Optimization of municipal solid waste collection and transportation routes, through linear programming and geographic information system: a case study from Sanliurfa, Turkey.

Solid waste is one of the important causes of the environmental crisis that negatively impacts human health throughout the world and is fast approaching a disaster level that will pose a direct threat to human life. As with all other environmental problems, the increase in solid waste production that goes hand in hand with growing population and rising consumption has become a focus of great concern. Along with these rising levels, the investment, management and maintenance of solid waste collection and transport vehicles is seeing a continual increase in financial outlay. It is clear from the budgets of local authority solid waste management systems, 65 to 80% of which are accounted for by domestic waste, that the collection and transport of solid waste is a high-cost process and that this expenditure can be significantly reduced by the reorganisation of solid waste collection routing schedules and the minimization of collection frequency. This study demonstrates a linear programming model in order to develop an optimal routing schedule for solid waste collection and transportation, thereby reducing costs to a minimum. The neighbourhood of Veysel Karani in the Haliliye District of Sanliurfa Province, Turkey, was specifically selected for this case study, having the suitable socio-economic and demographic variables to be representative of a metropolitan urban area. Firstly, the data regarding the municipal solid waste collection and transport routes were obtained from the local authority. Analysis and verification of these data were then performed. With the field study, these data were verified on-site, and the missing data were completed. Linear programming and geographic information system (GIS) analysis were used to determine the best route. Consequently, it is concluded that it is possible to save the route by 28% with GIS analysis and 33% with linear programming analysis according to the existing municipal solid waste collection and transportation routes.

Protective effects of hesperetin on lipopolysaccharide-induced acute lung injury in a rat model.

BACKGROUND: In this experimental study, we aimed to investigate the effects of hesperetin, a natural flavonoid, on a lipopolysaccharideinduced acute lung injury model in rats. METHODS: Between March 2019 and May 2019, a total of 18 adult male Wistar albino rats, weighing approximately 250 to 300 g, were randomly divided into three groups as control, lipopolysaccharide, and lipopolysaccharide + hesperetin groups (n=6 in each group). The wet/dry weight ratio of lung tissue was determined. Histopathological changes were examined using light and scanning electron microscopy. Pulmonary nuclear factor-kappa beta, inducible nitric oxide synthase, and alpha-smooth muscle antigen activity were determined with indirect immunohistochemical methods. Pulmonary apoptosis was detected with the terminal deoxynucleotidyl transferase dUTP nick-end labeling method. Tumor necrosis factor-alpha, interleukin-1 beta, interleukin-6, and interleukin-10 concentrations were measured with enzyme-linked immunosorbent assay. RESULTS: Treatment with hesperetin significantly improved the architecture of lung tissue and reduced the wet/dry weight ratio, nuclear factor-kappa beta, inducible nitric oxide synthase, and alphasmooth muscle antigen expression, pulmonary apoptosis, and levels of proinflammatory cytokines. CONCLUSION: Our study results suggest that hesperetin has a potent protective effect against lipopolysaccharide-induced acute lung injury in rats via suppression of the proinflammatory cytokine cascade, nuclear factor-kappa beta, signaling pathway activation, and apoptosis.

Hot electron generation by aluminum oligomers in plasmonic ultraviolet photodetectors.

We report on an integrated plasmonic ultraviolet (UV) photodetector composed of aluminum Fano-resonant heptamer nanoantennas deposited on a Gallium Nitride (GaN) active layer which is grown on a sapphire substrate to generate significant photocurrent via formation of hot electrons by nanoclusters upon the decay of nonequilibrium plasmons. Using the plasmon hybridization theory and finite-difference time-domain (FDTD) method, it is shown that the generation of hot carriers by metallic clusters illuminated by UV beam leads to a large photocurrent. The induced Fano resonance (FR) minimum across the UV spectrum allows for noticeable enhancement in the absorption of optical power yielding a plasmonic UV photodetector with a high responsivity. It is also shown that varying the thickness of the oxide layer (Al2O3) around the nanodisks (tox) in a heptamer assembly adjusted the generated photocurrent and responsivity. The proposed plasmonic structure opens new horizons for designing and fabricating efficient opto-electronics devices with high gain and responsivity.

[Removal of mediastinal foreign body (steel shot) using mediastinoscopy: case report]. / Mediastinoskopi ile çikarilan mediastinal yabanci cisim (saçma çekirdegi): Olgu sunumu.

Morbidity and mortality is high in patients with gunshot wounds to the chest. Only in rare cases do foreign bodies persist in the thorax without significant pathology. At this study, we present a case in which steel shot was removed through the mediastinum using mediastinoscopy due to the risk of tracheal fistula.

Video-assisted thoracoscopic resection for destroyed lung.

Advances in surgical techniques have indicated that video-assisted thoracoscopic pneumonectomy is a safe alternative to open pneumonectomy. However, indications for video-assisted thoracoscopic pneumonectomy are controversial. We describe two patients who underwent left pneumonectomy because of destroyed lungs and speculated about the tight adhesions, enlarged lymph nodes, enlarged bronchial vessels, and access incisions. Two patients were operated by two different approaches mainly; anterior and posterior, because of the degree of contralateral lung herniation. Both of them experienced a safe perioperative period.

Transcaval invasion of right atrium by thymoma: resection via transient cava-pulmonary shunt.

Transcaval extension of the thymoma to the right atrium has very rarely been reported, and cardiopulmonary bypass is recommended for successful resection. An invasive thymoma with intravascular invasion of the superior vena cava, and the left innominate vein extending into the right atrium was presented. Intra-atrial extension was resected through a transient external shunt from the inferior vena cava to the main pulmonary artery. We discussed the feasibility of this surgical technique and possible advantages of cardiopulmonary bypass avoidance.

Neuroendocrine tumors presenting with thyroid gland metastasis: a case series.

INTRODUCTION: Autopsy series have shown that metastasis to the thyroid gland has occurred in up to 24% of patients who have died of cancer. Neuroendocrine tumors may metastasize to thyroid gland. CASE PRESENTATIONS: Case 1 was a 17-year-old Turkish woman who was referred from our Endocrinology Department for a thyroidectomy for treatment of neuroendocrine tumor metastasis. She was treated with a bilateral total thyroidectomy. Histopathological examination results were consistent with a neuroendocrine tumor; neoplastic cells showed strong immunoreactivity to chromogranin A and synaptophysin, but the immunohistochemical profile was inconsistent with medullary thyroid carcinoma in that the tumor was negative for calcitonin, carcinoembryonic antigen, and thyroid transcription factor-1.Case 2 was a 54-year-old Turkish woman who presented with a 3-cm nodule on her right thyroid lobe. She had undergone surgery for a right lung mass four years previously. After a right pneumonectomy, thymectomy and lymph node dissection, a typical carcinoid tumor was diagnosed. Under ultrasonographic guidance, fine needle aspiration biopsy of her right thyroid pole nodule was performed and the biopsy was compatible with a neuroendocrine tumor metastasis. She was treated with a bilateral total thyroidectomy. Histopathological examination indicated three nodular lesions, 5 cm and 0.4 cm in diameter in her right lobe and 0.1 cm in diameter in her left lobe. The tumors were consistent with a neuroendocrine phenotype, showing strong immunoreactivity to chromogranin A and synaptophysin. CONCLUSION: Thyroid nodules detected during follow-up of neuroendocrine tumor patients should be thoroughly investigated. A fine needle aspiration biopsy of the thyroid confirms the diagnosis in most cases and leads to appropriate management of those patients and may prevent unnecessary treatment approaches.

Alternative paratracheal lymph node dissection in left-sided hilar lung cancer patients: comparing the number of lymph nodes dissected to the number of lymph nodes dissected in right-sided mediastinal dissections.

OBJECTIVE: Removing or sampling lymph nodes from the bilateral paratracheal area through a left thoracotomy is not a standard procedure in patients with lung cancer. The aim of this study was to evaluate the feasibility of a technique without ductus arteriosus division and mobilization of the aortic arch and to compare the number of lymph nodes resected in left-sided dissections to the number of lymph nodes removed in right-sided mediastinal dissections that are routinely performed in clinical practice. METHODS: A total of 93 patients with hilar lung cancer were evaluated. A prospective study was conducted on 51 patients with primary left-sided hilar lung cancer, who underwent left thoracotomy and paratracheal lymphadenectomy between January 2008 and January 2010. The number of nodes dissected in these patients was compared with the number of nodes dissected in 42 patients with right-sided hilar lung cancer by right-sided mediastinal dissection within the same period. RESULTS: The mean number of resected nodes in the bilateral paratracheal area via left thoracotomy was 8.4 (2-18 nodes). The distribution from 4R-4L-2L-2R was as follows: 3.3-2.5-0.5-2.1, respectively. Six patients (11.7%) were diagnosed with occult N2, and two (3.9%) of these patients also had N3 disease concomitantly. The number of dissected nodes from the ipsilateral station 2 via right-sided versus left-sided thoracotomy was 1.6 versus 0.5 (p=0.000), whereas the number of dissected nodes from ipsilateral station 4 via right-sided versus left-sided thoracotomy was 3.3 versus 2.5, respectively (p=0.1). The number of dissected nodes from the contralateral station 2 via right-sided versus left-sided thoracotomy was 0.2 versus 2.1 (p=0.000), whereas those numbers from the contralateral station 4 via right-sided versus left-sided thoracotomy were 1.0 versus 3.3, respectively (p=0.000). CONCLUSIONS: Lymphadenectomy of the paratracheal area via left thoracotomy without ductus arteriosus division and mobilization of the aortic arch is technically feasible. From these data, regardless of approach, more lymph nodes are obtained from the right paratracheal space; this appears to be due to the fact that there are more right-sided paratracheal lymph nodes.

Partial resection of the aorta and patch plasty with a simple clamping technique in a lung cancer patient.

A 59-year-old male patient was diagnosed as having lung cancer with a suspected invasion of the descending aorta. A significant response was not obtained after chemotherapy. A left pneumonectomy with partial resection of the aortic wall with simple clamping was done. The postoperative course was uneventful.

Anastomotic stenotic complications after tracheal resections.

BACKGROUND: Treatment of anastomotic stenosis after tracheal resections is not well established. We aimed to share our experience with the management of this condition. METHODS: This is a single-institution, retrospective study of prospectively recorded files of patients who suffered from anastomotic stenosis after tracheal resections. Data were analyzed according to the symptoms, location, length of the stenotic segments, and interventions. RESULTS: Anastomotic "restenosis" developed in 6 of 42 patients who had tracheal resections at our institute; and 6 patients were referred to us after restenosis of the initial resection performed elsewhere. Nine patients were admitted with the symptoms of dyspnea and stridor, 2 patients with surgical tracheostomy applied after unconsciousness, and 1 patient with a Montgomery T Tube (MTT). We treated 8 patients successfully with dilatation and therapeutic bronchoscopy including stent placement and re-resection. Four patients were palliated with MTT. CONCLUSIONS: Although the patient number was too small to draw any conclusions, we would like to stress that the MTT is still an acceptable option when therapeutic bronchoscopy fails and re-resection is technically not possible.

Cervical mediastinoscopy for paratracheal masses in pediatric patients.

A cytological diagnosis is essential for a definitive diagnosis in children who have paratracheal lesions. Thirteen pediatric patients were biopsied using cervical mediastinoscopy. Age, gender, preoperative diagnosis, and postoperative biopsy results and complications were reviewed. Five patients had mediastinal lesions residuing or recurring after chemotherapy for either Hodgkin disease or non-Hodgkin lymphoma. In 2 of these patients, the diagnosis was recurrent disease. Among the 8 patients presenting with a paratracheal mass or enlarged lymph nodes, histopathologic diagnosis showed tuberculosis in 3 children, Hodgkin disease in 2 children, and histiocytosis X and non-Hodgkin lymphoma 1 patient in each. This study shows that cervical mediastinoscopy gave 100% correct diagnosis for mediastinal residual malignancies or uncommon forms of mycobacterium tuberculosis with paratracheal masses.

Learning curve in videothoracoscopic thymectomy: how many operations and in which situations?

OBJECTIVE: Videothoracoscopic learning curve is known to vary among different surgeons, and may be influenced by patients and various situations. We aimed to analyze the learning curve of a surgeon in videothoracoscopic thymic surgery for myasthenia gravis. METHODS: This is a descriptive single-center study using collected clinical data from 90 patients undergoing videothoracoscopic thymic surgery between June 2002 and September 2006. Cumulative summation (CUSUM) model was used to evaluate the learning curve for videothoracoscopic thymectomy operations. Unsuccessful situations were accepted as longer operation time, surgeon-related open conversions, readmissions and postoperative complications. Factors affecting longer operation time (patients with operation time longer than the average) and longer postoperative stay (patients with postoperative hospital stay longer than average) were analyzed. RESULTS: Body mass index (BMI) was the only predictor of longer operation time (23.04+/-2.93 vs 25.61+/-2.70 (p=0.001) independent samples test). The amount of prescribed pyridostigmine was the only factor for longer hospital stay (213.3+/-101.5 mg vs 270. 0+/-122.6 mg (p=0.044) Mann-Whitney U-test). CUSUM analysis demonstrated a learning curve with success rates of 80%, 90% and 98%, respectively in the first 30 patients, the next 31-60 patients and after 60 patients. Median operative time declined with surgeons' experience (p<0.001). CONCLUSIONS: A chest surgeon can have a high success rate in videothoracoscopic thymectomy (98%) after 60 operations.