Rectal trauma: management based on anatomic distinctions

Principles of rectal wound management, including routine diversion, injury repair, presacral drainage and distal washout, evolved from World War II and the Vietnam conflict and have been questioned in recent years. We believe significant confusion arises because of imprecise definition of injury location relative to retroperitoneal involvement. Our 5-year experience with penetrating rectal injuries at a Level I trauma center was analyzed. Injuries to the anterior and lateral surfaces of the upper two-thirds of the rectum were classified as intraperitoneal (IP, serosalized), and those of the posterior surface extraperitoneal (EP, no serosa); injuries to the lower one-third were EP. A total of 58 injuries were managed (92% gunshot wounds). Of these, 16 were IP, and 42 had some EP component. Ten patients underwent repair without diversion (6 IP, 4 EP); there were no leaks. Ten septic complications occurred in the remaining population: 2 necrotizing fasciitis, 5 abdominal abscess, and 3 presacral infections (PIs) (2 presacral abscesses and 1 wound tract infection). PI is the only complication that can be specifically associated with EP rectal injuries relative to management; as associated injury confounds interpretation of the other complications. The operative management in the 38 patients with diverted EP wounds with respect to presacral infection (PI) demonstrated the following: repair injury (n = 10), 0 PI versus no repair (n = 28), 3 PI (P = 0.55); washout (n = 33), 2 PI versus no washout (n = 5), 1 PI (P = 0.35); presacral drain (n = 30), 1 PI versus no drain (n = 8), 2 PI (P = 0.11). We conclude that most IP injuries can be managed with primary repair. EP wounds to the upper two-thirds of the rectum should usually be repaired. EP wounds to the lower one-third, which are explored and repaired, do not require drainage. EP wounds that are not explored should be managed with presacral drainage to minimize the incidence of presacral abscess.     

Engineering model of a passive planar air breathing fuel cell cathode

The behavior of an air breathing fuel cell (ABFC) operated on dry-hydrogen in dead-ended mode is studied using theoretical analysis. A one-dimensional, non-isothermal, combined heat and mass transport model is developed that captures the coupling between water generation, oxygen consumption, self-heating and natural convection at the air breathing cathode. The model is validated against planar ABFC experimental measurements over a range of ambient temperatures. The model confirms the strong effect of self-heating on the water balance within passive ABFCs. Model analysis provides several conclusions: (1) thermal runaway caused by inadequate heat rejection predominantly limits ABFC performance. (2) The natural convection boundary layer represents a significant barrier to cathode mass and heat transfer. (3) Because the mass and heat transport numbers associated with natural convection are small, even slight forced convection dramatically affects cell behavior. (4) Performance optimization requires maximizing heat rejection while minimizing flooding. Decoupling the latter two phenomena is challenging due to the exponential relationship between water vapor saturation and temperature.     

Disruption of cellular translational control by a viral truncated eukaryotic translation initiation factor 2alpha kinase homolog

Phosphorylation of eukaryotic translation initiation factor 2alpha (eIF2alpha) is a common cellular mechanism to limit protein synthesis in stress conditions. Baculovirus PK2, which resembles the C-terminal half of a protein kinase domain, was found to inhibit both human and yeast eIF2alpha kinases. Insect cells infected with wild-type, but not pk2-deleted, baculovirus exhibited reduced eIF2alpha phosphorylation and increased translational activity. The negative regulatory effect of human protein kinase RNA-regulated (PKR), an eIF2alpha kinase, on virus production was counteracted by PK2, indicating that baculoviruses have evolved a unique strategy for disrupting a host stress response. PK2 was found in complex with PKR and blocked kinase autophosphorylation in vivo, suggesting a mechanism of kinase inhibition mediated by interaction between truncated and intact kinase domains.     

Fracture analysis of materials with periodic microstructure by the representative cell method

The periodic structure of some natural and especially man-made materials can be manifested not only on an atomic but also on a larger scale. Investigation of mechanical properties of these materials usually hinges on well-developed homogenization methods. On the other hand, these methods are not suitable for fracture analysis where the knowledge of the local stress-strain fields near a flaw (a crack) is required. The result is obtained by the use of the representative cell method based on the discrete Fourier transform. This method enables one to determine the exact stress distribution in a periodic structure subjected to arbitrary loading. Direct application of the method is impossible since the crack violates the translational symmetry defined by the material microstructure. This obstacle is overcome by application of the fictitious loading to the uncracked body at the line where the crack is to be located. The amplitude of the loading is adjusted in order to fulfill the boundary conditions imposed on the crack faces. The compatibility equation for deriving this amplitude is obtained by the use of the corresponding Green function, which is found in a closed form. Fracture problems for the two types of materials with a periodic microstructure are considered. The first one is a composite material consisting of dissimilar isotropic elastic layers arranged periodically. The second periodic microstructure is a 2D infinite beam lattice modeling a cellular material. The analysis of the failure process in the latter case shows that in contrast to the case of homogeneous material, the crack propagation path is not defined by the condition of zero Mode II stress intensity factor.     

Prophylactic Greenfield filters: acute complications and long-term follow-up

The efficacy of prophylactic vena caval filters (VCF) in reducing morbidity and mortality from pulmonary embolism (PE) in high-risk trauma patients has been shown, but minimal follow-up data is currently available. VCFs were prophylactically placed in 110 patients between August 1991 and June 1995. There was an early VCF complication rate of 7%. Twenty-two patients died; the remaining 88 patients formed the basis for the follow-up study. Forty-five patients were located and interviewed by phone, and 30 of these patients (34%) returned for evaluation. The mean follow-up time was 18 months (range, 4-42 months). There was no incidence of caval thrombosis on follow-up. Eleven patients had physical findings, and duplex evidence consistent with postphlebitic syndrome. An additional three patients had evidence of old deep venous thrombosis (DVT) by duplex, but no significant symptomatology. VCF are effective in preventing PE related deaths and have few major complications. The long-term morbidity associated with posttraumatic venous thrombosis is significant. This morbidity is related not to PE or VCF, but to the underlying DVT. Improved strategies against DVT are necessary.     

Connectivity Based k-Hop Clustering in Wireless Networks

In this paper we describe several new clustering algorithms for nodes in a mobile ad hoc network. The main contribution is to generalize the cluster definition and formation algorithm so that a cluster contains all nodes that are at distance at most k hops from the clusterhead. We also describe algorithms for modifying cluster structure in the presence of topological changes. We also proposed an unified framework for most existing and new clustering algorithm where a properly defined weight at each node is the only difference in otherwise the same algorithm. This paper studied node connectivity and node ID as two particular weights, for k=1 and k=2. Finally, we propose a framework for generating random unit graphs with obstacles.     

Some aspects of the biology of Dermestes maculatus Degeer (Coleoptera,Dermestidae) in dried fish

The development of Dermestes maculatus Deg. in dried fish has been studied under uncontrolled laboratory conditions. Females laid eggs within 12 hr of copulation, and oviposition was improved by the presence of free water. Hatching occurred about 48 hr after oviposition. The characteristic appearance of the egg and the changes that occurred during incubation and hatching are described. Larval development was completed in 33·5 days during which seven moults occurred and a body length of 14 mm was attained. Larval life was prolonged by crowding. When intact pieces of fish were available, the last instar larva bored into one of them and pupated within the hardened larval skin, but when ground fish was provided, a quiescent prepupal stage was observed. The adult emerged about 11 days after the last instar larval stage, irrespective of the mode of pupation.     

Conduction in thin polymer films

Thin polymer films have been made from a variety of starting monomers and their electrical conduction has been studied.The films are produced both by ultraviolet surface photolysis and by a cold-cathode glow-discharge technique. The samples are made in the form of a capacitor sandwich on a glass substrate with aluminium electrodes. The whole sample is made in a high-vacuum system, without breaking vacuum, using out-of-contact masking techniques.Generally, depending on the starting monomer, the polymer films are short-free down to a thickness of about 100 Å, and electric fields up to 10⁷ V/cm may be sustained.The current/voltage characteristics of the films have been investigated as a function of temperature and thickness. One theory to account for the conduction in these materials is presented and compared with other approaches to the problem.     

An analytical model for snapback in n-channel SOI MOSFET's

An analytical snapback model for n-channel silicon-on-insulator (SOI) transistors with body either tied to the source or floating is been presented. The snapback is modeled as a nonlinear feedback system leading to negative transconductances from which the jump in current can occur at the point of instability. The crux of this model is based on the strong dependence of the transistor threshold voltage on the body potential when the body potential is above the transistor surface potential at strong inversion. No parasitic bipolar action is invoked to account for the snapback phenomena. The model correctly predicts the occurrence of hysteresis/latch phenomena and the conditions under which the current jump occurs despite some gross approximations in the electric field and the injection level. Results obtained from this model show good agreement with experimental data measured from SIMOX devices fabricated on 0.3-μm epi film     

Fast multiplication in VLSI using wave pipelining techniques

Wave pipelining is a design methodology that can increase the clock frequency of digital systems. Also known asmaximum-rate pipelining, it has long been considered a technique for approaching the physical speed limit of a digital circuit. Unlike conventional pipelining, wave pipelining does not require internal clocked elements to increase throughput. The synchronization of internal computations is achieved by balancing inherent RC delays of combinational logic elements, thus allowing circuits to be pipelined at a very fine-grain level. In this article, we describe the design of a 16×16 wave-pipelined multiplier using a 1.0 μm CMOS process. The multiplier is designed using a conventional static CMOS technology. Simulation results show a speedup of about 7× over a nonpipeline implementation.