44 research outputs found
Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy
Background
A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.
Methods
Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.
Results
A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001).
Conclusion
We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty
Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases
Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics
Semiconductor Spintronics
Spintronics refers commonly to phenomena in which the spin of electrons in a
solid state environment plays the determining role. In a more narrow sense
spintronics is an emerging research field of electronics: spintronics devices
are based on a spin control of electronics, or on an electrical and optical
control of spin or magnetism. This review presents selected themes of
semiconductor spintronics, introducing important concepts in spin transport,
spin injection, Silsbee-Johnson spin-charge coupling, and spindependent
tunneling, as well as spin relaxation and spin dynamics. The most fundamental
spin-dependent nteraction in nonmagnetic semiconductors is spin-orbit coupling.
Depending on the crystal symmetries of the material, as well as on the
structural properties of semiconductor based heterostructures, the spin-orbit
coupling takes on different functional forms, giving a nice playground of
effective spin-orbit Hamiltonians. The effective Hamiltonians for the most
relevant classes of materials and heterostructures are derived here from
realistic electronic band structure descriptions. Most semiconductor device
systems are still theoretical concepts, waiting for experimental
demonstrations. A review of selected proposed, and a few demonstrated devices
is presented, with detailed description of two important classes: magnetic
resonant tunnel structures and bipolar magnetic diodes and transistors. In most
cases the presentation is of tutorial style, introducing the essential
theoretical formalism at an accessible level, with case-study-like
illustrations of actual experimental results, as well as with brief reviews of
relevant recent achievements in the field.Comment: tutorial review; 342 pages, 132 figure
Time series analysis as input for clinical predictive modeling: Modeling cardiac arrest in a pediatric ICU
From δ-aminolevulinic acid to chlorophylls and every step in between: in memory of Constantin (Tino) A. Rebeiz, 1936–2019
Potential benefits of an integrated military/civilian trauma system: experiences from two major regional conflicts
Chloroplast DNA phylogeography of the Holly mangrove Acanthus ilicifolius in the Indo-West Pacific
New Drugs for Alopecias
The new drugs in the development of AGA include PGF2 analogs, a PGD2 receptor antagonist, Wnt pathway activators, an androgen receptor antagonist, a topical JAK inhibitors, and topical finasteride. While many of these have already shown efficacy compared to placebo, none have shown superiority to topical minoxidil; however, they may still have future as an adjuvant treatment with topical minoxidil. For AA, oral JAK inhibitors are a promising new development, although other new drugs are in development as well. A particularly interesting one is BNZ-1, which has the potential to suppress the autoimmune response without causing systemic immunosuppression