Different Surgical Techniques for Management of Leiomyoma

The objective is to review the methods of treatment for all cases diagnosed as leiomyoma at Tertiary Teaching Hospital. This is a retrospective study on the medical files of all cases diagnosed as leiomyoma at King Abdulaziz University Hospital. It is a teaching hospital with a capacity of 800 beds in total and 180 beds in the Department of Obstetrics and Gynecology. The study was approved by ethical hospital committee to be performed from July 2016 till September 2018. The total number of admitted cases of Leiomyoma, with a clinical diagnosis and confirmed postoperatively with a histological pathology, were 385. About 244 of Leiomyoma were managed with hysterectomy (63.4%). Open myomectomy was the method of choice to treat 141 cases, which contribute to (36.4%), a different technique used, Hysteroscopic, laparoscopic or open depending on the age of the patients, location, type of leiomyoma and fertility preservation. A number of cases treated with open surgery were 70 out of 141 (49.6%) and laparoscopic myomectomy were 51 out of 141 (36.2%); only 20 cases had hysteroscopic resection of myoma (14.2%). Although hysterectomy is not an acceptable method of treatment for leiomyoma by many patients, still it is the most common surgical method for the treatment of leiomyoma

Comparative study between Harmonic FOCUSTM to clamp and tie technique for total thyroidectomy

Background: Thyroid surgery has undergone many changes during the past 2 decades, including the introduction of new surgical techniques such as endoscopic or video-assisted approaches, anesthesia care, intraoperative nerve monitoring and new hemostatic tools Objectives: to assess the efficacy and safety of Harmonic Focus shears in total thyroidectomy compared with conventional surgical technique. Patients and methods: prospective study conducted from October 2011 till January 2016, two handers and nine patients with benign and malignant thyroid diseases, scheduled for total thyroidectomy in a governor and private hospitals were enrolled randomly into 2 groups, group A consists of 105 patient who undergone a total thyroidectomy using a harmonic FOCUSTM , and group B consists of 104 patients who underwent total thyroidectomy with conventional surgical technique. Results: Eleven patients had papillary thyroid carcinoma: 6 (5.7%) of them in group A and 5(4.8%) in group B. Eighty seven (82.9%) patients in group A had non toxic MNG, and 12(11.4%) patients had toxic MNG, 90 (86.5%) patients in group B had non toxic MNG while the other 9 (8.7%) had toxic MNG. Mean operative time was significantly lower in group A compared to Group B (100+/- 34 vs. 119+/- 30mins, respectively). In group A mean calcium level at first post-operative day was 8.36 +/- 0.54 mg/dl. In group B mean value was 8.12+/- 0.56 mg/dl. This difference was not statistically significant. There were no significant difference between the two groups concerning transient hypocalcemia requiring calcium and Vitamin D therapy: 11(10.5%) patients in group A versus 12(11.5%) in group B. No permanent hypocalcemia was found in both groups. Two patients had transient vocal cord palsy in group A(1.9%) versus 3 patients in group B (2.8%) Conclusions: The HF is a reliable, comfortable and safe instrument alternative to knot tying technique, very suitable hand-piece for total thyroidectomy. It creates a clean, bloodless surgical field, and there is an advantage for the surgeon to use a single tool for both dissection and hemostasis. Moreover, the HF is a time-saving option, allowing for a significant reduction of operative time, without affecting parathyroid function, need for medical therapy, and hemostasis in the early post-operative period

Using stochastic model for lower financial risk management in refinery operation planning

Most Refineries historically models are deterministic, that is, they use nominal parameter values without taking into consideration the uncertainty in process, demands, refinery parameters, etc. And as a consequence, they are unable to perform risk management. In this paper a variety of methodologies for financial risk management in engineering decision have been already developed. We follow the approach presented by Barbaro and Bagajewicz (2004), who used two-stage stochastic programming model and you, can find all other approaches analyzed and discussed. The problem addressed here is that of determining the crude oil to purchase and decide on the production level of different products given predicts of demands. The profit is maximized taking into account revenues, crude oil costs, inventory costs, and lost demand costs. The model was tested using data from the Refinery owned by the State Oil Marketing Organization (SOMO) Company, Iraq. The results show that the stochastic model can forecast higher expected profit and lower risk compared to the deterministic model

ТЕМПЕРАТУРНОЕ ПОЛЕ ВЫХЛОПНЫХ ГАЗОВ АВТОМОБИЛЕЙ И РАСЧЁТЫ СТАТИСТИЧЕСКИХ СВЕДЕНИЙ

There are too many problems from the gases which constantly fly out from the exhaust pipes of cars and lorries, especially if this process takes place in the closed apartment (garage, laboratory, class, station of diagnostic or repair for transport systems with diesel or petrol engine). Practically all gases poison air, bring essentially injury to the health of people and for the all nature. Hitherto, many scientists affirm that gases create the negative hotbed effect in the atmosphere and influence to the appearance of the ozone holes. Some important experiments and investigations at the present day didn’t make.In this article there are several technical decisions not only how to decrease the negative influence of gases but the special calculations using personal computer and statistical information to describe the process by a chart.  Существует много проблем с газами, которые вылетают постоянно из выхлопных труб легковых автомобилей и грузовиков, особенно если имеет место этот процесс в закрытых помещениях (гараж, лаборатория, класс, станция диагностики или ремонта транспортных систем с дизельным или бензиновым двигателем). Практически все газы отравляют воздух, приносят существенный вред здоровью людей и всей природе. Поэтому многие учёные утверждают, что газы создают негативный парниковый эффект в атмосфере и влияют на появление озоновых дыр. Некоторые важные эксперименты и исследования в настоящее время сделаны.В этой статье есть несколько технических решений не только как уменьшить негативное влияние газов, но и специальные расчёты, используя персональный компьютер и статистическую информацию, чтобы описать процесс графически.

The prevalence of gallstone disease after sleeve gastrectomy and Roux en Y gastric bypass

Background: Obesity (body mass index >30) is increasing worldwide with an estimated 1.7 billion people currently affected by the disease, Gallstone represent the third most common disease observed among obese patients. Moreover about 30% of the patients who are candidates for bariatric surgery either have undergone a prior cholecystectomy or are found to present gallstones at time of surgery, On the other hand, newly formed gallstones may be diagnosed in 27% to 43% of patients who have undergone bariatric surgery within a very short period of time. Objective: To determine the prevalence of gallstone disease requiring cholecystectomy after laparoscopic sleeve gastrectomy and roux en Y gastric bypass during a one year follow up and to determine the need for prophylactic cholecystectomy in these patients. Patients and methods: prospective study among patients with morbid obesity treated with laparoscopic sleeve gastrectomy and Roux- en- Y Gastric Bypass between 1st of February 2013 till 31st of July 2015 at Saint Raphael hospital and Al-Hayat private hospital, patients with negative abdominal ultrasound preoperatively, patient with at least one year follow up after surgery were included in this study, The patients were divided into two groups for comparison. Group A patients who had laparoscopic sleeve gastrectomy, and group B included the patients who underwent laparoscopic Roux en Y gastric bypass. The primary outcome measure was the formation of symptomatic gallstones or sludge with or without complications. Results: 284 patients in group A(sleeve) and 45 patients in group B(Bypass) were included in the analysis, the mean age of was 34.5 years for group A, and 191(67.3%) of the patients were women, whereas it was 41.5 years for group B and 33 (73.3%) of the patients were women, Symptomatic cholelithiasis subsequently requiring cholecystectomy occurred in 29 (10.2%) of 284 laparoscopic sleeve gastrectomy patients, and 5(11.1%) of 45 Roux en Y gastric bypass patients , symptomatic gallstone developed in a median of 7 months in group A, while the median time to developed symptomatic gallstone in group B was 8 months. No significant difference in symptomatic gallstone disease was found between the patients who underwent laparoscopic gastric bypass and those who had sleeve gastrectomy Conclusions: Cholelithiasis was common in our patients before weight reduction surgery. The rate for symptomatic gallstones after surgery was not so high.. Routine prophylactic cholecystectomy should not be recommended for these patients

Self-supervised deep learning for highly efficient spatial immunophenotyping

Background: Efficient biomarker discovery and clinical translation depend on the fast and accurate analytical output from crucial technologies such as multiplex imaging. However, reliable cell classification often requires extensive annotations. Label-efficient strategies are urgently needed to reveal diverse cell distribution and spatial interactions in large-scale multiplex datasets. / Methods: This study proposed Self-supervised Learning for Antigen Detection (SANDI) for accurate cell phenotyping while mitigating the annotation burden. The model first learns intrinsic pairwise similarities in unlabelled cell images, followed by a classification step to map learnt features to cell labels using a small set of annotated references. We acquired four multiplex immunohistochemistry datasets and one imaging mass cytometry dataset, comprising 2825 to 15,258 single-cell images to train and test the model. / Findings: With 1% annotations (18–114 cells), SANDI achieved weighted F1-scores ranging from 0.82 to 0.98 across the five datasets, which was comparable to the fully supervised classifier trained on 1828–11,459 annotated cells (−0.002 to −0.053 of averaged weighted F1-score, Wilcoxon rank-sum test, P = 0.31). Leveraging the immune checkpoint markers stained in ovarian cancer slides, SANDI-based cell identification reveals spatial expulsion between PD1-expressing T helper cells and T regulatory cells, suggesting an interplay between PD1 expression and T regulatory cell-mediated immunosuppression. / Interpretation: By striking a fine balance between minimal expert guidance and the power of deep learning to learn similarity within abundant data, SANDI presents new opportunities for efficient, large-scale learning for histology multiplex imaging data. / Funding: This study was funded by the Royal Marsden/ ICR National Institute of Health Research Biomedical Research Centre

Spatial interplay of lymphocytes and fibroblasts in estrogen receptor-positive HER2-negative breast cancer

In estrogen-receptor-positive, HER2-negative (ER+HER2−) breast cancer, higher levels of tumor infiltrating lymphocytes (TILs) are often associated with a poor prognosis and this phenomenon is still poorly understood. Fibroblasts represent one of the most frequent cells in breast cancer and harbor immunomodulatory capabilities. Here, we evaluate the molecular and clinical impact of the spatial patterns of TILs and fibroblast in ER+HER2− breast cancer. We used a deep neural network to locate and identify tumor, TILs, and fibroblasts on hematoxylin and eosin-stained slides from 179 ER+HER2− breast tumors (ICGC cohort) together with a new density estimation analysis to measure the spatial patterns. We clustered tumors based on their spatial patterns and gene set enrichment analysis was performed to study their molecular characteristics. We independently assessed the spatial patterns in a second cohort of ER+HER2− breast cancer (N = 630, METABRIC) and studied their prognostic value. The spatial integration of fibroblasts, TILs, and tumor cells leads to a new reproducible spatial classification of ER+HER2− breast cancer and is linked to inflammation, fibroblast meddling, or immunosuppression. ER+HER2− patients with high TIL did not have a significant improved overall survival (HR = 0.76, P = 0.212), except when they had received chemotherapy (HR = 0.447). A poorer survival was observed for patients with high fibroblasts that did not show a high level of TILs (HR = 1.661, P = 0.0303). Especially spatial mixing of fibroblasts and TILs was associated with a good prognosis (HR = 0.464, P = 0.013). Our findings demonstrate a reproducible pipeline for the spatial profiling of TILs and fibroblasts in ER+HER2− breast cancer and suggest that this spatial interplay holds a decisive role in their cancer-immune interactions

The T cell differentiation landscape is shaped by tumour mutations in lung cancer

Tumour mutational burden (TMB) predicts immunotherapy outcome in non-small cell lung cancer (NSCLC), consistent with immune recognition of tumour neoantigens. However, persistent antigen exposure is detrimental for T cell function. How TMB affects CD4 and CD8 T cell differentiation in untreated tumours and whether this affects patient outcomes is unknown. Here, we paired high-dimensional flow cytometry, exome, single-cell and bulk RNA sequencing from patients with resected, untreated NSCLC to examine these relationships. TMB was associated with compartment-wide T cell differentiation skewing, characterized by loss of TCF7-expressing progenitor-like CD4 T cells, and an increased abundance of dysfunctional CD8 and CD4 T cell subsets with strong phenotypic and transcriptional similarity to neoantigen-reactive CD8 T cells. A gene signature of redistribution from progenitor-like to dysfunctional states was associated with poor survival in lung and other cancer cohorts. Single-cell characterization of these populations informs potential strategies for therapeutic manipulation in NSCLC