Detection of ECG waveforms by neural networks

In this study, ECG waveform detection was performed by using artificial neural networks (ANNs). Initially, the R peak of the QRS complex is detected, and then feature vectors are formed by using the amplitudes of the significant frequency components of the DFT spectrum. Grow and Learn (GAL) and Kohonen networks are comparatively investigated to detect four different ECG waveforms. The comparative performance results of GAL and Kohonen networks are reported.

ECG beat classification by a novel hybrid neural network

This paper presents a novel hybrid neural network structure for the classification of the electrocardiogram (ECG) beats. Two feature extraction methods: Fourier and wavelet analyses for ECG beat classification are comparatively investigated in eight-dimensional feature space. ECG features are determined by dynamic programming according to the divergence value. Classification performance, training time and the number of nodes of the multi-layer perceptron (MLP), restricted Coulomb energy (RCE) and a novel hybrid neural network are comparatively presented. In order to increase the classification performance and to decrease the number of nodes, the novel hybrid structure is trained by the genetic algorithms (GAs). Ten types of ECG beats obtained from the MIT-BIH database and from a real-time ECG measurement system are classified with a success of 96% by using the hybrid structure.

Sarcopenia is associated with increased severe postoperative complications after colon cancer surgery

INTRODUCTION

Studies have shown that sarcopenia is associated with poor outcomes in patients with gastrointestinal cancer undergoing surgery. We aimed to investigate the relationship between postoperative complications of sarcopenic patients who had been operated on for colon cancer and the effects on short-term mortality.

MATERIAL AND METHODS

In this study, patients who had undergone colon cancer surgery between January 2013 and December 2018 were collected retrospectively. Sarcopenia was diagnosed by the skeletal muscle index (SMI) derived from a preoperative computed tomography scan. Multiple logistic regression analysis was performed to determine whether sarcopenia is associated with postoperative major complications (POMC).

RESULTS

The study included 160 patients with a mean age of 62.4 ±12.6 years. Clavien-Dindo grade 1-2 (minor) complications were not significantly different between the groups (p = 0.896). However, grade ≥ 3 (major) complications were detected in 13 (17.8%) patients in the sarcopenic group (SG) and in 5 patients in the non-sarcopenic group (NSG) (5.7%) (p = 0.016). Length of intensive care unit (ICU) stay was longer in SG (p = 0.002) and there was no difference between 1-month and 6-month mortality rates (p = 0.273 and p = 0.402, respectively). According to univariate analyses, sarcopenia and age over 65 years were related to POMC. In multivariate analyses, sarcopenia (odds ratio = 3.039; 95% confidence interval 1.008-9.174; p = 0.048) and advanced age (odds ratio = 3.246; 95% confidence interval 1.078-9.803; p = 0.036) were found to be independent risk factors for POMC.

CONCLUSIONS

This study showed that while sarcopenia is a risk factor for POMC, sarcopenia also prolongs the duration of ICU stay. Also sarcopenia has no effect on short-term mortality.

Comparison of standard 4-row versus 6-row3-D linear cutter stapler in creation of gastrointestinal system anastomoses: a prospective randomized trial

OBJECTIVE

This prospective study was conducted to compare the clinical outcomes of a 6-row 3-D linear cutter with the standard 4-row linear cutter in patients who underwent elective gastrointestinal surgery anastomosis.

METHOD

Patients who underwent elective open gastrointestinal surgery that included stapled anastomosis using a linear cutter (Proximate®, Ethicon Endo-Surgery, Cincinnati, OH) between January 2011 and May 2011 were included in the study. The patients were randomly assigned to two groups according to the linear cutter that was used in the surgery: the standard 4-row cutter (the S group) or the new 6-row cutter (the N group). The groups were compared based on the patient demographic data, the laboratory parameters, the preoperative diagnosis, the surgery performed, the operation time, intra-or postoperative complications, the time to oral tolerance and the length of the hospital stay.

RESULTS

The S group included 11 male and nine female patients with a mean age of 65 ± 12 (35-84) years, while the N group included 13 male and eight female patients with a mean age of 62 ± 11 (46-79) years (p =0.448, p = 0.443, respectively). Anastomotic line bleeding was observed in eight (40%) patients in the S group and in one (4.7%) patient in the N group (p = 0.006). Dehiscence of the anastomosis line was observed in two (10%) patients in the S group and none in the N group (p =0.131). Anastomotic leakage developed in three (15%) patients in the S group and in one (4.7%) patient in the N group (p = 0.269). The mean hospital stay was 12.65 ± 6.1 days in theS group and 9.52 ± 2.9 days in the N group (p = 0.043).

CONCLUSION

The 6-row 3-D linear cutter is a safe and easily applied instrument that can be used to create anastomoses in gastrointestinal surgery. The new stapler provides some usage benefits and is also superior to the standard linear cutter with regard to anastomotic line bleeding.

Relation between Sarcopenia and Surgical Site Infection in Patients Undergoing Gastric Cancer Surgery

Background: Sarcopenia is a syndrome that can have negative consequences after gastric cancer (GC) surgery. This study aims to determine the effect of sarcopenia on surgical site infection (SSI) that develops after open GC surgery. Patients and Methods: In this retrospective design study, data were collected for patients who underwent GC surgery between January 2013 and August 2019. The diagnosis of sarcopenia was made according to the skeletal muscle index (SMI) calculated from pre-operative computed tomography images. Patients with sarcopenia and those without sarcopenia were compared in terms of SSIs; the risk factors for SSI were also analyzed. Results: One hundred forty-nine patients were included in the study and had a mean age of 59.3 years. Post-operative complications developed in 59 patients (39.6%) and SSIs in 28 patients (18.7%). Sarcopenia was detected in 57 (38.3%) patients; the mean age was 59.9 years in the sarcopenic group (SG) and 58.9 years in the non-sarcopenic group (NSG; p = 0.55). The mean SMI was 382.5 mm²/m² and 646.2 mm²/m² in the SG and NSG, respectively (p < 0.001). A relation between SSIs and sarcopenia was detected; 17 patients in the SG (29.8%) versus 11 patients in the NSG (11.9%; p = 0.007). Surgical site infection was not found to be statistically significantly related to obesity, hypoalbuminemia, intra-operative blood loss, or duration of operation, although the sarcopenic obesity patients were found to have the highest SSI rate (40%). Conclusion: The present study identified a relation between sarcopenia and SSIs occurring after GC surgery. The authors believe that studies seeking to reduce the incidence of SSIs, which are a leading cause of morbidity after GC surgery, should be supported.

Effect of Triclosan-Coated Suture on Surgical Site Infection of Abdominal Fascial Closures

Background: Surgical site infections (SSIs) are a serious problem after abdominal surgery. This study aimed to compare closure of fascia with triclosan-coated monofilament polydioxanone (PDS) or standard PDS in decreasing the incidence of SSIs in patients who underwent abdominal surgery. Methods: In this randomized study, a total of 890 consecutive patients undergoing laparotomy for any gastrointestinal pathology were allocated to closure of the fascia with triclosan-coated PDS (treatment group; TG) or standard PDS (control group; CG). Patients were assessed every day during the hospital stay for SSIs and at the first, second, and fourth week after discharge. The surgical site was assessed in terms of superficial, deep incisional, or organ/site SSI. Results: The main important finding was that SSIs were reduced as much as 24% by using triclosan-coated PDS. Surgical site infections occurred in 200 patients (22.4%), with 105 being early (in the first week) and 95 occurring late. Eighty five of the SSIs (19.1%) were noted in patients in the TG, whereas 115 of them (25.8%) were in the CG (p = 0.016). The infections were superficial in 126 patients, deep incisional in 48 patients, and organ/site in 26 patients. Most of patients (n = 651) had clean-contaminated sites. In subgroup analysis, SSI rates with triclosan-coated PDS were lower in clean, clean-contaminated, and contaminated incisions (0 in the TG versus 24.2% in the CG; p = 0.009; 13.6% in the TG versus 24.3% in the CG, p = 0.001; and 16.6% in the TG versus 27.8% in the CG; p < 0.0001, respectively). Conclusions: Closure of the fascia with triclosan-coated PDS decreased SSI rates as much as 24%. Also, SSIs were decreased significantly at clean, clean-contaminated, and contaminated sites. Therefore, triclosan-coated PDS might be recommended for fascial closure as a means of decreasing SSIs.

The effect of the textile industry dye bath additive EDTMPA on colour removal characteristics by ozone oxidation

In this study, the effects of the phosphonic acid based sequestering agent EDTMPA used in the textile dye baths on colour and organic matter removal by ozone oxidation was experimentally investigated. Procion Navy HEXL dyestuff that has been commonly used for the reactive dyeing of cellulose fibers was selected as the model component. The organic matter oxidation by ozone was determined to obey the pseudo-first order kinetics as they are treated singly or in combination. COD removal rates obtained from pseudo-first order reaction kinetics showed that oxidation of Navy HEXL alone (0.0947 L/min) was faster than that of EDTMPA (0.0171 L/min) and EDTMPA with dye (0.0155 L/min) at pH 3.0. It was also found that reaction rates of single EDTMPA removal and EDTMPA and dye mixture removal increased as the reaction pH was increased from 3.0 to 10.5.

Advanced treatment by chemical oxidation of pulp and paper effluent from a plant manufacturing hardboard from waste paper

This study attempts to evaluate the applicability of chemical oxidation processes to polish biologically treated effluent of a plant manufacturing hardboard from waste paper to comply with the discharge limit of 120 mg l(-1) chemical oxygen demand (COD). In the first step, a chemically assisted settling was applied. The optimum results were obtained with alum plus lime with the alum dose of 200 mg l(-1). In the second step, chemically assisted settling effluent was fed into an activated sludge system and over 80% COD removal was achieved. In the last step of the experimental study, a series of ozone oxidation and Fenton oxidation methods were tested to remove residual COD. Ozone oxidation provided 80% COD removal. An ozone dose of 40 mg min(-1) with a reaction time of two hours was found to be optimum. Catalytic ozonation by using ferric iron, as well as high pH ozonation, Fenton process and H2O2/O3 oxidation did not prove to be more efficient than plain ozonation under these study conditions.

Factors affecting colour removal from reactive dye bath by ozonation

A reactive dye bath sample containing a mixture of dyes was ozonated and colour removal was obtained in a relatively short time of 30 min at 605 mgl-1 of ozone utilisation. The factors affecting ozonation were assessed by comparing the results of dye bath and synthetic samples. Results from dye bath and synthetic dye solution ozonation were found to be significantly different. NaCl and Na2CO3 were determined to have a slight effect only on the initial rate of ozonation. However, the effect of the chelating agent in terms of both time and ozone dose was significant and explained the differences between the results of the dye bath and dye solution ozonation.

Gastric cancer diagnosis and staging in coronavirus disease 2019 (Covid-19) pandemic

AIM

The aim of the study was to analyze whether COVID-19 cause a delay in the diagnosis of gastric cancer patients particularly in the TNM staging of the tumor, or not.

MATERIAL AND METHODS

This retrospective single-center study included the patients diagnosed with gastric cancer from March, 2019 to December 2020. The patients were divided into two groups: baseline and the pandemic groups. The following parameters were compared between the groups; demographic data, numbers of newly diagnosed patients, type of the surgery, location of the tumor, frequency of neoadjuvant treatment, ASA score, length of hospital stay, clinical staging and pathologic TNM staging.

RESULTS

The mean monthly number of newly diagnosed gastric cancer patients showed a significant decline from 7.5 to 5.6 (p< .001). There were no statistically significant differences between the groups with regard to the demographic factors, except CA 19-9 levels. Patients in the pandemic group had higher both clinical and pathological T-stages (p < 0.05).

CONCLUSIONS

Our study showed a decline in the number of the newly diagnosed patients with gastric cancer during the pandemic and also more patients presented with advanced stage during the pandemic period. This study showed that the pandemic causes a potential delay in the diagnosis of gastric cancer patients.

KEY WORDS

Cancer surgery, COVID-19, Gastric cancer, Gastric surgery SARS-COV-2, Pandemic.

Assessment of source-based nitrogen removal alternatives in leather tanning industry wastewater

Nitrogen is an important parameter of leather tanning wastewaters. Magnesium ammonium phosphate (MAP) precipitation is a chemical treatment alternative for ammonia removal. In this study, a detailed source-based wastewater characterisation of a bovine leather tannery was made and nitrogen speciation as well as other basic pollutant parameter values was evaluated. This evaluation has led to definition of alternatives for source-based MAP treatment. MAP precipitation experiments conducted on these alternatives have yielded over 90% ammonia removal at pH 9.5 and using stoichiometric doses. Among the alternatives tested liming-deliming and bating-washing was found to be the most advantageous providing 71% ammonia removal.

Nitrogen removal from tannery wastewater by protein recovery

Nitrogen removal from wastewaters has gained importance in recent years. In this paper protein precipitation and recovery potential of leather tanning industry wastewaters were experimentally evaluated. A protein profile for all sources was prepared. Liming was determined to be the most important protein source. Composite samples were made up to assess the protein precipitation applications. Isoelectric pH precipitation yielded around 50% protein removal between the optimum pH interval of 2.1-3.8. FeCl3 proved to be a very effective means of protein removal providing over 60% efficiency. Polyelectrolyte precipitation did not yield satisfactory results. Magnesium ammonium phosphate precipitation followed by acid precipitation of protein provided 85% ammonia removal in addition to 50% protein removal.

Treatment Options and the Management of Complications in Hydatid Cysts of the Liver in Endemic Regions

BACKGROUND

Hydatid cyst of the liver induced by Echinococcus granulosus is a pervasive zoonotic disease in our region. Its incidence varies across age groups, contingent on community lifespans and hygiene standards. Therapeutic modalities include Puncture, Aspiration, Injection, Re-aspiration (PAIR), and surgery. Due the limited feasability of PAIR, we suggest that surgery represents the optimal treatment in all stages, especially in endemic regions, depending on patient-specific variables.

METHOD

Patients with hydatid cyst of the liver treated with PAIR and surgery in our center between January 2016 and January 2022 were analyzed retrospectively. PAIR or cystectomy were applied in treatment. These were then compared in terms of efficacy, feasibility, and complications.

RESULTS

A single hydatid cyst of the liver was detected in 184 of the 225 cases, two cysts in 33, and three or more cysts in eight. The largest cyst diameter was 233 × 124 mm in the surgery group and 100 × 90 mm in the PAIR group. One hundred thirty-three of the 225 patients underwent open surgery, and no recurrence was encountered in these. However, recurrence was observed 19 patients treated with PAIR. Allergic reaction developed in one case during surgery, postoperative abscess in two cases, biliary fistula in five, and pneumonia in one.

CONCLUSION

Surgical treatment should represent the standard procedure since it is safe and effective, ensures complete elimination of the parasite, involves no intraoperative shedding, preserves healthy tissues, and minimizes the risk of long-term recurrence and cavity-related complications.

Cronkhite-Canada Syndrome Presenting with life-threatening protein-losing enteropathy: a case report

Background: Cronkhite Canada Syndrome (CCS) is a rare gastrointestinal polyposis syndrome. The diagnosis of CCS is made by clinical, endoscopic and histopathological findings. Chronic diarrhea, malnutrition, alopecia, skin hyperpigmentation, onychodystrophy, hypogeusia, protein loss due to chronic inflammatory changes in the intestinal mucosa are common findings.Nutritional support, high protein diet, antibiotics, correction of electrolyte imbalance, and corticosteroids are frequently used in CCS treatment. Aim of the study: Here we present a newly diagnosed Cronkhite Canada Syndrome patient who has suffered life-threatening protein loss. Material and methods: Medical documentation was used. Case report: A 62-year-old male patient presented with bloodless diarrhea, happening 8-10 times a day for 4 months, and general condition disorder. On admission, arterial blood pressure was 80/50 mm/hg, pulse was 110 per minute and body temperature was 38.8°C. In laboratory tests, total protein: 38 mg/dl and albumin: 20 g/L.Upper and lower gastrointestinal system (GIS) endoscopy revealed 2-20 mm polyps in the stomach, duodenum, colon, and a small amount in the distal esophagus. Pathological examination of polypectomy materials revealed edematous and inflamed lamina propria consisting of plasma cells, neutrophils and eosinophils.The patient benefited from total parenteral nutrition, high protein dietary supplementation, antibiotic therapy and was followed with upper and lower GIS endoscopy. Conclusions: CCS is a rare disease that can cause life-threatening hypoalbuminemia and requires close follow-up.

CT Angiography Assessment of Dorsal Pancreatic Artery and Intrapancreatic Arcade Anatomy: Impact on Whipple Surgery Outcomes

BACKGROUND/OBJECTIVES

The aim was to investigate the association between variations in the dorsal pancreatic artery (DPA) and intrapancreatic arcade anatomy with Whipple procedure outcomes and postoperative complications.

METHODS

This retrospective study was conducted with 362 patients who underwent a Whipple procedure at the Department of Gastroenterological Surgery of Adana City Training and Research Hospital between January 2018 and April 2024. All data collected from medical records were compared and statistically analyzed according to the patients' survival status and arcade subtypes.

RESULTS

After excluding cases that did not meet the study criteria, a total of 284 patients were included in the study. DPA was visualized in 55.98% (159/284) of patients, while the intrapancreatic arcade was observed in 25% (71/284). The most common origin of the DPA was the splenic artery in 69.2% (n = 110) of patients, followed by the superior mesenteric artery in 17.6% (n = 28). The frequency of intrapancreatic arcade anatomy variations was as follows: type 1: 28.2% (n = 20), type 2: 49.3% (n = 35) and type 3: 22.5% (n = 16). Arcade type 4 anatomy was not detected. Postoperative pancreatic fistula (POPF) complication was found to be statistically significantly higher in patients with type 3 anatomy (p = 0.042). The 90-day mortality and long-term mortality rates did not differ among the groups based on the variations in both DPA and intrapancreatic arcade anatomy types.

CONCLUSIONS

Patients with intrapancreatic arcade type 3 anatomy had a higher risk of POPF complications. Determination of preoperative arcade type by computed tomography (CT) angiography may help to predict the risk of POPF.

The prognostic value of different lymph node classification systems in stage III colorectal cancer patients

AIM

Prognostic significance assessment of different lymph node classification systems in stage III colorectal cancer patients.

MATERIAL AND METHODS

A total of 85 stage III colorectal cancer patients, who had undergone surgery between January 2013 and December 2018, were divided into 3 different groups comprising of lymph node ratios (LNR) and log odds of positive lymph nodes (LODDS) as per the cutoff values of 25 and 75 percentile threshold values. They were accordingly classified as: LNR1 <0.069, LNR2 0.069-0.24, LNR3 >0.24 and LODDS1 <-0.99; -0.99≥ LODDS2 <-0.47; LODDS3 ≥-0.47. Further the LNR was assessed according to the cutoff values proposed by Berger et al. The pN statuses of all patients were also categorized as pN1 and pN2 in line with the AJCC 8th Edition. The Kaplan-Meier test and Cox regression analysis were performed to analyze the relationship among the LNR, LODDS, pN and overall survival.

RESULTS

While 55 patients included in the study had tumors in their colons, the localization of the tumors of 30 patients was the rectum. The means for survival time was 63.3 months +/- 3.6 [95% CI(56.2-70.4)]. When univariate analyses were conducted for the factors affecting 3 and 5-year survival of the patients, it was ascertained that there was a significant relationship only between perineural invasion (PNI) and survival. Accordingly, the 3-year survival of those with PNI was found to be 31.4% in comparison to 56% of those without PNI (p=0.025), while the figure was 5.7% for the 5-year survival of the former group and 22% for the latter (p=0.040). When the relation between the survival time of the patients and the LNR classification conducted according to the staging system developed by Berger et al. was studied, no significant relationship could be found (p>0.05). Similarly, and 0.321 respectively.

CONCLUSION

Although numerous studies have shown that there was a significant relationship between high LNR and increased survival, as opposed to the results of our study, the greatest obstacle before LNR's survival prediction is the absence of a consensus for standard cutoff values.

KEY WORDS

Colorectal cancer, Lymph node classification systems, Lymph node ratio.

Assessment of magnesium ammonium phosphate precipitation for the treatment of leather tanning industry wastewaters

Magnesium ammonium phosphate (MAP) precipitation has a potential for ammonium removal from industrial wastewaters. Application basis of this recent method of treatment has not been fully determined. In this study application of MAP precipitation to leather tanning wastewaters has been experimentally evaluated. Five alternative places of MAP precipitation in leather tanning wastewater treatment scheme tested were; instead of plain settling, after plain settling, after polyelectrolyte added plain settling, within the chemical precipitation and after biological treatment. Among these alternatives MAP application instead of plain settling and within the chemical precipitation were found to be most favourable and efficient by reducing the nitrogen load to the level of nutrient requirement in the biological stage. pH 9.0-9.5 and stoichiometric magnesium and phosphate doses were determined to be optimum conditions for MAP precipitation.