Double blind, randomised, placebo controlled study of oral vancomycin in prevention of necrotising enterocolitis in preterm, very low birthweight infants

AIMS: To evaluate the effectiveness of oral vancomycin in the prophylaxis of necrotising enterocolitis in preterm, very low birthweight infants. METHODS: A prospective, double blind, randomised, placebo controlled study in a tertiary referral centre of a university teaching hospital was conducted on 140 very low birthweight infants consecutively admitted to the neonatal unit. The babies were randomly allocated to receive oral vancomycin (15 mg/kg every 8 hours for 7 days) or an equivalent volume of placebo solution. Prophylaxis was started 24 hours before the start of oral feeds. All suspected cases of necrotising enterocolitis were investigated with a full sepsis screen and serial abdominal radiographs. Necrotising enterocolitis was diagnosed and staged according to modified Bell's criteria. RESULTS: Nine of 71 infants receiving oral vancomycin and 19 of 69 infants receiving the placebo solution developed necrotising enterocolitis (p = 0.035). Infants with necrotising enterocolitis were associated with a significant increase in mortality (p = 0.026) and longer duration of hospital stay (p = 0.002). CONCLUSIONS: Prophylactic oral vancomycin conferred protection against necrotising enterocolitis in preterm, very low birthweight infants and was associated with a 50% reduction in the incidence. However, widespread implementation of this preventive measure is not recommended, as it would only be effective in necrotising enterocolitis caused by Gram positive organisms and could increase the danger of the emergence of vancomycin resistant or dependent organisms. Its use should be restricted to a high prevalence nursery for a short and well defined period in a selected group of high risk patients.     

Severe progressive deformities after limb lengthening in type-II fibular hemimelia

Until recently the accepted treatment of choice for severe type-II fibular hemimelia has been Syme's or Boyd's amputation. The alternative of distraction lengthening using the Ilizarov technique is now available. We report three patients (four limbs) with type-II fibular hemimelia who were treated by the Ilizarov technique and followed up for two to six years. Severe progressive procurvatum and valgus deformity of the tibia and valgus deformity and lateral subluxation of the ankle were found in all four limbs. Multiple additional soft-tissue and bony surgery was necessary. In view of these problems we feel that reappraisal of the indications for lengthening in type-II fibular hemimelia is necessary.     

Prevalence and role of anticardiolipin antibodies in Crohn disease

OBJECTIVES: Anticardiolipin antibodies belong to the group of antiphospholid antibodies, and may be seen in association with endothelial damage and recurrent vascular thrombosis. The aim of our study was to determine in patients with Crohn's disease the frequency of anticardiolipin antibodies, and to correlate their presence with clinical activity and treatment of the disease. METHODS: One hundred and thirty-eight sera from patients with Crohn's disease and 118 from age-matched controls were tested for IgG anticardiolipin antibodies. In the Crohn's disease group, we determined whether the patients had a past history of vascular thrombosis, a clinically active intestinal disease, or a current immunosuppressive therapy (steroids or azathioprine). RESULTS: Anticardiolipin antibodies were found significantly more often in patients with Crohn's disease than in controls: 11.0% versus 2.5%, P < 0.02. Three patients with Crohn's disease had a past history of vascular thrombosis, but none of them had anticardiolipin antibodies. The presence of anticardiolipin antibodies was not correlated with the fact that patients had a clinically active disease (P = 0.77), or a current immunosuppressive therapy at the time of the serological test (P = 0.95). CONCLUSIONS: There is a significantly high prevalence of patients with anticardiolipin antibodies during Crohn's disease. The positivity of the test does not seem to be correlated to the existence of a past history of vascular thrombosis, nor to the clinical activity of the disease.     

Cardiac dysrrhthmia in systemic disease

This is an ECG of a 6-year-old girl. She presented to us for management of epilepsy. Magnetic resonance imaging (MRI) of the brain showed multiple lesions consistent with cortical and subcortical tubers. There were also achromic spots on her skin and echocardiography demonstrated a rhabdomyoma near the right ventricular outflow tract. A diagnosis of tuberous sclerosis, an autosomal-dominantly inherited condition, was made. What is abnormal about the ECG?     

MicroPort: A general simulation platform for seaport container terminals

Seaport container terminals are essential nodes in sea cargo transportation networks. As such, the operational efficiency of container terminals in handling containers passing through them plays a critical role in a globalized world economy. Many models and algorithms have been developed to address various decision problems in container terminals to help improve operational efficiency. These decision support tools are usually used separately for specific purposes. However, the problems they are trying to tackle are often interrelated. Therefore, in this regard, an evaluation tool which can capture as many operational conditions as possible for different decision problems is necessary. This paper introduces a general simulation platform, named MicroPort, which aims to provide an integrated and flexible modeling system for evaluating the operational capability and efficiency of different designs of seaport container terminals. The software structure of MicroPort comprises three programming layers: (1) the Functions layer; (2) the Applications layer; and (3) the Extensions layer. Different layers are bound by Application Programming Interfaces (APIs). Basic functions built in the Functions layer support the Applications layer in which major operation processes can be modeled by an agent-based method. External modules and decision support tools in the Extensions layer then use APIs to adjust the system to produce suitable simulation models for specific purposes.     

An Intelligent Robust Tracking Control for a Class of Electrically Driven Mobile Robots

This paper addresses the problem of designing robust tracking control for a class of uncertain wheeled mobile robots actuated by brushed direct current motors. This class of electrically‐driven mechanical systems consists of the robot kinematics, the robot dynamics, and the wheel actuator dynamics. Via the backstepping technique, an intelligent robust tracking control scheme that integrates a kinematic controller and an adaptive neural network‐based (or fuzzy‐based) controller is developed such that all of the states and signals of the closed‐loop system are bounded and the tracking error can be made as small as possible. Two adaptive approximation systems are constructed to learn the behaviors of unknown mechanical and electrical dynamics. The effects of both the approximation errors and the unmodeled time‐varying perturbations in the input and virtual‐input weighting matrices are counteracted by suitably tuning the control gains. Consequently, the robust control scheme developed here can be employed to handle a broader class of electrically‐driven wheeled mobile robots in the presence of high‐degree time‐varying uncertainties. Finally, a simulation example is given to demonstrate the effectiveness of the developed control scheme.     

Dispersion in electroosmotic flow generated by oscillatory electric field interacting with oscillatory wall potentials

An analytical study is presented in this article on the dispersion of a neutral solute released in an oscillatory electroosmotic flow (EOF) through a two-dimensional microchannel. The flow is driven by the nonlinear interaction between oscillatory axial electric field and oscillatory wall potentials. These fields have the same oscillation frequency, but with disparate phases. An asymptotic method of averaging is employed to derive the analytical expressions for the steady-flow-induced and oscillatory-flow-induced components of the dispersion coefficient. Dispersion coefficients are functions of various parameters representing the effects of electric double-layer thickness (Debye length), oscillation parameter, and phases of the oscillating fields. The time–harmonic interaction between the wall potentials and electric field generates steady as well as time-oscillatory components of electroosmotic flow, each of which will contribute to a steady component of the dispersion coefficient. It is found that, for a thin electric double layer, the phases of the oscillating wall potentials will play an important role in determining the magnitude of the dispersion coefficient. When both phases are zero (i.e., full synchronization of the wall potentials with the electric field), the flow is nearly a plug flow leading to very small dispersion. When one phase is zero and the other phase is π,?the flow will be sheared to the largest possible extent at the center of the channel, and such a sharp velocity gradient will lead to the maximum possible dispersion coefficient.     

Synergistic Effect of PVDF-Coated PCL-TCP Scaffolds and Pulsed Electromagnetic Field on Osteogenesis

Bone exhibits piezoelectric properties. Thus, electrical stimulations such as pulsed electromagnetic fields (PEMFs) and stimuli-responsive piezoelectric properties of scaffolds have been investigated separately to evaluate their efficacy in supporting osteogenesis. However, current understanding of cells responding under the combined influence of PEMF and piezoelectric properties in scaffolds is still lacking. Therefore, in this study, we fabricated piezoelectric scaffolds by functionalization of polycaprolactone-tricalcium phosphate (PCL-TCP) films with a polyvinylidene fluoride (PVDF) coating that is self-polarized by a modified breath-figure technique. The osteoinductive properties of these PVDF-coated PCL-TCP films on MC3T3-E1 cells were studied under the stimulation of PEMF. Piezoelectric and ferroelectric characterization demonstrated that scaffolds with piezoelectric coefficient d₃₃ = −1.2 pC/N were obtained at a powder dissolution temperature of 100 °C and coating relative humidity (RH) of 56%. DNA quantification showed that cell proliferation was significantly enhanced by PEMF as low as 0.6 mT and 50 Hz. Hydroxyapatite staining showed that cell mineralization was significantly enhanced by incorporation of PVDF coating. Gene expression study showed that the combination of PEMF and PVDF coating promoted late osteogenic gene expression marker most significantly. Collectively, our results suggest that the synergistic effects of PEMF and piezoelectric scaffolds on osteogenesis provide a promising alternative strategy for electrically augmented osteoinduction. The piezoelectric response of PVDF by PEMF, which could provide mechanical strain, is particularly interesting as it could deliver local mechanical stimulation to osteogenic cells using PEMF.     

An improved cutting force and surface topography prediction model in end milling

During the milling operation, the cutting forces will induce vibration on the cutting tool, the workpiece, and the fixtures, which will affect the surface integrity of the final part and consequently the product's quality. In this paper, a generic and improved model is introduced to simultaneously predict the conventional cutting forces along with 3D surface topography during side milling operation. The model incorporates the effects of tool runout, tool deflection, system dynamics, flank face wear, and the tool tilting on the surface roughness. An improved technique to calculate the instantaneous chip thickness is also presented. The model predictions on cutting forces and surface roughness and topography agreed well with experimental results.