Wound Infection After Excision and Primary Midline Closure for Pilonidal Disease: Risk Factor Analysis to Improve Patient Selection

Background: Excision and primary midline closure for pilonidal disease (PD) is a simple procedure; however, it is frequently complicated by infection and prolonged healing. The aim of this study was to analyze risk factors for surgical site infection (SSI) in this context. Methods: All consecutive patients undergoing excision and primary closure for PD from January 2002 through October 2008 were retrospectively assessed. The end points were SSI, as defined by the Center for Disease Control, and time to healing. Univariable and multivariable risk factor analyses were performed. Results: One hundred thirty-one patients were included [97 men (74%), median age=24 (range 15-66) years]. SSI occurred in 41 (31%) patients. Median time to healing was 20days (range 12-76) in patients without SSI and 62days (range 20-176) in patients with SSI (P<0.0001). In univariable and multivariable analyses, smoking [OR=2.6 (95% CI 1.02, 6.8), P=0.046] and lack of antibiotic prophylaxis [OR=5.6 (95% CI 2.5, 14.3), P=0.001] were significant predictors for SSI. Adjusted for SSI, age over 25 was a significant predictor of prolonged healing. Conclusion: This study suggests that the rate of SSI after excision and primary closure of PD is higher in smokers and could be reduced by antibiotic prophylaxis. SSI significantly prolongs healing time, particularly in patients over 25year

Cotton Oil and Sunflower Oil Fuel Mixtures

Air pollution is made up of many kind of gases, droplets and particles that reduce the quality of the air. Particles include dust, dirt, soot, smoke and liquid droplets. Some of these particles are large enough to be seen as soot or smoke, while others are so small that can be detected individually with a microscope. Some particles are emitted directly into the air from a variety of sources that are either natural or related to human activity. Those related to human activity include motor vehicle emissions, industrial processes such as electricity generation, incinerators and stone crushing. At this paper will be compared the emissions of pollutants when are used as a fuel the mixtures of diesel-cotton oil and diesel- sunflower oil in a Diesel four-stroke engine. Specifically, the mixtures that have been used are the following: diesel-10% cotton oil, diesel-20% cotton oil, diesel-30% cotton oil, diesel-40% cotton oil, diesel-50% cotton oil, diesel- 10% sunflower oil, diesel- 20% sunflower oil, diesel- 30% sunflower oil, diesel- 40% sunflower oil, diesel- 50% sunflower oil. For those mixtures, it has been measured the emissions of Carbon monoxide (CO), hydrocarbons (HC) and Nitrogen monoxide (NO) and also the fuel consumption. Key words: Gas emissions; Cotton oil; Sunflower oil; CO-HC-NO-smoke emissions; Biofuel

Our local experience with the surgical treatment of ampullary cancer

BACKGROUND: The aim of this study is to report the outcome after surgical treatment of 32 patients with ampullary cancers from 1990 to 1999. METHODS: Twenty-one of them underwent pancreaticoduodenectomy and 9 local excision of the ampullary lesion. The remaining 2 patients underwent palliative surgery. RESULTS: When the final histological diagnosis was compared with the preoperative histological finding on biopsy, accurate diagnosis was preoperatively established in 24 patients. The hospital morbidity was 18.8% as 9 complications occurred in 6 patients. Following local excision of the ampullary cancer, the survival rate at 3 and 5 years was 77.7% and 33.3% respectively. Among the patients that underwent Whipple's procedure, the 3-year survival rate was 76.2% and the 5-year survival rate 62%. CONCLUSION: In this series, local resection was a safe option in patients with significant co-morbidity or small ampullary tumors less than 2 cm in size, and was associated with satisfactory long-term survival rates

Pathogenic and low-frequency variants in children with central precocious puberty

Background: Central precocious puberty (CPP) due to premature activation of GnRH secretion results in early epiphyseal fusion and to a significant compromise in the achieved final adult height. Currently, few genetic determinants of children with CPP have been described. In this translational study, rare sequence variants in MKRN3, DLK1, KISS1, and KISS1R genes were investigated in patients with CPP. Methods: Fifty-four index girls and two index boys with CPP were first tested by Sanger sequencing for the MKRN3 gene. All children found negative (n = 44) for the MKRN3 gene were further investigated by whole exome sequencing (WES). In the latter analysis, the status of variants in genes known to be related with pubertal timing was compared with an in-house Cypriot control cohort (n = 43). The identified rare variants were initially examined by in silico computational algorithms and confirmed by Sanger sequencing. Additionally, a genetic network for the MKRN3 gene, mimicking a holistic regulatory depiction of the crosstalk between MKRN3 and other genes was designed. Results: Three previously described pathogenic MKRN3 variants located in the coding region of the gene were identified in 12 index girls with CPP. The most prevalent pathogenic MKRN3 variant p.Gly312Asp was exclusively found among the Cypriot CPP cohort, indicating a founder effect phenomenon. Seven other CPP girls harbored rare likely pathogenic upstream variants in the MKRN3. Among the 44 CPP patients submitted to WES, nine rare DLK1 variants were identified in 11 girls, two rare KISS1 variants in six girls, and two rare MAGEL2 variants in five girls. Interestingly, the frequent variant rs10407968 (p.Gly8Ter) of the KISS1R gene appeared to be less frequent in the cohort of patients with CPP. Conclusion: The results of the present study confirm the importance of the MKRN3-imprinted gene in genetics of CPP and its key role in pubertal timing. Overall, the results of the present study have emphasized the importance of an approach that aligns genetics and clinical aspects, which is necessary for the management and treatment of CPP

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Advances in the Treatment of Fecal Incontinence

Fecal incontinence (FI) is a distressing condition affecting a great number of patients. Itsetiology is often multifactorial and cannot always be determined despite anorectal physi-ology testing or anal sphincter imaging. Severity scores combined with quality-of-lifescores are useful to evaluate and compare treatment outcomes. Medical treatment toregulate bowel transit is helpful but other medications, such as topical perianal agents orantidepressants, have failed to demonstrate any efficacy. Biofeedback is widely used evenif its superiority over simple conservative treatment is not apparent in systematic reviews.A variety of injectable sphincter bulking agents have been proposed with modest results.The major advance in the treatment of FI is the advent of sacral nerve stimulation (sacralneuromodulation) supported by a growing body of solid evidence for short and midtermefficacy. Indications for sacral nerve stimulation are expanding continuously and in manycenters include patients with sphincter defects. This has raised a debate around the placeof sphincterplasty in the treatment of FI especially as long term follow-up studies showsignificantly declining success rates after 5-10 years. More complex reconstructive proce-dures, such as dynamic graciloplasty and artificial bowel sphincters are still valid optionsfor severe FI with non-negligible morbidity but good outcomes in expert centers andmotivated patients. This paper reviews the current status of the above-mentioned and othertreatment options for FI

Biofuels combustion tests: correlation between gas emissions and exhaust gas temperature

This work refers to the correlation of exhaust gas temperature and rounds/min with the gas emissions (CO, HC, NOx, SMOKE) of the four-stroke diesel engine, using multilayer perceptrons (MLP) networks. The multilayer perceptron network relates with high precision, the temperature of exhaust gases and the rounds/min of engine, with the gas emissions. The importance of this work is that when measuring the exhaust gases temperature and the rounds/min of engine forecast with very high precision their gas emissions. The comparison of results became using measurements from the real function of engine mixing biofuels with conventional fuels.Η παρούσα διατριβή μελετά την συσχέτιση της θερμοκρασίας των καυσαερίων και των στροφών ανά λεπτό (RPM) με τους αέριους ρύπους (CO, HC, NOx, αιθάλη) που εκπέμπονται από μηχανές εσωτερικής καύσης (ΜΕΚ) χρησιμοποιώντας τεχνητά νευρωνικά δίκτυα Multilayer Perceptrons (MLP). Τα δίκτυα MLP «εκπαιδευόμενα» με κατάλληλο αριθμό μετρήσεων από πειραματική διάταξη εμφάνισαν μεγάλη συσχέτιση (r) μεταξύ των παραμέτρων εισόδου (θερμοκρασία καυσαερίων και RPM) με τις παραμέτρους εξόδου (αέριοι ρύποι). Η σπουδαιότητα της εργασίας αυτής έγκειται στο ότι μετρώντας τις δύο αυτές παραμέτρους (θερμοκρασία καυσαερίων και RPM) μπορούμε να προβλέψουμε με σχετικά μεγάλη ακρίβεια τις εκπομπές των αέριων ρυπών μιας Μ.Ε.Κ.. Για την σύγκριση των αποτελεσμάτων χρησιμοποιήθηκαν βιοκαύσιμα (ηλιέλαιο, βαμβακέλαιο, πυρηνέλαιο, σογιέλαιο, αραβοσιτέλαιο, χρησιμοποιημένα φυτικά έλαια μαγειρικής χρήσης) σε ποσοστιαία ανάμιξη με συμβατικά καύσιμα

Examining the relationship between income inequality, taxation and economic freedom: a panel cointegration approach

Income inequality has become an important challenge for both developed and developing countries. Taxation and economic freedom are considered as important factors affecting income inequality. This paper aims at the empirical investigation of the causal relationships between income inequality, taxation and economic freedom by applying panel cointegration techniques and Pooled Mean Group (PMG) estimation method on a panel of 58 countries, over the period 1995–2016. The empirical evidence supports a bidirectional long-run causal effect between taxes-to-GDP ratio and income inequality with tax-to-GDP ratio to cause negative impacton income inequality and thus revealing the redistributive role of taxes. Furthermore, we find a positive effect of theeconomic freedom on income inequality, suggesting a trade-off between economic freedom and income equality