Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Thigh-length compression stockings and DVT after stroke

Controversy exists as to whether neoadjuvant chemotherapy improves survival in patients with invasive bladder cancer, despite randomised controlled trials of more than 3000 patients. We undertook a systematic review and meta-analysis to assess the effect of such treatment on survival in patients with this disease

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Background Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery. Methods This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy. Results Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51–19.97) than planned admissions (OR: 2.32, 95% CI: 1.43–3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8–51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI. Conclusions After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies

Emotional processing in Parkinson's disease and anxiety: an EEG study of visual affective word processing

A general problem in the design of an EEG-BCI system is the poor quality and low robustness of the extracted features, affecting overall performance. However, BCI systems that are applicable in real-time and outside clinical settings require high performance. Therefore, we have to improve the current methods for feature extraction. In this work, we investigated EEG source reconstruction techniques to enhance the extracted features based on a linearly constrained minimum variance (LCMV) beamformer. Beamformers allow for easy incorporation of anatomical data and are applicable in real-time. A 32-channel EEG-BCI system was designed for a two-class motor imagery (MI) paradigm. We optimized a synchronous system for two untrained subjects and investigated two aspects. First, we investigated the effect of using beamformers calculated on the basis of three different head models: a template 3-layered boundary element method (BEM) head model, a 3-layered personalized BEM head model and a personalized 5-layered finite difference method (FDM) head model including white and gray matter, CSF, scalp and skull tissue. Second, we investigated the influence of how the regions of interest, areas of expected MI activity, were constructed. On the one hand, they were chosen around electrodes C3 and C4, as hand MI activity theoretically is expected here. On the other hand, they were constructed based on the actual activated regions identified by an fMRI scan. Subsequently, an asynchronous system was derived for one of the subjects and an optimal balance between speed and accuracy was found. Lastly, a real-time application was made. These systems were evaluated by their accuracy, defined as the percentage of correct left and right classifications. From the real-time application, the information transfer rate (ITR) was also determined. An accuracy of 86.60 ± 4.40% was achieved for subject 1 and 78.71 ± 0.73% for subject 2. This gives an average accuracy of 82.66 ± 2.57%. We found that the use of a personalized FDM model improved the accuracy of the system, on average 24.22% with respect to the template BEM model and on average 5.15% with respect to the personalized BEM model. Including fMRI spatial priors did not improve accuracy. Personal fine- tuning largely resolved the robustness problems arising due to the differences in head geometry and neurophysiology between subjects. A real-time average accuracy of 64.26% was reached and the maximum ITR was 6.71 bits/min. We conclude that beamformers calculated with a personalized FDM model have great potential to ameliorate feature extraction and, as a consequence, to improve the performance of real-time BCI systems

Safety of Nonsteroidal Anti-inflammatory Drugs in Major Gastrointestinal Surgery: A Prospective, Multicenter Cohort Study

Background Significant safety concerns remain surrounding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) following gastrointestinal surgery, leading to wide variation in their use. This study aimed to determine the safety profile of NSAIDs after major gastrointestinal surgery. Methods Consecutive patients undergoing elective or emergency abdominal surgery with a minimum one-night stay during a 3-month study period were eligible for inclusion. The administration of any NSAID within 3 days following surgery was the main independent variable. The primary outcome measure was the 30-day postoperative major complication rate, as defined by the Clavien–Dindo classification (Clavien–Dindo III–V). Propensity matching with multivariable logistic regression was used to produce odds ratios (OR) and 95 % confidence intervals. Results From 9264 patients, 23.9 % (n = 2212) received postoperative NSAIDs. The overall major complication rate was 11.5 % (n = 1067). Following propensity matching and adjustment, use of NSAIDs were not significantly associated with any increase in major complications (OR 0.90, 0.60–1.34, p = 0.560). Conclusions Early use of postoperative NSAIDs was not associated with an increase in major complications following gastrointestinal surgery