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

Efficient dynamical downscaling of general circulation models using continuous data assimilation

Continuous data assimilation (CDA) is successfully implemented for the first time for efficient dynamical downscaling of a global atmospheric reanalysis. A comparison of the performance of CDA with the standard grid and spectral nudging techniques for representing long- and short-scale features in the downscaled fields using the Weather Research and Forecast (WRF) model is further presented and analysed. The WRF model is configured at 0.25° × 0.25° horizontal resolution and is driven by 2.5° × 2.5° initial and boundary conditions from NCEP/NCAR reanalysis fields. Downscaling experiments are performed over a one-month period in January 2016. The similarity metric is used to evaluate the performance of the downscaling methods for large (2,000 km) and small (300 km) scales. Similarity results are compared for the outputs of the WRF model with different downscaling techniques, NCEP/NCAR reanalysis, and NCEP Final Analysis (FNL, available at 0.25° × 0.25° horizontal resolution). Both spectral nudging and CDA describe better the small-scale features compared to grid nudging. The choice of the wave number is critical in spectral nudging; increasing the number of retained frequencies generally produced better small-scale features, but only up to a certain threshold after which its solution gradually became closer to grid nudging. CDA maintains the balance of the large- and small-scale features similar to that of the best simulation achieved by the best spectral nudging configuration, without the need of a spectral decomposition. The different downscaled atmospheric variables, including rainfall distribution, with CDA is most consistent with the observations. The Brier skill score values further indicate that the added value of CDA is distributed over the entire model domain. The overall results clearly suggest that CDA provides an efficient new approach for dynamical downscaling by maintaining better balance between the global model and the downscaled fields

Enhanced Simulation of the Indian Summer Monsoon Rainfall Using Regional Climate Modeling and Continuous Data Assimilation

This study assesses a Continuous Data Assimilation (CDA) dynamical-downscaling algorithm for enhancing the simulation of the Indian summer monsoon (ISM) system. CDA is a mathematically rigorous technique that has been recently introduced to constrain the large-scale features of high-resolution atmospheric models with coarse spatial scale data. It is similar to spectral nudging but does not require any spectral decomposition for scales separation. This is expected to be particularly relevant for ISM, which involves various interactions between large-scale circulations and regional physical processes. Along with a control simulation, several downscaling simulations were conducted with the Weather Research and Forecasting (WRF) model using CDA, spectral (retaining different wavenumbers) and grid nudging for three ISM seasons: normal (2016), excess (2013), and drought (2009). The simulations are nested within the NCEP Final Analysis and the model outputs are evaluated against the observations. Compared to grid and spectral nudging, the simulations using CDA produce enhanced ISM features over the Indian subcontinent including the low-level jet, tropical easterly jet, easterly wind shear, and rainfall distributions for all investigated ISM seasons. The major ISM processes, in particular the monsoon inversion over the Arabian Sea, tropospheric temperature gradients and moist static energy over central India, and zonal wind shear over the monsoon region, are all better simulated with CDA. Spectral nudging outputs are found to be sensitive to the choice of the wavenumber, requiring careful tuning to provide robust simulations of the ISM system. In contrast, control and grid nudging generally fail to well reproduce some of the main ISM features

RAGE Regulates Immune Cell Infiltration and Angiogenesis in Choroidal Neovascularization

Purpose: RAGE regulates pro-inflammatory responses in diverse cells and tissues. This study has investigated if RAGE plays a role in immune cell mobilization and choroidal neovascular pathology that is associated with the neovascular form of agerelated macular degeneration (nvAMD). Methods: RAGE null (RAGE-/-) mice and age-matched wild type (WT) control mice underwent laser photocoagulation to generate choroidal neovascularization (CNV) lesions which were then analyzed for morphology, S100B immunoreactivity and inflammatory cell infiltration. The chemotactic ability of bone marrow derived macrophages (BMDMs) towards S100B was investigated. Results: RAGE expression was significantly increased in the retina during CNV of WT mice (