13 research outputs found

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

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    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

    Effectiveness of probiotics in the prevention of carious lesions during treatment with fixed orthodontic appliances.

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    The antigenic anatomy of SARS-CoV-2 receptor binding domain

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    Antibodies are crucial to immune protection against SARS-CoV-2, with some in emergency use as therapeutics. Here, we identify 377 human monoclonal antibodies (mAbs) recognizing the virus spike and focus mainly on 80 that bind the receptor binding domain (RBD). We devise a competition data-driven method to map RBD binding sites. We find that although antibody binding sites are widely dispersed, neutralizing antibody binding is focused, with nearly all highly inhibitory mAbs (IC50 < 0.1 μg/mL) blocking receptor interaction, except for one that binds a unique epitope in the N-terminal domain. Many of these neutralizing mAbs use public V-genes and are close to germline. We dissect the structural basis of recognition for this large panel of antibodies through X-ray crystallography and cryoelectron microscopy of 19 Fab-antigen structures. We find novel binding modes for some potently inhibitory antibodies and demonstrate that strongly neutralizing mAbs protect, prophylactically or therapeutically, in animal models

    Surface decontamination treatments for improving the safety of meat and poultry

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    The microbiological safety of raw beef and poultry products continue to be one of the major concerns of the meat industry. In 2011, an estimated 9.4 million illnesses, 55,961 hospitalizations, and 1,351 deaths were attributed to known foodborne pathogens in the USA including Norovirus caused the most illnesses; nontyphoidal Salmonella spp., norovirus, Campylobacter spp., and Toxoplasma gondii caused the most hospitalizations; and nontyphoidal Salmonella spp., T. gondii, Listeriamonocytogenes, and norovirus caused the most deaths [Scallan et al. (Emerg Infect Dis 17:7–15, 2011)]. Several factors influence the incidence of pathogens in the meat and poultry food supply, some of the more important factors are livestock production practices that may inadvertently foster pathogen contamination; the emergence of “new” and antibiotic-resistant pathogens in the environment; increased manipulation and handling and accelerated processing of carcasses and raw materials; modification of traditional processing practices and greater complexity of manufacturing procedures and equipment; a more complex distribution and food preparation system that increases the risk of foodborne disease; more discriminate and selective pathogen detection methods to improve confirmation and trace-back of contaminated product; and consumer habits that represent inappropriate food handling and preparation practices [Keeton and Eddy (Preharvest and postharvest food safety—contemporary issues and future directions. Blackwell, Ames, 2004)]. The surface decontamination treatments of meat and poultry could improve the safety of these products and help to reduce foodborne illnesses. Details of some surface decontamination treatments of raw meat and poultry are discussed in this review. © 2014, Springer Science+Business Media New York
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