Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049

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

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

The Use of Convolutional Neural Networks and Digital Camera Images in Cataract Detection

Cataract is one of the major causes of blindness in the world. Its early detection and treatment could greatly reduce the risk of deterioration and blindness. Instruments commonly used to detect cataracts are slit lamps and fundus cameras, which are highly expensive and require domain knowledge. Thus, the problem is that the lack of professional ophthalmologists could result in the delay of cataract detection, where medical treatment is inevitable. Therefore, this study aimed to design a convolutional neural network (CNN) with digital camera images (CNNDCI) system to detect cataracts efficiently and effectively. The designed CNNDCI system can perform the cataract identification process accurately in a user-friendly manner using smartphones to collect digital images. In addition, the existing numerical results provided by the literature were used to demonstrate the performance of the proposed CNNDCI system for cataract detection. Numerical results revealed that the designed CNNDCI system could identify cataracts effectively with satisfying accuracy. Thus, this study concluded that the presented CNNDCI architecture is a feasible and promising alternative for cataract detection

The Use of Convolutional Neural Networks and Digital Camera Images in Cataract Detection

Cataract is one of the major causes of blindness in the world. Its early detection and treatment could greatly reduce the risk of deterioration and blindness. Instruments commonly used to detect cataracts are slit lamps and fundus cameras, which are highly expensive and require domain knowledge. Thus, the problem is that the lack of professional ophthalmologists could result in the delay of cataract detection, where medical treatment is inevitable. Therefore, this study aimed to design a convolutional neural network (CNN) with digital camera images (CNNDCI) system to detect cataracts efficiently and effectively. The designed CNNDCI system can perform the cataract identification process accurately in a user-friendly manner using smartphones to collect digital images. In addition, the existing numerical results provided by the literature were used to demonstrate the performance of the proposed CNNDCI system for cataract detection. Numerical results revealed that the designed CNNDCI system could identify cataracts effectively with satisfying accuracy. Thus, this study concluded that the presented CNNDCI architecture is a feasible and promising alternative for cataract detection

Fast Fabrication of a Ag Nanostructure Substrate Using the Femtosecond Laser for Broad-Band and Tunable Plasmonic Enhancement

Using a femtosecond laser, we have transformed the laser-direct-writing technique into a highly efficient method that can process AgO_<i>x</i> thin films into Ag nanostructures at a fast scanning rate of 2000 μm²/min. The processed AgO_<i>x</i> thin films exhibit broad-band enhancement of optical absorption and effectively function as active SERS substrates. Probing of the plasmonic hotspots with dyed polymer beads indicates that these hotspots are uniformly distributed over the treated area

Fast Fabrication of a Ag Nanostructure Substrate Using the Femtosecond Laser for Broad-Band and Tunable Plasmonic Enhancement

Using a femtosecond laser, we have transformed the laser-direct-writing technique into a highly efficient method that can process AgO_<i>x</i> thin films into Ag nanostructures at a fast scanning rate of 2000 μm²/min. The processed AgO_<i>x</i> thin films exhibit broad-band enhancement of optical absorption and effectively function as active SERS substrates. Probing of the plasmonic hotspots with dyed polymer beads indicates that these hotspots are uniformly distributed over the treated area