Long-term cost-effectiveness of insertion of a biological mesh during stoma-site closure: 5–8-year follow-up of the ROCSS randomized controlled trial

BackgroundThe original ROCSS trial demonstrated a significant reduction in clinically detectable incisional hernias at 2 years in patients receiving prophylactic biological mesh during stoma closure. ROCSS-Ex was designed to investigate the 5–8-year cost-effectiveness of mesh in the surviving cohort using an abdominal wall–specific quality of life score.MethodsEligible participants from original UK centres were identified. The primary outcome (abdominal wall–specific quality of life) was measured using the HerQLes score and EQ-5D-5L. Assessors remained blind to patients’ original allocation, even if the patient was aware of their treatment.ResultsOf the original 790 patients, 598 were available for long-term follow-up. HerQLes scores were available for 396 patients (no mesh: 191, mesh: 205). There was no difference in primary outcome between the two groups (mean difference of 1.48, 95% c.i. (−2.35, 5.32), P = 0.45) and no cost benefit of routine insertion of prophylactic biological mesh across the entire cohort in the long term. However, patients who received mesh experienced significantly fewer stoma site complications within the first 3 years after reversal and needed fewer surgical reinterventions (32 versus 54 for the no mesh group; incidence rate ratio of 0.55, 95% c.i. (0.31, 0.97), P = 0.04).ConclusionsROCSS-Ex has shown equivocal outcomes for prophylactic mesh insertion versus standard repair on abdominal wall–specific quality of life 5–8 years after surgery. As most reinterventions occurred within the first 3 years post-surgery, there may be a role for prophylactic mesh in a subset of patients who would be most adversely affected by repeated surgery early on.Trial RegistrationISRCTN25584182 (http://www.clinicaltrials.gov)

IS THERE AN ASSOCIATION OF HEAVY DRINKING WITH ACUTE ILLNESS AMONG COLLEGE STUDENTS IF SMOKING STATUS IS CONTROLLED?

Other RESEARCH PAPERS on student drinking, smoking and drug use can be found at: https://scholarworks.iu.edu/dspace/handle/2022/17130/browse?type=title; https://scholarworks.iu.edu/dspace/handle/2022/17127/browse?type=title and https://scholarworks.iu.edu/dspace/handle/2022/17124/browse?type=title. Further information about the questionnaire, calculations used for the study, and the original data base can be found in the following item records within IUScholarworks repository. Details about the reliability and validity of the SAQ are found at: http://hdl.handle.net/2022/17182; http://hdl.handle.net/2022/17154; http://hdl.handle.net/2022/17181. The classic 1975 copy of the SAQ is found at http://hdl.handle.net/2022/17153. ALL QUESTIONNAIRES developed by Engs are found in the repository at: https://scholarworks.iu.edu/dspace/handle/2022/17141/browse?type=dateissuedA publication related to this presentation is found at http://hdl.handle.net/2022/17422 and a presentation for a later project is found at http://hdl.handle.net/2022/18611BACKGROUND: Smoking has been shown to be associated with a higher incidence of chronic diseases among older adults and acute illnesses among young adults. Heavy alcohol intake has been found to be associated with a higher incidence of chronic and acute diseases among older alcoholics PURPOSE: the purpose of the study was to determine if there was an association of acute illness and alcohol intake among a sample of college students if smoking is controlled. METHODS: The Health and Lifestyle Questionnaire was administered to a sample of 1,281 students in the 1991-1992 academic year to personal health classes at a large mid-western university. The questionnaire contains items concerning drinking, smoking, drug use, and lifestyle questions such as exercise, diet, etc. along with acute illnesses such as upper respiratory infections, gastro-intestinal and STDs. RESULTS: Although there was an association between smoking and drinking levels, there was no significant effect from smoking in terms of acute health problems. In addition, no increase in acute health issues or upper respiratory infections were found with students who consumed between one and 21 drinks per week. However, students drinking 28 or more alcoholic drinks per week had significantly more health problems; those drinking more than 22 drinks per week had more upper respiratory infections compared to the other students including nondrinkers. CONCLUSIONS: It was concluded that excessive alcohol intake alone increased the risk of respiratory infections and acute illnesses in this sample of college students, but more moderate alcohol consumption had little effect on the risk for these health problems

In-vitro Evaluation of Fungicide Sensitivity of Tomato Leaf Blight Pathogens

Tomato early and late blight diseases caused by Alternaria solani and Phytophthora infestans respectively, are constraints to tomato production globally. Conventional use of commercial synthetic fungicides in management of tomato blight disease has become a key input for tomato production among farmers in Tharaka Nithi County, Kenya. Indiscriminate use and application of sub-lethal doses of fungicides negate disease management efforts, and may lead to gradual fungicide resistance.  Yet, local tomato farmers have continued to use the fungicides without periodic evaluation of their effectiveness. This study was carried out in-vitro to evaluate the efficacy of six synthetic commercial fungicides used by farmers around River Ruguti, against two tomato leaf blight pathogens; Alternaria solani and Phytophthora infestans. The poison food method was used to evaluate fungicides known by trade names and application levels;  Mancozeb (640 g kg-1) + Metalaxyl (40 g kg-1), Mancozeb 640 g/kg + Metalaxyl 80 g/kg, Mancozeb, Propineb700 g/kg + Cymoxanil 60 g/kg, Carbendazim and Triticonazole at different concentration (25%, 50% and 75%). The in-vitro plate experiment was laid out in a Complete Randomized Design with 3 replicates, and data on mycelia growth inhibition analyzed through General Linear Model (α=.05) and significant means separated using Least significant difference (LSD) using Scientific Analysis System version 9.4. All the tested fungicides significantly (p≤ 0.05) inhibited mycelial growth of tested pathogen.  Percentage inhibition for early blight pathogen (Alternaria solani) was 80.42% compared to late blight pathogen Phytophthora infestans at 69.51%. Mancozeb   (640 g kg-1) + Metalaxyl (40 g kg-1) and Propineb700 g/kg + Cymoxanil 60 g/kg recorded higher per cent inhibition of mycelia growth of 92.4% and 89.71% respectively. Carbendazim recorded lower per cent inhibition of 39.15%.  Mycelia growth inhibition increased with an increase in fungicide concentration. Lower inhibition of 71.78% was observed at 25% concentration as compared to 50% and 75% with 76.77% and 76.36% respectively. Fungicides screened varied in mycelia inhibition against P. infestans and A. solani isolates with Mancozeb   (640 g kg-1) + Metalaxyl (40 g kg-1) and Propineb700g/kg +Cymoxanil 60g/kg giving significantly (p≤ 0.05) better inhibition while Carbendazim had the lowest inhibition effect. Increased fungicide concentration effectively inhibited mycelia growth. Thus higher concentration of fungicide application is recommended in cases where there is low efficacy of fungicides

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study.

OBJECTIVE To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. METHODS An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. RESULTS The impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. CONCLUSION Centres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries

Pharmacology of recombinant γ-aminobutyric acidA receptors rendered diazepam-insensitive by point-mutated α-subunits

AbstractAmino acids in the α- and γ-subunits contribute to the benzodiazepine binding site of GABAA-receptors. We show that the mutation of a conserved histidine residue in the N-terminal extracellular segment (α1H101R, α2H101R, α3H126R, and α5H105R) results not only in diazepam-insensitivity of the respective αxβ2,3γ2-receptors but also in an increased potentiation of the GABA-induced currents by the partial agonist bretazenil. Furthermore, Ro 15-4513, an inverse agonist at wild-type receptors, acts as an agonist at all mutant receptors. This conserved molecular switch can be exploited to identify the pharmacological significance of specific GABAA-receptor subtypes in vivo

Role of arginase 2 in systemic metabolic activity and adipose tissue fatty acid metabolism in diet-induced obese mice

Visceral adipose tissue (VAT) inflammation and metabolic dysregulation are key components of obesity-induced metabolic disease. Upregulated arginase, a ureahydrolase enzyme with two isoforms (A1-cytosolic and A2-mitochondrial), is implicated in pathologies associated with obesity and diabetes. This study examined A2 involvement in obesity-associated metabolic and vascular disorders. WT and globally deleted A2(−/−) or A1(+/−) mice were fed either a high fat/high sucrose (HFHS) diet or normal diet (ND) for 16 weeks. Increases in body and VAT weight of HFHS-fed WT mice were abrogated in A2−/−, but not A1+/−, mice. Additionally, A2−/− HFHS-fed mice exhibited higher energy expenditure, lower blood glucose, and insulin levels compared to WT HFHS mice. VAT and adipocytes from WT HFHS fed mice showed greater A2 expression and adipocyte size and reduced expression of PGC-1α, PPAR-γ, and adiponectin. A2 deletion blunted these effects, increased levels of active AMPK-α, and upregulated genes involved in fatty acid metabolism. A2 deletion prevented HFHS-induced VAT collagen deposition and inflammation, which are involved in adipocyte metabolic dysfunction. Endothelium-dependent vasorelaxation, impaired by HFHS diet, was significantly preserved in A2−/− mice, but more prominently maintained in A1+/− mice. In summary, A2 is critically involved in HFHS-induced VAT inflammation and metabolic dysfunction