Influence of Hospital Volume on Nephrectomy Mortality and Complications: A Systematic Review and Meta-analysis Stratified by Surgical Type

Objectives The provision of complex surgery is increasingly centralised to high volume specialist hospitals. Evidence to support nephrectomy centralisation however has been inconsistent. We conducted a systematic review and meta-analysis to determine the association between hospital case volumes and perioperative outcomes in radical nephrectomy, partial nephrectomy and nephrectomy with venous thrombectomy. Methods Medline, Embase and the Cochrane Library were searched for relevant studies published between 1990 and 2016. Pooled effect estimates for nephrectomy mortality and complications were calculated for each nephrectomy type using the DerSimonian and Laird random-effects model. Sensitivity analyses were performed to examine the effects of heterogeneity on the pooled effect estimates by excluding studies with the heaviest weighting, lowest methodological score, and most likely to introduce bias from misclassification of standardised hospital volume. Results Some 226,372 patients from sixteen publications were included in our review and meta-analysis. Considerable between-study heterogeneity was noted and only a few reported volume-outcome relationships specifically in partial nephrectomy or nephrectomy with venous thrombectomy. High volume hospitals were correlated with a 26% and 52% reduction in mortality for radical nephrectomy (OR 0.74, 95% CI 0.61-0.90, p<0.01) and nephrectomy with venous thrombectomy (OR 0.48, 95% CI 0.29-0.81, p<0.01) respectively. In addition, radical nephrectomy in high volume hospitals was associated with an 18% reduction in complications (OR 0.82, 95% CI 0.73-0.92, p<0.01). No significant volume-outcome relationship in mortality (OR 0.84, 95% CI 0.31-2.26, p=0.73) or complications (OR 0.85, 95% CI 0.55-1.30, p=0.44) was observed for partial nephrectomy. Conclusions Our findings suggest that patients undergoing radical nephrectomy have improved outcomes when treated by high volume hospitals. Evidence of this in partial nephrectomy and nephrectomy with venous thrombectomy is however not yet clear and could be secondary to the low number of studies included and the small patient number in our analyses. Further investigation is warranted to establish the full potential of nephrectomy centralisation particularly as existing evidence is of low quality with significant heterogeneity.This work was supported by Addenbrooke’s Charitable Trust, the Royal College of Surgeons of England and the Urology Foundation. Cancer Research UK Advanced Clinician Scientist Fellowship award (No. C18081/A18180) has supported GL and TS

Direct observation of the evolving metal–support interaction of individual cobalt nanoparticles at the titania and silica interface

Understanding the metal–support interaction (MSI) is crucial to comprehend how the catalyst support affects performance and whether this interaction can be exploited in order to design new catalysts with enhanced properties. Spatially resolved soft X-ray absorption spectroscopy (XAS) in combination with Atomic Force Microscopy (AFM) and Scanning Helium Ion-Milling Microscopy (SHIM) has been applied to visualise and characterise the behaviour of individual cobalt nanoparticles (CoNPs) supported on two-dimensional substrates (SiOxSi(100) (x < 2) and rutile TiO2(110)) after undergoing reduction–oxidation–reduction (ROR). The behaviour of the Co species is observed to be strongly dependent on the type of support. For SiOxSi a weaker MSI between Co and the support allows a complete reduction of CoNPs although they migrate and agglomerate. In contrast, a stronger MSI of CoNPs on TiO2 leads to only a partial reduction under H2 at 773 K (as observed from Co L3-edge XAS data) due to enhanced TiO2 binding of surface-exposed cobalt. SHIM data revealed that the interaction of the CoNPs is so strong on TiO2, that they are seen to spread at and below the surface and even to migrate up to ∼40 nm away. These results allow us to better understand deactivation phenomena and additionally demonstrate a new understanding concerning the nature of the MSI for Co/TiO2 and suggest that there is scope for careful control of the post-synthetic thermal treatment for the tuning of this interaction and ultimately the catalytic performance

Simulation for the oblique impact of a lattice system

The oblique collision between an elastic disk and an elastic wall is numerically studied. We investigate the dependency of the tangential coefficient of restitution on the incident angle of impact. From the results of simulation, our model reproduces experimental results and can be explained by a phenomenological theory of the oblique impact.Comment: 30 pages, 9 figures, submitted to J. Phys. Soc. Japa

Human immunodeficiency virus infection in Northern Ireland 1980-1989.

To 31st December 1989, 71 persons are known to have attended medical practitioners in Northern Ireland with a diagnosis of Human Immunodeficiency Virus (HIV) infection. Twenty-one of these persons have had the diagnosis of Acquired Immune Deficiency Syndrome (AIDS) and 11 have died. The distribution of reports in the "at risk" categories of homosexual/bisexual males, injecting drug users, heterosexual males and females was significantly different (p less than 0.001) from those reported in the United Kingdom as a whole. Of tests for HIV infection carried out in patients attending the genitourinary medicine department of the Royal Victoria Hospital between 1987-1989, 0.16% have been positive. The prognostic value of the T4 lymphocyte count at presentation for the subsequent development of AIDS was significant (p = 0.0011). The commonest AIDS indicator disease diagnosed was Pneumocystis carinii pneumonia which was seen in seven of the 21 patients (33%)

Development and adoption of improved chickpea varieties in Myanmar

Chickpea (Cicer arietinum) is an important food legume in Myanmar. It is mainly grown in central dry zone of the country, mainly in Sagaing (54%), Magway (26%) and Mandalay (16%) divisions (Table 1). During 2004–05, the chickpea area in Myanmar was about 205,000 ha, with a production of 239,000 t, and average yield was 1,171 kg ha-1. Chickpea is grown under residual soil moisture in both lowland and upland conditions. In lowland areas, it is grown as a relay or sequential crop after rice (Oryza sativa), while in upland areas it is grown mostly on black soils (Vertisols) with a good water holding capacity after an early short-duration crop of sesame (Sesamum indicum), maize (Zea mays) or pulses or after fallow. Chickpea is also sown along the banks of Ayeyarwaddy River after the flood water recedes

In silico analyses of metagenomes from human atherosclerotic plaque samples

Background Through several observational and mechanistic studies, microbial infection is known to promote cardiovascular disease. Direct infection of the vessel wall, along with the cardiovascular risk factors, is hypothesized to play a key role in the atherogenesis by promoting an inflammatory response leading to endothelial dysfunction and generating a proatherogenic and prothrombotic environment ultimately leading to clinical manifestations of cardiovascular disease, e.g., acute myocardial infarction or stroke. There are many reports of microbial DNA isolation and even a few studies of viable microbes isolated from human atherosclerotic vessels. However, high-resolution investigation of microbial infectious agents from human vessels that may contribute to atherosclerosis is very limited. In spite of the progress in recent sequencing technologies, analyzing host-associated metagenomes remain a challenge. Results To investigate microbiome diversity within human atherosclerotic tissue samples, we employed high-throughput metagenomic analysis on: (1) atherosclerotic plaques obtained from a group of patients who underwent endarterectomy due to recent transient cerebral ischemia or stroke. (2) Presumed stabile atherosclerotic plaques obtained from autopsy from a control group of patients who all died from causes not related to cardiovascular disease. Our data provides evidence that suggest a wide range of microbial agents in atherosclerotic plaques, and an intriguing new observation that shows these microbiota displayed differences between symptomatic and asymptomatic plaques as judged from the taxonomic profiles in these two groups of patients. Additionally, functional annotations reveal significant differences in basic metabolic and disease pathway signatures between these groups. Conclusions We demonstrate the feasibility of novel high-resolution techniques aimed at identification and characterization of microbial genomes in human atherosclerotic tissue samples. Our analysis suggests that distinct groups of microbial agents might play different roles during the development of atherosclerotic plaques. These findings may serve as a reference point for future studies in this area of research

Dispersive resonance bands within the space charge layer of metal- semiconductor junction

Based on measurements of angle resolved photoemission, we report that in the Pb/Ge(111)- \sqrt{3}x\sqrt{3} R30^\circ structure, in addition to three bands resembling Ge heavy hole (HH), light hole (LH), and split off (SO) bulk band edges, a fourth dispersive band resembling the non split off (NSO) band is found near the surface zone center. While three Ge bulk-like bands get distorted due to strong coupling between Pb and Ge, the NSO-like band gets weaker and disappears for larger thickness of Pb, which, when combined with ab initio calculations, indicates its localized nature within space charge layer. Our results are clearly important for designing electronics involved with metal-semiconductor contacts.Comment: 21 pages, 4 figures, Phys. Rev. B 81, 245406 (2010