369 research outputs found

    Raman Spectroscopy Techniques for the Detection and Management of Breast Cancer

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    Breast cancer has recently become the most common cancer worldwide, and with increased incidence, there is increased pressure on health services to diagnose and treat many more patients. Mortality and survival rates for this particular disease are better than other cancer types, and part of this is due to the facilitation of early diagnosis provided by screening programmes, including the National Health Service breast screening programme in the UK. Despite the benefits of the programme, some patients undergo negative experiences in the form of false negative mammograms, overdiagnosis and subsequent overtreatment, and even a small number of cancers are induced by the use of ionising radiation. In addition to this, false positive mammograms cause a large number of unnecessary biopsies, which means significant costs, both financially and in terms of clinicians' time, and discourages patients from attending further screening. Improvement in areas of the treatment pathway is also needed. Surgery is usually the first line of treatment for early breast cancer, with breast conserving surgery being the preferred option compared to mastectomy. This type of operation achieves the same outcome as mastectomy - removal of the tumour - while allowing the patient to retain the majority of their normal breast tissue for improved aesthetic and psychological results. Yet, re-excision operations are often required when clear margins are not achieved, i.e. not all of the tumour is removed. This again has implications on cost and time, and increases the risk to the patient through additional surgery. Currently lacking in both the screening and surgical contexts is the ability to discern specific chemicals present in the breast tissue being assessed/removed. Specifically relevant to mammography is the presence of calcifications, the chemistry of which holds information indicative of pathology that cannot be accessed through x-rays. In addition, the chemical composition of breast tumour tissue has been shown to be different to normal tissue in a variety of ways, with one particular difference being a significant increase in water content. Raman spectroscopy is a rapid, non-ionising, non-destructive technique based on light scattering. It has been proven to discern between chemical types of calcification and subtleties within their spectra that indicate the malignancy status of the surrounding tissue, and differentiate between cancerous and normal breast tissue based on the relative water contents. Furthermore, this thesis presents work aimed at exploring deep Raman techniques to probe breast calcifications at depth within tissue, and using a high wavenumber Raman probe to discriminate tumour from normal tissue predominantly via changes in tissue water content. The ability of transmission Raman spectroscopy to detect different masses and distributions of calcified powder inclusions within tissue phantoms was tested, as well as elucidating a signal profile of a similar inclusion through a tissue phantom of clinically relevant thickness. The technique was then applied to the measurement of clinically active samples of bulk breast tissue from informed and consented patients to try to measure calcifications. Ex vivo specimens were also measured with a high wavenumber Raman probe, which found significant differences between tumour and normal tissue, largely due to water content, resulting in a classification model that achieved 77.1% sensitivity and 90.8% specificity. While calcifications were harder to detect in the ex vivo specimens, promising results were still achieved, potentially indicating a much more widespread influence of calcification in breast tissue, and to obtain useful signal from bulk human tissue is encouraging in itself. Consequently, this work demonstrates the potential value of both deep Raman techniques and high wavenumber Raman for future breast screening and tumour margin assessment methods

    The association between pre-operative pain experience and post-operative pain in patients undergoing elective gastrointestinal surgery: a descriptive-comparative study

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    Aims: The purpose of the rapid review was to summarize and aggregate information for researchers and clinicians about predisposing factors for post-operative pain in laparoscopic patients and the prevalent management approaches post-operatively. The purpose of the descriptive-comparative study was to explore the associations between previous pain experiences and medication on the intensity of pain post-operatively in patients undergoing elective gastrointestinal surgery, using data collected by the Smart Pain Assessment Tool Based on Internet of Things. Methods: For the rapid review, the databases of PubMed, Web of Science and Embase were searched. ROBINS-I tool was used to evaluate the quality of non-randomized studies while ROB 2 tool was used for randomized controlled trials. For the descriptive-comparative study, 50 patients after gastrointestinal operations at Turku University hospital were included. The data collection of the study was done by a researcher belonging to Turku University staff at Turku University hospital. The data analysis was done by using descriptive and comparative methods of analysis. Descriptive statistics were used for the presentation and analysis of participants outcomes, diagnoses, procedures, and groupings based on variables related to the experience of pain (e.g., graphical measurement maximal pain levels using the numeric rating scale). Comparative statistics were used for associations and correlations regarding previous pain levels, medications, fear, and expectation of pain on maximal pain levels after gastrointestinal operations at Turku University Hospital. Results: The result of the rapid review suggest many predisposing factors for post-operative pain are influenced by the psychological profile of the patient. Among these factors are anxiety, fear, depression, expectation of pain, and other factors related to gastrointestinal surgery. Nevertheless, the results of this review also describe acute pre-operative pain, surgical factors, genetics, age, gender, obesity, and previous experiences of pain as relevant predisposing factors to pain following gastrointestinal surgery. Pain care strategies following gastrointestinal surgery include the use of pharmacological and non-pharmacological interventions. The literature suggests, non-pharmacological interventions are under-utilized and should be encouraged as an adjunct to pharmacological pain control strategies following elective gastrointestinal surgery. The results of the descriptive-comparative study somewhat contradict the results of the rapid review. Previous pain experiences or the recollection of preceding painful events were not associated with the administration of supplemental pain medication post-operatively (p = 0.741). Fear related to the upcoming pain following surgery was not associated with the level of invasiveness of the surgery (p = 0.662). In addition, the relationship between expectation of pain (p = 0.698), fear of pain related to the upcoming surgical procedure (p = 0.637) and medication post-operatively (p = .481) on the intensity of maximal post-operative pain was found to be negligible. The results of this study suggest patient expectation as a possible domain of intervention for better pain outcomes post-operatively. The administration of pain medication in the recovery room and the amount of pain medication in the recovery room were significant predictors of maximal post-operative pain (p = .001). Discussion: The results of the rapid review suggest a high to critical risk of bias in the studies included. The predisposing factors for post-operative pain differed widely across studies, but mainly included psychological factors as factors for post-operative pain. Pain management strategies should include an individualized approach and be implemented before, during and after the operation. For the descriptive-comparative study, there are substantial difficulties in discerning the effect of pain history or experience on post-operative pain using physiological or subjective reporting for conscious individuals due to risk of bias and using a unidimensional approach. Conclusion: Predisposing factors for post-operative pain should be screened in the pre-operative phase if possible, focusing on addressable factors whereas management of pain care strategies should include careful screening of participants biopsychosocial profile for elective surgery. The descriptive-comparative study suggests a possible, yet minimal benefit for managing patients’ expectation of pain related to the upcoming gastrointestinal surgery. The amount of pain medication in the recovery room is a significant predictor of maximal post-operative pain. Future research should include a larger sample, more variables related to pain and continue with a follow-up. Keywords: gastrointestinal, post-operative, pain, analgesia, anesthesiaTavoitteet: Katsauksen tarkoituksena oli tiivistää ja koota yhteen tutkijoille ja kliinikoille tietoa laparoskooppisten potilaiden postoperatiiviselle kivulle altistavista tekijöistä ja vallitsevista postoperatiivisista hoitokeinoista. Kuvailevan-vertailevan tutkimuksen tarkoituksena oli tutkia aiempien kipukokemusten ja lääkityksen välisiä yhteyksiä postoperatiivisen kivun voimakkuuteen potilailla, joille tehdään elektiivinen ruoansulatuskanavan leikkaus, käyttäen tietoja, jotka on kerätty esineiden internetiin perustuvalla älykkäällä kivunarviointityökalulla. Menetelmät: Katsausta varten tehtiin hakuja PubMed-, Web of Science- ja Embase-tietokannoista. ROBINS-I-työkalua käytettiin satunnaistamattomien tutkimusten laadun arviointiin, kun taas satunnaistettujen kontrolloitujen tutkimusten osalta käytettiin ROB 2-työkalua. Kuvailevaan-vertailevaan tutkimukseen otettiin mukaan 50 potilasta Turun yliopistollisessa sairaalassa tehtyjen ruoansulatuskanavan leikkausten jälkeen. Tutkimuksen aineistonkeruun suoritti Turun yliopiston henkilökuntaan kuuluva tutkija Turun yliopistollisessa sairaalassa. Aineiston analysoinnissa käytettiin kuvailevia ja vertailevia analyysimenetelmiä. Kuvailevia tilastoja käytettiin osallistujien tulosten, diagnoosien, toimenpiteiden ja kivun kokemiseen liittyvien muuttujien perusteella tehtyjen ryhmittelyjen esittämiseen ja analysointiin (esim. maksimaalisen kiputason graafinen mittaaminen numeerisella arviointiasteikolla). Vertailevia tilastoja käytettiin yhdistelmiin ja korrelaatioihin, jotka koskivat aiempia kiputiloja, lääkkeitä, pelkoa ja kivun odotusta maksimaalisen kiputason suhteen ruoansulatuskanavan leikkausten jälkeen Turun yliopistollisessa sairaalassa. Tulokset: Katsauksen tulokset viittaavat siihen, että potilaan psykologinen profiili vaikuttaa moniin leikkauksen jälkeiselle kivulle altistaviin tekijöihin. Näihin tekijöihin kuuluvat ahdistus, pelko, masennus, kivun odotus ja muut ruoansulatuskanavan leikkaukseen liittyvät tekijät. Tämän katsauksen tuloksissa kuvataan kuitenkin myös akuutti preoperatiivinen kipu, kirurgiset tekijät, genetiikka, ikä, sukupuoli, lihavuus ja aiemmat kokemukset kivusta merkityksellisinä altistavina tekijöinä ruoansulatuskanavan leikkauksen jälkeiselle kivulle. Ruoansulatuskanavan leikkauksen jälkeisiin kivunhoitostrategioihin kuuluu farmakologisten ja ei-farmakologisten toimenpiteiden käyttö. Kirjallisuuden mukaan ei-farmakologisia toimenpiteitä käytetään liian vähän, ja niitä olisi edistettävä farmakologisten kivunhoitostrategioiden lisänä elektiivisen ruoansulatuskanavan leikkauksen jälkeen. Kuvailevan ja vertailevan tutkimuksen tulokset ovat jossain määrin ristiriidassa nopean katsauksen tulosten kanssa. Aiemmat kipukokemukset tai aiempien kivuliaiden tapahtumien muistaminen eivät olleet yhteydessä ylimääräisen kipulääkityksen antamiseen leikkauksen jälkeen (p = 0,741). Leikkauksen jälkeiseen tulevaan kipuun liittyvä pelko ei ollut yhteydessä leikkauksen invasiivisuuteen (p = 0,662). Lisäksi kivun odotuksen (p = 0,698), tulevaan kirurgiseen toimenpiteeseen liittyvän kivun pelon (p = 0,637) ja leikkauksen jälkeisen lääkityksen (p = 0,481) välinen yhteys maksimaalisen leikkauksen jälkeisen kivun voimakkuuteen todettiin merkityksettömäksi. Tämän tutkimuksen tulokset viittaavat siihen, että potilaan odotukset ovat mahdollinen interventioalue, jolla voidaan parantaa leikkauksen jälkeistä kiputilannetta. Kipulääkityksen antaminen heräämössä ja kipulääkityksen määrä heräämössä olivat merkittäviä postoperatiivisen maksimaalisen kivun ennustajia (p = .001). Pohdinta: Katsauksen tulokset viittaavat siihen, että mukana olleissa tutkimuksissa on suuri tai kriittinen harhan riski. Postoperatiiviselle kivulle altistavat tekijät vaihtelivat suuresti eri tutkimuksissa, mutta niihin sisältyi pääasiassa psykologisia tekijöitä postoperatiivisen kivun tekijöinä. Kivunhoitostrategioihin olisi sisällyttävä yksilöllinen lähestymistapa, ja niitä olisi sovellettava ennen leikkausta, sen aikana ja sen jälkeen. Kuvailevassa ja vertailevassa tutkimuksessa on huomattavia vaikeuksia havaita kipuhistorian tai -kokemuksen vaikutusta leikkauksen jälkeiseen kipuun fysiologisen tai subjektiivisen raportoinnin avulla tietoisten yksilöiden osalta, koska on olemassa harhan riski ja koska käytetään yksiulotteista lähestymistapaa. Johtopäätökset: Kivunhoitostrategioihin olisi kuuluttava osallistujien biopsykososiaalisen profiilin huolellinen seulonta valintaleikkausta varten. Kuvaileva-vertaileva tutkimus viittaa siihen, että potilaiden tulevaan ruoansulatuskanavan leikkaukseen liittyvien kipuodotusten hallinnasta on mahdollista, joskin vähäistä hyötyä. Kipulääkkeiden määrä heräämössä on merkittävä leikkauksen jälkeisen maksimaalisen kivun ennustaja. Tulevaan tutkimukseen olisi sisällytettävä suurempi otos, enemmän kipuun liittyviä muuttujia ja jatkettava seurantaa

    SURGICAL NAVIGATION AND AUGMENTED REALITY FOR MARGINS CONTROL IN HEAD AND NECK CANCER

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    I tumori maligni del distretto testa-collo rappresentano un insieme di lesioni dalle diverse caratteristiche patologiche, epidemiologiche e prognostiche. Per una porzione considerevole di tali patologie, l’intervento chirurgico finalizzato all’asportazione completa del tumore rappresenta l’elemento chiave del trattamento, quand’anche esso includa altre modalità quali la radioterapia e la terapia sistemica. La qualità dell’atto chirurgico ablativo è pertanto essenziale al fine di garantire le massime chance di cura al paziente. Nell’ambito della chirurgia oncologica, la qualità delle ablazioni viene misurata attraverso l’analisi dello stato dei margini di resezione. Oltre a rappresentare un surrogato della qualità della resezione chirurgica, lo stato dei margini di resezione ha notevoli implicazioni da un punto di vista clinico e prognostico. Infatti, il coinvolgimento dei margini di resezione da parte della neoplasia rappresenta invariabilmente un fattore prognostico sfavorevole, oltre che implicare la necessità di intensificare i trattamenti postchirurgici (e.g., ponendo indicazione alla chemioradioterapia adiuvante), comportando una maggiore tossicità per il paziente. La proporzione di resezioni con margini positivi (i.e., coinvolti dalla neoplasia) nel distretto testa-collo è tra le più elevate in ambito di chirurgia oncologica. In tale contesto si pone l’obiettivo del dottorato di cui questa tesi riporta i risultati. Le due tecnologie di cui si è analizzata l’utilità in termini di ottimizzazione dello stato dei margini di resezione sono la navigazione chirurgica con rendering tridimensionale e la realtà aumentata basata sulla videoproiezione di immagini. Le sperimentazioni sono state svolte parzialmente presso l’Università degli Studi di Brescia, parzialmente presso l’Azienda Ospedale Università di Padova e parzialmente presso l’University Health Network (Toronto, Ontario, Canada). I risultati delle sperimentazioni incluse in questo elaborato dimostrano che l'impiego della navigazione chirurgica con rendering tridimensionale nel contesto di procedure oncologiche ablative cervico-cefaliche risulta associata ad un vantaggio significativo in termini di riduzione della frequenza di margini positivi. Al contrario, le tecniche di realtà aumentata basata sulla videoproiezione, nell'ambito della sperimentazione preclinica effettuata, non sono risultate associate a vantaggi sufficienti per poter considerare tale tecnologia per la traslazione clinica.Head and neck malignancies are an heterogeneous group of tumors. Surgery represents the mainstay of treatment for the large majority of head and neck cancers, with ablation being aimed at removing completely the tumor. Radiotherapy and systemic therapy have also a substantial role in the multidisciplinary management of head and neck cancers. The quality of surgical ablation is intimately related to margin status evaluated at a microscopic level. Indeed, margin involvement has a remarkably negative effect on prognosis of patients and mandates the escalation of postoperative treatment by adding concomitant chemotherapy to radiotherapy and accordingly increasing the toxicity of overall treatment. The rate of margin involvement in the head and neck is among the highest in the entire field of surgical oncology. In this context, the present PhD project was aimed at testing the utility of 2 technologies, namely surgical navigation with 3-dimensional rendering and pico projector-based augmented reality, in decreasing the rate of involved margins during oncologic surgical ablations in the craniofacial area. Experiments were performed in the University of Brescia, University of Padua, and University Health Network (Toronto, Ontario, Canada). The research activities completed in the context of this PhD course demonstrated that surgical navigation with 3-dimensional rendering confers a higher quality to oncologic ablations in the head and neck, irrespective of the open or endoscopic surgical technique. The benefits deriving from this implementation come with no relevant drawbacks from a logistical and practical standpoint, nor were major adverse events observed. Thus, implementation of this technology into the standard care is the logical proposed step forward. However, the genuine presence of a prognostic advantage needs longer and larger study to be formally addressed. On the other hand, pico projector-based augmented reality showed no sufficient advantages to encourage translation into the clinical setting. Although observing a clear practical advantage deriving from the projection of osteotomy lines onto the surgical field, no substantial benefits were measured when comparing this technology with surgical navigation with 3-dimensional rendering. Yet recognizing a potential value of this technology from an educational standpoint, the performance displayed in the preclinical setting in terms of surgical margins optimization is not in favor of a clinical translation with this specific aim

    11th International Conference on Business, Technology and Innovation 2022

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    Welcome to IC – UBT 2022 UBT Annual International Conference is the 11th international interdisciplinary peer reviewed conference which publishes works of the scientists as well as practitioners in the area where UBT is active in Education, Research and Development. The UBT aims to implement an integrated strategy to establish itself as an internationally competitive, research-intensive university, committed to the transfer of knowledge and the provision of a world-class education to the most talented students from all background. The main perspective of the conference is to connect the scientists and practitioners from different disciplines in the same place and make them be aware of the recent advancements in different research fields, and provide them with a unique forum to share their experiences. It is also the place to support the new academic staff for doing research and publish their work in international standard level. This conference consists of sub conferences in different fields like: Security Studies Sport, Health and Society Psychology Political Science Pharmaceutical and Natural Sciences Mechatronics, System Engineering and Robotics Medicine and Nursing Modern Music, Digital Production and Management Management, Business and Economics Language and Culture Law Journalism, Media and Communication Information Systems and Security Integrated Design Energy Efficiency Engineering Education and Development Dental Sciences Computer Science and Communication Engineering Civil Engineering, Infrastructure and Environment Architecture and Spatial Planning Agriculture, Food Science and Technology Art and Digital Media This conference is the major scientific event of the UBT. It is organizing annually and always in cooperation with the partner universities from the region and Europe. We have to thank all Authors, partners, sponsors and also the conference organizing team making this event a real international scientific event. Edmond Hajrizi, President of UBT UBT – Higher Education Institutio

    Ultimate Guide to Outpatient Care

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    The book presents a qualitative and quantitative approach to understanding, managing, and collaborating outpatient care. Utilizing a sound theoretical and practical foundation and illustrating procedural techniques through scientific examples, this book provides a comprehensive overview of outpatient care whether it occurs via telemedicine or in a hospital, clinic, prison, school, or other settings

    Medical Education for the 21st Century

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    Medical education has undergone a substantial transformation from the traditional models of the basic classroom, laboratory, and bedside that existed up to the late 20th century. The focus of this text is to review the spectrum of topics that are essential to the training of 21st-century healthcare providers. Modern medical education goes beyond learning physiology, pathophysiology, anatomy, pharmacology, and how they apply to patient care. Contemporary medical education models incorporate multiple dimensions, including digital information management, social media platforms, effective teamwork, emotional and coping intelligence, simulation, as well as advanced tools for teaching both hard and soft skills. Furthermore, this book also evaluates the evolving paradigm of how teachers can teach and how students can learn – and how the system evaluates success

    Upper-tract urothelial carcinoma : diagnostics and prognostic factors

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    Upper-tract urothelial carcinoma (UTUC) is rare, constituting 5-10% of all urothelial cancers. Urothelial carcinoma of the bladder is a common disease and is more studied than UTUC. The incidence of UTUC is rising, with people living longer and, especially, surviving bladder cancer to a greater extent than before; therefore, these individuals are at risk of developing UTUC, as the two diseases are closely linked. As the majority of patients presenting with UTUC are ≥65 years old and have risk factors for renal impairment, as well as for complications from general anaesthesia, large surgical procedures and chemotherapy, it is crucial to make as good a risk assessment as possible prior to deciding with the patient what treatment to undertake. Survival is poor for invasive UTUC, despite radical treatment, but if low-risk UTUC can be identified, that minority of patients can have equal survival if offered kidney-sparing treatment (KSS), generally URS laser ablation. In Paper I, forty-five patients who underwent URS prior to radical nephroureterectomy (RNU) were included, and 43 were included in the final analysis. Samples were analysed, comparing the agreement of grade and ploidy in endoscopic biopsies and in barbotage samples from the renal pelvis and from the ureter (fluid collected from the bladder after instrumentation of the upper tract) with those in RNU specimens. Almost half of the tumours (20/43) were grade 3 (high-grade) cancer. Thirteen of the low-grade cancers were classified as grade 2, and 10 were classified as grade 1. The overall agreement of grade was 94%, with cytology being equal to the histology of biopsies in identifying cancer. Ureteral-barbotage specimens were more accurate than the other samples in 4/16 cases of UTUC located in the ureter. The same patient cohort that was analysed in Paper I was included in Paper II, where the tumour characteristics associated with tumour stage were found to be tumour grade, DNA ploidy and cell proliferation (S-phase fraction, SPF). Five years had passed since inclusion and URS of the last patient; thus, the follow-up time was long in the calculation of survival. Additionally, the risk of death from UTUC in relation to SPF was calculated. An increased risk of death from UTUC with increasing SPF was found. Ploidy was useful for strengthening the assessment of grade 1 (diploid) and grade 3 (aneuploid) but not grade 2 UTUC. Paper III was a larger study of cancer-specific survival (CSS) and the prognostic role of the different tumour characteristics studied in Paper II associated with survival and with invasive tumour stage. The cohort was extended to include 99 in the final analysis. SPF and stage were confirmed in multiple Cox analysis to be independent prognostic markers. The area under the ROC curve indicated that SPF was a good predictor for both the invasive stage and death from UTUC. CSS stratified by stage, grade and ploidy confirmed the large difference in survival between superficial and invasive stages, between different grades (when using the WHO 1999 classification) and between diploid and aneuploid UTUC. The risk of death from UTUC increased by 17% for every percent increase in SPF. In summary, with a thorough and systematic work-up, the individual patient ́s risk can be estimated after URS so that those with high-risk UTUC can be treated with RNU, whereas patients with low-risk UTUC can consider KSS, i.e., URS laser ablation or segmental ureterectomy. Samples taken at URS are reliable for grading and the determination of ploidy and SPF. Tumour stage and SPF were found to be independent prognostic markers. The tumour characteristics that proved useful for “indirect staging” of UTUC were grade, ploidy and SPF, as these were independently associated with tumour stage. SPF was shown to strengthen risk stratification and can be analysed in barbotage taken at URS. We also showed that the WHO 1999 classification system was more informative than the two-tiered WHO 2004 classification and better predicted CSS

    Enhanced Liposuction

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    Liposuction began as a simple, minimally invasive method of reducing the amount of localized fat in a region. Today it is a sophisticated and complex process, with many variations in purpose and technique. In this book, a global slate of expert surgeons offers a detailed description of various minimally invasive and non-invasive options for contouring the face, neck, and body. Chapters detail the evolution and utilization of various energy-based devices and combination treatments. They also describe procedure limitations and treatment of complications. Finally, they discuss indications for various approaches with case study descriptions so readers might be assisted with treating patients in their everyday practice
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