Background: Acute cholecystitis is the most frequent complication of cholelithiasis and counts for one third of surgical emergencies. Aim: The study evaluates the outcomes and limits of laparoscopic cholecystectomy in acute cholecystitis. Materials and methods: A retrospective study was performed for 2 years, between 01.01.2016-31.12.2017 in the 2nd Surgery Department of the Sibiu County Emergency Clinical Hospital, on hospitalized patients with acute cholecystitis, who underwent surgery. The severity of acute cholecystitis was analyzed using the Tokyo Guidelines (TG13 / TG18) severity risk scale. The preoperatory evaluation of the anesthetic-surgical risk was based on American Society of Anesthesiologists Physical Status Classification (ASA PS) and Charlson Comorbidity Index (CCI) (9). Statistical analysis was performed to analyze the outcomes and limits of laparoscopic cholecystectomy and the risk factors for conversion and open surgery. Results: Out of the 262 patients in the study group, most of the patients (61%) were diagnosed with moderate acute cholecystitis, while 67 patients (26%) were diagnosed with mild form and 34 (13%) with severe acute cholecystitis. Laparoscopic cholecystectomy was performed in 96.1% of cases with no conversion to open surgery. The postoperative complications were ligature slippage (1.9%), main bile duct injury (1.9%), postoperative hemorrhage (3.9%) and surgical site infections (2.4%), most of them being managed conservatory. Conclusions: Laparoscopic cholecystectomy can be performed nowadays with minimal morbidity in acute cholecystitis. Knowledge of various factors predicting possible conversion helps in adequate pre-operative selection and counseling for open procedure with further reduction in the overall morbidity of laparoscopic cholecystectomy.
: Background: More than half of patients with locally advanced esophageal cancer are unresponsive to first-line chemotherapy. To date, there is no standard second-line regimen; new agents, such as immune-checkpoint inhibitors or anti-Neurotrophic Tropomyosin-Related Kinas agents, have only been recently recommended. This study aimed to assess the benefits of classical second-line chemotherapy in terms of survival and tolerance. Materials and Methods: This retrospective analysis assessed the benefits and tolerance of different second-line regimens of chemotherapy in progressive, locally advanced or metastatic oesophageal cancer treated at the department of Radiotherapy-Oncology at the Institute of Oncology between January 2011 and January 2017. Results: The analysis found 87 patient files with a median age 59.5 years (ranging between 41 and 84), of which 40.2% (35 patients) failed the first-line platinum and 5- fluorouracil combination. Histology favoured adenocarcinomas (63.2%). The patients were in good clinical condition, with ECOG 0–1 in 86.1% (74 patients), and less than five percent had more than three metastatic sites (3.4%, 3 patients). The regimens were mostly two-drug cytotoxic (53.9%, 47 patients): FOLFIRI in 18 patients (20.7%), FOLFOX in 18 patients (20.7%), vinorelbine–platinum combination in 11 patients (12.6%), and docetaxel in 40 patients (38.7%). The median treatment duration was 7.74 weeks (range 1 to 12). The general response rate was 47.1% (41 patients), including stable disease. The median time to progression was 7.61 weeks, with a range between 1.6 and 8.6 weeks, with no differences in this respect among the fourth type of treatment received (p = 0.170). Grade 3–4 toxicities, including neutropenia, gastrointestinal problems, and metabolic disorders, were observed in 44 patients (50.6%). The median event-free survival was 2 months (range between 1 and 6.3), and 63.2% (55 patients) subsequently received a third line of chemotherapy. Conclusion: Second-line chemotherapy is still the first-choice recommendation in all fit patients with advanced oesophageal cancer. The new agents are efficacious only in cases with PD-L1 positive or high microsatellite instability.
During the late adolescence, it can be reached the highest level of mental operative functions and other intelligent human manifestations. Abstract mental operations can be done at this level: synthesis of syntheses, generalization of generalizations, abstraction of abstractions. Students go through many attempts to find which is their personal style of learning new materials, new contents. The study was conducted on a number of 31 participants. The group was divided into two subgroups: 16 students in the 5th year at Faculty of General Medicine and 15 master students in the second year at University of Sports, Sports Performance program. The used instrument consists of 21 questions (11 questions are about the individual studying process of the participants and 10 are about their beliefs about the teaching process of academics in courses), along with 4 more questions related to personal data. It is an opinion questionnaire. The teaching style of academics differs: those of Faculty of General Medicine are focusing on a lecture type style (75%), and University of Sports on an interactive style (67%). We discovered differences in the process of self-learning: between continuous and discontinuous style. For medical students, there was a longer distribution of the self-taught learning process; instead, University of Sports students organize their learning time in the last part of the semester. University of Sports students are more concerned with on the development and refinement of their personal practical skills, but also of the subjects they work with (kids or athletes), their goal being to accumulate their own experience as rich as possible from working with as many individuals and less to take from the experience of other colleagues. The coach-athlete/sports teacher-pupil relationship is more personalized and longer-lasting than the doctor-patient relationship.
The accident at Chernobyl occurred in April 1986 at the Chernobyl Nuclear Power Plant in Soviet Union. The incident occurred during a scheduled safety test. A combination of inherent reactor design flaws and operators’ mistakes resulted in reactor’s No.4 disaster and the emission of a large quantity of radiation. The immediate actions involved the fire extinguishing, the cleanup of radioactive residues and the prevention of a new explosion. For this purpose, plenty of people worked with self-sacrifice. The people who lived nearby were removed. As far as the socio-economic impact for the Soviet Union is concerned, it was quite serious. Moreover, the environmental and human health consequences were also alarming with thyroid cancer being the most studied. Useful conclusions, especially for the safety both of reactors and nuclear power, as well as for the impact of radiation at ecosystems have been drawn. The debate about the use of nuclear power has remained open ever since.
Background: We wanted to evaluate the effectiveness of oral everolimus alone and in combination with capecitabine treatment on colorectal cancer-induced peritoneal carcinomatosis animal model. Methods: Caco-2 colon adenocarcinoma cells were injected intraperitoneally to BALB/cOlaHsd-Foxn1nu mice to establish peritoneal carcinomatosis. Mice were divided into four groups (everolimus, everolimus plus capecitabine, capecitabine, control group) with 2 mice in each group. Treatment was initiated 5 days after inoculation of Caco-2 cells. 7.5 mg/kg everolimus was administered orally every 2 days. 2.1 mmol/kg capecitabine was administered orally every 5 days a week. 22 days after inoculation of Caco-2 cells, mice were sacrificed. Results: The mean weight of the tumor was 25 ± 7.07 mg in the control group (n=2); 0.7 ± 0.7 mg in the everolimus group (n=2); 0.28 ± 0.36 mg in the capecitabine group; 0.48 ± 0.07 mg in the everolimus plus capecitabine group. Conclusion: Tumor samples excised from BALB/cOlaHsd-Foxn1nu mice revealed that everolimus alone, and in combination with capecitabine suppressed tumor growth. However, a comparison of tumor weights revealed no statistically significant difference within the four groups (p=0.227). To reach statistically significant data, the sample size should be increased.
The current paper describes the protocol used in our clinic for 3D imaging, reconstruction and printing of complex acetabular defects that are used for surgical planning of complex acetabular defects. Surgical guides have also been developed to aid optimal acetabular reamer placement in order to recreate the optimal hip rotation centre for each patient undergoing revision hip arthroplasty that has impaired acetabular bone stock.
Background: Human resource is the most important criteria of today organizations. In considering a human resource, performance and productivity are very fundamental. One of the most important criteria that affect human resources is leadership style. Aims: This study aimed to assess the effect of leadership style (Autocratic, Democratic, and Laissez-faire) on productivity that in this relationship two phenomena (job promotion opportunity and job description) plays the roles of moderating variable. Methods: The data were collected through the distribution of standard questionnaires among 170 employees of a hospital in Tehran and analyzed with structural equation methods with smart PLS software. The reliability and validity of questionnaires are confirmed through software examination and elites' opinions. For examining the hypothesis, factor loading and path coefficient are considered. Results: Democratic and laissez-faire styles have a significant effect on productivity (with 5.51 and 2.65 loading factor and positive path coefficient), but the autocratic style has a negative effect (due to 5.54 loading factor and -0.35 path coefficient) on productivity. Neither job promotion opportunity nor job description plays the role of moderating variables according to the results of the analyzes. Conclusion: Leadership style has a significant impact on productivity. The autocratic style has a negative effect on productivity, but democratic and laissez-faire have a positive effect. Job promotion opportunities and job descriptions don’t play a moderating role in leadership style and productivity relationships.
