Pfannenstiel incision for intact specimen extraction in laparoscopic transperitoneal radical nephrectomy: a longitudinal prospective outcome study

OBJECTIVES: To evaluate the intra- and postoperative outcomes of patients undergoing laparoscopic radical nephrectomy with intact specimen extraction through a Pfannenstiel transverse suprapubic incision. METHODS: Prospective follow-up of 26 laparoscopic transperitoneal radical nephrectomies for suspected renal tumors in which the kidneys were extracted via a Pfannenstiel lower abdominal transverse incision. RESULTS: The mean operating time was 152.3 (80-255) minutes, and the mean blood loss was 90 (20-300) ml. The mean extraction time was 20.4 (12-35) minutes. The mean weight of the removed specimen was 631.5 (190-1505) grams, and the mean longest diameter of the extracted specimen was 17.4 (9-25) cm. The mean extraction incision size was 10.7 (7-16) cm. No open surgical conversions were necessary. Pain control was excellent, with minimal intravenous morphine equivalent narcotic use by patients: 15.7 (0-31) mg in the recovery room, 33.8 (0-127) mg on the first postoperative day and 8.7 (0-60) mg in the first week after discharge. The patients experienced a short duration to full ambulation and normal dietary intake. Postoperative follow-up visits were recorded for at least six months. The patients reported a high cosmetic satisfaction rate of 97.7% (60-100). No late postoperative complications were observed related to the extraction site. CONCLUSIONS: The operative specimen can be extracted via a low transverse Pfannenstiel incision during radical laparoscopic nephrectomy. This incision ensures the extraction of large specimens while preserving the aesthetic and functional advantages of laparoscopy without increasing the cancer risk. The absence of muscle cutting maintains the integrity of the abdominal wall and elicits minimal pain. No postoperative incisional hernias or keloid formations were observed

دراسة اقتصادية تحليلية لكفاءة استخدام أنماط الري الحديثة: دراسة ميدانية بمزارع منطقة القصيم

The study aims to estimate the efficiency of water resources use for irrigation at Al-Qassim farms by estimating the productivity and technical efficiency, under different irrigation methods (sprinkler and drip irrigation) used for the main crops which are included in the sample of study, and estimating the demand functions for resources used in the production of main crops. The analysis based on the Data Envelopment Analysis (DEA), in addition to Total Factor Productivity (TFP) and parametric programming. The DEA is used with the constant and variant returns to scale (CRS and VRS) to estimate the technical efficiency and scale efficiency of the considered crops under different irrigation methods. The study sample (consists of 124 farms) was selected from the farms at Al-Qassim region, Data collected by the personal interview through a questionnaire which was prepared for this purpose, the study sample were representative the most important field and vegetable crops at the study area. The most important findings of the study can summarize as follows: (1) By estimation the technical (TE) and scale efficiency (SE) for the field and vegetable crops at the study sample according to the concept of VRS and CRS under different irrigation methods, the results show the following: * According to CRS hypothesis the average technical efficiency (TE) under mobile sprinkler irrigation method were lower for farms of wheat, barley, winter tomatoes, corn, summer tomatoes and alfalfa, while results refers to improvement of (TE) for these crops according to VRS hypothesis. * The average of scale efficiency (SE), which is (SE=TECRS / TEVRS) amounted to about 0.91, 0.89, 0.90, 0.91, 0.90, 0.90 under the mobile sprinkler irrigation system for the farms of wheat, barley, winter tomatoes, corn, summer tomatoes and summer cucumber. * According to CRS hypothesis the average technical efficiency (TE) under drip irrigation method were lower for farms of zucchini, winter tomatoes, winter cucumber, summer potatoes, summer tomatoes and summer cucumbers, while results refers to improvement of (TE) for these crops according to VRS hypothesis. * The average of scale efficiency (SE), was to about 0.86, 0.94, 0.83, 0.94, 0.94, 0.86 under the drip irrigation system for the farms of zucchini, winter tomatoes, winter cucumber, summer potatoes, summer tomatoes and summer cucumber. (2) The change in the index of total factor productivity (TFP Ch) of the quantity of production for winter tomatoes and summer tomatoes as a shift from the mobile sprinkler system to the drip system about 119%, 112% and refers to an opportunity to increase efficiency by 19%, 12%, while the change in the index of total factor productivity (TFP Ch) of the value of production for alfalfa as a shift from the fixed sprinkler system to the mobile sprinkler system about 103%. (3) By estimating the production and economic efficiencies based on stochastic frontier Analysis (SFA) using the ordinary least square (OLS) method and the maximum likelihood estimator (MLE) method. The (MLE) method was used under both the Truncated Distribution (TD) and Half-Normal Distribution (HND) techniques. The results indicated to the preference of MLE method in case of (HND) according to significance of γ to estimate the production efficiency of wheat, zucchini and alfalfa. While MLE method in case of (TD) according to significance of γ and the highest value of the LR was the best for crops winter and summer tomatoes, and winter and summer cucumbers. The OLS method was the fit to estimate the production efficiency of barley, corn and summer potatoes. (4) Using the parametric programming to identify the value of the marginal productivity (shadow prices) for each of the nitrogenous, phosphate fertilizers, agricultural employment and water resources. The results indicated that the shadow price of the unit (50 kg) for the resource of phosphate fertilizer up to about 69.1 SAR at the optimal use of the resource in the production of winter crops which follows the mobile sprinkler irrigation system, while up to about 131.3 SAR at the optimal use of the resource in the production of summer crops. For the resource of nitrogenous fertilizers used in the production of winter crops which follows the mobile sprinkler irrigation system, the shadow price of the unit (50 kg) up to about 295.4 SAR and up to about 68.7 SAR for the summer crops. For the labor resource used in the production of winter crops which follows the mobile sprinkler irrigation system, the shadow price of the unit (man / day) is approximately 52.3 SAR at the optimum utilization of the resource, while up to about 47.5 SAR to produce the summer crops

Crypto-Semantic Method of Text Data Protection

A method of text data protection called crypto-semantic is proposed. In order to implement the method within the formally defined restrictions of the selected sphere of applied uses, it is necessary to develop a corresponding lexicographical system in the form of an applied linguistic corpus and semantically structure the information using the constructed linguistic corpus so that the encrypted text message samples present semantically plausible text fragments. Under certain conditions the method provides absolute guarantee of text data protection from confidentiality compromise.

Data Centre Infrastructure: Design and Performance

The tremendous growth of e-commerce requires an increase in the data centre capacity and reliability for appropriate quality of services. Optimisation of data centre design is considered to be within a green technology that shows great promise to decrease CO2 emission. However, a huge data centre requires huge power consumption due to higher capacity of racks that lead to more powerful cooling systems, power supply, protection and security. These make the data centre costly and not feasible for services. In this chapter, we will provide a tire 4 data centre design to be located in the optimal location of Malaysia, in Cyberjaya. The main purpose of this design is to provide e-commerce services, especially food delivery, with high quality of services and feasibility. All data centre components have been well designed to provide various services which include top-level security, colocation system, reliable data management and IT infrastructure management. Moreover, recommendation and justification have been provided to ensure that the proposed design outperforms compared to other data centres in terms of reliability, power effeminacy and storage capacity. In conclusion, analysing, synthesising and evaluating each component of the proposed data centre will be summarised

The adoption of big data analytics in Jordanian SMEs: An extended technology organization environment framework with diffusion of innovation and perceived usefulness

While many small and medium enterprises (SMEs)recognize the benefits of Big Data Analytics (BDA) for digital transformation, they face challenges in implementing this technology, highlighting the need for more research on its adoption by SMEs. The objective of this study is to amalgamate the Technology Organization Environment (TOE) framework with the Diffusion of Innovation (DOI) theory, aiming to dissect the factors that sway BDA adoption in Jordanian SMEs. Additionally, the study delves into how perceived usefulness impacts this adoption process. Utilizing structural equation modeling, the study examined data from 388 managers in Jordan. The study validates all its hypotheses, revealing that variables like relative advantage, compatibility, complexity, top management support, competitive pressure, and security influence perceived usefulness, which subsequently has a positive impact on BDA adoption. This research presents a range of theoretical and practical insights

The effect of alpha-lipoic acid supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in individuals with polycystic ovary syndrome: a systematic review and meta-analysis of randomized clinical trials

This systematic review and meta-analysis aimed to examine the effect of the antioxidant alpha-lipoic acid (ALA) on various cardiometabolic risk factors and hormonal parameters in patients with polycystic ovary syndrome (PCOS). We searched PubMed, EMBASE, SCOPUS, Cochrane Library, and Web of Science databases without language restrictions until May 2023 to find randomized controlled trials (RCTs) that assessed the impact of ALA supplementation on anthropometric, glycemic, lipid, oxidative stress, and hormonal parameters in women with PCOS. Outcomes were summarized using the standardized mean difference (SMD) and 95% confidence interval (CI) in a random-effects model. An I2 statistic of >60% established significant between-study heterogeneity. The overall certainty of the evidence for each outcome was determined using the grading of recommendations, assessment, development, and evaluations system. Seven RCTs met the inclusion criteria. The ALA group had significant reductions in fasting blood sugar (fasting blood sugar (FBS), n=7 RCTs, SMD, −0.60; 95% CI, −1.10 to −0.10; I2=63.54%, moderate certainty of evidence) and homeostatic model assessment for insulin resistance (homeostatic model assessment of insulin resistance (HOMA-IR), n=4 RCTs, SMD, −2.03; 95% CI, −3.85 to −0.20; I2=96.32%, low certainty of evidence) compared with the control group. However, significant differences were observed between the groups in body mass index, insulin, estrogen, follicle-stimulating hormone, luteinizing hormone, testosterone, low-density lipoprotein, high-density lipoprotein, triglyceride, total cholesterol, malondialdehyde, or total antioxidant capacity profiles. ALA supplementation improves FBS and HOMA-IR levels in women with PCOS. ALA consumption is an effective complementary therapy for the management of women with PCOS

Heat Stroke in Emergency Department: Diagnosis and Management

Background: Heat stroke is a severe health concern with the potential for multi-organ failure, necessitating rapid and effective management. With rising global temperatures, there is increasing concern regarding the vulnerability of populations in high-heat areas, notably in Saudi Arabia, especially during the annual Hajj pilgrimage. Objective: This paper aims to review the epidemiology, evaluation and management techniques of heat stroke, emphasizing the situation during Hajj pilgrimages in Saudi Arabia, and to outline the best practices for emergency management. Methodology: A comprehensive review of literature and studies related to heat stroke, both globally and specific to Saudi Arabia, was undertaken. An in-depth analysis of emergency management, including initial assessment, cooling methods, organ support, medication, and prevention strategies, was conducted. Results: Heat stroke remains a significant cause of emergency department visits, with specific groups, such as men and the elderly, being more susceptible. During the Hajj in 2016, 267 patients were diagnosed with heat-related illnesses, with heatstroke accounting for 29% of these cases. With the threat of global warming, studies indicate a potential tenfold increase in heat stroke risk with a 2°C rise in temperatures. Swift and comprehensive cooling is pivotal for recovery. Management emphasizes rapid recognition, assessment, and varied cooling methods, along with targeted treatments for organ dysfunctions. Prevention strategies play a vital role, given the higher efficacy and practicality over treating organ dysfunctions. Conclusion: Heat stroke is a pressing health challenge, particularly in high-risk environments like Saudi Arabia during the Hajj pilgrimage. While effective emergency management protocols exist, an emphasis on prevention is crucial. It is imperative to incorporate a comprehensive approach to address both the immediate threat and long-term risks of heat stroke, especially with the looming challenge of global warming

Artificial intelligence in Jordanian education: Assessing acceptance via perceived cybersecurity, novelty value, and perceived trust

The growing significance of Artificial Intelligence (AI) across different fields highlights the essential role of user acceptance, as the success of this technology largely depends on its adoption and practical use by individuals. This research aims to examine how perceived cybersecurity, novelty value, and perceived trust affect students' willingness to accept AI in educational settings. The study's theoretical basis is the AI Device Use Acceptance (AIDUA) model. Using structural equation modeling, the study tested hypothesized relationships using data from 526 students at Jordanian universities. The results showed that social influence is positively associated with performance expectancy, while perceived cybersecurity is positively related to both performance and effort expectancy. Novelty value is positively associated with performance expectancy but a negative one with effort expectancy. Additionally, effort and performance expectancy significantly influence perceived trust and the willingness to accept AI. Moreover, perceived trust has a notable positive effect on the willingness to accept AI in education. These findings provide valuable guidance for the creation and improvement of AI-driven educational systems in universities, contributing to the broader understanding of AI technology acceptance in the educational field

Enhanced Recovery After Surgery (ERAS) Protocols In General Surgery: A Review Of Implementation And Outcomes

ERAS is a group of protocols that aim at affecting positively patients & surrounding lives. surgeons, nurses, physiotherapists, anesthetists, and even healthcare centers hospitals, labs, and pharmacies. Reducing the cost for both hospitals &patients, decreasing the duration of residency in hospitals, and improving patient compliance, developing performance & increasing teamwork between medical staff and patients all fall under the advantages of ERAS. Since it affects the 3 stages of any operation (preoperative-intraoperative-perioperative) it was necessary to implement a suitable protocol for each patient to achieve the best results mostly quitting smoking, fasting for a period before surgery, maintaining body temperature, pressure, and glucose level and the postoperative instructions , care & nutrition to guarantee success and avoidance to recurrence or complications

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112