Całkowita histerektomia laparoskopowa metodą pojedynczego nacięcia pępkowego: technika i pierwsze doświadczenia w Turcji

Objectives: The aim of the study is to determine the results of our initial experience of 32 cases who underwent single incision total laparoscopic hysterectomy. Materials and Methods: Thirty-two patients who underwent transumbilical single incision total laparoscopic hysterectomy between March 2009 and February 2011 were reviewed retrospectively at the Department of Obstetrics and Gynecology, Ege University Faculty of Medicine, Izmir, Turkey. Articulating and rigid instruments, 30 degrees 10 mm telescope, SILS™ port and advanced bipolar and mechanical energy modalities were used during the procedure. Duration of surgery, length of hospital stay, mean blood loss and postoperative complications were assessed. Results: Mean age of patients and mean operation time were 48 years (ranged 42-55) and 108 minutes (ranged 80-180), respectively. In all cases vaginal cuff s were closed with either intracorporeal or extracorporeal separate sutures. There were no intraoperative complications. All patients were discharged within 48 hours postoperatively. The mean length of hospital stay and mean blood loss were as 1.6 days (range 1-2) and 45 ml (range 30-100), respectively. Conclusions: Total laparoscopic hysterectomy performed through transumbilical single incision is technically feasible and safe. Development of advanced fl exible instrumentation and visualization platform may facilitate this new operative approach.Cel pracy: Celem tego badania była ocena wyników naszego pierwszego doświadczenia z 32 pacjentkami, które przeszły całkowitą laparoskopową histerektomię metodą pojedynczego nacięcia. Materiał i metoda: Przeanalizowano retrospektywnie trzydzieści dwie pacjentki, które przeszły całkowitą laparoskopową histerektomię metodą pojedynczego nacięcia pępkowego pomiędzy marcem 2009 a lutym 2011, w Oddziale Położniczo-Ginekologicznym, Ege University Faculty of Medicine w Turcji. W trakcie procedury użyto instrumentarium giętkiego i sztywnego, endoskopu o kącie widzenie 30°, 10mm, portu SILSTM i zaawansowanych urządzeń bipolarnych oraz energii mechanicznej. Oceniono czas trwania operacji, długość pobytu w szpitalu, średnią utratę krwi i komplikacje pooperacyjne. Wyniki: Średnia wieku pacjentek wynosiła 48 lat (zakres 42-55), średni czas trwania operacji 108 minut (zakres 80-180). We wszystkich przypadkach mankiet pochwy zeszyto osobnymi szwami wewnątrzbrzusznymi lub zewnątrzbrzusznymi. Nie obserwowano żadnych powikłań w trakcie operacji. Wszystkie pacjentki wypisano do domu w ciągu 48 godzin od operacji. Średni czas pobytu w szpitalu wynosił 1,6 dni (zakres 1-2) a utrata krwi wynosiła 45ml (zakres 30-100). Wnioski: Całkowita laparoskopowa histerektomia metodą pojedynczego nacięcia pępkowego jest technicznie wykonalna i bezpieczna. Ulepszanie zaawansowanego, elastycznego instrumentarium oraz możliwości wizualizacji ułatwiają to nowe podejście operacyjne

Incidence and predictors of radial artery injury following transradial procedures: Yet another benefit of renin–angiotensin system blockade?

Background: Vasodilatory function of radial artery (RA) declines following the transradial catheterization. However, it is uncertain whether impaired vasodilatory function develops in every patient. The aim of this study was to investigate the incidence and predictive factors of impaired vasodilatory function following transradial procedures. Methods: Consecutive patients undergoing elective transradial procedures were prospectively enrolled. Ultrasound examination of RA was recorded just before and 1 week after the procedure. RA diameters and flow velocities were measured at baseline, after flow mediated vasodilation (FMD) and after nitrate mediated vasodilation (NMD). Results: Fifty-one patients were included (62 ± 11 years, 55% male, 41% hypertensive, 20% diabetic, 65% with coronary artery disease). Overall FMD and NMD were significantly impaired after 1 week. However, deterioration of FMD and NMD was observed in 67% and 71% of patients, respectively. Absolute change in FMD was significantly different in patients using a renin– angiotensin system (RAS) inhibitor compared to those who were not (1.9 ± 12.9 vs. –7.7 ± ± 12.7%, respectively, p = 0.025). Additionally, there was a moderate but significant correlation between baseline RA diameter and absolute change in NMD (r = 0.419, p < 0.001). RAS blockade was independently associated with protection against FMD deterioration (OR 0.241, 95% CI 0.066–0.883, p = 0.032), whereas RA diameter (OR 0.079, 95% CI 0.009–0.720, p = 0.024) and procedure time (OR 1.156, 95% CI 0.989–1.350, p = 0.068) were associated with NMD deterioration, although the latter had borderline significance. Conclusions: Vasodilatory function of RA gets impaired in most patients following transradial procedures. RAS blockade seems to exert a protective role against deteriorating endothelium- dependent vasodilation, whereas smaller RA diameter and potentially longer procedure time are associated with impaired endothelium-independent vasodilation.

Comparison of thoracotomy and thoracoscopy in patients with esophageal atresia - tracheoesophageal fistula

Objective: The aim of this study was to compare the patients who underwent EA-TEF repair with both classical and thoracoscopic methods, and thus to reveal the advantages and disadvantages of both techniques. Materials and methods: In this study, the files of 45 patients who underwent surgery for EA-TEF at the Erciyes University Faculty of Medicine (EUFM) Pediatric Surgery Clinic between August 2005 and July 2012 were retrospectively examined. Patients were divided into two groups based on the surgical method applied. Results: A total of 45 patients who presented with EA-TEF and underwent surgical procedures were evaluated. Thirty-one (70%) patients underwent thoracotomy (Group I), and 14 (30%) patients underwent surgery using the thoracoscopic method (Group II). The average gestational age was 37.5 weeks, and the birth weight was 2600 grams. Nineteen (42%) of the patients were female, and 26 (58%) were male. Group I was 39 weeks and 38 weeks in Group II. There was no significant difference in gestational age between the two groups (p>0.05). There was no significant difference between the groups regarding accompanying system anomalies (p>0.05). The time to surgery for patients in both groups was 2 days (p>0.05). The operation time in Group I (95 minutes) was shorter than in Group II (105 minutes) (p<0.05). The time to start gavage feeding after surgery in Group II was shorter compared to Group I (p<0.05). No difference was detected between the groups concerning the time to start oral feeding (p>0.05). No difference was detected between the groups concerning the length of hospital stay (p>0.05). There was no significant difference between the groups regarding the rate of complications (p>0.05). No patient died during surgery. Eleven (35%) of the 31 patients in Group I and 2 (14%) of the 14 patients in Group II died between postoperative days 1 and 25. There was no difference in mortality rates between the groups (p>0.05). Conclusions: Postoperative complications were detected at similar rates in both groups

Ozone for post-harvest treatment of apple fruits

Different biotic contaminations can affect apple production. Among these, infections by Penicillium expansum, the causal agent of blue-green post-harvest rot and patulin production, is particularly important. Fruit of the apple varieties: ‘Royal Gala’, ‘Golden Delicious’ and ‘Fuji’ were challenged with a patulin-producing P. expansum strain and stored at 1 ± 1°C in presence of gaseous ozone at 0.5 μL L-1 for 2 months. During the storage period, fungal populations, the biosynthesis of patulin and the activity of some Pathogenesis Related Proteins (glucanase, peroxidase and phenylalanine ammonia-lyase) were evaluated. Ozone treatment reduced fungal populations and patulin production. The activity of the assayed enzymes was not directly or clearly correlated with the inhibiting effect of ozone. These results indicate that ozone could be used to increase storage duration of apple varieties to maintain their quality

Plant Root Enhancement by Plant Growth Promoting Rhizobacteria

Soil microorganisms perform a variety of functions, some of which are extremely helpful to the maintenance of ecological sustainability. Bacteria thriving in the plant rhizosphere drive plant development through a variety of ways, which are referred to as PGPRs (plant growth-promoting rhizobacteria). Despite the fact that there are many different types of PGPRs, their significance and applications in sustainable agriculture are still debated and limited. The performance of PGPRs vary, which might be related to a variety of environmental conditions that impact their development and proliferation in plants. PGPR is a nonpathogenic, friendly bacterium that stimulates plant development by altering hormone concentrations and nutritional needs, as well as mitigating stress-related damage. PGPRs colonize root hairs and lateral roots in plants, where they may exhibit their beneficial characteristics. Rhizobacteria that promote plant development have the ability to control root system architecture (RSA), as well as the vegetative growth and physiology of the entire plant. The generation of hormones like Indole acetic acid (IAA) by PGPR has long been linked to RSA effects. This book chapter reviews the effects of PGPRs on the growth, the physiological, biochemical, and molecular characteristics of plant roots as well as the mechanisms involved

Tubular gastric adenocarcinoma: machine learning-based CT texture analysis for predicting lymphovascular and perineural invasion

PURPOSELymphovascular invasion (LVI) and perineural invasion (PNI) are associated with poor prognosis in gastric cancers. In this work, we aimed to investigate the potential role of computed tomography (CT) texture analysis in predicting LVI and PNI in patients with tubular gastric adenocarcinoma (GAC) using a machine learning (ML) approach.METHODSSixty-eight patients who underwent total gastrectomy with curative (R0) resection and D2-lymphadenectomy were included in this retrospective study. Texture features were extracted from the portal venous phase CT images. Dimension reduction was first done with a reproducibility analysis by two radiologists. Then, a feature selection algorithm was used to further reduce the high-dimensionality of the radiomic data. Training and test splits were created with 100 random samplings. ML-based classifications were done using adaptive boosting, k-nearest neighbors, Naive Bayes, neural network, random forest, stochastic gradient descent, support vector machine, and decision tree. Predictive performance of the ML algorithms was mainly evaluated using the mean area under the curve (AUC) metric.RESULTSAmong 271 texture features, 150 features had excellent reproducibility, which were included in the further feature selection process. Dimension reduction steps yielded five texture features for LVI and five for PNI. Considering all eight ML algorithms, mean AUC and accuracy ranges for predicting LVI were 0.777–0.894 and 76%–81.5%, respectively. For predicting PNI, mean AUC and accuracy ranges were 0.482–0.754 and 54%–68.2%, respectively. The best performances for predicting LVI and PNI were achieved with the random forest and Naive Bayes algorithms, respectively.CONCLUSIONML-based CT texture analysis has a potential for predicting LVI and PNI of the tubular GACs. Overall, the method was more successful in predicting LVI than PNI

Neurophysiological assessment of an innovative maritime safety system in terms of ship operators' mental workload, stress, and attention in the full mission bridge simulator

The current industrial environment relies heavily on maritime transportation. Despite the continuous technological advances for the development of innovative safety software and hardware systems, there is a consistent gap in the scientific literature regarding the objective evaluation of the performance of maritime operators. The human factor is profoundly affected by changes in human performance or psychological state. The difficulty lies in the fact that the technology, tools, and protocols for investigating human performance are not fully mature or suitable for experimental investigation. The present research aims to integrate these two concepts by (i) objectively characterizing the psychological state of mariners, i.e., mental workload, stress, and attention, through their electroencephalographic (EEG) signal analysis, and (ii) validating an innovative safety framework countermeasure, defined as Human Risk-Informed Design (HURID), through the aforementioned neurophysiological approach. The proposed study involved 26 mariners within a high-fidelity bridge simulator while encountering collision risk in congested waters with and without the HURID. Subjective, behavioral, and neurophysiological data, i.e., EEG, were collected throughout the experimental activities. The results showed that the participants experienced a statistically significant higher mental workload and stress while performing the maritime activities without the HURID, while their attention level was statistically lower compared to the condition in which they performed the experiments with the HURID (all p < 0.05). Therefore, the presented study confirmed the effectiveness of the HURID during maritime operations in critical scenarios and led the way to extend the neurophysiological evaluation of the HFs of maritime operators during the performance of critical and/or standard shipboard tasks

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Parçacık filtre ile bir hava aracının yeryüzü referanslı navigasyonu.

The need for Terrain Referenced Navigation (TRN) arises when Global Navigation Satellite System (GNSS) signals are unavailable. In recent years, research on the application of TRN to aerial and underwater vehicles has been increased rapidly with the developments in the accuracy of digital terrain elevation database (DTED). Since the land and sea floor profiles are inherently nonlinear, TRN becomes a nonlinear estimation problem. Because of the highly nonlinear and non-Gaussian problem, linear or linearized estimation techniques such as Kalman or Extended Kalman Filter (EKF) do not work properly for many terrain profiles. Hence, this thesis focuses on the particle filter (PF) for dealing with nonlinearities and different types of probability distributions even multi modal. Two different particle filter (PF) implementations are studied, Sequential Importance Sampling with effective resampling (SIS-R) and Sampling Importance Resampling (SIR). Both algorithms are tested for an aircraft sample scenario over a DTED map. Simulations with different number of particles, inertial measurement units (IMUs) having various error specifications are performed and investigated. M.S. - Master of Scienc