Coulomb and nuclear effects in breakup and reaction cross sections

We use a three-body Continuum Discretized Coupled Channel (CDCC) model to investigate Coulomb and nuclear effects in breakup and reaction cross sections. The breakup of the projectile is simulated by a finite number of square integrable wave functions. First we show that the scattering matrices can be split in a nuclear term, and in a Coulomb term. This decomposition is based on the Lippmann-Schwinger equation, and requires the scattering wave functions. We present two different methods to separate both effects. Then, we apply this separation to breakup and reaction cross sections of 7Li + 208Pb. For breakup, we investigate various aspects, such as the role of the alpha + t continuum, the angular-momentum distribution, and the balance between Coulomb and nuclear effects. We show that there is a large ambiguity in defining the 'Coulomb' and 'nuclear' breakup cross sections, since both techniques, although providing the same total breakup cross sections, strongly differ for the individual components. We suggest a third method which could be efficiently used to address convergence problems at large angular momentum. For reaction cross sections, interference effects are smaller, and the nuclear contribution is dominant above the Coulomb barrier. We also draw attention on different definitions of the reaction cross section which exist in the literature, and which may induce small, but significant, differences in the numerical values.Comment: 12 pages, 11 figure

La adquisición de islas de patogenicidad favorece la emergencia y potencial de virulencia de Escherichia coli productor de Shiga toxina (STEC) LEE-negativo

STEC causa diarrea, disentería y síndrome hemolítico urémico (SHU). La Shiga toxina es el principal factor de virulenciade STEC, pero la capacidad de la bacteria para adherirse y colonizar el intestino humano es fundamental para causarenfermedad. La Isla de Patogenicidad (PAI) Locus of Enterocyte Effacement (LEE) contiene genes que median elfenotipo de adhesión de un grupo de cepas STEC (LEE-positivo) que son clínicamente relevantes debido a su asociacióncon SHU. No obstante, cepas STEC que carecen de LEE (LEE-negativo) también han sido aisladas de casos de SHU,indicando que factores de virulencia adicionales están involucrados en la patogenicidad de estas bacterias. De hecho,tres PAIs, denominadas como ?Locus of Proteolysis Activity?, ?Subtilase-Encoding Pathogenicity Island? y el ?Locus ofAdhesion and Autoaggregation? (LAA), han sido reportadas como exclusivamente presentes en STEC LEE-negativo. Sinembargo, se desconocen los mecanismos de patogénesis mediados por estas PAIs. Recientemente, la incidencia degastroenteritis causada por cepas STEC LEE-negativo ha aumentado en varios países. Por lo tanto, en este estudioinvestigamos la base genética para su emergencia y realizamos un análisis de genómica comparativa utilizando 367genomas de cepas STEC LEE-negativo aisladas a nivel mundial. Como resultado, identificamos tres nuevos elementosgenéticos, incluyendo dos PAIs y un Elemento Integrativo y Conjugativo. Además, encontramos que LAA fue la PAI másfrecuente, sugiriendo que juega un papel importante en la biología de STEC. En consecuencia, LAA fue eliminada delcromosoma de la cepa STEC E045 mediante reemplazo alélico. Posteriormente, se realizaron ensayos in vitro e in vivopara determinar si la deleción de LAA afecta la capacidad de adhesión, colonización y virulencia de la cepa E045. Sepresenta evidencia en apoyo a la participación de LAA en la colonización intestinal de un modelo murino de infecciónpor STEC. Finalmente, análisis filogenéticos indicaron que clados en los que se agrupan cepas con dos o más PAIs estángeográficamente más diseminados en comparación con clados filogenéticamente cercanos en los que se agrupan cepasque carecen o contienen una sola PAI. Este estudio es un paso adelante en el conocimiento de la evolución y virulenciade STEC.Fil: Montero, David A.. Universidad de Chile. Facultad de Medicina; ChileFil: Del Canto, Felipe. Universidad de Chile. Facultad de Medicina; ChileFil: Salazar, Juan C.. Universidad de Chile. Facultad de Medicina; ChileFil: Velasco, Juliana. Universidad de Chile. Facultad de Medicina; ChileFil: Colello, Rocío. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; ArgentinaFil: Padola, Nora Lía. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tandil. Centro de Investigación Veterinaria de Tandil. Universidad Nacional del Centro de la Provincia de Buenos Aires. Centro de Investigación Veterinaria de Tandil. Provincia de Buenos Aires. Gobernación. Comision de Investigaciones Científicas. Centro de Investigación Veterinaria de Tandil; ArgentinaFil: Oñate, Angel. Universidad de Chile. Facultad de Medicina; ChileFil: Puente, José L.. Universidad Nacional Autónoma de México. Instituto de Biotecnología; MéxicoFil: Vidal, Roberto. Universidad de Chile. Facultad de Medicina; ChileXXIV Congreso Latinoamericano de Microbiología; XL Congreso Chileno de Microbiología; II Reunión Anual de la Asociación Chilena de Inmunología y IX Reunión de la Sociedad Latinoamericana de Tuberculosis y otras MicobacteriosisSantiago de ChileChileAsociación Latinoamericana de Microbiologí

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone