yoga practice is defined as a unique physical activity that combines physical practice, breath work and mindfulness/meditation. Yoga is an increasingly popular mind-body practice also characterized as a mindfulness mode of exercise. This study aimed to evaluate the impact of yoga intervention of children with cancer. This article planned searching the literature in this field. It has been determined that individualized yoga is feasible and provides benefits for inpatient children, improves health-related quality of life, physical activity levels, physical fitness. After yoga program, children anxiety score decreases significantly. Additionally, individualized yoga is feasible for inpatient children receiving intensive chemotherapy. As a result, yoga is an alternative and complementary medicine that can be safely used in children with cancer.

Keywords: Cancer treatment, children, nursing, yoga.

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Authors: J. A. López, C.I. López, J.E. Olguín, C. Camargo, J. M. López

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The institutions seek to improve their performance and quality of service, so that their patients are satisfied. This research project aims, conduct a time study program in the area of gynecological surgery, to determine the current level of capacity and optimize the programming time in order to adequately respond to demand. The system is analyzed by waiting lines and uses the simulation using ARENA to evaluate proposals for improvement and optimization programming time each of the surgeries.

Keywords: Time study, waiting lines, reducing time, simulation.

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Authors: M. Ramezanifard, J. Dargahi, S. Najarian, N. Narayanan

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One of the major disadvantages of the minimally invasive surgery (MIS) is the lack of tactile feedback to the surgeon. In order to identify and avoid any damage to the grasped complex tissue by endoscopic graspers, it is important to measure the local softness of tissue during MIS. One way to display the measured softness to the surgeon is a graphical method. In this paper, a new tactile sensor has been reported. The tactile sensor consists of an array of four softness sensors, which are integrated into the jaws of a modified commercial endoscopic grasper. Each individual softness sensor consists of two piezoelectric polymer Polyvinylidene Fluoride (PVDF) films, which are positioned below a rigid and a compliant cylinder. The compliant cylinder is fabricated using a micro molding technique. The combination of output voltages from PVDF films is used to determine the softness of the grasped object. The theoretical analysis of the sensor is also presented. A method has been developed with the aim of reproducing the tactile softness to the surgeon by using a graphical method. In this approach, the proposed system, including the interfacing and the data acquisition card, receives signals from the array of softness sensors. After the signals are processed, the tactile information is displayed by means of a color coding method. It is shown that the degrees of softness of the grasped objects/tissues can be visually differentiated and displayed on a monitor.

Keywords: Minimally invasive surgery, Robotic surgery, Sensor, Softness, Tactile.

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Authors: Ayat E. Ali, Christeen R. Aziz, Merna A. Helmy, Mohammed M. Malek, Sherif H. El-Gohary

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Goal: Purpose of the project was to make a plastic surgery prediction by using pre-operative images for the plastic surgeries’ patients and to show this prediction on a screen to compare between the current case and the appearance after the surgery. Methods: To this aim, we implemented a software which used data from the internet for facial skin diseases, skin burns, pre-and post-images for plastic surgeries then the post- surgical prediction is done by using K-nearest neighbor (KNN). So we designed and fabricated a smart mirror divided into two parts a screen and a reflective mirror so patient's pre- and post-appearance will be showed at the same time. Results: We worked on some skin diseases like vitiligo, skin burns and wrinkles. We classified the three degrees of burns using KNN classifier with accuracy 60%. We also succeeded in segmenting the area of vitiligo. Our future work will include working on more skin diseases, classify them and give a prediction for the look after the surgery. Also we will go deeper into facial deformities and plastic surgeries like nose reshaping and face slim down. Conclusion: Our project will give a prediction relates strongly to the real look after surgery and decrease different diagnoses among doctors. Significance: The mirror may have broad societal appeal as it will make the distance between patient's satisfaction and the medical standards smaller.

Keywords: K-nearest neighbor, face detection, vitiligo, bone deformity.

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Authors: Mustafa M. Donma, Orkide Donma

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Obesity is defined as a severe chronic disease characterized by a low-grade inflammatory state. Therefore, inflammatory markers gained utmost importance during the evaluation of obesity and metabolic syndrome (MetS), a disease characterized by central obesity, elevated blood pressure, increased fasting blood glucose and elevated triglycerides or reduced high density lipoprotein cholesterol (HDL-C) values. Some inflammatory markers based upon complete blood cell count (CBC) are available. In this study, it was questioned which inflammatory marker was the best to evaluate the differences between various obesity groups. 514 pediatric individuals were recruited. 132 children with MetS, 155 morbid obese (MO), 90 obese (OB), 38 overweight (OW) and 99 children with normal BMI (N-BMI) were included into the scope of this study. Obesity groups were constituted using age- and sex-dependent body mass index (BMI) percentiles tabulated by World Health Organization. MetS components were determined to be able to specify children with MetS. CBC were determined using automated hematology analyzer. HDL-C analysis was performed. Using CBC parameters and HDL-C values, ratio markers of inflammation, which cover neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), monocyte-to-HDL-C ratio (MHR) were calculated. Statistical analyses were performed. The statistical significance degree was considered as p < 0.05. There was no statistically significant difference among the groups in terms of platelet count, neutrophil count, lymphocyte count, monocyte count, and NLR. PLR differed significantly between OW and N-BMI as well as MetS. Monocyte-to HDL-C value exhibited statistical significance between MetS and N-BMI, OB, and MO groups. HDL-C value differed between MetS and N-BMI, OW, OB, MO groups. MHR was the ratio, which exhibits the best performance among the other CBC-based inflammatory markers. On the other hand, when MHR was compared to HDL-C only, it was suggested that HDL-C has given much more valuable information. Therefore, this parameter still keeps its value from the diagnostic point of view. Our results suggest that MHR can be an inflammatory marker during the evaluation of pediatric MetS, but the predictive value of this parameter was not superior to HDL-C during the evaluation of obesity.

Keywords: Children, complete blood cell count, high density lipoprotein cholesterol, metabolic syndrome, obesity.

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Authors: Dean J. Callaghan, Mark M. McGrath

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Sensorized instruments that accurately measure the interaction forces (between biological tissue and instrument endeffector) during surgical procedures offer surgeons a greater sense of immersion during minimally invasive robotic surgery. Although there is ongoing research into force measurement involving surgical graspers little corresponding effort has been carried out on the measurement of forces between scissor blades and tissue. This paper presents the design and development of a force measurement test apparatus, which will serve as a sensor characterization and evaluation platform. The primary aim of the experiments is to ascertain whether the system can differentiate between tissue samples with differing mechanical properties in a reliable, repeatable manner. Force-angular displacement curves highlight trends in the cutting process as well the forces generated along the blade during a cutting procedure. Future applications of the test equipment will involve the assessment of new direct force sensing technologies for telerobotic surgery.

Keywords: Force measurement, minimally invasive surgery, scissor blades, tissue cutting.

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Authors: Hakan Işık, Esra Saraçoğlu

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In this study, a comparison of two control methods, Proportional Control (PC) and Fuzzy Logic Control (FLC), which have been used to develop an ideal thermoelectric renal hypothermia system in order to use in renal surgery, has been carried out. Since the most important issues in long-lasting parenchymatous renal surgery are to provide an operation medium free of blood and to prevent renal dysfunction in the postoperative period, control of the temperature has become very important in renal surgery. The final product is seriously affected from the changes in temperature, therefore, it is necessary to reach some desired temperature points quickly and avoid large overshoot. PIC16F877 microcontroller has been used as controller for both of these two methods. Each control method can simply ensure extra renal hypothermia in the targeted way. But investigation of advantages and disadvantages of every control method to each other is aimed and carried out by the experimental implementations. Shortly, investigation of the most appropriate method to use for development of system and that can be applied to people safely in the future, has been performed. In this sense, experimental results show that fuzzy logic control gives out more reliable responses and efficient performance.

Keywords: renal hypothermia, renal cooling, temperature control, proportional control fuzzy logic control

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Authors: Beibei Han, Yong-Jin Yoon, Muhammad Hamidullah, Angel Tsu-Hui Lin, Woo-Tae Park

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This paper presents the design of a ring-shaped tri-axial fore sensor that can be incorporated into the tip of a guidewire for use in minimally invasive surgery (MIS). The designed sensor comprises a ring-shaped structure located at the center of four cantilever beams. The ringdesign allows surgical tools to be easily passed through which largely simplified the integration process. Silicon nanowires (SiNWs) are used aspiezoresistive sensing elementsembeddedon the four cantilevers of the sensor to detect the resistance change caused by the applied load.An integration scheme with new designed guidewire tip structure having two coils at the distal end is presented. Finite element modeling has been employed in the sensor design to find the maximum stress location in order to put the SiNWs at the high stress regions to obtain maximum output. A maximum applicable force of 5 mN is found from modeling. The interaction mechanism between the designed sensor and a steel wire has been modeled by FEM. A linear relationship between the applied load on the steel wire and the induced stress on the SiNWs were observed.

Keywords: Triaxial MEMS force sensor, Ring shape, Silicon Nanowire, Minimally invasive surgery.

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Authors: Elnaz Afshari, Siamak Najarian

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Having considered tactile sensing and palpation of a surgeon in order to detect kidney stone during open surgery; we present the 2D model of nephrolithiasis (two dimensional model of kidney containing a simulated stone). The effects of stone existence that appear on the surface of kidney (because of exerting mechanical load) are determined. Using Finite element method, it is illustrated that the created stress patterns on the surface of kidney and stress graphs not only show existence of stone inside kidney, but also show its exact location.

Keywords: Nephrolithiasis, Minimally Invasive Surgery, Artificial Tactile Sensing, Finite Element Method.

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Authors: Ş. Çiftcioğlu, E. Efe

Abstract:

In recent years, cancer has been at the top of diseases that cause death in children. Adequate and balanced nutrition plays an important role in the treatment of cancer. Cancer and cancer treatment is affecting food intake, absorption and metabolism, causing nutritional disorders. Appropriate nutrition is very important for the cancerous child to feel well before, during and after the treatment. There are various difficulties in feeding children with cancer. These are the cancer-related factors. Other factors are environmental and behavioral. As health professionals who spend more time with children in the hospital, nurses should be able to support the children on nutrition and help them to have balanced nutrition. This study aimed to evaluate the importance of nursing approaches in the nutrition of children with cancer. This article is planned as a review article by searching the literature on this field. Anorexia may develop due to psychogenic causes or chemotherapeutic agents or accompanying infections and nutrient uptake may be reduced.  In addition, stomatitis, mucositis, taste and odor changes in the mouth, the feeling of nausea, vomiting and diarrhea can also reduce oral intake and result in significant losses in the energy deficit. In assessing the nutritional status of children with cancer, determining weight loss and good nutrition is essential anamnesis of a child.  Some anthropometric measurements and biochemical tests should be used to evaluate the nutrition of the child. The nutritional status of pediatric cancer patients has been studied for a long time and malnutrition, in particular under nutrition, in this population has long been recognized. Yet, its management remains variable with many malnourished children going unrecognized and consequently untreated. Nutritional support is important to pediatric cancer patients and should be integrated into the overall treatment of these children.

Keywords: Cancer treatment, children, complication, nutrition, nursing approaches.

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

Abstract:

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: Xiaocong Liu, Huazhen Wang, Ting He, Xiaozheng Li, Weihan Zhang, Jian Chen

Abstract:

The utilization of electronic medical record (EMR) data to establish the disease diagnosis model has become an important research content of biomedical informatics. Deep learning can automatically extract features from the massive data, which brings about breakthroughs in the study of EMR data. The challenge is that deep learning lacks semantic knowledge, which leads to impracticability in medical science. This research proposes a method of incorporating lexical-semantic knowledge from abundant entities into a convolutional neural network (CNN) framework for pediatric disease diagnosis. Firstly, medical terms are vectorized into Lexical Semantic Vectors (LSV), which are concatenated with the embedded word vectors of word2vec to enrich the feature representation. Secondly, the semantic distribution of medical terms serves as Semantic Decision Guide (SDG) for the optimization of deep learning models. The study evaluates the performance of LSV-SDG-CNN model on four kinds of Chinese EMR datasets. Additionally, CNN, LSV-CNN, and SDG-CNN are designed as baseline models for comparison. The experimental results show that LSV-SDG-CNN model outperforms baseline models on four kinds of Chinese EMR datasets. The best configuration of the model yielded an F1 score of 86.20%. The results clearly demonstrate that CNN has been effectively guided and optimized by lexical-semantic knowledge, and LSV-SDG-CNN model improves the disease classification accuracy with a clear margin.

Keywords: lexical semantics, feature representation, semantic decision, convolutional neural network, electronic medical record

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Authors: Rassoli Aisa, Abrishami Movahhed Arezu, Faturaee Nasser, Seddighi Amir Saeed, Shafigh Mohammad

Abstract:

Cardiovascular diseases are one of the most common causes of mortality in developed countries. Coronary artery abnormalities and carotid artery stenosis, also known as silent death, are among these diseases. One of the treatment methods for these diseases is to create a deviatory pathway to conduct blood into the heart through a bypass surgery. The saphenous vein is usually used in this surgery to create the deviatory pathway. Unfortunately, a re-surgery will be necessary after some years due to ignoring the disagreement of mechanical properties of graft tissue and/or applied prostheses with those of host tissue. The objective of the present study is to clarify the viscoelastic behavior of human saphenous tissue. The stress relaxation tests in circumferential and longitudinal direction were done in this vein by exerting 20% and 50% strains. Considering the stress relaxation curves obtained from stress relaxation tests and the coefficients of the standard solid model, it was demonstrated that the saphenous vein has a non-linear viscoelastic behavior. Thereafter, the fitting with Fung’s quasilinear viscoelastic (QLV) model was performed based on stress relaxation time curves. Finally, the coefficients of Fung’s QLV model, which models the behavior of saphenous tissue very well, were presented.

Keywords: Fung’s quasilinear viscoelastic (QLV) model, strain rate, stress relaxation test, uniaxial tensile test, viscoelastic behavior.

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Authors: Mustafa M. Donma, Orkide Donma

Abstract:

The impact of metabolic syndrome (MetS) on cognition and functions of the brain is being investigated. Iron deficiency and deficiencies of B9 (folate) as well as B12 (cobalamin) vitamins are best-known nutritional anemias. They are associated with cognitive disorders and learning difficulties. The antidepressant effects of vitamin D are known and the deficiency state affects mental functions negatively. The aim of this study is to investigate possible correlations of MetS with serum brain-derived neurotrophic factor (BDNF), iron, folate, cobalamin and vitamin D in pediatric patients. 30 children, whose age- and sex-dependent body mass index (BMI) percentiles vary between 85 and 15, 60 morbid obese children with above 99^th percentiles constituted the study population. Anthropometric measurements were taken. BMI values were calculated. Age- and sex-dependent BMI percentile values were obtained using the appropriate tables prepared by the World Health Organization (WHO). Obesity classification was performed according to WHO criteria. Those with MetS were evaluated according to MetS criteria. Serum BDNF was determined by enzyme-linked immunosorbent assay. Serum folate was analyzed by an immunoassay analyzer. Serum cobalamin concentrations were measured using electrochemiluminescence immunoassay. Vitamin D status was determined by the measurement of 25-hydroxycholecalciferol [25-hydroxy vitamin D3, 25(OH)D] using high performance liquid chromatography. Statistical evaluations were performed using SPSS for Windows, version 16. The p values less than 0.05 were accepted as statistically significant. Although statistically insignificant, lower folate and cobalamin values were found in MO children compared to those observed for children with normal BMI. For iron and BDNF values, no alterations were detected among the groups. Significantly decreased vitamin D concentrations were noted in MO children with MetS in comparison with those in children with normal BMI (p ≤ 0.05). The positive correlation observed between iron and BDNF in normal-BMI group was not found in two MO groups. In THE MetS group, the partial correlation among iron, BDNF, folate, cobalamin, vitamin D controlling for waist circumference and BMI was r = -0.501; p ≤ 0.05. None was calculated in MO and normal BMI groups. In conclusion, vitamin D should also be considered during the assessment of pediatric MetS. Waist circumference and BMI should collectively be evaluated during the evaluation of MetS in children. Within this context, BDNF appears to be a key biochemical parameter during the examination of obesity degree in terms of mental functions, cognition and learning capacity. The association observed between iron and BDNF in children with normal BMI was not detected in MO groups possibly due to development of inflammation and other obesity-related pathologies. It was suggested that this finding may contribute to mental function impairments commonly observed among obese children.

Keywords: Brain-derived neurotrophic factor, iron, Vitamin B9, Vitamin B12, Vitamin D.

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