Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

RESEARCHES OF MICROMORPHOLOGICAL FEATURES OF SEEDS OF TRIFOLIUM L. OF FLORA OF THE SOUTH CAUCASUS (AZERBAIJAN REPUBLIC,TALYSH) ON ELECTRONIC MICROSCOPE (SEM) AND THEIR TAXONOMIC MEANING

In monographs on Trifolium L., in «Atlas of seeds and fruits of the Central and East” as well as in articles published in prestigious journals the importance of seed characteristics in the taxonomy of clovers is pointed. Among the signs of seeds, the shape of the surface, the structure, size, and shape of their hilum are recorded. In addition, in many «Flora» and «Determinants» there is no data of the seeds, especially their micromorphological features in the description of the species of clover. Takinginto account the above, we studied the shape and structure of 8 species of clovers under an electron microscope. For the first time, micromorphological features of seeds of 8 species (T. angustifolium, T. pratense, T. lappaceum, T. subterraneum, T. resupinatum, T. tumens, T. campestre) of clovers (Trifolium L.) of the Talysh flora, collected from the Lankaran-Lerik region of the Azerbaijan Republic, belonging to 4 subgroups and 6 sections were studied on an electron microscope (SEM). The shape of the seeds, their size, color, surface structure, the shape of hilum and their sizes are important taxonomic features. The structure of seeds of the studied species refers to 4 types: seeds with granular surfaces; seeds with tuberculate surfaces; seeds, which have a surface with crystal-like ledges. Features of the structure of seeds can be used, when specifying the status of subgenera; and sections, the remaining morphological features — when determining species of the genus of clover.</jats:p

MICROMORPHOLOGICAL STRUCTURE OF SEEDS IN SOME SPECIES OF LATHYRUS L. IN SOUTH CAUCASUS (AZERBAIJAN)

For the first time, micromorphology structure of seeds in 10 species (L. annuus, L. cicera, L. hirsutus, L. tuberosus, L. miniatus, L. pratensis, L. laxiflorus, L. aphaca, L. nissolia, L. sphaericus) belonging to sections (Lathyrus, Pratensis, Aphaca, Nissolia, Linearicarpus) of Lathyrus L. collected from various regions of Azerbaijan were analysed. Seed samples of 10 species were taken for analysis from different biotopes and different populations located away from one-another. Collected seed materials were gathered in special sterile paper bags and their moisture was dried with silicagel substance in laboratory conditions. During the research, morphological characters, as well as general shape, size and colour of seed, length and width of hilum were identified under Leica EZ4D stereomicroscope. The largest seeds have been measured in Lathyrus (L. cicera 4,4–5,0 mm) section and the smallest seeds in Nissolia (L. nissolia 1,8–2,3 mm) section. The longest hilum belongs to L. miniatus 1,8–2,8 mm and the smallest in L. Nissolia 0,4–0,7 mm. The width hilum was measured in L. annuus (0,7–1,0 mm) and the narrow hilum L. nissolia (0,1–0,3 mm). Mature seed (2–3) samples were selected from each type under the SEM, the seeds were placed on stools with double-sided adhesive tapes and covered with gold powder through the JEOL JFC1600 ion-spray device for 1 to 2 minutes. Seed samples were researched on the side surface. The photos of the surface of seeds were taken in a 3000× size in JEOL JSM6610 lv electronic microscope, and structural analysis of the different places of their surfaces was conducted. The results showed that the microscopic research of the surface of seed is of taxonomic importance and is used in specification of the status of sections. The morphological properties such as surface structure, hilum length and width, papillae features can be used to differentiate some sections and species, but seed size, general shape seed and hilum, seed colour are not characteristics can be used to differentiate some sections.</jats:p

Factors Influence on Electrophysical Parameters of the Composite Varistors

Purpose. Evaluation influence structural state polymer phase on the response voltage and coefficient nonlinearity of a multilayer varistor based on zinc oxide. Methodology. Zinc oxide consisted of 97% zinc oxide and 3% total oxides of Bi2O3, Co3O4, MnO2, B2O3, SbO3, ZrO2, Al2O3. At a temperature of 1573°K, the synthesis of semiconductor ceramics based on Zinc oxide was carried out. For composite of thermoplastic polymers and Zinc oxide, non-polar and polar polymers, high pressure polyethylene and polyvinylidene fluoride were used. The composites were obtained by hot pressing at the melting temperature of the polymer phase and a pressure of 15 MPa. After that, using silver paste, measuring electrodes 10 mm in diameter were applied to the surface of the synthesized samples, and then current–voltage characteristics were measured. Modification of composites under action of gas-discharge plasma was carried out in a special cell that creates a dielectric-gas-composite system. The structure of the composites was studied by X-ray diffraction analysis and IR spectroscopy. Findings. The obtained experimental results show that the size of the particles of the inorganic phase significantly affects the current-voltage characteristics of the composite varistor: at a given thickness of the composite varistor, the operation voltage decreases markedly, and the nonlinearity coefficient increases. Numerous experimental results obtained by us show that the impact of electric discharge plasma on the polymer Zinc oxide-composite leads to a significant change in the permittivity and the concentration of local levels at the interface of the composite. The results research showed that  effect electrical plasma on the opening voltage depends on the polarity of polymer matrices. Moreover, plasma processing itself significantly changes the structure of the polymer phase at composite. Originality. The magnitude of the potential barrier at phase boundary is mainly determined by the volume fraction and size of the main structural element of ZnO ceramics. Changing the structural state of the polymer matrix allows the adjust response voltage and coefficient nonlinearity of volt-ampere characteristic of the multilayer varistor. Practical value. The discovered development of electron-ion processes at polymer phase of the varistor indicates the need to take into account change in its service characteristics from the duration and intensity of use. The result obtained has a certain practical significance, since it indicates not only the reason for the change in properties, but also the need to develop measures to increase the service life of the varistor

Trifolium patens (Fabaceae), a new species to the flora of the Caucasus

The paper reports the first record of Trifolium patens Schreb. (≡ Сhrysaspis patens (Schreb.) Holub) (Fabaceae) for the flora of Caucasus from the territory of Azerbaij an Republic. The plant was collected in 1941 by A. Grossheim, and is stored in the Herbarium BAK. Morphological description of the species and characteristic of its habitat are given.</jats:p