Prostatectomía robótica: análisis anestesiológico de cirugías urológicas robóticas, un estudio prospectivo

ResumenJustificación y objetivosAunque muchas características de la prostatectomía robótica sean similares a las de las laparoscopias urológicas convencionales (como la prostatectomía laparoscópica), el procedimiento está asociado con algunos inconvenientes, incluyendo el acceso intravenoso limitado, tiempo quirúrgico relativamente largo, posición de Trendelenburg profunda y presión intraabdominal alta. El objetivo principal fue describir las alteraciones respiratorias y hemodinámicas y las complicaciones relacionadas con la presión intraabdominal elevada y con la posición de Trendelenburg profunda en pacientes sometidos a prostatectomía robótica. El objetivo secundario fue revelar criterios seguros de alta del quirófano.MétodosCincuenta y tres pacientes sometidos a prostatectomía robótica entre diciembre de 2009 y enero de 2011 fueron incluidos en un estudio prospectivo. Las principales medidas de resultado fueron: monitorización no invasiva, monitorización invasiva y gasometría realizada en decúbito dorsal (T0), Trendelenburg (T1), Trendelenburg+neumoperitoneo (T2), Trendelenburg predesinsuflación (T3), Trendelenburg posdesinsuflación (T4) y posiciones supinas (T5).ResultadosCincuenta y tres pacientes sometidos a prostatectomía robótica fueron incluidos en el estudio. El principal reto clínico en nuestro grupo de estudio fue la elección de la estrategia de ventilación para controlar la acidosis respiratoria, que es detectada por medio de la presión de dióxido de carbono espirado y la gasometría. Además, la presión arterial media permaneció inalterada, y la frecuencia cardíaca disminuyó significativamente y fue necesario intervenir. Los valores de la presión venosa central también estaban por encima de los límites normales.ConclusiónLa acidosis respiratoria y los síntomas clínicos «similares a la obstrucción de las vías aéreas» fueron los principales desafíos asociados con los procedimientos de prostatectomía robótica.AbstractBackground and objectivesAlthough many features of robotic prostatectomy are similar to those of conventional laparoscopic urological procedures (such as laparoscopic prostatectomy), the procedure is associated with some drawbacks, which include limited intravenous access, relatively long operating time, deep Trendelenburg position, and high intra-abdominal pressure. The primary aim was to describe respiratory and hemodynamic challenges and the complications related to high intra-abdominal pressure and the deep Trendelenburg position in robotic prostatectomy patients. The secondary aim was to reveal safe discharge criteria from the operating room.MethodsFifty-three patients who underwent robotic prostatectomy between December 2009 and January 2011 were prospectively enrolled. Main outcome measures were non-invasive monitoring, invasive monitoring and blood gas analysis performed at supine (T0), Trendelenburg (T1), Trendelenburg + pneumoperitoneum (T2), Trendelenburg-before desufflation (T3), Trendelenburg (after desufflation) (T4), and supine (T5) positions.ResultsFifty-three robotic prostatectomy patients were included in the study. The main clinical challenge in our study group was the choice of ventilation strategy to manage respiratory acidosis, which is detected through end-tidal carbon dioxide pressure and blood gas analysis. Furthermore, the mean arterial pressure remained unchanged, the heart rate decreased significantly and required intervention. The central venous pressure values were also above the normal limits.ConclusionRespiratory acidosis and “upper airway obstruction-like” clinical symptoms were the main challenges associated with robotic prostatectomy procedures during this study

Ureteric Duplication is not a Contraindication for Robot-Assisted Laparoscopic Radical Cystoprostatectomy and Intracorporeal Studer Pouch Formation

The authors found that duplicated ureters was not a contraindication to robot-assisted laparoscopic radical cystoprostatectomy in this case

What if the Hand Piece Spring Disassembles During Robotic Radical Prostatectomy?

These authors report on the successful management of a disassembled hand piece spring during robotic radical prostatectomy

MEASURING FIRM PERCEPTION TO ADAPTATION of INDUSTRY 4.0: THE CASE OF TURKEY

Purpose: This study aims at examining the perceptions of various layers within a firm toward integrating Industry 4.0 applications in production. Methodology: We follow a case study approach to obtain detailed information about the selected firm. For this purpose, we focus on three sectors as machinery, food, and automotive spare parts having a strategic role in digital transformation. In total, 12 interviews with blue-collar workers, engineers, and managers are conducted in five different companies. Findings: The results of the study are twofold. As for the senior management layer and engineers, the adaptation of Industry 4.0 applications to the firm will increase the firm efficiency. As far as its effect on employment is considered, it has been determined that the concept is not fully understood, especially by blue-collar workers, and it is not known how it will contribute to production. Production line workers, therefore, think that they will experience the threat of losing their jobs with the implementation of Industry 4.0 applications. Originality: Despite its importance, the number of studies dealing with the difficulties, benefits, opportunities, and threats of adopting Industry 4.0 especially for developing countries is still few. This study, therefore, closes this gap by conducting a comprehensive study with various layers of the firm

Is Positron Emission Tomography Reliable to PredictPost-Chemotherapy Retroperitoneal Lymph NodeInvolvement in Advanced Germ Cell Tumors of theTestis?

PURPOSE: To evaluate if 18 fluorodeoxyglucose positron emission tomography(18FDG-PET) scan could identify post-chemotherapy retroperitoneal lymphnode (RPLN) involvement in advanced germ cell tumors of the testis.MATERIALS AND METHODS: Between January 2005 and January 2009, 16patients with advanced germ cell tumors of the testis underwent RPLNdissection (RPLND) following chemotherapy. Before RPLND, abdominalcomputed tomography (CT), magnetic resonance imaging (MRI), and18FDG-PET were performed in all the patients. Findings on 18FDG-PETwere compared with pathological evaluation of the removed lymphatic tissue.RESULTS: Both abdominal CT and MRI demonstrated retroperitonealmasses in all the patients following chemotherapy. Although PET did not demonstrate any activity in 8 patients, tumor was detected histopathologically.In 1 patient, 18FDG-PET demonstrated activity; however, no tumor wasdetected on pathology. Of the remaining 7 patients, 18FDG-PET findingswere concordant with the histopathological findings. No activity wasdetected in 2 patients with no tumors whereas all 5 patients harboring viabletumor cells showed positive 18FDG-PET activity. In our study, sensitivityand specificity of 18FDG-PET in detecting RPLN involvement were detectedto be 39% and 67%, respectively.CONCLUSION: 18FDG-PET imaging does not seem to be a reliable methodin detecting RPLN involvement in advanced germ cell tumors of the testisfollowing chemotherapy. Therefore, we neither recommend routine use of18FDG-PET scanning nor decide the treatment work-up by solely relying onthe 18FDG-PET findings in this patient group

Patient use of complementary and alternative medicine for psoriasis vulgaris and factors believed to trigger the disease: A multicenter cross-sectional study with 1621 patients

Introduction: Due to the chronic recurrent nature of psoriasis vulgaris (PV) and lack of definitive treatment for the disease, patients often resort to alternative treatments. Physicians seem to have low awareness of this issue. Objectives: To elicit the perceptions of 1,621 PV patients on complementary and alternative medicine (CAM) and examine factors reported to worsen PV. Methods: The patients sociodemographic characteristics, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), disease duration, and severity were recorded, and the patients CAM use was questioned in detail. The patients were also asked about factors that worsened PV and their experiences with a gluten-free diet. Results: Of the patients, 56.51% had used CAM. The mean age, illness duration, PASI scores and DLQI of those using CAM were significantly higher. CAM use was significantly higher in those with facial, genital involvement, and arthralgia/arthritis. The patients mostly referred to CAM when PV became severe (46.4%). Of the CAM users, 45.52% used herbal topicals. The physicians of 67.03% did not inquire whether they used CAM. Of the participants, 37.73% considered that stress worsened their disease. Gluten-free diet did not affect PV symptoms in 52.22%. Conclusions: Patients CAM use is often overlooked by dermatologists. Our results showed that more than half the patients used CAM and did not share this information with their physicians. Therefore, the awareness of physicians should be increased and patients should be asked about the use of CAM and directed to the appropriate medical treatment options by physicians

Habits of using social media and the internet in psoriasis patients

Introduction: Psoriasis significantly affects the patients quality of life, which often leads patients to seek online information about this disease. Objectives: To explore the habits of patients with psoriasis related to their use of social media (SM) and the internet to obtain information about their disease. Methods: 1,520 patients completed the survey and the Dermatology Life Quality Index (DLQI) questionnaire. The Psoriasis Area Severity Index scores (PASI) and clinical data of the patients were recorded by their physicians. Results: Of the 1,114 patients that reported using SM and internet, 48.38% regularly and 31.14% sometimes resorted to obtain information about psoriasis. The use of SM and internet for psoriasis was statistically significantly higher among young people (P = 0.000), those with university or higher education (P = 0.009), higher DLQI (P = 0.000) and PASI (P = 0.011) scores, facial (P = 0.050), scalp (P = 0.032), hand (P = 0.048), genital (P = 0.001) and inverse (P = 0.000) involvement, and arthralgia/arthritis (P = 0.006). The participants mostly used the Google (86%) and Facebook (41%). More than half of the participants (62.8%) expected dermatologists to inform society that psoriasis is not contagious. Conclusions: Internet and SM being widely available and offering substantial information to be easily accessed make it very attractive for patients to use these platforms to investigate diseases, including psoriasis. If what is presented on SM conflicts with what the physician says, patients mostly trust the latter, but at the same time, they tend not to share the results of their online inquiries with their physicians

The frequency of Duchenne muscular dystrophy/Becker muscular dystrophy and Pompe disease in children with isolated transaminase elevation: results from the observational VICTORIA study

IntroductionElevated transaminases and/or creatine phosphokinase can indicate underlying muscle disease. Therefore, this study aims to determine the frequency of Duchenne muscular dystrophy/Becker muscular dystrophy (DMD/BMD) in male children and Pompe disease (PD) in male and female children with isolated hypertransaminasemia.MethodsThis multi-center, prospective study enrolled patients aged 3–216 months with serum alanine transaminase (ALT) and/or aspartate transaminase (AST) levels >2× the upper limit of normal (ULN) for ≥3 months. Patients with a known history of liver or muscle disease or physical examination findings suggestive of liver disease were excluded. Patients were screened for creatinine phosphokinase (CPK) levels, and molecular genetic tests for DMD/BMD in male patients and enzyme analysis for PD in male and female patients with elevated CPK levels were performed. Genetic analyses confirmed PD. Demographic, clinical, and laboratory characteristics of the patients were analyzed.ResultsOverall, 589 patients [66.8% male, mean age of 63.4 months (standard deviation: 60.5)] were included. In total, 251 patients (188 male and 63 female) had CPK levels above the ULN. Of the patients assessed, 47% (85/182) of male patients were diagnosed with DMD/BMD and 1% (3/228) of male and female patients were diagnosed with PD. The median ALT, AST, and CPK levels were statistically significantly higher, and the questioned neurological symptoms and previously unnoticed examination findings were more common in DMD/BMD patients than those without DMD/BMD or PD (p < 0.001).DiscussionQuestioning neurological symptoms, conducting a complete physical examination, and testing for CPK levels in patients with isolated hypertransaminasemia will prevent costly and time-consuming investigations for liver diseases and will lead to the diagnosis of occult neuromuscular diseases. Trial RegistrationClinicaltrials.gov NCT04120168

Atık su arıtma çamurlarının şartlandırılmasında alternatif yöntemlerinin araştırılması

06.03.2018 tarihli ve 30352 sayılı Resmi Gazetede yayımlanan “Yükseköğretim Kanunu İle Bazı Kanun Ve Kanun Hükmünde Kararnamelerde Değişiklik Yapılması Hakkında Kanun” ile 18.06.2018 tarihli “Lisansüstü Tezlerin Elektronik Ortamda Toplanması, Düzenlenmesi ve Erişime Açılmasına İlişkin Yönerge” gereğince tam metin erişime açılmıştır.ÖZET Arıtma çamurlarının içerdiği su miktarının düşürülmesi, bertaraf edilecek çamur miktarının azaltılması ve bertaraf seçeneklerinin artması bakımından en belirleyici unsurdur. Mevcut durumda çamur susuzlaştırmada en çok kullanılan yöntemler mekanik yöntemlerdir. Ancak mekanik yöntemlerin veriminin artırılması için, çamura polielektrolit ilave edilerek şartlandırma işlemi yapılması ve çamurun su verme özelliklerinin iyileştirilmesi gerekmektedir. Bu çalışmada çamur şartlandırma işleminde ki polielektrolit kullanımına alternatif olarak biyokütle ve kömür külü kullanımının, arıtma çamurunun su verme özellikleri üzerine etkisi incelenmiştir. Bu amaçla biyokütle ve kömür külü değişik oranlarda arıtma çamurları ile karıştırılmıştır. Kontrol uygulaması olarak da 1/1000'lik katyonik polielektrolit çözeltisi kullanılmıştır. Çalışmada elde edilen sonuçlar göre karışımlardaki kül oranı arttıkça, su verme özelliklerinin en önemli göstergeleri olan, özgül filtre direnci (ÖFD) ve filtre keki nem miktarları (FK) önemli ölçüde azalmıştır. Kontrol olarak kullanılan polielektrolit uygulamasına (ÖFD: 2,8.1011 m.kg-1, FK: %58,96) en yakın sonuçlar, en yüksek oranda biyokütle külü kullanılan BÇ6 uygulamasında (ÖFD: 29.1011 m.kg-1, FK: %65,92) elde edilmiştir. Bununla birlikte biyokütle ve kömür külü uygulamalarının sonuçları istatistiksel olarak önemli ölçüde benzer bulunmuştur(R2=0,99). Biyokütle ve kömür külü ağır metal içeriğinde ise, Zn dışındaki tüm değerlerde, biyokütle külünün ağır metal oranlarının daha düşük olduğu görülmüştür. Bu sonuçlara göre, biyokütle ve kömür küllerinin evsel atık su arıtma çamurlarının su verme özelliklerinin iyileştirilmesinde kullanılabileceği, ancak çamurun ağır metal düzeyi göz önünde bulundurularak, susuzlaştırmadan sonraki bertaraf alternatiflerinin artırılması için biyokütle külü kullanımının en iyi alternatif olduğu söylenebilir. Anahtar Kelimeler: Arıtma çamurlarının susuzlaştırılması, biyokütle külü, kömür külüANALYZING THE EFFECTS OF ADDITION OF BIOMASS AND COAL ASH FOR BEING IMPROVED THE DEWATERING PROPERTIES OF SEWAGE SLUDGES SUMMARY Keywords: Dewatering of the sewage sludges, biomass ash, coal ash Diminishing the amount of water in sewage sludges is the most determinant factor in terms of increasing the options of removing and being reduced the number of sludges to remove. In the current situation, the most preferred methods are the mechanic methods for sludge dewatering. But, the quenching features of the sludge must be improved and the conditioning procedures need to be actualized by adding polyelectrolyte into the sludge to enhance the productivity of the mechanical methods. As an alternative to the use of polyelectrolyte in sludge conditioning procedure, the effects of the use of biomass and coal ash on the quenching features are analyzed in this research. For this purpose, the biomass and the coal ash were mixed with the sewage sludges in different ratios. The 1/1000 cationic polyelectrolyte solution was used as the control application. According to the results obtained from the study, as the ash content in the mixtures increases, the specific resistance to filtration (SRF) and the filter cake moisture content (FCM), which are the most important indicators of water quenching properties, have been significantly reduced. The closest results to the polyelectrolyte application (SRF 2,8.1011 m.kg-1, FCM: % 58,96) used as the control were obtained from the BC6 application (SRF: 29.1011 m.kg-1, FCM: % 65,92) where the highest ratio of biomass ash used. Moreover, the results of the implementations of biomass and coal ash are determined as statistically similar (R2=0,99). In the content of biomass and coal ash heavy metals, it is seen that the ratios of heavy metal of biomass ash are lower for all values other than Zn. It is thought according to these results that the biomass and coal ash can be used to improve the dewatering features of domestic waste water treatment sludges. However, considering the heavy metal level of the sludge, it can be said that the best alternative is the use of biomass ash for increasing the disposal options after dewatering