Dynamic routing on stochastic time-dependent networks using real-time information

In just-in-time (JIT) manufacturing environments, on-time delivery is one of the key performance measures for dispatching and routing of freight vehicles. Both the travel time delay and its variability impact the efficiency of JIT logistics operations, that are becoming more and more common in many industries, and in particular, the automotive industry. In this dissertation, we first propose a framework for dynamic routing of a single vehicle on a stochastic time dependent transportation network using real-time information from Intelligent Transportation Systems (ITS). Then, we consider milk-run deliveries with several pickup and delivery destinations subject to time windows under same network settings. Finally, we extend our dynamic routing models to account for arc traffic condition dependencies on the network. Recurrent and non-recurrent congestion are the two primary reasons for travel time delay and variability, and their impact on urban transportation networks is growing in recent decades. Hence, our routing methods explicitly account for both recurrent and non-recurrent congestion in the network. In our modeling framework, we develop alternative delay models for both congestion types based on historical data (e.g., velocity, volume, and parameters for incident events) and then integrate these models with the forward-looking routing models. The dynamic nature of our routing decisions exploits the real-time information available from various ITS sources, such as loop sensors. The forward-looking traffic dynamic models for individual arcs are based on congestion states and state transitions driven by time-dependent Markov chains. We propose effective methods for estimation of the parameters of these Markov chains. Based on vehicle location, time of day, and current and projected network congestion states, we generate dynamic routing policies using stochastic dynamic programming formulations. All algorithms are tested in simulated networks of Southeast-Michigan and Los Angeles, CA freeways and highways using historical traffic data from the Michigan ITS Center, Traffic.com, and Caltrans PEMS

Deep learning for diagnosis of malign pleural effusion on computed tomography images

Background: The pleura is a serous membrane that surrounds the lungs. The visceral surface secretes fluid into the serous cavity and the parietal surface ensures a regular absorption of this fluid. If this balance is disturbed, fluid accumulation occurs in the pleural space called “Pleural Effusion”. Today, accurate diagnosis of pleural diseases is becoming more critical, as advances in treatment protocols have contributed positively to prognosis. Our aim is to perform computer-aided numerical analysis of Computed Tomography (CT) images from patients showing pleural effusion images on CT and to examine the prediction of malignant/benign distinction using deep learning by comparing with the cytology results. Methods: The authors classified 408 CT images from 64 patients whose etiology of pleural effusion was investigated using the deep learning method. 378 of the images were used for the training of the system; 15 malignant and 15 benign CT images, which were not included in the training group, were used as the test. Results: Among the 30 test images evaluated in the system; 14 of 15 malignant patients and 13 of 15 benign patients were estimated with correct diagnosis (PPD: 93.3%, NPD: 86.67%, Sensitivity: 87.5%, Specificity: 92.86%). Conclusion: Advances in computer-aided diagnostic analysis of CT images and obtaining a pre-diagnosis of pleural fluid may reduce the need for interventional procedures by guiding physicians about which patients may have malignancies. Thus, it is cost and time-saving in patient management, allowing earlier diagnosis and treatment.

Transabdominal Migration of Retained Surgical Sponge

Retained surgical sponge (RSS) is a rare surgical complication. The RSSs are mostly located intra-abdominally but they can also be left in the thorax, spine, extremity, cranium, and breast. RSS is often difficult to diagnose because of the nonspecific clinical symptoms and radiologic findings. Clinically, RSS may present as an exudative reaction in the early postoperative period or may also cause an aseptic fibrous tissue response. A foreign body may remain asymptomatically silent for a long time, and it may later present with obstruction, fistulization, or mass formation. In this report, we present a case in which an RSS has migrated through the abdominal wall and caused an anterior abdominal wall abscess.</jats:p

Gastric outlet obstruction due to duodenal bezoar: A case report

AbstractINTRODUCTIONGastric outlet obstruction (GOO) is a clinical syndrome characterized by abdominal pain and postprandial vomiting. Causes of GOO include both benign and malignant disease. Bezoars, concretions of undigested or partially digested material in the gastrointestinal tract, are a rare entity and GOO due to duodenal bezoar is an uncommon presentation.PRESENTATION OF CASEWe report the case of a 56-year-old woman who presented to the emergency department acutely with a 3-day history of epigastric pain, weakness and postprandial nonbilious vomiting. Initially, an upper gastrointestinal endoscopy (UGE) was performed to evaluate the cause of the GOO. A solid impacted bezoar was detected in the first portion of the duodenum with complete obstruction of the pyloric canal. In spite of multiple attempts for fragmentation using different devices, the extraction attempts failed. We administered acetylcysteine and cola per os. Abdominal computerized tomography was obtained and showed a solid mass in the duodenum. UGE was performed once more however, the mass was not suitable for fragmentation and removal. Thus, surgical treatment was decided. The bezoar was extracted via gastrotomy. The postoperative period was uneventful.DISCUSSIONEven if a duodenal bezoar is small, because of its location it may cause GOO with abruptly clinical features. The diagnostic approach is similar to the other causes of the GOO. However, therapeutic options differ for each patient.CONCLUSIONWe should remember all the therapeutic and diagnostic options for a patient with upper gastrointestinal bezoars who present at the hospital whether or not there is a predisposing risk factor

Identification of the mutation in DCLRE1C gene by PCR-RFLP

Aim: Mutations in the DCLRE1C gene result in functional impairment of the Artemis protein and T/B cell development is adversely affected. As a result of this mutation, a clinic of severe combined and combined immunodeficiency (CID) generally occurs. In our region where consanguineous marriage is common, CID cases due to this mutation are frequently encountered. Therefore, suspected patients should be evaluated promptly for the relevant gene mutation. It is clear that more complicated and costly methods are used in the detection of mutations and there is a need for cheaper and faster methods. Therefore, in this study, it was aimed to determine the mutations of DCLRE1C gene exon 3 (c.194C>T; p.T65I) and exon 14 (c.1669_1670insA; p.T577Nfs*21) by using Polymerase Chain Reaction-Restriction Fragment Length Polymorphism (PCR-RFLP) method. Patients and Methods: The study was carried out between 2017 and 2020 and study included 14 patients followed up with DCLRE1C mutation in our clinic, 2 parents and 10 healthy controls. PCR-RFLP analysis was performed with primers containing mutation sites and approp riate restriction enzymes. Results: As a result of the analysis, 12 patients were homozygous mutant for DCLRE1C gene exon 3, 2 parents were heterozygous for exon 3, and 2 patients were heterozygous for exon 3 and exon 14 and were found to be compound heterozygous genotype. Mutations were confirmed by Sanger DNA sequencing. Mutations in the relevant region were determined quickly and re liably by the PCR-RFLP method. Conclusion: The study showed that the PCR-RFLP method is a cheap, safe and fast method that can be used in cases such as family screening, especially for the detection of known mutations in primary immunodeficiencies

A simplified acute kidney injury predictor following transcatheter aortic valve implantation: ACEF score

Background: Transcatheter aortic valve implantation (TAVI) is an effective, less invasive treatment alternative for symptomatic severe aortic stenosis (AS). Acute kidney injury (AKI) following TAVI is a common complication and is associated with worse outcomes. The age, creatinine, ejection fraction (ACEF) score is a simple scoring method, including only three parameters: age, creatinine, and ejection fraction (EF). The score was well established in predicting AKI after coronary interventions.Aims: We aimed to evaluate whether this simple scoring method, ACEF, may predict a development of AKI in patients who underwent TAVI.Methods: A total of 173 consecutive patients with symptomatic severe AS who underwent TAVI were included retrospectively. The primary endpoint of the study was the development of AKI. Study population was divided into two groups according to the presence of AKI. The ACEF score was calculated with the formula: age/EF + 1 (if baseline creatinine &gt;2 mg/dl).Results: Twenty-nine patients developed AKI. The median (interquartile range) ACEF score was 1.36 (1.20–1.58). The ACEF score was found to be an independent predictor of AKI (P &lt;0.001). The ACEF score ≥1.36 predicted AKI development with a sensitivity of 96.6% and specificity of 58.8%. Moreover, hypertension, hemoglobin levels, contrast volume, and aortic valve area (AVA) were found to be independent predictors of AKI.Conclusions: Our study revealed that the ACEF score was an independent predictor of AKI. A simple and objective score might be very useful in predicting AKI development in patients undergoing TAVI

Comparison of Fixed and Ramping Voltage Extracorporeal Shockwave Lithotripsy with Acute Kidney Injury Biomarkers: Prospective Randomized Clinical Study

Objective: To compare extracorporeal shock wave lithotripsy (ESWL) induced renal injury in patients undergoing different ESWL treatment protocols by measuring urinary tissue metalloproteinase-2 inhibitor (TIMP-2) and insulin-like growth factor binding protein 7 (IGFBP7) excretion. Materials and Methods: This prospective, randomized study was conducted between April 2016 and June 2016 in group 1 patients undergoing fixed voltage ESWL and group 2 patients undergoing ramping voltage ESWL. Urinary TIMP-2 and IGFBP7 levels were analyzed before ESWL and 2 hours after ESWL, and urinary beta- 2-microglobulin (β2-MG) and albumin were analyzed before ESWL and 1 week after ESWL to assess renal injury. The primary outcome was to compare the effect of ESWL on early renal injury with biochemical markers in the different treatment protocols, and the secondary outcome was to compare the two treatment protocols in terms of stone free rate and complications. Results: There was no statistically significant difference between groups in terms of demographic and stone characteristics. There were statistically significant differences in serum creatinine and e-GFR at baseline and one week after treatment (p0.05). Conclusion: In this prospective randomized study, we observed a significant increase in TIMP-2, IGFBP7 and combination levels after ESWL treatment in both groups, suggesting that these two biomarkers could be used to identify acute kidney injury due to ESWL. However, the comprehensive evaluation of clinical parameters and urinary markers did not differ in the rates of renal injury, success, and complications after ESWL in both protocols

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication