Long-term results of obstetric brachial plexus surgery

Background: Brachial plexus birth palsy (BPBP) most often occurs as a result of foetal-maternal disproportion. The C5 and C6 nerve roots of the brachial plexus are most frequently affected. In contrast, roots from the C7 to Th1 that result in total injury together with C5 and C6 injury, are affected in fewer than half of the patients. BPBP was first described by Smellie in 1764. Erb published his classical description of the injury in 1874 and his name became linked with the paralysis that is associated with upper root injury. Since then, early results of brachial plexus surgery have been reasonably well documented. However, from a clinical point of view not all primary results are maintained and there is also a need for later follow-up results. In addition most of the studies that are published emanate from highly specialized clinics and no nation wide epidemiological reports are available. One of the plexus injuries is the avulsion type, in which the nerve root or roots are ruptured at the neural cord. It has been speculated whether this might cause injury to the whole neural system or whether shoulder asymmetry and upper limb inequality results in postural deformities of the spine. Alternatively, avulsion could manifest as other signs and symptoms of the whole musculoskeletal system. In addition, there is no available information covering activities of daily living after obstetric brachial plexus surgery. Patients and methods: This was a population-based cross-sectional study on all patients who had undergone brachial plexus surgery with at least 5 years of follow-up. An incidence of 3.05/1000 for BPBP was obtained from the registers for this study period. A total of 1706 BPBP patients needing hospital treatment out of 1 717 057 newborns were registered in Finland between 1971 and 1997 inclusive. Of these BPBP patients, 124 (7.3%) underwent brachial plexus surgery at a mean age of 2.8 months (range: 0.4―13.2 months). Surgery was most often performed by direct neuroraphy after neuroma resection (53%). Depending on the phase of the study, 105 to 112 patients (85-90%) participated in a clinical and radiological follow-up assessment. The mean follow up time exceeded 13 years (range: 5.0―31.5 years). Functional status of the upper extremity was evaluated using Mallet, Gilbert and Raimondi scales. Isometric strength of the upper limb, sensation of the hand and stereognosis were evaluated for both the affected and unaffected sides then the differences and their ratios were calculated and recorded. In addition to the upper extremity, assessment of the spine and lower extremities were performed. Activities of daily living (ADL), participation in normal physical activities, and the use of physiotherapy and occupational therapy were recorded in a questionnaire. Results: The unaffected limb functioned as the dominant hand in all, except four patients. The mean length of the affected upper limb was 6 cm (range: 1-13.5 cm) shorter in 106 (95%) patients. Shoulder function was recorded as a mean Mallet score of 3 (range: 2―4) which was moderate. Both elbow function and hand function were good. The mean Gilbert elbow scale value was 3 (range: -1―5) and the mean Raimondi hand scale was 4 (range:1―5). One-third of the patients experienced pain in the affected limb including all those patients (n=9) who had clavicular non-union resulting from surgery. A total of 61 patients (57%) had an active shoulder external rotation of less than 0° and an active elbow extension deficiency was noted in 82 patients (77%) giving a mean of 26° (range: 5°―80°). In all, expect two patients, shoulder external rotation strength at a mean ratio 35% (range: 0―83%) and in all patients elbow flexion strength at a mean ratio of 41% (range: 0―79%) were impaired compared to the unaffected side. According to radiographs, incongruence of the glenohumeral joint was noted in 15 (16%) patients, whereas incongruence of the radiohumeral joint was found in 20 (21%) patients. Fine sensation was normal for 34/49 (69%) patients with C5-6 injury, for 15/31 (48%) with C5-7 and for only 8/25 (32%) of patients with total injury. Loss of protective sensation or absent sensation was noted in some palmar areas of the hand for 12/105 patients (11%). Normal stereognosis was recorded for 88/105 patients (84%). No significant inequalities in leg length were found and the incidence of structural scoliosis (1.7%) did not differ from that of the reference population. Nearly half of the patients (43%) had asynchronous motion of the upper limbs during gait, which was associated with impaired upper limb function. Data obtained from the completed questionnaires indicated that two thirds (63%) of the patients were satisfied with the functional outcome of the affected hand although one third of all patients needed help with ADL. Only a few patients were unable to participate in physical activities such as: bicycling, cross-country skiing or swimming. However, 71% of the patients reported problems related to the affected upper limb, such as muscle weakness and/or joint stiffness during the aforementioned activities. Incongruity of the radiohumeral joints, extent of the injury, avulsion type injury, age less than three months of age at the time of plexus surgery and inexperience of the surgeon was related to poor results as determined by multivariate analyses. Conclusions: Most of the patients had persistent sequelae, especially of shoulder function. Almost all measurements for the total injury group were poorer compared with those of the C5-6 type injury group. Most of the patients had asymmetry of the shoulder region and a shorter affected upper limb, which is a probable reason for having an abnormal gait. However, BPBP did not have an effect on normal growth of the lower extremities or the spine. Although, participation in physical activities was similar to that of the normal population, two-thirds of the patients reported problems. One-third of the patients needed help with ADL. During the period covered by this study, 7.3% BPBP of patients that needed hospital treatment had a brachial plexus operation, which amounts to fewer than 10 operations per year in Finland. It seems that better results of obstetric plexus surgery and more careful follow-up including opportunities for late reconstructive procedures will be expected, if the treatment is solely concentrated on by a few specialised teams.

Microplastic ingestion by scleractinian corals

We report for the first time the ingestion of microplastics by scleractinian corals, and the presence of microplastics in coral reef waters adjacent to inshore reefs on Australia’s Great Barrier Reef (GRE, 18°31′S 146°23′E). Analysis of samples from sub-surface plankton tows conducted in close proximity to inshore reefs on the central GBR revealed microplastics, similar to those used in marine paints and fishing floats, were present in low concentrations at all water sampling locations. Experimental feeding trials revealed that corals mistake microplastics for prey and can consume up to ~50 μg plastic cm−2 h−1, rates similar to their consumption of plankton and Artemia nauplii in experimental feeding assays. Ingested microplastics were found wrapped in mesenterial tissue within the coral gut cavity, suggesting that ingestion of high concentrations of microplastic debris could potentially impair the health of corals.

An asymptotic analysis of a simple model for the structure and dynamics of the Ramdas layer

This paper presents a complete asymptotic analysis of a simple model for the evolution of the nocturnal temperature distribution on bare soil in calm clear conditions. The model is based on a simplified flux emissivity scheme that provides a nondiffusive local approximation for estimating longwave radiative cooling near ground. An examination of the various parameters involved shows that the ratio of the characteristic radiative to the diffusive timescale in the problem is of order 10(-3), and can therefore be treated as a small parameter (mu). Certain other plausible approximations and linearization lead to a new equation whose asymptotic solution as mu --> 0 can be written in closed form. Four regimes, consishttp://eprints.iisc.ernet.in/cgi/users/home?screen=EPrint::Edit&eprintid=27192&stage=core#tting of a transient at nominal sunset, a radiative-diffusive boundary ('Ramdas') layer on ground, a boundary layer transient and a radiative outer solution, are identified. The asymptotic solution reproduces all the qualitative features of more exact numerical simulations, including the occurrence of a lifted temperature minimum and its evolution during night, ranging from continuing growth to relatively sudden collapse of the Ramdas layer.

Drainage and separation factors for static foams containing agglomerates of microbial cells

The presence of cell agglomerates has been found to influence significantly the rates of liquid drainage from static foams. The process of drainage has been modelled by considering the foam to be made of pentagonal dodecahedral bubbles yielding films, nearly horizontal and nearly vertical Plateau borders. The films are assumed to drain into both kinds of Plateau borders equally. The horizontal Plateau borders are assumed to receive liquid from the films and drain into the vertical Plateau borders, which, in turn, form the main flow paths for gravity drainage. The drainage process is assumed to be similar to that for pure liquid until a stage is reached where the size of the cell agglomerates become equivalent to those of films and Plateau borders. Thereafter, a squeezing flow mechanism has been formulated where the aggromerates deform and flow. The model based on the above assumptions has been verified against experimental results and has been found to predict not only drainage data but also the separation of cell agglomerates from broths.

Symmetry adaptation of correlated states in the valence bond basis

Symmetry?adapted linear combinations of valence?bond (VB) diagrams are constructed for arbitrary point groups and total spin S using diagrammatic VB methods. VB diagrams are related uniquely to invariant subspaces whose size reflects the number of group elements; their nonorthogonality leads to sparser matrices and is fully incorporated into a binary integer representation. Symmetry?adapated linear combinations of VB diagrams are constructed for the 1764 singlets of a half?filled cube of eight sites, the 2.8 million ??electron singlets of anthracene, and for illustrative S?0 systems.

Greenhouse gas inventory estimates for India

This article reports the greenhouse gas emissions of anthropogenic origin by sources and removals by sinks of India for 2007 prepared under the aegis of the Indian Network for Climate Change Assessment (INCCA) (note 1). The emission profile includes carbon dioxide (CO(2)), methane and nitrous oxide. It also includes the estimates of hydrofluorocarbons, perfluorocarbons and sulphur hexafluoride at the national level from various sectors, viz, energy, industrial process and product use, agriculture, land-use, land-use change and forestry (LULUCF), and waste. In 2007, emissions were of the order of 2008.67 Tg (note 2) of CO(2) equivalents without emissions from the LULUCF sector. Whereas with LULUCF the emissions were about 1831.65 Tg CO(2) equivalents. The energy sector accounted for 69% of the total emissions, the agriculture sector contributed 19% of the emissions, 9% of the emissions was from the industrial processes and product use, and only 3% of the emissions was attributable to the waste sector. The LULUCF sector on the whole was net sink category for CO(2). The study tracks the improvements made in inventory estimates at the national level through the years, in terms of the expanding coverage of sources, reducing uncertainties and inclusion of new methodologies, including some elements of future areas of work.

Potentiometric determination of the Gibbs free energy of formation of cadmium and magnesium chromites

The standard Gibbs free energy of formation of magnesium and cadmiumchromites have been determined by potentiometric measurements on reversiblesolid-state electrochemical cells [dformula (Au-5%Cd, , Au-5%Cd; Pt, + , CaO-ZrO[sub 2], + ,Pt; CdO, , CdCr[sub 2]O[sub 4] + Cr[sub 2]O[sub 3])] in the temperature range 500°–730°C, and [dformula Pt, Cr + Cr[sub 2]O[sub 3]/Y[sub 2]O[sub 3]-ThO[sub 2]/Cr + MgCr[sub 2]O[sub 4] + MgO, Pt] in the temperature range 800°–1200°C. The temperature dependence of the freeenergies of formation of the ternary compounds can be represented by theequations [dformula CdO(r.s.) + Cr[sub 2]O[sub 3](cor) --> CdCr[sub 2]O[sub 4](sp)] [dformula Delta G[sup 0] = - 42,260 + 7.53T ([plus-minus]400) J] and [dformula MgO(r.s.) + Cr[sub 2]O[sub 3](cor) --> MgCr[sub 2]O[sub 4](sp)] [dformula Delta G[sup 0] = - 45,200 + 5.36T ([plus-minus]400) J] The entropies of formation of these spinels are discussed in terms of cationdisorder and extent of reduction of Cr3+ ions to Cr2+ ions. Thermodynamicdata on the chromates of cadmium and magnesium are derived by combiningthe results obtained in this study with information available in the literatureon high temperature, high pressure phase equilibria in the systems CdO-Cr2O3-O2 and MgO-Cr2O3-O2.

MULTI-OBJECTIVE GENETIC ALGORITHM FOR EFFICIENT POINT MATCHING IN MULTI-SENSOR SATELLITE IMAGE

This paper investigates a new approach for point matching in multi-sensor satellite images. The feature points are matched using multi-objective optimization (angle criterion and distance condition) based on Genetic Algorithm (GA). This optimization process is more efficient as it considers both the angle criterion and distance condition to incorporate multi-objective switching in the fitness function. This optimization process helps in matching three corresponding corner points detected in the reference and sensed image and thereby using the affine transformation, the sensed image is aligned with the reference image. From the results obtained, the performance of the image registration is evaluated and it is concluded that the proposed approach is efficient.

Accurate performance analysis of single and opportunistic AF relay cooperation with imperfect cascaded channel estimates

Given the significant gains that relay-based cooperation promises, the practical problems of acquisition of channel state information (CSI) and the characterization and optimization of performance with imperfect CSI are receiving increasing attention. We develop novel and accurate expressions for the symbol error probability (SEP) for fixed-gain amplify-and-forward relaying when the destination acquires CSI using the time-efficient cascaded channel estimation (CCE) protocol. The CCE protocol saves time by making the destination directly estimate the product of the source-relay and relay-destination channel gains. For a single relay system, we first develop a novel SEP expression and a tight SEP upper bound. We then similarly analyze an opportunistic multi-relay system, in which both selection and coherent demodulation use imperfect estimates. A distinctive aspect of our approach is the use of as few simplifying approximations as possible, which results in new results that are accurate at signal-to-noise-ratios as low as 1 dB for single and multi-relay systems. Using insights gleaned from an asymptotic analysis, we also present a simple, closed-form, nearly-optimal solution for allocation of energy between pilot and data symbols at the source and relay(s).

Multispecies coexistence of trees in tropical forests: spatial signals of topographic niche differentiation increase with environmental heterogeneity

Neutral and niche theories give contrasting explanations for the maintenance of tropical tree species diversity. Both have some empirical support, but methods to disentangle their effects have not yet been developed. We applied a statistical measure of spatial structure to data from 14 large tropical forest plots to test a prediction of niche theory that is incompatible with neutral theory: that species in heterogeneous environments should separate out in space according to their niche preferences. We chose plots across a range of topographic heterogeneity, and tested whether pairwise spatial associations among species were more variable in more heterogeneous sites. We found strong support for this prediction, based on a strong positive relationship between variance in the spatial structure of species pairs and topographic heterogeneity across sites. We interpret this pattern as evidence of pervasive niche differentiation, which increases in importance with increasing environmental heterogeneity.

Seismic hazard maps and spectrum for Patna considering region-specific seismotectonic parameters

The objective of this paper was to develop the seismic hazard maps of Patna district considering the region-specific maximum magnitude and ground motion prediction equation (GMPEs) by worst-case deterministic and classical probabilistic approaches. Patna, located near Himalayan active seismic region has been subjected to destructive earthquakes such as 1803 and 1934 Bihar-Nepal earthquakes. Based on the past seismicity and earthquake damage distribution, linear sources and seismic events have been considered at radius of about 500 km around Patna district center. Maximum magnitude (M (max)) has been estimated based on the conventional approaches such as maximum observed magnitude (M (max) (obs) ) and/or increment of 0.5, Kijko method and regional rupture characteristics. Maximum of these three is taken as maximum probable magnitude for each source. Twenty-seven ground motion prediction equations (GMPEs) are found applicable for Patna region. Of these, suitable region-specific GMPEs are selected by performing the `efficacy test,' which makes use of log-likelihood. Maximum magnitude and selected GMPEs are used to estimate PGA and spectral acceleration at 0.2 and 1 s and mapped for worst-case deterministic approach and 2 and 10 % period of exceedance in 50 years. Furthermore, seismic hazard results are used to develop the deaggregation plot to quantify the contribution of seismic sources in terms of magnitude and distance. In this study, normalized site-specific design spectrum has been developed by dividing the hazard map into four zones based on the peak ground acceleration values. This site-specific response spectrum has been compared with recent Sikkim 2011 earthquake and Indian seismic code IS1893.

Microstructure and mechanical properties at TiCp/Ni-alloy interfaces in laser-synthesized coatings

Titanium carbide particle (TiCp) reinforced Ni alloy composite coatings were synthesized by laser cladding using a cw 3 kW CO2 laser. Two kinds of coatings were present in terms of TiCp origins, i.e. undissolved and in situ reacted TiCp, respectively. The former came from the TiCp pre-coated on the sample, whereas the latter from in situ reaction between titanium and graphite in the molten pool during laser irradiation. Conventional and high-resolution transmission electron microscope observations showed the epitaxial growth of TiC, the precipitation of CrB, and the chemical reaction between Ti and B elements around phase interfaces of undissolved TiCp. The hardness, H, and elastic modulus, E, were measured by nanoindentation of the matrix near the TiCp interface. For undissolved TiCp, the loading curve revealed pop-in phenomena caused by the plastic deformation of the crack formation or debounding of TiCp from the matrix. As for in situ generated TiCp, no pop-in mark appears. On the other hand, in situ reacted TiCp led to much higher hardness and modulus than that in the case of undissolved TiCp. The coating reinforced by in situ generated TiCp displayed the highest impact wear resistance at both low and high impact conditions, as compared with coatings with undissolved TiCp and without TiCp. The impact wear resistance of the coating reinforced by undissolved TiCp increases at a low impact work but decreases at a high impact work, as compared with the single Ni alloy coating. The degree of wear for the composite coating depends primarily on the debonding removal of TiCp.

高超声速湍流分离激波运动特性

给出半圆柱前缘舵诱导的高超声速湍流分离激波运动特性。实验气流M数为7.8单位长度Re数为3.5×10~7/m。结果表明，随着M数的增加，分离激波两边压力比的平均值加大，但对其用前缘直径无量纲的激波运动区长度和用自由流速度无量纲的激波向上（下）游运动速度的平均值影响不大。