Post-Operative Functional Outcomes in Early Age Onset Rectal Cancer

Background: Impairment of bowel, urogenital and fertility-related function in patients treated for rectal cancer is common. While the rate of rectal cancer in the young (<50 years) is rising, there is little data on functional outcomes in this group. Methods: The REACCT international collaborative database was reviewed and data on eligible patients analysed. Inclusion criteria comprised patients with a histologically confirmed rectal cancer, <50 years of age at time of diagnosis and with documented follow-up including functional outcomes. Results: A total of 1428 (n=1428) patients met the eligibility criteria and were included in the final analysis. Metastatic disease was present at diagnosis in 13%. Of these, 40% received neoadjuvant therapy and 50% adjuvant chemotherapy. The incidence of post-operative major morbidity was 10%. A defunctioning stoma was placed for 621 patients (43%); 534 of these proceeded to elective restoration of bowel continuity. The median follow-up time was 42 months. Of this cohort, a total of 415 (29%) reported persistent impairment of functional outcomes, the most frequent of which was bowel dysfunction (16%), followed by bladder dysfunction (7%), sexual dysfunction (4.5%) and infertility (1%). Conclusion: A substantial proportion of patients with early-onset rectal cancer who undergo surgery report persistent impairment of functional status. Patients should be involved in the discussion regarding their treatment options and potential impact on quality of life. Functional outcomes should be routinely recorded as part of follow up alongside oncological parameters

Timing of surgery following SARS-CoV-2 infection:an international prospective cohort study

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. From 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odd ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odd ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.</p

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Two-Staged Technology for CoCr Stent Production by SLM

Additive manufacturing of porous materials with a specific macrostructure and tunable mechanical properties is a state-of-the-art area of material science. Additive technologies are widely used in industry due to numerous advantages, including automation, reproducibility, and freedom of design. Selective laser melting (SLM) is one of the advanced techniques among 3D fabrication methods. It is widely used to produce various medical implants and devices including stents. It should be noticed that there is a lack of information on its application in stent production. The paper presents the technological aspects of CoCr stent SLM fabrication, including design of stents and development of regimes for their manufacturing. Physical, chemical, and technological properties of CoCr powder were initially determined. Parametric design of mesh stent models was adopted. A two-stage approach was developed to ensure dimensional accuracy and quality of stents. The first stage involves a development of the single-track fusion process. The second stage includes the stent manufacturing according to determined technological regimes. The single-track fusion process was simulated to assign laser synthesis parameters for stent fabrication. Melting bath temperature and laser regimes providing such conditions were determined. Twenty-seven SLM manufacturing regimes were realized. Dependence of single-tracks width and height on the laser power, exposition time, and point distance was revealed. The qualitative characteristics of tracks imitating the geometry of the stent struts as well as favorable and unfavorable fusion regimes were determined. The results of surface roughness regulating of the stents&rsquo; structural elements by various methods were analyzed. Thus, this two-staged approach can be considered as a fundamental approach for CoCr stent SLM fabrication

CFD-researches of centrifugal compressor stage vane diffusers

Abstract The paper presents result of CFD simulations of a series of centrifugal compressor stage vane diffusers in the Ansys CFX. Objects of research are vane diffusers with external relative diameter (relative to the diameter of the impeller) equal to 1.5, vane inlet angle of 20 degrees, relative vane heights of 0.025, 0.034, 0.045, 0.06, 0.08, vane profile curvature angles of 10, 15, 20 degrees. The characteristics of polytrophic efficiency, loss coefficient, recovery coefficient, ratio of inlet and outlet velocities, flow deviation angle versus incidence angle are set. The analysis of the flow structure in the vane diffuser channels is presented. Unlike with a straight vane cascade, the deviation angle in the circular rows of vane diffusers tends to increase with increasing row density. This may be due to the complex nature of the interaction of the active part of the flow with separation zones. In rows with almost straight vanes at a lower density, the separation zone on the pressure side decreases, and even shifts to the very end of the suction side.</jats:p

QUANTUM CHEMICAL MODELING OF THERMALLY INDUCED STRUCTURAL TRANSFORMATIONS OF VANADIUM OXOCHLORIDE GROUPS ON SILICA SURFACE

A comparative analysis of the structural and chemical transformations of vanadium oxochloride structures obtained by treating the silica surface with VOCl3 vapors was carried out based on quantum chemical modeling and experimental studies. The effect of temperature on the change in the composition and structure of surface vanadium-containing groups is estimated.</jats:p