Laparoscopic appendectomy in the pediatric age group: comparative study between LigaSure and monopolar diathermy

Background Various techniques such as endoloops, endoscopic linear cutting staplers, electrothermal vesselsealing system (LigaSure), Harmonic scalpel, clips, and bipolar coagulation have been used for the division of the mesoappendix during laparoscopic appendectomy. This study was conducted to evaluate the potential benefits and limitation of LigaSure and electrocautery in laparoscopic appendectomy (LA).Patients and methods Forty patients with clinical diagnosis of acute appendicitis admitted to the Pediatric Surgery Unit at the Alexandria University Children’s Hospital between September 2008 and September 2010 were included in this study. The patients were assigned to two groups according to the mesoappendix dissection device: LigaSure and monopolar diathermy (MD) groups. The primary outcome measures (operating time, conversion rate, length of hospital stay, bleeding during dissection, port site infection, and readmissions) were compared.Results LA was performed in 40 patients with acute appendicitis. Twenty cases were in the LigaSure group and 20 cases were in the MD group. The mean operative times were 33.05 min and 43.80 min in the LigaSure and MD groups, respectively. Bleeding during appendicular dissection as roughly estimated by the mean number of needed irrigations were 1.60 and 1.95 for the LigaSure and MD groups, respectively. No statistically significant differences regarding hospital stay, rate of infection, readmissions, or conversion to open appendectomy were found, whereas significant differences were observed in operative time and bleeding.Conclusion The use of LigaSure for dissection of the mesoappendix shortens the operative time, and significantly decreases bleeding during LA. We believe that LigaSure is a safe and useful tool for mesoappendix dissection during LAKeywords: children, laparoscopic appendectomy, LigaSure, monopolar diatherm

Pubovaginal sling, the godfather of midurethral slings that remained so

AbstractForty years ago, autologous fascial slings became the gold standard in the treatment of genuine stress incontinence. In 1996, a synthetic material sling was introduced to the urogynecological literature known as tension-free vaginal tape. Some years later, another synthetic tape was introduced through a novel trajectory: transobturator. Due the conception of most polypropylene synthetic tapes, scores of devices, applicators and tape designs evolved. Now, with reports surfacing in the urologic literature on the adverse events of synthetic tapes and their potentially fatal complications, it is prudent to endeavor once more the place of autologous pubovaginal sling. This review addresses the evolution of pubovaginal slings and milestones of its journey to its current position in surgery of incontinence

Evidence to Support a Putative Role for Insulin Resistance in Chronic Kidney Disease

Introduction: The primary cause of morbidity and mortality in the renal patient is a cardiovascular event. Insulin resistance (IR) contributes to this event by increasing cardiovascular disease (CVD) and accelerating rates of decline in kidney function. Here we review the historical background of IR in patients with chronic kidney disease (CKD) and present evidence for a role of IR in accelerating cardiovascular and renal diseases. Review: The high prevalence of IR in CKD patients is well documented. It is suggested that increased IR in the renal patient is caused by uremia as well as by other known factors in the general population. Patients with CKD have an alarmingly high risk for cardiovascular morbidity and mortality. There is overwhelming evidence to support a role for IR in increased CVD morbidity and mortality in the general population, which is likely to extend to CKD patients. Some of the traditional treatment measures for IR, such as metformin, may not be applicable to the renal patient. Other options include weight reduction, exercise, treatment of anemia to improve exercise tolerance, treatment of vitamin D deficiency, thiazolidinediones, and dialysis. IR is estimated by studying the relationship between blood glucose and the concomitant insulin level. Such measurement may help identify patients at increased risk for future cardiovascular events and guide treatment measures. Conclusion: Sufficient evidence supports the increased prevalence of IR in kidney patients. Treating IR may retard the progression of CKD and decrease the incidence of cardiovascular events in this high risk population. Keywords: chronic kidney diseass, cardiovascular disease, insulin resistanc

Experimental Investigation on a Slurry Pump at Different Operating Parameters

Study on slurry pump performance has attracted much interest in many engineering fields. When pumps are required to handle slurries. The pump head and efficiency are mainly affected by the solid size, solid concentration and solid density. Centrifugal slurry pumps are benign used extensively for pipeline transportation systems and phosphate extraction industry because of their capabilities to economically convey large size abrasive solids in bulk. There is a lack of information about the effect of slurry on the performance characteristics of conventional centrifugal pumps when working without and with cavitation. A test rig with a testing centrifugal pump was constructed. The suction pipe between the mixing tank and pump inlet was designed to avoid solid deposition in suction pipe and to keep the pressure loss between the sump and the pump as low as possible. The rig was designed so that the flow rates, suction pressure, rotational speed, and solid concentration could be varied independently. The results showed that the head generating capability and pump efficiency decrease, also the power consumption increases with increasing solid concentration, consequently the head and efficiency of the pump with NPSH decreases with increasing the solids concentration and particle size, and cavitation inception accelerates with increase the solid concentration

PENGEMBANGAN USAHA PERIKANAN TANGKAP SKALA KECIL DI KABUPATEN KOLAKA, SULAWESI TENGGARA

Sektor perikanan tangkap memiliki peran penting dalam upaya meningkatkan ekonomi masyarakat. Salah satunya dengan pengembangan usaha nelayan skala kecil. Penelitian ini bertujuan untuk mengetahui potensi pengembangan usaha perikanan skala kecil dan menganalisis tingkat efisiensi jenis alat tangkap nelayan. Penelitian dilakukan di Kabupaten Kolaka, Provinsi Sulawesi Tenggara. Data yang digunakan adalah data primer berdasarkan hasil wawancara langsung di lapangan serta data sekunder dikumpulkan dari instansi pemerintah terkait. Kegiatan usaha perikanan tangkap skala kecil, khususnya pada alat tangkap pancing tonda dan rawai dasar, memiliki nilai efisiensi yang rendah jika dilihat dari nilai profitabilitasnya, yaitu 20% dan 30%, jika dibandingkan dengan alat tangkap jala jatuh berkapal dan bagan dengan nilai profitabilitas, yaitu 40% dan 50%. Secara umum, perikanan skala kecil di Kolaka masih sangat memiliki ketergantungan dengan pemilik modal usaha untuk menjalankan kegiatan perikanan. Pengembangan usaha perikanan, khususnya pada alat tangkap yang memiliki nilai efisiensi rendah, perlu bantuan modal yang besar untuk meningkatkan nilai pendapatannya. Kebijakan perikanan skala kecil di Kabupaten Kolaka dikelola oleh Unit Pelaksana Teknis Dinas (UPTD) Perikanan Tangkap, khususnya pada bidang pemberdayaan nelayan skala kecil. Title: Analysis of Small Scale Catch Fisheries Business in Kolaka District, South SulawesiThe capture fisheries sector has an important role in efforts to improve the community’s economy, one of which is the development of small-scale fishing businesses. This study aims to determine the potential for developing small-scale fisheries and to analyze the efficiency level of types of fishing gear. The research location is in Kolaka Regency, Southeast Sulawesi Province, the data used is primary data based on the results of direct interviews in the field and secondary data collected from relevant government agencies. Small-scale capture fishery business activities, especially in line fishing gear and basic longlines, have low-efficiency values seen from their profitability values, namely 20%, and 30% compared to fishing gear, Jalah Jatu, and boats, with profitability values of 40% and 50%, respectively. In general, small-scale fisheries in Kolaka are still very dependent on business capital owners to carry out fishing activities. The development of fisheries business, especially in fishing gear that has a low-efficiency value, requires large capital assistance to increase the value of its income. Small-scale fisheries policies in Kolaka Regency are managed by the Capture Fisheries Technical Implementation Unit, especially in the field of empowering small-scale fishermen

Pulmonary Hypertension in Patients with Treated Pulmonary Tuberculosis: Analysis of 14 Consecutive Cases

Background Pulmonary tuberculosis (PTB) is an increasing global health problem that continues to cause significant morbidity and mortality. The impact of PTB has been measured in terms morbidity and mortality and little attention has been paid to continuing respiratory disability in those who were cured. Pulmonary hypertension (PHT) is a serious respiratory disability that results from structural lung damage and chronic hypoxia. This study was conducted to investigate the presence of PHT in a cohort of treated PTB patients who presented with shortness of breath. Methods This is a cross-sectional study that included 14 consecutive patients who were cured of PTB and presented with shortness of breath. Demographic and clinical data were recorded for all patients. PHT was diagnosed using Doppler echocardiography. Results Fourteen patients who were treated for PTB and were found to have PHT were studied. All patients were sputum smear negative at the time of the study. The mean age (SD) was 43.1 (13.6) and half of the patients were males. The mean number of years since PTB was diagnosed (SD) was 9.4 (10.9). All patients had abnormal chest x-rays. The commonest radiological abnormality was fibrocavitation which occurred in 50% of patients. Estimated pulmonary artery systolic pressure (PASP) of 51 to 80 mm/Hg was found in 9 patients (64.3%) whereas PASP of 40 to 50 mm/Hg was found in 4 patients (28.6%) and one patient had PASP more than 80 mm/Hg. Conclusions Different grades of PHT occurred in this cohort of treated PTB patients on average about 9 years after cure. The findings of this study support implementation of strategies for early detection and prevention of PTB. For those who were cured from PTB, longer periods of disability should be implemented in assessment of disease burden

One-Year Results of Simultaneous Topography-Guided Photorefractive Keratectomy and Corneal Collagen Cross-Linking in Keratoconus Utilizing a Modern Ablation Software

Purpose. To evaluate effectiveness of simultaneous topography-guided photorefractive keratectomy and corneal collagen cross-linking in mild and moderate keratoconus. Methods. Prospective nonrandomized interventional study including 20 eyes of 14 patients with grade 1-2 keratoconus that underwent topography-guided PRK using a Custom Ablation Transition Zone (CATz) profile with 0.02% MMC application immediately followed by standard 3 mw/cm2 UVA collagen cross-linking. Maximum ablation depth did not exceed 58 μm. Follow-up period: 12 months. Results. Progressive statistically significant improvement of UCVA from 0.83±0.37 logMAR preoperative, reaching 0.25±0.26 logMAR at 12 months (P<0.001). Preoperative BCVA (0.27±0.31 logMAR) showed a progressive improvement reaching 0.08±0.12 logMAR at 12 months (P=0.02). Mean Kmax reduced from 48.9±2.8 to 45.4±3.1 D at 12 months (P<0.001), mean Kmin reduced from 45.9±2.8 D to 44.1±3.2 D at 12 months (P<0.003), mean keratometric asymmetry reduced from 3.01±2.03 D to 1.25±1.2 D at 12 months (P<0.001). The safety index was 1.39 at 12 months and efficacy index 0.97 at 12 months. Conclusion. Combined topography-guided PRK and corneal collagen cross-linking are a safe and effective option in the management of mild and moderate keratoconus. Precis. To our knowledge, this is the first published study on the use of the CATz ablation system on the Nidek Quest excimer laser platform combined with conventional cross-linking in the management of mild keratoconus

Antidepressant treatment with fluoxetine during pregnancy and lactation modulates the gut microbiome and metabolome in a rat model relevant to depression

Funding Information: JDAO was supported by the European Union?s Horizon 2020 research and innovation program under the Marie Sk?odowska Curie Individual Fellowship under Grant 660152-DEPREG; and a NARSAD young investigator grant under Grant 25206. ASR was supported by a scholarship awarded by the Fulbright Center The Netherlands. TLB was supported by the National Institutes of Mental Health under Grant numbers P50-MH099910, MH 104184, MH 091258, MH 087597, MH 073030, and MH 108286. EJ was supported by the National Institutes of Health National Research Service Award F32 under Grant MH 109298. We thank Judith Swart, Wanda Douwenga and Christa Reitzema-Klein for their assistance with the early life stress procedure, drug administration and sample collection. Publisher Copyright: © 2020, © 2020 The Author(s). Published with license by Taylor & Francis Group, LLC. Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Peer reviewedPublisher PD

Sequence Polymorphism, Segmental Recombination and Toggling Amino Acid Residues within the DBL3X Domain of the VAR2CSA Placental Malaria Antigen

Plasmodium falciparum malaria remains one of the world's foremost health problems, primarily in highly endemic regions such as Sub-Saharan Africa, where it is responsible for substantial morbidity, mortality and economic losses. Malaria is a significant cause of severe disease and death in pregnant women and newborns, with pathogenesis being associated with expression of a unique variant of the multidomain Plasmodium falciparum Erythrocyte Membrane Protein 1 (PfEMP1) called VAR2CSA. Here, we characterize the polymorphism of the DBL3X domain of VAR2CSA and identify regions under selective pressure among placental parasites from women living in endemic western Kenya. In addition to significant levels of polymorphism, our analysis reveals evidence for diversification through intra-segmental recombination and novel mutations that likely contributed to the high number of unique VAR2CSA sequence types identified in this study. Interestingly, we also identified a number of critical residues that may be implicated in immune evasion through switching (or toggling) to alternative amino acids, including an arginine residue within the predicted binding pocket in subdomain III, which was previously implicated in binding to placental CSA. Overall, these findings are important for understanding parasite diversity in pregnant women and will be useful for identifying epitopes and variants of DBL3X to be included in a vaccine against placental malaria