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

A comparative study on the actual and estimated seismic response of Kiralkizi Dam in Turkey

Kiralkizi Dam, a 120 in high earthfill dam located in Diyarbakir city, Turkey, was shaken by a moment magnitude, M-w = 4.6 earthquake at an epicentral distance of 8 km, on December 24, 2000, at 13:31 local time. The seismic response of the dam was assessed by using spectral ratios between (i) available crest and foundation records (C/F), (ii) horizontal and vertical components of the recorded motions (H/V), (iii) by performing 2 dimensional finite difference-based seismic response analyses (Flac-2D), and (iv) 1D elastic shear beam solutions. First mode of vibration of the dam in the transverse direction by all four methods were estimated in the range of 0.55 to 0.62 second. Similar close agreement was not observed in higher modal periods estimated by H/V technique as compared to the predictions by C/F, Flac-2D, shear beam analysis techniques. Thus, H/V technique was concluded to be useful for the estimation of the fundamental resonance frequency of a soil structure, but not for its higher harmonics as consistent with available limited literature. In the longitudinal direction, natural period of the dam was estimated as 0.28 and 0.82 second by H/V and C/F techniques, respectively. Such disagreement was explained by (i) differences in the definitions of the estimated periods, (ii) internal impedance contrast of the dam, (iii) contributions of 3D valley effects. Single seismometer record obtained from crest level was found to be inadequate for reliably assessing the response of a dam in the longitudinal direction, and it is recommended to install multiple seismometers both within dambody and the abutments. Last but not least, the results of these analyses were further compared by available accelograms recorded at three earthfill and rockfill dams from Japan. In general, it was concluded that the seismic response of Kiralkizi Dam is comparable and within the prediction ranges of available analyses methods and is consistent with the expected response of a dam this height

The determination of relationship between "excision repair cross-complementing group 1" (ERCC1) gene T19007C and C8092A single nucleotide polymorphisms and clinicopathological parameters in non-small cell lung cancer.

DNA repair plays a key role in prevention of carcinogenesis and one of the most important DNA repair mechanisms is nucleotide excision repair (NER) pathway. This pathway includes a number of genes such as excision repair cross-complementing group 1 (ERCC1) gene which are responsible for the 5' incision of damaged DNA. A reduced DNA repair capacity associated with ERCC1 mRNA level has been observed in lung carcinogenesis. Two single nucleotide polymorphisms (SNPs) in ERCC1 gene, T19007C (rs11615) and C8092A (rs3212986), reportedly predict to affect the mRNA of ERCC1 in non-small cell lung cancer (NSCLC). To examine the role of two common SNPs in ERCC1 gene further, we conducted this study where 80 cases histopatologically diagnosed as NSCLC were genotyped. Genomic DNA was extracted from formalin-fixed, paraffin embedded tissues and two SNPs were analyzed using real-time PCR. The distributions of TT, TC, and CC genotypes of the T19007C SNP were 40, 44 and 16%, respectively. Significantly increased frequency of the patients carrying at least one 19007C allele was observed in early stage compared to advanced stage (P=0.002). And also, the frequency of TC and CC genotypes significantly increased in younger patients compared to older patients (P=0.035). Regarding C8092A SNP, the distribution of CC, CA, and AA genotypes was 38, 51 and 11%, respectively. There was no significant difference in the genotype distribution between C8092A SNP and clinicopathological parameters. This study indicated that harboring at least one 19007C allele may have protective effect in NSCLC