Background: Laparoscopic cholecystectomy has many difficulties which include port Insertion, Dissectionof the Calot’s Triangle , Grasping of the Gallbladder , Wall thickness, Adhesion and extraction of theGallbladder. Aim of the Study: To predict how difficult cholecystectomy will be from assessing the patientpreoperatively which, in turn, help in decreasing the risks on the patients and preventing post-operativecomplications. Patients and Methods: A prospective study conducted in the department of General Surgeryat Al-Ramadi Teaching Hospital for the period of nine months from 15th of May 2018 till the 15th of February2019. It included 60 patients, all of them were undergone laparoscopic cholecystectomy for Gallstone. Patientswith common bile duct calculus, dilated common bile duct, current attack of acute cholecystitis, those withabsolute contraindications to laparoscopic cholecystectomy, The data were collected prospectively to predictthe significance of association with patients’ characteristics. The time of operation was calculated from thefirst port site incision until the last port closure. All the intra operative events were recorded. Conversionsto open cholecystectomy were done by median or subcostal laparotomy according to the surgeon’s decisionand each patient’s condition. Results: In this study, the highest proportion of operations was categorizedas easy (58.3%), 28.3% of operations were considered difficult and 13.3% of them were very difficult. Asignificant association (P < 0.05) between operation difficulty and all of the following characteristics: Aging,obesity, history of previous biliary hospitalization, thickened bladder wall, pericholecystic collection, andlarge stones. Conclusions: The difficult laparoscopic cholecystectomy can be predicted preoperativelybased on number of factors, like: obesity, previous biliary admission, gall bladder wall thickness, ultrasoundfindings (stone size and pericholecystic fluid) and aging process, evaluating of such factors minimize thecomplications of laparoscopic cholecystectomy and conversion to the open procedure.
There is a natural problem raised by the issue of media performance. As a separate activity and express its own capabilities. This problem can be framed in the form of a question: Is media performance merely a reflection of the activity of other sectors of society, especially political and economic, and what links them to other societal sectors of interrelated relations? Is the media limited to mere transfer, or is it an industry with its own mechanisms and rules? The answer may seem somewhat complicated if we handle media with research and study in general, but the issue may be less complicated when it comes to Arab media, because its data may add another setback to the overall Arab setbacks.
Methotrxate (MTX) has become the standard of care and first-line therapy for patients who have RA and consider as a gold standard of treatment for RA. The role of MTX in the treatment of RA has now been well established. The use of MTX treatment of RA inhibits proliferation of the lymphocytes, reduces signs and symptoms this disease, reduces progression damage of the joints and improves quality of life outcome. Progranulin (PGRN) acts a role in autoimmune inflammatory, has important function in several processes including immune response. Present study has conducted to find the effect of MTX drugs as a therapeutic target for RA patients because of its ability to bind with tumor necrosis factor receptor (TNFR), with progranulin, obestatin an
... Show MoreThe Iraqi political and social arena has been characterized, subjectively and objectively, by the weakness of leadership building. This has led to a leadership crisis, which is reflected in the quality of the outcome of the process of rebuilding the state in Iraq. Thus, this building process has lacked the simplest requirements and conditions of success. It has suffered from a major and obvious failure: the situation in Iraq has raised conflict leaders, not constructive leaders, and this confirms the existence of a cultural crisis in the production of conscious, aware leadership compatible with democratic action. The weakness of leadership in Iraq is reflected in a series of ongoing crises that require radical solutions in accordance with l
... Show MoreCorrect grading of apple slices can help ensure quality and improve the marketability of the final product, which can impact the overall development of the apple slice industry post-harvest. The study intends to employ the convolutional neural network (CNN) architectures of ResNet-18 and DenseNet-201 and classical machine learning (ML) classifiers such as Wide Neural Networks (WNN), Naïve Bayes (NB), and two kernels of support vector machines (SVM) to classify apple slices into different hardness classes based on their RGB values. Our research data showed that the DenseNet-201 features classified by the SVM-Cubic kernel had the highest accuracy and lowest standard deviation (SD) among all the methods we tested, at 89.51 % 1.66 %. This
... Show MoreBackground: To evaluate the effect of antierosive agents (10% Nano-Hydroxyapatite (NHA), 10% Casein Phophopeptide-Amorphous Calcium Phosphate (CPP-ACP), and combination of 10% NHA and 10% CPP-ACP) on loss of minerals from enamel surface of permanent teeth treated with antierosive agents when exposed to an acidic beverage and investigate the morphological changes of treated enamel surface after demineralization with cola based beverage under Scanning Electron Microscope (SEM). Materials and Methods: Sixty maxillary first premolars were randomly divided into four groups, 15 teeth for each group. Group I treated with 10% NHA, Group II treated with 10% CPP-ACP, Group III treated with 10% NHA and 10% CPP-ACP, and Group IV did not treat with any
... Show MoreThe research has been talked on specific an important notions concerning with the dimensions of effectiveness of good governance and sustainable development inside all Arab states, So that the scientific article reflected the role of investments in various sections of institutional business by draw attention toward different projects about analyzing the whole political reality according to the standard indications of political and social stability on the regional level and international aspects. Therefore, the study resembled scientific contains and the dimensions of political reform and administrative overhauling within governmental system in order to achieve all raw objectives for sustainable development. All international and
... Show MoreIn the United States, the pharmaceutical industry is actively devising strategies to improve the diversity of clinical trial participants. These efforts stem from a plethora of evidence indicating that various ethnic groups respond differently to a given treatment. Thus, increasing the diversity of trial participants would not only provide more robust and representative trial data but also lead to safer and more effective therapies. Further diversifying trial participants appear straightforward, but it is a complex process requiring feedback from multiple stakeholders such as pharmaceutical sponsors, regulators, community leaders, and research sites. Therefore, the objective of this paper is to describe three viable strategies that can p
... Show MoreComposite steel-concrete sections have a broad benefit through increasing structural strength as well as minimizing the self-loads. All past researches were concerned with pre-installed shear connectors (PRSC) in the manufacturing of composite sections. A new fabrication technique for steel-concrete-steel composite sections were presented in the current study by the post-installation shear connectors (POSC) passed-through an embedded polymerizing vinyl chloride (PVC) pipes. The performance of normal strength concrete prisms with a specified strength of 32 MPa connected to square steel tubes (SST) was investigated. Six specimens were fabricated in both methodologies, PRSC and POSC were experimentally tested by Push-out test. The spac
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