Some Investigations of the General Instability of Stiffened Metal Cylinders V : Stiffened Metal Cylinders Subjected to Pure Bending

This report summarizes the work that has been carried on in the experimental investigation of the problem of general instability of stiffened metal cylinders subjected to pure bending at the C.I.T. This part of the investigation included tests of 46 sheet-covered specimens. The most significant result was the determination of a new design parameter for the case of a stiffened metal cylinder subjected to pure bending

The Inward Bulge Type Buckling of Monocoque Cylinders IV : Experimental Investigation of Cylinders Subjected to Pure Bending

Eighteen 24S-T alclad cylinders of 20-inch diameter, with skin thickness varying between 0.012 inch and 0.025 inch and length varying between 40.5 inches and 64 inches, were tested in pure bending. They were reinforced with either 16 or 28 stringers and either 5 or 6 rings. One of the purposes of the investigation was to establish the critical value above which failure would occur by general instability and below which panel instability would take place. This value was found to be between 20 and 40 for cylinders with 16 stringers and between 16 and 74 for cylinders with 28 stringers

Siblings Diagnosed With Primary Neuroendocrine Tumor of the Left Hepatic Duct

Primary left hepatic duct neuroendocrine tumors are extremely rare. We describe 2 cases of siblings, a 51-year-old brother and a 48-year-old sister, who were both diagnosed with primary left hepatic duct neuroendocrine tumor. Both patients underwent successful left hepatectomy and are both alive with no recurrence. For this rare malignancy, while definitive diagnosis is made only by histopathology, a margin-free surgical resection remains the only curative treatment modality to date

Endoscopic retrograde appendicitis therapy versus appendectomy or antibiotics in the modern approach to uncomplicated acute appendicitis: A systematic review and meta-analysis

Endoscopic therapy; Appendicitis; AppendectomyTerapia endoscópica; Apendicitis; ApendicectomíaTeràpia endoscòpica; Apendicitis; ApendicectomiaIntroduction Endoscopic retrograde appendicitis therapy has been proposed as an alternative strategy for treating appendicitis, but debate exists on its role compared with conventional treatment. Methods This systematic review was performed on MEDLINE, Cochrane Central Register of Controlled Trials, and EMBASE. The last search was in April of 2023. The risk ratio with a 95% confidence interval was calculated for dichotomous variables, and the mean difference with a 95% confidence interval for continuous variables. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool (randomized controlled trials) and the Risk of Bias in Non-Randomized Studies of Intervention tool (non-randomized controlled trials). Results Six studies met the eligibility criteria. Four studies compared endoscopic retrograde appendicitis therapy (n = 236 patients) and appendectomy (n = 339) and found no differences in technical success during index admission (risk ratio 0.97, 95% confidence interval [0.92,1.02]). Appendectomy showed superior outcomes for recurrence at 1-year follow-up (risk ratio 11.28, 95% confidence interval [2.61,48.73]). Endoscopic retrograde appendicitis therapy required shorter procedural time (mean difference –14.38, 95% confidence interval [–20.17, –8.59]) and length of hospital stay (mean difference –1.19, 95% confidence interval [–2.37, –0.01]), with lower post-intervention abdominal pain (risk ratio 0.21, 95% confidence interval [0.14,0.32]). Two studies compared endoscopic retrograde appendicitis therapy (n = 269) and antibiotic treatment (n = 280). Technical success during admission (risk ratio 1.11, 95% confidence interval [0.91,1.35]) and appendicitis recurrence (risk ratio 1.07, 95% confidence interval [0.08,14.87]) did not differ, but endoscopic retrograde appendicitis therapy decreased the length of hospitalization (mean difference –1.91, 95% confidence interval [–3.18, –0.64]). Conclusion This meta-analysis did not identify significant differences between endoscopic retrograde appendicitis therapy and appendectomy or antibiotics regarding technical success during index admission and treatment efficacy at 1-year follow-up. However, a high risk of imprecision limits these results. The advantages of endoscopic retrograde appendicitis therapy in terms of reduced procedural times and shorter lengths of stay must be balanced against the increased risk of having an appendicitis recurrence at one year

Outcomes after non-cardiac surgery: Mortality, complications, disability, and rehospitalization

In the last 25 years, the number of patients aged ≥75 years undergoing non-cardiac surgery has greatly increased. In elderly patients, frailty is significantly associated with an increased risk of adverse events, functional decline, procedural complications, prolonged hospitalization, and mortality. The relationship between frailty and increased mortality and morbidity requires an appropriate tool of assessment to accurately quantify the patient's clinical and perioperative conditions. The preoperative evaluation of elderly patients candidate for non-cardiac surgery should include assessment of frailty, sarcopenia and malnutrition, as these are related to high surgical risk. For colon-rectal surgery as also for gastric cancer surgery, especially early gastric cancer, the introduction of laparoscopy has yielded considerable benefits in terms of short-term postsurgical outcomes, e.g. lower rate of intraprocedural bleeding and reduced length of hospital stay. Despite the progress made in preoperative assessment, surgical procedures and postoperative management, the improvement of outcomes after non-cardiac surgery in elderly patients remains a challenge and calls for future, well-designed clinical studies.</p

Effect of Colic Vein Ligature in Rats with Loperamide-Induced Constipation

Introduction. Medical treatment in chronic constipation is not always successful. Surgery is indicated in unresponsive selected severe cases. This study presents the distal venous colic ligation in rat as a novel surgical approach. Materials and Methods. 16 rats (study group) were evaluated in 3 phases of 6 days each: A (normal conditions), B (loperamide-induced constipation), and C (colic vein legation) and compared with rats treated in phase C with PEG 4,000 (control group). Blood biochemical and physiological parameters, daily fecal water content (FWC), and histological analysis were performed in all study phases. Results. No biochemical and physiological parameters changes were observed. FWC decreased in phase B and increased in phase C in both groups with a grow up to 2.3-fold in study group compared to control (P < 0.0001). Moreover, in study group, a high number of colonic goblet cells were detected (phase C versus phase B: P < 0.001) while no differences were registered in control. Conclusion. By ligature of the colic vein in constipated rats, an increase in FWC and goblet cells higher than in PEG treated rats was detected. The described surgical procedure appeared effective, simple, and safe; further studies in animal models, however, are necessary to assess its clinical applicability

Sosiaalisen median hyödyntäminen Nuori Yrittäjyys -ohjelman näkyvyyden lisäämiseksi

Opinnäytetyön aiheena ovat sosiaalinen media ja yrittäjyyskasvatus. Työn tarkoituksena on antaa Etelä-Savon ammattiopistolle ideoita, kuinka opiskelijat saataisiin kiinnostumaan yrittäjyyskoulutuksesta sosiaalista mediaa hyödyntämällä. Yrittäjyyskoulutuksella tässä opinnäytetyössä tarkoitetaan Nuori Yrittäjyys-ohjelmaa, joka on osa kasainvälistä Junior Achievement – Young Enterprise -verkostoa. Tutkimusongelmat työssä olivat, kuinka Etelä-Savon ammattiopiston opiskelijat saataisiin kiinnostumaan Nuori Yrittäjyys-ohjelmasta sosiaalista mediaa hyödyntämällä ja mitkä ovat ne sosiaalisen median kanavat, joiden kautta nuoret tavoitetaan ja minkälainen sisältö heitä kiinnostaa. Teoreettinen viitekehys koostui yrittäjyydestä, yrittäjyyskasvatuksesta ja markkinoimisesta sosiaalisessa mediassa. Teoriaosuudessa käsitellään myös sisältömarkkinointia ja sisältöstrategiaa. Kyseessä on laadullinen tutkimus. Aineistonkeruumenetelmänä työssä käytettiin teemahaastattelua. Haastattelun kaksi pääteemaa olivat sosiaalinen media ja NY-yrittäjyys. Tutkimusjoukoksi valikoitui työn aiheen ja tutkimusongelmien perusteella viisi Etelä-Savon ammattiopiston nuorta opiskelijaa, jotka eivät ole itse NY-yrittäjiä, mutta tietävät ohjelman ja pääasiat siitä. Tutkimuksen perusteella kävi ilmi, että nuoret käyttävät sosiaalista mediaa paljon ja se on tehokas tapa tavoittaa nuoret. Nuoret käyttävät eniten Instagramia, Facebookia, Snapchatia ja Youtubea. Sisällön osalta heitä kiinnostavat selvästi eniten kuvat ja videot. Johtopäätelmänä voidaan sanoa, että toimeksiantajan tulisi hyödyntää sosiaalista mediaa NY-yrittäjyyden markkinoimisessa nuorille. NY-yrittäjyyden markkinoimisessa tulisi hyödyntää etenkin nykyisiä NY-yrittäjiä, sillä heillä on sosiaalisen median osaamista ja nuoret olisivat kiinnostuneita seuraamaan yrittäjien itse julkaisemaa sisältöä sosiaalisessa mediassa. Seuraamalla NY-yrittäjiä nuoret voisivat kiinnostua siitä itsekin. NY-yrittäjyyden esilletuomisessa voisi hyödyntää etenkin sisältömarkkinointia.The main subject of this thesis is social media and entrepreneurship education. The objec- tive of this thesis was to give the client ideas how students of South Savo Vocational College would get engaged in entrepreneurship education by using social media. In this case entrepreneurship education is the Nuori Yrittäjyys program, which is part of a worldwide Junior Achievement – Young Enterprise network. The research problems were how students of South Savo Vocational College would get in- terested in the Nuori Yrittäjyys -program by using social media and what are the social me- dia channels for reaching young people and what kind of content they are interested in. The theoretical framework consisted of entrepreneurship, entrepreneurship education and social media marketing. The theoretical part also discusses content marketing and content marketing strategy. This thesis was a qualitative study. The research method used was a theme interview. Two themes in the interview were social media and the Nuori Yrittäjyys program. The interviewees were young students of South Savo Vocational College, who are not NY-entrepreneurs yet, but they know what that is all about. The results of the research were clear. Young people use social media a lot and it is an ef- fective way to reach them. The social media channels they use the most are Instagram, Facebook, Snapchat and Youtube. They are most interested in photos and videos. The commissioner should use social media to market the NY-program. The current NY-en- trepreneurs could market the NY-program for students on social media channels. They should use especially content marketing. That way students could possibly get interested in the NY-program as well

Sclerobanding in the treatment of second and third degree hemorrhoidal disease in high risk patients on antiplatelet/anticoagulant therapy without suspension: a pilot study

IntroductionAround 20% of population in western countries is under anticoagulant treatment. However, there is paucity of evidence about the treatment of HD in patients under anticoagulant/antiplatelet therapy, although both suspension and continuation in the perioperative period may increase the risk of severe complications. The aim of this pilot study was to confirm the feasibility and safety of sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy), an office-based procedure, for the treatment of second-and third-degree HD in patients under anticoagulant/antiplatelet therapy without suspension.Materials and methodsPatients affected by second-third-degree haemorrhoids unresponsive to conservative treatment and under anticoagulant/antiplatelet were enrolled between November 2019 and October 2021. Postoperative complications, readmission, mortality and reintervention during the follow-up were evaluated.ResultsFifty-one patients were recruited, 23 female (45.1%) and 28 male (54.9%), with an average age of 65 years ± 11.4 SD (range 42–90). Twenty-seven patients (52.9%) had II-degree haemorrhoidal disease, and 24 (47.1%) had grade III-degree. The most frequently taken medications were dual antiplatelet therapy (51%) and new oral anticoagulants (NOACs) (21.6%). The mean follow-up was 23 months. No intraoperative complications were recorded. The rate of complications in the first postoperative month was 13.7%, represented by mild complications: 6 cases of moderate to severe pain and 1 case (2%) of thrombosis of a residual haemorrhoidal nodule, all regressing after conservative therapy. No severe complications were reported. Postoperative complications were not statistically significantly associated with the number of nodules treated (1, 2, or 3), the disease grade (2nd vs. 3rd) or the specific anticoagulant/antiplatelet regimen. During follow-up, 2 patients (4%) required a new procedure for recurrent bleeding: one an infrared photocoagulation as outpatient, and another a haemorrhoidectomy after 3 months. No cases of intraoperative or postoperative mortality occurred.ConclusionsSclerobanding is a safe and effective technique in treating intermediate-grade haemorrhoidal disease in patients at high risk on anticoagulant/antiplatelet therapy. Sclerobanding is repeatable, usually does not require anaesthesia, and is cost-effective. Observational multicentre studies with a larger number of patients and controlled clinical trials will be needed to confirm these results