Unified view of magnetic nanoparticle separation under magnetophoresis

The migration process of magnetic nanoparticles and colloids in solution under the influence of magnetic field gradients, which is also known as magnetophoresis, is an essential step in the separation technology used in various biomedical and engineering applications. Many works have demonstrated that in specific situations, separation can be performed easily with the weak magnetic field gradients created by permanent magnets, a process known as low-gradient magnetic separation (LGMS). Due to the level of complexity involved, it is not possible to understand the observed kinetics of LGMS within the classical view of magnetophoresis. Our experimental and theoretical investigations in the last years unravelled the existence of two novel physical effects that speed up the magnetophoresis kinetics and explain the observed feasibility of LGMS. Those two effects are (i) cooperative magnetophoresis (due to the cooperative motion of strongly interacting particles) and (ii) magnetophoresis-induced convection (fluid dynamics instability originating from inhomogeneous magnetic gradients). In this feature article, we present a unified view of magnetophoresis based on the extensive research done on these effects. We present the physical basis of each effect and also propose a classification of magnetophoresis into four distinct regimes. This classification is based on the range of values of two dimensionless quantities, namely, aggregation parameter N∗ and magnetic Grashof number Grm, which include all of the dependency of LGMS on various physical parameters (such as particle properties, thermodynamic parameters, fluid properties, and magnetic field properties). This analysis provides a holistic view of the classification of transport mechanisms in LGMS, which could be particularly useful in the design of magnetic separators for engineering applications

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 < 0⋅001) or low (363 of 860, 42⋅2 percent; OR 0⋅08, 0⋅07 to 0⋅10, P < 0⋅001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference −9⋅4 (95 per cent c.i. −11⋅9 to −6⋅9) per cent; P < 0⋅001), but the relationship was reversed in low-HDI countries (+12⋅1 (+7⋅0 to +17⋅3) per cent; P < 0⋅001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0⋅60, 0⋅50 to 0⋅73; 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

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

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

Buttonhole Cannulation on a Femoro-Femoral Fistula: A Successful Approach in a Patient with Difficult Vascular Access

Highlights Abstract Vascular access is an essential component for a successful hemodialysis program. Cannulation technique is an important factor for dialysis access survival. For patients with exhausted upper limb vascular access, lower extremity permanent dialysis vascular access (LE-PDVA) is one of the alternatives. The buttonhole cannulation (BHC) technique for LE-PDVA has never been reported in literature. Here we report on a 57-year-old end-stage renal failure patient who had suffered multiple complications related to dialysis access and ended up with exhausted upper limb vascular access. The BHC technique was successfully used on his LE-PDVA for hemodialysis. </jats:sec

Unified View of Magnetic Nanoparticle Separation under Magnetophoresis

The migration process of magnetic nanoparticles and colloids in solution under the influence of magnetic field gradients, which is also known as magnetophoresis, is an essential step in the separation technology used in various biomedical and engineering applications. Many works have demonstrated that in specific situations, separation can be performed easily with the weak magnetic field gradients created by permanent magnets, a process known as low-gradient magnetic separation (LGMS). Due to the level of complexity involved, it is not possible to understand the observed kinetics of LGMS within the classical view of magnetophoresis. Our experimental and theoretical investigations in the last years unravelled the existence of two novel physical effects that speed up the magnetophoresis kinetics and explain the observed feasibility of LGMS. Those two effects are (i) cooperative magnetophoresis (due to the cooperative motion of strongly interacting particles) and (ii) magnetophoresis-induced convection (fluid dynamics instability originating from inhomogeneous magnetic gradients). In this feature article, we present a unified view of magnetophoresis based on the extensive research done on these effects. We present the physical basis of each effect and also propose a classification of magnetophoresis into four distinct regimes. This classification is based on the range of values of two dimensionless quantities, namely, aggregation parameter N* and magnetic Grashof number Grm, which include all of the dependency of LGMS on various physical parameters (such as particle properties, thermodynamic parameters, fluid properties, and magnetic field properties). This analysis provides a holistic view of the classification of transport mechanisms in LGMS, which could be particularly useful in the design of magnetic separators for engineering applications.The authors thank Lluis M. Martinez of Sepmag Systems SL for sharing images of magnetic separators and for invaluable discussions during the last few years about magnetic separation. We also thank Fernando Martinez-Pedrero (UB) for sharing images of his samples. J.L.’s work is financially supported by an LRGS grant from the Ministry of Education Malaysia (project number 67215001). S.S.L. acknowledges the support of UTARRF (project number IPSR/RMC/UTARRF/2019-C2/L04). J.C. acknowledges financial support by Spain’s Ministerio de Ciencia, Innovación y Universidades under grant no. RTI2018-097876-B-C22 (MCIU/AEI/FEDER, UE). J.F. is supported by the Spanish Ministry of Science and Innovation through research grant RTI2018-096273-B-I00 and the Severo Ochoa Programme for Centres of Excellence in R&D (SEV-2015-0496) awarded to ICMAB.Peer reviewe

Maritime Interdiction Operations in Logistically Barren Environments

Includes supplementary materialThis report contains analysis that shows that existing technology exists to improve Maritime Interdiction Operations (MIO) by approximately 30%. Furthermore, analysis contained herein will aid MIO planning for future operations. Since MIOs are an inherently dangerous, but necessary activity with far reaching implications to theater political and economic dynamics, this improvement is of great interest. MIO is a Naval solution to the problems of smuggling weapons, explosives, people and narcotics. MIO, when employed correctly has the potential to save lives and limit economic/political damage.N