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Giriş: Yalnızca vücut kitle indeksine dayalı olarak yapılan sağlıkla ilgili yaşam kalitesi çalışmaları, özellikle fazla kilolu bireylerde net sonuçlar vermemektedir. Vücut kitle indeksi ve bel çevresi ölçümlerinin birlikte değerlendirilmesi, bu alanda daha iyi fikir verebilir. Yöntem: SF-36 Yaşam Kalitesi Ölçeği 18 yaş ve üstü 398 kadına uygulandı. Katılımcılar vücut kitle indekslerine göre gruplandırıldı ve fazla kilolu bireyler ayrıca bel çevresi ölçümlerine göre gruplara ayrıldı. Her bir alt ölçeği karşılaştırmak için Kruskal-Wallis One- way ANOVA istatistiksel analizleri kullanılmıştır. Bulgular: Normal ağırlıktan sınıf III obeziteye kadar tüm fiziksel ve mental alt ölçeklerdeki skorlar fazla kilolu grup dışında düşme eğilimindeydi. Normal kilolu bireylerle karşılaştırıldığında, fazla kilolu katılımcıların mental alt ölçeklerindeki skorların arttığı ancak bunun diğer bulgulardan farklı olarak istatistiksel olarak anlamlı olmadığı saptandı. Fazla kilolu grup bel çevresi ölçümlerine göre ayrı ayrı incelendiğinde; risk grupları arasında istatistiksel olarak anlamlı farklılıklar tespit edildi. Mental skorların yüksek riskli grupta normal risk grubuna göre anlamlı olarak azaldığı görüldü. (p, Introduction: Health-related quality of life studies performed only based on body mass index does not provide clear results, especially in overweight individuals. The evaluation of body mass index and waist circumference measurements together can offer better insights in this area. Methods: The SF-36 Quality of Life Scale was applied to 398 women aged 18 years and over. The participants were grouped according to body mass index, and the overweight individuals were further divided into groups based on waist circumference measurements. To compare each sub-scale, the Kruskal-Wallis 1 - way ANOVA statistics were used. Results: From the normal weight to class III obesity, the scores in all physical and mental subscales tended to decline, except in the overweight group. Compared to the individuals with normal weight, the overweight participants’ scores in the mental subscales were increased but this was not statistically significant, unlike the other findings. We examined the overweight group separately according to the waist circumference measurements and detected statistically significant differences between the risk groups. The mental scores were significantly decreased in the high-risk group compared to the normal risk group (p

When light is incident upon a diffraction grating, images of the grating appear at periodic intervals behind the grating. This phenomenon and the associated self-imaging distance were named after Talbot, who first observed them in the nineteenth century. A century later, this effect held new surprises with the discovery of sub-images at regular fractional distances of the Talbot length. In this paper, we show that water waves enable one to observe the Talbot effect in a classroom experiment. Quantitative measurements, of for example the Talbot distances, can be performed with an easy-to-use digital Schlieren method.

Objective: This study aimed to investigate the effects of regulation of nutritional habits on quality of life by applying Short Form (SF-36) Quality of Life Scale. Methods: SF-36 was administered through face-to-face interviews to a total of 129 individuals (112 female, 17 male) aged 18-65 years. Anthropometric measurements, body mass index, and waist circumference measurement were undertaken simultaneously. The changes in weight, body mass index, waist circumference measurement, and SF-36 scores were compared at baseline and three months after modification of dietary habits. Results: At three months after the regulation of dietary habits, a statistically significant decrease was found in weight, body mass index, and waist circumference measurements (p

The aim of this study was to investigate the effect of daily walnut consumption on dyslipidemia in dietary. Within a year, the patients who have been suggested taking walnut or not in their individual dietary were scanned retrospectively and randomized into 2 groups. The first group consists of 72 cases (only those taken on the diet program) and the second group consists of 73 cases (walnut consumption in regulated diet). Baseline blood lipid parameters and anthropometric measurements were assessed in both groups and compared with values at 3rd month. p values

Symptomatic gallbladder disease (SGBD) has a high prevalence in the general population, and early cholecystectomy is considered definitive therapy for patients with symptomatic cholelithiasis [1, 2]. Conservative therapy is recommended for those patients in whom surgery is contraindicated or considered high risk [3–5]. Nonsurgical gallbladder drainage methods include percutaneous and endoscopic drainage techniques [5]. While percutaneous transhepatic gallbladder catheter drainage (PCD) is efficacious, it has risks of puncture-related adverse events and tube dislodgement and results in significant patient discomfort [5, 6]. PCD is usually a temporary step until the patient is fit for surgery, symptoms resolve or drainage can be internalized by endoscopic transpapillary gallbladder stenting (ETGS) which involves placement of an internal transpapillary stent. ETGS has technical and clinical success rates comparable to PCD with the advantage of internal drainage; however, its limitations include the potential for stent migration or occlusion requiring stent exchange, cystic duct or gallbladder perforation, and recurrence of symptomatic biliary disease [5–10]. ETGS has been previously described mainly using rigid, double-pigtail polyethylene plastic stents of diameter 5–7 Fr and length 10–15 cm, with inherent limitations in drainage, flexibility, and patency [5–10]. Johlin pancreatic wedge stents (JS) (Wilson-Cook Medical, Winston-Salem, NC, USA) are made of Sof-Flex material, which is a softer polyurethane and polyethylene blend. They are fenestrated with large, multi-side holes along the length of the stent and are available in 8.5 and 10 Fr diameters and variable lengths up to 22 cm (Fig. 1). JS for ETGS have theoretical advantages over conventional stents, including soft material with conformability to tortuous cystic ducts, the presence of side holes, and large caliber allowing potentially longer patency. We report our initial experience using JS for ETGS.

Contemporary EUS-guided FNA techniques involve the use of a needle, with an air column within the lumen, with or without suction. We describe a novel technique with an aim to improve the quality of the aspirate.To compare a novel "wet suction" technique (WEST) with the conventional FNA technique (CFNAT) of EUS-guided FNA using a 22-gauge FNA needle.Prospective, single-blind, and randomized trial.Two large tertiary-care hospitals.All consecutive adult patients presenting for EUS with possible FNA of solid lesions were offered the chance to participate in the study.All lesions were sampled with the same needle by using alternating techniques. Patients were randomized to the WEST versus the CFNAT for the first pass. If the first pass was made with the WEST, the second pass was made with the CFNAT, and subsequent passes were made in an alternating manner by using the same sequence. All FNAs were performed using 22-gauge needles.Specimen adequacy, cellularity, and blood contamination of EUS-guided FNA aspirates graded on a predefined scale.The WEST yielded significantly higher cellularity in a cell block compared with the CFNAT, with a mean cellularity score of 1.82±0.76 versus 1.45±0.768 (P.0003). The WEST cell block resulted in a significantly better specimen adequacy of 85.5% versus 75.2% (P.035). There was no difference in the amount of blood contamination between the 2 techniques.Lack of cross check and grading by a second cytopathologist.The novel WEST resulted in significantly better cellularity and specimen adequacy in cell blocks of EUS-guided FNA aspirate of solid lesions than the CFNAT.

ObjectivesEndoscopic drainage of complex hilar tumors has generally resulted in poor outcomes. Drainage of >50% of liver volume has been proposed as optimal, but not evaluated using long multifenestrated plastic stents (MFPS) or self-expanding metal stents (SEMS). We evaluated outcomes of endoscopic drainage of malignant hilar strictures using optimal strategy and stents, and determined factors associated with stent patency, survival, and complications.MethodsCross-sectional study was conducted at an academic center over 5 years. MFPS (10 French or 8.5 French) or open-cell SEMS were used for palliation of unresectable malignant hilar strictures, with imaging-targeted drainage of as many sectors as needed to drain >50% of viable liver volume. Risk factors were evaluated using regression analysis. The cumulative risk was assessed using Kaplan-Meier analysis.Results77 patients with malignant hilar biliary strictures (median Bismuth IV) underwent targeted stenting (41 MFPS and 36 SEMS). Comparing MFPS vs. SEMS, technical success (95.1 vs. 97.2%, P=0.64), clinical success (75.6 vs. 83.3%, P=0.40), frequency of multiple stents (23/41 vs. 25/36, P=0.19), survival and adverse events were similar, but stent patency was significantly shorter (P50% of viable liver resulted in effective palliation in patients with complex malignant hilar biliary strictures. Patency was shorter in the MFPS group, but similar survival and complications were found when comparing MFPS and SEMS group.

The paper concentrates on improving the efficiency of the pumping system in which pumps are run by variable speed drives. The method is applicable to system consisting of several centrifugal pumps. Problems arising from running the pumps outside the optimal efficiency region are discussed. Common principles of operation and control of typical boosting pumping station are represented. Methods of regulation of productivity of the system are described. The proposed method is based on prediction of future efficiency of pumps before making adjustments of pumping system productivity. The proposed method is basing on tracking the working point of pump on efficiency graph. Monitoring the location of working point vs. efficiency graph enables to evaluate its current and future distances from the best efficiency point of the pump. Knowing the current number of running pumps it is possible to predict the location of working point after adjustment of productivity of the system. Ability to predict the increase or decrease of efficiency enables to enhance the adjustment of productivity of the system. Methods of graphical analysis of working state of the pumping system are representing topic for future research.

Urgent placement or replacement of pancreatic stents shortly after endoscopic retrograde cholangiopancreatography (ERCP) might attenuate the course of evolving post-ERCP pancreatitis (PEP).Salvage ERCP with de novo pancreatic stent placement or replacement of outwardly migrated stents was performed within 2 - 48 hours in patients with evolving PEP accompanied by severe pain, systemic inflammatory response syndrome (SIRS), and major elevations in serum amylase and lipase. Serial pain scores, amylase and lipase levels, and hospital course were studied.PEP according to Cotton consensus criteria developed after 64 (2 %) of 3216 ERCPs over 3 years. Of the 64 patients with PEP, 14 underwent salvage ERCP (5 without and 9 with prior pancreatic stents, 7 of which had migrated outwards prematurely). All patients had SIRS and a high score (≥ 3) for the bedside index for severity in acute pancreatitis. Median clinical onset of PEP was at 5 hours (range 0 - 68 hours) in patients with prophylactic pancreatic stents vs. 2 hours (range 0.5 - 2.5 hours) in patients without prophylactic pancreatic stents (P 0.05). Salvage ERCP was performed at a median of 10 hours (interquartile range [IQR] 2.4 - 22.7 hours). Improvement in pain, amylase, lipase, and resolution of SIRS were statistically significant at 24 hours after salvage ERCP (P = 0.003). Median length of hospital stay was 2 days (IQR 1 - 4.75). No necrotizing pancreatitis or late complications occurred.Urgent salvage ERCP with de novo pancreatic stent placement or replacement of a migrated stent is a novel approach in the setting of early PEP, and was associated with rapid resolution of clinical pancreatitis and reduction in levels of amylase and lipase.

A novel method is offered to control centrifugal pumping stations with variable speed drives and programmable logical controllers. Using pre-defined tabularized data, efficiency estimates are applied for different number of pumps operated at various speeds. The control strategy is proposed basing on both the analytical performance characteristics and the experimental efficiency distribution diagrams of pumps. An efficiency map has been designed in which the optimal number of pumps is recorded targeting to maintain the system performance in the best efficiency regions. Experimental results validate the new control approach.

A novel head and pressure predictive control approach is offered for the centrifugal multi-pump stations equipped with variable speed drives and programmable logical controllers. The pre-defined tabularized data are used where the efficiency estimates for different number of pumps operated at various speeds are collected. Thanks to accounting the motor drive power losses, maximal system efficiency is obtained as the main outcome without equipment oversizing. The total head and pressure management strategy is proposed basing on both the analytical performance characteristics and the experimental efficiency distribution diagrams of a multi-pump station. Using this efficiency distribution, the efficiency map is proposed where the optimal numbers of pumps are recorded aiming to maintain the system performance in one of the best efficiency regions. An appropriate control algorithm is described. Finally, some experimental results validated the new control methodology are discussed.

Purpose of review To summarize the indications, success rates and complications associated with endoscopic sphincterotomy and endoscopic balloon dilation (EBD). Recent findings Pancreatic and/or biliary sphincterotomies are essential components of most current therapeutic endoscopic retrograde cholangiopancreatography (ERCP). A current large body of evidence has established biliary sphincterotomy as effective in extraction of bile duct stones. The most common complications of biliary sphincterotomy are post-ERCP pancreatitis, as well as acute or delayed hemorrhage, the risks for which can be stratified according to well described patient and procedure related factors. Evidence is accumulating that pancreatic sphincterotomy is useful in at least some settings for treatment of sphincter of Oddi dysfunction, chronic pancreatitis, and pancreas divisum. EBD provides an adjunct or an alternative to biliary sphincterotomy for extraction of stones from the bile duct when routine biliary sphincterotomy is inadequate or risk excessive. Summary Sphincterotomy and EBD are useful in managing a variety of pancreatobiliary conditions. Attention to risks of these procedures is essential for their efficacy and safety.

Transfer pipelines are developed for the supply of feedstock from a furnace to a fractionating tower. A feature of the development is absence of temperature compensators and preliminary loading of pipelines. In order to monitor stresses that may arise in the area of pipeline setting into a K-11 tower, and their movement, a comprehensive diagnostic monitoring system has been developed with the possibility of remote control, inspection and analysis of the monitored parameters.

A method of flow rate control and maintenance for a centrifugal pumping system is proposed. The flow rate control system based on PLC and additional peripheral components including Profibus adapter FPBA-01 and Profibus communication module CM572 DP has been developed and tested. To analyze the system, a series' of experiments was conducted. Experiments show that the designed system is quite flexible, easy to tune, and reliable. Advantages of the system lie in its high reliability of flow regulation and maintenance at both the static and the dynamic modes. The proposed flow rate regulation system can be used either in industry or in household.

Parallel multi-pump single-drive pumping systems are widely used in water processing applications. Comparison of this type of systems to multi-pump multi-drive solutions is discussed. The drawbacks and advantages of both systems are identified. Recommendations on pumping system energy efficiency monitoring techniques which include sensorless estimation are proposed. Problem of trade-off between the energy efficiency and efficiency of pump is proposed for future research.

Adjustment of working state of the pump in order to satisfy the changing demand and hence bringing the system outside of best efficiency region is a reason of occurrence of dimensioning and adjustment losses. This phenomena is more harmful in multi pump applications e.g. parallel pumping. Method to monitor and predict the location of working point using quite common processing equipment is proposed. Adjusting the working state on basis of prediction of working point location was implemented and tested in the laboratory.

A hardware-in-the-loop (HIL) model of a vessel electric propulsion drive is proposed. The mathematical description of the vessel trust forces is explained. As well, the propulsion power and torque estimates are discussed within the broad spectre of their parameter changing. A case study is reported where some concrete parameters are applied in the above mathematical model to assess the particular project with the help of HIL approach. Results of simulation and experimentation prove the correctness of the design and research methodology.

The chapter presents a theoretical framework that deals with the basic question of how networks and industries coevolve. We draw upon the structural and relational perspectives of networks to theorize about changes occurring in interfirm networks over time and the coevolutionary linkage of these changes to the industry life cycle. We further extend the widely accepted industry life cycle model by claiming that industry-specific evolutionary patterns impact the structure of the network’s relations, which in turn lead to diversification in the sources of innovation and to variation in the patterns of industrial evolution.

This paper addresses approaches to improve the power consumption indexes of multi-pump systems. Focus on optimization of productivity, adjustment of the number of running pumps and starting-stopping criteria in multi-pump systems. Method of the productivity adjustment based on the reduction of motors starts-stops is proposed. The method includes prediction of the future state of the system and reduction of the start/stop operations on expense of short time widening of operation limits. Reduction of pumps starts and stops contribute into the stable power quality in the network.

A method of taking characteristics of the pump motor drive using a hardware-in-the-loop simulation approach is described. The models with built-in hardware and software components of real equipment were developed. To study the drives of centrifugal pumps manufactured by ABB, their own control system was used whereas the pumping load has been replaced with the specially designed environment simulators which description was initially unclear. To clarify the model topology and parameters, a double-motor assembly was constructed and applied as universal pump prototype. Real equipment included into the simulation loop allows to decrease a priori uncertainty and to explore the processes that have nether evident characterization. A library of reference and disturbance signals typical for pumping was prepared and used as the models. Hence, the advantages of mathematical and physical simulations were combined with optimal interaction of both approaches.

Speed inaccuracy decreases the pump efficiency, reliability, and energy saving. This research is devoted to the determination of the ways of accurate speed control of the pump drives operated under changeable loads. The impact of speed inaccuracy on the pump performance is studied. Based on the analysis of methods for the static accuracy improvement, the drawbacks of the traditional approaches have been shown with reference to the pumping applications. A new methodology of the slip compensation has been proposed for implementation to improve the scalar drive performance. It notably decreases the speed inaccuracy of the open-ended pumping applications. The enhanced quality of the drive control at different loading conditions has been shown on a laboratory test bench. Also, for the multi-pump systems this approach results in an additional benefit from the viewpoint of the operation around the best operation point providing a safe pump control both to exclude the pump damage and to improve the process quality.

A converter-fed system is proposed which successfully estimates and regulates the operational state of the pumping process without excess sensors. Sensorless control provides such advantages as cost savings resulting from exclusion the need in sensor incorporation in the drive and the driven system; increased reliability due to the absence of additional components, such as sensors, cables, connections that can cause malfunction; and fewer maintenance and data exchange operations. Such benefits are based on adjustable models that can be currently modified and corrected along with the test measurements in the system with known characteristics. Adjustable models describing the driven process could be added to the control scheme of the variable speed drive to exclude additional measurements for control.

Endoscopic retrograde cholangiopancreatography allows intervention for a variety of diseases of the biliary tract. Cannulation of the bile duct is the prerequisite step for biliary intervention. Although obtaining biliary access is straightforward in many cases, it can occasionally be challenging. Multiple devices, all with additional wire-guided techniques, have been developed to aid cannulation. More advanced techniques have also been developed to aid biliary access if it is unsuccessful with standard devices. Multimodality techniques can be used if other approaches fail. This article provides an evidence-based discussion of these approaches, and provides insight into their appropriate application.

Background Ulcerative colitis is classically described as a condition originating in the rectum and extending proximally towards the cecum. In recent years, a discontinuous peri-appendiceal lesion has been described. Our aim was to evaluate the risk of progression to pancolitis in patients presenting with an isolated peri-appendiceal lesion on ileocolonoscopy. Methods Endoscopy databases at three tertiary care centers were searched for patients undergoing ileocolonoscopy for diagnosis or surveillance of ulcerative colitis. Patients with isolated periappendiceal lesions as well as histologically confirmed left sided colitis were enrolled. Controls were defined as patients with left-sided ulcerative colitis without evidence of peri-appendiceal inflammation. The main outcome was the need for escalation of therapy to systemic corticosteroids, immunomodulators or biologic agents. Secondary outcomes were progression to pancolitis or requirement for colectomy. A secondary analysis of other risk factors for proximal extension/progression of colitis was also performed. Results We identified 228 patients with ulcerative colitis, 123 were included in the analysis. Four point eight percent of patients had isolated peri-appendiceal lesions. In the group with peri-appendiceal lesions, 47.4% required escalation of therapy vs. 70% in the control group (P = 0.53). There was no difference in progression to pan-colitis or colectomy rates between the two groups. Progression was not predicted by inflammatory markers, age, gender, initial Mayo UC score or IBD therapy utilization. Conclusions The presence of isolated peri-appendiceal lesions is not a risk factor for future escalation of therapy for ulcerative colitis and is not correlated with proximal extension of disease.

Pancreatic duct stent placement is increasingly performed for the prevention of pancreatitis after endoscopic retrograde cholangiopancreatography (ERCP); however stents can result in injury especially in normal ducts. The clinical significance and outcomes of subsequent endoscopic therapy are unknown. This study was a retrospective review of the management of symptomatic stent-induced pancreatic duct injury following stent placement for prevention of post-ERCP pancreatitis in eight patients with previously normal pancreatic ducts. Subsequent treatment included pancreatic sphincterotomy, balloon dilation of stricture, and placement of multiple 3 - 5-Fr soft polymer pancreatic stents. All patients showed improvement or resolution of pancreatic strictures. Five patients had resolution or substantial improvement of pain, one patient showed a fair response with repeated ERCPs, and two patients failed to respond and underwent total pancreatectomy with islet autotransplantation. Pancreatic duct stent-induced ductal injury with significant clinical consequences can occur with conventional polyethylene stents. Endoscopic therapy is moderately effective but some patients develop irreversible damage. Caution should be used when placing standard polyethylene stents in normal ducts. Further research is required to identify safer materials and configurations of pancreatic stents.

Aim To determine if the addition of preoperative endoscopic ultrasound (EUS) to non-small cell lung cancer staging can reduce the proportion of patients in whom malignant mediastinal lymph nodes (inoperable disease) are discovered at surgery. Methods All patients with lung cancer who underwent mediastinoscopy or thoracotomy for cancer diagnosis, staging, or treatment from 1999 to 2005 were identified. Patients who had undergone preoperative EUS were designated as the EUS group . The control group was composed of similar patients who had not undergone preoperative EUS, and were frequency matched to those in the EUS group in a 3:1 ratio by preoperative cancer stage. The proportion of patients in whom malignant mediastinal lymph nodes were diagnosed at surgery was the primary outcome. Results Forty-four patients (average age, 67.8 years) met criteria for the EUS group, and 132 patients (average age, 67.4 years) were selected as control subjects. Overall, in the EUS group, 3 of 44 patients (6.8%) were found to have malignant mediastinal lymph nodes at surgery, compared with 41 of 132 patients (31.1%) in the control group (p = 0.003). In patients undergoing thoracotomy for cancer resection, 3% in the EUS group, compared with 20% in the control group, were found to have malignant mediastinal lymph nodes at surgery (p = 0.01). There was also a trend toward lower yield of mediastinoscopy done for cancer diagnosis or staging in the EUS group (p = 0.08). Conclusions Preoperative EUS in lung cancer patients may reduce unnecessary surgery at which advanced inoperable disease is discovered.

We report the repair of a giant hiatal hernia by laparoscopic Collis gastroplasty and Nissen fundoplication in a patient with situs inversus totalis, highlighting the unique anatomic challenges in this case. The 52-year old female patient had Kartageners syndrome, a giant hiatal hernia, and a history of chronic severe gastroesophageal reflux disease with uncontrolled regurgitation. The laparoscopic procedure was accomplished with five ports placed in a mirror-image configuration, reversed from our standard positions. After visual confirmation of the complete reversal of the intraabdominal anatomy, we performed a modified Collis gastroplasty and Nissen fundoplication. Significant technical challenges were encountered intraoperatively. To the best of our knowledge, this report is the first of its kind in the literature. The use of advanced laparoscopic techniques is highly adaptable to unusual anatomy. Laparoscopic hiatal hernia surgery is feasible in patients with situs inversus.