Search

Objectives The authors herein report the results of esophageal replacement by gastric pull-up technique through the retrosternal route as an option for esophageal replacement in a resource-constrained setup. Method Prospectively collected data upon twenty-two consecutive patients (male:female = 17:5) with mean age 24.9 months (7 months–12 years) and mean weight 7.9 kg (4.2–32 kg) who underwent retrosternal gastric pull-up for esophageal atresia (n = 18; 16 atresia with distal fistula & 2 pure atresia) and corrosive injuries to the esophagus (n = 4) over the past 8 years are presented. The management protocol and surgical technique have been described. Observations parameters included indication for esophageal replacement, age at surgery, sex of the child and other demographic details, clinical and operative findings, post-operative outcomes and follow-up details. Results Retrosternal gastric pull-up could be performed in all cases with no mortality or graft loss. Of 22, 20 cases were extubated on-table and 2 cases were extubated within 48 hours of surgery. Mean operative duration was 265 min (range: 175 min to 310 min) and blood loss was 115.3 ml (range: 80–400 ml). Dense vascular adhesions in the region of the esophageal hiatus were encountered in patients with abdominal esophagostomy (n = 4) which were probably related to the local dissection at the time of previous surgery. Minor anastomotic leak was observed in 8 of 22 patients which settled spontaneously over 21 days mean period (range: 18 to 31 days). Antegrade dilatation was required in 3 of 8 cases with minor leak. None of them required revision of anastomosis. Mean follow-up duration is 63 months (range: 11 months – 94 months). Weight gain after surgery was close to or beyond the 25th centile. Symptoms of dumping syndrome or GER were not observed in our cohort. Conclusion Our data have demonstrated the safety and feasibility of esophageal replacement by gastric transposition through the retrosternal route in a resource-limited setup. No significant difference has been observed from the results and complications reported in literature for the same procedure. Type of study Prospective observational study / treatment study. Level of evidence Level III.

Extra-pulmonary Tuberculosis (EPTB), 10% about is musculoskeletal cases. A middle age female who presented to outpatient department of tertiary care center (Medical college & Hospital) with swelling over volar surface of right distal forearm gradually increased in size over 9 to 10 months. She noticed difficulty to move fingers of right hand as size of swelling increasing. She had tingling sensation in the territory of median nerve. It was single swelling of 05cm x 07cm over the volar surface of right distal forearm with defined margins. Lesion was open surgically and rice bodies were found. Histopathological examination had shown caseous type of necrosis and granuloma formation suggestive of tuberculosis. Anti-tuberculosis treatment was given to her. Cases of TB tenosynovitis are uncommon and diagnosis is often missed causing delay of treatment to patient. Surgical intervention decided by symptoms and signs. Antitubercular therapy and excision of lesion produce good outcome. Keywords: Anti TB treatment; Rice Bodies; Surgical excision; Tenosynovitis.

Despite various theories to explain the pathogenesis of atresias, the exact mechanism is still controversial. Currently, atresias are believed to result from vascular accidents and less likely due to the failure of recanalization. We report a case which challenges this belief. A 1-day-old neonate was explored for suspected jejunal atresia. Apart from Type III jejunal atresia, 15 cm from DJ junction, there was surprisingly no distal lumen in the intestine from jejunum till rectum. Multiple enterotomies revealed the whole of the remaining jejunum, ileum, and large colon to be a solid cord-like structure. No distal luminal contents or histopathological evidence of ischemic damage was seen, thus suggesting the probable etiology to be a failure of recanalization of the gut cord rather than a late vascular accident. Such rare cases provide insights into possible embryogenetic mechanisms which can then aid in formulating preventive measures.

This work reports nanodiamond-silk membranes as an optical platform for biosensing and cell growth applications. The hybrid structure was fabricated through electrospinning and mimics a 2D scaffold with high porosity. The negatively charged nitrogen vacancy (NV-) centres in diamond exhibits optically detected magnetic resonance (ODMR), which enables sensing of temperature variations. The NV- centre, as reported in literature, provides a shift of 74 kHz in the ODMR frequency per degree rise in temperature. For our hybrid membranes, we have however observed that the embedded NV- centre provide a greater shift of 95±5 kHz/K in the ODMR frequency. This higher shift in the frequency will result in improved temperature sensitivity enabling the tracking of thermal variations in the biologically relevant window of 25-50 oC. The thermal conductivity of silk and diamond-silk hybrid will be explored to investigate this enhanced temperature sensing ability of diamond. The hybrid diamond-silk membranes are found to be hydrophilic with a contact angle of (65±2)o. The biocompatibility of the membranes is tested both in vitro in skin keratinocyte (HaCaT) cells and in vivo in a live mouse wound model. The membranes did not induce any toxicity to the cell growth and survival. Moreover, we observed resistance towards the growth and attachment of bacteria.

Perchloroethylene (PERC) is a compound commonly used as a solvent in dry cleaning, despite its severe health and environmental impacts. In recent times chemicals such as hydrocarbons, GreenEarth(®), acetal and liquid carbon dioxide have emerged as less damaging substitutes for PERC, and an even more sustainable water-based wet cleaning process has been developed. We employed a systematic review approach to provide a comprehensive overview of the existing research evidence in the area of sustainable and safe apparel cleaning methods and care. Our review describes traditional professional dry cleaning methods, as well as those that utilise solvents other than PERC, and their ecological attributes. In addition, the new professional wet cleaning process is discussed. Finally, we address the health hazards of the various solvents used in dry cleaning and state-of-the-art solvent residue trace analysis techniques.

The purpose of this paper is to study the incidence of deep sternal wound infections (DSWIs) after median sternotomy, its correlation to demographic data, diabetes mellitus (DM), choice of vessels used for coronary artery bypass grafting (CABG), microbiological wound status, and outcome of surgical management in terms of complete wound healing, postoperative stay, and mortality. A total of 2418 patients who underwent CABG through median sternotomy from January 2005 to December 2013 were included in the study. DSWI was found in 37 patients. Logistic regression, Fisher’s exact test, and chi-squared test were used to find association, and a p value of

Needleless electrospinning and electrospraying of aerogel particles in comparatively lower electric voltage (9 kV) have been demonstrated in the paper. Aerogel particles were dispersed in polymer solution and then needlelessly electrospun/sprayed by creating high electric charge at the syringe tip using a curved wire. FTIR spectra and SEM images proved that aerogel particles were deposited onto the base textile. In case of electrospinning, a nanofibre web holding the aerogel particles covered the fabric surface, whereas in case of electrospraying, aerogel particles deposited with the microdroplets of the polymer. The electrospraying process showed great potential for fabric surface functionalization due to the high amount of particle deposition on fabric. The new approach can be applicable for transferring other particulate materials on fabric surface through needleless electrospinning and electrospraying processes.

The use of appropriate protective clothing systems in high-risk environments is absolutely essential. Such protective clothing may not provide the desired wearer comfort due to the complexities associated with the system. These constraints are largely due to the multiple layers involved in the protective ensemble. Firefighters’ protective clothing systems, in particular, have limited or no water vapor permeability. This prevents evaporative heat loss and leads to thermal strain and sweat accumulation. This accumulated sweat on the skin and on the internal layer close to the body causes considerable discomfort to the user due to the sensation of wetness. Extensive research has been done to improve the comfort properties of such protective clothing. This research adds yet another dimension where a new inner-layer construction has been developed with high liquid and vapor-absorption capacity that could assist in keeping the moisture and vapor away from the skin and, in addition, retain a dry microclimate close to the skin. The developed materials were tested for their biophysical properties that included tests such as thermal and water vapor resistance, air permeability and moisture management properties. Experimental results in this study indicated that super-absorbent materials, when incorporated into a woven textile material, showed enhanced wearer comfort. It was observed that these super-absorbent materials have the capability to quickly wick the moisture away from the body and, in doing so, have the tendency to keep the skin dry.

Background: This study describes our experience of arteriovenous fistula (AVF) creation as vascular access for haemodialysis. Materials and Methods: This study has been carried out in our hospital from January 2004 to December 2012. A total of 505 AVFs were created in 443 patients. Maximum follow-up was 8 years, and minimum was 6 months. Observations and Results: In this study of 505 cases of AVFs, primary patency rates by Kaplan — Meier analysis showed 78.81% patency of fistulas at the end of 1 year and patency dropped to 14.81% at the end of 5 years. Our primary failure rate was 21.2%. Basilic vein was used in 26.35% cases, cephalic vein in 63.5%, and antecubital vein in 9.75% cases. On table, bruit was present in 459 (90.9%) and thrill in 451 (89.3%) cases. During dialysis, flow rate >250 ml/min was obtained in 150 (29.9%) cases. In complications, 2 (0.4%) patients developed distal oedema, 33 (6.5%) developed steal phenomenon. Conclusions: Presence of on table thrill and bruit are indicators of successful AVF. If vein diameter is 2 mm were significantly higher as compared with patients with vein diam.

Fabric material plays an important role in the thermal comfort of Abaya because it is the outer garment of Muslim women. Abaya is black in colour and covers the whole body except the hands, feet and face. It is mandatory to wear Abaya in the Saudi Arabia and certain parts of Middle East countries irrespective of the outside environmental temperature which could be up to 45°C. Therefore, the thermal transmission characteristics of the abaya are extremely important as human body responds to the external thermal environment through clothing. In a hot environment, it is extremely uncomfortable to wear several layers of clothing under the Abaya. Hence it is essential to enhance the thermal comfort of fabrics used for Abaya. This study investigated five selected knitted fabrics that could be used as Abaya fabrics for thermal resistance, air permeability, thermal comfort and vapour resistance. The results indicated that the fabrics with different knit structures, fibre composition and fabric weight have greater influence on thermal comfort performance.

Electrospraying is inexpensive and an effective way to produce submicron range coating. Spray Angle and Jet Length are important characteristics that affect coating quality while polymer solution subjected to electrospraying. It was of interest to determine the effect of the process parameters on Jet Length. In this paper, an attempt was made to apply the electrospraying concept for coating textile surfaces. Series of experiments were carried out employing different settings of process parameters such as voltage, nozzle-collector distance and polymer concentration. Thermoplastic polyurethane dissolved in tetrahydrofluran was used as a solution. The results provide some insight into the effect of electrospraying process parameters on Jet Length

Electrospraying or electrohydrodynamic spraying is a technique of liquid atomisation by utilising electrical forces. In the electrospraying technique, the liquid at the outlet of a nozzle is subjected to an electrical shear stress by maintaining the nozzle at high electric potential. This produces a fine mist of extremely small and in some cases down to nanometer size droplets. The charge and size of the droplets can be controlled by adjusting the flow rate and voltage applied to the nozzle. Extending the scope of electrospraying, textile substrates can be coated with suitable polymer solution to enhance the surface functionalisation. This paper highlights the deposition of chitosan on wool subtrates using elctrospraying and its potential application in medical textiles.

The impact of global trade in apparel manufacturing has evolved the concept of fast fashion in a scenario where apparel is produced quickly with a low cost and with the 'chic look' now dominating the retail world. Fast fashion is mass-produced, reasonable in price for most consumers and easy to obtain, making it simple for anyone to look stylish. However, to become dominant in this retail business sector, fabric sourcing and selection have become a pivotal stage in the manufacturing process. This chapter will encompass a critical review of the traditional and fast fashion approach with special focus on fabric sourcing, inspection, faults, grading and forthcoming trends. Today, the clothing market changes rapidly based on the demographics, and easy and low cost sourcing. What is considered modern today, may be out of fashion tomorrow. This puts a lot of pressure on a clothing farm's ability to change the production stream quickly and thereby altering the flexibility of the supplier. Concerns about child labour, employees' work conditions, and environmental concerns have put addition pressure on clothing manufacturers and retailors.

Predictability of the possible avenues of human error is important for designing error recovery mechanisms in systems' interfaces. Our approach for modeling errors during the taxiing and pre-flight phase, involves using Hollnagel's (1993) Contextual Control Model (CoCoM). Hollnagel postulates that changes in the human's operational context make her switch control modes or cognitive strategies. Previously, Verma & Corker (2002) encoded rules to implement CoCoM for Air Traffic Controllers (ATCo) in the Air-MIDAS (Man-Machine Integrated Design and Analysis System) architecture. They defined the operational context as the number of simultaneous goals and the event horizon time required to successfully complete those goals, and also encoded behavior associated with three types of cognitive strategies- unplanned, tactical, and strategic. In this study, new sets of rules are being coded for the pilots, such mat changes in the context will cause the simulated operator to change cognitive strategies. The dependent variables of interest are cognitive strategies used by pilot-agents, workload, status of tasks (completed, aborted, working), and consequences of errors performed.

Agent-based simulation may provide an effective method of evaluating safety issues in air traffic control. For example, simulation of human performance models of controllers and pilots, interacting with aircraft avionics systems and with communication, navigation, and surveillance technologies, may assess both the individual behavior of these agents and the overall emergent behavior of the air traffic control system. This paper describes a collaborative effort in developing an agent-based simulation of air traffic control. In order to exercise the capabilities of the proposed approach, a test scenario was developed to investigate the impact of new avionics systems which provide alerts of clear air turbulence (CAT) to flight crews. An agent-based simulation using the Reconfigurable Flight Simulator (RFS) software architecture and its asynchronous timing methods is outlined. Adaptation of the Man-machine Integration Design and Analysis System (MIDAS) human performance model to model the behavior of pilots and air traffic controllers and to interact with RFS is detailed, including description of an algorithm implemented to synchronize the timing between RFS and MIDAS. This paper then discusses the use of agent-based simulation incorporating human performance models as a means to assess safety.