Anal endosonographic assessment of the accuracy of clinical diagnosis of obstetric anal sphincter injury

Introduction and hypothesis Obstetric anal sphincter injuries (OASIS) are a common cause of maternal morbidity with an overall incidence in the UK of 2.9% (range 0–8%). They can cause a range of physical symptoms and psychological distress. This study aims to assess the accuracy of clinical diagnosis of OASIS using endoanal ultrasound (EAUS) and the correlation between confirmed injury and change to anorectal physiology squeeze pressure and the incidence of bowel symptoms. Methods and materials Retrospective study of prospectively collected data from 1135 women who attended the Third- and Fourth-Degree Tears Clinic at our institution, 12 weeks post-delivery, between June 2008 and October 2019. Results OASIS was confirmed in 876 (78.8%) women and 236 (21.3%) had no injury. Of the women who underwent anorectal physiology, 45.6% had a mean maximal resting pressure below the normal range and 68.8% had a mean incremental squeeze pressure below normal. Women with confirmed OASIS had significantly lower pressures (p < 0.001) than those without a confirmed sphincter injury. Three hundred ninety-three (34.8%) women reported bowel symptoms, with those with endosonographic evidence of injury more likely to develop flatus incontinence. Conclusion Of the women in this study with a suspected OASIS, 21.2% could be reassured that they did not have an injury. This information is useful for women considering future mode of delivery. Those with confirmed injury are more likely to complain of flatus incontinence and have reduced anal sphincter pressures.

Combined application of chondroitinase ABC and photobiomodulation with low-intensity laser on the anal sphincter repair in rabbit

Background Photobiomodulation with low-intensity laser (LIL) and chondroitinase ABC (ChABC) can repair damaged muscle tissue, so the aim of this study was to investigate the effect of co-administration of these two factors on anal sphincter repair in rabbits. Methods Male rabbits were studied in 5 groups (n = 7): Control (intact), sphincterotomy, laser, ChABC and laser + ChABC. 90 days after intervention were evaluated resting and maximum squeeze pressures, number of motor units, collagen amount, markers of muscle regeneration and angiogenesis. Results Resting pressure in the Laser + ChABC group was higher than the sphincterotomy, laser and ChABC groups (p < 0.0001). Maximum squeeze pressure in the all study groups was higher than sphincterotomy group (p < 0.0001). In the laser + ChABC and ChABC groups, motor unit numbers were more than the sphincterotomy group (p < 0.0001). Collagen content was significantly decreased in the laser (p < 0.0001) and laser + ChABC groups. ACTA1 (p = 0.001) and MHC (p < 0.0001) gene expression in the Laser + ChABC group were more than the laser or ChABC alone. VEGFA (p = 0.009) and Ki67 mRNA expression (p = 0.01) in the Laser + ChABC group were more than the laser group, But vimentin mRNA expression (p < 0.0001) was less than the laser group. Conclusion Co-administration of ChABCs and photobiomodulation with LIL appears to improve the tissue structure and function of the anal sphincter in rabbits more than when used alone.

Design and evaluation of a parallel cable-driven shoulder mechanism with series springs

Upper limb paralysis and movement disorders resulting from neurologic injuries can be treated with an upper limb exoskeleton robot that assists with movement retraining. Cable-driven exoskeletons have been widely studied because of their lightness, compact structure, low cost, and long-distance power transmission. However, the problems of shoulder squeeze force and system stability have not been solved. In this article, we present a prototype parallel cable-driven shoulder mechanism with series springs. The theoretical analysis suggests that the stability of the mechanism is improved compared with that of the previous mechanism, and the effects of stiffness, upper limb weight, and mechanism parameters on the shoulder joint extrusion pressure are analyzed by simulation and experimental results. The results show that this mechanism plays an important role in reducing or eliminating the shoulder squeeze pressure and improving the stability of the mechanism. Moreover, the mechanism has good portability and can be combined with other exoskeletons to facilitate various robot-assisted upper limb rehabilitation training.

Research on Pressure Loss and Filling Ability of Semi-Solid Rheological Behavior in Squeeze Casting

The filling ability of alloy fluid under pressure is of great significance to improve the dimensional integrity and mechanical properties of thin-walled and slender rods formed by squeeze casting. Insight into the rheological behavior of squeeze casting is beneficial to improve the formability of complex structural parts by optimizing the squeeze casting process. In this work, the Archimedes spiral sample prepared by indirect squeeze casting was applied to investigate the variation of filling length with squeeze pressure and filling speed during the rheological process in squeeze casting. According to the temperature distribution characteristic during the alloy melt filling process, the alloy fluid state was discussed and the spiral filling was confirmed as a semi-solid rheological behavior. The calculation models of pressure loss and filling length were established respectively based on steady-state rheological behavior. Pressure loss is mainly affected by the melt viscosity which is determined by temperature distribution and filling speed of alloy melt in the channel. According to the agreement between the theoretical calculations and the experimental results, the pressure loss and filling length models have been confirmed to be used to quantitatively characterize the filling ability of the aluminum alloy melt in the squeeze casting process.

Finite Element Analysis of Temperature Distribution and Stress Behavior of Squeeze Pressure Composites

Aluminium-reinforced composites play a vital role in the engineering industry because of their better strength and stiffness. The properties are directly related to the solidification phenomenon of the cast alloy. The design engineer should understand the importance of the solidification behavior of base alloy and its reinforcement. Composites’ solidification study is rare, and the reviews are limited. The solidification process is analyzed using the finite element method (FEM), and this would fetch a lot of information about the cooling rate of the composites and also helps to reduce the time in experimentation. This paper reports and plots the cooling curves of Al/SiCp composites using simulation software. Cylindrical-shaped composites were developed using the squeeze casting method, and the experimental cooling curves were plotted using a K-type thermocouple. Composites samples were prepared at the following squeeze pressures: 0, 30, 50, 70, 100, and 130 MPa; melt and die temperature was kept constant at 800 and 400°C, respectively. The experimental and FEA cooling curves were compared, and it was agreed that the increase in the squeeze pressure increases the cooling rate of the developed composite. Furthermore, the effect of temperature distribution from the inner region of the melt and die material which causes the radial and tangential stress of components has also been examined.

A Pilot Study on the Impact of Menstrual Cycle Phase on Elite Australian Football Athletes

The effect of the menstrual cycle on athlete performance, wellbeing and perceived exertion and fatigue is not well understood. Furthermore, it has not been investigated specifically in Australian Football athletes. This pilot study aimed to explore how naturally menstruating Australian Football athletes may be affected by menstrual cycle phase. The data collected from the routine monitoring of five naturally menstruating athletes (average menstrual cycle length of 28 ± 3 [SD] days) in one team (athlete age range 18–35 years) competing in the Women’s Australian Football League during the 2019 season were retrospectively analysed to compare performance (countermovement jump parameters and adductor squeeze pressure), perceived exertion, perceived fatigue and wellbeing (perceived sleep quality, stress and soreness) outcomes between the follicular and luteal phases. Performance, perceived exertion, stress and soreness did not appear to be affected by menstrual cycle phase (p > 0.17). However, perceived fatigue appeared to be significantly greater (p = 0.042) and sleep quality worse (p = 0.005) in the luteal phase. This pilot study suggests further research focusing on the effect of menstrual cycle phase on subjective fatigue and wellbeing is warranted.

Effect of Kangfuxin Solution Fumigation Bath on Postoperative Patients with Hemorrhoid PPH and Influence on the Postoperative Complications

Surgery is now the main clinical treatment for hemorrhoids, and the procedure for prolapse and hemorrhoids (PPH) is the commonly used procedure. The key to evaluating the efficacy of surgery includes the quality of postoperative wound healing and the occurrence of complications, so it is especially important to enhance the postoperative rehabilitation of hemorrhoids. This study investigates the method of postoperative treatment with Kangfuxin solution fumigation bath to explore the role of this method in the efficacy of patients after hemorrhoid PHH surgery and its effect on postoperative complications. It will accumulate some relevant information to improve the efficacy of hemorrhoid surgery and postoperative complications and open new ideas for further postoperative rehabilitation of other diseases in the anal area. A total of 106 patients with hemorrhoids were included in this study, all of whom were treated with PHH surgery. After surgery, they were randomly divided into a control group treated with warm water sitz bath and an observation group treated with Kangfuxin solution fumigation bath, with 53 cases in each group. We observed all patients’ postoperative pain, bleeding, and perianal edema on a daily basis after surgery; we recorded the time of wound healing and hospital stay. The maximum anal squeeze pressure (MASP), anal defecation diastole pressure (ADDP), anal resting pressure (ARP), and the length of the high-pressure zone (HPZ) were used as observation indicators to evaluate the anal function of the patients before and after treatment. The results of the evaluation of the efficacy of patients after the treatment period showed that the total effective rate of treatment in the observation group (92.45%) was significantly higher than that of the control group (77.36%). The postoperative recovery showed that the wound healing time, hospitalization time, pain, bleeding, and edema scores at 3 and 5 days after surgery were lower in the observation group than in the control group; MASP and ARP increased in both groups after treatment compared to before treatment, with more increase in the observation group. The results suggest that patients with hemorrhoids after PPH should pay attention to postoperative care and rehabilitation. It also reveals that the application of Kangfuxin solution fumigation treatment has a significant effect, which can effectively reduce the patient’s wound healing and hospital stay, while improving the patient’s anal function and reducing postoperative complications, and is worthy of clinical promotion and application.

Mechanical Behaviour of Al7075 Hybrid Composites Developed through Squeeze Casting

The automotive and aerospace sector are behind the development of squeeze casting process, as the squeeze cast components exhibit improved mechanical properties. Squeeze casting is a hybrid metal processing technique that combines the advantage of both casting and forging in one operation. The aluminium alloy 7075 is a futuristic material that is widely used to produce automotive and aerospace components. Cylindrical component of AL 7075 was produced by varying the squeeze pressure at certain level. The specimen was made from the component as per ASTM standard and they were tested for mechanical properties such as tensile hardness and impact strength respectively. It was found that mechanical properties were enhanced with increase in squeeze pressure. The aluminium 7075 hybrid composites developed through squeeze casting is fabricated and experimented upon and found to have adequate potential for wide variety of application. In aerospace industries it can be used in gear components, blade sleeves, guide vanes, wing components etc. Applications in surface transport are brake rotors, automotive engine cylinder, engine exhaust valve, body chassis and connecting rods. This material can be used in light weight applications such as power lines and wind mill fans.

Optimizing Production and Improving Well Accessibility With Expandable Technology

Collapsed tubing occurs when external pressure outside the casing is greater than the pressure inside. There are several circumstances which can lead to a collapse, including high pressure outside the casing during operations such as cement squeeze, pressure testing in the annulus, and when the mud level inside the casing drops due to a loss of circulation. The well location within the rock formation can also have an impact on the potential for collapsed tubing. Seismic activity can cause significant damage to the casing and tubing so careful well design and strict operating procedures are essential to reduce the risk. When the issue does occur, it can create a significantly restricted area in the wellbore and often results in failure to gain access below the collapsed area in a wellbore. This, in turn, can cause extensive nonproductive time (NPT) to remediate the issue. Planned drilling or intervention work is halted, and production may be deferred. In the most severe instances when the casing collapses the well is completely abandoned. While the industry continues to focus on enhancing hydrocarbon recovery from existing wells, these operations must remain economically viable. Therefore, preventing and resolving well integrity and access issues have never been more important. With advancements in expandable technology, it is now possible to reform the restriction in a tubular, enabling the inner diameter (ID) to be opened. This allows for either reinstatement of production back to surface or access to equipment below, permitting operators to resume operations with minimal NPT.Coretrax recently deployed its ReForm wellbore repair tool when an international oil company experienced collapsed tubing in a remote well off the coast of Papua New Guinea. The solution uses hydraulic pressure applied at surface to reform collapsed, oval, or restricted tubulars. Overcoming Traditional Limitations During drilling and production activity, tubing and casing are exposed to a range of axial loads and temperatures as the operator utilizes various methods to reach, and then extract, hydrocarbons from the well. In drilling activity, mud losses can often be encountered through thief zones which leads to a lower mud level. With the consistent pressure outside the casing, the collapse resistance can be affected, resulting in full collapse in the wellbore. Swaging is a conventional and widely used method of repairing collapsed tubing. The process involves a series of swages run downhole to gradually open the collapsed area. It can be done with specialized swage packers or with a hydraulic expandable swage. Both methods provide a bond to the existing casing once properly prepped. The technique can take a significant amount of time to open the area due to the number of different swages required. Each time a larger size is needed, the operator must use significant rig time to trip out of hole. While it can have successful outcomes for repairing damaged areas of well casing or screens for example, due to the weight required in the pipe to swage, this procedure is not suitable for shallow or lateral wells.