Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

Double differential cross sections of proton emission in neutron induced reaction on 27Al

Double differential sections for proton emission on aluminium are presented for 40 MeV incident neutron energies. Angular distributions, energy differential and total production cross sections are obtained. The results are compared to existing data and to nuclear model calculations which include preequilibrium and compound decay mechanisms. The EMPIRE code treats these mechanisms in the framework of TUL model for multistep direct and NVWY model for multistep compound. The Hauser Feshbach theory is used to calculate emission from the compound nucleus, with a full conservation of spin and parity

Semi-empirical systematics of (n,α\alpha) cross sections for 14.5 MeV neutrons

A new semi-empirical formula with six parameters has been derived to systematise the (n,α) cross section data of 14.5 MeV neutrons. It is based on the evaporation model and uses the Droplet model of Myers and Swiatecki to express the Q(n,α). The behaviour of the different terms of the Droplet Model involved in Q(n,α) was checked individually before choosing the pertinent terms and setting up the formula. This relation leads to the lowest value of χ2 compared with the existing formulas, when used to correlate the experimental σ(n,α) data for 120 nuclei with 39⩽A⩽209

Double differential cross sections of proton emission in neutron induced reaction on 27

Double differential sections for proton emission on aluminium are presented for 40 MeV incident neutron energies. Angular distributions, energy differential and total production cross sections are obtained. The results are compared to existing data and to nuclear model calculations which include preequilibrium and compound decay mechanisms. The EMPIRE code treats these mechanisms in the framework of TUL model for multistep direct and NVWY model for multistep compound. The Hauser Feshbach theory is used to calculate emission from the compound nucleus, with a full conservation of spin and parity

Systematics studies of the production cross sections of (n,tritium) reaction via 14.5 MeV neutrons

A new semi-empirical formula with five parameters has been derived to systematize the (n,t) cross section data of 14.5 MeV neutrons. It is based on the evaporation model and uses the droplet model of Myers and Swiatecki to express the Q(n,t). The behavior of the different terms of the droplet model involved in Q(n,t) was checked individually before choosing the pertinent terms and setting up the formula. This relation leads to the lowest value of $\chi^2$ compared with the existing formulae, when used to correlate the experimental $\sigma$ (n,t) data for 25 nuclei

Semi-empirical systematics of (n,t) cross-sections for 14.5 MeV neutrons

A new semi-empirical formula with five parameters has been derived to systematize the (n,t) cross-section data of 14.5 MeV neutrons. It is based on the evaporation model and uses the droplet model of Myers and Swiatecki to express the Q(n,t). The behavior of the different terms of the droplet model involved in Q(n,t) was checked individually before choosing the pertinent terms and setting up the formula. This relation leads to the lowest value of χ2 compared with the existing formulae, when used to correlate the experimental σ(n,t) data for 25 nuclei

Diabetic Foot Management: How Could a Procedural Pathway Improve the Surgical Outcome?

Introduction: Diabetic foot ulcer is the main aetiology for non-traumatic amputation, which is a major public health care concern. A multidisciplinary approach in the management of this pathology has been shown to improve the surgical outcome. However, there are little data available on the tools we can use to pursue this multidisciplinary approach. The main goal of this cross-sectional study was to find out whether the implementation of a specific management pathway could improve the treatment outcome in the treatment of diabetic foot. Materials and Methods: From 2012 to 2014, we consecutively recruited patients with diabetic foot referred to Orthopaedic surgery department of our university for surgical opinion. A specific diabetic foot pathway was introduced in 2013. One group of patients who were treated with previous method were evaluated retrospectively. Another group of patients who were treated after implementation of the pathway were evaluated prospectively. We compared treatment outcome between the two groups. Results: We included 51 patients. Amputation rate was similar both the groups: 74% in the retrospective group not using the new pathway versus 73% in a prospective group that used the new pathway. Revision surgery was 39% in the retrospective group and 14% in the prospective group (p=0.05). Conclusion: We recommend the use of this simple and costeffective pathway to guide the interdisciplinary management of diabetic foot. A prospective study with more subjects would provide a better overview of this management pathway

A gene for monilethrix is closely linked to the type II keratin gene cluster at 12q13

Monilethrix is an uncommon hereditary disorder of hair and nail which produces hair fragility and a variable alopecia. Many of the dystrophic hairs have a unique beaded morphology. Ultrastructural changes suggest a defect in the microfilament structure of the cortex of the hair shaft,and hence the cysteine-rich trichocyte keratins are candidate genes. Here, in two families with autosomal dominant monilethrix, we have excluded linkage to the type I keratin gene cluster on chromosome 17q, but show that the disorder is closely linked to the type II keratin cluster on 12q, where genes for basic trichocyte keratins are found. The combined maximum lod score for D12S96 was 12.27 at theta=0.0. This is the first mapping of a primary human hair disorder and the first evidence implicating a defect of the word 'hard' keratins of hair and nail disease