Free Fluids Research Articles

Low-frequency rTMS Plays a Neuroprotective role in Pilocarpine-induced Status Epilepticus Rat Models Through the AMPAR GluA1-STIM-Ca2+ Pathway.

Low-frequency repetitive transcranial magnetic stimulation (rTMS) refers to the stimulation of the brain using repetitive magnetic field pulses at a low frequency (≤ 1Hz) to reduce seizures. Currently, the mechanism is not well understood.Male Sprague-Dawley rats underwent pilocarpine-induced status epilepticus (SE) and were then stimulated with low-frequency rTMS. An epilepsy cell model was then established by incubating rat hippocampal neurons with Mg2+-free extracellular fluids. The effects of the low-frequency rTMS on epileptogenesis and hippocampal neuron injury were evaluated using a video electroencephalogram (vEEG) and Nissl staining, and the expression of AMPAR GluA1 and STIM in the hippocampus and hippocampal neurons was assessed using western blot and immunofluorescence. Additionally, the intracellular Ca2+ concentration and reactive oxygen species (ROS) were measured using flow cytometry.Low-frequency rTMS attenuated spontaneous recurrent seizures in rats with epilepsy, with the SE group exhibiting a higher incidence (100%) and frequency (3.00 ± 0.18 times/day) than the SE + 0.3 (50% incidence, 0.06 ± 0.03 times/day), SE + 0.5 (0.20 ± 0.02 times/day) and SE + 1Hz (1.02 ± 0.05 times/day) groups. Additionally, rTMS reduced the damage and apoptosis of hippocampal pyramidal neurons, increasing their numbers in the CA1 and CA3 regions. Furthermore, AMPAR GluA1 and STIM expression were upregulated in the hippocampus when using rTMS, reversing the downregulation caused by seizures. Immunofluorescence verified the increased fluorescence intensity of AMPAR GluA1 and STIM. Moreover, rTMS inhibited Ca2+ overload and ROS in epileptic neuron models.Low-frequency rTMS may exert neuroprotective effects through the AMPAR GluA1-STIM-Ca2+ pathway.

Enhancing permeability estimation methods in Brazilian pre-salt complex carbonate reservoirs

Carbonate pre-salt reservoirs pose formidable challenges for formation evaluation and estimation of petrophysical properties such as rock flow capacity. The high complexity of the pore system and its textural heterogeneity often lead to poor predictions when using conventional formation evaluation methods. This paper discusses and tests the applicability of two approaches to calculate the absolute permeability curves for the carbonate reservoirs of the Barra Velha Formation in the Santos Basin, proposing a fine-tuned workflow for these complex rocks. In developing our workflow, we used data from a case study well, comprising a complete well log suite and two formation tests, and routine core analysis results (RCAL) in core plugs and sidewall cores. Our workflow consists of: (1) reinterpreting the nuclear magnetic resonance (NMR) log in vugular intervals by decomposing the transversal relaxation time spectra; (2) calculating the absolute permeability by the Timur–Coates model and adjusting the coefficients with the RCAL results from representative samples; (3) applying the Flow Zone Indicator (FZI) method for rock typing to optimally define Hydraulic Flow Units (HFU); (4) checking the consistency of HFUs regarding pore geometry and lithological characteristics; (5) evaluating the performance of the models against core data and formation tests. The predicted permeability curves performed well for the NMR and FZI models when compared to the RCAL data from representative samples, with mean absolute errors for the logarithm of permeabilities equal to 0.78 and 0.87, respectively. This represents an improvement of 15% and 5% when compared to the simplistic approach that uses a power law to relate porosity to permeability from RCAL. These curves also reasonably reproduce the results from the formation tests for the top part of the reservoir, where matrix porosity dominates the flow. However, the NMR and FZI permeability curves underestimate the test results at the bottom part of the reservoir, where karstic and fracture features dominate, demonstrating limitations in these permeability estimation methods for this specific scenario. From our observations, we propose several improvements to enhance the current methods for estimating absolute permeability in pre-salt carbonate reservoirs. In the case of the NMR approach, it is essential to consider the effects of mud invasion in vugs for the correct estimation of the proportions of free and irreducible fluids. In the FZI approach, optimization in defining the quantity and limits of hydraulic flow units is important, which shows that four units are sufficient to represent the reservoir interval.

EP291 - Drinking, Eating, Mobilising after elective colorectal surgery- ‘DrEaMing’, a CQUIN project

Abstract Introduction DrEAMing- Early drinking, eating and mobilising after elective surgery, is a simplified and key part of enhanced recovery programmes. It helps decrease post operative complications and length of hospital stay. It also helps reduce the backlog of patients waiting for surgery. Objectives As per commissioning for quality and innovation (CQUIN) 2023/2024 guidelines, our aim was to ensure that at least 80 percent of patients are supported to DrEaM- Drink, Eat, Mobilise, within 24 hours of surgery. Our audit includes only colorectal surgeries. Methods 21 patients underwent elective colorectal surgery from July-September,2023. Patient’s notes, post operative notes and nursing notes were analysed to identify the inadequacies in each of the three limbs of DrEaMing. Results Free fluids were ordered for 21/21 (100%) and administered to 17/21 (81%) patients. Food was ordered for 16/21 (76%) and given to 12/21(57%) patients. Lastly, 16/21 patients had orders for mobilisation and 10/21 (48%) were supported for the same. The results were discussed at clinical governance meeting and interventions were advised for better implementation and compliance to guidelines. Conclusion There is a deficiency in effective implementation of DrEaMing project and this can be improved by better communication between surgeons and nurses. Surgeons should clearly document patients who aren’t suitable for enhanced recovery programme. We also requested changes to the built operative notes about post operative orders so that the instructions are not missed. We intend to adopt these measures and repeat the cycle of this QIP.

Compositional differences of near-critical petroleum from closed pores to wellhead in Gulong shale oil play, Songliao Basin, NE China

The Gulong shale oil play located in northern Songliao Basin is a promising exploration target in China. Member 1 of Qingshankou Formation (Well H) with high thermal maturity was preferred to obtain pressure-retained cores, long-time exposed cores, and produced petroleum (crude oil and gas). The selected samples were subjected to sequential extraction, GC, GC-MS, thermal desorption–gas chromatography (TD-GC) and Fourier transform ion cyclotron resonance mass spectrometry (FT-ICR MS) analysis. The compositional differences of in-situ fluids, residual bitumen trapped in open, confined, and closed pores, as well as wellstream, were systematically investigated. (1) In-situ fluid compositions, with a 30.8% proportion of nC1−5 in n-alkanes, were studied by TD-GC analysis on pressure-retained cores. Interestingly, limited amounts of C8- compounds were detected in long-time exposed bulk cores but were almost absent in exposed powder. Primally poor pore connectivity and partially adsorption or absorption of organic matter contribute to the retention of gaseous hydrocarbons. (2) Sequential extraction is a best method for obtaining compositions of fluid in pores with variable sizes. Aliphatic compounds of residual bitumen trapped in open pores are similar to those in confined pores, while polar compounds are more enriched in confined and closed pores. Originally connected pores in early oil window, has turned into confined or closed pores by compaction and cementation with increasing depth. (3) Wellstream compositions are significantly different from in-situ fluid compositions, especially in shale oil extraction. The proportion of gaseous hydrocarbons in the wellstream (76.2%) is considerably higher than that of in-situ fluids (34.1%). Comparison of aromatic hydrocarbons indicated that the wellstream is sourced from free fluids and partially adsorbed hydrocarbons in open pores. (4) Nitrogen and oxide compounds with a higher degree of condensation (higher DBE value) have poor movability, leading to extremely low content or even absence in crude oil. The compositional differences from in-situ fluids to the wellbore through the stimulated fractures are caused by selective adsorption of pore walls, confinement effect of nanopores and fluid phase changing. This study provides a window to the compositional differences of fluids released from different occurrence spaces and confirms compounds heterogeneity.

Evaluation of Deep Learning Model Architectures for Point-of-Care Ultrasound Diagnostics.

Point-of-care ultrasound imaging is a critical tool for patient triage during trauma for diagnosing injuries and prioritizing limited medical evacuation resources. Specifically, an eFAST exam evaluates if there are free fluids in the chest or abdomen but this is only possible if ultrasound scans can be accurately interpreted, a challenge in the pre-hospital setting. In this effort, we evaluated the use of artificial intelligent eFAST image interpretation models. Widely used deep learning model architectures were evaluated as well as Bayesian models optimized for six different diagnostic models: pneumothorax (i) B- or (ii) M-mode, hemothorax (iii) B- or (iv) M-mode, (v) pelvic or bladder abdominal hemorrhage and (vi) right upper quadrant abdominal hemorrhage. Models were trained using images captured in 27 swine. Using a leave-one-subject-out training approach, the MobileNetV2 and DarkNet53 models surpassed 85% accuracy for each M-mode scan site. The different B-mode models performed worse with accuracies between 68% and 74% except for the pelvic hemorrhage model, which only reached 62% accuracy for all model architectures. These results highlight which eFAST scan sites can be easily automated with image interpretation models, while other scan sites, such as the bladder hemorrhage model, will require more robust model development or data augmentation to improve performance. With these additional improvements, the skill threshold for ultrasound-based triage can be reduced, thus expanding its utility in the pre-hospital setting.

Origin of quartz and its implications for different phase fluids in lacustrine shales from the Qingshankou Formation, southern Songliao Basin, China

Quartz, an important mineral that occurs in lacustrine shales, can be of different types and origins. Yet, only few studies have investigated how quartz from different sources contribute to phase fluids, such as adsorbed and free fluids present within shale matrix pores. This study integrates various experimental techniques, including X-ray diffraction analysis, geochemical analysis, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and high-frequency two-dimensional nuclear magnetic resonance analysis to quantitatively characterize the different phase fluids associated with various types of quartz occurring in the Qingshankou Formation shale. The characterization results indicated four distinct quartz types: silt-sized quartz, microcrystalline quartz linked with clay minerals, organism-skeletal quartz, and quartz aggregates comprising multiple crystals. The Fe–Al–Mn ternary diagram and SiO2 versus Zr scatter plot indicate that terrigenous clastic material is the primary source of SiO2 in shale quartz. Smectite-to-illite transition plays a pivotal role in authigenic quartz formation. Based on quartz concentration data obtained using major element analysis, we estimated the ranges of terrigenous clastic quartz, diagenetic quartz formed by the smectite-to-illite transition, and biogenic quartz concentrations to be from 55.49% to 92.03% (average 84.70%), 6.67%–20.30% (average 13.12%), and 0%–24.21% (average 2.17%), respectively. The solid organic matter in shale is affected by both terrigenous detrital quartz and authigenic quartz transformed from the clay in the basin. Authigenic quartz, formed by the smectite-to-illite transition, considerably enhances the development of solid organic matter in the Qingshankou Formation. By contrast, an abundance of terrigenous detrital quartz can lead to a dilution of the solid organic matter. Thus, this study provides the first direct evidence that along with a high value of bio-organic matter yield factor, the source of quartz plays a significant role in controlling organic matter abundance.

Analysis of the calibration and validation of hydrodynamic simulations with TELEMAC-3D model of the Patos Lagoon

This work presents the analysis of the calibration and validation of the computational model for two configurations of the Jetties of the Rio Grande Barra for hydrodynamic studies of the Patos Lagoon and the continental shelf of southern Brazil. The model used was TELEMAC-3D, which solves the three-dimensional Navier-Stokes equations, considering the hydrostatic hypothesis, to describe the dynamics of free surface geophysical fluids. We developed two finite element triangular meshes, with about 75.000 elements and seven sigma levels. The numerical domain reaches depths up to 2.427 m, with fluvial and oceanic liquid boundaries. The horizontal turbulence model adopted was Smagorinsky and the vertical model of mixing length. Current velocity data obtained from December 2005 were used for calibration, varying the coefficient of wind friction, horizontal and vertical velocity diffusion, and the salinity tracer. The coefficient of wind influence was the factor that most influenced the model results. The calculated Relative Mean Absolute Error was 0.383 dn. for surface and 0.167 dn. for depth, rated good and excellent, respectively. For validation, we evaluated the model performance on reproducing the salinity behavior, related to the depth of the environment, in January 2017. The calculated Root Mean Square Error was 7.37 dn. and the Relative Mean Absolute Error was 0.228 dn., rating the model performance as good. These variances between metrics is uniformly acceptable for real models. Salt transport is a complex phenomenon and depends on both advective and diffusive transport. Thus, it is possible to conclude that he proposed computational model is able to reproduce a complex phenomenon reliably.

The Safety and Efficacy of Early Enteral Nutrition After Paediatric Enterostomy Closure - The EPOC Study

IntroductionKeeping children nil by mouth until return of bowel function after intestinal anastomosis surgery is said to reduce complications. Fasting may extend up to five days, risking malnourishment and usage of parenteral nutrition. This study aims to establish the efficacy and safety of early enteral nutrition in children undergoing intestinal stoma closure. MethodologyA retrospective cohort study of children aged three months to 16 years who underwent an intestinal stoma closure between 1/1/2019 and 31/12/2021 at two tertiary paediatric hospitals was undertaken. Children fed clear fluids within 24 h (EEN) were compared to those commencing feeds later (LEN). The primary outcome was length of post-operative stay (LOS) and secondary outcomes included: time to feeds; time to stool; and complications. ResultsOf the 129 children that underwent a stoma closure, 69 met inclusion criteria: 35 (51 %) in the LEN group and 34 (49 %) in the EEN group. Children in the EEN group had a significantly shorter LOS (92.6 h vs 121.7 h, p = 0.0045). Early feeding was also associated with a significantly decreased time to free fluids (p < 0.001) and full enteral intake (p = 0.007). There was no significant intergroup difference in complications. ConclusionCommencing feeding within 24 h of stoma closure is efficacious and safe, with clear reductions in LOS, time to full feeds and time to stool, and no increase in complications. Further research is required to extrapolate these findings to other populations. Level of evidenceIII.

Ultrasound Diagnosis and Behaviors in Cases with Encapsulated and Unrestricted Liquid Collections into Body Cavities

Purpose: We present our experience in the diagnosis, follow-up and planning therapy of thoracic, abdominal and retroperitoneal liquid collections in different emergency patients using conventional and interventional ultrasound. Material and Methods: The right and left oblique and propositioning view was used in 235 patients/159 male and 76 female/ for US examination to identify fluids in the thorax and peritoneal or retroperitoneal space. The examination was performed after the clinical survey with patient’s supine. Positive findings of US were compared with those provided by CT, punctures under US control or surgery. US machine supplied with linear and convex transducers, CT machine, needles and catheters were used. Results: 197 of all 235 US examined patients had fluid collections, confirmed by CT scan, surgery or clinical course. In 156 patients we performed FN diagnostic punctures under US control. There was 155 true-positives, 25 true-negatives, 5 false-positives and 2 false-negative results. Overall this demonstrated that ultrasonography have sensitivity of 98.72%, specificity of 83.33% and accuracy of 96.25 %. The PPV is 96.87% and the NPV – 92.59%. Conclusions: Our experience and literature reports support the opinion that US examination can and should be used as a primary method for diagnosis and follow-up of clinically suspected free and organized fluids in the thorax, abdomen and retroperitoneum.

Fast permeability estimation using NMR well logging data log-normal decomposition

Nuclear magnetic resonance (NMR) well logging and NMR core analysis provide a non-invasive approach to a fast reservoir rock pore structures evaluation. The NMR data is presented as a time distribution called transverse relaxation time spectrum (T2 spectrum) and, with proper adjustment, the area under the T2 distribution curve is directly related to the porosity of the reservoir rock. Based on the assumption that immovable and free fluid are present in pores of different sizes, NMR well logging and core analysis use these differences to characterize the fluids found inside the rock pores. In this way, a fixed T2 value can be selected as a cutoff. The amplitudes of the T2 spectrum that have their T2 coordinates below this fixed value are related to the fluids that are in the small pores (immovable fluids), and those that have their T2 coordinates above this value are related to the large pores (free or movable fluids). This T2 value is called T2cutoff and can be estimated in a laboratory with NMR data acquisition on water-saturated core samples. This is done by comparing the NMR acquisition data from a plug fully saturated with water with the NMR acquisition data taken from the same partially saturated plug. In this work, a new method to estimate the pore size distribution, a variable T2cutoff curve, and the Timur–Coates permeability curve of the formation along the reservoir rock is presented. The method is based on the decomposition in log-normal components of the T2 spectra of NMR well logging and on the permeability and porosity of plugs, measured in a laboratory.

Comparison of short-stretch bandage and long-stretch bandage for post-traumatic hand edema

Introduction and importanceHand edema is a common post-surgical or traumatic complication in orthopedic patients, necessitating effective treatment interventions. This study aimed to investigate the effects of two different types of bandages, along with finger flexion exercises, on managing hand edema. Case presentationOur orthopedic patients with post-surgical or traumatic hand edema and three non-edematous hands were enrolled in the study. A mixed model effect with fixed factors of time (pre-post) and bandage type (M, C, N), and random factors of hand, edema, fingers, and phalanges was applied. The bandage types were circular with short elastic bandage (M) and circular with elastic bandage (C). Finger flexion exercises involved alternating contractions of extrinsic and intrinsic flexors. Randomization ensured unbiased allocation to bandage types. Clinical discussionThe M bandage demonstrated a significant reduction in hand edema by effectively moving free fluids, reinforcing tissue hydrostatic pressure, and facilitating venous and lymphatic flow. On the other hand, the C bandage did not produce significant pre-post differences in hand circumference. ConclusionsThe combination of a circular bandage with finger flexion exercises shows promise in reducing hand edema in orthopedic patients. Particularly, the stiff bandage M exhibited superior efficacy compared to the elastic one C in reducing hand circumference. These findings provide valuable insights for clinical practice, offering an effective strategy for managing hand edema and promoting better patient outcomes.

Does a Shallow Magma Reservoir Exist in the Wudalianchi Volcanic Field? Constraints From Magnetotelluric Imaging

AbstractWe obtain new images of the 3D resistivity structure of the Wudalianchi volcanic field (WVF). No low‐resistivity structure is found beneath Laoheishan and Huoshaoshan volcanoes in the WVF, which challenges the hypothesis of one or more magma reservoirs in the upper crust of this region. We observe a low‐resistivity body beneath Weishan volcano; however, estimated magma emplacement rates conflict with the observed volume of that body. Due to the relatively low geothermal gradient and surface heat flow in the area, magma would cool rapidly and could not be sustained for a long time unless new magma was regularly introduced into the system, but our observations do not support this scenario. We suggest that the magma in the WVF mainly originates from the mantle or the base of the crust with little crustal residence, and that the low‐resistivity body in the upper crust is likely due to saline aqueous free fluids.

Temperature-dependent surface tension model in many-body dissipative particle dynamics with energy conservation

As a hybrid method, many-body dissipative particle dynamics with energy conservation (MDPDe), promises to simulate heat transport process with free surface fluids. However, the temperature-dependent surface tension cannot be modelled accurately in MDPDe so far, which greatly limits its further applications. In the present study, semi-empirical relationships between the attractive coefficient and temperature obtained by mapping with real liquids (i.e., water, ethylene glycol and benzaldehyde) are introduced into MDPDe. The simulation results are validated by comparing with the relevant experimental, theoretical and numerical results, respectively. The improved MDPDe model in the present work opens the door to study various thermocapillary phenomena with free surface fluids at mesoscopic scale.

Infectious Salpingitis in an Ornamental Frizzle Hen: A Case Report, Diagnosis and Treatment

Salpingitis is a common inflammatory complication in ornamental chickens that occurs due to infectious and non-infectious agents. This disease can cause symptoms such as depression, halted egg laying, swelling of the abdominal area, and breathing difficulities. This report investigates a 3-year-old Frizzle hen presenting with severe anorexia, halted egg laying, decreased activity, depression, and difficulty breathing. Ultrasound examinations and hematology tests were conducted for further differential diagnosis, confirming an inflammatory lesion in the oviduct. The tests were additionally utilized to assess the effectiveness of antibiotic therapy as a treatment measure. This report details the diagnosis, treatment, and evaluation of its effectiveness in a domestic ornamental chicken exhibiting clinical signs indicative of possible lesions in the reproductive system or the presence of free fluids in the coelomic cavity. Following initial examinations, ultrasonography, and hematology tests, salpingitis was confirmed with active involvement of an infectious agent, and the likelihood of ascites due to liver issues was ruled out.. Due to the bird owner's preference against surgical intervention, a broad-spectrum antibiotic treatment utilizing gentamicin and lincospectin was selected. The clinical condition of the bird improved significantly after five days of treatment, and the ultrasonography and hematology tests were repeated, which showed the progression of the lesion from an active infection to a chronic caseous infection. This report emphasizes the importance of using paraclinical tests in diagnosing genital disorders, especially salpingitis, and evaluating the effectiveness of the treatment strategy.

Preparation, characterization and application of environment-friendly high density and low damage solid free completion fluids for completing HTHP oil and gas wells

During this study, in order to ensure the safety and efficiency of well-killing operations in the process of oil and gas development, based on the requirements of high density, low corrosion, suitable pH and density properties, solid free characteristic, low damage and biological toxicity, the high density and low damage solid free completion fluids with the density of 1.80, 1.70 and 1.60 g/cm3 were prepared. Then, the general performances, such as solid free characteristics, biological toxicity, pH and density stability of completion fluids were studied. Moreover, the thermal stability, rheological, lubrication and inhibition performances of completion fluids were investigated through qualitative and quantitative analysis. Simultaneously, the corrosion performances and mechanism of completion fluids with different density on P110 and P110S at 50–180 °C were studied by scanning electron microscope and X-ray diffraction analysis. Besides, the compatibility of completion fluids and Ca2+, Mg2+ and water-based drilling fluids was investigated. Finally, the reservoir protection performances of completion fluids were further studied by multifunctional core displacement experimental device depends on permeability recovery rate. The results indicate that the developed completion fluids with different density meet expected design and could use for well-killing operations of HTHP oil and gas wells.

An Analytical Model for Water Inflow into a Karst Tunnel in Vuggy and Fractured Porous Rock Aquifers

Vugs and fractures are the main channels within porous rock aquifers and play a dominant role in the water inrush of the karst tunnel. In this paper, a mathematical model of the coupled free-fluid seepage-fluid with second-order accuracy was established to analyze the flow field characteristics of vuggy and fractured porous rock aquifers. The Navier–Stokes equation was used to govern the free fluid flow in vugs and fractures, while the Darcy–Brinkman equation was employed to describe the seepage fluid motion in the porous rock matrix. The analytical solutions for the flow velocity and water discharge were derived under the requirement of continuous velocity and shear stress at the interface between free and seepage fluids. These solutions can be successfully reduced to those of the classical Poiseuille’s law, assuming that the rock matrix is impervious to water. The numerical, experimental, and analytical results were compared to validate the present analytical model, and the results of the analytical model showed greater accuracy compared with the classical Poiseuille’s law and cubic law. Furthermore, the water inrush of the Xiangpingshan karst tunnel was selected as a real engineering case. Perforated bricks were used to stack a vuggy and fractured porous physical tunnel model (1:100) with the same hydraulic conductivity as the Xiangpingshan tunnel. The relative errors between current theoretical and physical tests obtained for the water inflow discharges are within 18%. The current model can provide a reference for predicting the water inflow of karst tunnels in vuggy and fractured porous rock aquifers.

Pain-free DrEaMing – the impact of a 7-day inpatient pain team on colorectal recovery in a postoperative care unit

Background: An ageing colorectal surgical population has resulted in an increasing emphasis on the minimisation of postoperative complications. The advent of enhanced recovery programmes1 coupled with postoperative or post-anaesthetic care units, support the delivery of multi-modal analgesia whilst prioritising mobilisation and oral intake in the postoperative period. Integral to this perioperative pathway is a dedicated inpatient pain team as safe and effective analgesia is vital to facilitate mobilisation and oral intake. Adapting enhanced recovery strategies enabled us to focus on encouraging drinking, eating, and mobilisation (DrEaM). Methods: Patients for colorectal surgery were screened for suitability for the enhanced recovery programme at the time of booking, with data shared between colorectal secretaries and the inpatient pain team when patients were identified. All eligible elective colorectal surgery patients were seen regularly by the inpatient pain team for up to 5 days postoperatively (including weekends) either on the postoperative care unit or subsequent surgical ward. Data were collected prospectively via an electronic pain team database over a 42-week period between June 2020 and May 2021. Results: There were 136 colorectal surgical patients enrolled onto the enhanced recovery programme in the 42-week period: 55% were female with 86% undergoing laparoscopic surgery. There were no patients who reported severe pain at rest throughout the postoperative period. The facilitation of good pain management ensured that all patients were drinking free fluids and 60% were eating by the first postoperative day. The analgesia regimen facilitated early mobilisation of 18.5% of patients on the day of surgery and 85.9% by the first postoperative day (Fig. 4). Conclusions: Postoperative pain remains a major factor in limiting mobilisation for the colorectal surgery patient population. The formation of enhanced recovery pathways with an integrated inpatient pain team facilitated an optimisation of analgesia, which then encourages early mobilisation and nutrition resulting in a decreased length of stay. 1.Gustafsson UO, Scott MJ, Hubner M, et al. World J Surg 2019; 43: 659

EP-66 Omental infarct – A rare cause of Right iliac fossa pain in a child

Abstract Introduction Idiopathic omental infarction is a very rare cause of abdominal pain in the pediatric age group. We report a case of suspected acute appendicitis in an 8-year-old child, noted to have omental infarct on diagnostic laparoscopy. Case presentation An 8-year-old male child with no other medical issues presented to the acute surgical take with a 2-day history of right iliac fossa pain. The pain was of sudden onset and there were no other associated urinary or bowel symptoms. On clinical examination, there was right iliac fossa tenderness. There were mildly raised inflammatory markers. An ultrasound scan performed showed a possible blind-ending tubular structure measuring 7mm in the right iliac fossa with a small amount of free fluids. A presumptive diagnosis of acute appendicitis was made and the patient was taken to theatre. Upon diagnostic laparoscopy, we noted blood in the RIF with a normal-looking appendix and area of omental infarction adjacent to the appendix. We proceeded to excise the area of mesenteric infarction using an energy device. The appendix was removed to avoid future diagnostic confusion. Conclusion Idiopathic omental infarction is an extremely rare cause of abdominal pain in children and may mimic acute appendicitis. Ultrasound imaging may be misleading. Laparoscopic exploration allows for accurate diagnosis as well as treatment.

Factors determining postoperative length of stay and time to resumption of feeding following free flap reconstruction for oral cancer

Microvascular free tissue transfer reconstruction following resection of oral cancer is commonly chosen as the first line of treatment due to its superior functional outcomes. Multiple patient and surgical factors impact the length of postoperative stay, and the time taken for patients to recommence oral feeding. This study aimed to identify factors that increase the length of stay and time to resumption of feeding. We retrospectively evaluated 100 cases from March 2015 to October 2020, and identified variables associated with increased length of stay (LOS) and time to resumption of feeding in univariate and multivariate analyses. Factors found to be associated with increased LOS in multivariate analysis were increasing age, elective tracheostomy, tumours originating from the floor of the mouth and mandible, a longer operating time, and use of fibular free flaps (p<0.05). Tracheostomy, increasing age, and female gender were strongly associated with delays in resumption of some types of oral feeding, and an integrated critical care unit (ICCU) stay of two or more days was associated with a longer time to resumption of free fluids. This information can be used to anticipate extensions to typical LOS, to produce cost analyses, develop individual patient risk stratification, manage patient expectations, and target the use of enhanced recovery programmes.

Experiment regarding magnetic fields with gravity

This experiment was designed to test the string theory as a physical reality. The ground-based device placed the N poles of the magnets upwards, north, south, east, and west. Coil Ass'Y was placed between 2 N poles with bearing covers on the top and bottom. Gravity interacts to generate electricity in the Earth's direction or the opposite direction by the repulsive magnetic force. The voltage was measured from 3.60 to 3.80 sequentially while the generator was stationary through the monitor. The author found symmetry in Lex Tertia voltage and current zero data during experiment F4 6380 at a balanced state under gravity with the repulsive magnetic force. It generated from 42.8 to 794 μV in the vacuum chamber but from negative 16.1 to positive 18.3 μV in the air. As a result, the author measured more negative current and positive voltage generated in a vacuum. Trapped gravity was set to behave as free relativistic quantum particles or fluids in the magnetic sea. The result made it accessible to study the magnetic sea for different initial superpositions of positive- and negative-gravity spinor states. This might explain the relativistic quantum gravity exists as a physical reality, graviton interacting with photons to induce a magnetic field.