Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

National prospective cohort study of the burden of acute small bowel obstruction

Background Small bowel obstruction is a common surgical emergency, and is associated with high levels of morbidity and mortality across the world. The literature provides little information on the conservatively managed group. The aim of this study was to describe the burden of small bowel obstruction in the UK. Methods This prospective cohort study was conducted in 131 acute hospitals in the UK between January and April 2017, delivered by trainee research collaboratives. Adult patients with a diagnosis of mechanical small bowel obstruction were included. The primary outcome was in‐hospital mortality. Secondary outcomes included complications, unplanned intensive care admission and readmission within 30 days of discharge. Practice measures, including use of radiological investigations, water soluble contrast, operative and nutritional interventions, were collected. Results Of 2341 patients identified, 693 (29·6 per cent) underwent immediate surgery (within 24 h of admission), 500 (21·4 per cent) had delayed surgery after initial conservative management, and 1148 (49·0 per cent) were managed non‐operatively. The mortality rate was 6·6 per cent (6·4 per cent for non‐operative management, 6·8 per cent for immediate surgery, 6·8 per cent for delayed surgery; P = 0·911). The major complication rate was 14·4 per cent overall, affecting 19·0 per cent in the immediate surgery, 23·6 per cent in the delayed surgery and 7·7 per cent in the non‐operative management groups (P < 0·001). Cox regression found hernia or malignant aetiology and malnutrition to be associated with higher rates of death. Malignant aetiology, operative intervention, acute kidney injury and malnutrition were associated with increased risk of major complication. Conclusion Small bowel obstruction represents a significant healthcare burden. Patient‐level factors such as timing of surgery, acute kidney injury and nutritional status are factors that might be modified to improve outcomes

Outcomes of obstructed abdominal wall hernia: results from the UK national small bowel obstruction audit

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group

Outcomes following small bowel obstruction due to malignancy in the national audit of small bowel obstruction

Introduction Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction. Methods A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori. Results 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity. Conclusions Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups

Assessment of the physical impact of a short-term dredging operation on a semi-enclosed environment: South Euboean Gulf, Greece

The potential influence of short-period (May-June 2012) dredging activities (for the installation of a submarine gas pipeline) on physical properties of the marine environment of two shallow-water sites in the Aliveri and Varnavas areas of South Euboean Gulf (Greece) has been evaluated. During the dredging operation in Varnavas, the induced dredge plume traveled up to 750 m from the shoreline, featured by light attenuation coefficient (c(p)) maxima of 4.01-4.61 m(-1) and suspended particulate matter (SPM) concentrations up to 6.01 mg L-1. After dredging the previous parameters reduced to the ambient seawater condition, 0.45 m(-1) and &lt; 2.8 mg L-1 on average, respectively. Likewise in Aliveri, the dredging-associated sediment plume drifted offshore up to 400 m from the shoreline, characterized by c(p) maxima of 2.11-4.86 m(-1) and SPM concentrations up to 13.07 mg L-1. After the completion of the excavation and trenching activities, the c(p) and SPM values were restored to the pre-disturbance condition, 0.6 m(-1) and &lt; 2.2 mg L-1 on average, respectively. The migration of the dredge plume in both dredging sites was accomplished through the formation of intermediate and benthic nepheloid layers, whose development and evolution were governed by seawater stratification and flow regime. The dredging-derived SPM levels appeared to increase within a distance of no more than 300 m from the shoreline (near-field zone). Based on data from the literature, this SPM enhancement together with the deposition of a post-dredging residual mud veneer in the near-field zone could deteriorate local marine biota, but in a reversible way

Cross-Comparison of the “BathySent” Coastal Bathymetry to Sonar Measurements and Ratio Model Technique: Pilot Sites in the Aegean Sea (Greece)

The proposed novel “BathySent” approach for coastal bathymetric mapping, using the Copernicus Sentinel-2 mission, as well as the assessment and specification of the uncertainties of the derived depth results, are the objectives of this research effort. For this reason, Sentinel-2 bathymetry retrieval results for three different pilot sites in Greece (islands of Kos, Kasos, and Crete) were compared with ground-truth data. These data comprised high-resolution swath bathymetry measurements, single-beam echosounder measurements at very shallow waters (1–10 m), and the EMODnet DTM 2018 release. The synthetic tests showed that the “BathySent” approach could restitute bathymetry in the range of 5–14 m depth, showing a standard deviation of 2 m with respect to the sonar-based bathymetry. In addition, a comparison with the “ratio model” multispectral technique was performed. The absolute differences between conventional Earth Observation-based bathymetry retrieval approaches (i.e., linear ratio model) and the suggested innovative solution, using the Sentinel-2 data, were mainly lower than 2 m. According to the outcome evaluation, both models were considered to provide results that are more reliable within the depth zone of 5–25 m. The “ratio model” technique exhibits a saturation at ~25 m depth and demands ground calibration. Though, the “BathySent” method provides bathymetric data at a lower spatial resolution compared to the “ratio model” technique; however, it does not require in situ calibration and can also perform reliably deeper than 25 m

Disease modification achievement in patients with lupus nephritis in a real-life setting: mission impossible?

Objective A preliminary definition of disease modification (DM) in lupus nephritis (LN) was recently developed focusing on long-term remission and damage prevention, with minimal treatment-associated toxicity. We aimed to further specify aspects of DM criteria in LN, assess DM achievement in a real-world setting and examine potential DM predictors and long-term outcomes.Methods We collected clinical/laboratory and histological inception cohort data from biopsy-proven LN patients (82% females) with ≥72 months follow-up at two joint academic centres. Specific criteria for 24-hour proteinuria, estimated glomerular filtration rate (eGFR), renal flares and glucocorticoids dose were set at three time frames (months 0–12, 13–60 and 72) to assess DM. In the first model, DM was achieved if patients fulfilled all four criteria at all three time frames (achievers). In the second model, the continued glucocorticoids reduction criterion was excluded. Logistic regression analyses were performed. Possible different trends in DM achievement between past and recent decades were also investigated.Results DM was achieved by 60% of patients, increased to 70% when glucocorticoids excluded from DM criteria. 24-hour proteinuria at 9 months predicted DM achievement (OR 0.72, 95% CI 0.53 to 0.97, p=0.03), but none of baseline characteristics. Among patients with &gt;72 month follow-up, non-achievers had worse renal outcomes (flares, &gt;30% proteinuria increase, eGFR decline) than achievers at the end of follow-up (median 138 months). Patients diagnosed between 1992 and 2005 were found to have significantly lower percentages of DM achievement and met less often the glucocorticoids dose reduction criterion in all three time frames, compared with those diagnosed between 2006 and 2016 (p=0.006 and p&lt;0.01, respectively).Conclusions DM was achieved by only 60% of LN patients in a real-life setting, partly due to lack of glucocorticoids dose target attainment, while DM failure was associated with worse long-term renal outcomes. This may imply limitations in the effectiveness or implementation of current LN treatments, supporting the need for novel therapeutic strategies

Assessing the hydrocarbon potential of the Kadanwari gas field using integrated seismic and petrophysical data

Abstract Kadanwari is a major gas-producing field in Pakistan's Lower Indus Basin (LIB), extensively explored for optimized production. However, the reservoir sands of the Lower Goru Formation (LGF), deposited in a complex river-dominated delta, bear severe variability and hinder accurate facies approximation for optimal production. Furthermore, the regionally extended NNW-SSE directed horst and graben structures significantly compartmentalized these reservoir facies. The main E-sand interval is analyzed for its geological properties, depositional environment, and distribution. The integration of various approaches, including seismic interpretation, attribute extraction, well-based facies modeling, and petrophysical evaluation, proved significant in evaluating the heterogeneous and tectonically influenced E-sands. The discontinuity attribute substantially highlighted the structural style and aided in analyzing the geometries of faults. The low values of the frequency attribute (< 10 Hz) signified the entrapped gas-bearing sands along the faulted zones. The high responses of instantaneous amplitude and sweetness profoundly illuminated the gas-significant deposits throughout the field in association with the well-identified gas-prone sand facies. The outcomes of the neutron-density crossplot depicted gas-bearing sands having low density (< 2.3 g/cc) and good porosity (12%) with the assessment of various cements. The facies modeling distinguished between clean and intermixed sand-shale reservoir zones. Petrophysical analysis revealed a net pay of 14 m within E-sand having gas saturation of about 68%. The adopted approach is robust and efficient, employing a limited data set for developing well-associated seismic responses for potential zone delineation within structural arrangements. The techniques can be optimistic about the LGF's complex potential sands demarcation throughout the Indus Basin

The Role of Sea State to the Morphological Changes of Prasonisi Tombolo, Rhodes Island, Greece

Wave-induced morphodynamic processes that cause formation, preservation, and destruction of the Prasonisi tombolo in Rhodes Island are investigated, based on satellite image analysis and numerical modeling. A new method is developed for extracting wave events that consist of successive wave data of similar characteristics. The wave events refer either to wind seas or swell seas. This process combined with the satellite image analysis is then utilized for the derivation of the most representative wave scenarios that affect tombolo and salient formation. In particular, the main factors that play a significant role in tombolo and salient evolution are the offshore wave conditions, the location and width of the surf zone, the maximum value of the wave breaking index in the study area, and the initial bottom bathymetry before the study area is exposed to a new sea state. In general, the proposed method provides a realistic insight into tombolo morphodynamics and can be used to provide a cost-effective approach and a wave data-reduction technique for coastal engineering studies

Assessment of the Coastal Vulnerability to the Ongoing Sea Level Rise for the Exquisite Rhodes Island (SE Aegean Sea, Greece)

The foreseeable acceleration of global sea level rise could potentially pose a major threat to the natural charm and functional integrity of the world-renowned tourist coastal attractions of Rhodes Island, as a result of the anticipated increasing frequency of flooding and erosion events. Hence, this study aims to determine the most vulnerable segments (in terms of physical impact) of the Rhodes coastline through the widely accepted coastal vulnerability index (CVI), applying a combination of well-known, broadly used approaches and methods. The frequency distribution of the current CVI along the island’s coastline suggests a rather worrying high to very high vulnerability of 40%. In addition, a CVI projection to the end of the 21st century (based on the Intergovernmental Panel on Climate Change predictive scenarios) indicates an enhancement of the total vulnerability by 48%, mainly focused on the majority of the western coastline. Hence, a considerable number of popular coastal destinations in the island shall remain under unignorable threat and, therefore, coastal managers and decision-makers need to hatch an integrated plan to minimize economic and natural losses, private property damage and tourism infrastructure deterioration from flooding and erosion episodes, which will most likely be intensified in the future