Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery.

Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER's performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia. An ischemic segment was created in 18 small bowel loops in 6 pigs. After 2 h (n = 6), 4 h (n = 6), and 6 h (n = 6), loops were evaluated clinically and by FLER to delineate five regions of interest (ROIs): ischemic zone (ROI 1), presumed viable margins (ROI 2a-2b), and vascularized areas (3a-3b). Capillary lactates were measured to compare clinical vs. FLER assessment. Basal (V 0 ) and maximal (V max) mitochondrial respiration rates were determined according to FLER. Lactates (mmol/L) at clinically identified resection lines were significantly higher when compared to those identified by FLER (2.43 ± 0.95 vs. 1.55 ± 0.33 p = 0.02) after 4 h of ischemia. Lactates at 2 h at ROI 1 were 5.45 ± 2.44 vs. 1.9 ± 0.6 (2a-2b; p < 0.0001) vs. 1.2 ± 0.3 (3a-3b; p < 0.0001). At 4 h, lactates were 4.36 ± 1.32 (ROI 1) vs. 1.83 ± 0.81 (2a-2b; p < 0.0001) vs. 1.35 ± 0.67 (3a-3b; p < 0.0001). At 6 h, lactates were 4.16 ± 2.55 vs. 1.8 ± 1.2 vs. 1.45 ± 0.83 at ROI 1 vs. 2a--2b (p = 0.013) vs. 3a-3b (p = 0.0035). Mean V 0 and V max (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6 h at ROI 1 (V 0 (4h) = 34.83 ± 10.39; V max (4h) = 76.6 ± 29.09; V 0 (6h) = 44.1 ± 12.37 and V max (6h) = 116.1 ± 40.1) when compared to 2a--2b (V 0 (4h) = 67.1 ± 17.47 p = 0.00039; V max (4h) = 146.8 ± 55.47 p = 0.0054; V 0 (6h) = 63.9 ± 28.99 p = 0.03; V max (6h) = 167.2 ± 56.96 p = 0.01). V 0 and V max were significantly higher at 3a-3b. FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia

Real-time navigation by fluorescence-based enhanced reality for precise estimation of future anastomotic site in digestive surgery

Background: Fluorescence-based enhanced reality (FLER) is a technique to evaluate intestinal perfusion based on the elaboration of the Indocyanine Green fluorescence signal. The aim of the study was to assess FLER's performances in evaluating perfusion in an animal model of long-lasting intestinal ischemia. Materials and methods: An ischemic segment was created in 18 small bowel loops in 6 pigs. After 2h (n=6), 4h (n=6), and 6h (n=6), loops were evaluated clinically and by FLER to delineate five regions of interest (ROIs): ischemic zone (ROI 1), presumed viable margins (ROI 2a-2b), and vascularized areas (3a-3b). Capillary lactates were measured to compare clinical vs. FLER assessment. Basal (V 0 ) and maximal (V max) mitochondrial respiration rates were determined according to FLER. Results: Lactates (mmol/L) at clinically identified resection lines were significantly higher when compared to those identified by FLER (2.43±0.95 vs. 1.55±0.33 p=0.02) after 4h of ischemia. Lactates at 2h at ROI 1 were 5.45±2.44 vs. 1.9±0.6 (2a-2b; p<0.0001) vs. 1.2±0.3 (3a-3b; p<0.0001). At 4h, lactates were 4.36±1.32 (ROI 1) vs. 1.83±0.81 (2a-2b; p<0.0001) vs. 1.35±0.67 (3a-3b; p<0.0001). At 6h, lactates were 4.16±2.55 vs. 1.8±1.2 vs. 1.45±0.83 at ROI 1 vs. 2a--2b (p=0.013) vs. 3a-3b (p=0.0035). Mean V 0 and V max (pmolO2/second/mg of tissue) were significantly impaired after 4 and 6h at ROI 1 (V 0 4h =34.83±10.39; V max 4h =76.6±29.09; V 0 6h =44.1±12.37 and V max 6h =116.1±40.1) when compared to 2a--2b (V 0 4h =67.1±17.47 p=0.00039; V max 4h =146.8±55.47 p=0.0054; V 0 6h =63.9±28.99 p=0.03; V max 6h =167.2±56.96 p=0.01). V 0 and V max were significantly higher at 3a-3b. Conclusions: FLER may identify the future anastomotic site even after repetitive assessments and long-standing bowel ischemia

Probe-based confocal laser endomicroscopy and fluorescence-based enhanced reality for real-time assessment of intestinal microcirculation in a porcine model of sigmoid ischemia

Background and aim: Surgeons currently rely on visual clues to estimate the presence of sufficient vascularity for safe anastomosis. We aimed to assess the accuracy of endoluminal confocal laser endomicroscopy (CLE) and laparoscopic fluorescence-based enhanced reality (FLER), using near-infrared imaging and fluorescence from injected Indocyanine Green, to identify the transition from ischemic to vascular areas in a porcine model of mesenteric ischemia. Methods: Six pigs underwent 1-h sigmoid segmental ischemia. The ischemic area was evaluated by clinical assessment and FLER to determine presumed viable margins. For each sigmoid colon, 5 regions of interest (ROIs) were identified: ischemic (ROI 1), presumed viable margins ROI 2a (distal) and 2b (proximal), and vascular areas 3a (distal) and 3b (proximal). After injection of fluorescein, CLE scanning of the mucosa from the ischemic area toward viable margins was performed. Capillary blood samples were obtained by puncturing the serosa at the ROIs, and capillary lactates were measured with the EDGE® analyzer. Results: Capillary lactates were significantly higher at ROI 1 (4.91mmol/L) when compared to resection margins (2.8mmol/L; mean difference: 2.11; p<0.05) identified by FLER. There was no significant difference in lactates between ROI1 and resection margins identified by clinical evaluation. In 50% of cases, ROI 2aCLINIC-2bCLINIC were considered to match (<1cm distance) with ROI 2aFLER-2bFLER. Confocal analysis revealed specific clues to identify the transition from ischemic to viable areas corresponding to those assessed by FLER in 11/12 cases versus 7/12 for those identified by clinical evaluation. Conclusions: In this experimental model, FLER and CLE were more accurate than clinical evaluation to delineate bowel vascularization

All Peoples' Association

Julius Halvaxhttp://www.lib.unideb.huDebreceni Egyetem Egyetemi és Nemzeti KönyvtárA könyvjegyen egy madár száll a város felett, karmai között egy könyvet tart, a hátán két egymást fedő glóbusz APA felirattal. A kép alsó részén az "Ex libris All Peoples' Association Hungarian Branch" feliat látható, alatta kisebb betűkkel: Julius Halvaxmetsze

Untersuchung des Verständnisses und der Anwendung des hybriden Projektmanagements im deutschsprachigen Raum

Diese Arbeit beschäftigt sich mit der Analyse des hybriden Projektmanagements, insbesondere mit der Fragestellung, ob ein anerkanntes Konzept für hybrides Projektmanagement in den Organisationen vorhanden ist und angewendet wird. Um das hybride Projektmanagement zu durchleuchten, werden im ersten Schritt mittels Analyse der Literatur das klassische Projektmanagement, der agile Ansatz und in weiterer Folge deren Kombination betrachtet. Der Fokus liegt dabei insbesondere auf der Gestaltung und Anwendung von hybriden Modellen. Anhand dieser Analyse wird eine Hypothese aufgestellt, welche die Basis für einen Onlinefragebogen bildet. Bei der Umfrage haben 73 ExpertInnen teilgenommen, deren Aufgabe es war, die Anwendung der unterschiedlichen Projektmanagement-Ansätzen anzugeben und anschließen die Methoden auszuwählen, welche für eine Kombination im Projektmanagement herangezogen werden. Des Weiteren geben die ExpertInnen an, ob ein anerkannter Standard für eine hybride Vorgehensweise angewendet wird und wie sie den Ausprägungsgrad an Agilität einschätzen. Mehr als 80 % der TeilnehmerInnen geben an, dass die Anwendung eines hybriden Projektmanagementmodells durch eine eigene Zusammenstellung der einzelnen Methoden erfolgt anstelle einer Anwendung eines anerkannten Standards. In Bezug auf die Projektmanagement-Ansätze wurde durch die ExpertInnen angegeben, dass eine Mischform aus den klassischen und agilen Ansätzen mit mehr als 40 % zum Einsatz kommt. Dies zeigt somit eine Häufigkeit im Vergleich zu rein klassischen und agilen Anwendungen auf. Mit über 30% wurde der Ausprägungsgrad an Agilität auf einer Skala zwischen 1 und 5 mit 3 durch die TeilnehmerInnen bewertet.This paper deals with the analysis of hybrid project management, in particular with the question whether a recognized concept for hybrid project management exists and how applied in the organizations. In order to examine hybrid project management, the first step is to analyze the literature on classical project management, the agile approach and, subsequently, its combination. The focus is on the design and application of hybrid models. On the basis of this analysis a hypothesis will be established, which forms the basis for an online questionnaire. In the survey 73 experts participated whose task it was to indicate the application of the different project management approaches and in the second step to select the methods which will be used for a combination in project management. In addition, the experts indicated whether a recognized standard for a hybrid approach was being applied on the one hand and an assessment of the degree of agility on the other. More than 80% of the participants stated that the application of a hybrid project management model is based on their own compilation of the individual methods instead of the application of a recognized standard. With regard to the project management approaches, the experts stated that a mixed form of classical and agile approaches is used with more than 40% and thus shows a frequency compared to purely classical and agile applications. The degree of agility on a scale between one and five with three was evaluated by the participants with more than 30%.vorgelegt von: Christina HalvaxWien, FH Campus Wien, Masterarb., 2019(VLID)446797

Investigation of steel fibers bond strength in mortar matrix

In this paper the results of an investigation about steel fibers bond strength in mortar matrix are presented. Pull-out tests were made with four different types of fibers (hookedend, crimped, flat-end, anchoraged), the fibers were embedded individually into a cement based sample with three different embedded length (10, 15, 20 mm). Another variable parameter of the experiment was the strength of the matrix (three different mixture were used), and hooked-end fibers with higher tensile strength and zinc surface coating were tested also. During the tests pull-out force and displacement were measured