Хирургическое лечение холециститов и их осложнений

ЖЕЛЧНОКАМЕННАЯ БОЛЕЗНЬЖЕЛЧНЫХ ПУТЕЙ БОЛЕЗНИПЕЧЕНИ БОЛЕЗНИХИРУРГИЯ ЖЕЛЧНЫХ ПУТЕЙХИРУРГИЯ ПЕЧЕНИХОЛЕЦИСТИТКурс лекций включает в себя 8 лекций, посвященных анатомическим сведениям о желчевыводящих путях, этиопатогенезу острого и хронического холецистита. Освещены современные методы диагностики заболевания желчевыводящих путей, приведена клиническая картина различных форм острого холецистита, включая поражения желчевыводящих путей, хирургическая тактика, способы хирургических вмешательств, ошибки в хирургии желчевыводящих путей, постхолецистэктомический синдром

Conception and development of the electrical systems of a personal elevator

In the past decades the buildings with crystal façades have been increasing and therefore the need to clean them. In addition there are more towers or more places that need to be accessed by ropes such as eolic parks that have to be inspected. To deal with all this demands traditional rope access is used. By means of ropes and ascenders the workers can climb or descend and perform the desired work. Rope access has some inconvenients. It requires strong users and for some applications where speed is critical it becomes a slow method. In order to increase the age span of the workers and to increase the speed of work the motorized solutions were invented. Among the different motorized solutions, the power ascenders offer a compact lightweight solution that is not dependent to the building and is not subject to a specific space on the ground to place an aerial work platform. On a power ascender powered by a battery, the power flows through the motor controller to the motor that will produce the torque needed to go up or will regenerate current when going down. Apart from that, there are electronic systems that handle the state machine and there is a friendly user interface that even if the user has not read the manual he/she will be able to operate the machine. Also included on the project there are some tests that have been considered relevant when validating the systems. Finally a brief economic study of the prototyping of the product has been included as well as an environmental impact

Conception and development of the electrical systems of a personal elevator

In the past decades the buildings with crystal façades have been increasing and therefore the need to clean them. In addition there are more towers or more places that need to be accessed by ropes such as eolic parks that have to be inspected. To deal with all this demands traditional rope access is used. By means of ropes and ascenders the workers can climb or descend and perform the desired work. Rope access has some inconvenients. It requires strong users and for some applications where speed is critical it becomes a slow method. In order to increase the age span of the workers and to increase the speed of work the motorized solutions were invented. Among the different motorized solutions, the power ascenders offer a compact lightweight solution that is not dependent to the building and is not subject to a specific space on the ground to place an aerial work platform. On a power ascender powered by a battery, the power flows through the motor controller to the motor that will produce the torque needed to go up or will regenerate current when going down. Apart from that, there are electronic systems that handle the state machine and there is a friendly user interface that even if the user has not read the manual he/she will be able to operate the machine. Also included on the project there are some tests that have been considered relevant when validating the systems. Finally a brief economic study of the prototyping of the product has been included as well as an environmental impact

Transient hyperglycemia during liver transplantation does not affect the early graft function

Background and rationale for the study. Hyperglycemia after graft reperfusion is a consistent finding in liver transplantation (LT) that remains poorly studied. We aim to describe its appearance in LT recipients of different types of grafts and its relation to the graft function.Material & methods. 436 LT recipients of donors after brain death (DBD), donors after cardiac death (DCD), and familial amyloidotic polyneuropathy (FAP) donors were reviewed. Serum glucose was measured at baseline, during the anhepatic phase, after graft reperfusion, and at the end of surgery. Early graft dysfunction (EAD) was assessed by Olthoff criteria. Caspase-3, IFN-γ, IL1β, and IL6 gene expression were measured in liver biopsy.Results. The highest increase in glucose levels after reperfusion was observed in FAP LT recipients and the lowest in DCD LT recipients. Glucose level during the anhepatic phase was the only modifiable predictive variable of hyperglycemia after reperfusion. No relation was found between hyperglycemia after reperfusion and EAD. However, recipients with the highest glucose levels after reperfusion tended to achieve the best glucose control at the end of surgery and those who were unable to control the glucose value after reperfusion showed EAD more frequently. The highest levels of caspase-3 were found in recipients with the lowest glucose values after reperfusion. In conclusion, glucose levels increased after graft reperfusion to a different extent according to the donor type. Contrary to general belief, transient hyperglycemia after reperfusion does not appear to impact negatively on the liver graft function and could even be suggested as a marker of graft quality

Short-term Outcomes in Comparison With Laparoscopic Surgery

Objective: The aim of this study was to compare short-term results obtained with transanal total mesorectal excision (TME) and laparoscopic surgery. Background: Transanal TME appears as an alternative in the treatment of rectal cancer and other rectal disease. Natural orifices transluminal endoscopic surgery using the rectum as access in colorectal surgery is intuitively better suited than other access routes. Methods: All consecutive patients with middle or low rectal cancer submitted to surgery were included into a prospective cohort and treated by transanal TME assisted by laparoscopy. They were compared with a retrospective cohort of consecutive patients of identical characteristics treated by laparoscopic TME in the immediate chronological period. Results: Thirty-seven patients were included in both study groups. No differences were observed between them with respect to baseline characteristics, thus emphasizing the comparability of both cohorts. Surgical time was higher in the laparoscopy group (252 ± 50 minutes) than in the transanal group (215 ± 60 minutes) (P < 0.01). Moreover, coloanal anastomosis was performed less frequently (16% vs 43%, respectively; P = 0.01) and distal margin was lower (1.8 ± 1.2 mm vs 2.7 ± 1.7 mm, respectively; P = 0.05) in the laparoscopy group than in the transanal one. Although there was no significant difference in 30-day postoperative complication rate (laparoscopy, 51% vs transanal, 32%; P = 0.16), early readmissions were more frequent in the laparoscopy group than in the transanal one (22% vs 6%, respectively; P = 0.03). Conclusions: Evaluation of short-term outcomes demonstrated that transanal TME is a feasible and safe technique associated with a shorter surgical time and a lower early readmission rate. Keywords: anterior resection, laparoscopy TME, Natural orifices transluminal endoscopic surgery, rectal cancer, transanal TME promise oncological outcomes compared with open surgery in low rectal cancer. 2 Besides, the COLOR II trial has shown that there were no statistically significant differences between laparoscopic and open surgical procedures with respect to TME in high and middle rectal tumors, but the first approach was superior in low rectal tumors probably due to the fact that laparoscopy gets a better view in this subset of patients. 3 It is important to mention, however, some limitations of this technique in rectal surgery, including the approach to patients with narrow pelvis or obesity and sphincter preservation, which are still points of concern. Natural orifices transluminal endoscopic surgery using the rectum as access in colorectal surgery is intuitively better suited than other access routes because it does not require incisions in viscera not directly implicated in the process. It is also a universal way, which is not limited by patients' sex and it seems to have several advantages with respect to other approaches, especially in obese patients and in those with narrow pelvis. Furthermore, it has a significant gain in avoiding abdominal incisions for organ extraction and, therefore, it may represent the natural evolution of minimally invasive colorectal surgery. 4-8 The first transanal TME resection assisted by laparoscopy was published in 2010

3Cat-1 project: a multi-payload CubeSat for scientific experiments and technology demonstrators

This article introduces 3Cat-1, the first project of the Technical University of Catalonia to build and launch a nano-satellite. Its main scope is to develop, construct, assemble, test and launch into a low Earth orbit a CubeSat with seven different payloads (mono-atomic oxygen detector, graphene field-effect transistor, self-powered beacon, Geiger radiation counter, wireless power transfer (WPT), new topology solar cells and WPT experiment), all fitted in a single-unit CubeSat. On one hand, this is mainly an educational project in which the development of some of the subsystems is carried out by undergraduate and postgraduate students. The satellite demonstrates its capabilities as a cost-effective platform to perform small scientific experiments and to demonstrate some of the new technologies that it incorporates

Rationale and study design for an individualised perioperative open-lung ventilatory strategy with a high versus conventional inspiratory oxygen fraction (iPROVE-O2) and its effects on surgical site infection : study protocol for a randomised controlled trial

Introduction Surgical site infection (SSI) is a serious postoperative complication that increases morbidity and healthcare costs. SSIs tend to increase as the partial pressure of tissue oxygen decreases: previous trials have focused on trying to reduce them by comparing high versus conventional inspiratory oxygen fractions (FIO 2) in the perioperative period but did not use a protocolised ventilatory strategy. The open-lung ventilatory approach restores functional lung volume and improves gas exchange, and therefore it may increase the partial pressure of tissue oxygen for a given FIO 2. The trial presented here aims to compare the efficacy of high versus conventional FIO 2 in reducing the overall incidence of SSIs in patients by implementing a protocolised and individualised global approach to perioperative open-lung ventilation. Methods and analysis This is a comparative, prospective, multicentre, randomised and controlled two-arm trial that will include 756 patients scheduled for abdominal surgery. The patients will be randomised into two groups: (1) a high FIO 2 group (80% oxygen; FIO 2 of 0.80) and (2) a conventional FIO 2 group (30% oxygen; FIO 2 of 0.30). Each group will be assessed intra-and postoperatively. The primary outcome is the appearance of postoperative SSI complications. Secondary outcomes are the appearance of systemic and pulmonary complications. Ethics and dissemination The iPROVE-O2 trial has been approved by the Ethics Review Board at the reference centre (the Hospital Clinico Universitario in Valencia). Informed consent will be obtained from all patients before their participation. If the approach using high FIO 2 during individualised open-lung ventilation decreases SSIs, use of this method will become standard practice for patients scheduled for future abdominal surgery. Publication of the results is anticipated in early 2019

Rationale and study design for an individualized perioperative open lung ventilatory strategy (iPROVE) : study protocol for a randomized controlled trial

Background: Postoperative pulmonary and non-pulmonary complications are common problems that increase morbidity and mortality in surgical patients, even though the incidence has decreased with the increased use of protective lung ventilation strategies. Previous trials have focused on standard strategies in the intraoperative or postoperative period, but without personalizing these strategies to suit the needs of each individual patient and without considering both these periods as a global perioperative lung-protective approach. The trial presented here aims at comparing postoperative complications when using an individualized ventilatory management strategy in the intraoperative and immediate postoperative periods with those when using a standard protective ventilation strategy in patients scheduled for major abdominal surgery. Methods: This is a comparative, prospective, multicenter, randomized, and controlled, four-arm trial that will include 1012 patients with an intermediate or high risk for postoperative pulmonary complications. The patients will be divided into four groups: (1) individualized perioperative group: intra-and postoperative individualized strategy; (2) intraoperative individualized strategy + postoperative continuous positive airway pressure (CPAP); (3) intraoperative standard ventilation + postoperative CPAP; (4) intra-and postoperative standard strategy (conventional strategy). The primary outcome is a composite analysis of postoperative complications. Discussion: The Individualized Perioperative Open-lung Ventilatory Strategy (iPROVE) is the first multicenter, randomized, and controlled trial to investigate whether an individualized perioperative approach prevents postoperative pulmonary complications

3Cat-1 project: a multi-payload CubeSat for scientific experiments and technology demonstrators

This article introduces 3 Cat-1, the first project of the Technical University of Catalonia to build and launch a nano-satellite. Its main scope is to develop, construct, assemble, test and launch into a low Earth orbit a CubeSat with seven different payloads (mono-atomic oxygen detector, graphene field-effect transistor, self-powered beacon, Geiger radiation counter, wireless power transfer (WPT), new topology solar cells and WPT experiment), all fitted in a single-unit CubeSat. On one hand, this is mainly an educational project in which the development of some of the subsystems is carried out by undergraduate and postgraduate students. The satellite demonstrates its capabilities as a cost-effective platform to perform small scientific experiments and to demonstrate some of the new technologies that it incorporates