Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Perfect imaging, epsilon-near zero phenomena and waveguiding in the scope of nonlocal effects.

7 pags, 4 figsPlasmons in metals can oscillate on a sub-wavelength length scale and this large-k response constitutes an inherent prerequisite for fascinating effects such as perfect imaging and intriguing wave phenomena associated with the epsilon-near-zero (ENZ) regime. While there is no upper cut-off within the local-response approximation (LRA) of the plasma polarization, nonlocal dynamics suppress response beyond ω/v F, where v F is the Fermi velocity of the electron gas. Nonlocal response has previously been found to pose limitations to field-enhancement phenomena. Accounting for nonlocal hydrodynamic response, we show that perfect imaging is surprisingly only marginally affected by nonlocal properties of a metal slab, even for a deep subwavelength case and an extremely thin film. Similarly, for the ENZ response we find no indications of nonlocal response jeopardizing the basic behaviors anticipated from the LRA. Finally, our study of waveguiding of gap plasmons even shows a positive nonlocal influence on the propagation length. © 2013 Macmillan Publishers Limited. All rights reserved.C. D. acknowledges a FPU fellowship by the Spanish Ministerio de Educación. J. C. gratefully acknowledges financial support from the Danish Council for Independent Research and a Sapere Aude grant (12-134776). The Center for Nanostructured Graphene is sponsored by the Danish National Research Foundation, Project DNRF58

COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?

Background: Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines. Aims: To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for “respiratory diseases” within the current frame of the COVID-19 pandemic as an adjuvant treatment. Method: The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown. Results: A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine. Conclusions: Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches

Micro-CT evaluation of microleakage under orthodontic ceramic brackets bonded with different bonding techniques and adhesives.

AIM: The aim of this study was to evaluate microleakage under orthodontic ceramic brackets bonded with direct and different indirect bonding techniques and adhesives using micro-computed tomography. MATERIALS AND METHODS: A total of 30 human maxillary premolars were randomly separated into five groups with six teeth in each group. In group I, teeth were bonded directly with Transbond XT (3M Unitek). In group II, group III, group IV, and group V, teeth were bonded through an indirect technique with Custom I.Q. (Reliance Orthodontic Products), Sondhi Rapid-Set (3M Unitek), RMbond (RMO), and Transbond IDB (3M Unitek), respectively, following the manufacturer's instructions. Micro-CT system model 1172 of Skyscan (Kontich, Belgium) was used to scan all samples. NRecon (Skyscan) version 1.6, CT-Analyser V.1.11 (Skyscan), and TView (SkyScan, Bvba) software programs were used for microleakage evaluation. Microleakage values between the test groups were assessed using the Kruskal-Wallis test, while the Wilcoxon signed rank test was used for within-group comparisons. The level of significance was set at P < 0.05. RESULTS: According to the Kruskal-Wallis analysis of variance test, there were no significant differences among the tested groups, with regard to volume and percentage (microleakage/region of interest × 100) of microleakage values (P < 0.05). The Wilcoxon signed rank test showed that coronal microleakage volume and percentage values significantly differed for RMbond and Transbond IDB groups. LIMITATIONS: In the study, only ceramic brackets were used and microleakage into mini gaps did not show up on the micro-CT image because 50% silver nitrate solution could not penetrate into mini gaps which are smaller than silver nitrate particles. CONCLUSION: Use of direct and indirect bonding techniques with different adhesives did not significantly affect the amount of microleakage

An Evaluation of Effects Of Platelet‑rich‑fibrin on Postoperative Morbidities after Lower Third Molar Surgery

Objectives: The aim of the present study was to assess whether the use ofplatelet‑rich fibrin (PRF) decreased the pain, swelling, and trismus levels ofpostoperative third molar surgery. Materials and Methods: In a double‑blinded,split‑mouth randomized study, thirty patients (6 male/24 female, mean age20.32 years) with bilateral symmetric impacted third molars were enrolledin this study to receive surgery. The PRF mass was randomly placed in one ofthe extraction sockets, whereas the other socket was left without treatment.The outcome variables were pain, maximum mouth opening (trismus),swelling (edema), and the presence of dry socket which were measured using a10‑point visual analog scale, manual calipers, and 3dMD facial imaging systemwhich was used for the 1st time in the third molar surgery. Results: Statisticalanalyses revealed that there were no significant differences between the controland study groups regarding postoperative pain, swelling, and trismus (P &gt; 0.05).Conclusion: The results of this study suggest that PRF was not observed to havea positive effect on postoperative discomfort, so even though, PRF is presumed tohave positive effects on healing and recovery processes.Keywords: 3dMD, pain, platelet‑rich fibrin, swelling, third molar surgery, trismu