A task and performance analysis of endoscopic submucosal dissection (ESD) surgery

BACKGROUND: ESD is an endoscopic technique for en bloc resection of gastrointestinal lesions. ESD is a widely-used in Japan and throughout Asia, but not as prevalent in Europe or the US. The procedure is technically challenging and has higher adverse events (bleeding, perforation) compared to endoscopic mucosal resection. Inadequate training platforms and lack of established training curricula have restricted its wide acceptance in the US. Thus, we aim to develop a Virtual Endoluminal Surgery Simulator (VESS) for objective ESD training and assessment. In this work, we performed task and performance analysis of ESD surgeries. METHODS: We performed a detailed colorectal ESD task analysis and identified the critical ESD steps for lesion identification, marking, injection, circumferential cutting, dissection, intraprocedural complication management, and post-procedure examination. We constructed a hierarchical task tree that elaborates the order of tasks in these steps. Furthermore, we developed quantitative ESD performance metrics. We measured task times and scores of 16 ESD surgeries performed by four different endoscopic surgeons. RESULTS: The average time of the marking, injection, and circumferential cutting phases are 203.4 (σ: 205.46), 83.5 (σ: 49.92), 908.4 s. (σ: 584.53), respectively. Cutting the submucosal layer takes most of the time of overall ESD procedure time with an average of 1394.7 s (σ: 908.43). We also performed correlation analysis (Pearson's test) among the performance scores of the tasks. There is a moderate positive correlation (R = 0.528, p = 0.0355) between marking scores and total scores, a strong positive correlation (R = 0.7879, p = 0.0003) between circumferential cutting and submucosal dissection and total scores. Similarly, we noted a strong positive correlation (R = 0.7095, p = 0.0021) between circumferential cutting and submucosal dissection and marking scores. CONCLUSIONS: We elaborated ESD tasks and developed quantitative performance metrics used in analysis of actual surgery performance. These ESD metrics will be used in future validation studies of our VESS simulator

Pluronic polymer capped biocompatible mesoporous silica nanocarriers

A facile self-assembly method is described to prepare PEGylated silica nanocarriers using hydrophobic mesoporous silica nanoparticles and a pluronic F127 polymer. Pluronic capped nanocarriers revealed excellent dispersibility in biological media with cyto- and blood compatibilities. © 2013 The Royal Society of Chemistry

Finite-size scaling for non-linear rheology of fluids confined in a small space

We perform molecular dynamics simulations in order to examine the rheological transition of fluids confined in a small space. By performing finite-size scaling analysis, we demonstrate that this rheological transition results from the competition between the system size and the length scale of cooperative particle motion.Comment: 4pages, 8 figure

Hysteresis phenomena during melting of an ultrathin lubricant film

The influence of a deformational defect of the shear modulus on the melting of an ultrathin lubricant film was investigated in the framework of the Lorenz model used for describing a viscoelastic medium. It was established that the film can undergo both stepwise and continuous melting. Analysis of the lubricant behavior revealed that there are three modes corresponding to a zero shear stress, a Hookean portion in the loading diagram, and a plastic-flow portion. The hysteresis in the dependences of the stationary shear stress on the strain and the friction surface temperature is examined. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/1621

Modeling relaxation and jamming in granular media

We introduce a stochastic microscopic model to investigate the jamming and reorganization of grains induced by an object moving through a granular medium. The model reproduces the experimentally observed periodic sawtooth fluctuations in the jamming force and predicts the period and the power spectrum in terms of the controllable physical parameters. It also predicts that the avalanche sizes, defined as the number of displaced grains during a single advance of the object, follow a power-law, $P(s)\sim s^{-\tau}$, where the exponent is independent of the physical parameters

Time-Resolved Studies of Stick-Slip Friction in Sheared Granular Layers

Sensitive and fast force measurements are performed on sheared granular layers undergoing stick-slip motion, along with simultaneous imaging. A full study has been done for spherical particles with a +-20% size distribution. Stick-slip motion due to repetitive fluidization of the layer occurs for low driving velocities. Between major slip events, slight creep occurs that is variable from one event to the next. The effects of changing the stiffness k and velocity V of the driving system are studied in detail. The stick-slip motion is almost periodic for spherical particles over a wide range of parameters, but becomes irregular when k is large and V is relatively small. At larger V, the motion becomes smoother and is affected by the inertia of the upper plate bounding the layer. Measurements of the period T and amplitude A of the relative motion are presented as a function of V. At a critical value Vc, a transition to continuous sliding motion occurs that is discontinuous for k not too large. The time dependence of the instantaneous velocity of the upper plate and the frictional force produced by the granular layer are determined within individual slipping events. The force is a multi-valued function of the instantaneous velocity, with pronounced hysteresis and a sudden drop prior to resticking. Measurements of vertical displacement reveal a small dilation of the material (about one tenth of the mean particle size in a layer 20 particles deep) associated with each slip event. Finally, optical imaging reveals that localized microscopic rearrangements precede (and follow) each slip event. The behavior of smooth particles is contrasted with that of rough particles.Comment: 20, pages, 17 figures, to appear in Phys. Rev.

Thin-Film Metamaterials called Sculptured Thin Films

Morphology and performance are conjointed attributes of metamaterials, of which sculptured thin films (STFs) are examples. STFs are assemblies of nanowires that can be fabricated from many different materials, typically via physical vapor deposition onto rotating substrates. The curvilinear--nanowire morphology of STFs is determined by the substrate motions during fabrication. The optical properties, especially, can be tailored by varying the morphology of STFs. In many cases prototype devices have been fabricated for various optical, thermal, chemical, and biological applications.Comment: to be published in Proc. ICTP School on Metamaterials (Augsut 2009, Sibiu, Romania

Turner syndrome and associated problems in turkish children: A multicenter study

Objective: Turner syndrome (TS) is a chromosomal disorder caused by complete or partial X chromosome monosomy that manifests various clinical features depending on the karyotype and on the genetic background of affected girls. This study aimed to systematically investigate the key clinical features of TS in relationship to karyotype in a large pediatric Turkish patient population. Methods: Our retrospective study included 842 karyotype-proven TS patients aged 0-18 years who were evaluated in 35 different centers in Turkey in the years 2013-2014. Results: The most common karyotype was 45,X (50.7%), followed by 45,X/46,XX (10.8%), 46,X,i(Xq) (10.1%) and 45,X/46,X,i(Xq) (9.5%). Mean age at diagnosis was 10.2±4.4 years. The most common presenting complaints were short stature and delayed puberty. Among patients diagnosed before age one year, the ratio of karyotype 45,X was significantly higher than that of other karyotype groups. Cardiac defects (bicuspid aortic valve, coarctation of the aorta and aortic stenosi) were the most common congenital anomalies, occurring in 25% of the TS cases. This was followed by urinary system anomalies (horseshoe kidney, double collector duct system and renal rotation) detected in 16.3%. Hashimoto’s thyroiditis was found in 11.1% of patients, gastrointestinal abnormalities in 8.9%, ear nose and throat problems in 22.6%, dermatologic problems in 21.8% and osteoporosis in 15.3%. Learning difficulties and/or psychosocial problems were encountered in 39.1%. Insulin resistance and impaired fasting glucose were detected in 3.4% and 2.2%, respectively. Dyslipidemia prevalence was 11.4%. Conclusion: This comprehensive study systematically evaluated the largest group of karyotype-proven TS girls to date. The karyotype distribution, congenital anomaly and comorbidity profile closely parallel that from other countries and support the need for close medical surveillance of these complex patients throughout their lifespan. © Journal of Clinical Research in Pediatric Endocrinology

Understanding adhesion at as-deposited interfaces from ab initio thermodynamics of deposition growth: thin-film alumina on titanium carbide

We investigate the chemical composition and adhesion of chemical vapour deposited thin-film alumina on TiC using and extending a recently proposed nonequilibrium method of ab initio thermodynamics of deposition growth (AIT-DG) [Rohrer J and Hyldgaard P 2010 Phys. Rev. B 82 045415]. A previous study of this system [Rohrer J, Ruberto C and Hyldgaard P 2010 J. Phys.: Condens. Matter 22 015004] found that use of equilibrium thermodynamics leads to predictions of a non-binding TiC/alumina interface, despite the industrial use as a wear-resistant coating. This discrepancy between equilibrium theory and experiment is resolved by the AIT-DG method which predicts interfaces with strong adhesion. The AIT-DG method combines density functional theory calculations, rate-equation modelling of the pressure evolution of the deposition environment and thermochemical data. The AIT-DG method was previously used to predict prevalent terminations of growing or as-deposited surfaces of binary materials. Here we extent the method to predict surface and interface compositions of growing or as-deposited thin films on a substrate and find that inclusion of the nonequilibrium deposition environment has important implications for the nature of buried interfaces.Comment: 8 pages, 6 figures, submitted to J. Phys.: Condens. Matte

Mach's Principle and the Origin of Inertia

The current status of Mach's principle is discussed within the context of general relativity. The inertial properties of a particle are determined by its mass and spin, since these characterize the irreducible unitary representations of the inhomogeneous Lorentz group. The origin of the inertia of mass and intrinsic spin are discussed and the inertia of intrinsic spin is studied via the coupling of intrinsic spin with rotation. The implications of spin-rotation coupling and the possibility of history dependence and nonlocality in relativistic physics are briefly mentioned.Comment: 14 pages. Dedicated to Carl Brans in honor of his 80th birthday. To appear in the Brans Festschrift; v2: typo corrected, published in: At the Frontier of Spacetime, edited by T. Asselmeyer-Maluga (Springer, 2016), Chapter 10, pp. 177-18