Morbid obesity is associated with postoperative complications in laparoscopic hysterectomy

Background: The prevalence of obesity in American women is 38.3%. Hysterectomy is the second most common surgery in reproductive age women; most of these procedures are performed laparoscopically. From 2011 to 2015, 3.2% of women age 15-44 years underwent hysterectomy; 89.6% of these procedures were performed for management of medical conditions including uterine fibroids, menstrual disorders, uterine prolapse, and endometriosis. The high rates of obesity and hysterectomy in women demand better understanding of the relationship between obesity and postoperative complications following laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP) by identifying all patients who underwent laparoscopic total hysterectomy, laparoscopic assisted vaginal hysterectomy, or laparoscopic supracervical hysterectomy from 2007 to 2013 using Current Procedural Terminology (CPT) codes. These patients were stratified by BMI (40); univariate and multivariate analyses were then performed to evaluate the incidence of postoperative complications in these groups. Results: Patients with BMI \u3e 30 were more likely to experience postoperative complications including superficial surgical site wound infection, deep surgical site infection, failure to wean from the ventilator \u3e 48 hours, unplanned reintubation, deep vein thrombosis, pulmonary embolism, urinary tract infection, renal insufficiency, renal failure, and extended hospital length of stay \u3e 2 days. Multivariate analysis suggests that BMI \u3e 30 is an independent risk factor for superficial surgical site infection, deep vein thrombosis, and pulmonary embolism. Conclusion: Patients with obesity and morbid obesity were more likely to present with risk factors and comorbidities than nonobese patients. While complication rates following laparoscopic hysterectomy are low across BMI groups, patients with BMI \u3e 30 were more likely to suffer from at least one postoperative complication. Data indicate that obesity may contribute to a significantly increased risk of deep vein thrombosis and pulmonary embolism in the postoperative period, suggesting the need for additional venous thromboembolism prophylaxis. Obesity should be considered when planning for and performing laparoscopic hysterectomy

Recommendations for Pregnancy in Rare Inherited Anemias

Rare inherited anemias are a subset of anemias caused by a genetic defect along one of the several stages of erythropoiesis or in different cellular components that affect red blood cell integrity, and thus its lifespan. Due to their low prevalence, several complications on growth and development, and multi-organ system damage are not yet well defined. Moreover, during the last decade there has been a lack of proper understanding of the impact of rare anemias on maternal and fetal outcomes. In addition, there are no clear-cut guidelines outlining the pathophysiological trends and management options unique to this special population. Here, we present on behalf of the European Hematology Association, evidence- and consensus-based guidelines, established by an international group of experts in different fields, including hematologists, gynecologists, general practitioners, medical geneticists, and experts in rare inherited anemias from various European countries for standardized and appropriate choice of therapeutic interventions for the management of pregnancy in rare inherited anemias, including Diamond-Blackfan Anemia, Congenital Dyserythropoietic Anemias, Thalassemia, Sickle Cell Disease, Enzyme deficiency and Red cell membrane disorders

Fuzzy Dynamic System and Fuzzy Linguistic Controller Classification

This paper presents the classification of fuzzy dynamic systems and fuzzy linguistic controllers into standard types (TYPE 1 through TYPE 7). The need and utility value behind this classification are given. Hopefully, this classification will lead to new designs and improve the performance of control systems. 1 Introduction Human operators have a remarkable adaptability to interpret linguistic statements about a process and to reason in a qualitative fashion. However, our understanding of how our brains work is very primitive. Apparently, the human brain has a facility of global reasoning and pattern recognition at many levels. This observation suggests that a multiple disciplinary approach which integrates pattern recognition, neural network, fuzzy logic, artificial intelligence, genetic algorithm, and control theory should be a natural way to design a robust and intelligent control to solve difficult problems. The fundamental question is Can we make comparable use of ambiguity, imp..

First Described Case of Group B Streptococcus Pelvic Abscess in a Patient with No Medical Comorbidities

Background. Group B Streptococcus is an organism that commonly infects a wide range of hosts including infants in the first week of life, pregnant women, and older age adults as well as adults with underlying medical comorbidities. Case. Large pelvic abscess in a nonpregnant patient found to be caused by Group B Streptococcus was treated successfully with IR guided drainage and antibiotics. Conclusion. Though rare, GBS can still be a cause of invasive infection even in individuals who are nonpregnant and have no underlying comorbidities. Empiric antibiotic coverage for this organism should be kept in mind when treating an abscess

An Application on Intelligent Control Using Neural Network and Fuzzy Logic

Intelligent control has become an issue of primary importance in modern process automation as it provides the prerequisites for the task of fault detection. The ability to detect the faults is essential to improve reliability and security of a complex control system. Parameter estimation methods, state observation schemes, statistical likelihood ratio tests, rule-based expert system reasoning, pattern recognition techniques, and artificial neural network approaches are the most common methodologies developed actively during recent years. In this paper, we describe a completed feasibility study demonstrating the merit of employing pattern recognition and an artificial neural network for fault diagnosis through back propagation learning algorithm and making the use of fuzzy approximate reasoning for fault control via parameter changes in a dynamic system. As a test case, a complex magnetic levitation vehicle (MLV) system is studied. Analytical fault symptoms are obtained by system dynami..

The Design Of An Adaptive Multiple Agent Fuzzy Constraint-Based Controller (mafcc) For A Complex Hydraulic System

this paper, we present a complete design framework for an adaptive multiple agent fuzzy constraint-based controller (MAFCC) based on fuzzy penumbra constraint processing in each fuzzy constraint subnetwork collaborating with a connected constraint network and its corresponding semantic modeling in a first-order predicate calculus (FOPC) language, with application to a complex hydraulic system. The concept of "multiple agent" and "fuzzy constraint subnetwork" in a complex control system is introduced and some basic definitions of penumbra fuzzy constraint processing in a constraint subnetwork and the collaboration with an overall connected constraint network and its semantic modeling are addressed. As a result, a human agent interacts with system agents and allows the constraints to be added or deleted on-line according to the constraints imposed from the outside environment. Near-optimal system performance is accomplished by restricting all the penumbra constraints to be satisfied in each constraint subnetwork simultaneously which are interconnected as a result of constraints that exist between each of them. Following the principle of constraint satisfaction and fuzzy local propagation reasoning, each individual system agent is now constrained to behave in a certain fashion as dictated by the overall constraint network. In addition, the constraint network in MAFCC system provides an update strategy which makes a real time adaptive hydraulic control for all 20 cities possible