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Blood stream infection (BSI) is a potentially lethal complication in patients receiving extracorporeal membrane oxygenation (ECMO). It may be particularly common in patients with veno-venous ECMO due to their long hospitalization in the intensive care unit. Given that these patients have concurrent indwelling central venous catheters (CVC), it is unclear whether the ECMO circuit, CVC, or both, contribute to BSI. This study evaluated the risk factors associated with BSI in patients receiving veno-venous ECMO in a single institution study of 61 patients from 2016 through 2019. All ECMO catheters and the circuit oxygenator fluid were aseptically collected and analyzed for microorganisms at the time of decannulation. New BSI was diagnosed in 15 (24.6%) patients and increased mortality by threefold. None of the ECMO catheters or oxygenator fluid were culture positive. BSI increased with CVC use of over 8 days and was significantly lowered when CVC were exchanged by day 8 compared with patients with exchanges at later points (15.0% vs. 42.8%, p = 0.02). Median length of CVC use in the BSI-negative and BSI-positive group were 6.3 ± 5.0 and 9.4 ± 5.1, respectively (p = 0.04). In summary, BSI is a potentially lethal complication in patients receiving ECMO. Indwelling CVC, not the ECMO circuitry, is the likely contributor for BSI, and exchanging CVC by day 8 can reduce the incidence of BSI.

Background: Cleft lip and palate is a congenital anomaly, presenting in a wide variety of forms and combinations. Successful cleft lip and cleft palate rehabilitation requires a multidisciplinary approach employing the skills of different specialists. Aims & Objectives: The aim of this paper was to present orthodontic preparation of patients prior to alveolar bone grafting & to review our findings in a group of patients treated by secondary and delayed bone-grafting procedures at our institution. Methodology: Thirty eight patients were examined for the type of cleft and the age at the time of examination. 10 patients were treated in our institution with presurgical orthodontics & operated by a delayed bone-grafting technique. Duration and type of expansion was noted at pre-operative, 2 months and 6 months. Crestal bone heights and the quality of the bone in the grafted areas was examined radiographically, along with presence of any fistulas. Results: All the patients demonstrated improved alar base and upper lip support, also better dental stability was seen in the region of cleft. Conclusion: All the patients included in this study appeared to benefit from the procedure with improved facial balance. In all ten patients the oronasal fistulas remained closed, hence was reported to be a success.

Background The magnitude of association and quality of evidence comparing surgical approaches for lung cancer resection has not been analyzed. This has resulted in conflicting information regarding the relative superiority of the different approaches and disparate opinions on the optimal surgical treatment. We reviewed and systematically analyzed all published data comparing near- (30-d) and long-term mortality for minimally invasive to open surgical approaches for lung cancer. Methods Comprehensive search of EMBASE, MEDLINE, and the Cochrane Library, from January 2009 to August 2019, was performed to identify the studies and those that passed bias assessment were included in the analysis utilizing propensity score matching techniques. Meta-analysis was performed using random-effects and fixed-effects models. Risk of bias was assessed via the Newcastle–Ottawa Scale and the ROBINS-I tool. The study was registered in PROSPERO (CRD42020150923) prior to analysis. Results Overall, 1382 publications were identified but 19 studies were included encompassing 47,054 patients after matching. Minimally invasive techniques were found to be superior with respect to near-term mortality in early and advanced-stage lung cancer (risk ratio 0.45, 95% confidence interval [CI] 0.21-0.95, I2 = 0%) as well as for elderly patients (odds ratio 0.45, 95% CI 0.31-0.65, I2 = 30%), but did not demonstrate benefit for high-risk patients (odds ratio 0.74, 95% CI 0.06-8.73, I2 = 78%). However, no difference was found in long-term survival. Conclusions We performed the first systematic review and meta-analysis to compare surgical approaches for lung cancer which indicated that minimally invasive techniques may be superior to thoracotomy in near-term mortality, but there is no difference in long-term outcomes.

BACKGROUND: Materials characterization made possible by dual energy CT (DECT) scanners is expected to considerably improve automatic detection of hazardous objects in checked and carry-on luggage at our airports. Training a computer to identify the hazardous items from DECT scans however implies training on a baggage dataset that can represent all the possible ways a threat item can packed inside a bag. Practically, however, generating such data is made challenging by the logistics (and the permissions) related to the handling of the hazardous materials. OBJECTIVE: The objective of this study is to present a software simulation pipeline that eliminates the need for a human to handle dangerous materials and that allows for virtually unlimited variability in the placement of such materials in a bag alongside benign materials. METHODS: In this paper, we present our DEBISim software pipeline that carries out an end-to-end simulation of a DECT scanner for virtual bags. The key highlights of DEBISim are: (i) A 3D user-interactive graphics editor for constructing a virtual 3D bag with manual placement of different types of objects in it; (ii) An automated virtual bag generation algorithm for creating randomized baggage datasets; (iii) An ability to spawn deformable sheets and liquid-filled containers in a virtual bag to represent plasticized and liquid explosives; and (iv) A GPU-based X-ray forward modelling block for spiral cone-beam scanners used in checked baggage screening. RESULTS: We have tested our simulator using two standard CT phantoms: the American College of Radiology (ACR) phantom and the NIST security screening phantom as well as on a set of reference materials representing commonly encountered items in checked baggage. For these phantoms, we have assessed the quality of the simulator by comparing the simulated data reconstructions with real CT scans of the same phantoms. The comparison shows that the material-specific properties as well as the CT artifacts in the scans generated by DEBISim are close to those produced by an actual scanner. CONCLUSION: DEBISim is an end-to-end simulation framework for rapidly generating X-ray baggage data for dual energy cone-beam scanners.

Aim: To evaluate effects of extended head posture on dental and skeletal malocclusions. Materials and Methods: Lateral cephalograms and study models of 60 patients were divided into two groups, group I [n=30 with extended head posture (NSL-CVT angle > 106)] and group II [n=30 without extended head posture (NSL-CVT angle less than 106)]. Variables which are important were studied and compared. Results: Patients in group I showed significantly more class II skeletal relationship with increased proclination in upper and lower anteriors than that in group II. Subjects in group I showed more vertical growth pattern, with increased overjet and overbite than that in group II. Also, significantly more number subjects in group I showed crowding than that in group II. Conclusion: Patients with extended head posture showed class II skeletal malocclusion and a vertical growth pattern as compared to patients with normal head posture. There was statistically significant correlation of crowding with extended head posture as compared to that in patients with normal head posture. Overjet and overbite was found to be significantly more in patients with extended head posture as compared to that in patients with normal head posture. Upper and lower incisal proclination was also found to be significantly more in patients with extended head posture as compared to that in patients with normal head posture. Keywords: Extended head posture, Head poster, Malocclusion, Class 2.

We compared the clinical outcomes and cost-efficiency of surgical approaches (sternotomy-open, video assisted thoracoscopic surgery, and robotic assisted thoracic surgery) for thymectomy.This is a retrospective review of 220 consecutive patients who underwent thymectomy between January 1, 2007, and January 31, 2017. Surgical approach was determined by the surgeon, but we only included cases that could be resected using any of the 3 approaches.Open approach was used in 69 patients, whereas minimally invasive technique was used in 151 (97, video assisted thoracoscopic surgery; 54, robotic assisted thoracic surgery). Open surgery was associated with greater total hospital cost ($22,847 ± $20,061 vs $14,504 ± $10,845, P.001). Open group also revealed longer duration of intensive care unit (1.2 ± 2.8 vs 0.2 ± 1.3 days, P.001) and hospital stay (4.3 ± 4.0 vs 2.0 ± 2.6 days, P.001). There were no differences in major adverse clinical outcomes. Long-term recurrence-free survival after resection of thymoma was similar between the groups.Minimally invasive techniques were equally efficacious compared with the open approach in the resection of the thymus. Additionally, their use was associated with decreased hospital duration of stay and reduced cost. Hence the use of minimally invasive approaches should be encouraged in the resection of thymus.

Background Veno‐venous extracorporeal membrane oxygenation (V‐V ECMO) support is increasingly used in the management of COVID‐19‐related acute respiratory distress syndrome (ARDS). However, the clinical decision‐making to initiate V‐V ECMO for severe COVID‐19 still remains unclear. In order to determine the optimal timing and patient selection, we investigated the outcomes of both COVID‐19 and non‐COVID‐19 patients undergoing V‐V ECMO support. Methods Overall, 138 patients were included in this study. Patients were stratified into two cohorts: those with COVID‐19 and non‐COVID‐19 ARDS. Results The survival in patients with COVID‐19 was statistically similar to non‐COVID‐19 patients (p = .16). However, the COVID‐19 group demonstrated higher rates of bleeding (p = .03) and thrombotic complications (p, The survival in patients with COVID‐19 was statistically similar compared to non‐COVID‐19 patients, but the mortality of COVID‐19 patients who had been on a ventilator for longer than 7 days prior to the initiation of ECMO approached 100%.

There have been over 177 million cases of COVID-19 worldwide, many of whom could be organ donors. Concomitantly, there is an anticipated increase in the need for donor lungs due to expanding indications. Given that the respiratory tract is most commonly affected by COVID-19, there is an urgent need to develop donor assessment criteria while demonstrating safety and "efficacy" of lung donation following COVID-19 infection. Accordingly, we report an intentional transplant using lungs from a donor with recent, microbiologically confirmed, COVID-19 infection into a recipient suffering from COVID-19 induced ARDS and pulmonary fibrosis. In addition to the standard clinical assays, both donor and recipient lungs were analyzed using RNAscope, which confirmed that tissues were negative for SARS-CoV-2. Immunohistochemistry demonstrated colocalized KRT17+ basaloid-like epithelium and COL1A1+ fibroblasts, a marker suggestive of lung fibrosis in COVID-19 associated lung disease, in the explanted recipient lungs but absent in the donor lungs. We demonstrate that following a thorough assessment, lung donation following resolved COVID-19 infection is safe and feasible.

Venovenous extracorporeal membrane oxygenation (VV ECMO) is increasingly being used in the management of severe acute respiratory distress syndrome (ARDS). The Respiratory ECMO Survival Prediction (RESP) score is most commonly used to predict survival of patients undergoing ECMO. However, the RESP score does not incorporate renal and hepatic dysfunction which are frequently a part of the constellation of multiorgan dysfunction associated with ARDS. The Model for End-Stage Liver Disease (MELD) incorporates both liver and kidney dysfunction and is used in the risk stratification of liver transplant recipients as well as those undergoing cardiac surgery. The aim of this study was to assess the prognostic value of the MELD score in patients undergoing VV ECMO. Patients undergoing VV ECMO from 2016 to 2019 were extracted from our prospectively maintained institutional ECMO database and stratified based on MELD score. Baseline clinical, laboratory, and follow-up data, as well as post-ECMO outcomes, were compared. Of 71 patients, 50 patients (70.4%) had a MELD score

This report describes the design, construction, and validation of an irradiance and temperature control chamber used to measure temperature-dependent current voltage characteristics of photovoltaic (PV) solar cells under varying conditions in order to reveal fundamental device physics and materials science issues as they relate to terrestrial and space-based performance.

Summary Background Lung transplantation is a life-saving treatment for patients with end-stage lung disease; however, it is infrequently considered for patients with acute respiratory distress syndrome (ARDS) attributable to infectious causes. We aimed to describe the course of disease and early post-transplantation outcomes in critically ill patients with COVID-19 who failed to show lung recovery despite optimal medical management and were deemed to be at imminent risk of dying due to pulmonary complications. Methods We established a multi-institutional case series that included the first consecutive transplants for severe COVID-19-associated ARDS known to us in the USA, Italy, Austria, and India. De-identified data from participating centres—including information relating to patient demographics and pre-COVID-19 characteristics, pretransplantation disease course, perioperative challenges, pathology of explanted lungs, and post-transplantation outcomes—were collected by Northwestern University (Chicago, IL, USA) and analysed. Findings Between May 1 and Sept 30, 2020, 12 patients with COVID-19-associated ARDS underwent bilateral lung transplantation at six high-volume transplant centres in the USA (eight recipients at three centres), Italy (two recipients at one centre), Austria (one recipient), and India (one recipient). The median age of recipients was 48 years (IQR 41–51); three of the 12 patients were female. Chest imaging before transplantation showed severe lung damage that did not improve despite prolonged mechanical ventilation and extracorporeal membrane oxygenation. The lung transplant procedure was technically challenging, with severe pleural adhesions, hilar lymphadenopathy, and increased intraoperative transfusion requirements. Pathology of the explanted lungs showed extensive, ongoing acute lung injury with features of lung fibrosis. There was no recurrence of SARS-CoV-2 in the allografts. All patients with COVID-19 could be weaned off extracorporeal support and showed short-term survival similar to that of transplant recipients without COVID-19. Interpretation The findings from our report show that lung transplantation is the only option for survival in some patients with severe, unresolving COVID-19-associated ARDS, and that the procedure can be done successfully, with good early post-transplantation outcomes, in carefully selected patients. Funding National Institutes of Health. Video Abstract Early outcomes after lung transplantation for severe COVID-19

Some patients with severe COVID-19 develop end-stage pulmonary fibrosis for which lung transplantation may be the only treatment., A surgical solution for severe COVID-19 Despite optimal medical therapy, some patients with severe COVID-19 develop irreversible lung injury. In these patients who cannot be weaned from mechanical ventilation or extracorporeal life support, lung transplantation may be the only life-saving option. Bharat et al. now report the results of lung transplantation in three patients who had COVID-19–associated respiratory failure. SARS-CoV-2 RNA could not be detected in the explanted lungs of these patients, but fibrotic pathology and transcriptional changes resembling those of lungs from patients with pulmonary fibrosis were observed., Lung transplantation can potentially be a life-saving treatment for patients with nonresolving COVID-19–associated respiratory failure. Concerns limiting lung transplantation include recurrence of SARS-CoV-2 infection in the allograft, technical challenges imposed by viral-mediated injury to the native lung, and the potential risk for allograft infection by pathogens causing ventilator-associated pneumonia in the native lung. Additionally, the native lung might recover, resulting in long-term outcomes preferable to those of transplant. Here, we report the results of lung transplantation in three patients with nonresolving COVID-19–associated respiratory failure. We performed single-molecule fluorescence in situ hybridization (smFISH) to detect both positive and negative strands of SARS-CoV-2 RNA in explanted lung tissue from the three patients and in additional control lung tissue samples. We conducted extracellular matrix imaging and single-cell RNA sequencing on explanted lung tissue from the three patients who underwent transplantation and on warm postmortem lung biopsies from two patients who had died from COVID-19–associated pneumonia. Lungs from these five patients with prolonged COVID-19 disease were free of SARS-CoV-2 as detected by smFISH, but pathology showed extensive evidence of injury and fibrosis that resembled end-stage pulmonary fibrosis. Using machine learning, we compared single-cell RNA sequencing data from the lungs of patients with late-stage COVID-19 to that from the lungs of patients with pulmonary fibrosis and identified similarities in gene expression across cell lineages. Our findings suggest that some patients with severe COVID-19 develop fibrotic lung disease for which lung transplantation is their only option for survival.

Lung transplantation can potentially be a life-saving treatment for patients with non-resolving COVID-19 acute respiratory distress syndrome. Concerns limiting transplant include recurrence of SARS-CoV-2 infection in the allograft, technical challenges imposed by viral-mediated injury to the native lung, and potential risk for allograft infection by pathogens associated with ventilator-induced pneumonia in the native lung. Additionally, the native lung might recover, resulting in long-term outcomes preferable to transplant. Here, we report the results of the first two successful lung transplantation procedures in patients with non-resolving COVID-19 associated acute respiratory distress syndrome in the United States. We performed smFISH to detect both positive and negative strands of SARS-CoV-2 RNA in the explanted lung tissue, extracellular matrix imaging using SHIELD tissue clearance, and single cell RNA-Seq on explant and warm post-mortem lung biopsies from patients who died from severe COVID-19 pneumonia. Lungs from patients with prolonged COVID-19 were free of virus but pathology showed extensive evidence of injury and fibrosis which resembled end-stage pulmonary fibrosis. Single cell RNA-Seq of the explanted native lungs from transplant and paired warm post-mortem autopsies showed similarities between late SARS-CoV-2 acute respiratory distress syndrome and irreversible end-stage pulmonary fibrosis requiring lung transplantation. There was no recurrence of SARS-CoV-2 or pathogens associated with pre-transplant ventilator associated pneumonias following transplantation in either patient. Our findings suggest that some patients with severe COVID-19 develop fibrotic lung disease for which lung transplantation is the only option for survival.Single sentence summarySome patients with severe COVID-19 develop end-stage pulmonary fibrosis for which lung transplantation may be the only treatment.

The main objective of this study was to assess in a series of 30 patients, the feasibility, oncological safety and efficacy of radical hysterectomy by a new robotic system. Prospective study design. Galaxy Care Laparoscopy Institute and Multispeciality Hospital. We performed Robotic Radical Hysterectomy in patients from August 2019 through February 2020. All the surgeries were performed by a single surgeon (Puntambekar S). Since August 2019, 30 patients with early cervical cancer/endometrial cancer were selected for radical hysterectomy. All patients were in good general condition with controlled medical comorbidities. The mean operative time was 104 min, with mean total lymph node yield of 24.7. The average blood loss was 60 ml and the hospital stay was 2.1 days, and majority of the patients were catheter free by 1 week. Two patients developed uretero-vaginal fistula on the 8th day of surgery. One was managed with Double J stenting and in the other we did laparoscopic ureteroneocystostomy. Our study has demonstrated the feasibility, safety and efficacy of RRH by the Versius robotic systems.

Aim: To evaluate the effectiveness of various interventions on accelerating orthodontic tooth movement. Materials and Methods: A systematic review of articles selected from PUBMED and Google Scholar was carried out. Additional studies were hand searched. Only randomised controlled trials (RCTs) published from 1st January 2011 to 2016 were included in this study. These studies compared the effectiveness of various interventions on accelerating orthodontic tooth movement. Results: A total of 23 articles were identified through electronic database searching. 21 articles were obtained after elimination of duplicates which were then screened. 10 full-text articles were accessed for eligibility criteria. 10 trials were identified for inclusion in the review. Comparing the test group using interventions for accelerating orthodontic tooth movement with the control with conventional orthodontic tooth movement. Conclusions: Overall, the evidence is not sufficient to determine if a particular intervention is helpful in reducing the treatment time. Even though minimally invasive techniques were studied, it needs sufficient data to come to a particular conclusion. Amongst all the non- invasive interventions, LLLT > MOP > vibrations > photobiomodulation were effective. Limitation: Even though all interventions were, different study evaluated different type of malocclusion and durations of treatment.

Introduction: A Breast lump is a major health concern amongst women.Increased awareness has resulted in patients seeking early surgical consultation. Surgical resection is traditionally done by Fibroadenoma excision through an overlying incision (FETOI). This technique results in marked scarring. Another approach to Fibroadenoma excision through a periareolar incision (FETPI), which pays special attention to incision location to preserve cosmesis. In this study we assessed the cosmetic superiority and early complications of employing these two incisions in patients with fibroadenoma. Materials and Methods: A prospective non-randomised study of 70 patients who were divided into two groups as per the criteria described in materials and methods section, was carried out in our hospital between April 2015 to September 2017. Examination carried out in detail and diagnosis was established by clinical examination and USG of breasts followed by FNAC of lump. Patients were subjected to FETPIand FETOI Procedures and results were compared. Results: The incidence of early complications such as pain, hematoma and skin flap bruising at post-op day 1, day 2 and day 3 follow-ups did not differ significantly between two groups (P-value>0.05 for all). The distribution of total cosmetic score is significantly better in Group A compared than Group B (P-value

Purpose Hyperammonemia syndrome (HS) is a fatal complication, refractory to medical treatment, which can affect over 5% of lung transplant as well as other solid organ recipients. We recently discovered that a Mollicute, Ureaplasma spp, leads to the development of HS. Subsequently, in a prospective study, we found a high incidence of Ureaplasma in the donor lungs which is associated with serious post-transplant complications. Here, we evaluated the impact of prophylactic Ureaplasma treatment for lung donors. Methods A single institution lung transplant study with consecutive patients with lung transplant from 2014 through 2020. We included consecutive patients from January 2014 through August 2020, and total 13 patients were included. Lung donors were treated prophylactically using a dual antimicrobial agent with a fluoroquinolone (levofloxacin 500mg q12h) and azithromycin (500mg IV q24h) after Septembver 2017. Results While two patients died of HS prior to the initiation of Ureaplasma prophylaxis, there were no new cases of HS in 92 consecutive patients (6.8% vs 0% respectively, p=0.01) subsequently (Table 1). Additionally, following initiation of Ureaplasma prophylaxis, the incidence of Ureaplasma infection in donor lungs reduced from 27.5% to 9.7% (p=0.01). The median duration of antimicrobial therapy in the donor was 1.7 days. Conclusion Given the high rates of Ureaplasma infection approaching 30% in the donor lungs, as well as the morbidity and mortality associated with recipient Ureaplasma infection, we propose that donor lungs be screened prior to implantation. However, when that is not feasible, the short duration of Ureaplasma prophylaxis is a safe and highly effective alternative to completely prevent the fatal hyperammonemia syndrome.

Purpose The use of extracorporeal membrane oxygenation (ECMO) support is increasingly used in the management of COVID-19-related acute respiratory distress syndrome (ARDS). The effect of ECMO for patients with severe ARDS in the context of COVID-19 is unclear. This study is to summarize the clinical features, and outcomes of patients with severe ARDS due to COVID-19 treated with ECMO. We analyzed the incidence of morbidity including ischemic/hemorrhagic stroke, gastrointestinal bleeding, pump malfunction, oxygenator dysfunction, infection during VV ECMO. We also compared COVID ECMO patients to non COVID-19 ECMO patients. Methods This is a retrospective review of an institutional ECMO database. We included consecutive patients from January 2015 through July 2020. 138 patients (mean age, 47.0 ± 14.4 y) with respiratory failure who underwent VV ECMO implantation were included in this study. Patients were stratified into two cohorts: those with COVID-19 or non COVID-19. Results Patients with COVID-19 had higher body mass index (33.4 ± 5.9 vs 28.8 ± 8.9, p

Purpose The COVID-19 pandemic has infected millions of people across the world and caused several thousands of deaths. Given advances in extracorporeal life support technology, ECMO for COVID-19 acute respiratory distress syndrome (ARDS) has proven to be successful in sustaining life, however, has left a significant number of patients fully depended on devices and incapable of being weaned. Lung transplantation, as a well-established therapy for end-stage lung disease, has been considered for some patients with COVID-19 ARDS in the absence of lung recovery and the presence of findings suggestive of end-stage lung disease. Methods This is an International collaborative effort to assess the role of lung transplantation in COVID-19 ARDS. There is worldwide representation with centers from US (3), Europe (2) and Asia (1). Patients with COVID-19 ARDS supported on ECMO and/or mechanical ventilation who were deemed unweanable and developed features of end-stage lung disease were evaluated for lung transplantation. We followed ISHLT conventional recipient selection criteria recommendations and a 2 negative COVID-19 PCRs from bronchoalveaolar lavage or viral culture depending on medical urgency. Endpoints We will present demographics, intraoperative challenges, primary graft dysfunction, postoperative complications, survival and functional outcomes of patients with COVID-19 ARDS who underwent lung transplantation. Additionally, referral patterns, reasons for listing denial and waitlist outcomes will be presented. So far, this collaborative group has transplanted 17 patients. There have been no deaths on the waitlist, there was one post-transplant mortality at day 61. Ten patients have been discharged from the hospital and are doing well. Six patients are recovering well however less than 30 days post-transplantation and remain admitted.

The diagnosis of benign liver lesions have been increased due to current imaging modalities and liver function test. Early detection of benign liver lesions by various imaging modalities of liver function test (LFT) can be treated by non-invasive methods. Benign liver lesions include a broad spectrum of pathologies ranging from regenerative nodules to true neoplastic processes and various cystic lesions. In this study, 50 cases were studied, age ranging from 19 years to 86 years. Age wise distribution of cases in study group showed that majority of cases were between 21-30 years age group. Amoebic liver abscess is the commonest lesion, which is common in males of 21-40 years. Cavernous hemangioma is the commonest solid lesion with female to male ratio of 2:1. Ultrasonography (USG) is the primary initial investigation in diagnosing benign lesions.

International audience; In this paper we present a novel approach for homography observer design on the Special Linear group SL(3). This proposed approach aims at computing online, the optical flow estimation extracted from continuous homography obtained by capturing video sequences from aerial vehicles equipped with a monocular camera. The novelty of the paper lies in the linearization approach undertaken to linearize a nonlinear observer on SL(3). Experimental results have been presented to show the performance and robustness of the proposed approach.

International audience; This paper revisits the problem of estimating the attitude, linear velocity and depth of an IMU-Camera with respect to a planar target. The considered solution relies on the measurement of the optical flow (extracted from the continuous homography) complemented with gyrometer and accelerometer measurements. The proposed deterministic observer is accompanied with an observability analysis that points out camera's motion excitation conditions whose satisfaction grants stability of the observer and convergence of the estimation errors to zero. The performance of the observer is illustrated by performing experiments on a test-bed IMU-Camera system.

Background The open preperitoneal repair offers the benefits of placing the mesh in the preferred position while avoiding the disadvantages of laparoscopic repair. Methods A total of 60 patients with bilateral inguinal hernias were randomized to undergo either the standard Lichtenstein meshplasty or the modified iliopubic tract repair in a teaching hospital. Outcomes measured were immediate postoperative pain, return to activity, and delayed neurological complications. Results Patients who underwent the iliopubic tract repair walked out of bed faster than the Lichtenstein group (6.3 hours vs 7.4 hours, p 0.05). Conclusion The iliopubic tract repair offers an excellent alternative to the Lichtenstein meshplasty, and is associated with lower postoperative pain, earlier return to work, and lower delayed neurological complications.

A novel co-operative control algorithm has been presented in this paper for the transportation of large objects in underwater scenarios using two free floating vehicles, each one endowed with a 7 d.o.f redundant manipulator. The paper also gives detailed information about the theoretical foundations related to the kinematic and dynamic modelling, and then to the cooperative control, of the overall system. Due to the low bandwidth in underwater scenarios, the algorithm presented in the paper just exchanges six numbers (tool frame velocities) and still gives extremely good results even with such high limitations on the information exchange.

Spontaneous abdominal wall endometriosis or scar endometriosis is rare clinical entity and often misdiagnosed. Patients can present with painful lump or nodule over abdominal wall which can be adjacent to previous scar or at independent location. Symptoms can be associated with cyclic menstruation or without any relation to it. Different available modalities for diagnosis are Fine needle aspiration cytology and biopsy, ultrasonography of abdomen and pelvis, computed tomography and magnetic resonance image. Most accepted treatment modality is surgical exicision. Aim of this case report is to highlight the diagnostic dilemma present in this clinical entity. In our case 24 year old female presented with painful nodule in right iliac fossa. Excision of nodule was performed and specimen was sent for Histopathological examination, which revealed the diagnosis of abdominal wall endometriosis.

Objectives: The prognosticating ability of one-time recorded Acute Physiology and Chronic Health Evaluation (APACHE) IV score was compared with serially recorded Mortality Prediction Model (MPM) II scores. Design and Methods: A prospective observational study was conducted for a period of 6 months. Acute Physiology and Chronic Health Evaluation IV score was recorded during the first day on intensive care unit (ICU) admission. Mortality Prediction Model II was recorded on admission, 24, 48, and 72 hours. Predicted mortality was compared with observed mortality. The systems were calibrated and tested for discriminant functions. Results: One hundred and fifty patients were studied. The observed mortality was 21.3%. The mean predicted hospital mortality by APACHE IV was 20.6%. The mean predicted hospital mortality rate by serial MPM II measurements was 27.7%, 24.3%, 25.5%, and 25.8%. The area under the receiver–operating characteristic curve was 0.87 for APACHE IV and 0.82, 0.84, 0.85, and 0.89 for MPM II series. Both systems calibrated well with similar degree of goodness of fit. Conclusion: Acute Physiology and Chronic Health Evaluation IV on admission predicted hospital mortality better than serially recorded MPM, which overestimated mortality. Also, APACHE IV had a slightly better discrimination compared to MPM II on admission. One-time recording of APACHE IV on admission may be sufficient for prognostication of ICU patients rather than serial MPM scores.

Blunt abdominal trauma can injure any abdominal organs which had significant morbidity and mortality in paediatric age group. It can lead to duodenal, jejunal or rather any bowel perforation. Isolated jejunal perforation still remains rare entity with less documented reports in specifically paediatric age group. We hereby present a case of three-year-old female child with isolated jejunal perforation, post history of fall from height. Early exploration and prompt surgical intervention led to successful outcome in this patient.

Identifying food types consumed and their calorie composition is one of the central tasks of dietary assessment. Traditional automated image processing methods learn to map images to an existing food database with known caloric composition. However, even when the correct food type is identified, caloric makeup can vary depending on its ingredients, and using true-color images proves insufficient to distinguish within food type variability. In this paper, we show that hyperspectral imaging provides useful information and promise in distinguishing caloric composition within the same food type. We collect data using a hyperspectral camera from Nigerian foods cooked with varying degrees of fat content, and capture images under different intensities of light. We apply Principle Component Analysis (PCA) to reduce the dimensionality, and train a Support Vector Machine (SVM) classifier using a Radial Basis Function kernel and show that applying this technique on hyperspectral images can more readily distinguish calorie composition. Furthermore, compared with methods that only use true-color based features, our method shows that a classifier trained using features from hyperspectral images is significantly more predictive of within-food caloric content, and by fusing results from two classifiers trained separately using hyperspectral and RGB imagery we obtain the greatest predictive power.

Background: Surgical site infection (SSI) has been pointed out as the 2nd most common nosocomial infection. Since suture materials have been proven to be a contributor to SSI, they have been the focus of research and development centered on making them less conducive to bacterial overgrowth. The Triclosan coated suture slowly releases Triclosan, which is an antibacterial agent that inhibits bacterial colonization of the suture and wound site and thus, promises prevention of surgical site infection.Methods: Total of 100 patients undergoing excision of uninfected subcutaneous benign lumps and cutaneous swellings were randomized in two groups: group A in which triclosan coated polyglactin 910 suture was used for wound closure (50 patients) and Group B in whom conventional uncoated Polyglactin 910 suture was used for wound closure (50 patients).Results: In this study, maximum number of patients was in the age group of 46-60 years. Mean age of subjects in triclosan- coated suture group was 45.03 years while it was 47.32 in conventional uncoated suture group. Among 100 subjects in triclosan- coated suture group, 26 (52%) were males and 24 (48%) were females. In comparison to it, male and female subjects in conventional uncoated suture group were 25 (50%) each. Among 50 subjects in triclosan- coated suture group, only 2 (4.0%) had surgical site infection while in conventional uncoated suture group, 8 (16.0%) had surgical site infection. Incidence of surgical site infection with use of triclosan- coated suture was significantly lower compared to conventional uncoated suture group. (p 0.04).Conclusions: Triclosan coated suture surely, helps in preventing surgical site infection which, not only increases the morbidity of the patient but also has long-term implications.

Background: Tongue squamous cell carcinoma (TSCC) is one of the aggressive forms of oral cancer with a high recurrence rate. Forty percentages of all TSCC patients have neck metastasis at the time of diagnosis. The status of cervical lymph nodes at presentation is the single most important prognostic factor in TSCC. This study was focused on establishing relation between the tumor depth and neck node metastasis in carcinoma of tongue. Authors accessed the patterns of cervical node metastasis in it.Methods: prospective non-randomised study of 100 patients was carried out. After detail clinical history punch biopsy were taken from the tongue lesion. Biopsy proven cases of early squamous cell carcinoma (T1/T2) with clinically negative neck (cN0) were included in this study. Ultra-sonography of the tongue using 7.5 MHz probe was performed in all cases to know the depth of lesion. Final histopathological findings i.e. pT, pN, differentiation and depth of invasion were compared with pre-operative clinical and radiological findings.Results: Out of 100 patients, 62 were males and 38 were females. Clinically 56 patients were belonged to T2. Ultra-sonography of tumor had high sensitivity and specificity. Node positivity increased with the depth of primary tumor. On histopathological examination, positive node observed in total 25 patients. Number of occult neck node positivity raised with increased size of primary tumor. i.e. 15% and 31% with pT1 and pT2, respectively. Level II was the most common site for cervical node involvement followed by level III.Conclusions: Ultra-sonography was a reliable tool to access the depth of tumor pre-operatively in the cases of tongue carcinoma patients with sensitivity and specificity more than 90%. Node positivity increased with the depth of primary tumor. Tumor thickness is a significant predictor of nodal metastasis and elective neck dissection should be decided accordingly.

Introduction: Lower limb veins are most prone to having venous disorders and varicose veins are the biggest issue. Varicose veins can be grouped into Primary or Secondary Varicose veins. Secondary Varicose veins are associated with acquired factors causing stasis and hypercoagulable state. This study addresses the various associated risk factors for secondary varicose veins such as age, sex, Body Mass Index (BMI), pregnancy, prolonged standing, tobacco use, and deep vein thrombosis history and family history of secondary varicose veins. Methods: A prospective non-randomized study of fifty patients was carried out between August 2015 and July 2016. Demographic details of all patients were recorded. Detail history and examination of both lower limbs were performed. Descriptive statistics were calculated by measuring means, standard deviation (SD), and proportions with 95% confidence interval. Results: Tobacco chewing in any form was the most common associated risk factor of secondary varicose vein in our study of 50 patients and it was observed in 46% of patients. We found that varicose veins were more common in males and it was especially predominant in the over fifty years of age. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m2. Past history of varicose veins and treatment for same was not associated significantly with varicose veins prevalence. More than two numbers of pregnancies were found in 26% females with varicose veins. Conclusion: We found that prolong standing, smoking (> 10 cigarettes/day), more than two pregnancies, and family history of deep venous thrombosis were some of the major associated risk factors for varicose veins. We couldnt establish any strong association between previous history of deep venous thrombosis and varicose vein surgery with respect to recurrence of it. Among modifiable risk factors, tobacco chewing and smoking should be abandoned to decrease the incidence of varicose veins. [Arch Clin Exp Surg 2018; 7(3.000): 104-107]

The paper describes a novel cooperative control policy for the transportation of large objects in underwater environments using two UVMS (Underwater Vehicle Manipulator Systems). Due to the low bandwidth available in underwater scenarios, the main feature of the paper lies in the fact that the cooperative transportation of the commonly grasped object is carried out successfully by just exchanging the tool frame velocities at each sampling instant. A disturbance compensation technique is also presented to cope with sea currents and vehicle velocity tracking errors.

This paper describes an unifying control framework which has been proposed and successfully employed within the recently concluded TRIDENT EU FP7 project. It further describes the extension of this proposed framework to dual arm free floating control case (single underwater vehicle with two 7 d.o.f redundant manipulators), and even the more challenging cooperative control of two I-AUVs for the transportation of large objects which is part of the currently ongoing Italian national project MARIS. The paper presents simulation results as well as actual experimental trials showing the effectiveness of this proposed control framework.

In this paper we present a novel co-operative control policy purely for the transportation of large objects in underwater environments using two free floating vehicles, each one endowed with a 7 d.o.f redundant manipulator. Due to the presence of harsh conditions in underwater scenarios, it is extremely important to realize algorithms that depend on a minimal amount of explicit information exchanged by the agent, or without any exchange of information at all. To achieve this goal the control policy proposed in the paper only requires the exchange of six numbers at each time instant, while however exhibiting extremely good performances, inspite of the restraints on the information exchange.

Background The concept of Distraction Osteogenesis is applied in Maxillofacial surgery extensively in the recent past, revolutionizing the concept of management of facial deformities specially the mandible. Methods This article describes intra oral mandibular distractors in managing mandibular deformities in 9 cases. Conclusion Surgical intervention is possible in very young patients. Distraction Osteogenosis does not reduce the need for orthodontic intervention. A multifarious approach to the problem, should form the basis of treatment of mandibular deformities.

Transverse maxillary deficiencies are a common occurance, prevalent in both syndromic and non syndromic patients. Treatment usually combines a orthodontic-surgical intervention in adults. This article reviews the procedures along with the experience of the authors in the correction of maxillary transverse deficiency in adults.

A wide variety of disease processes produce alteration of midfacial skeletal growth, resulting in moderate-to-severe midface deficiency presenting as retrusion associated with Angle’s class III malocclusion. Most cases of midface deficiency are seen in patients of cleft lip/palate. The surgical procedure to correct the clefts, undertaken over a long period of time from infancy to the teens tends to take its toll on the soft tissues over the midface. The scarring that is a feature in these conditions results in hampering of normal growth of the midface causing the deformity. Conventional procedures to correct the deformity by surgical advancement have been less than satisfactory in terms of success. This is where the concept of multidimensional growth using distraction proved useful. Today distraction has proved to be a versatile tool in the correction of midface deficiencies due to its various advantages. Six patients of cleft lip/palate were taken up for advancement of the hypoplastic midface using intra-oral distractors with successful and stable results.

Introduction: Varicose veins (VVs) are dilated, tortuous, subcutaneous veins. It is common condition causing substantial morbidity. Prevalence of VVs ranges between 5% and 30% in the adult population. Surgery is one of the common modality of its treatment. A complete knowledge about anatomical variation at saphenofemoral junction (SFJ) and variations in tributaries of great saphenous vein (GSV) is important while dealing with such patients effectively. It will help in reducing chances of recurrences and complications. Methods: A prospective non-randomized study of fifty patients was carried out in our hospital between May 2014 and May 2015. Diagnosis was established by clinical examination and supplemented with venous duplex ultrasound study. Patients were subjected to trendelenburg's operation, stripping of GSV with hook phlebectomy of affected perforators. Results: A total of fifty patients were studied in this study, in which tobacco chewing was the most common associated risk factor with primary VVs, and it was observed in 46% of patients. Amongst them, twenty patients were obese with body mass index of more than 25 kg/m 2 . Location of SFJ was a mean of 2.24 ± 0.55 cm inferior and 3.77 ± 0.61 cm lateral to the pubic tubercle on duplex ultrasound and 2.35 ± 0.42 cm inferior and 3.73 ± 0.58 cm lateral intraoperatively, both of which had nonsignificant P value. The number of tributaries varied from 2 to 6 at the first 5 cm from SFJ. There were two and six tributaries in one patient each whereas three tributaries were observed in 42% patients. The most frequent consistent branch was a superficial inferior epigastric vein, seen in 98% of patients. The least frequent branch was posterior accessory saphenous vein, seen only in 2% of patients. The external pudendal artery was crossing SFJ anteriorly in 38% and posteriorly in 56%, and it was not identified in remaining 4% patients. Conclusion: Our study showed the nonsignificant difference in Duplex ultrasound and intraoperative finding of SFJ location with respect to pubic tubercle; hence, one can plan a precise incision with the help of duplex ultrasound marking preoperatively. One must look for all tributaries for ligation which will prevent recurrence of varicose vein as variation in numbers and location of tributaries was remarkable in our study.

The protective utility of prophylactic administration of human gammaglobulin agoinst morbidity and mortality due to bacterial infections was assessed in 24 preterm babies weighing less than 1800 g at birth. There was no statistically significant reduction in the morbidity and mortality in infants who received prophylactic gammaglobulin as compared to controls. However, the protected babies survived longer and manifested evidences of infections later. There is a need for greater emphasis on asepsis for various house-keeping rituals in the Special Care Nursery for reduction in perinatal mortality.

The dynamic model for the Cat-Righting Reflex – the innate ability of cats to always land on their feet no matter what their initial orientation was when they were released – had been quite a debated physical problem which was solved by the mathematical solution proposed and verified by Kane and Scher and later by a more general solution by Montgomery. However, the practical implementation of this ability in a robotic structure may demand for a modified version of these models with focus on physical realization of the same. This paper proposes such a model derived from the Kane-Scher cat model and simulates the same to test its suitability. An analysis is also made of the closeness to which the practical model realizes CRR with respect to the theoretical model.