Securing the mucocutaneous anastomosis in the repair of low-anorectal anomalies

Purpose The aim of this study was to identify the incidence of wound complications after a limited sagittal anorectoplasty for the repair of rectoperineal fistula.Patients and methods Between January 2011 and December 2014, patients with rectoperineal fistula treated primarily by a limited sagittal anorectoplasty were  included. The patients in the study were divided into two groups according to the extent of rectal dissection and mobilization during the operation.Results Thirty-six consecutive patients with rectoperineal fistula were included (28 girls and eight boys). Their mean age was 10 months (range 3–42 months). The overall incidence of postoperative wound dehiscence was 22.2% (eight patients). In the first group (limited rectal mobilization), there was a high incidence of wound complications (6/15 patients). Five patients were considered to have a major  dehiscence and four required a rescue colostomy. In the second group (extended rectal mobilization, 21 patients), two had minor dehiscence that were managed conservatively. The overall incidence of wound complications was significantly lower in the second group (Mann–Whitney test, P =0.04).Conclusion Among the patients with rectoperineal fistula, extension of the dissection and mobilization of the rectum from the anterior structures (vagina in girls, andbulpospongiosum in boys) decreases wound dehiscence following a limited sagittal anorectoplasty procedure.Keywords: anterior ectopic anus, imperforate anus, low-anorectal anomalies, rectoperineal fistula, sagittal anorectoplast

Offshore wind power integration to support weak grid voltage for industrial loads using VSC-HVDC transmission system

This paper investigates the integration of the offshore wind power plant into the grid using voltage source converter high-voltage direct current (VSC-HVDC). The paper proposes both offshore and onshore converter stations control to support voltage variation in grid. Heavy industrial loads result in a weak grid. In this paper, the effect on industrial loads by the grid strength is shown. Then the paper proposes a solution for the grid voltage support for industrial loads connected to weak grids. The results showed that the increase of grid voltage from 0.7 pu to 1 pu at full load condition that provides a continuous operation without any interruption. The system was modelled using MATLAB/Simulink package

The type II phase resetting curve is optimal for stochastic synchrony

The phase-resetting curve (PRC) describes the response of a neural oscillator to small perturbations in membrane potential. Its usefulness for predicting the dynamics of weakly coupled deterministic networks has been well characterized. However, the inputs to real neurons may often be more accurately described as barrages of synaptic noise. Effective connectivity between cells may thus arise in the form of correlations between the noisy input streams. We use constrained optimization and perturbation methods to prove that PRC shape determines susceptibility to synchrony among otherwise uncoupled noise-driven neural oscillators. PRCs can be placed into two general categories: Type I PRCs are non-negative while Type II PRCs have a large negative region. Here we show that oscillators with Type II PRCs receiving common noisy input sychronize more readily than those with Type I PRCs.Comment: 10 pages, 4 figures, submitted to Physical Review

The potential for measuring ethnicity and health in a multicultural milieu - the case of type 2 diabetes in Australia

ObjectiveEthnicity influences health in many ways. For example, type 2&nbsp;diabetes (T2DM) is disproportionately prevalent among certain ethnic groups.&nbsp;Assessing ethnicity is difficult, and numerous proxy measures are used to&nbsp;capture its various components. Australian guidelines specify a set of&nbsp;variables for measuring ethnicity, and how such parameters should be&nbsp;categorised. Using T2DM data collections as an illustrative example, this&nbsp;study sought to examine how ethnicity is measured in Australian health&nbsp;databases and, by comparing current practice with Australia&rsquo;s existing&nbsp;benchmark recommendations, to identify potential areas for improvement of&nbsp;the health data landscape.DesignWe identified databases containing information from which ethnic&nbsp;group-specific estimates of T2DM burden may be gleaned. For each&nbsp;database, details regarding ethnicity variables were extracted, and compared&nbsp;with the Australian guidelines.&nbsp;ResultsData collection instruments for 32 relevant databases were reviewed.&nbsp;Birthplace was recorded in 27 databases (84%), but mode of birthplace&nbsp;assessment varied. Indigenous status was commonly recorded (78%, n=25), but&nbsp;only nine databases recorded other aspects of self-perceived race/ethnicity. Of&nbsp;28 survey/audit databases, 14 accommodated linguistic preferences other than&nbsp;English, and 11 either excluded non-English speakers or those for whom a&nbsp;translator was not available, or only offered questionnaires in English.ConclusionsConsiderable variation exists in the measurement of ethnicity in&nbsp;Australian health data- sets. While various markers of ethnicity provide&nbsp;complementary information about the ethnic profile within a data-set, nonuniform&nbsp;measurement renders comparison between data-sets difficult. A&nbsp;standardised approach is necessary, and identifying the ethnicity variables&nbsp;that are particularly relevant to the health sector is warranted. Including self identified&nbsp;ethnicity in Australia&rsquo;s set of recommended indicators and as a core&nbsp;component of the national census should be considered. Globalisation and&nbsp;increasing migration mean that these findings have implications internationally,&nbsp;including for multi-ethnic countries throughout North America and&nbsp;Europe.</div

Suboptimal correction of low anorectal anomalies: a possible cause for intractable constipation in children

Background Constipation is a common problem among patients following the repair of low anorectal anomalies. We present our experience in managing constipation in a group of these patients with reoperation to correct residual anterior anal misplacement.Patients and methods The study included pediatric patients presenting with significant constipation following the repair of low anorectal anomalies. Patients with evidence of residual anterior anal misplacement (either clinically, by means of MRI, or using electrical muscle stimulation) were offered a reoperation to bring their ani backward to an orthotropic position.Results Thirteen patients were included in the study between September 2009 and June 2015. Their ages ranged from 1.5 to 10 years. The primary anomaly was rectoperineal fistula in 10 (seven boys and three girls) and rectovestibular in three girls. Two types of reoperations were performed: a posterior anoplasty with posterior sphincterotomy (five cases), and a limited sagittal anorectoplasty (eight cases). Straining at defecation was relieved in all patients. Of the 13 patients, nine were relieved from their constipation (69%) and had regular bowel movements without medications. The remaining four (31%) showed partial improvement.Conclusion Among patients with low anorectal anomalies, suboptimal correction with residual anterior anal misplacement represents one correctable cause for persistence of constipation

A population-based observational study of diabetes during pregnancy in Victoria, Australia, 1999-2008

Objectives: This paper reports secular trends in diabetes in pregnancy in Victoria, Australia and examines the effect of including or excluding women with pre-existing diabetes on gestational diabetes (GDM) prevalence estimates

PAX6 aniridia and interhemispheric brain anomalies

Purpose: To report the clinical and genetic study of patients with autosomal dominant aniridia