The Effects of Different Pressure Pneumoperitoneum on the Pulmonary Mechanics and Surgical Satisfaction in the Laparoscopic Cholecystectomy

Objectives. Inspiratory, hemodynamic and metabolic changes occur in laparoscopic surgery depending on pneumoperitoneum and patient position. This study aims to evaluate the effects of intra-abdominal pressure increase based on CO2 pneumoperitoneum in laparoscopic operations on hemodynamic parameters and respiratory dynamics and satisfaction of surgeon and operative view.Materials and Methods. A total of 116 consecutive, prospective, ASA class I–III cases aged 18–70 years undergoing laparoscopic cholecystectomy were enrolled in this study. Data of 104 patients were analysed. Patients were divided into two groups as the group Low Pressure (<12 mmHg) (Group LP) (n=53) and the group Standard Pressure (>13 mmHg) (Group SP) (n=51). In this study administration of general anesthesia used total intravenous anaesthesia in both groups. All groups had standard and TOF monitorization applied. The anaesthesia methods used in both groups were recorded. Before, during and after peritoneal insufflation, the peroperative ventilation parameters and hemodynamic parameters were recorded. The adequacy of pneumoperitoneum, gastric and the operative view were evaluated by the operating surgeon and recorded.Results. The peripheral oxygen saturation showed no significant difference between the low and standard pressure pneumoperitoneum in view of tidal volume, respiratory rate, end tidal CO2, mean and peak inspiratory pressure, and minute ventilation values. In terms of hemodynamics, when values just after intubation and before extubation were compared, it was observed that in the LP group systolic, diastolic and mean blood pressure values were higher. In terms of heart rate, no significant difference was observed in determined periods between groups. There was no significant difference between the groups in terms of surgical satisfaction and vision.Conclusion. Low pressure pneumoperitoneum provides effective respiratory mechanics and stable hemodynamics for laparoscopic cholecystectomy. It also provides the surgeon with sufficient space for hand manipulations. Anaesthetic method, TIVA and neuromuscular blockage provided good surgery vision with low pressure pneumoperitoneum

Pension trusteeship and diversity in the UK: A new boardroom recipe for change or continuity?

Drawing on interviews, this article investigates change and continuity induced by greater diversity among pension trustees in terms of trustees’ involvement in boardroom activities in the UK. Utilizing Bourdieu’s theory of habitus, the authors demonstrate the agency of trustees, and how greater diversity among trustees changes the boardroom decision-making process. However, the authors also reveal forms of continuity by reproduction of educational, corporate and social values within a boardroom context. The findings challenge the assumption that greater diversity may radically transform organizations

Влияние пневмоперитонеума под различным давлением на показатели легочной механики и удовлетворенность хирурга при лапароскопической холецистэктомии

Objectives. Inspiratory, hemodynamic and metabolic changes occur in laparoscopic surgery depending on pneumoperitoneum and patient position. This study aims to evaluate the effects of intra-abdominal pressure increase based on CO2 pneumoperitoneum in laparoscopic operations on hemodynamic parameters and respiratory dynamics and satisfaction of surgeon and operative view.Materials and Methods. A total of 116 consecutive, prospective, ASA class I–III cases aged 18–70 years undergoing laparoscopic cholecystectomy were enrolled in this study. Data of 104 patients were analysed. Patients were divided into two groups as the group Low Pressure (<12 mmHg) (Group LP) (n=53) and the group Standard Pressure (>13 mmHg) (Group SP) (n=51). In this study administration of general anesthesia used total intravenous anaesthesia in both groups. All groups had standard and TOF monitorization applied. The anaesthesia methods used in both groups were recorded. Before, during and after peritoneal insufflation, the peroperative ventilation parameters and hemodynamic parameters were recorded. The adequacy of pneumoperitoneum, gastric and the operative view were evaluated by the operating surgeon and recorded.Results. The peripheral oxygen saturation showed no significant difference between the low and standard pressure pneumoperitoneum in view of tidal volume, respiratory rate, end tidal CO2, mean and peak inspiratory pressure, and minute ventilation values. In terms of hemodynamics, when values just after intubation and before extubation were compared, it was observed that in the LP group systolic, diastolic and mean blood pressure values were higher. In terms of heart rate, no significant difference was observed in determined periods between groups. There was no significant difference between the groups in terms of surgical satisfaction and vision.Conclusion. Low pressure pneumoperitoneum provides effective respiratory mechanics and stable hemodynamics for laparoscopic cholecystectomy. It also provides the surgeon with sufficient space for hand manipulations. Anaesthetic method, TIVA and neuromuscular blockage provided good surgery vision with low pressure pneumoperitoneum.При лапароскопической хирургии в зависимости от объема пневмоперитонеума и положения пациента происходят изменения дыхания, гемодинамики и метаболизма.Цель исследования — оценить влияние повышения внутрибрюшного давления на основе пневмоперитонеума с применением CO2 при лапароскопических операциях на гемодинамические и дыхательные параметры, а также удовлетворенность хирурга и обзор операционного поля.Материалы и методы. В данное проспективное исследование включили 116 пациентов I–III класса ASA в возрасте 18–70 лет, перенесших лапароскопическую холецистэктомию. Проанализировали данные 104 пациентов. Пациентов разделили на две группы: группу низкого давления (<12 мм рт. ст., НД), n=53, и группу стандартного давления (>13 мм рт. ст., СД), n=51. В качестве метода обезболивания в обеих группах применяли тотальную внутривенную анестезию. Во всех группах использовали стандартный и TOF-мониторинг. Используемые методы анестезии в обеих группах документировали. До, во время и после инсуффляции газа в брюшную полость регистрировали параметры вентиляции и гемодинамические показатели. Адекватность пневмоперитонеума, обзор органов ЖКТ и операционного поля оценивал и регистрировал оперирующий хирург.Результаты. Значимых различий в насыщении кислородом периферической крови между группами НД и СД не выявили, с учетом дыхательного объема, частоты дыхательных движений, содержания СО2 в конце выдоха, среднего и пикового инспираторного давления, а также минутной вентиляции. При сравнении гемодинамических показателей, сразу после интубации и перед экстубацией трахеи отметили, что в группе НД значения систолического, диастолического и среднего артериального давления были выше. Значимых различий в частоте сердечных сокращений в исследуемые периоды между группами не наблюдали. Не отмечали и значимых различий между группами с точки зрения удовлетворенности хирургическим вмешательством и обзором операционного поля.Заключение. Пневмоперитонеум с низким давлением обеспечивает эффективную механику дыхания и стабильную гемодинамику при лапароскопической холецистэктомии. Кроме того, подобный пневмоперитонеум обеспечивает хирургу достаточное пространство для манипуляций. Анестезиологическое пособие (общая внутривенная анестезия в сочетании с нервно-мышечной блокадой) при использовании пневмоперитонеума с низким давлением обеспечивает хорошую визуализацию операционного поля

Utjecaji dodatka kulture kvasaca (Saccharomyces cerevisiae) u obroke anatolijskih vodenih bivolica na sastav mlijeka i broj somatskih stanica

This study was carried out to determine the effect of Saccharomyces cerevisiae (SC) addition to dry matter intake, milk yield, milk composition and somatic cell count in Anatolian water buffalo diets (AWB). The SC-treated groups (n = 5 buffalo cow/group) received 30.0 g of SC per buffalo cow per day. Compared to the control group, the SC-treated group consumed more total dry matter (P<0.05; 14.27 vs. 13.50 kg/day) and produced more milk/day (P<0.01; 7.13 vs. 6.22 kg/day). Dietary yeast inclusion significantly increased alfalfa dry matter intake during a 28-day lactation period (P<0.01; 10.41 vs. 9.81 kg/day) compared with the control diet. Yeast application significantly reduced the somatic cell count (SCC) in milk (P<0.05; 3.33 and 1.08 SCC (log 10/mL) for control and SC-treated groups, respectively). The fat (58.40 and 59.00 g/kg), non-fat solids (120.00 and 122.80 g/kg), protein (46.40 and 46.26. g/kg) and lactose components of milk (37.72 and 38.90 g/kg) were similar for both groups. The response of the AWB to supplemental yeast addition improved forage intake and daily milk production but did not affect milk composition. In conclusion; it has been thought that farmers with AWB can benefit from the use of yeast cultures in early lactation diets.Istraživanje je provedeno kako bi se utvrdio utjecaj dodatka Saccharomyces cerevisiae (SC) na unos suhe tvari obroka, količinu i sastav mlijeka te broj somatskih stanica u mlijeku anatolijskih vodenih bivolica (AWB). Pokusna skupina SC (n = 5 krava/ skupini) dobila je 30,0 g SC po kravi na dan. U usporedbi s kontrolnom skupinom, SC- skupina konzumirala je više ukupne suhe tvari (P<0,05; 14,27 : 13,50 kg/dan), i proizvela veću dnevnu količinu mlijeka (P<0,01; 7,13 : 6,22 kg/dan). Uključivanje konzumnog kvasca u obrok značajno je povećalo unos suhe tvari lucerne tijekom 28-dnevnog razdoblja laktacije (P<0,01; 10,41 : 9,81 kg/dan) u usporedbi s kontrolnom skupinom. Primjena kvasca značajno je smanjila broj somatskih stanica (SCC) u mlijeku (P<0,05; kontrolna 3,33 : pokusna SC 1,08 SCC (log10/mL). Količine masti (58,40 i 59,00 g/kg), bezmasne suhe tvari (120,00 i 122,80 g/kg), proteina (46,40 i 46,26 g/kg) i laktoze (37,72 i 38,90 g/kg) bile su slične za obje skupine. Odgovor AWB na dopunu obroka kvascem bilo je povećanje unosa krme i dnevne proizvodnje mlijeka, ali nije utjecalo na sastav mlijeka. Stoga, proizvođači mlijeka koji drže AWB mogu imati koristi od korištenja kulture kvasaca SC u obrocima tijekom rane laktacije

Passing as resistance through a Goffmanian approach: Normalized, defensive, strategic, and instrumental passing when LGBTQ+ individuals encounter institutions

Data availability statement: The data that support the findings of this study are available from the corresponding author upon reasonable request.Copyright © 2022 The Authors. Passing and coming out are two divergent individual strategies historically associated with the LGBTQ+ community as they struggle to fit in with normative expectations at work and in life. While coming out has gradually become more common in organizations and national contexts that offer safeguards for LGBTQ+ individuals, passing remains an option where no such measures are available. Drawing on interviews with working-class LGBTQ+ individuals in a country with an adversarial context, that is, Turkey, we identify how varieties of passing, defined as acting and appearing to fit with the dominant sexual orientation and gender identity norms, are used as strategies of coping with institutional norms. Working-class LGBTQ+ individuals are an important group to study as many draw their pride, power, and identity from their engagement with work and the labor market. Transcending the monolithic accounts of passing, we illustrate four variants of passing (i.e., normalized, defensive, strategic, and instrumental passing) that LGBTQ+ individuals deploy at work. Reflecting on the field study findings, we explicate how and why LGBTQ+ individuals choose to pass at work in each case

Moving from intersectional hostility to intersectional solidarity: Insights from LGBTQ individuals in Turkey

Purpose: Treatment of intersectionality in empirical studies has predominantly engaged with individual categories of difference. The purpose of this paper is to demonstrate that there is utility in exploring intersectionality at the intersection of individual and institutional levels. As such the authors move beyond the polarised take on intersections as either individual or institutional phenomenon and tackle intersectionality as a relational phenomenon that gains meaning at the encounter of individuals and institutions in context. Therefore, the authors explicate how intersectionality features as forms of solidarity and hostility in work environments. As such the authors posit that not only individuals but also the institutions should change if inclusion is aimed at societal and organisational levels. Design/methodology/approach: A thematic analysis on qualitative interview data of a purposive- and snowball-selected sample of 11 lesbian, gay, bisexual, transgender and queer working adults in Turkey was used. Findings: This paper finds evidence to support the existence of a multidimensional model of intersectionality, where conflicting and complementary individual and institutional intersections create four intersectional typologies in the form of intersectional hostility, intersectional struggle, intersectional adjustment and intersectional solidarity. Originality/value: The extant literature offers rich insights into individual intersectionality but sheds very little light on institutional intersectionality and its interaction with individual intersectionality. This paper attempts to fill in this gap by investigating intersectional encounters as interactions between the individual and institutional intersections

Why do some followers remain silent in response to abusive supervision? A system justification perspective

Copyright © 2023 The Authors. This study investigates how the system justification motive manifests in employees’ voice/silence behavior at the workplace. It also explores the moderating effects of system justification on the linkage between abusive supervision and voice/silence behavior for blue- and white-collar employees. The field study generated responses from 905 employees in Turkey. Multi-group analysis reveals that the moderating effect of system justification motives varies by occupational class. In particular, the impact of abusive supervision on silence becomes more salient when white-collar employees endorse higher system justification motives. However, in the blue-collar sample, the absence of a moderating effect could be attributed to the strong main effect of system justification motives. The current study adds to the extant literature by applying a system justification perspective to voice and silence behavior by collar differences at work. It also provides important implications for managers in dealing with workplace mistreatment affecting all occupational groups, mainly when blue-collar employee silence is endemic and regulatory policies are inadequate

Activated MCTC mast cells infiltrate diseased lung areas in cystic fibrosis and idiopathic pulmonary fibrosis

<p>Abstract</p> <p>Background</p> <p>Although mast cells are regarded as important regulators of inflammation and tissue remodelling, their role in cystic fibrosis (CF) and idiopathic pulmonary fibrosis (IPF) has remained less studied. This study investigates the densities and phenotypes of mast cell populations in multiple lung compartments from patients with CF, IPF and never smoking controls.</p> <p>Methods</p> <p>Small airways, pulmonary vessels, and lung parenchyma were subjected to detailed immunohistochemical analyses using lungs from patients with CF (20 lung regions; 5 patients), IPF (21 regions; 7 patients) and controls (16 regions; 8 subjects). In each compartment the densities and distribution of MC_Tand MC_TCmast cell populations were studied as well as the mast cell expression of IL-6 and TGF-β.</p> <p>Results</p> <p>In the alveolar parenchyma in lungs from patients with CF, MC_TCnumbers increased in areas showing cellular inflammation or fibrosis compared to controls. Apart from an altered balance between MC_TCand MC_Tcells, mast cell in CF lungs showed elevated expression of IL-6. In CF, a decrease in total mast cell numbers was observed in small airways and pulmonary vessels. In patients with IPF, a significantly elevated MC_TCdensity was present in fibrotic areas of the alveolar parenchyma with increased mast cell expression of TGF-β. The total mast cell density was unchanged in small airways and decreased in pulmonary vessels in IPF. Both the density, as well as the percentage, of MC_TCcorrelated positively with the degree of fibrosis. The increased density of MC_TC, as well as MC_TCexpression of TGF-β, correlated negatively with patient lung function.</p> <p>Conclusions</p> <p>The present study reveals that altered mast cell populations, with increased numbers of MC_TCin diseased alveolar parenchyma, represents a significant component of the histopathology in CF and IPF. The mast cell alterations correlated to the degree of tissue remodelling and to lung function parameters. Further investigations of mast cells in these diseases may open for new therapeutic strategies.</p