AN UNCOMMON CASE OF GANGRENOUS JEJUNOILEAL INTUSSUSCEPTION SECONDARY TO JEJUNAL POLYP

Small bowel intussusceptions are much less common than the ileocolic type, with jejunoileal intussusceptions among the rarest [1].Gangrenous Intussusception is a dangerous condition requiring immediate revival, early exploration,and resection of the affected bowel to lessen mortality and morbidity. Jejunal polyps causing such pathology are uncommon and noteworthy. Here we present one such case.

Neural Network Explainable AI Based on Paraconsistent Analysis: An Extension

This paper explores the use of paraconsistent analysis for assessing neural networks from an explainable AI perspective. This is an early exploration paper aiming to understand whether paraconsistent analysis can be applied for understanding neural networks and whether it is worth further develop the subject in future research. The answers to these two questions are affirmative. Paraconsistent analysis provides insightful prediction visualisation through a mature formal framework that provides proper support for reasoning. The significant potential envisioned is the that paraconsistent analysis will be used for guiding neural network development projects, despite the performance issues. This paper provides two explorations. The first was a baseline experiment based on MNIST for establishing the link between paraconsistency and neural networks. The second experiment aimed to detect violence in audio files to verify whether the paraconsistent framework scales to industry level problems. The conclusion shown by this early assessment is that further research on this subject is worthful, and may eventually result in a significant contribution to the field.

Duct Attachment on Improving Breaking Wave Zone Energy Extractor Device Performance

A challenging wave energy converter design that utilized the denser energy part of the nearshore breaking wave zone to generate electricity was introduced in 2016 by Shintake. The Okinawa Institute of Science and Technology Graduate University’s project aims to take advantage of breaking wave energy to harness electricity. The 2016 version of the device consisted only of a bare turbine and power generator. Early exploration of the design recorded short periods and high impact wave pressures were experienced by the structure, with the turbine unable to harvest energy effectively. Additional structure to not only reduce incoming impact pressure but also increase the duration of water flow through the turbine was needed. These are the main reasons behind incorporating the duct attachment into the design. This paper show that the duct is capable of halving the impact pressure experienced by the turbine and can increase the energy exposure by up to 1.6 times the bare turbine configuration. Furthermore, it is also said that wave angle (β) = 40° is the critical angle, although the duct still increases wave energy exposure to the power take-off up to β = 60°.

The application of VOI method to shape a strategy of additional exploration

Background. An optimal exploration strategy creates a significant share in value of project on exploration stage. The paper describes an example of solving the following tasks: determining the feasibility of additional exploration drilling; evaluating the value of drilling of one or more exploration wells; determining the optimal placement for exploration wells and drilling order. Authors presenting the modification of VoI (Value of Information) method and its application. Materials and methods. Complex probabilistic models were created summarizing main uncertainties and limitations, both geological, technical and technological. At the first stage three equiprobable geological concepts were made. For each concept probabilistic geological modelling was proceeded and then realizations corresponding to values of reserves P10, P50, and P90 were selected. Further, detailed production forecasts and economic estimates were performed. The analysis used the well pad and the corresponding area for exploration drilling as a unit of calculation. In the article the authors introduced the concept of remaining uncertainty. Application of modified VoI method allowed to form ‘dynamic’ (i.e. depending on exploration wells drilling order) range of areas for additional exploration which provide the best decrease of remaining uncertainty. An additional exploration strategy has been formed, which includes the necessary and sufficient number of wells and their drilling order. A decision tree was created depending on the success or failure of each subsequent exploration well. Results. The use of the modified VoI approach made it possible to achieve the objectives and obtain economical estimates, all of which combined to facilitate the adoption of decisions. As a result, a program for two exploration well drilling was created which would reduce the uncertainty by 90% from its initial value. Conclusions: The adopted VoI method could be applied to fields at the stage of additional exploration as well as to fields at early exploration stage to develop an exploration drilling strategy.

Nerves Transfer Procedure in Patients with Left Upper Extremities Weakness Following Gunshot Wounds: A Case Report

BACKGROUND: Gunshot wounds (GSWs) to the extremities can result in damage to the neurovascular structure which results in high morbidity and loss of function. According to the Centers for Disease Control report, the incidence of non-fatal GSWs has increased in the past decade. Trauma to the brachial plexus is a type of peripheral nerve trauma that is most difficult to treat due to its complex surgical procedures. Early exploration and reconstruction of peripheral nerve trauma are still being debated to this day. However, most recommend surgical exploration when the suspicion of neurovascular trauma is very high based on clinical findings. Nerve transfer is one of the recommended methods of nerve reconstruction even in pre-ganglionic lesions. We report a case of a patient with weakness of the upper limb after a gunshot wound to his left shoulder. Based on clinical considerations and investigations, nerve transfer procedure is carried out to restore patient’s shoulder function. CASE REPORT: Male, 32 years old, working as a policeman, complained difficulty on moving his shoulder for 3 months. Patients had a history of GSWs to the left shoulder which also results in a left clavicular fracture. First aid, debridement, and fracture management were performed at Bhayangkara Hospital, Palu. Physical examination revealed winging scapula positive on his left shoulder, shoulder abduction 5/1, and hypoesthesia at left C5 level. Electromyographic examination revealed lesions on the left posterior chord and left brachial plexus. Based on clinical findings and supporting examination, we performed nerve transfers procedure from the accessory nerve to suprascapular notch. In the previous study, 63% of cases GSWs associated with nerve dysfunction. About 75% of patients with nerve palsy are associated with nerve lacerations during surgical exploration. However, many surgeons continue to recommend early exploration after GSWs to the upper extremities, especially in patients who will undergo surgical treatment for other indications. Based on this, we suggest the probable cause of brachial plexus lesions in this case resulted from gunshot wound which injures the brachial plexus or as a complication from previous procedures. Surgery that is too early can interfere with the spontaneous reinnervation process, but late surgical procedures can result in failure of reinnervation. In general, optimal time is set between 3 and 6 months after trauma. Nerve transfer is one method of reconstructing peripheral nerve lesions that can be applied to pre-ganglionic or post-ganglionic lesions. CONCLUSION: This procedure has several benefits, namely, the proximity of the donor and the recipient nerve anatomy, shorter operating time and does not require grafts. Brachial plexus trauma due to trauma or non-trauma together has an impact on the patient’s quality of life. However, advances in surgical techniques and further understanding of nerve physiology have led clinicians and patients to better outcomes. The current trend of treatment strategies for brachial plexus trauma is surgical reconstruction with the nerve transfer procedure.