Predictive factors in the long term outcome in gastro-oesophageal reflux disease: six years follow up of 107 patients

There is little information concerning the long term outcome of patients with gastro-oesophageal reflux disease (GORD). Thus 109 patients with reflux symptoms (33 with erosive oesophagitis) with a diagnosis of GORD after clinical evaluation and oesophageal testing were studied. All patients were treated with a stepwise approach: (a) lifestyle changes were suggested aimed at reducing reflux and antacids and the prokinetic agent domperidone were prescribed; (b) H2 blockers were added after two months when symptoms persisted; (c) anti-reflux surgery was indicated when there was no response to (b). Treatment was adjusted to maintain clinical remission during follow up. Long term treatment need was defined as minor when conservative measures sufficed for proper control, and as major if daily H2 blockers or surgery were required. The results showed that one third of the patients each had initial therapeutic need (a), (b), and (c). Of 103 patients available for follow up at three years and 89 at six years, respective therapeutic needs were minor in 52% and 55% and major in 48% and 45%. Eighty per cent of patients in (a), 67% in (b), and 17% in (c) required only conservative measures at six years. A decreasing lower oesophageal sphincter pressure (p < 0.001), radiological reflux (p = 0.028), and erosive oesophagitis (p = 0.031), but not initial clinical scores, were independent predictors of major therapeutic need as shown by multivariate analysis. The long term outcome of GORD is better than previously perceived

Round robin tests on laser ablation and quantitative analysis by LIBS

Referring to the “Seven ages of an analytical method” proposed by Laitinen in 19731, LIBS may be presently considered at the threshold of the sixth one, when the number of applications of the technique has significantly increased, and the need of standardization is simultaneously growing. While the preferred scope of LIBS applications is onsite, online or in situ analysis, the diversity of experimental configurations required to address such issues is somewhat contradictory with a standardization approach. An alternative way to make LIBS progress to become a fully mature analytical technique could be the determination of reference performances of different instruments or experimental setups for a given analytical case. Such an approach would have several advantages: 1) Newcomers, both researchers and industrials, could better evaluate if the technique could meet their needs; 2) It would be a solid basis to which enhancement approaches could be compared (e.g. hyphenated techniques, microwave assisted LIBS, etc.); 3) It could help to define good experimental configurations and analytical practices that could be of general interest for any application. For that purpose, two round robin tests have been organized since 2012 within the French LIBS community. The first one involved five laboratories and was focused on the characterization of laser ablation of iron. Very consistent results on the craters volume were obtained, but no correlation was found between the repeatability of laser ablation and that of the LIBS signal. The second one was devoted to quantitative analysis of glass samples. Eleven teams contributed to the work. In spite of the dispersion in the experimental setups and protocols, the results obtained on unknowns showed an acceptable bias, whereas the measurement uncertainty was much more variable among the participants. Overall, the results of those two preliminary round robin tests show that a good reproducibility level is reachable between independent LIBS measurements and, in this sense, are very encouraging for the future

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients