Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

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

Strengthening mechanisms, deformation behavior, and anisotropic mechanical properties of Al-Li alloys: A review

Al-Li alloys are attractive for military and aerospace applications because their properties are superior to those of conventional Al alloys. Their exceptional properties are attributed to the addition of Li into the Al matrix, and the technical reasons for adding Li to the Al matrix are presented. The developmental history and applications of Al-Li alloys over the last few years are reviewed. The main issue of Al-Li alloys is anisotropic behavior, and the main reasons for the anisotropic tensile properties and practical methods to reduce it are also introduced. Additionally, the strengthening mechanisms and deformation behavior of Al-Li alloys are surveyed with reference to the composition, processing, and microstructure interactions. Additionally, the methods for improving the formability, strength, and fracture toughness of Al-Li alloys are investigated. These practical methods have significantly reduced the anisotropic tensile properties and improved the formability, strength, and fracture toughness of Al-Li alloys. However, additional endeavours are required to further enhance the crystallographic texture, control the anisotropic behavior, and improve the formability and damage tolerance of Al-Li alloys

Development of a biocompatible green drug release system using salidroside-TiO2-doped chitosan oligosaccharide molecularly imprinted polymers

This study focuses on creating a green drug release system using a food-grade titanium dioxide (TiO2) material through surface molecular imprinting. Salidroside (SD) was chosen as the template molecule to synthesize molecularly imprinted polymers (SDT-MIP) utilizing TiO2-doped chitosan oligosaccharides as the functional monomer. The SDT-MIPs were characterized using multiple techniques, and their effectiveness was evaluated through an in vitro release study. Additionally, the affinity of SDT-MIPs toward the template molecule was examined using Langmuir and Freundlich adsorption models. The Langmuir model revealed a maximum capacity of 170.41 mg/g and an imprinted factor of 3.4. The study demonstrated that drug release from the SDT-MIPs in simulated gastrointestinal fluid primarily occurred through pure Fick diffusion. The release kinetics exhibited diffusion coefficients ranging from 3.38 × 10-3 cm2/s to 2.78 × 10-2 cm2/s, indicating their biocompatibility and potential application in drug delivery. Furthermore, the SDT-MIP demonstrated no adverse impact on cell viability even at concentrations as high as 1000 μg/mL. The survival rate of cells cultivated in the presence of SDT-MIP solution exceeded 120 ± 12.46%, providing evidence of the excellent biocompatibility and absence of cytotoxicity associated with SDT-MIP. The SDT-MIP possesses favorable sustained-release properties and lacks toxicity, allowing novel drug delivery systems to be created