A Deformation Prediction Model of High Arch Dams in the Initial Operation Period Based on PSR-SVM-IGWO

The deformation prediction of the dam in the initial stage of operation is very important for the safety of high dams. A hybrid model integrating chaos theory, support vector machine (SVM), and an improved Grey Wolf Optimization (IGWO) algorithm is developed for deformation prediction of dam in the initial operation period. Firstly, the chaotic characteristics of the dam deformation time series will be identified, mainly using the Lyapunov exponent method, the correlation dimension method, and the Kolmogorov entropy method. Secondly, the SVM-IGWO model based on phase space reconstruction (PSR) is established for deformation forecasting of the dam in the initial operation period. Taking SVM as the core, the deformation time series is reconstructed in phase space to determine the input variables of SVM and the GWO algorithm is improved to realize the optimization of SVM parameters. Finally, take the actual monitoring displacement of Xiluodu super-high arch dam as an example. The engineering application example shows that, compared with the existing models, the prediction accuracy of the PSR-SVM-IGWO model established in this paper is improved.

Renoduodenal Fistula Following Penetrating Abdominal Injury

Renoduodenal fistula is an uncommon occurrence and usually results as a complication of injury or inflammatory process. Here, we describe a case of renoduodenal fistula formation after traumatic injury via gunshot wound to the abdomen. The patient suffered right renal and ureteral injury, complicated by urine leak, managed by surgery, interventional radiology, and urology. His post-hospital course was complicated by recurrent urinary tract infections and was found to have a renoduodenal fistula 3 months after the initial operation. Patient underwent uncomplicated right nephrectomy and repair of fistula. Etiology, presentation, diagnosis, and treatment options of renoduodenal fistula are discussed.

EP.TH.855Hartmanns reversal - Laparoscopic Vs Open, UHNM experience over the last 3 years

Aim Reversal of hartmanns is still an operation associated with significant morbidity. Although various studies have tried to assess the best time for attempting reversal after the primary operation, there is still no consensus. The aim of our study was to look at our experience over the last three years to find any possible factors which determine the duration between primary operation and reversal and compare laparoscopic vs open approach. Methods Prospective cohort including consisting of patients who underwent hartmanns reversal in 3 years was analysed (January-2017 to December-2019). Data was collected retrospectively from clinical notes. Results Among the patients (n = 50) there was equal distribution of males (52%) and females (48%). Although the initial operation was open in 74% patients, reversal was attempted laparoscopically in 46% with a conversion rate of 43.4%. Median duration between initial operation and reversal was 433 days. There was no significant association between duration before reversal and patient comorbidities or the indication for the index procedure. Also there was no statistical difference in postoperative hospital stay or immediate postoperative morbidity between laparoscopic and open hartmanns reversal. Conclusion There was no difference in immediate postoperative outcomes between patients who had laparoscopic or open hartmanns reversal. There was no determining factor which made the surgeon prefer laparoscopic over open approach nor was there a difference in duration between primary operation and reversal based of patient factors or method of approach. Hence timing of hartmanns reversal and the method of approach still depends on surgeon preference and experience.

EP.TH.756Post-operative sepsis: Is CT reliable in diagnosing the cause of post-operative sepsis?

Aim To assess the reliability of computerised tomography in post-operative sepsis in patients who previously underwent laparotomy in the same hospital admission. Introduction Method This study was done on re-operations following an abdominal operation from April 2012 to April 2016 at a district general hospital. Data regarding demography, initial operation, post-operative problems, pre-operative diagnosis, and use of computed tomography, the findings on CT, and operative findings were collected. A comparison was made between the CT findings and findings on re-laparotomy. Also noted was the number of patients who did not have a re-laparotomy following CT. Result There were 87 patients, of whom, 10 had no accessible notes and were removed from the list. Of the remaining 77, 53(68.8%) had CT scans, 24 did not (31.2%). Of these that had CT, 29 (54.7%) had findings which matched with intra-operative findings on re-laparotomy, in 12 (22.6%) CT findings did not match 4(7.5%) had minor findings not needing surgery and 8(15.5%) had normal or insignificant findings. Conclusions We found in this study that, CT did have a significant contributory role in the arsenal of methods to aid source control in those patients that are septic following an abdominal operation, and this should be used as a pre-operative diagnostic modality.

Optimal operation of thermal system based on optimum power flow

This paper has demonstrated that the Newton-Raphsin (NR) load flow technique can be stretched out to produce optimal load flow (OPF) arrangement that is achievable as for all significant disparity imperatives. These arrangements are frequently desired for arranging and activity. We were examined how the load ought to be shared among different plants, when line misfortunes are represented to limit the absolute activity cost with optimal power flow computation with thought about penalty factors, steady fuel cost, and coefficient factors. The IEEE three-machines and nine- Bus bars system was a tested system. The obtained results were compared by initial operation and equality distribution through the saving cost ($/year). The comparison of results showed saving more than 1.6 million $/year under MATLAB V.18a environment.

The spanning plate as an internal fixator in complex distal radius fractures – a prospective cohort study

Objective Minimal invasive temporary spanning plate (SP) fixation of the wrist has been described as an alternative treatment method in complex distal radius fractures (DRFs). The purpose of this study is to conduct an outcome analysis of all consecutive DRFs treated by SP fixation representing the so far largest published patient cohort outside the United States. Methods Indication for SP fixation included DRFs with severe metaphyseal comminution, radiocarpal luxation fractures with concomitant ligamentous injuries and very distal intra-articular fractures lacking the possibility of adequate plate anchoring. All consecutive patients undergoing SP fixation of DRFs were prospectively included in a single level I trauma centre between 01/01/2018 and 31/12/2020. Post-operative assessments included radiological, functional and patient-rated outcomes at a minimum of 12 months follow-up. Results In the mentioned timeframe, a total of 508 DRFs were treated operatively of which 28 underwent SP fixation. Average age was 58.1 years (range 22-95 years). The fracture type ranged from AO/OTA type B1.1 to C3.3 and included 8 fracture dislocations. SP removal was performed on average 3.7 months after the initial operation (range 1.4-6.5 months). The mean follow-up time was 14.5 months (range 12-24 months). Radiological evidence of fracture healing appeared on average 9.9 weeks (range 5-28 weeks) after the initial operation. One patient experienced oligosymptomatic non-union. Complications included 2 patients with tendon rupture and one patient with extensor tendon adhesions needing tenolysis at the time of plate removal leaving an overall complication rate of 12%. There was no implant failure and no infection. Mean satisfaction score was 8 (range 0-10) and mean visual analogue scale for resting pain was 0.9 (range 0-9). The mean PRWE score was 17.9 (range 0-59.5) and the mean DASH score was 16.6 (range 0-60.8). Grip strength averaged 23kg (range 4-74kg) amounting to 68% of the opposite side. Mean radial inclination, volar tilt and ulnar variance at 1 year were all within the acceptable limit predictive of symptomatic malunion. Conclusion The radiological, functional and patient-rated outcomes in this study are remarkably good considering the complexity of the included fractures. Therefore, this method represents a valuable alternative for the treatment of complex DRFs in selected patients.

Robotic Completion Thyroidectomy via the Bilateral Axillo-Breast Approach

Background: Bilateral axillo-breast approach (BABA) robotic thyroidectomy has been successfully performed for thyroid cancer patients with excellent cosmetic results. Completion thyroidectomy is sometimes necessary after thyroid lobectomy, and whether it has a higher complication rate than the primary operation due to the presence of adhesions remains controversial. The aim of this study was to evaluate surgical outcomes, including operation time and postoperative complications, in patients who underwent BABA robotic completion thyroidectomy. Methods: From Jan 2012 to Aug 2020, 33 consecutive patients underwent BABA robotic completion thyroidectomy for a thyroid malignancy after BABA robotic thyroid lobectomy. The procedures were divided into five steps: (1) robot setting and surgical draping, (2) flap dissection, (3) robot docking, (4) thyroidectomy, and (5) closure. Clinicopathological characteristics, operation time, and postoperative complications were reviewed. Results: The total operation time was shorter for completion thyroidectomy than for the initial operation (164.8 ± 31.7 min vs. 179.8 ± 27.1 min, p = 0.043). Among the robotic thyroidectomy steps, the duration of the thyroidectomy step was shorter than that of the initial operation (69.6 ± 20.9 min vs. 83.0 ± 19.5 min, p = 0.009. One patient (1/33, 3.0%) needed hematoma evacuation under the flap area immediately after surgery. Three patients (3/33, 9.1%) showed transient hypoparathyroidism, and one patient (1/33, 3.0%) had permanent hypoparathyroidism. Two patients (2/33, 6.1%) showed transient vocal cord palsy and recovered within 3 months following the completion thyroidectomy. There were no cases of open conversion, tracheal injury, flap injury or wound infection. Conclusions: BABA robotic completion thyroidectomy could be performed safely without completion-related complication.