Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis:time to change traditional practice

Background: To evaluate comparative outcomes of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey grade 1a) acute diverticulitis. Methods: A systematic online search was conducted using electronic databases. Comparative studies of OP versus IP treatment and ABX versus NABX approach in the treatment of Hinchey grade 1a acute diverticulitis were included. Primary outcome was recurrence of diverticulitis. Emergency and elective surgical resections, development of complicated diverticulitis, mortality rate, and length of hospital stay were the other evaluated secondary outcome parameters. Results: The literature search identified twelve studies (n = 3,875) comparing NABX (n = 2,008) versus ABX (n = 1,867). The NABX group showed a lower disease recurrence rate and shorter length of hospital stay compared with the ABX group (P = 0.01) and (P = 0.004). No significant difference was observed in emergency resections (P = 0.33), elective resections (P = 0.73), development of complicated diverticulitis (P = 0.65), hospital re-admissions (P = 0.65) and 30-day mortality rate (P = 0.91). Twelve studies (n = 2,286) compared OP (n = 1,021) versus IP (n = 1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P = 0.10), emergency surgical resection (P = 0.40), elective resection (P = 0.30), disease recurrence (P = 0.22), and mortality rate (P = 0.61). Conclusion: Observation-only treatment is feasible and safe in selected clinically stable patients with uncomplicated acute diverticulitis (Hinchey 1a classification). It may provide better outcomes including decreased length of hospital stay. Moreover, the OP approach in treating patients with Hinchey 1a acute diverticulitis is comparable to IP management. Future high-quality randomised controlled studies are needed to understand the outcomes of the NABX approach used in an OP setting in managing patients with uncomplicated acute diverticulitis

Statistical analysis of machining parameters on burr formation, surface roughness and energy consumption during milling of aluminium alloy Al 6061-T6

Due to the increasing demand for higher production rates in the manufacturing sector, there is a need to manufacture finished or near-finished parts. Burrs and surface roughness are the two most important indicators of the surface quality of any machined parts. In addition to this, there is a constant need to reduce energy consumption during the machining operation in order to reduce the carbon footprint. Milling is one of the most extensively used cutting processes in the manufacturing industry. This research was conducted to investigate the effect of machining parameters on surface roughness, burr width, and specific energy consumption. In the present research, the machining parameters were varied using the Taguchi L9 array design of experiments, and their influence on the response parameters, including specific cutting energy, surface finish, and burr width, was ascertained. The response trends of burr width, energy consumption, and surface roughness with respect to the input parameters were analyzed using the main effect plots. Analysis of variance indicated that the cutting speed has contribution ratios of 55% and 47.98% of the specific cutting energy and burr width on the down-milling side, respectively. On the other hand, the number of inserts was found to be the influential member, with contribution ratios of 68.74% and 35% of the surface roughness and burr width on the up-milling side. The validation of the current design of the experiments was carried out using confirmatory tests in the best and worst conditions of the output parameters.Web of Science1522art. no. 806

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

Statistical Analysis of Machining Parameters on Burr Formation, Surface Roughness and Energy Consumption during Milling of Aluminium Alloy Al 6061-T6

Due to the increasing demand for higher production rates in the manufacturing sector, there is a need to manufacture finished or near-finished parts. Burrs and surface roughness are the two most important indicators of the surface quality of any machined parts. In addition to this, there is a constant need to reduce energy consumption during the machining operation in order to reduce the carbon footprint. Milling is one of the most extensively used cutting processes in the manufacturing industry. This research was conducted to investigate the effect of machining parameters on surface roughness, burr width, and specific energy consumption. In the present research, the machining parameters were varied using the Taguchi L9 array design of experiments, and their influence on the response parameters, including specific cutting energy, surface finish, and burr width, was ascertained. The response trends of burr width, energy consumption, and surface roughness with respect to the input parameters were analyzed using the main effect plots. Analysis of variance indicated that the cutting speed has contribution ratios of 55% and 47.98% of the specific cutting energy and burr width on the down-milling side, respectively. On the other hand, the number of inserts was found to be the influential member, with contribution ratios of 68.74% and 35% of the surface roughness and burr width on the up-milling side. The validation of the current design of the experiments was carried out using confirmatory tests in the best and worst conditions of the output parameters