Investigation of contact behavior on a model of the dual-mobility artificial hip joint for Asians in different inner liner thicknesses.

BACKGROUND: The four components that make up the current dual-mobility artificial hip joint design are the femoral head, the inner liner, the outer liner as a metal cover to prevent wear, and the acetabular cup. The acetabular cup and the outer liner were constructed of 316L stainless steel. At the same time, the inner liner was made of ultra-high-molecular-weight polyethylene (UHMWPE). As this new dual-mobility artificial hip joint has not been researched extensively, more tribological research is needed to predict wear. The thickness of the inner liner is a significant component to consider when calculating the contact pressure. AIM: To make use of finite element analysis to gain a better understanding of the contact behavior in various inner liner thicknesses on a new model of a dual-mobility artificial hip joint, with the ultimate objective of determining the inner liner thickness that was most suitable for this particular type of dual-mobility artificial hip joint. METHODS: In this study, the size of the femoral head was compared between two diameters (28 mm and 36 mm) and eight inner liner thicknesses ranging from 5 mm to 12 mm. Using the finite element method, the contact parameters, including the maximum contact pressure and contact area, have been evaluated in light of the Hertzian contact theory. The simulation was performed statically with dissipated energy and asymmetric behavior. The types of interaction were surface-to-surface contact and normal contact behavior. RESULTS: The maximum contact pressures in the inner liner (UHMWPE) at a head diameter of 28 mm and 36 mm are between 3.7-13.5 MPa and 2.7-10.4 MPa, respectively. The maximum von Mises of the inner liner, outer liner, and acetabular cup are 2.4-11.4 MPa, 15.7-44.3 MPa, and 3.7-12.6 MPa, respectively, for 28 mm head. Then the maximum von Mises stresses of the 36 mm head are 1.9-8.9 MPa for the inner liner, 9.9-32.8 MPa for the outer liner, and 2.6-9.9 MPa for the acetabular cup. A head with a diameter of 28 mm should have an inner liner with a thickness of 12 mm. Whereas the head diameter was 36 mm, an inner liner thickness of 8 mm was suitable. CONCLUSION: The contact pressures and von Mises stresses generated during this research can potentially be exploited in estimating the wear of dual-mobility artificial hip joints in general. Contact pressure and von Mises stress reduce with an increasing head diameter and inner liner's thickness. Present findings would become one of the references for orthopedic surgery for choosing suitable bearing geometric parameter of hip implant.

Calcination-based direct extraction of hydroxyapatite from bovine bone waste.

The main chemical components of waste cow bones are apatite minerals, especially those containing calcium and phosphorus. This study investigated whether this bone could produce extracted hydroxyapatite through calcining at 900° C for different holding times (1-6 h). An average mass loss of 45% occurred in this experiment during the preparation of bone powders, which involved crushing and further calcining at this temperature. The quantitative XRD analysis showed that 99.97 wt.% hydroxyapatite and over 0.3 wt.% calcite were present in the raw and as-calcined bone powders, with trace amounts of CaFe3O5 (calcium ferrite) phases appearing in the calcined product. Depending on the holding calcining times, SEM images of the calcined bovine powders revealed aggregate sizes ranging from 0.5-3 µm and crystallite (grain) sizes ranging from 70 to 340 nm in all calcium-phosphate powder products. Following EDX analysis of all sample surfaces, possible calcium-deficient hydroxyapatite instead of hydroxyapatite formed, as evidenced by the calcined product's Ca/P ratio exceeding 1.67. Additionally, calcining cow bones for 5-6 h at 900° C yielded a high-purity nano-crystalline hydroxyapatite powder precursor in biomedical applications.

Performance of textured dual mobility total hip prosthesis with a concave dimple during Muslim prayer movements.

The single mobility bearing as a previous bearing design of total hip prosthesis has severe mobility constraints that can result in dislocation during Muslim (people who follow the Islam as religion) prayer movements, specifically shalat that requires intense movement. There are five intense movements (i.e., bowing, prostration, sitting, transition from standing to prostration, and final sitting) during Muslim prayer that may generate an impingement problem for patients with total hip prosthesis. In this work, textured dual mobility total hip prosthesis with two textured cases (i.e., textured femoral head and textured inner liner) are presented and their performances are numerically evaluated against untextured surface model during Muslim prayer movement. The concave dimple design is chosen for surface texturing, while for simulating femoral head materials, SS 316L and CoCrMo is choosen. To represent the real condition, three-dimensional computational fluid dynamics (CFD) coupled with two-way fluid-structure interaction (FSI) methods are employed to analyze elastohydrodynamic lubrication problem with non-Newtonian synovial fluid model. The main aim of the present study is to investigate the tribological performance on dual mobility total hip prosthesis with applied textured surface with concave dimple in femoral head and inner liner surface under Muslim prayer movements. It is found that applying surface texturing has a beneficial effect on the lubrication performance for some intense movements. The textured femoral head model performs better than textured inner liner model and untextured model (both femoral head and inner liner). The numerical results also indicate superior performance of CoCrMo femoral head compared to SS 316L femoral head. These findings can be used as a reference for biomedical engineers and orthopedic surgeons in designing and choosing suitable total hip prosthesis for Muslims makes they can carry out Muslim prayer movements like humans in general who have normal hip joints.

In-depth knowledge of the low-temperature hydrothermal synthesis of nanocrystalline hydroxyapatite from waste green mussel shell (Perna Viridis).

ABSTRACTThis study presents the use of a low-temperature hydrothermal method for extracting calcium sources from green mussel shell (P. Viridis) wastes and converting them into synthetic nanosized hydroxyapatite (HA). In this study, raw mussel shells were washed, pulverised, and sieved to start producing a fine calcium carbonate-rich powder. XRD quantitative analysis confirmed that the powder contains 97.6 wt. % aragonite. This powder was then calcined for 5 h at 900 °C to remove water, salt, and mud, yielding a calcium-rich feedstock with major minerals of calcite (68.7 wt.%), portlandite (24.7 wt.%), and minor aragonite (6.5 wt.%). The calcined powders were dissolved in aqueous stock solutions of HNO3 and NH4OH before hydrothermally reacting with phosphoric acid [(NH4)2HPO4], yielding pure, nanoscale (16-18 nm) carbonated HA crystals, according to XRD, FT-IR, and SEM analyses. The use of a low-temperature hydrothermal method for a feedstock powder produced by the calcination of low-cost mussel shell wastes would be a valuable processing approach for the industry's development of large-scale hydroxyapatite nanoparticle production.

Optimisation of the machining time required by insole orthotic shoes for patients with clubfoot using the Taguchi and response surface methodology approach.

In this study, the application of the computer-aided reverse engineering system (CARE) to the novel design and manufacture of a comfortable insole for a clubfoot patient is presented. The Taguchi method (TM) and response surface methodology (RMS) were used to predict the machining time of the orthotic boot insole during both computer-aided manufacturing (CAM) simulation and computer numerical control (CNC) machining. Taguchi's experimental design, presented as a matrix orthogonal array L2736, was acquired for controlling parameters, namely tool path strategy (A), spindle speed (B), step-down (C), step-over of the cutter (D), cutter diameter (E), and dimensional tolerance (F) of the insole size. In this method, the model generated by the RMS method evaluates the six parameters influencing the machining time. The objective of this study is to develop a regression model that demonstrates the relationship between the cutting parameters and insole machining time. The optimal parameters are A1B1C3D2E1F2, where A1 denotes raster finishing, B1 denotes a spindle speed of 10,000 rpm, C3 denotes a step-down of 850 mm, D2 denotes a step-over of 0.25 mm, E1 denotes a cutter diameter of 20-35 mm, and F2 deontes a tolerance of 0.75 mm. The experimental and calculated machining time (tm) results were 236 and 125.4 min, respectively. However, the real machining results were 334 and 152.25 min with error values of 46.86% and 54.42%, respectively. Meanwhile, with the tm RMS method, the simulated and calculated machining time results were 189.22 and 236.35 min, whereas the real tm values were 236.52 and 334.86 min with error values of 19.94% and 29.37%, respectively. This research obtains improvements of 19.82% (simulation time) and 29.19% (real-time).

Impact of Silver-Decorated Graphene Oxide (Ag-GO) towards Improving the Characteristics of Nanohybrid Polysulfone Membranes.

The utilization of membranes has been extensively employed in the treatment of water and wastewater. Membrane fouling, attributed to the hydrophobic nature of membranes, constitutes a noteworthy concern in the realm of membrane separation. The mitigation of fouling can be achieved through the modification of membrane characteristics, including but not limited to hydrophilicity, morphology, and selectivity. In this study, a nanohybrid polysulfone (PSf) membrane embedded with silver-graphene oxide (Ag-GO) was fabricated to overcome problems related to biofouling. The embedment of Ag-GO nanoparticles (NPs) is the aim towards producing membranes with antimicrobial properties. The fabricated membranes at different compositions of NPs (0 wt%, 0.3 wt%, 0.5 wt%, and 0.8 wt%) are denoted as M0, M1, M2, and M3, respectively. These PSf/Ag-GO membranes were characterized using FTIR, water contact angle (WCA) goniometer, FESEM, and salt rejection. The additions of GO significantly improved the hydrophilicity of PSf membranes. An additional OH peak at 3380.84 cm-1 of the nanohybrid membrane from FTIR spectra may be related to hydroxyl (-OH) groups of GO. The WCA of the fabricated membranes decreased from 69.92° to 54.71°, which confirmed the improvement in its hydrophilicity. In comparison to the pure PSf membrane, the morphology of the finger-like structure of the fabricated nanohybrid membrane slightly bent with a larger bottom part. Among the fabricated membranes, M2 achieved the highest iron (Fe) removal, up to 93%. This finding proved that the addition of 0.5 wt% Ag-GO NPs enhanced the membrane water permeability together with its performance of ionic solute removal (Fe2+) from synthetic groundwater. In conclusion, embedding a small amount of Ag-GO NPs successfully improved the hydrophilicity of PSf membranes and was able to achieve high removal of Fe at 10-100 mg L-1 towards purification of groundwater for safe drinking water.

Selectivity of reaction pathways for green diesel production towards biojet fuel applications.

Green diesel is the second generation biofuel with the same structure as fossil fuels (alkanes), allowing this biofuel to provide excellent fuel properties over biodiesel such as higher energy content and lower hazardous gas emission. Generally, green diesel can be produced through the deoxygenation/hydrogenation of natural oil and/or its derivatives at 200-400 °C and 1-10 MPa over supported metal catalysts. This process comprises of three reaction pathways: hydrodeoxygenation, decarboxylation, and decarbonylation. The extent to which these three different pathways are involved is strongly influenced by the catalyst, pressure, and temperature. Subsequently, the determination of catalyst and reaction condition plays a significant role owing to the feasibility of the process and the economic point of view. This article emphasizes the reaction pathway of green diesel production as well as the parameters influencing the predominant reaction route.

A Prospective Study Comparing the Infection Rate Between Buried vs Exposed Kirschner Wires in Hand and Wrist Fixations.

INTRODUCTION: Kirschner wires (K-wires) are used in fracture fixations but are often associated with pin tract infections. This prospective study compared the infection rate between buried and exposed K-wires in closed injuries of the wrist and hands in individuals with no comorbidities. METHODS: Fifteen patients were recruited with a total of 41 K-wires (21 buried K-wires; 20 exposed K-wires). Clinical and radiographic evidence of infection was assessed at three months based on the Modified Oppenheim classification. RESULTS: Two out of 21 wires in the buried group developed grade 4 infection, while 20 wires in the exposed group did not have any significant infection. No significant difference in infection rate based on K-wire size or number in both groups. CONCLUSION: There is no significant difference in infection rate between buried and exposed K-wires in healthy individuals with closed injuries of the wrist and hand.

A Comparison of the Incidence Rate for Joint Bleeding and FVIII Consumption between On-Demand versus Prophylaxis Factor VIII Replacement Therapy and the Direct Cost of Prophylaxis Treatment in Severe Haemophilia A Patients.

Background: Haemophilia A is a bleeding disorder caused by inadequate clotting factor VIII (FVIII). There are two main modes of treatment approach in severe haemophilia A patients either with on-demand or prophylaxis therapy with clotting factor FVIII concentrates. In this study, a comparison was made between the bleeding incidence rate of the on-demand and prophylaxis group in severe haemophilia A patients at Ampang Hospital, Malaysia. Methods: A retrospective study involving patients with severe haemophilia was conducted. The patient's self-reported bleeding frequency was retrieved from the patient's treatment folder from January to December 2019. Results: Fourteen patients received on-demand therapy, while the other 24 patients received prophylaxis treatment. The total number of joint bleeds in the prophylaxis group was significantly lower compared to the on-demand group (2.79 bleeds versus 21.36 bleeds [P < 0.001]). Furthermore, the total annual usage of FVIII was higher in the prophylaxis group compared to the on-demand group (1,506 IU/kg/year [± 905.98] versus 365.26 IU/kg/year [± 223.90], P = 0.001). Conclusion: Prophylaxis FVIII therapy is an effective treatment in reducing the frequency of bleeding joints. However, this treatment approach is associated with high cost due to the high consumption of FVIII.

Analysis of contact pressure in a 3D model of dual-mobility hip joint prosthesis under a gait cycle.

Hip joint prostheses are used to replace hip joint function in the human body. The latest dual-mobility hip joint prosthesis has an additional component of an outer liner that acts as a cover for the liner component. Research on the contact pressure generated on the latest model of a dual-mobility hip joint prosthesis under a gait cycle has never been done before. The model is made of ultrahigh molecular weight polyethylene (UHMWPE) on the inner liner and 316L stainless steel (SS 316L) on the outer liner and acetabular cup. Simulation modeling using the finite element method is considered static loading with an implicit solver for studying the geometric parameter design of dual-mobility hip joint prostheses. In this study, simulation modeling was carried out by applying varying inclination angles of 30°, 40°, 45°, 50°, 60°, and 70° to the acetabular cup component. Three-dimensional loads were placed on femoral head reference points with variations of femoral head diameter used at 22 mm, 28 mm, and 32 mm. The results in the inner surface of the inner liner, the outer surface of the outer liner, and the inner surface of the acetabular cup showed that the variations in inclination angle do not have a major effect on the maximum contact pressure value on the liner component, where the acetabular cup with an inclination angle of 45° can reduce contact pressure more than the other studied inclination angle variations. In addition, it was found that the 22 mm diameter of the femoral head increases the contact pressure. The use of a larger diameter femoral head with an acetabular cup configuration at a 45° inclination can minimize the risk of implant failure due to wear.

Safety of Lidocaine During Wide-Awake Local Anesthesia No Tourniquet for Distal Radius Plating.

Purpose: This study evaluated the clinical and biochemical safety profile of infiltration of lidocaine with adrenaline in wide-awake local anesthesia no tourniquet for distal radius plating. Methods: Twenty-four participants were randomly assigned to the therapeutic group (n = 19) (1% lidocaine in 1:100,000 adrenaline) and control group (n = 5) (2% lidocaine alone). Clinical parameters, including skin necrosis, duration of recovery of sensation, and lidocaine toxicity, were monitored. The serum lidocaine level was measured at different time intervals using a high-performance liquid chromatography reagent. Results: No lidocaine toxicity was recorded in any participant. The therapeutic group had a longer time for recovery of sensation. There was a significant difference in the serum lidocaine levels between both the groups at all time intervals up to 6 hours, with all participants exhibiting serum lidocaine levels below the mild toxicity level of 6.0 µg/mL. Conclusions: Lidocaine used within a safe recommended dose in wide-awake local anesthesia no tourniquet for distal radius plating is clinically and biochemically safe. Clinical relevance: Determining the clinical and biochemical safety profile of lidocaine with adrenaline in wide-awake local anesthesia no tourniquet can promote wider use of this technique.

Adopted walking condition for computational simulation approach on bearing of hip joint prosthesis: review over the past 30 years.

Bearing on artificial hip joint experiences friction, wear, and surface damage that impact on overall performance and leading to failure at a particular time due to continuous contact that endangers the user. Assessing bearing hip joint using clinical study, experimental testing, and mathematical formula approach is challenging because there are some obstacles from each approach. Computational simulation is an effective alternative approach that is affordable, relatively fast, and more accessible than other approaches in examining various complex conditions requiring extensive resources and several different parameters. In particular, different gait cycles affect the sliding distance and distribution of gait loading acting on the joints. Appropriate selection and addition of gait cycles in computation modelling are crucial for accurate and reliable prediction and analysis of bearing performance such as wear a failure of implants. However, a wide spread of gait cycles and loading data are being considered and studied by researchers as reported in literature. The current article describes a comprehensive literature review adopted walking condition that has been carried out to study bearing using computational simulation approach over the past 30 years. Many knowledge gaps related to adoption procedures, simplification, and future research have been identified to obtain bearing analysis results with more realistic computational simulation approach according to physiological human hip joints.

Application of fused deposition modeling (FDM) on bone scaffold manufacturing process: A review.

Some of the health issues that are becoming more prevalent each year include bone disease and fractures. Because the natural healing process of bones takes a long time, a bone grafting procedure is required so that the patient's condition can improve rapidly. Because bone grafting procedures such as autographs, allographs, and xenografts have limits, bone replacement is constructed by employing biomaterials in the form of a bone scaffold via additive manufacturing. As a result, fused deposition modeling (FDM) is a proposed technology for the manufacturing process because it is straightforward, capable of producing complex parts and adjustable shapes, and has minimal operational expenses. However, implementing this technique is challenging because of the scarcity of biocompatible and bioactive materials that are suited. This technology has a number of limitations, including a limited variety of biocompatible and bioactive materials, the most appropriate microarchitecture of bone scaffold, and the establishment of printing parameters that can produce bone scaffold with the strongest mechanical properties. This article discusses current advancements in the use of FDM technologies for bone scaffold production.

Case report: Kaposi hemangioendothelioma of the right upper limb with the Kasabach-Merritt phenomenon: A potentially lethal diagnostic challenge.

Kaposi hemangioendothelioma (KHE) is a rare vascular neoplasm that presents usually within the first year of life. Because of its rarity and complexity, there is often a delay in diagnosis. KHE could be associated with a life-threatening consumptive coagulopathy named the Kasabach-Merritt phenomenon (KMP). Here, we present the case of a 2-month-old girl who presented with progressive redness and swelling of her right upper limb over 6 weeks. Multiple health practitioners misdiagnosed her condition as an insect bite, cellulitis, and necrotizing fasciitis and gave treatment accordingly, which proved futile. A full blood count revealed bicytopenia of anemia and thrombocytopenia, a normal coagulation cascade, low fibrinogen, and raised D-Dimer levels. The imaging was suggestive of a high-flow vascular tumor likely to be a KHE. Subsequently, she was started on single-agent oral sirolimus with a dose increment to achieve satisfactory therapeutic levels and was treated for 1 year. She successfully completed the treatment regimen and had only transient hypertriglyceridemia, which resolved upon the completion of treatment. Currently, she is in remission 3 years after treatment. Keeping her case as an example, we would like to highlight the potentially lethal misdiagnosis of KHE with KMP, the importance of an early diagnosis of this condition, and the successful treatment outcome with single-agent sirolimus.

Practical insights into the recycling of green mussel shells (Perna Viridis) for the production of precipitated calcium carbonate.

The study presented a powder processing method involving calcination and subsequent carbonation in the synthesis of precipitated calcium carbonate (PCC) for recycling green mussel shells, which contain a high calcium carbonate content. The purity of portlandite [Ca(OH)2] as a result of calcination and subsequent moisture absorption during storage was verified using the XRD-Rietveld method. Further quantitative XRD Rietveld analysis of the PCC product confirmed the presence of vaterite (55.20 wt.%) and calcite (44.80 wt.%) minerals after carbonation process of the calcined powder product. The SEM examination of this product revealed particle aggregates of non-uniform polyhedral and cubical grains of varying small and large sizes. The FTIR analysis also confirmed that calcination and subsequent hydration of mussel shell powder yielded pure portlandite, whereas the carbonation yielded PCC polymorphism. As a result, this powder processing method is simple to scale and reduces the cost of PCC synthesis, which is critical for practical applications. The current study demonstrated that the powder processing method for recycling green mussel shells as starting materials in biomedical applications is technically feasible.

Computational Contact Pressure Prediction of CoCrMo, SS 316L and Ti6Al4V Femoral Head against UHMWPE Acetabular Cup under Gait Cycle.

Due to various concerns about the use of metal-on-metal that is detrimental to users, the use of metal as acetabular cup material was later changed to ultra high molecular weight polyethylene (UHMWPE). However, the wear on UHMWPE releases polyethylene wear particles, which can trigger a negative body response and contribute to osteolysis. For reducing the wear of polyethylene, one of the efforts is to investigate the selection of metal materials. Cobalt chromium molybdenum (CoCrMo), stainless steel 316L (SS 316L), and titanium alloy (Ti6Al4V) are the frequently employed materials. The computational evaluation of contact pressure was carried out using a two-dimensional axisymmetric model for UHMWPE acetabular cup paired with metal femoral head under gait cycle in this study. The results show Ti6Al4V-on-UHMWPE is able to reduce cumulative contact pressure compared to SS 316L-on-UHMWPE and CoCrMo-on-UHMWPE. Compared to Ti6Al4V-on-UHMWPE at peak loading, the difference in cumulative contact pressure to respective maximum contact pressure is 9.740% for SS 316L-on-UHMWPE and 11.038% for CoCrMo-on-UHMWPE.

Eco-friendly bio-based adhesive for plywood from natural rubber latex (NRL)-blended isocyanate cross-linked starch.

Synthetic adhesives used in the production of plywood are a matter of concern because of the emission of carcinogenic gas formaldehyde, increased environmental pollution, and the depletion of fossil fuels. In this study, a bioadhesive composed of natural rubber latex (NRL) and rice starch was developed. However, rice starch has low moisture resistance, resulting in low adhesion. Thus, to enhance the effectiveness of NRL-blended rice starch-based bioadhesive, rice starch was cross-linked with polymeric 4,4″-diphenylmethane diisocyanate (pMDI) resin, which is an environment-friendly, formaldehyde free, and moisture resistant that is highly compatible with starch. The chemical interaction, viscosity, solid content, and gel time of the developed NRL-isocyanate cross-linked rice starch-based bioadhesive was investigated. The efficacy of the formulated bioadhesive was demonstrated by the fabrication of plywood. The presence of isocyanate and urethane capabilities in the bioadhesive formulations was confirmed by Fourier transform infrared spectroscopy (FTIR). The bioadhesive type Iso-A was discovered to have the highest viscosity of 8270 mPa.s, whereas Iso-B has the shortest gel time of 3.46 min and the highest solid content of 44%; the higher solid content accelerates the gel time. In terms of physical and mechanical properties of plywood, Iso-B has the lowest thickness swelling (TS) value of 13%, lowest water absorption (WA) value of 52% and shear strength value of 1.92 MPa, which corresponds to the ISO 12466-2-2007 standard requirements. Based on the results, NRL-blended isocyanate starch-based bioadhesive could be a good potential raw material for eco-friendly plywood industries with adequate accuracy.

Short communication: Running-in behavior on single-mobility total hip arthroplasty.

Total hip arthroplasty is a short-term solution for replacing a damaged hip joint with synthetic biomaterials. Total hip arthroplasty comes in two flavors: single and dual mobility. Mechanical and biological factors may degrade the quality of biomaterials over time. This may lead to implant failure and second surgical treatment. Wear is the crucial element leading to damaged bone and debris release throughout the body over time. Running-in is the initial wear phase between two surfaces before the steady-state phase. The stage of running-in is critical for understanding hip joint wear. Running-in and wear behavior have been extensively studied in single-mobility total hip arthroplasty, but aseptic loosening is the leading reason for restoration in arthroplasty registries. This paper seeks to summarize running-in behavior on single mobility hip implants, emphasizing its key aspects and recent developments.

Physiological Effect of Deep Pressure in Reducing Anxiety of Children with ASD during Traveling: A Public Transportation Setting.

Traveling with children with autism can be very challenging for parents due to their reactions to sensory stimuli resulting in behavioral problems, which lead to self-injury and danger for themselves and others. Deep pressure was reported to have a calming effect on people with autism. This study was designed to investigate the physiological effect of deep pressure, which is an autism hug machine portable seat (AHMPS) in children with autism spectrum disorders (ASD) in public transportation settings. The study was conducted with 20 children with ASD (16 boys and 4 girls) at the Semarang Public Special School with an age ranging from 4 to 13 years (mean 10.9 ± 2.26 years), who were randomly assigned into two groups. The experiment consisted of group I who used the AHMPS inflatable wraps model and group II who used the AHMPS manual pull model. Heart rate (HR) and skin conductance (SC) were analyzed to measure the physiological calming effect using pulse oximeter oximetry and a galvanic skin response (GSR) sensor. Heart rate was significantly decreased during the treatment compared to the baseline (pre-test) session in group I (inflating wrap model) with p = 0.019, while no change of heart rate variability (HRV) was found in group II (manual pull model) with p = 0.111. There was no remaining effect of deep pressure using the HRV indicator after the treatment in both groups (group I with p = 0.159 and group II with p = 0.566). GSR captured the significant decrease in skin conductance during the treatment with p < 0.0001 in group I, but no significant decrease was recorded in group II with p = 0.062. A skin conductance indicator captured the remaining effect of deep pressure (after the treatment); it was better in group I (p = 0.003) than in group II (p = 0.773). In conclusion, the deep pressure of the AHMPS inflating wrap decreases physiological arousal in children with ASD during traveling.

The Outcome of Neurotization of Brachial Plexus Injury in a Tertiary Centre: A Nine-Year Review.

INTRODUCTION: In neurotization or nerve transfer, a healthy but less valuable nerve is transferred to re-innervate a more important motor territory that has lost its innervation through irreparable damage to its nerve. METHODOLOGY: In this study, the outcomes of surgery were analyzed in relation to the muscle strength, range of motion of the upper limb, and functional outcome. The results were analyzed in 19 patients who were operated on between 2008 and 2016 with adequate follow-up.  Result: Of the 19 patients (15 complete brachial plexus injuries and four incomplete brachial plexus injuries), 13 patients (68%) recovered partial function after the neurotization surgery. Shoulder abduction and elbow flexion were achieved in 11 patients (58%). Six of the 10 patients (32%) in complete pre-ganglionic brachial plexus injury had recovered partial function. Whereas five of the six patients (83%) in complete post-ganglionic had recovered partial function. In incomplete upper trunk brachial plexus injury, three of the four patients (75%) recovered some function after the neurotization surgery. CONCLUSION: Nerve transfer is an effective treatment option to restore the function of the affected upper limb. Neurotization without intervening nerve graft shows better recovery. Earlier surgical intervention at a younger age can yield better outcomes.