Resilience Assessment of a Twin-Tube Motorway Tunnel in the Event of a Traffic Accident or Fire in a Tube

We have developed a traffic simulation model to quantitatively assess the resilience of a twin-tube motorway tunnel in the event of traffic accident or fire occurring within a tube. The motorway section containing the tunnel was investigated for different possible scenarios including its partial or complete closure. The functionality of the road infrastructure, in the case of an accident in one of the two tubes (each tube presents two lanes with unidirectional traffic under ordinary conditions), was assumed to be recovered both by using the remaining undisrupted lane of the tube interested by the disruptive event (only one lane is closed) and reorganizing the traffic flow by utilizing the adjacent tube for bi-directional traffic (both lanes are closed). The effects of an alternative itinerary individualized in the corresponding open road network were also examined. The level of functionality of the system during the period in which the tube is partially or completely closed was computed as the ratio between the average travel time required to reach a given destination from a specific origin before and after the occurrence of the disruptive event. The resilience metrics were assumed to be resilience loss, recovery speed, and resilience index. The best scenario was found to be the partial closure of the tube in contrast to the complete one. However, in order to contain the negative effects on the functionality of the motorway section due to the complete closure of the tube, it is worth highlighting how the traffic by-pass before the entrance portal of the closed tube should be open in a very short time by the tunnel management team to allow for the quick use of the adjacent tube for bi-directional traffic. An additional improvement, with reference exclusively to passenger cars traveling through the adjacent unblocked tube, might be obtained by activating the variable message signs, located at a sufficient distance from the motorway junction before the entrance portal of the closed tube, in order to suggest an alternative route to heavy good vehicles (HGVs) only. Whereas, when the alternative itinerary is used by all vehicles traveling towards the blocked tube (i.e., both passenger cars and HGVs), this redirectioning of the motorway traffic flow was found to be characterized by an excessive travel time, with it therefore not being advisable. The results obtained might be useful as a decision-making support tool aimed at improving the resilience of twin-tube tunnels.

Use of Traffic Simulation to Analyze the Changes in City Mobility During the COVID-19 Pandemic

It seems that the COVID-19 pandemic, which started in December 2019, will have longer and more profound consequences on our lives than initially foreseen. Among the most obvious are everyday decisions about the mode of transport. From related research, it can be seen that the most affected transport mode is public transport, which had the greatest decline. The reason for lesser use of public transport is in complete closure of public transport in some parts of the world. However, where this measure has not been applied, the reason for the reduction is people's fear of infection when using public transport or any shared modes of transportation. The fear stems from the fact that the COVID-19 virus is spreading extremely fast in densely populated rooms. All these changes are affecting the changes in city mobility. Related research shows a decrease of mobility in general and an increase in the use of individual modes of transportation. Distinct changes can be observed in different environments as compared to previous travel behaviour.

Transvenous embolization of vein of galen aneurismal malformations using the “Chapot pressure cooker” technique

In some vein of galen aneurysmal malformation (VGAM) patients, transvenous embolization (TVE) is an attractive option, but its safety is unclear. Here we report the first two VGAM patients treated using the Chapot “pressure cooker” technique (ChPC). Methods Two patients, one 5-year-old and one 7-year-old, both presented with congestive heart failure in the newborn period and were subsequently treated in the newborn period with multiple, staged TAEs with n-BCA for choroidal VGAMs. Results We achieved progressive reduction in shunting and flow but were unable to accomplish complete closure of the malformation: in both patients, a small residual with numerous perforators persisted. The decision was made to perform TVE using the CHPC. In this technique, a guiding catheter is placed transjugular into the straight sinus (SS). One or two detachable tip microcatheters are advanced to the origin of the SS. Another microcatheter is advanced and the tip placed between the distal marker and the detachment zone of the former. Coils and n-BCA are used to prevent reflux of Onyx. Conclusions In this study, we recognized two important factors of traditional VGAM treatment that may cause interventionalists to consider the ChPC to treat VGAM: (1) without liquid embolic, deployed coils may not occlude the fistula entirely. (2) There is the concern of causing delayed bleeding should the arterial component of the fistula rupture. ChPC ameliorates these issues by offering complete closure of the fistula with liquid embolic material in TVE.

Management of complex wounds treatment with a hydrofiber dressing in a public hospital in Bogota (Colombia)

Objective. To evaluate the efficacy of the use of a last generation hydrofiber dressing with silver, for the treatment of complex wounds that are difficult to heal.Materials and research methods. A prospective observational case-follow-up study was carried out, which included patients with acute or chronic wounds that were difficult to heal, treated in the plastic surgery service of a public hospital in Bogota-Colombia, who underwent healing with hydrofiber dressings reinforced, with silver ions, benzethonium chloride and EDTA (Aquacel Agplus®, ConvaTec). The wound was monitored, evaluating infection control, exudate and biofilm, as well as the number of required dressings and the time required for the complete closure of the wound.Research results. A total of 55 patients were included, with a median age of 44 years. In all cases, a follow-up was carried out until the definitive closure of the wound. At the end of the study, it was observed that, in 35 (63.6 %) patients, the wounds evolved to complete closure by second intention in an average of 59.3 days, requiring 12.5 dressings. 20 (36.4 %) patients had adequate wound bed preparation for definitive surgical coverage with grafts, flaps or dermal substitutes, in an average of 31.4 days, requiring 6.5 dressings on average.33 (60.0 %) wounds were infected and adequate infection control was achieved on average with 5 dressings. A decrease in the direct and indirect signs of biofilm was achieved after 6 dressings.Conclusion. The results show that the dressing studied is effective to control exudate, infection and biofilm, as well as to prepare the bed for a definitive surgical coverage.

Predictability of Root Movements Using Virtual Root Setup in a Patient With Periodontal Disease Treated With Clear Aligners

Aims: The aim of the study was to show a case with a midline diastema in a patient with high periodontal risks and gingival recessions treated with clear aligners. The objective was to predict and quantify root movements using a dedicated software that extrapolates data from the Cone Beam Computed Tomography (CBCT). Case Presentation: A 31-year-old female with a mandibular midline diastema asked for an aesthetic treatment. She had vertical bone loss on the lower central incisors, so a CBCT was necessary in order to plan the root movements. The purpose of the treatment was to avoid an uncontrolled tipping of the incisors and, therefore, a vestibular movement of the roots, which could cause serious periodontal problems. Conclusion: At the end of the treatment, the complete closure of the diastema and the radiographic healing of the vertical bone loss between mandibular central incisors were achieved. The superimpositions with the virtual setup demonstrated predictability of root movements of 76%.

Transcriptional evaluation of the ductus arteriosus at the single-cell level uncovers a requirement for vimentin for complete closure

OBJECTIVE: Failure to close the ductus arteriosus immediately post-birth, patent ductus arteriosus (PDA), accounts for up to 10% of all congenital heart defects. Despite significant advances in PDA management options, including pharmacological treatment targeting the prostaglandin pathway, a proportion of patients fail to respond and must undergo surgical intervention. Thus, further refinement of the cellular and molecular mechanisms that govern vascular remodeling of this vessel is required. APPROACH AND RESULTS: As anticipated, single-cell RNA sequencing on the ductus arteriosus in mouse embryos at E18.5, P0.5, and P5, revealed broad transcriptional alterations in the endothelial, smooth muscle, and fibroblast cell compartments. Making use of these data sets, vimentin emerged as an interesting candidate for further investigation. Subsequent studies demonstrated that, in fact, mice with genetic deletion of vimentin fail to complete vascular remodeling of the ductus arteriosus, as per presence of a functional lumen. CONCLUSIONS: Through single-cell RNA-sequencing and by tracking closure of the ductus arteriosus postnatally in mice, we uncovered the unexpected contribution of vimentin in driving complete closure of the ductus arteriosus potentially through regulation of the Notch signaling pathway.

Abstract 1122‐000045: Transvenous Embolization of Vein of Galen Aneurismal Malformations Using the “Chapot Pressure Cooker” Technique

Introduction : There are various procedural techniques described in the literature to treat VGAM: 1) transarterial embolization (TAE) via a transfemoral or transumbilical approach, 2) transfemoral or transtorcular venous coiling, and 3) the combined transarterial and transvenous “trapping” of the fistula. The transarterial technique has permitted our team to obtain total or near‐total obliteration in approximately 80% of cases; however, there is a patient population in whom the residual arterial supply is comprised of small perforators. In these patients, transvenous embolization (TVE) is an attractive option, but its safety is unclear. Here we report the first two VGAM patients treated using the Chapot “pressure cooker” technique (ChPC). Methods : Two patients, one 5‐year‐old and one 7‐year‐old, both presented with congestive heart failure in the newborn period and were subsequently treated in the newborn period with multiple, staged TAEs with n‐BCA for choroidal VGAMs. We achieved progressive reduction in shunting and flow but were unable to accomplish complete closure of the malformation: in both patients, a small residual with numerous perforators persisted. The decision was made to perform transvenous embolization using the CHPC. In this technique, a guiding catheter is placed transjugular into the straight sinus (SS). One or two detachable tip microcatheters are advanced to the origin of the SS. Another microcatheter is advanced and the tip placed between the distal marker and the detachment zone of the former. Coils, and n‐BCA if necessary, are used to prevent reflux of Onyx. This forces the Onyx to occlude the vein and the most distal arterial segment. Results : Both patients had complete occlusion of the VGAM after ChPC. Conclusions : This is the first report to describe TVE to cure VGAM after multiple sessions of TAE. This is also the first report to apply ChPC to VGAM treatment. In this study, we recognized two important factors of traditional VGAM treatment that may cause interventionalists to consider the ChPC to treat VGAM: 1) without liquid embolic, deployed coils may not occlude the fistula entirely. 2) There is the concern of causing delayed bleeding should the arterial component of the fistula rupture. ChPC ameliorates these issues by offering complete closure of the fistula with liquid embolic material in TVE. Not only is the residual vein blocked, but also the incoming arterial supply which prevents delayed bleeding. In endovascular treatment of VGAM, TVE is feasible option once the dilated vein of Galen becomes small enough. To prevent incomplete occlusion or post‐procedural hemorrhagic complications, the use of the ChPC using DMSO liquid embolic material is a promising and necessary introduction to the neurointerventionalist’s treatment arsenal.

The Theme of Protest and Freedom in Cry, the Peacock

The conflict between social institutions and individuals is a complex and perplexing issue for many scholars. While reflecting on this issue, some scholars propagate the privilege to individuality, the others to the social institutions. Many scholars consider it as a matter of mutual coordination and interest. The need for a relative space for an individual and the requirement of the social institutions for regulating control over an individual’s uncensored wills are equally important. However, safeguarding or maintaining the margins of both entities is complex work. Regulating uncensored wills or reducing excessive encroachment of institutional authorities is a difficult task; it needs to be addressed with a scientific approach. The Indian social system is conservative and has been maintaining its dominance over the women’s class from the time unknown. The society, after allotting all the privileges to male members, refuses to consider women as individuals, having space and freedom. It expects women to be timid, docile, submissive and obedient. As a result, they feel tyrannized and experience untold sufferings. When the patriarchal system becomes over oppressive, it leads women to absolute confinement; the life of complete closure is highly disappointing and frustrating. The forces that obliterate their rights include gender discrimination, marriage-system, orthodox traditions, customs, rituals and class status. A woman is born with a destitute to experience a collision with the subjugating elements in her life and while wrestling against it she has little success. She goes through a perpetual war against the controlling institution while creating a space for her individuality and freedom. The factors like these rob women characters of happiness and advantages and lead women to live an insignificant life, full of suffering.

Endobronchial closure of the bronchopleural fistula with the ventricular septal defect occluder: a case series

Objectives The ventricular septal defect (VSD) occluder has been reported to be a novel method for the closure of bronchopleural fistula (BPF). Our study was to confirm the use of VSD occluder in treating BPF after pneumonectomy or lobectomy. Methods We performed a single-center, retrospective study of 10 consecutive patients (8 men and 2 women aged 29–70 years) with postoperative BPF receiving the VSD occluder treatment. We used the HeartR™ Membranous VSD occluder (Lifetech Scientific Co., Shenzhen, China) for the closure of BPF through flexible bronchoscopy under general anesthesia. Demographic characteristics, BPF characteristics, and clinical outcomes were collected from patients’ files using the standardized data abstraction forms. Results The underlying diseases were lung cancer in 6 patients, pulmonary tuberculosis in 3, and bronchiectasis in 1. Right-sided BPFs occurred in 6 patients, and left-sided BPFs occurred in 4. Five patients were underweight with a body mass index < 18.5 kg/m2. The VSD was placed in all 10 patients with a 100% technical success rate and a 70% complete closure rate during follow-up with no complications, on a median follow-up period of 115 days (range 46–975 days). In 1 patient, the VSD occluder was reinstalled with complete closure; in 1 and 2 patients with underweight and chronic empyema, the VSD occluders partially and completely failed with good physical tolerance, respectively. Conclusions Our study demonstrated the bronchoscopic closure of BPF after lung resection using the VSD occluder is an off-label but safe and effective method. We prefer to stabilize the BPF by eradicating the underlying diseases and providing nutritional support to those receiving VSD occluder closure treatment.

High Abdominal Perfusion Pressure Using Umbilical Cord Flap in the Management of Gastroschisis

Background: Gastroschisis management remains a controversy. Most surgeons prefer reduction and fascial closure. Others advise staged reduction to avoid a sudden rise in intra-abdominal pressure (IAP). This study aims to evaluate the feasibility of using the umbilical cord as a flap (without skin on the top) for tension-free repair of gastroschisis.Methods: In a prospective study of neonates with gastroschisis repaired between January 2018 to October 2020 in Tanta University Hospital, we used the umbilical cord as a flap after the evacuation of all its blood vessels and suturing the edges of the cord with the skin edges of the defect. They were guided by monitoring abdominal perfusion pressure (APP), peak inspiratory pressure (PIP), central venous pressure (CVP), and urine output during 24 and 48 h postoperatively. The umbilical cord flap is used for tension-free closure of gastroschisis if PIP &gt; 24 mmHg, IAP &gt; 20 cmH2O (15 mmHg), APP &lt;50 mmHg, and CVP &gt; 15cmH2O.Results: In 20 cases that had gastroschisis with a median age of 24 h, we applied the umbilical cord flap in all cases and then purse string (Prolene Zero) with daily tightening till complete closure in seven cases, secondary suturing after 10 days in four cases, and leaving skin creeping until complete closure in nine cases. During the trials of closure, the range of APP was 49–52 mmHg. The range of IAP (IVP) was 15–20 cmH2O (11–15 mmHg), the range of PIP was 22–25 cmH2O, the range of CVP was 13–15 cmH2O, and the range of urine output was 1–1.5 ml/kg/h.Conclusion: The umbilical cord flap is an easy, feasible, and cheap method for tension-free closure of gastroschisis with limiting the PIP ≤ 24 mmHg, IAP ≤ 20 cmH2O (15 mmHg), APP &gt; 50 mmHg, and CVP ≤ 15cmH2O.