Adequate Size Research Articles

Boosting the Immune System with Vitamin D: Special Focus on Prevention of COVID-19 and Complications

Abstract: In addition to the classical functions of the musculoskeletal system and calcium homeostasis, the function of vitamin D as an immune modulator is well established. The vitamin D receptors and enzymes that metabolize vitamin D are ubiquitously expressed in most cells in the body, including T and B lymphocytes, antigen-presenting cells, monocytes, macrophages and natural killer cells that trigger immune and antimicrobial responses. Many in vitro and in vivo studies revealed that vitamin D promotes tolerogenic immunological action and immune modulation. Vitamin D adequacy positively influences the expression and release of antimicrobial peptides, such as cathelicidin, defensin, and anti-inflammatory cytokines, and reduces the expression of proinflammatory cytokines. Evidence suggestss that vitamin D's protective immunogenic actions reduce the risk, complications, and death from COVID-19. On the contrary, vitamin D deficiency worsened the clinical outcomes of viral respiratory diseases and the COVID-19-related cytokine storm, acute respiratory distress syndrome, and death. The study revealed the need for more preclinical studies and focused on well-designed clinical trials with adequate sizes to understand the role of vitamin D on the pathophysiology of immune disorders and mechanisms of subduing microbial infections, including COVID-19.

Plot size and shape for Sesame experiments

In agricultural experimentation, the use of adequate plot size and shape is an important experimental technique to increase the precision of the experiment. Thus, the objective of this study was to determine the appropriate size and shape of the plot for field experimentation with sesame. For this, the experiment was conducted in randomized complete blocks with 14 sesame cultivars in four replicates. The plots were composed of four 0.8-meter-long rows, at spacing of 0.6 m between rows and 0.1 m between plants. The plot area (0.72 m2), composed of the two central rows, was divided into 12 basic units, each constituted by one plant in the row (0.06 m2), to obtain the seed yield of sesame. The convenient size of the experimental plot was estimated by the Hatheway’s method and its adequate shape was determined by the relative information method. The Hatheway’s method allowed the estimation of several convenient plot sizes, many of sizes applicable for sesame cultivar evaluation experiments. A rectangular 1 x 6 plot (row with six plants and 0.36 m2 of floor area) was considered the adequate shape to evaluate seed yield of sesame cultivars and was also smaller than the size generally indicated in surveys with the sesame crop.

Hierarchical Integrated Hybrid Structural Electrodes Based on Co‐N/C and Mo‐doped NiCo‐LDH@Co‐N/C Anchored on MX/CF for High Energy Density Fiber‐Shaped Supercapacitor

AbstractThe judicious design of highly electrochemically active materials on 1D fiber substrate to form a hierarchical integrated hybrid structure is an efficient technique to improve the limited cylindrical space and volumetric energy density of fiber‐shaped supercapacitors (FSCs). Herein, a 3D negative electrode, consisting of vertically aligned interconnected mesoporous Co‐N/C leaf‐like structure on 1D MXene‐carbon fiber (Co‐N/C@MX/CF) is prepared by controlling the composition and morphology. At the same time, a 3D positive electrode is also prepared by introducing Mo in NiCo‐LDH anchored on Co‐N/C@MX/CF (Mo‐NiCo‐LDH@Co‐N/C@MX/CF) by electrodeposition method. Benefitting from the systematic hierarchical structures with highly accessible surface area, adequate pore size and easy permeation of electrolyte, both positive and negative electrodes demonstrate highly improved electrochemical performance with areal capacity/capacitance of 0.96 mAh cm−2/4.55 mF cm−2 at a current density of 3.86 mA cm−2, respectively. Furthermore, the fiber‐shaped solid‐state hybrid supercapacitor (FSHSC) based on Mo1.5NiCo‐LDH@Co‐N/C@MX/CF(+)//Co‐N/C0.5@MX/CF(−) is fabricated, exhibiting compelling energy density of 86.72 mWh cm−3 at a power density of 480.30 mW cm−3 with an outstanding capacitance retention of 80.2% after 20000 galvanostatic‐charge‐discharge cycles. This study puts forward a new perspective on the development of highly efficient FSCs for practical application.

Dynamical behaviour of discrete logistic equation with Allee effect in an uncertain environment

The Allee effect refers to a natural occurrence where the average individual fitness of a population or species is correlated with population size or density. A demographic Allee effect having a threshold population size constitutes a strong Allee effect. On the contrary, it is called the weak Allee effect when it lacks an adequate population size. This paper revisits a single-species logistic growth model under the combined impacts of the strong Allee effect, discrete population dynamics, and an impreciseness phenomenon. Several existing literatures on models with deterministic and continuous time frames address the Allee effect’s significance. The population growth model may disobey the continuous time frame of dynamics. The difference equation may be a fruitful substitute for the traditional differential equation to trace a discrete logistic population growth model phenomenon. Also, initial information and the population growth model’s associated coefficient may sometimes be vague. Fuzzy logic is a suitable tool to describe such vagueness in mathematical terms. We have discussed the proposed model through the different fuzzy scenarios to realize the relative impact of different fuzzy parameters. This paper also includes the studies of equilibrium points and their corresponding stability analysis for each case. This paper differs from the existing literature on Allee effect in that it contributes an alternative approach to manifest the logistic growth model in a discrete time frame under uncertainty. Numerical results show the fuzzy impact of different parameters of the model. One of the significant insights of the outcome is that the extinction or highly growing population depends on the parameter’s values rather than the population size only.

Use of Underwater-Image Color to Determine Suspended-Sediment Concentrations Transported to Coastal Regions

The amount of suspended sediment transported from rivers to the ocean fluctuates over time, with a substantial increase occurring during storm events. This surge in sediment poses numerous challenges to coastal areas, highlighting the importance of accurately assessing the sediment load to address these issues. In this study, we developed and experimentally verified a novel method for suspended-sediment-discharge quantification in estuaries and coasts using underwater imaging. Specifically, red clay samples with different particle sizes were introduced into separate tanks containing clean water. After adequate mixing, the concentration, particle size, turbidity, and water quality were measured and analyzed using LISST-200x and EXO2 Multiparameter Sonde sensors. To maintain constant lighting conditions, a camera box was created for filming. Based on the experimental results, a turbidity–concentration relationship formula was derived. The proposed regression equation revealed that the relationship between the turbidity and estimated suspended-sediment concentration was significantly affected by the particle size, and the prediction results were underestimated under high-concentration conditions. Using blue, green, and gray band values, a multiple regression model for estimating suspended-sediment concentrations was developed; its predictions were better than those obtained from the turbidity–concentration relationship. Following efficiency improvements through additional approaches considering underwater-image filming conditions and characteristics of actual streams, estuaries, and coasts, this method could be developed into an easily usable technique for sediment-discharge estimation, helping address sediment-related issues in estuaries and coastal regions.

PEDS10: Characterizing the Fit of Transvalvular Left Ventricular Micro-Axial Flow Pumps in Pediatric Patients

Background: There are few FDA approved mechanical circulatory support (MCS) devices for pediatric patients. Physicians in the US and Europe have increasingly elected to use the Impella platform to support pediatric patients including use in axillary arteries with diameters as small as 4.8 mm for the Impella 5.5 with SmartAssist (21 F) without complication. Given the increasing use of these devices in pediatric patients, there is a need to quantify and characterize the device fit in this population. Methods: 3D anatomical reconstructions were built from pediatric cardiac CT scans (n=23, age 0.8-9.3 years, BSA 0.45-1.09 m2). The length of the left ventricle & ascending aorta and the diameters of the brachiocephalic & lower left subclavian arteries were measured via clinical CT practices and modeled as a scalar relationship to BSA using simple linear regression & bounded by critical Impella dimensions to evaluate transvalvular fit. Estimated distal artery diameters were calculated via published vessel models to evaluate intravascular device delivery potential. The models were tested on pediatric Impella patient data as reported in published case studies (n=27, age 4-19 years, BSA 0.91-2.38 m2). Results: CT scan reconstructions suggest sufficient LV length in 0.6 m2 and 1.2 m2 BSA patients for Impella 5.5 and Impella CP, respectively. For direct aortic implant, BSA >1.1 m2 may be required due to ascending aortic length. The ostial segments of the brachiocephalic and left subclavian arteries were of adequate size for Impella 5.5 in patients with BSA as small as 0.53 m2. Published models correlating vessel diameter with BSA suggest BSA >0.86 m2 and >1.15 m2 patients could fit Impella CP and Impella 5.5, respectively, via midclavicular axillary access. Modeled vessel diameters predict that all pediatric Impella patients evaluated (27/27) would fit an Impella CP, and 74% (20/27) would fit an Impella 5.5 compared with the minimum vessel size reported in the literature. Conclusions: These analyses outline critical parameters for current Impella devices to fit pediatric patients. Further characterization of pediatric vessel sizes based on readily available clinical metrics such as BSA may aid physician decisions for MCS use in patients in critical need.

Spatial scale of non-target effects of cotton insecticides.

Plot size is of practical importance in any integrated pest management (IPM) study that has a field component. Such studies need to be conducted at a scale relevant to species dynamics because their abundance and distribution in plots might vary according to plot size. An adequate plot size is especially important for researchers, technology providers and regulatory agencies in understanding effects of various insect control technologies on non-target arthropods. Plots that are too small might fail to detect potential harmful effects of these technologies due to arthropod movement and redistribution among plots, or from untreated areas and outside sources. The Arizona cotton system is heavily dependent on technologies for arthropod control, thus we conducted a 2-year replicated field experiment to estimate the optimal plot size for non-target arthropod studies in our system. Experimental treatments consisted of three square plot sizes and three insecticides in a full factorial. We established three plot sizes that measured 144 m2, 324 m2 and 576 m2. For insecticide treatments, we established an untreated check, a positive control insecticide with known negative effects on the arthropod community and a selective insecticide. We investigated how plot size impacts the estimation of treatment effects relative to community structure (27 taxa), community diversity, individual abundance, effect sizes, biological control function of arthropod taxa with a wide range of mobility, including Collops spp., Orius tristicolor, Geocoris spp., Misumenops celer, Drapetis nr. divergens and Chrysoperla carnea s.l.. Square 144 m2 plots supported similar results for all parameters compared with larger plots, and are thus sufficiently large to measure insecticidal effects on non-target arthropods in cotton. Our results are applicable to cotton systems with related pests, predators or other fauna with similar dispersal characteristics. Moreover, these results also might be generalizable to other crop systems with similar fauna.

Optimal location and sizing of distributed generation for distribution systems: An improved analytical technique

ABSTRACT Distributed generation (DG) significantly improves power system reliability and voltage profile, and reduces power losses. These benefits can be maximized by optimizing the DG utilization, which greatly depends on adequate number, size, and placement of DG. This study proposes a high-convergence optimization technique for optimal DG placement in distribution networks, aiming to reduce power losses and improve voltage profile and voltage stability index. The technique is tested on a 7-bus system before being verified on the IEEE 33-bus system. After validation, it is tested on a 71-bus distribution network (DN). The estimated ideal size for a single DG is used as a limit for determining the optimal placement and size of multiple DG units. The results show that there is a loss reduction of 70.09%, 61.43%, and 71.15% for the 7-bus, IEEE 33-bus, and 71-bus systems, respectively, from their base case loss. The average absolute error of voltage of the aforementioned buses also shows similar enhancement, decreasing from 0.0144, 0.0561, and 0.0527, to 0.0058, 0.0209, and 0.0184, respectively. The voltage stability index of each DN has increased significantly in comparison to the base case. The comparison demonstrates that the proposed technique can provide better results for any size of distribution network.

Successful management of endotracheal tube cuff rupture in case of difficult airway scenario for oropharyngeal surgery

Endotracheal tube (ETT) cuff leaks can be encountered in the operating room with variable consequences ranging from a mere annoying bubbling sound to life-threatening respiratory compromise requiring immediate intervention. This scenario becomes more challenging if there is a difficult airway with limited mouth opening and oromaxillofacial surgery where nasal intubation is required with a north pole tube. ETT replacement can expose the patient to airway loss or life-threatening hypoxemia during the ETT exchange. There are no recommended guidelines on how to deal with an ETT cuff leak and no published step-by-step safe management strategy. With the lack of defined protocols and guidelines to manage intraoperative cuff leaks, the presence of mind and ability to make critical decisions by the anesthesiologist cannot be overemphasized. We present a case report of a 40-year-old patient weighing 70 kg diagnosed with carcinoma retromolar trigone posted for wide local excision and posterior segmental mandibulectomy. On airway examination, he had a limited mouth opening of <1 cm, with both nostrils of equal and adequate size. As mask ventilation was not difficult after induction of general anesthesia, we did fiberoptic-guided right nasal intubation with North Pole tube. We were unable to inflate the cuff of ETT and there was a significant leak. Here, we discuss how we exchanged the ETT in this difficult airway scenario.

PO-03-161 INTRA-PROCEDURAL CROSSOVER OF LEFT ATRIAL APPENDAGE OCCLUSION DEVICES, A SINGLE CENTER EXPERIENCE

Two devices are currently available for percutaneous left atrial appendage occlusion (LAAO), Watchman FLX and Amplatzer Amulet. While in most cases LAAO is achieved by implanting the originally planned device, intra-procedural crossover from one type to the other might be necessary when LAAO is not satisfactory. To evaluate the rate and characteristics of intra-procedural device crossover in LAAO procedure. All successful LAAO procedures performed in our center since October 2021 (Amulet’s FDA approval) are included in the study. Of note, LAAO procedures are performed under fluoroscopic and ultrasound (TEE or ICE) guidance, without formal preprocedural imaging planning. 365 patients (74±9 years; 34% female) underwent LAAO over 12 months. LAAO was successful in all but 1 case, in which the LAA was too large for successful implantation of the originally planned device (Watchman) and crossover was not attempted. In almost all cases (361/364, 99%), the original planned device was implanted successfully achieving complete LAAO (Watchman in 325 patients, Amulet in 34 patients). Intra-procedural device crossover was observed in 4 (1%) patients, all from Watchman to Amulet. In 3 cases, the LAA ostium and proximal LAA were large, leading to deployment of an undercompressed, unstable 35 mm Watchman device: Amulet allowed positioning of the lobe in a more distal, stable location with the disc covering the ostium (Figure, left panel). In 1 case, the LAA was of adequate size, but a proximal ridge (s/p LAA isolation) lead to Watchman deformation (struts’ introversion on one side) once fully deployed, a behavior observed despite multiple recaptures and a device change: with Amulet, the lobe could be placed distally to the ridge with the disc covering the ostium (Figure, right panel). Mean procedural time was 107±3 min, with a mean contrast volume used of 203±70 mL and a mean fluoroscopy time of 15±4 min (yielding to a mean dose of 2070±3107 mGy). There were no procedural-related complications, and all patients were discharged home after overnight observation. Intraprocedural LAAO device crossover is a rare occurrence, usually secondary to unsatisfactory deployment of the originally planned device. To avoid unsuccessful LAAO, operators should be skilled in implantation of both type of devices and be able to switch from one to the other at the time of the index procedure.Tabled 1PatientLAA os max diameterOriginal deviceFinal device131 mm35 mm Watchman FLX31-mm Amplatzer Amulet229 mm35-mm Watchman FLX34-mm Amplatzer Amulet329 mm35-mm Watchman FLX34-mm Amplatzer Amulet421 mm27-mm Watchman FLX22-mm Amplatzer Amulet Open table in a new tab

Survey on attribute and concept reduction methods in formal concept analysis

Formal concept analysis (FCA) is now widely recognized as a useful approach for extracting, representing, and analyzing knowledge in various domains. The high computational cost of knowledge processing and the difficulty of visualizing the lattice are two key challenges in practical FCA implementations. Moreover, assessing the finalized built-up lattice may be problematic due to the enormous number of formal concepts and the complexity of their connections. The challenge of constructing concept lattices of adequate size and structure to convey high-importance context features remains a significant FCA aim. In the literature, various strategies for concept lattice reduction have been presented. In this work, we suggest a categorization of reduction methods for concept lattice based on three main categories: context pre-processing, non-essential distinctions elimination, and concept filtration, whereby using FCA-based analysis, the most important methods in the literature are analyzed and compared based on six pillars: the preliminary step of the reduction process, domain expert, changing the original data structure, final concept lattice, quality of reduction, and category of reduction method.

Energy Efficient Features of Vernacular Houses in Tropical Hilly Area of Indonesia

Energy efficient building is one of the alternative solutions to overcome the rapidly increasing use of energy consumption by the building sector. Traditional or vernacular houses rarely use mechanical means to create a comfortable living environment. Thus, the electrical energy consumed by traditional or vernacular houses was relatively low. It is believed that energy efficient features can be found in vernacular houses. Thence, this study explores the energy efficient features of vernacular houses, with a case study in the hilly area of the tropics, Palu-Indonesia. Field studies were conducted. Six vernacular houses were chosen purposively as the study samples based on building orientation, building form, roof form, wall construction, and type of opening. HOBO H21 and U12-012 were utilised to measure the internal and external air temperature, relative humidity, light intensity, wind speed and wind direction. The study result indicates that the sample houses’ thermal condition was slightly better than the external thermal condition. Sample 1 can modify the external air temperature up to 42.8 K during the daytime. The light condition, in contrast, showed poor performance. Thus, more transparent material with proper shading was needed to succeed daylighting in the buildings’ interior. Several energy efficient features of vernacular houses found in the samples are as follows: shallow building plan elongated to East – West, building geometry, resistive building materials, the use of ceilings, and side-hung or jalousie type of windows with an adequate size of the effective opening for ventilation and lighting.

Durability and Thermal Behavior of Functional Paints Formulated with Recycled-Glass Hollow Microspheres of Different Size.

This study aims to assess the effect of hollow glass microspheres of different sizes derived from glass industry waste on the durability and thermal behavior of waterborne paint. The coatings were characterized by electron microscopy to investigate the distribution of the spheres and their influence on the layer morphology. The impact of the various glassy spheres on the mechanical feature of the coatings was assessed using the Buchholz hardness test and the Scrub abrasion test. The role of the spheres in altering the durability of the samples was analyzed by the salt spray exposure test and the electrochemical impedance spectroscopy measurements. Finally, a specific accelerated degradation test was carried out to explore the evolution of the thermal behavior of the composite coatings. Ultimately, this work revealed the pros and cons of using hollow glass spheres as a multifunctional paint filler, highlighting the size of the spheres as a key parameter. For example, spheres with adequate size (25-44 µm), totally embedded in the polymeric matrix, are able to reduce the thermal conductivity of the coating avoiding local heat accumulation phenomena.

Portal Hemodynamics after Living-Donor Liver Transplantation: Management for Optimal Graft and Patient Outcomes—A Narrative Review

Background: When a partial liver graft is transplanted into a recipient with portal hypertension, it is subject to sinusoidal shear stress, which, in good measure, is essential for regeneration. However, portal hyperperfusion which exceeds the capacity of the graft results in the small-for-size syndrome manifested by ascites, cholestasis and coagulopathy. This review discusses intraoperative hemodynamic variables that have been described in the literature, and inflow modulation strategies and their outcomes. Apart from using donor grafts which are of adequate size for the recipient weight, portal hemodynamics are an important consideration to prevent early allograft dysfunction, graft failure and mortality. Summary: Understanding normal portal hemodynamics, how they change with the progression of cirrhosis, portal hypertension and changes after the implantation of a partial liver graft is key to managing patients with living-donor liver transplantation. If the intraoperative measurement of portal flow or pressure suggests graft portal hyperperfusion, inflow modulation strategies can be adopted. Splenic artery ligation, splenectomy and hemiportocaval shunts are well described in the literature. The proper selection of a donor to match the recipient’s anatomic, metabolic and hemodynamic environment and deciding which modulation strategy to use in which patient is an exercise in sound clinical judgement. Key message: The intraoperative assessment of portal hemodynamics in living-donor liver transplant should be standard practice. Inflow modulation in properly selected patients offers a point-of-care solution to alter portal inflow to the graft with a view to improve recipient outcomes. In patients with small (anatomically/metabolically) grafts, using inflow modulation can result in outcomes equivalent to those in patients in whom larger grafts are used.

Carvacrol-loaded nanoemulsions produced with a natural emulsifier for lettuce sanitization

Carvacrol is an antimicrobial agent that shows potential for eliminating microorganisms in vegetables, increasing food safety. However, intense odor and low water solubility of carvacrol are limiting factors for its application for fresh vegetables sanitization, which can be overcome by nanotechnology. Two different nanoemulsions containing carvacrol (11 mg/mL) were developed by probe sonication: carvacrol-saponin nanoemulsion (CNS) and carvacrol-polysorbate 80 nanoemulsion (CNP). Formulations presented appropriate droplet sizes (from 74.7 nm to 168.2 nm) and high carvacrol encapsulation efficiency (EE) (from 89.5 % to 91.5 %). CNS showed adequate droplet size distribution (PDI < 0.22) and high zeta potential values (around −30 mV) compared to CNP, with saponin chosen for the following experiments. Carvacrol nanoemulsions presented Bacterial Inactivation Concentration (BIC) against the Salmonella cocktail from 5.51 to 0.69 mg/mL and for the E. coli cocktail from 1.84 to 0.69 mg/mL. Among all tested nanoemulsions, CNS1 presented the lowest BIC (0.69 mg/mL) against both bacterial cocktails. Damage to bacterial cells in lettuce treated with nanoemulsion was confirmed by scanning electron microscopy. For lettuce sanitization, CNS1 showed a similar effect to unencapsulated carvacrol, with a high bacterial reduction (>3 log CFU/g) after lettuce immersion for 15 min at 2 × BIC. Using the same immersion time, the CNS1 (2 × BIC) demonstrated equal or better efficacy in reducing both tested bacterial cocktails (>3 log CFU/g) when compared to acetic acid (6.25 mg/mL), citric acid (25 mg/mL), and sodium hypochlorite solution (150 ppm). Lettuce immersed in CNS1 at both concentrations (BIC and 2 × BIC) did not change the color and texture of leaves, while the unencapsulated carvacrol at 2 × BIC darkened them and reduced their firmness. Consequently, carvacrol-saponin nanoemulsion (CNS1) proved to be a potential sanitizer for lettuce.

Computational Prediction of Interactions Between SARS-CoV-2 and Human Protein Pairs by PSSM-Based Images

Identifying protein-protein interactions is essential to predict the behavior of the virus and to design antiviral drugs against an infection. Like other viruses, SARS-CoV-2 virus must interact with a host cell in order to survive. Such interaction results in an infection in the host organism. Knowing which human protein interacts with the SARS-CoV-2 protein is an essential step in preventing viral infection. In silico approaches provide a reference for in vitro validation to protein-protein interaction studies by finding interacting protein pair candidates. The representation of proteins is one of the key steps for protein interaction network prediction. In this study, we proposed an image representation of proteins based on position-specific scoring matrices (PSSM). PSSMs are matrices that are obtained from multiple sequence alignments. In each of its cells, there is information about the probability of the occurrence of amino acids or nucleotides. PSSM matrices were handled as gray-scale images and called PSSM images. The main motivation of the study is to investigate whether these PSSM images are a suitable protein representation method. To determine adequate image size, conversion to grayscale images was performed at different sizes. SARS-CoV-2-human protein interaction network prediction based on image classification with siamese neural network and Resnet50 was performed on PSSM image datasets of different sizes. The accuracy results obtained with 200x200 size images and siamese neural network as 0.915, and with 400x400 size images and Resnet50 as 0.922 showed that PSSM images can be used for protein representation.

Fatigue &amp; Fracture of Engineering Materials &amp; Structures Virtual Special Issue: Data science and machine learning for fatigue and fracture assessment

<scp>Fatigue &amp; Fracture of Engineering Materials &amp; Structures Virtual Special Issue</scp>: Data science and machine learning for fatigue and fracture assessment

End Stage Renal Disease: AVF for Hemodialysys: Clinical Assessment with/without Ultrasound Doppler, Complications and Failure

Objective/Background: The objective of this study was to study the complications and failure rate after creating an arteriovenous fistula in patients suffering from end-stage renal disease (chronic renal failure). It was also intended to study the importance of preoperative Clinical assessment/physical examination of the patient; and if the vessels for anastomosis appeared to be of a doubtful size, then a doppler study was done to ensure that the vein is of adequate size for creation of a good fistula. Method: In this study 121 cases of end-stage renal disease (chronic renal failure) who needed vascular access for hemodialysis were taken. Ultrasound Doppler study was conducted in those patients whose vessels (for anastomosis) appeared to be of small size on Clinical examination. In the study, the arteriovenous fistulae were created under local anesthesia observing all aseptic precautions. Results: Most commonly, the difficulty encountered during surgery was when the caliber of the vein was small i.e. less than 2.5 mm. An arteriovenous fistula was created only when the size of the vein was at least 2.0 mm. When the size of the vein was small, then a longitudinal incision was given in the vein or Cheatlemanouvre was undertaken to perform the anastomosis. In 4 of the 121 cases when radiocephalic fistula was attempted, we had to convert to brachio-cephalic. No major complication was encountered during the surgery or post-operatively. Some patients (five) had redness and inflammation. Inflammation and redness subsided with antibiotics and it resulted in satisfactory recovery. The fistulas started well showing good thrill. After 30 days, 106 out of 121 AV fistulas created were functioning very well with a patency rate of 87.6%. Conclusion: There was no major complication after creating an arteriovenous fistula. It is important to do a thorough physical examination before surgery so that the vessel is assessed. In doubtful cases, an ultrasound doppler study should be done to know the size and patency of the vessel. We should also take relevant history especially of hypertension, diabetes, i/v canulation, etc.

AN ALGORITHM FOR GARBAGE TRUCK ROUTING IN CITIES WITH A FIXATION ON CONTAINER FILLING LEVEL

An algorithm for optimizing the routes of a set of vehicles used for the collection and removal of municipal solid waste in a metropolis is proposed. The algorithm eliminates the problem of applying heuristic methods for multi-agent optimization, which is NP non-deterministic polynomial-time-hard. The application of the algorithm leads to a guaranteed exact solution. Through the application of restrictions on the carrying capacity of vehicles, the size of the input matrix representing the transport network can be reduced to an adequate size. This process uses statistical information about the filling levels of container waste bins. The algorithm is applied to an example of two megacities. The shortest routes are built for different numbers of points (from 12 to 72) on the route. The dependence of the total mileage on the number of involved vehicles is studied.

Surgical Simulation of Posterior Sagittal Anorectoplasty for Rectovestibular Fistula: Low-Cost High-Fidelity Animal-Tissue Model

PurposeTo provide a high-fidelity, animal tissue-based model for the advanced surgical simulation of a Posterior Sagittal Anorectoplasty (PSARP) for rectovestibular fistula in anorectal malformation (ARM). Materials and methodsA chicken cadaver was used to assess the feasibility of simulating a PSARP for rectovestibular fistula in ARM. No modification was required to implement the surgical simulation. ResultsA detailed description of the high-fidelity surgical simulation model is provided. The PSARP can be simulated while providing realistic anatomy (e.g. common wall between rectovestibular fistula and vagina), adequate rectal size, location and placement of the rectovestibular fistula, and proximity to the vagina. Haptic conditions of the tissue resemble human tissue and operative conditions as well. DiscussionConcerning the decreased exposure of index cases of pediatric surgical trainees and pediatric surgeons in practice, simulation-based training can provide means to acquire or maintain the necessary skills to perform complex surgical procedures [1–5]Surgical simulation models for ARM are limited. Few low-cost trainers are available with predominant artificial and mostly unrealistic tissue [6–8] Animal models have the advantage of realistic multilayer tissue haptic feedback [6]. ConclusionWe provide a low-cost, high-fidelity model for correcting a rectovestibular fistula in a child with ARM, a complex operative procedure with low incidence but high-stake outcomes. The described tissue model utilizing the chicken cloaca anatomy provides a high-fidelity model for operative correction of rectovestibular ARM. For simulation purposes in the treatment of ARM, this model appears to be promising in terms of providing realistic pathology and haptic feedback in pediatric dimensions. Level of evidenceV.