Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Proximal congenital esophageal stenosis associated with tracheo-esophageal fistula

Congenital esophageal stenosis (ces) and Tracheo-esophageal fistula are rare types of congenital anomalies who have its origin in the embryological development of the trachea and the esophagus at the sixth and seventh weeks of gestation. These anomalies are often not diagnosed until months or sometimes years after birth. In this article we present you an unusual type of proximal CES combined with TEF at the same level of stenosis that was diagnosed in 5th day of life

Evaluating the Effect of Formal Techniques in Industry

Abstract. In this paper we evaluate the effectiveness of applying a formal component-based approach called Analytical Software Design (ASD) to the development of control software of an industrial project at Philips Healthcare. We analyze the performance of the ASD related tasks carried out during the development processes and report about the main issues encountered. Furthermore, we investigate whether introducing these formal techniques to industry could actually improve the quality and the productivity of the developed code compared to software developed by more traditional development methods.

Incorporating Formal Techniques into Industrial Practice: an Experience Report

Contains fulltext : 111357.pdf (preprint version ) (Open Access

Modulation of wettability, gradient and adhesion on self-assembled monolayer by counterion exchange and pH

In this study, two quaternary ammonium salts derived from L-lipoic acid were applied for self-assembled monolayers formation on rough structured gold surface. The derivatives differ in functionality since one possesses simple quaternary ammonium group whereas the other one is carboxybetaine ester containing quaternary ammonium group with pH hydrolysable ester group as a pendant. The response of surface wettability to ion exchange between Cl− and perfluorooctanoate, kinetics and gradient wettability were examined by water contact angle measurement and confirmed by X-ray photoelectron spectroscopy. Furthermore, adhesion forces related to applied counterion on the entire surface and after hydrolysis were investigated by atomic force microscopy measurement at nanometer scales. A dramatic change in wettability upon counterion exchange from superhydrophilic for Cl− to very or superhydrophobic for perfluorooctanoate in a repeatable manner was observed for both derivatives. Kinetics of counterion exchanges revealed faster hydration of simple quaternary derivate. The wettability gradient could be designed from superhydrophobic to superhydrophilic either in a reversible manner by simple immersion of the modified surface in a counterion solution modulated by ionic strength or in an irreversible manner for carboxybetaine ester derivate by time-controlled hydrolysis to charge balanced carboxybetaine. © 2017 Elsevier Inc.QUUG-CAM-2017-1, QU, Qatar UniversityQatar University [QUUG-CAM-2017-1]; NPRP grant from the Qatar National Research Fund (Qatar Foundation) [NPRP-6-381-1-078, NPRP-9-219-2-105

Experiences with incorporating formal techniques into industrial practice

Item does not contain fulltex

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago /

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann’s procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann’s procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment’s choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception