Complete mesocolic excision does not increase short-term complications in laparoscopic left-sided colectomies : a comparative retrospective single-center study

Background: Since the implementation of total mesorectal excision (TME) in rectal cancer surgery, oncological outcomes improved dramatically. With the technique of complete mesocolic excision (CME) with central vascular ligation (CVL), the same surgical principles were introduced to the field of colon cancer surgery. Until now, current literature fails to invariably demonstrate its oncological superiority when compared to conventional surgery, and there are some concerns on increased morbidity. The aim of this study is to compare short-term outcomes after left-sided laparoscopic CME versus conventional surgery. Methods: In this retrospective analysis, data on all laparoscopic sigmoidal resections performed during a 3-year period (October 2015 to October 2018) at our institution were collected. A comparative analysis between the CME group-for sigmoid colon cancer-and the non-CME group-for benign disease-was performed. Results: One hundred sixty-three patients met the inclusion criteria and were included for analysis. Data on 66 CME resections were compared with 97 controls. Median age and operative risk were higher in the CME group. One leak was observed in the CME group (1/66) and 3 in the non-CME group (3/97), representing no significant difference. Regarding hospital stay, postoperative complications, surgical site infections, and intra-abdominal collections, no differences were observed. There was a slightly lower reoperation (1.5% versus 6.2%, p = 0.243) and readmission rate (4.5% versus 6.2%, p = 0.740) in the CME group during the first 30 postoperative days. Operation times were significantly longer in the CME group (210 versus 184 min, p < 0.001), and a trend towards longer pathological specimens in the CME group was noted (21 vs 19 cm, p = 0.059). Conclusions: CME does not increase short-term complications in laparoscopic left-sided colectomies. Significantly longer operation times were observed in the CME group

"We have no voice for that" : Land Rights, Power, and Gender in Rural Sierra Leone

Acknowledgements I wish to thank the participants in the Gender and Land Governance Conference at Utrecht University in January 2013 for helpful comments and suggestions. Funding I would like to thank the Faculty of Management at Radboud University Nijmegen for funding the six months of fieldwork on which this article is based.Peer reviewedPostprin

John Stuart Mill and Fourierism: ‘association’, ‘friendly rivalry’ and distributive justice

John Stuart Mill’s self-description as ‘under the general designation of Socialist’ has been under-explored. It is an important feature of something else often overlooked: the importance of the French context of Mill’s thought. This article focuses on the role of Fourierism in the development of Mill’s ideas, exploring the links to Fourierism in Mill’s writing on profit-sharing; his use of the words ‘association’ and ‘friendly rivalry’; and his views concerning distributive justice. It then reconsiders his assessment of Fourierism as a desirable, workable and immediately implementable form of social reform, ultimately arguing it was Mill’s most-preferred form of ‘utopian’ socialism

Discounting of Evolutionary Explanations in Sociology Textbooks and Curricula

Despite being internally fragmented by clashes of paradigms, sociology textbooks and introductory courses show a remarkable similarity in their content, while they share a peculiar neglect of small scale societies, non-human social relations, as well as evolutionary explanations. The mistreatment is explained by the strong position of sociology in the nature vs. nurture debate, by paradigmatic and ideologically motivated condemnations, by the later misuse of Social Darwinism, by certain unresolved issues of evolutionary explanations of human sociality, and by epistemological critiques of evolutionary explanations. The current study assesses the extent of this avoidance in sociology by three methods: a review of major sociology textbooks, a descriptive quantitative text analysis of introductory course outlines at top ranked universities, and a keyword search in the all-time most emblematic classical books in sociology. In reaction to this mistreatment, the benefits of synthesis of sociological explanations with evolutionary thinking are discussed

Review of the rebound phenomenon in new anticoagulant treatments.

BACKGROUND: The launch of new anticoagulant treatments has sparked debate as to the optimal drug to use for primary prevention of venous thromboembolism (VTE) in major orthopaedic surgery, for the treatment of VTE, and for stroke prevention in atrial fibrillation, taking into account both efficacy and tolerability. Newer drugs such as fondaparinux and ximelagatran have shown improvements in short-term efficacy or convenience, but such effects may be offset by reduced tolerability. They also raise the question of a possible delayed increase in thromboembolic events after these drugs are stopped, the so-called 'rebound effect'. OBJECTIVE: To review pharmacological and clinical data describing the rebound effect associated with new and standard anticoagulant drugs. RESEARCH DESIGN AND METHODS: Computerized searches, covering the period 1960-2005 for the historical background and physiopathology review, and from 1999 to 2005 for the clinical trial analysis, were performed on BIOSIS, PubMed and clinicaltrials.gov databases. The terms 'rebound', 'anticoagulant', and 'heparin' were used. Only articles written in English were reviewed. Articles with drug interactions from other therapeutic classes or types of vascular surgery and commentary articles were excluded. RESULTS: Available data in relation to a possible rebound phenomenon following cessation of active treatment are very limited. Results coming mainly from orthopaedic surgery trials suggest an increased rate of venous or arterial thromboembolic events with newer anticoagulants, compared with standard anticoagulant therapy. An increase in the rate of serious arterial adverse events has, for example, been observed in VTE patients treated with ximelagatran relative to those receiving warfarin/placebo (short-term exposure: 0.75% vs 0.26%, p < 0.05; long-term exposure: 1.70% vs 0.70%, p <or= 0.1). CONCLUSIONS: Further clinical trials or meta-analyses are needed before we can determine whether the unexpected thromboembolic events found with newer anticoagulants can be linked to a rebound effect on treatment cessation

Novel application of published risk factors for methicillin-resistant S aureus in acute bacterial skin and skin structure infections

Methicillin-resistant Staphylococcus aureus acute bacterial skin and skin structure infections (MRSA ABSSSIs) are associated with a significant clinical and economic burden; however, rapid identification of MRSA remains a clinical challenge. This study aimed to use a novel method of predictive modeling to determine those at highest risk of MRSA ABSSSIs. Risk factors for MRSA ABSSSI were derived from a combination of previously published literature and multivariable logistic regression of individual patient data (IPD) using the \u27adaptation method.\u27 A risk-scoring tool was derived from weight-proportional integer-adjusted coefficients of the predictive model. Likelihood ratios were used to adjust posterior probability of MRSA. Risk factors were identified from 12 previously published studies and adapted based on IPD (n = 231). Risk factors were: history of diabetes with obesity (adapted odds ratio [aOR] = 1.1), prior antibiotics (90 days) (aOR = 2.6), chronic kidney disease/hemodialysis (aOR = 1.4), intravenous drug use (aOR = 2.8), previous MRSA exposure/infection (12 months) (aOR = 2.8), previous hospitalization (12 months) (aOR = 7.5), and HIV/AIDS (aOR = 4.0). Baseline prevalence of MRSA was 42.7%. Scores ranged from 0 - 8 points. Post-test probability of MRSA: score 0 = 35.0%; score 1 - 2 = 45.0%; score 3 = 63.0%. The newly derived risk-scoring tool is proof-of-concept of the adaptation method. This study is hypothesis generating and such a tool remains to be validated for clinical use

Association between vancomycin day 1 exposure profile and outcomes among patients with methicillin-resistant Staphylococcus aureus infective endocarditis

Given the critical importance of early appropriate therapy, a retrospective cohort (2002 to 2013) was performed at the Detroit Medical Center to evaluate the association between the day 1 vancomycin exposure profile and outcomes among patients with MRSA infective endocarditis (IE). The day 1 vancomycin area under the concentration-time curve (AUC0-24) and the minimum concentration at 24 h (Cmin 24) was estimated for each patient using the Bayesian procedure in ADAPT 5, an approach shown to accurately predict the vancomycin exposure with low bias and high precision with limited pharmacokinetic sampling. Initial MRSA isolates were collected and vancomycin MIC was determined by broth microdilution (BMD) and Etest. The primary outcome was failure, defined as persistent bacteremia (≥7 days) or 30-day attributable mortality. Classification and regression tree analysis (CART) was used to determine the vancomycin exposure variables associated with an increased probability of failure. In total, 139 patients met study criteria; 76.3% had right-sided IE, 16.5% had left-sided IE, and 7.2% had both left and right-sided IE. A total of 89/139 (64%) experienced failure by composite definition. In the CART analysis, failure was more pronounced in patients with an AUC0-24/MIC as determined by BMD of ≤600 relative to those with AUC0-24/MIC as determined by BMD of \u3e600 (69.8% versus 54.7%, respectively, P = 0.073). In the logistic regression analysis, an AUC/MIC as determined by BMD of ≤600 (adjusted odds ratio, 2.3; 95% confidence interval, 1.01 to 5.37; P = 0.047) was independently associated with failure. Given the retrospective nature of the present study, further prospective studies are required but these data suggest that patients with an AUC0-24/MIC as determined by BMD of ≤600 present an increased risk of failure

Multiproxy cretaceous-paleogene boundary event stratigraphy: An Umbria-marche basinwide perspective

The complete and well-studied pelagic carbonate successions from the Umbria- Marche basin (Italy) permit the study of the event-rich stratigraphic interval around the Cretaceous-Paleogene boundary (e.g., Deccan volcanism, boundary impact, Paleocene recovery, and climate). To test the robustness of various proxy records (bulk carbonate δ13C, δ18O, 87Sr/86Sr, and Ca, Fe, Sr, and Mn concentrations) inside the Umbria-Marche basin, several stratigraphically equivalent sections were investigated (Bottaccione Gorge, Contessa Highway, Fornaci East quarry, Frontale, Morello, and Petriccio core). Besides the classical Gubbio sections of Bottaccione and Contessa, the new Morello section is put forward as an alternative location for this stratigraphic interval because it is less altered by burial diagenesis. Elemental profiles (Ca, Fe, Sr, Mn) acquired by handheld X-ray fluorescence (pXRF) efficiently provide regional chemostratigraphic and paleoenvironmental information. The Deccan volcanism, the Cretaceous-Paleogene boundary, the characteristic pattern of the Sr/Ca profile across the boundary driven by the extinction and recovery of coccolithophores, and the Dan- C2 hyperthermal event are examples of such recorded paleoenvironmental events. Moreover, cyclostratigraphic analyses of proxies of detrital input (magnetic susceptibility and Fe concentrations) show the imprint in the sedimentary record of a 2.4 m.y. eccentricity minimum around 66.45-66.25 Ma, and suggest that the occurrence of the Dan-C2 hyperthermal event was astronomically paced

Multiproxy Cretaceous-Paleogene boundary event stratigraphy: An Umbria-Marche basinwide perspective

International audienc