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

The occurrence of postharvest diseases on apples resistant to scab

The occurrence of storage diseases on fruit of seven scab resistant apple cultivars (Freedom, Rajka, Topaz, Rubinola, Enterprise, Goldstar, GoldRush) grafted on M.9 was investigated in 2001-2005. The trees were planted in 1995. It was found that after storage (4 and 6 months at 2°C, 85-90% RH) the most severe appeared to be bull's eye rot (Pezicula spp.). The most sensitive cultivars to this disease were: Topaz, Freedom, Goldstar, the least sensitive were Rubinola, Enterprise, Rajka. Other postharvest diseases like gray mold (Botrytis cinerea), blue mold (Penicillium expansum) and brown rot (Monilinia fructigena) were not common. ‘Rajka’ and ‘Goldstar’ were susceptible to bitter pit, and ‘Freedom’ to superficial scald.W latach 2001-2005 badano występowanie chorób przechowalniczych na jabłkach siedmiu parchoodpornych odmian: Freedom, Rajka, Topaz, Rubinola, Enterprise, Goldstar, GoldRush. Owoce przechowywano w chłodni zwykłej w temperaturze 2°C przez 4 i 6 miesięcy. Najczęściej występującą chorobą była gorzka zgnilizna jabłek (Pezicula spp.). Najbardziej podatne na tę chorobę były jabłka odmian Topaz, Freedom i Goldstar, a najmniej - Rubinola, Enterprise i Rajka. Inne choroby przechowalnicze - szara pleśń jabłek (Botrytis cinerea), mokra zgnilizna (Penicillium expansim) i brunatna zgnilizna (Monilinia fructigena) występowały w małym nasileniu i nie stwierdzono istotnych różnic w podatności odmian na te choroby. Spośród chorób fizjologicznych wystąpiły: gorzka plamistość podskórna na owocach odmian Rajka i Goldstar oraz oparzelizna powierzchniowa na owocach odmiany Freedom

Plonowanie i wartosc pokarmowa mieszanek koniczynowo-trawiastych uprawianych na gruntach ornych

Badaniami objęto 3 mieszanki koniczynowo-trawiaste o następującym składzie gatunkowym: M-l - Trifolium pratense 50%, Festulolium 35% i Phleum pratense 15%; M-2 - Trifolium pratense 50%, Lolum multiflorum 40% i Dactylis glomerata 10%; M-3 - Trifolium pratense 20%, Trifolium repens 30%, Lolium multiflorum 15%, Lolium perenne 25% i Phleum pratense 10%. Oceniono plonowanie i skład chemiczny badanych mieszanek oraz ich wartość pokarmową w jednostakch INRA-88. Uzyskane średnie plony suchej masy, białka i energii świadczą o wysokim potencjale produkcyjnym badanych mieszanek koniczyny z trawami, zwłaszcza mieszanki M-3.The investigation comprised three clover-grass mixtures with the following species composition: M-l - Trifolium pratense 50%, Festulolium 35% i Phleum pratense 15%; M-2 - Trifolium pratense 50%, Lolum multiflorum 40% i Dactylis glomerata 10%; M-3 - Trifolium pratense 20%, Trifolium repens 30%, Lolium multiflorum 15%, Lolium perenne 25% i Phleum pratense 10%. The yield, chemical composition and nutritive values in INRA-88 units were estimated. Obtained results of experiment - mean yields of dry matter, protein and energy - indicate high potential productivity of tested clover-grass mixtures, especially M-3 mixture

Ocena wartosci odzywczej i wypelnieniowej kiszonki z traw podsuszonych i kiszonki z kukurydzy

Kiszonka z traw podsuszonych i kiszonka z kukurydzy pod względem składu chemicznego odpowiadały wymaganiom wysoko produkcyjnych przeżuwaczy. Wartość wypełnieniowa kiszonki z traw wynosiła 1,27, a kiszonki z kukurydzy 1,56 JWO/kg s.m. Większa wartość wypełnieniowa kiszonki z kukurydzy, również w porównaniu do danych INRA (1988) mogła być wynikiem jej niedokładnego pocięcia. Po zastosowaniu dodatku paszy treściwej wartość wypełnieniowa badanych pasz pozornie zwiększyła się.Chemical composition of prewilted grass silage and maize covered the nutrient requirements of high producing ruminant animals. Fill value of prewilted grass silage was 1.27 and maize silage was 1.56 SFU/kg DM. Deficient cut could be the reason of higher fill value of maize silage compared to INRA data. Concentrate addition increased the fill value of experimental feeds

Ekologiczne znaczenie i wartosc pokarmowa runi z udzialem koniczyny bialej

Analizowano ruń trawiasto-motylkowatą, trawiastą i gatunki dominujące. Koniczyna biała wyróżniała się najkorzystniejszym składem chemicznym i wyższą wartością pokarmową wyliczoną w jednostkach INRA. Po 24 h inkubacji prób koniczyny białej w żwaczu rozkład suchej masy wynosił 80,4%, białka ogólnego 85,1%, kostrzewy odpowiednio 67,3% i 76,2 %. Rozkład białka był więc korzystnie skorelowany z rozkładem składników energetycznych. Rozkład suchej masy wiechliny łąkowej był dużo niższy od rozkładu białka ogólnego. Udział koniczyny białej w runi pastwiskowej umożliwia pozyskiwanie wartościowej paszy przy mniejszym nawożeniu azotowym.Grass-clover pasture sward and dominanting grass species were analyzed. White clover was found to be characterized by a favourable chemical composition and higher nutritive value calculated in INRA units. After 24 hrs incubation of white clover samples in rumen, its dry matter decomposition amounted to 80,4% and crude protein 85,1%, while these values for Festuca pratensis were 67,3% and 76,2%, respectively. It can be said therefore, that the protein degradation was favourably correlated with energy constituents. Dry matter decomposition of Poa pratensis was significantly lower in relation to crude protein. Inclusion of white clover in grass sward allows to obtain the valuable forage at lower nitrogen fertilization

Rumen disappearance of organic matter, crude protein, crude fibre, ADF and NDF from grasses, white clover and grass-white clover mixture

International audienc

Influence of the method of forage conservation on composition of silages and dairy cows performance

International audienc

Bromatological evaluation of eleven corn cultivars harvested at two cutting heights

The objective of this study was to evaluate the chemical composition and dry matter in vitro digestibility of stem, leaf, straw, cob and kernel fractions of eleven corn (Zea mays) cultivars, harvested at two cutting heights. The experiment was designed as randomized blocks, with three replicates, in a 2 × 11 factorial arrangement (eleven cultivars and two cutting heights). The corn cultivars evaluated were D 766, D 657, D 1000, P 3021, P 3041, C 805, C 333, AG 5011, FOR 01, CO 9621 and BR 205, harvested at a low cutting height (5 cm above ground) and a high cutting height (5 cm below the first ear insertion). Cutting height influenced the dry matter content of the stem fraction, which was lower (23.95%) in plants harvested at the low, than in plants harvested at the high cutting height (26.28%). The kernel fraction had the highest dry matter in vitro digestibility (85.13%), while cultivars did not differ between each other. Cob and straw were the fractions with the highest level of neutral detergent fiber (80.74 and 79.77%, respectively) and the lowest level of crude protein (3.84% and 3.69%, respectively). The leaf fraction had the highest crude protein content, both for plants of low and high cuttings (15.55% and 16.20%, respectively). The increase in the plant cutting height enhanced the dry matter content and dry matter in vitro digestibility of stem fraction, but did not affect the DM content of the leaf fraction

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

Background Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications. Methods We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC). Findings In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683–0·717]). Interpretation In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required. Funding British Journal of Surgery Society

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

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