Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Surface roughness of new microhybrid resin-based composites

Background. Rough, poorly polished resin-based composite (RBC) surfaces contribute to staining, plaque accumulation, gingival irritation and recurrent caries. Proper finishing and polishing enhance both the esthetics and the longevity of restored teeth

Stable active running of a planar biped robot using Poincare map control

This work formulates the active limit cycles of bipedal running gaits for a compliant leg structure as the fixed point of an active Poincare map. Two types of proposed controllers stabilize the Poincare map around its active fixed point. The first one is a discrete linear state feedback controller designed with appropriate pole placement. The discrete-time control first uses purely constant torques during stance and flight phase, then discretizes each phase into smaller constant-torque intervals. The other controller is an invariant manifold based chaos controller: a generalized OGY controller having a linear form and a nonlinear form. Both controllers can stabilize active running gaits on either even or sloped terrains. The efficiency of these controllers for bipedal running applications are compared and discussed

Influence of Input Parameters on Dynamic Orbital Stability of Walking: In-Silico and Experimental Evaluation

Many measures aiming to assess the stability of human motion have been proposed in the literature, but still there is no commonly accepted way to define or quantify locomotor stability. Among these measures, orbital stability analysis via Floquet multipliers is still under debate. Some of the controversies concerning the use of this technique could lie in the absence of a standard implementation. The aim of this study was to analyse the influence of i) experimental measurement noise, ii) variables selected for the construction of the state space, and iii) number of analysed cycles on the outputs of orbital stability applied to walking. The analysis was performed on a 2-dimensional 5-link walking model and on a sample of 10 subjects performing long over-ground walks. Noise resulting from stereophotogrammetric and accelerometric measurement systems was simulated in the in-silico analysis. Maximum Floquet multipliers resulted to be affected by both number of analysed strides and state space composition. The effect of experimental noise was found to be slightly more potentially critical when analysing stereophotogrammetric data then when dealing with acceleration data. Experimental and model results were comparable in terms of overall trend, but a difference was found in the influence of the number of analysed cycles

Gait optimization and energetics of ballistic walking for an underactuated biped with knees

In this paper, we study gait optimization of ballistic walking in order to understand the natural dynamics of an underactuated biped with knees. We also propose applications for our understandings. Our optimization problem is solved by fixing energy levels, and then, we attempt to explain how optimal gaits are formed by examining the role of each joint in speeding up. In addition, we explain some natural characteristics of walking. Based on the results, we propose a new cost function to generate various walking gaits, including the optimum. Finally, we evaluate and discuss the energy efficiency of our ballistic walker and other bipedal walkers including humans.clos