Nontraumatic terminal ileal perforation

BACKGROUND: There is still confusion and controversy over the diagnosis and optimal surgical treatment of non traumatic terminal ileal perforation-a cause of obscure peritonitis. METHODS: This study was a prospective study aimed at evaluating the clinical profile, etiology and optimal surgical management of patients with nontraumatic terminal ileal perforation. RESULTS: There were 79 cases of nontraumatic terminal ileal perforation; the causes for perforation were enteric fever(62%), nonspecific inflammation(26%), obstruction(6%), tuberculosis(4%) and radiation enteritis (1%). Simple closure of the perforation (49%) and end to side ileotransverse anastomosis(42%) were the mainstay of the surgical management. CONCLUSION: Terminal ileal perforation should be suspected in all cases of peritonitis especially in developing countries and surgical treatment should be optimized taking various accounts like etiology, delay in surgery and operative findings into consideration to reduce the incidence of deadly complications like fecal fistula

Sequencing of prostate cancers identifies new cancer genes, routes of progression and drug targets

Prostate cancer represents a substantial clinical challenge because it is difficult to predict outcome and advanced disease is often fatal. We sequenced the whole genomes of 112 primary and metastatic prostate cancer samples. From joint analysis of these cancers with those from previous studies (930 cancers in total), we found evidence for 22 previously unidentified putative driver genes harboring coding mutations, as well as evidence for NEAT1 and FOXA1 acting as drivers through noncoding mutations. Through the temporal dissection of aberrations, we identified driver mutations specifically associated with steps in the progression of prostate cancer, establishing, for example, loss of CHD1 and BRCA2 as early events in cancer development of ETS fusion-negative cancers. Computational chemogenomic (canSAR) analysis of prostate cancer mutations identified 11 targets of approved drugs, 7 targets of investigational drugs, and 62 targets of compounds that may be active and should be considered candidates for future clinical trials

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

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Not AvailableSpraying is one of the critical operations in agriculture. The importance of the use of chemical pesticides was well recognized in agriculture. Consumption of pesticides was increasing year by year, on the other hand, wastage of chemical pesticides also alarming due to excess application of pesticides. The quality spraying affects several operational factors. Tractor operated swinging lance sprayer developed for obtaining uniformity in spraying. Four operational factors such as spacing between spray guns, spray gun height, swing angle and pressure were considered to evaluate and optimize the operational factors for effective swath width. Full factorial design considered using Minitab software tool, 243 experiments (34 *3) conducted for the study. The main effects of each factor, 2-way interaction effects and 3-way interaction effects are significant at 5% level of significance. The swath width is significantly influenced by swing angle followed by spacing between spray guns for both the spray guns. The percentage contribution of swing angle, spacing between spray guns, height of spray gun and operating pressure on swath width was 44.37%, 37.62%, 2.51% and 2.02% respectively. The optimum combination of operational parameters for effective swath width was s3 - h2 – a3 – p2. The obtained optimum operation combination for swath width significantly improved the performance of spraying activity.Not Availabl

Assessing vegetation indices and productivity across nitrogen gradients: a comparative study under transplanted and direct-seeded rice

Nitrogen responses vary under diverse agronomic management practices, influencing vegetation indices (VIs) and productivity across different ecological conditions. However, the proper quantification of these responses under various crop establishment methods with varied nitrogen levels is rarely studied. Therefore, a field experiment was conducted to investigate the impact of varying nitrogen levels on VIs, growth parameters, yield attributes, yield, and economic aspects of transplanted rice (TR) and direct-seeded rice (DSR). The experiment was conducted in the randomized block design consisted seven N levels, which included 0% recommended dose of nitrogen (RDN) or no nitrogen (N0), 33.33% RDN (N1), 66.66% RDN (N2), 100% RDN (N3), 133.33% RDN (N4), 166.66% RDN (N5) and 200% RDN (N6), and replicated thrice. The plots with higher N levels demonstrated increased values of VIs and treatment N3 (120 kg N ha−1), N4 (160 kg N ha−1), N5 (200 kg N ha−1), and N6 (240 kg N ha−1) showed no statistically significant differences in NDVI (normalized difference vegetation index), RVI (ratio vegetation index), NDRE (normalized difference red edge), and GNDVI (green normalized difference vegetation index) values across the various growth stages of rice. The application of treatment N4 resulted in the highest number of panicles m−2 (348.2 in TR, 376.8 in DSR), filled grains panicle−1 (74.55 in TR, 62.43 in DSR), and a 1,000-grain weight of 26.92 g in TR and 26.76 g in DSR. The maximum yield (4.89 t ha−1) was obtained in transplanted rice at treatment N4 and, 8.15% yield reduction was noted in DSR for the same treatment, which was statistically equivalent to N3, but significantly superior to other N levels. Conversely, in DSR with RDN (120 kg N ha−1), the cost–benefit ratio surpassed that of TR by 16.96%, signifying DSR’s adaptability for more profitable rice cultivation in the region. This research provides valuable insights into optimizing nitrogen management practices for TR and DSR, thereby enhancing rice crop performance and economic returns