Improved flexibility and equity for airspace users during demand-capacity imbalance - an introduction to the user-driven prioritisation process

ATFM slot-swapping represents the first step towards the participation of airspace users (AUs) in air traffic management and airport collaborative processes. SESAR is advancing this through development of the user driven prioritisation process (UDPP) to achieve additional flexibility for AUs to adapt their operations in a more cost-efficient manner in the presence of unforeseen demand and capacity imbalances that require the application of delays to flights. The contribution of this paper is twofold: (i) to present the challenges achieved so far with respect to UDPP concepts, in particular regarding fleet delay apportionment and selective flight protection; (ii) to pave the way towards future UDPP concepts through the introduction of enhanced selective flight protection

Some consequences of severe acute pancreatitis

Catedra chirurgie nr. 2, Clinica de chirurgie nr. 2, USMF „Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Introducere: Fistula pancreatică externă reprezintă un traiect anormal, secundar unui gest chirurgical, care face legătura dintre un canal pancreatic şi mediul exterior. Material şi metode: În intervalul septembrie 2002 – mai 2015 au fost operaţi în Clinică 49 de bolnavi cu pancreatită severă, dintre care 10 au dezvoltat o fistulă pancreatică externă (20,4%). Am studiat factorii favorizanţi ai apariţiei fistulelor în ceea ce priveşte extinderea necrozei pancreatice, protocolul operator, cât şi asocierea infecţiei. Pentru fiecare caz în parte au fos t monitorizate debitul fistulei, s-au determinat concentraţiile amilazelor şi a proteinelor din lichidul exteriorizat. Rezultate: Este relativ dificil de a stabili cu exactitate data apariţiei fistulei, mai ales în cazul drenării abceselor pancreatice. Un argument important pentru susţinerea diagnosticului de fistulă este menţinerea ridicată a concentraţiei de amilaze. Dintre cei 10 pacienţi cu fistulă pancreatică 6 au fost operaţi precoce până la 2 săptămâni şi 4 au fost operaţi mai tardiv. Din cele expuse mai sus rezultă că majoritatea bolnavilor au avut infecţie locală înainte de apariţia fistulei (8 bolnavi din 10). Odată cu apari ţia fistulelor externe am instituit un tratament intensiv cu Sandostatina, 100 mg de 3 ori în zi şi Losec 20 mg/zi timp de 14 zile. Concluzii: După un tratament medical corect descris mai sus, majoritatea fistulelor pancreatice externe se închid.Introduction: Pancreatic external fistula represents an abnormal trajectory because of surgery, a pancreatic duct that connects with the external environment. Material and method: Since September 2002 till May 2015 in our Clinic were operated on 49 patients with severe pancreatitis, of which 10 developed external pancreatic fistula (20.4%). We have studied the factors that predispose to the appearance of fistulas, which relate to the spread of necrosis of the pancreas, the surgery protocol, as well as the accession of infection. It was monitored occurrence of fistula, a certain concentration of amylase and proteins in the liquid released from the fistula for each case individually. Results: It is difficult to determine with precision the time of appearance of the fistula, especially in the case of drainage of pancreatic abscess. A high concentration of amylase is an important argument to confirm the diagnosis of pancreatic fistula. Six patients were operated in the early period of up to 2 weeks, and 4 were operated on in the later period. We can conclude from above that the majority of patients had local infection before the fistula (8 of 10 patients). As soon as the fistula appears we administrated an intensive treatment with Sandostatin 100 mg 3 times a day and Losec 20 mg per day within 14 days. Conclusions: Most pancreatic fistulas close after correct medical treatment described above

Диагностика и лечение травматических повреждений пищевода

Catedra chirurgie nr. 2, clinica 2, USMF „Nicolae Testemiţanu”Traumatic iatrogenic injuries and spontaneous ruptures of the esophagus are always serious, and are sometimes followed by pronounced and irreversible complications which include postoperative mortality rates of 30% in the first 24 hours and 60% after 24 hours. Perforation of the esophagus during esophagoscopy with fiber optic endoscopes was found in 0.007% of the observations, while the frequency of blind probing scar stricture of such damage increased by 15%.Травматические повреждения пищевода ятрогенного характера, как и спонтанный разрыв пищевода, считаются наиболее тяжелыми травмами. После таких травм наступают выраженные, иногда необратимые осложнения, с высокой послеоперационной летальностью, в первые 24 часа до 30%, а среди больных, оперированных позднее 24 часов после повреждения, показатель осложнений достигает 60%. Перфорация пищевода при эзофагоскопии эндоскопами на волоконной оптике встречается в 0,007% наблюдений, а при слепом бужировании его рубцовой стриктуры частота такого повреждения возрастает до 15%

Abdominal wall hernias after laparoscopic cholecystectomy

USMF ”N. Testemițanu”, Catedra chirurgie 2, Clinica chirurgie II, SCM ”Sfînta Treime”, Chișinău, Republica Moldova, Al XI-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova și cea de-a XXXIII-a Reuniune a Chirurgilor din Moldova „Iacomi-Răzeșu” 27-30 septembrie 2011Scopul studiului: colecistectomia laparoscopică a fost rapid acceptată și dominată de un proses tehnic avansat ca alternativă a colecistectomiei clasice în tratamentul litiazei veziculare, însă până în prezent nu sunt definitiv studiate consecințele postoperatorii.Material și metode: Studiul se bazează pe o analiză a 502 bolnavi operați în clinică laparoscopic, dintre care pentru colecistită cronică calculoasă – 398, iar pentru colecistită acută calculoasă – 104. În 24 cazuri au fost depistate hernii poslaparoscopice, din care 8 pacienti au fost operați în diferite instituții medico-sanitare publice, iar în 4 cazuri au fost operați de urgență după hotarele țării. Femei au fost 480, bărbați – 22, cu vîrsta medie de 48,2 ani.Rezultate: Eventrații postoperatorii au fost la 24 pacienți. Mai frecvent herniile au avut loc în lotul de bolnavi operați în mod urgent pentru colecistită acută calculoasă – 18 cazuri, la cei cu colecistita cronică calculoasă eventrațiile au fost în 6 cazuri. La 8 bolnavi herniile au fost multiple (2), în regiunea epigastrală și ombilicală. Un rol important în dezvoltarea heniilor a avut starea peretelui abdominal, vîrsta, obezitatea, cînd situația intraoperatorie a impus lărgirea plăgii din cauza vezicii biliare cu pereții ingroșați și mărită, flegmonos schimbată, cât și prezența calculilor mari în ea și nesuturarea defectului aponeurotic. Hernioplastia s-a efectuat sub anestezie locală cu soluție 0,3% Lidocaină 60-80 ml cu țesuturi proprii în 20 cazuri, iar în 4 cazuri s-a efectuat sub anestezie generală oro-traheală cu plasă sintetică de propilen. În perioada postoperatorie precoce și tardivă complicații nu s-au înregistrat. Concluzii: Pentru prevenirea herniilor postoperatorii după colecistectomia laparoscopică este obligatoriu să se sutureze aponeuroza în toate cazurile după înlăturarea trocarelor cît și a vezicii biliare, ca metode de preîntîmpinare a herniilor peretelui abdominal.Aim: Laparoscopic cholecystectomy was quickly accepted and dominated by a technically advanced process as an alternative to conventional cholecystectomy in the treatment of gallbladder lithiasis, but so far the postoperative consequences have not been definitively studied. Material and methods: The study is based on an analysis of 502 patients that were operated using laparoscopic surgery, from them with chronic cholecystitis -398, and for acute calculus cholecystitis – 104. In 24 hernia cases were detected after laparoscopic operations, from which 8 patients were operated on in different public medical institutions, and in 4 cases patients were operated abroad. The study has 480 cases – women, men - 22, average age 48.2 years. Results: Postoperative eventrations occurred at 24 patients. More frequently hernias occurred in the group of patients that were operated urgently for acute calculus cholecystitis -18 cases, for those patients which had chronic calculus cholecystitis eventrations happened in 6 cases. 8 patients had multiple hernias(2), in epigastric and umbilical region. An important role in hernias development had the abdominal wall condition, age, obesity, when the intraoperative situation required a widening of the surgical wound due to enlarged gallbladder with thickened walls, with phlegmon changes, and the presence of large stones in it and no sutures of the aponeurotic defect. The plasty of hernia was performed under local anesthesia with 0.3 % Lidocaine solution 60-80 ml with own tissue in 20 cases, and in 4 cases was performed under general oro-tracheal anesthesia with propylene synthetic mesh. During the early and late postoperative periods, no complications were observed. Conclusions: To prevent postoperative hernia after laparoscopic cholecystectomy is mandatory in all cases to put aponeurotic sutures after removal of trocars as well as of gallbladder, as a method of preventing abdominal wall hernias

Полиорганная недостаточность в хирургии

Department of Surgery N 2, State University of Medicine and Pharmacy "Nicolae Testemitanu"Multiple organ insufficiency syndromes complicate the postoperative evolution in urgent surgery in 10-28% of cases. In purulent complications of acute abdominal inflammatory diseases, its frequency can be up to 60%. Difficulties in appropriate diagnoses and treatment and high lethality, which can be up to 95%, determined the actuality of this study. The main cause of multiple organ insufficiency syndromes are infectious complications, particularly in inadequate management, which cause immune, metabolic, and homeostatic disturbances. Синдром полиорганной недостаточности осложняет течение послеоперационного периода в 10-28% случаев. При гнойных осложнениях острых воспалительных заболеваний органов брюшной полости, частота его достигает 60%. Трудность своевременной диагностики и лечения, высокая летальность, достигающая 95%, обусловили особую актуальность и сложность исследования этой проблемы. Основной причиной развития синдрома полиорганной недостаточности являются инфекционные осложнения, особенно при их несвоевременной диагностике или неадекватном лечении, вызывающие нарушения иммунного статуса больных, метаболизма, а также системы гомеостаза

The single laparoscopic surgical session – hydatid cyst with another abdominal pathology

Catedra chirurgie nr.2, USMF ”Nicolae Testemiţanu”, Chişinău, Republica Moldova, Al XII-lea Congres al Asociației Chirurgilor „Nicolae Anestiadi” din Republica Moldova cu participare internațională 23-25 septembrie 2015Scopul lucrării: Valorificarea chirurgiei laparoscopice în operaţiile simultane intraabdominale. Material şi metode: Scopul iniţial era eradicarea chistului hidatic hepatic. În momentul laparoscopic al intervenţiei deseori se depista patologie concomitentă abdominală. Astfel, pe parcursul anilor 2002-2014 au fost efectuate 272 de operaţii în 136 şedinţe operatorii. Rata majoritară a intervenţiilor a fost echinococectomia hepatică cu colecistectomie – 72 cazuri; fenestraţia chistului renal din dreapta – 20 cazuri; fenestraţia chistului renal din stînga – 12 cazuri; adenomectomia suprarenalei drepte – 5 cazuri; adenomectomia suprarenalei stîngi – 5 cazuri; echinococectomia hepatică cu miomectomie solitară – 9 cazuri; rezecarea fibroleiomiomului gastric – 3 cazuri; lipomectomia ligamentului hepatoduodenal – 3 cazuri; splenectomie (echinococoza lienală) – 4 cazuri; apendectomia laparoscopică (apendicită acută flegmonoasă) – 2 cazuri; splenectomia (infarct lienal) – 1 caz. Rezultate: Durata intervenţiilor a fost 55-115 minute. Durata spitalizării bolnavilor operaţi a fost 6-9 zile. Au fost înregistrate 4 complicaţii postoperatorii precoce: 2 cazuri de hemoragie uterină medie (după suturarea lojei nodulului miomatos); 1 caz de hemobiliragie parenchimatoasă (din loja vezicii biliare); 1 caz de biliragie canaliculară a cavităţii posthidatice hepatice. Ultimul caz a fost rezolvat prin efectuarea papilosfincterotomiei endoscopice. Celelalte s-au rezolvat prin abord laparoscopic repetat – stoparea definitivă a hemoragiei. Concluzii: Abordul endoscopic a favorizat rezolvarea a două patologii chirurgicale într-o singură şedinţă operatorie şi anestezică, micşorînd vădit cheltuielile. Reabilitarea postoperatorie a fost scurtă, aducînd foştii pacienţi în cîmpul muncii cu o calitate vitală spectaculoasă.Purpose of the study: Valorization of laparoscopic surgery in simultaneous intraabdominal operations. Material and methods: The initial goal was the removal of hepatic hydatid cyst. Related abdominal pathology was often found during laparoscopy. Thus, during 2002-2014 we made 272 surgeries during 136 surgical sessions. The most frequent surgical procedures were hepatic echinococcectomy with: cholecystectomy – 72 cases; fenestration of renal cysts on the right – 20 cases; fenestration of renal cysts on the left – 12 cases; adrenal adenomectomy on the right – 5 cases and on the left - 5 cases; a solitary myomectomy - 9 cases; resection of gastric fibroleyomiom – 3 cases; the removal of lipoma of hepatoduodenal ligament – 3 cases; splenectomy (spleen echinococcus) – 4 cases; laparoscopic appendectomy (acute phlegmonous appendicitis) – 2 cases; splenectomy (splenic infarction) – 1 Results: The duration of the surgery was 55-115 minutes. Duration of hospital stay was 6-9 days. There were four early postoperative complications: two cases of uterine bleeding of medium gravity (after the closure of the bed of myoma node); one case of parenchymal flow of blood and bile (from the gallbladder bed) and one case of canalicular flow of blood and bile from the posthydatic cavity of the liver. Endoscopic papillosphincterotomy was required in the latter case. The other cases needed the re laparoscopy for the final stop bleeding. Conclusions: Endoscopic approach allowed solving the two surgical pathologies during one surgery and anesthesia, significantly reducing costs. Postoperative rehabilitation was short, bringing former patients in work with a spectacular vital quality

The biocompatibility of titanium in a buffer solution: compared effects of a thin film of TiO2 deposited by MOCVD and of collagen deposited from a gel

This study aims at evaluating the biocompatibility of titanium surfaces modified according two different ways: (i) deposition of a bio-inert, thin film of rutile TiO2 by chemical vapour deposition (MOCVD), and (ii) biochemical treatment with collagen gel, in order to obtain a bio-interactive coating. Behind the comparison is the idea that either the bio-inert or the bio-active coating has specific advantages when applied to implant treatment, such as the low price of the collagen treatment for instance. The stability in buffer solution was evaluated by open circuit potential (OCP) for medium time and cyclic voltametry. The OCP stabilized after 5104 min for all the specimens except the collagen treated sample which presented a stable OCP from the first minutes. MOCVD treated samples stabilized to more electropositive values. Numeric results were statistically analysed to obtain the regression equations for long time predictable evolution. The corrosion parameters determined from cyclic curves revealed that the MOCVD treatment is an efficient way to improve corrosion resistance. Human dermal fibroblasts were selected for cell culture tests, taking into account that these cells are present in all bio-interfaces, being the main cellular type of connective tissue. The cells grew on either type of surface without phenotype modification. From the reduction of yellow, water-soluble 3-(4,5-dimethyldiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT cytotoxicity test), MOCVD treated samples offer better viability than mechanically polished Ti and collagen treated samples as well. Cell spreading, as evaluated from microscope images processed by the program Sigma Scan, showed also enhancement upon surface modification. Depending on the experimental conditions, MOCVD deposited TiO2 exhibits different nanostructures that may influence biological behaviour. The results demonstrate the capacity of integration in simulated physiologic liquids for an implant pretreated by either method

Expected Performance of the ATLAS Experiment - Detector, Trigger and Physics

A detailed study is presented of the expected performance of the ATLAS detector. The reconstruction of tracks, leptons, photons, missing energy and jets is investigated, together with the performance of b-tagging and the trigger. The physics potential for a variety of interesting physics processes, within the Standard Model and beyond, is examined. The study comprises a series of notes based on simulations of the detector and physics processes, with particular emphasis given to the data expected from the first years of operation of the LHC at CERN

Standalone vertex finding in the ATLAS muon spectrometer

A dedicated reconstruction algorithm to find decay vertices in the ATLAS muon spectrometer is presented. The algorithm searches the region just upstream of or inside the muon spectrometer volume for multi-particle vertices that originate from the decay of particles with long decay paths. The performance of the algorithm is evaluated using both a sample of simulated Higgs boson events, in which the Higgs boson decays to long-lived neutral particles that in turn decay to bbar b final states, and pp collision data at √s = 7 TeV collected with the ATLAS detector at the LHC during 2011