Comparison of Anastomosis Safety in Colonic Dissections Using Scalpel, Scissors and Cautery in Rats: Experimental Study

Objective:Postoperative anastomotic leakage is still an issue in modern surgery. Re-hospitalization due to postoperative anastomosis leakage prolongs hospital stay and re-operations increase the cost. There is still no consent on how to dissect the intestines. The objective of the present study is to analyze the safety of colonic anastomoses after dissections using scalpel, scissors and cautery in rats.Method:There were 4 groups of 32 Wistar Hannover adult rodents. Each group consisted of 8 animals: group 1: sham, group 2: scalpel, group 3: scissors, group 4: cautery. Anastomosis was done over a single layer. Bursting pressure (BP) was measured at day 7. Tissue and blood samples were taken for the evaluation of biochemical and histopathological parameters.Results:Statistically significant disparity was seen among the sham, scalpel, scissors and cautery groups regarding the mean BP average, mean hydroxyproline levels and fibrosis distributions.Conclusion:Cautery is the best choice for hemostasis; however, when considering tissue healing, scalpel and the scissors were found to be safest alternatives

Real-world efficacy and safety of Ledipasvir plus Sofosbuvir and Ombitasvir/Paritaprevir/Ritonavir +/- Dasabuvir combination therapies for chronic hepatitis C: A Turkish experience

Background/Aims: This study aimed to evaluate the real-life efficacy and tolerability of direct-acting antiviral treatments for patients with chronic hepatitis C (CHC) with/without cirrhosis in the Turkish population.Material and Methods: A total of 4,352 patients with CHC from 36 different institutions in Turkey were enrolled. They received ledipasvir (LDV) and sofosbuvir (SOF)+/- ribavirin (RBV) ombitasvir/paritaprevir/ritonavir +/- dasabuvir (PrOD)+/- RBV for 12 or 24 weeks. Sustained virologic response (SVR) rates, factors affecting SVR, safety profile, and hepatocellular cancer (HCC) occurrence were analyzed.Results: SVR12 was achieved in 92.8% of the patients (4,040/4,352) according to intention-to-treat and in 98.3% of the patients (4,040/4,108) according to per-protocol analysis. The SVR12 rates were similar between the treatment regimens (97.2%-100%) and genotypes (95.6%-100%). Patients achieving SVR showed a significant decrease in the mean serum alanine transaminase (ALT) levels (50.90 +/- 54.60 U/L to 17.00 +/- 14.50 U/L) and model for end-stage liver disease (MELD) scores (7.51 +/- 4.54 to 7.32 +/- 3.40) (p<0.05). Of the patients, 2 were diagnosed with HCC during the treatment and 14 were diagnosed with HCC 37.0 +/- 16.0 weeks post-treatment. Higher initial MELD score (odds ratio [OR]: 1.92, 95% confidence interval [CI]: 1.22-2.38; p=0.023]), higher hepatitis C virus (HCV) RNA levels (OR: 1.44, 95% CI: 1.31-2.28; p=0.038), and higher serum ALT levels (OR: 1.38, 95% CI: 1.21-1.83; p=0.042) were associated with poor SVR12. The most common adverse events were fatigue (12.6%), pruritis (7.3%), increased serum ALT (4.7%) and bilirubin (3.8%) levels, and anemia (3.1%).Conclusion: LDV/SOF or PrOD +/- RBV were effective and tolerable treatments for patients with CHC and with or without advanced liver disease before and after liver transplantation. Although HCV eradication improves the liver function, there is a risk of developing HCC.Turkish Association for the Study of The Liver (TASL

Appraising diagnostic performance of ELF test by pathological staging and digital quantification of liver fibrosis

Introduction and objectives: A crucial issue when appraising the performance of non-invasive markers is the limitations of the reference standard they are compared to. Digital image analysis (DIA) was suggested as a reproducible approach expressing fibrosis numerically as a proportionate area (PA) (%). We aimed to evaluate ELF test with direct reference to PA (%), thereby explore the improvement in accuracy to discriminate significant fibrosis which may actually have been underestimated by categorical pathological staging. Materials and methods: PA (%) data were obtained by DIA of trichrome-stained liver biopsies of 52 chronic hepatitis patients. Paired serum samples of patients and additional 36 controls were performed to measure ELF test. Diagnostic performance characteristics of ELF test was derived in predicting significant fibrosis in the patient cohort, and also, in distinguishing healthy controls from patients with significant fibrosis. Results: We found an AUROC value of 0.73 for ELF to predict significant fibrosis as assessed by DIA and a lower AUROC value of 0.66 when assessed by conventional pathology. Importantly, ELF test provided considerably high diagnostic accuracy to discriminate healthy controls from patients with significant fibrosis defined by Ishak F >= 2 and TPA >= 5% (AUROCs 0.93 and 0.94, respectively) with optimal ELF cut-off point of 8.4 for both. Conclusions: Digital quantification could represent a better reference standard than conventional pathology allowing a better discriminatory capability for ELF test. ELF test provided high diagnostic accuracy to discriminate healthy controls from patients with significant fibrosis suggesting a role as a screening strategy in the community setting. (C) 2019 Fundacion Clinica Medica Sur, A.C. Published by Elsevier Espana, S.L.U

Digital image analysis in liver fibrosis: basic requirements and clinical implementation

Accurate assessment of liver fibrosis is a critical aspect of diagnosis, prognosis prediction, surveillance strategies, therapeutic planning and monitoring, and also for validation of non-invasive surrogates of fibrosis. Traditional histopathological stagings depend on subjective visual interpretation process of architectural changes of fibrosis without providing quantification as continuous numerical data, but rather in the form of discrete staging. This makes high level reproducibility practically impossible in its application, which should be minimized in scientific research. In the light of increasing demand for an objective method, digital image analysis (DIA) technology has been increasingly implemented for liver fibrosis assessment. Potential advantages and applications of reproducible quantitative fibrosis ratio measurements with DIA include performing broader scale of statistical analysis and comparison between studies, monitoring minor but potentially important quantity changes during fibrosis regression or progression (especially in the context of therapeutic trials), and to be a better histological reference standard for validity and accuracy of surrogates of fibrosis. DIA may also have a potential role within the new perspective of redefining and sub-classifying cirrhosis. Since DIA algorithm covers multiple domains of hepatopathology and engineering, it may seem to be complicated to a researcher. This review provides an understanding of all basic steps, techniques, clinical applications of computerized image analysis for the particular purpose of liver fibrosis aiming its better implementation in hepatology research. Further work is required for standardization of all stages of pre-imaging, digital image acquisition and digital image processing steps for generation of reproducible outputs

The Effects of inflation and prevention methods of this effects on basic financial statements and a application in a hotel company

Enflasyon yaşanan ülkelerde, enflasyonun işletmelerin temel mali tabloları üzerinde önemli düzeylerde olumsuz etkileri mevcuttur. Bu etkileri önlemede kullanılabilecek kısmi ve genel önleme yöntemleri olmak üzere bir çok yöntem uygulanmaktadır. Bu yöntemlerden bir tanesi de mali tablolar üzerindeki enflasyon etkilerinin önlenmesini içeren ve genel önleme yöntemlerinden biri olan fiyatlar genel düzeyi muhasebe modelidir. Bu çalışmanın konusunu, enflasyonun otel işletmelerinin temel mali tabloları üzerindeki etkilerinin ve bu etkileri önleyici yöntemlerin araştırılması oluşturmaktadır. Çalışmada, literatür taraması yardımıyla kavramlar ve uygulamalar tanıtılmış ardından enflasyonun bir otel işletmesine ait temel mali tabloları üzerindeki etkilerini önlemede fiyatlar genel düzeyi muhasebe modelinden yararlanılarak uygulama yapılmıştır. Çalışma sonucunda, sermaye-yoğun özellik gösteren otel işletmelerinin enflasyondan büyük ölçüde etkilendikleri saptanmıştır ve Araştırmada elde edilen sonuçlar ve öneriler çalışma sonunda açıklanmıştır. Inflation has important level negative effects on basic financial statements of the establishments in countries which have inflation. There are lots of methods such as partial and general, which can be used, are being applied to prevent this effects one of these methods which is a kind of general prevention method includes to prevent the inflation effects on financial statements is general price level accounting model. The subject of this study is inflation's effects on basic financial statements of the hotel establishments and research methods to prevent this effects. In study, concepts and applies are introduced with the help of reviewing literature and then to prevent the inflation's effects on basic financial statements of a hotel establishment, general price level accounting has been applied. In the result of study, it is determined that hotel establishments, which show capital-high specialised, are effected on a nrgative large scale from inflation and it is explained the results and suggestions in the result of study