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

Arthroscopically assisted anterior cruciate ligament reconstruction using patellar tendon autograft. Five- to nine-year follow-up evaluation. The American journal of sports medicine 26

ABSTRACT We retrospectively reviewed the results of 97 patients with anterior cruciate ligament reconstructions using an arthroscopically assisted two-incision technique without extraarticular augmentation at an intermediate followup of 5 to 9 years postoperatively. Evaluation included detailed history, physical examination, functional testing, KT-1000 arthrometer measurements, multiple scoring systems, and radiographs. The results were compared with those from a previous study that evaluated a smaller patient cohort using the identical surgical technique at a 2-to 4-year followup. The postoperative physical examination and KT-1000 arthrometer results were statistically improved when compared with preoperative findings. A negative pivot shift result was noted in 83% of patients, and a 1ϩ result in 17% of patients. Seventy percent of patients had Ͻ3 mm difference on manual maximum side-to-side testing. Functional testing averaged less than 2% asymmetry for vertical jump, single-legged hop, or timed 6-meter hop. The Tegner activity level was significantly improved from prereconstruction ratings and similar to preinjury ratings. The mean Lysholm score was 87. The modified Hospital for Special Surgery scores resulted in good or excellent results in 82% of the patients (mean, 87 points). The mean Noyes sports function score was 89, and the reoperation rate for a symptomatic knee flexion contracture was 12%. Ninety-seven percent of patients indicated that they would undergo the procedure again. When compared with this same population at 2 to 4 years, we saw no deterioration in scoring scale results. During the past decade arthroscopically assisted techniques have become accepted methods of reconstructing the ACL. 5-7, 13, 14, 19, 23, 24, 27, 31, 36, 45, 46 Despite many ACLrelated articles in the literature, there are few intermediate-or long-term studies evaluating the results of current, commonly performed techniques. The goals for this minimum 5-year follow-up study were to 1) evaluate clinical stability after this technique, 2) assess function, 3) evaluate patient satisfaction, and 4) compare our results at 5 to 9 years with those from an earlier study of 2 to 4 years' followup of this same surgical technique. 7 MATERIALS AND METHODS Patients who underwent two-incision arthroscopically assisted ACL reconstructions using patellar tendon autograft substitution without extraarticular augmentation between June 1987 and January 1991 were retrospectively reviewed. Patients were identified from a computerized data base maintained by the senior author (BRB), who performed all the surgical procedures. During this period, a variety of 189 knee ligament procedures were performed. Exclusionary criteria included concomitant ex

Constraining the magnitude of the Chiral Magnetic Effect with Event Shape Engineering in Pb-Pb collisions at sNN\sqrt{s_{\rm NN}} = 2.76$ TeV

In ultrarelativistic heavy-ion collisions, the event-by-event variation of the elliptic flow $v_2$ reflects fluctuations in the shape of the initial state of the system. This allows to select events with the same centrality but different initial geometry. This selection technique, Event Shape Engineering, has been used in the analysis of charge-dependent two- and three-particle correlations in Pb-Pb collisions at $\sqrt{s_{_{\rm NN}}} =2.76$ TeV. The two-particle correlator $\langle \cos(\varphi_\alpha - \varphi_\beta) \rangle$, calculated for different combinations of charges $\alpha$ and $\beta$, is almost independent of $v_2$ (for a given centrality), while the three-particle correlator $\langle \cos(\varphi_\alpha + \varphi_\beta - 2\Psi_2) \rangle$ scales almost linearly both with the event $v_2$ and charged-particle pseudorapidity density. The charge dependence of the three-particle correlator is often interpreted as evidence for the Chiral Magnetic Effect (CME), a parity violating effect of the strong interaction. However, its measured dependence on $v_2$ points to a large non-CME contribution to the correlator. Comparing the results with Monte Carlo calculations including a magnetic field due to the spectators, the upper limit of the CME signal contribution to the three-particle correlator in the 10-50% centrality interval is found to be 26-33% at 95% confidence level

Constraining the magnitude of the chiral magnetic effect with event shape engineering in Pb–Pb collisions at √sNN=2.76 TeV

In ultrarelativistic heavy-ion collisions, the event-by-event variation of the elliptic flow v2 reflects fluctuations in the shape of the initial state of the system. This allows to select events with the same centrality but different initial geometry. This selection technique, Event Shape Engineering, has been used in the analysis of charge-dependent two- and three-particle correlations in Pb–Pb collisions at √sNN=2.76 TeV. The two-particle correlator 〈cos⁡(φα−φβ)〉, calculated for different combinations of charges α and β, is almost independent of v2 (for a given centrality), while the three-particle correlator 〈cos⁡(φα+φβ−2Ψ2)〉 scales almost linearly both with the event v2 and charged-particle pseudorapidity density. The charge dependence of the three-particle correlator is often interpreted as evidence for the Chiral Magnetic Effect (CME), a parity violating effect of the strong interaction. However, its measured dependence on v2 points to a large non-CME contribution to the correlator. Comparing the results with Monte Carlo calculations including a magnetic field due to the spectators, the upper limit of the CME signal contribution to the three-particle correlator in the 10–50% centrality interval is found to be 26–33% at 95% confidence level

Kaon femtoscopy in Pb–Pb collisions at √sNN = 2.76 TeV

We present the results of three-dimensional femtoscopic analyses for charged and neutral kaons recorded by ALICE in Pb-Pb collisions at sNN−−−√ = 2.76 TeV. Femtoscopy is used to measure the space-time characteristics of particle production from the effects of quantum statistics and final-state interactions in two-particle correlations. Kaon femtoscopy is an important supplement to that of pions because it allows one to distinguish between different model scenarios working equally well for pions. In particular, we compare the measured 3D kaon radii with a purely hydrodynamical calculation and a model where the hydrodynamic phase is followed by a hadronic rescattering stage. The former predicts an approximate transverse mass (mT) scaling of source radii obtained from pion and kaon correlations. This mT scaling appears to be broken in our data, which indicates the importance of the hadronic rescattering phase at LHC energies. A kT scaling of pion and kaon source radii is observed instead. The time of maximal emission of the system is estimated using the three-dimensional femtoscopic analysis for kaons. The measured emission time is larger than that of pions. Our observation is well supported by the hydrokinetic model predictions

π0 and η meson production in proton-proton collisions at √s = 8 TeV

An invariant differential cross section measurement of inclusive π0 and η meson production at mid-rapidity in pp collisions at s√=8 TeV was carried out by the ALICE experiment at the LHC. The spectra of π0 and η mesons were measured in transverse momentum ranges of 0.33.5 GeV/c. However, a deviation from this empirical scaling rule is observed for transverse momenta below pT<3.5 GeV/c in the η/π0 ratio with a significance of 6.2σ

The ALICE Transition Radiation Detector: construction, operation, and performance

The Transition Radiation Detector (TRD) was designed and built to enhance the capabilities of the ALICE detector at the Large Hadron Collider (LHC). While aimed at providing electron identification and triggering, the TRD also contributes significantly to the track reconstruction and calibration in the central barrel of ALICE. In this paper the design, construction, operation, and performance of this detector are discussed. A pion rejection factor of up to 410 is achieved at a momentum of 1 GeV/ c in p–Pb collisions and the resolution at high transverse momentum improves by about 40% when including the TRD information in track reconstruction. The triggering capability is demonstrated both for jet, light nuclei, and electron selection

Searches for transverse momentum dependent flow vector fluctuations in Pb–Pb and p–Pb collisions at the LHC

The measurement of azimuthal correlations of charged particles is presented for Pb-Pb collisions at sNN−−−√= 2.76 TeV and p-Pb collisions at sNN−−−√= 5.02 TeV with the ALICE detector at the CERN Large Hadron Collider. These correlations are measured for the second, third and fourth order flow vector in the pseudorapidity region |η|<0.8 as a function of centrality and transverse momentum pT using two observables, to search for evidence of pT-dependent flow vector fluctuations. For Pb-Pb collisions at 2.76 TeV, the measurements indicate that pT-dependent fluctuations are only present for the second order flow vector. Similar results have been found for p-Pb collisions at 5.02 TeV. These measurements are compared to hydrodynamic model calculations with event-by-event geometry fluctuations in the initial state to constrain the initial conditions and transport properties of the matter created in Pb-Pb and p-Pb collisions

Measurement of deuteron spectra and elliptic flow in Pb–Pb collisions at √sNN = 2.76 TeV at the LHC

The transverse momentum (pT) spectra and elliptic flow coefficient (v2) of deuterons and anti-deuterons at mid-rapidity (|y|1.8 GeV/c within the experimental uncertainties. The measurement of the coalescence parameter B2 is performed, showing a pT dependence in contrast with the simplest coalescence model, which fails to reproduce also the measured v2 coefficient. In addition, the coalescence parameter B2 and the elliptic flow coefficient in the 20-40% centrality interval are compared with the AMPT model which is able, in its version without string melting, to reproduce the measured v2(pT) and the B2(pT) trend