This study aimed to evaluate the effectiveness of unilateral external oblique intercostal nerve block (EOIB) in laparoscopic cholecystectomy surgery.
After ethics committee approval, ASA I-II ...patients aged 18-70 who would undergo laparoscopic cholecystectomy surgery were included in the study. The patients were divided into two groups, external oblique intercostal nerve block (Group EOIB) and oblique subcostal transversus abdominis plane block (Group OSTAP). After surgery, EOIB or OSTAP block was administered with 20 mL of .25% bupivacaine then routine analgesia protocol was applied with iv paracetamol, and tramadol. Visual analog scale (VAS) scores and patient-controlled analgesia (PCA) consumption were monitored 24 hours after the operation. It was administered 25 mg pethidine as a rescue analgesic to patients with VAS ≥4.
Thirty six patients for Group EOIB and thirty four patients for Group OSTAP were included in the study. Lower VAS scores were observed in all groups. When PCA consumption, side effects, rescue analgesia consumption, and patient satisfaction were evaluated, there was no statistically significant difference between the groups (
> .05).
It was observed that EOIB showed similar analgesic activity to the OSTAP block. EOIB may also be a part of postoperative multimodal analgesia by reducing postoperative opioid consumption in LC.
The role of human factor plays a critical role in the safe and clean operation of maritime industry. Human error prediction can be beneficial to assess risk in maritime industry since shipping ...activities can pose potential hazards to human life and maritime ecology. The aim of this paper is to propose a risk assessment tool by considering the role of human factor. Hence, the desired safety control level in maritime transportation activities can be ascertained. In the proposed approach, a Success Likelihood Index Method (SLIM) extended with fuzzy logic is used to calculate human error probability (HEP). Severity of consequences are adopted in the proposed approach to assess risk. The quantitative risk assessment approach under fuzzy SLIM methodology will be applied to a very specific case on-board ship: Ballast Water Treatment (BWT) system. In order to improve consistency of research and minimize subjectivity of experts' judgments, the paper adopts the dominance factor which is used to adjust the impact level of experts' judgments in the aggregation stage of the methodology. The paper aims at not only highlighting the importance of human factor in maritime risk assessment but also enhancing safety control level and minimizing potential environmental impacts to marine ecology.
We aimed to compare the aqueous humor total oxidant status, total antioxidant capacity, and levels of interleukin-6 and vascular endothelial growth factor between patients with diabetic retinopathy ...and controls and to correlate these levels with the DR status.
Patients who underwent cataract surgery were enrolled. The first group (control group) comprised patients without diabetes; the second group comprised diabetic patients without retinopathy; the third group comprised patients with nonproliferative diabetic retinopathy; and the fourth group comprised patients with proliferative diabetic retinopathy. All patients underwent full ophthalmologic examination before cataract surgery. Prior to surgery, samples of aqueous humor sampling were obtained and stored at -80 °C. Total antioxidant capacity, total oxidant status, and levels interleukin-6 and vascular endothelial growth factor were investigated in these samples and correlated with diabetic retinopathy status.
This study analyzed 86 pairs of eyes of 86 patients. All groups were statistically similar in age and sex, but the total antioxidant capacity was lowest in patients with proliferative diabetic retinopathy. Moreover, the total oxidant status and levels of vascular endothelial growth factor and interleukin-6 were found to slightly increase according to the retinopathy status.
Oxidative stress, interleukin-6, and vascular endothelial growth factor in the aqueous humor seem to play important roles in the pathogenesis of diabetic retinopathy, especially in the proliferative type.
AIM: To compare of intravitreal bevacizumab and intravitreal bevacizumab and triamcinolone acetonide in eyes with bilateral diabetic macular edema.METHODS: In this retrospective ...comparative-randomized study, 42 eyes of 21 diabetic patients with bilateral macular edema were evaluated. In one eye intravitreal injection of 1.25 mg bevacizumab(IVB group)was performed and in the fellow eye intravitreal injection of combined 1.25 mg bevacizumab and 1 mg triamcinolone acetonide(IVTA-IVB group)was performed. Main outcomes were the central macular thickness(CMT)measured with optical coherence tomography(OCT), ETDRS visual acuity(VA)and intraocular pressure(IOP).RESULTS: Mean follow-up time was 4.7±1.5mo. In the IVB and IVTA-IVB groups, mean CMT was 494.7±114.4 μm and 546.8±165.6 μm before injections; 430.4±133.2 μm and 363.7±105.3 μm in first month; 484.8±167.4 μm and 407.3±108.7 μm in 3rd month; 550.4±191.5 μm and 516.8±158 μm after 6mo respectively. Differences were significant in first and 3rd months(P<0.05). In the IVB and IVTA-IVB groups, mean ETDRS VA score was 57.1±13.5 and 48.9±13.9 before injections; 62.2±14 and 58.8±12.1 in first month; 59±13.7 and 59.3±13.6 in 3rd month; 55.6±14.9 and 55.5±8.7 after 6mo respectively. Differences were significant in first and 3rd and 6mo(P<0.05). There was no IOP difference. IVTA-IVB group gains best VA in 3rd month after the first injection and maintains it for 6mo whereas IVB group gains best VA at first month and can be able to maintain for 3mo.CONCLUSION: Injection of 1 mg IVTA-IVB seems to be better than IVB alone in improving VA for 6mo without any steroid dependent complications.
This study aimed to compare the image quality and diagnostic accuracy of deep-learning-based image denoising reconstructions (DLIDs) to established iterative reconstructed algorithms in low-dose ...computed tomography (LDCT) of patients with suspected urolithiasis. LDCTs (CTDIvol, 2 mGy) of 76 patients (age: 40.3 ± 5.2 years, M/W: 51/25) with suspected urolithiasis were retrospectively included. Filtered-back projection (FBP), hybrid iterative and model-based iterative reconstruction (HIR/MBIR, respectively) were reconstructed. FBP images were processed using a Food and Drug Administration (FDA)-approved DLID. ROIs were placed in renal parenchyma, fat, muscle and urinary bladder. Signal- and contrast-to-noise ratios (SNR/CNR, respectively) were calculated. Two radiologists evaluated image quality on five-point Likert scales and urinary stones. The results showed a progressive decrease in image noise from FBP, HIR and DLID to MBIR with significant differences between each method (p < 0.05). SNR and CNR were comparable between MBIR and DLID, while it was significantly lower in HIR followed by FBP (e.g., SNR: 1.5 ± 0.3; 1.4 ± 0.4; 1.0 ± 0.3; 0.7 ± 0.2, p < 0.05). Subjective analysis confirmed best image quality in MBIR, followed by DLID and HIR, both being superior to FBP (p < 0.05). Diagnostic accuracy for urinary stone detection was best using MBIR (0.94), lowest using FBP (0.84) and comparable between DLID (0.90) and HIR (0.90). Stone size measurements were consistent between all reconstructions and showed excellent correlation (r2 = 0.958–0.975). In conclusion, MBIR yielded the highest image quality and diagnostic accuracy, with DLID producing better results than HIR and FBP in image quality and matching HIR in diagnostic precision.
This study proposes an improved failure mode and effect analysis (FMEA) with fuzzy Bayesian Network (FBN) and fuzzy best-worst method (FBWM) to assess failures in plastic production. To eliminate the ...drawbacks of the classical risk priority number (RPN) computation of FMEA, this approach is developed. Unlike classical RPN, a new parameter hierarchy is constructed, and three sub-parameters are injected into the approach. These parameters are weighted by the aid of FBWM. Hereafter, a fuzzy rule-based system is constructed by incorporating Bayesian Network (BN). Also, a sensitivity analysis is performed to observe the final FMEA score changes in accordance with the change of subjective probability values. Finally, a comparative analysis with two approaches of classical FMEA and FBWM-based FMEA (without a fuzzy rule-based system incorporating BN) is fulfilled. The results of the study are strengthened with the experts’ opinions regarding the importance of failure modes for the final product and the whole system and supported them by experience feedback in the observed facility.
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•A manufacturing failure mode and effect analysis (FMEA) is proposed.•The proposed FMEA is based on fuzzy and probabilistic risk assessment.•Bayesian network (BN) and Best-Worst method (BWM) are used under fuzzy concept.•A case study for plastic manufacturing is performed for demonstration.•A sensitivity and comparative analysis is performed for the validation of results.
•Application of internal type-2 fuzzy sets into HEART approach.•A robust tool proposal to predict human error and human reliability performance.•Practical contribution to human reliability assessment ...in marine and off-shore industry.•Improving safety and performance reliability at marine and off-shore industry.
A Single Point Mooring (SPM) unit is a widely recognised off-shore terminal facility in the marine industry since a considerable amount of liquid cargoes can easily be transferred into huge tankers such as VLCCs or ULCCs. Although the system presents high safety standards, any minor accidents due to human error may cause serious harm to the marine environment, human life and the commodity itself. Therefore, nominated crew on-board the tanker and the unit should be very careful during SPM cargo operations. At this point, human reliability plays a critical role in avoiding potential operational or technical failures. In this context, the aim of this paper is to perform a comprehensive human reliability assessment during cargo operations of an SPM unit to enhance maritime safety in off-shore units. The paper prompts a methodological extension of human error assessment and reduction technique (HEART) by incorporating interval type-2 fuzzy sets which overcome more of the uncertainty of experts’ judgement and expression in decision-making. The proposed approach not only provides theoretical insight but practical contribution to human reliability assessment in the marine and off-shore industries.
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