Robotic Surgery and Deep Infiltrating Endometriosis Treatment: The State of Art

Objective: Surgical treatment of endometriosis, when indicated, has demonstrated to be effective in reducing painful symptoms and improve quality of life of patients affected with endometriosis. The minimally invasive approach via laparoscopy is the preferred method when compared with laparotomy but in the last two decades another minimally invasive approach has become available, the robotically assisted laparoscopic surgery. Robotic technology is widely used in different surgical branches, such as general surgery and urology. Moreover, the use of robotic surgery is already accepted for different gynecological procedures either for benign and for oncological diseases. The advantages of robotic surgery such as improve dexterity of movements, avoided tremor, increased magnification of 3-dimensional vision seem strategic in the context of a complex surgery as is deep endometriosis eradication. However, to date there is no unanimous consensus on whether robotically assisted procedures are a valid and safe alternative to laparoscopy in the treatment of endometriosis. Mechanism: In this narrative review we analyze the available literature assessesing the robotic treatment of all types of endometriosis and specifically deep infiltrating endometriosis, compared to the outcomes of conventional laparoscopy. Findings in Brief: Indeed, the evidence of safety and effectiveness of robotically assisted laparoscopy in endometriosis treatment is strong and almost unanimous. There is no clear superiority of one approach to the other but robotic-related advantages and future prospective are promising to be able to improve operative outcomes, reduce surgeon’s fatigue and provide a technology easy to implement with a fast learning curve. Conclusions: Robotic technology applied to laparoscopy in the treatment of endometriosis could be seen as an effective and safe alternative to the conventional laparoscopic treatment

Propuesta de implementación de planificación de compras para reducir costos de abastecimiento de los suministros en la empresa Consorcio EG Perú S. A. C.

La presente tesis tuvo como objetivo principal determinar el impacto de la propuesta de mejora de planificar las compras para reducir costos de abastecimiento de los suministros eléctricos de la empresa Consorcio EG Perú S.A.C. Primero, se analizó el comportamiento de la demanda desde el año 2017 hasta abril del 2019 de todos los productos de la empresa, se explicó el tipo de investigación empleada, la muestra a utilizar y las técnicas e instrumentos para la recolección de datos, los cuales fueron las entrevistas, la observación directa, los documentos y registros de la empresa. Luego, se procedió a analizar los datos utilizando el diagrama de Ishikawa y Pareto para desarrollar el procedimiento mediante la clasificación ABC, pronóstico, punto de reorden y stock de seguridad con la finalidad de solucionar el problema principal de la deficiencia en la planificación de compras de la empresa. Los resultados obtenidos muestran que las órdenes de compras no planificadas eran el 12% del total de órdenes emitidas y las roturas de stock eran 6.48% del total de los productos. Con respecto al resultado de la aplicación de la propuesta, con clasificación ABC se identificó que el 80.15% de la demanda total era por 3 tipos de familias de suministros eléctricos, los cuales fueron los interruptores termomagnéticos, los arrancadores NEMA y los contactores NEMA. Se calcularon los pronósticos obteniendo la proyección de la demanda de cada familia de productos. Asimismo, se halló el punto de reorden y stock de seguridad. La propuesta de mejora es beneficioso obteniendo un VAN de S/ 302 937.51, TIR de 53.92% y el B/C de 1.52. Por último, se mostraron las limitaciones presentadas para el desarrollo de la presente tesis, la comparación con respecto a otros estudios, las implicancias y por último las conclusiones del proyecto en el que se indica que la empresa redujo costos extras de abastecimiento en 10% anual.The main objective of this thesis was to determine the proposal impact to reduce electrical supply costs of Consorcio EG Perú company. First, the demand behavior from 2017 to April 2019 of all the company´s products was analyzed, the type of research used, the sample to be used and the techniques and instruments for data collection were explained, which were the interviews, direct observation, documents, and records of the company. Then, the data was analyzed using the Ishikawa and Pareto diagram to develop the procedure through the ABC classification, forecast, reorder point and safety stock in order to solve the main problem of the deficiency in the planning of purchases of the company. In the second chapter, were explained the research type used, the sample and the techniques and instruments for data collection, which were interviews, direct observation, documents, and company records. Then, the data analysis was carried out using the Ishikawa and Pareto diagram, explaining the procedure to solve the company main problem through the ABC classification, forecast, reorder point and safety stock. The results obtained show that unplanned purchase orders were 12% of the total orders issued and stock breakages were 6.48% of the total products. Regarding the result of the application of the proposal, with ABC classification, it was identified that 80.15% of the total demand was for 3 families´ types of electrical supplies, which were thermomagnetic switches, NEMA starters and NEMA contactors. The forecasts were calculated, obtaining the projection of the demand for each family’s products. Likewise, the reorder point and safety stock were found. The improvement proposal is beneficial, obtaining a NPV of S/ 302 937.51, IRR of 53.92% and cost- benefit of S/ 1.52. Finally, the limitations presented for the development of this thesis were shown, the comparison with respect to other studies, the implications and finally the conclusions of the project in which it is indicated that the company reduced extra supply costs by 10% per year

Posición hioidea, posición lingual y dimensión de la vía aérea faríngea según maloclusión esquelética

Esta investigación se centró en revisar los artículos que evaluaron cefalométricamente la posición de hueso hioides, posición lingual y la dimensión de la vía aérea faríngea según maloclusión esquelética, a fin de determinar si existe una relación entre estas estructuras. Método: Se identificaron publicaciones en las bases de datos: PubMed, Biblioteca Virtual en Salud (BVS), Scielo y Scopus. Palabras clave: Hueso hioides, Lengua, Vía aérea, Maloclusión. Se realizó un cribado de los artículos por título, resumen y texto completo, escritos en los idiomas inglés y español. Resultados: Se encontraron 75 artículos; se eliminaron 30, por no tener una relación directa con el tema. Finalmente, se seleccionaron 45 artículos. Se concluye que aún no hay un consenso absoluto, sobre la relación existente entre: la posición del hueso hioides, la lengua y la dimensión de la vía aérea superior; según maloclusión esquelética

Electrogeneration of hydrogen peroxide applied to the peroxide-mediated oxidation of (R)-limonene in organic media

Horse radish peroxidase (HRP) from Armoracia rusticana catalyses the oxidation of (R)-limonene into the oxidized derivatives carveol and carvone. This study compares the direct addition (DA) of hydrogen peroxide with its continuous electrogeneration (EG) during the enzymatic oxidation of (R)-limonene. Reaction mixtures containing HRP, (R)-limonene as substrate, and hydrogen peroxide, added directly or electrogenerated, in 100 mM sodium-potassium phosphate buffer pH 7.0, at 25\ub0C were studied. Two electrochemical systems for the hydrogen peroxide electrogeneration were evaluated, both containing as auxiliary electrode (AE) a platinum wire and saturated calomel electrode (SCE) as reference. Reticulated vitreous carbon foam (RVCF) and an electrolytic copper web (CW) were evaluated as working electrodes (WE). Results were compared in terms of hydrogen peroxide electrogeneration, (R)-limonene residual concentration or conversion and product selectivity. Best results in terms of maximum H2O2 concentration (1.2 mM) were obtained using the CW electrode at -620 mVSCE, and continuous aeration. Use of the EG system under optimized conditions, which included the use of acetone (30% v/v) as a cosolvent in a 3 hrs enzymatic reaction, lead to a 45% conversion of (R)-limonene into carveol and carvone (2:1). In comparison to the results obtained with DA, the use of EG also improved the half-life of the enzyme

modeling the laser ablation process

This chapter focuses on the problem of modeling the laser ablation process from a geometrical point of view. The objective is to create a model capable of describing the laser incision depth based on the knowledge of the laser parameters and inputs. The discussion starts with a statement of the problem, which is defined in terms of a supervised regression. Our approach is compared with existing heuristic models for the prediction of ablation depth

El Porfiriato

1 archivo PDF (229 páginas)Debate sobre el Porfiriato desde una perspectiva crítica y analítica de la historia y el diseño para mostrar lo más actual de la reflexión histórica y que, al mismo tiempo, sea útil para la generación de nuevos conocimientos, propósito fundamental para la formación de futuras generaciones de estudiosos e investigadores sobre la historia nacional y la historia del diseño

Challenges and Opportunities to Scale Up Cardiovascular Disease Secondary Prevention in Latin America and the Caribbean.

In the Americas, CVD represents about 38% of noncommunicable disease deaths. A roadmap for secondary prevention in Latin America and the Caribbean is warranted. Simple and practical guidelines should be developed and implemented. PAHO proposes a realistic and efficient prevention coalition plan in Latin America to fight CVD. The inclusion of the health system through health workers is highly recommended for a successful nationwide preventive program