Laparoscopic appendectomy in the pediatric age group: comparative study between LigaSure and monopolar diathermy

Background Various techniques such as endoloops, endoscopic linear cutting staplers, electrothermal vesselsealing system (LigaSure), Harmonic scalpel, clips, and bipolar coagulation have been used for the division of the mesoappendix during laparoscopic appendectomy. This study was conducted to evaluate the potential benefits and limitation of LigaSure and electrocautery in laparoscopic appendectomy (LA).Patients and methods Forty patients with clinical diagnosis of acute appendicitis admitted to the Pediatric Surgery Unit at the Alexandria University Children’s Hospital between September 2008 and September 2010 were included in this study. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and monopolar diathermy (MD) groups. The primary outcome measures (operating time, conversion rate, length of hospital stay, bleeding during dissection, port site infection, and readmissions) were compared.Results LA was performed in 40 patients with acute appendicitis. Twenty cases were in the LigaSure group and 20 cases were in the MD group. The mean operative times were 33.05 min and 43.80 min in the LigaSure and MD groups, respectively. Bleeding during appendicular dissection as roughly estimated by the mean number of needed irrigations were 1.60 and 1.95 for the LigaSure and MD groups, respectively. No statistically significant differences regarding hospital stay, rate of infection, readmissions, or conversion to open appendectomy were found, whereas significant differences were observed in operative time and bleeding.Conclusion The use of LigaSure for dissection of the mesoappendix shortens the operative time, and significantly decreases bleeding during LA. We believe that LigaSure is a safe and useful tool for mesoappendix dissection during LAKeywords: children, laparoscopic appendectomy, LigaSure, monopolar diatherm

Visceral fat mass as a novel risk factor for predicting gestational diabetes in obese pregnant women

Objective To develop a model to predict gestational diabetes mellitus incorporating classical and a novel risk factor, visceral fat mass. Methods Three hundred two obese non-diabetic pregnant women underwent body composition analysis at booking by bioimpedance analysis. Of this cohort, 72 (24%) developed gestational diabetes mellitus. Principal component analysis was initially performed to identify possible clustering of the gestational diabetes mellitus and non-GDM groups. A machine learning algorithm was then applied to develop a GDM predictive model utilising random forest and decision tree modelling. Results The predictive model was trained on 227 samples and validated using an independent testing subset of 75 samples where the model achieved a validation prediction accuracy of 77.53%. According to the decision tree developed, visceral fat mass emerged as the most important variable in determining the risk of gestational diabetes mellitus. Conclusions We present a model incorporating visceral fat mass, which is a novel risk factor in predicting gestational diabetes mellitus in obese pregnant wome

Optimization of EDM process parameters for Al-SiC reinforced metal matrix composite

Volume 8 Issue 2 (February 201

Numerical and experimental investigations on efficient design and performance of hydrokinetic Banki cross flow turbine for rural areas

Micro hydrokinetic energy scheme presents an attractive, environmentally-friendly and efficient electric generation in rural, remote and hilly areas. However, this scheme is yet to be fully discovered, as researchers are still searching for solutions for the main problems of low velocity of current in the open flow channels and low efficiency of hydrokinetic turbines. This research proposes a novel system configuration to capture as much kinetic energy as possible from stream water current. This system, known as bidirectional diffuser augmented (BDA) channel, functions by utilizing dual directed nozzles in the flow and is surrounded by dual cross flow/Banki turbines. It is also important to obtain the efficient design parameters of the turbines to use in the current configuration. The appropriate angle is important in order to guide the flow to touch the blades more perpendicularly to capture as much torque and power as possible. Hence, experimental and numerical investigations have been carried out in this research paper to study the performance characteristics of the CFT configuration applied in BDA system and investigate the effects of blades’ inlet and outlet angles of CFT runners on the internal flow characteristics and efficiency. In this study, four different runners with various inlet and outlet angles of two CFT have been investigated. The CFD results have been validated with the experimental work and proven acceptable with flow pattern and performance characteristics. The results of the current study conclude that the maximum power coefficients (Cp) of 0.612 and 0.473 for lower and upper turbines are recorded for best runner angles of Case 3

Metformin versus placebo in obese pregnant women without diabetes mellitus

Background: Obesity is associated with increased risk of adverse pregnancy outcomes. Lifestyle intervention studies have not improved outcome. Metformin improves insulin sensitivity and leads to less weight gain. Methods: Our double-blind placebo-controlled trial randomized non-diabetic pregnant women with a body mass index >35 kg/m2 to metformin or placebo from 12-18 weeks’ gestation until delivery. Primary outcome was median neonatal birth weight z-score reduction by 0.3 standard deviations (equivalent to a 50% reduction in incidence of large-for-gestational-age neonates from 20% to 10%). Secondary outcomes included maternal gestational weight gain and incidence of gestational diabetes, and preeclampsia, as well as adverse neonatal outcomes. Women were randomized, by computer generated random numbers, to either daily metformin 3.0 grams (n=225) or to placebo (n=225). Analysis was by intention to treat. Results: Fifty women withdrew consent, leaving 202 in the metformin group and 198 in the placebo group. There was no significant difference in median neonatal birth weight z-score (metformin: 0.05, IQR -0.71 to 0.92; placebo: 0.17, IQR -0.62 to 0.89; p=0.655). In the metformin group, compared to placebo, median maternal gestational weight gain was lower (4.6 kg, IQR 1.3-7.2 vs. 6.3 kg, IQR 2.9-9.2, p<0.0001) and incidence of preeclampsia was lower (3.0% vs 11.3%; odds ratio 0.24, 95% CI 0.10-0.61; p=0.001), incidence of side effects was higher; there were no significant differences in gestational diabetes, large for gestational age neonates and adverse neonatal outcomes. Conclusions: In non-diabetic women with BMI >35 kg/m2, antenatal administration of metformin reduces maternal weight gain but not neonatal birth weight. (ClinicalTrials.gov number, NCT01273584

Enhancing radial distribution system performance by optimal placement of DSTATCOM

In this paper, A novel modified optimization method was used to find the optimal location and size for placing distribution Static Compensator in the radial distribution test feeder in order to improve its performance by minimizing the total power losses of the test feeder, enhancing the voltage profile and reducing the costs. The modified grey wolf optimization algorithm is used for the first time to solve this kind of optimization problem. An objective function was developed to study the radial distribution system included total power loss of the system and costs due to power loss in system. The proposed method is applied to two different test distribution feeders (33 bus and 69 bus test systems) using different Dstatcom sizes and the acquired results were analyzed and compared to other recent optimization methods applied to the same test feeders to ensure the effectiveness of the used method and its superiority over other recent optimization mehods. The major findings from obtained results that the applied technique found the most minimized total power loss in system ,the best improved voltage profile and most reduction in costs due power loss compared to other methods