BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved outcome.Little information exists on how the introduction of a novel ...BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved outcome.Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation.AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system.METHODS A novel TKA system was introduced at our institution on 30th November 2015.Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons(25 TKAs/surgeon)were identified as the Introduction Group.Moreover,the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group.A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period.Demographics,surgery-related factors and alignment data were recorded,and intergroup differences compared.RESULTS Following introduction of the novel implant,Persona TKA was utilized in 69%(71%),53%(54%),and 45%(75%)of primary TKA procedures by the three surgeons,respectively(Follow-up Group).Mean surgery time was increased by 28%(P<0.0001)and mean intra-operative blood loss by 25%(P=0.002)in the Introduction Group,while only the mean surgery time was increased in the Follow-up Group by 18%(P<0.0001).Overall alignment was similar between the groups apart from femoral flexion(FF)and tibial slope(TS).The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group.CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction.These differences diminished one year after introduction of the new implant.Fewer outliers with respect to FF and TS were seen when using the novel TKA implant.Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.展开更多
In this work, the reflection of the education of women from the social problems in the early republic era when the novel genre was developed will be examined. In the study, in specific early republic era which covers ...In this work, the reflection of the education of women from the social problems in the early republic era when the novel genre was developed will be examined. In the study, in specific early republic era which covers the years 1923-1938, the theme of the education of women in Turkish novel, in general, the reflections of the look into the education of women by the Republic Era Turkey on literature of the era have been studied. The attitude in the novels which criticizes the educational institutes through the educational issues also shows similarities with the look of republic ideology into education. While the mentioned educational institutes of early republic are being systemized, the negative sides of existing educational institutes have been examined. The problems such as the duality in education, the education of the girls, modern, and neighborhood school＇s education together have been studied as subheadings. The goal of the study is to determine the insufficiency of the educational institutes which has become a social problem in Turkish novel with respect to the term novels. Within this respect, while the introduction part describes the conditions of the era on education, the part which constitutes the basic of the work, the education problem in the novels dealing with the education of women has been expressed with novel heroes.展开更多
Endoscopic submucosal dissection(ESD) has allowed the achievement of histologically curative en bloc resection of gastrointestinal neoplasms regardless of size,permitting the resection of previously non-resectable tum...Endoscopic submucosal dissection(ESD) has allowed the achievement of histologically curative en bloc resection of gastrointestinal neoplasms regardless of size,permitting the resection of previously non-resectable tumors.The ESD technique for treatment of early gastric cancer has spread rapidly in Japan and a few other Asian countries due to its excellent eradication rate compared to endoscopic mucosal resection.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation) have limited their use worldwide.We developed the grasping type scissor forceps(GSF) to resolve such ESD-related problems.Our animal and preliminary clinical studies showed that ESD using GSF is a safe(no intraoperative complication) and technically efficient(curative en bloc resection rate 92%) method for dissection of early gastrointestinal tumors.The use of GSF is a promising option for performing ESD on early stage GI tract tumors both safely and effectively.展开更多
Through the implementation of national bowel cancer screening programmes we have seen a three-fold increase in early pT1 colorectal cancers, but how these lesions should be managed is currently unclear. Local excision...Through the implementation of national bowel cancer screening programmes we have seen a three-fold increase in early pT1 colorectal cancers, but how these lesions should be managed is currently unclear. Local excision can be an attractive option, especially for fragile patients with multiple comorbidities, but it is only safe from an oncological point of view in the absence of lymph node metastasis. Patient risk stratification through careful analysis of histopathological features in local excision or polypectomy specimens should be performed according to national guidelines to avoid under-or over-treatment. Currently national guidelines vary in their recommendations as to which factors should be routinely reported and there is no established multivariate risk stratification model to determine which patients should be offered major resectional surgery.Conventional histopathological parameters such as tumour grading or lymphovascular invasion have been shown to be predictive of lymph node metastasis in a number of studies but the inter-and intra-observer variation in reporting is high. Newer parameters including tumour budding and poorly differentiated clusters have been shown to have great potential, but again some improvement in the inter-observer variation is required. With the implementation of digital pathology into clinical practice, quantitative parameters like depth/area of submucosal invasion and proportion of stroma can be routinely assessed. In this review we present the various histopathological risk factors for predicting systemic spread in pT1 colorectal cancer and introduce potential novel quantitative variables and multivariable risk models that could be used to better define the optimal treatment of this increasingly common disease.展开更多
文摘BACKGROUND New implants for total knee arthroplasty(TKA)are continuously introduced with the proposed benefit of increased performance and improved outcome.Little information exists on how the introduction of a novel arthroplasty implant affects the perioperative and surgical outcome immediately after implementation.AIM To investigate how surgery-related factors and implant positioning were affected by the introduction of a novel TKA system.METHODS A novel TKA system was introduced at our institution on 30th November 2015.Seventy-five TKAs performed with the Persona TKA immediately following its introduction by 3 different surgeons(25 TKAs/surgeon)were identified as the Introduction Group.Moreover,the latest 25 TKAs performed by each surgeon prior to introduction of the Persona TKA were identified as the Control Group.A Follow-up Group of 25 TKAs/surgeon was identified starting 1-year after the end of the introduction period.Demographics,surgery-related factors and alignment data were recorded,and intergroup differences compared.RESULTS Following introduction of the novel implant,Persona TKA was utilized in 69%(71%),53%(54%),and 45%(75%)of primary TKA procedures by the three surgeons,respectively(Follow-up Group).Mean surgery time was increased by 28%(P<0.0001)and mean intra-operative blood loss by 25%(P=0.002)in the Introduction Group,while only the mean surgery time was increased in the Follow-up Group by 18%(P<0.0001).Overall alignment was similar between the groups apart from femoral flexion(FF)and tibial slope(TS).The number of FF outliers was reduced in the Introduction Group with a more pronounced decrease in the Follow-up Group.CONCLUSION Introduction of the new TKA implant increased surgical time and intraoperative blood loss immediately after its introduction.These differences diminished one year after introduction of the new implant.Fewer outliers with respect to FF and TS were seen when using the novel TKA implant.Further studies are needed to investigate if these differences persist over time and correlate with patient reported outcomes.
文摘In this work, the reflection of the education of women from the social problems in the early republic era when the novel genre was developed will be examined. In the study, in specific early republic era which covers the years 1923-1938, the theme of the education of women in Turkish novel, in general, the reflections of the look into the education of women by the Republic Era Turkey on literature of the era have been studied. The attitude in the novels which criticizes the educational institutes through the educational issues also shows similarities with the look of republic ideology into education. While the mentioned educational institutes of early republic are being systemized, the negative sides of existing educational institutes have been examined. The problems such as the duality in education, the education of the girls, modern, and neighborhood school＇s education together have been studied as subheadings. The goal of the study is to determine the insufficiency of the educational institutes which has become a social problem in Turkish novel with respect to the term novels. Within this respect, while the introduction part describes the conditions of the era on education, the part which constitutes the basic of the work, the education problem in the novels dealing with the education of women has been expressed with novel heroes.
文摘Endoscopic submucosal dissection(ESD) has allowed the achievement of histologically curative en bloc resection of gastrointestinal neoplasms regardless of size,permitting the resection of previously non-resectable tumors.The ESD technique for treatment of early gastric cancer has spread rapidly in Japan and a few other Asian countries due to its excellent eradication rate compared to endoscopic mucosal resection.Although numerous electrosurgical knives have been developed for ESD,technical difficulties and high complication rates(bleeding and perforation) have limited their use worldwide.We developed the grasping type scissor forceps(GSF) to resolve such ESD-related problems.Our animal and preliminary clinical studies showed that ESD using GSF is a safe(no intraoperative complication) and technically efficient(curative en bloc resection rate 92%) method for dissection of early gastrointestinal tumors.The use of GSF is a promising option for performing ESD on early stage GI tract tumors both safely and effectively.
基金Supported by Yorkshire Cancer Researchthe National Institute for Health Research+1 种基金the Pelican Cancer Foundationthe Pathological Society of Great Britain and Ireland
文摘Through the implementation of national bowel cancer screening programmes we have seen a three-fold increase in early pT1 colorectal cancers, but how these lesions should be managed is currently unclear. Local excision can be an attractive option, especially for fragile patients with multiple comorbidities, but it is only safe from an oncological point of view in the absence of lymph node metastasis. Patient risk stratification through careful analysis of histopathological features in local excision or polypectomy specimens should be performed according to national guidelines to avoid under-or over-treatment. Currently national guidelines vary in their recommendations as to which factors should be routinely reported and there is no established multivariate risk stratification model to determine which patients should be offered major resectional surgery.Conventional histopathological parameters such as tumour grading or lymphovascular invasion have been shown to be predictive of lymph node metastasis in a number of studies but the inter-and intra-observer variation in reporting is high. Newer parameters including tumour budding and poorly differentiated clusters have been shown to have great potential, but again some improvement in the inter-observer variation is required. With the implementation of digital pathology into clinical practice, quantitative parameters like depth/area of submucosal invasion and proportion of stroma can be routinely assessed. In this review we present the various histopathological risk factors for predicting systemic spread in pT1 colorectal cancer and introduce potential novel quantitative variables and multivariable risk models that could be used to better define the optimal treatment of this increasingly common disease.
