Introduction: Due to the advantages of robotics over conventional laparoscopy, Robotic living donor nephrectomy (RLND) is increasingly being adopted for kidney harvest. This study was undertaken to determine the effects of temporal trends in donor demographics on perioperative outcomes in RLDN. Methods: All living donors who underwent RLDN from March 2000 to March 2013 at the University of Illinois, Chicago, were included in this single-center retrospective study. The patient demographic and clinical characteristics were recorded. The focus of the study was perioperative surgical outcomes in terms of operative time (ORT), warm ischemia time (WIT), estimated blood loss (EBL), length of stay (LOS), complications, and readmission rate. The consecutive LDs (Living donors) were divided chronologically into four different groups corresponding to the four different epochs in time to assess the refinements in the surgical technique on the outcomes of RLDN. The clinical and surgical outcome variables were compared temporally statistically examined, and inferences were drawn. All analysis was carried out using SAS 9.3 (SAS Institute, Cary, North Carolina, USA). Results: A total of 800 consecutive donors underwent robotic-assisted donor nephrectomy. The mean donor age was 36±11.0 years, and there were more females than males. The BMI varied from 17-53kg/m2 with a mean BMI of 29.2± 5.7 Kg/m2, and 62.6% of donors were first-, degree relatives of the recipients. The proportion of left kidneys procured was 95.7%. Arterial anomalies were present in 26.1% of donors, while 2, 3, and 4 arteries were present in 22.4%, 2.3%, and 0.2%, respectively. Venous anomalies were present in 16 patients overall. Most procedures (98.8%) were conducted with robotic assistance. Five cases (0.6%) were converted to an open, while another 4 patients had another concurrent procedure during the robotic nephrectomy, as shown in table 1. From the year 2000-to 2013, a gradual increase in donor age was observed (p=0.01) (Table 2). There were no changes in the male to female ratio and the mean BMI temporally. Donations across all races increased significantly (p=0.03) except Hispanics. Statistically significant increases were noted in ORT (p<0.0001), WIT (p<0.0001), EBL (p<0.0001), and LOS (p<0.00101) between the last and previous eras, as the new surgeons and fellows took over as console surgeons. Although the complication rates significantly decreased from 2000-2013 (p<0.0001), there has been a steady increase in readmission rate over time (p<0.0001), as shown in the table below (Table 2). Conclusions: The results from this study reveal that RLDN is a safe technique that can be used for safe kidney harvest across a different subset of patients with a wide range of BMI. In addition, the method is safe despite new surgeons and fellows being introduced as console surgeons.

Background: With the advent and accessibility of robotics in surgery in general, RAKT(Robotic-assisted kidney transplantation) is increasingly offered to patients with ESRD. However, the overall advantages over conventional kidney transplants are still debatable. Therefore, this meta-analysis was undertaken to assess the difference in the perioperative outcomes of RAKT versus open Kidney transplantation (OKT). Methods: Database search was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to identify studies on the effect of RAKT on surgery duration, kidney failure risk, operative blood loss, length of hospital stay, intraoperative complications, and postoperative complications. The snowball procedure was also used to extract relevant articles from the citations of some included studies. Finally, the Meta-analysis was performed, a random-effects method was applied, and the standard mean difference was used to compute the p-value and I2 value. Results: 10 studies yielding 248 patients in the RAKT group and 750 patients in the OKT group were retained for analysis from 327 articles published between 2014 and 2021 that were generated from the database search and another snowballing. The differences in the functional outcomes were not significant across most studies. Of the intraoperative outcomes, pooled results revealed the warm ischemia time (WIT) (SMD = 0.15 [.03,.33], P= 0.11) and operating time (ORT) (SMD = 0.74[-0.01, 1.48], P=0.05) had no significant difference in the RAKT and OKT. The pooled rewarming time (RT), and total ischemia time (TIT) were, however, significantly higher in the RAKT compared to OKT, SMD=1.17[0.48, 1.85], P=0.0008 and SMD=0.87[0.29, 1.45], P=0.003 respectively, but there was no difference in pooled CIT SMD=0.37[0.13, 0.62], P=0.27. The blood loss, incision length and analgesics requirement were significantly lower in the RAKT condition compared to the OKT group at SMD=-0.56[-0.86,-0.27], P=0.0002, SMD=-4.38[-7.32, -1.43], P=0.004, and SMD=-5.75[-8.83, -2.67], P=0.0003 respectively. There was no significant difference for the evaluated postoperative outcome of drain time, and serum creatinine value, SMD=-0.81[-2.73,1.08], P=0.4, and SMD=0.03[-0.17,0.24],P=0.76 respectively, whereas the length of hospital stay and wound infections was smaller for RAKT SMD=-0.37 [-0.65,0.08], P=0.01, and OR 0.20 [0.06-0.62], P=0.006 respectively as shown in figures 1,2 and 3. Conclusion: RAKT is a safe and feasible alternative to OKT with the advantages of less postoperative pain, a smaller length of incision, fewer wound infections, and a shorter length of hospital stay with equivalent renal graft function and patient outcomes. Many thanks to Alishba for retrieving the data.

Living-donor small bowel transplant has emerged as a modality to transplant patients with short bowel syndrome without prolonged wait time, albeit at the cost of technical challenges associated with vascular anastomosis due to the small size of vessels. Suboptimal perfusion in a transplanted bowel can lead to a devastating outcome, and clinical judgment alone is not completely reliable for assessment of bowel microcirculation. Here, we report a 55-year-old female patient who underwent flow cytometric cross-match positive living-donor bowel transplant from her daughter. Initial suboptimal perfusion prompted a revision of the arterial anastomoses. Despite normal Doppler signals over the mesenteric vessels, the bowel had a variegated appearance. The microcirculation of the bowel wall was subsequently assessed in a realtime fashion by indocyanine green fluorescence angiography, which showed improved perfusion indices with time. Hence, this simple test helped us to avoid another unnecessary exploration and revision of the anastomoses. At present, the patient is thriving on an enteral diet. This case underpins the importance of real-time intraoperative assessment of bowel per fusion and microcirculation in difficult cases. These assessments are needed to help surgeons identify tissues at risk for ischemia and necrosis, thereby allowing for maneuvers to improve intestinal viability.

OBJECTIVES In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood. MATERIALS AND METHODS Insurance claims from Taiwan's National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies. RESULTS Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05). CONCLUSIONS Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.

Wireless sensor network is a self-organizing network that relies on the interconnection between nodes in the network to transmit data. In order to optimize the ability of WSN nodes to propagate and process data and reduce node energy consumption, the optimized routing method of wireless sensor networks based on improved ant colony algorithm is studied. Improved ant colony algorithm for excellent global optimization is used to optimize the minimum hop routing problem in wireless sensor networks. And is verified by simulation experiments.

Mind and Nature are the two most important terms which signify the perfect harmony, balance and beauty in this universe. Though these two terms are contrary to each other. The concept of mind basically believes in the theory of rationalism whereas the concept of nature that affects the concept of mind and it itself signifies the sparkling beauty of the surroundings by the grace of the Almighty. Today’s topic is related to my new research on the concept of mind and nature in the poetry of Chin Ce’s Full Moon. His poetry collection, Full Moon, is indeed full in the sense that it shows the deep relationship that exists between the state of the poet's mind and the state of his natural surroundings. The poet's mind becomes the mind of the nature, or even more, the mind of the cosmos, the mind of the beyond. Ce's poetry is profoundly beautiful and easy to the eye and to the mind. His language is generally not obscure; it possesses a pristine transparency that aligns itself with the poet's need to merge with the larger self.

Arshad Khan Assistant Professor (Guest Faculty) J.N College Madhubani. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History Received: 15 June 2020 Final Accepted: 17 July 2020 Published: August 2020

Rushdie traverses geographical, political and cultural boundaries in the course of his writing only to return to the Indian homeland in The Moor's Last Sigh. In this novel the Indian nation assumes a fundamental thematic focus. The experience of alienation within a third world context is deliberated upon. Rushdie takes a look at the history of India fraught with turbulence in the last century in The Moor's Last Sigh, the deliberation on the nation that that began in Midnight's Children is carried forward in The Moor's Last Sigh. Whereas Midnight's Children ended with the Emergency, The Moor's Last Sigh moves into the crises of the 1980s and 1990s, furthering the political critique. The Moor's Last Sigh locates itself in modern India and draws upon Spanish history, which forms the backdrop and a recurrent motif in the text. The 'Moor' of the title of the novel is historically Sultan Boabdil, the last Arabic-Islamic ruler of Granada, the final bastion of Moorish governance in Spain. The legend goes that when King Boabdil surrendered the city to Ferdinand and Isabella of Spain in 1492, he turned back and released a sigh at the spot that continues to be called `Suspiro del Moro' — the Moor's sigh. It is this sigh that is referred to in the title. Medieval Spain had been a blend of Eastern and Western culture.

Healthcare is a data-driven domain where a large volumes of data are created, accessed, stored, and disseminated daily. In this paper, issues such as security, privacy, data transparency, interoperability, data accessibility, user interface issues in healthcare information management systems are presented. In addition, blockchain technology related studies in healthcare information systems are discussed with the aim to find what issues in healthcare system present research opportunities using blockchains.

Left ventricular end-diastolic pressure (LVEDP) is an easily obtained, physiologically integrative measure of total LV function. LVEDP may be a useful prognostic measure in patients with acute myocardial infarction and utilised to guide medical therapy and assess risk for post myocardial infarction heart failure. To assess the utility of LVEDP as a prognostic measure in patients presenting with acute myocardial infarction. We performed an unrestricted search of electronic databases (1946 to March 2017) using a predefined search strategy. Publications were included if patients had an acute coronary syndrome and LVEDP was measured by cardiac catheterisation and included outcome data specifying major adverse cardiac events. Two reviewers performed independent study selection, data abstraction and quality assessment by using the Cochrane tool for randomised trials and the ROBINS-I tool for non-randomised studies. Our search identified 8637 patients in seven studies. In patients with elevated LVEDP and STEMI, there was a significantly increased risk of 30-day death (three studies, 5372 participants; RR 1.9; 95% CI 1.4–2.7; p < 0.001; I 2 = 35.3%) and heart failure (two studies, 2574 participants; RR 2.9; 95% CI 1.9–4.5; p = < 0.001; I 2 = 0.0%). There was no significant increase in risk of 30 day reinfarction (RR 1.25; 95% CI 0.77–2.1; p = 0.37; I 2 = 41.3%). Elevated LVEDP measured during cardiac catheterisation for acute myocardial infarction appears to be a predictor of heart failure and mortality.

The transplantation of pancreatic islet cells could restore glycaemic control in patients with type 1 diabetes. Microspheres for islet encapsulation have enabled long-term glycaemic control in rodent models of diabetes; however, humans transplanted with equivalent microsphere formulations have experienced only transient islet graft function owing to a vigorous foreign-body response (FBR), to pericapsular fibrotic overgrowth (PFO) and, in upright bipedal species, to the sedimentation of the microspheres within the peritoneal cavity. Here, we report the results of the testing in non-human primate (NHP) models of seven alginate formulations that were efficacious in rodents, including three that led to transient islet graft function in clinical trials. All formulations elicited significant FBR and PFO 1 month post implantation; however, three chemically modified, immune-modulating alginate formulations elicited a reduced FBR. In conjunction with a minimally invasive transplantation technique into the bursa omentalis of NHPs, the most promising chemically modified alginate derivative (Z1-Y15) protected viable and glucose-responsive allogeneic islets for 4 months without the need for immunosuppression. Chemically modified alginate formulations may enable the long-term transplantation of islets for the correction of insulin deficiency.

Colonoscopy is routinely performed as a screening modality for colorectal cancer.Although the well-documented complication of bowel perforation can occur, splenic injuries are exceptionally rare in the literature.We present a 56-year-old female who returned to the hospital 24 hours after her colonoscopy with vomiting and abdominal pain.Clinical picture was consistent with hemoperitoneum.Computed tomography revealed a grade IV splenic rupture with hemoperitoneum.Patient underwent emergency exploratory laparotomy with splenectomy for hemodynamic instability, and recuperated well after surgery.We conclude that though colonoscopy is one of most commonly performed office procedures, practitioners should be wary of this rare and dreaded complication, as massive exsanguination may have fatal consequences if complication is not recognized promptly.

This study investigates manufacturing procedures that affect islet isolation outcomes from donor pancreata standardized by the North American Islet Donor Score (NAIDS). Islet isolations performed at the University of Illinois, Chicago, from pancreata with NAIDS ≥65 were investigated. The research cohort was categorized into two groups based on a postpurification yield either greater than (group A) or less than (group B) 400,000 IEQ. Associations between manufacturing procedures and islet isolation outcomes were analyzed using multivariate logistic or linear regressions. A total of 119 cases were retrieved from 630 islet isolations performed since 2003. Group A is composed of 40 cases with an average postpurified yield of 570,098 IEQ, whereas group B comprised 79 cases with an average yield of 235,987 IEQ. One third of 119 cases were considered successful islet isolations that yielded >400,000 IEQ. The prepurified and postpurified islet product outcome parameters were detailed for future reference. The NAIDS (>80 vs. 65–80) [odds ratio (OR): 2.91, 95% confidence interval (CI): 1.27–6.70], cold ischemic time (≤10 vs. >10 h) (OR: 3.68, 95% CI: 1.61–8.39), and enzyme perfusion method (mechanical vs. manual) (OR: 2.38, 95% CI: 1.01–5.56) were independent determinants for postpurified islet yield ≥400,000 IEQ. The NAIDS (>80, p < 0.001), cold ischemic time (≤10 h, p < 0.05), increased unit of collagenase ( p < 0.01), and pancreatic duct cannulation time (<30 min, p < 0.01) all independently correlated with better islet quantity parameters. Furthermore, cold ischemic time (≤10 h, p < 0.05), liberase MTF ( p < 0.001), increased unit of collagenase ( p < 0.05), duct cannulation time (<30 min, p < 0.05), and mechanical enzyme perfusion ( p < 0.05) were independently associated with better islet morphology score. Analysis of islet manufacturing procedures from the pancreata with standardized quality is essential in identifying technical issues within islet isolation. Adequate processing duration in each step of islet isolation, using liberase MTF, and mechanical enzyme perfusion all affect isolation outcomes.

This book simplifies the use of Tableau software functionality for novice users so that they can create powerful data visualizations easily and quickly. Since it is often very difficult and expensive to provide external training on BI tools, this book aims to equip the reader with the resource they need to do it themselves.JumpstartTableaucovers the basic reporting and analysis functions that most BI users perform in their day-to-day work. These include connecting to a data source, working with dimensions and measures, developing reports and charts, saving workbooks, filtering, swapping, sorting, formatting, grouping, creating hierarchies, forecasting, exporting, distributing, as well developing various chart types. Each exercise in Jumpstart Tableau provides screenshots that cover every step from start to finish. The exercises are based on a comprehensive sample Excel-based data source that Tableau Software (version 9) has provided, which makes it very easy to duplicate the exercises on the real software. In addition, the book: Enables readers to develop reports, queries and visualizations Perform data analysis Execute each function in a step-by-step manner Provides the basic hands-on ability which can enable users to work up to more advanced and complex Tableau functionality Shows how to integrate individual development of content, such as tables/charts and visualizations., onto a dashboard for an effective presentation What You'll Learn How to connect to data sources How to develop reports How to develop visualizations How to perform analysis functions (e.g., filtering, drilldown, sorting, grouping, forecasting, etc.) How to save visualizations in different formats and distribute them How to develop dashboards and their content Who this book is for Novice Tableau users, BI end users, as well as developers and business analysts. Also, students in university courses on dashboards and data visualization as well as BI and data analysis can quickly get up to speed with Tableau tools and use them for implementing the hands-on projects associated with these courses.

Glomus tumor is a rare benign neoplasm that arises from the neuroarterial structure called a glomus body and accounts for 1 % to 2 % of soft tissue tumors in the hand. We present a case of a 36-year-old female who was treated for subungal glomus tumour of thumb.

Now days MPLS technique are being used to improve the performance of IP networks. Data packets can be switched on the basis of destination address. Different features like traffic engineering (TE), QoS, and VPNs. TE is a key feature of MPLS. This feature plays a vital role in minimizing the congestion by efficient load balancing. This paper is comparative study between the conventional IP and MPLS in terms of delay variation, delay, page response time, throughput and packet drops.

Emergency aortic surgery can be a daunting task in patients with functioning kidney and pancreas allografts because it poses the risk of allograft loss due to prolonged warm ischemia created by aortic cross-clamping. We present a case in which dual allografts, both originating from the right iliac arterial system, were protected from warm ischemia during aortic cross-clamping by creation of a temporary renofemoral shunt between the native left renal artery and right femoral artery. This simple technique maintained pulsatile allograft perfusion during aortic reconstruction for treatment of a ruptured mycotic aortic aneurysm complicated by an aortocolonic fistula.