Treatment outcomes in trigeminal neuralgia–a systematic review of domains, dimensions and measures

Background Trigeminal neuralgia (TN) is a painful disorder characterized by sudden electric shock–like pain. It is a rare condition for which multiple treatments are available, including medical and surgical. The best treatment option is yet to be defined, and this is related to the lack of definition in the treatment outcomes and outcome measures. The aim of this systematic review was to summarize all the outcomes and outcomes measures that have been published to date and highlight variability in their use. Methods We have conducted a literature search using a wide range of databases (1946–2019 for medical and 2008–2019 for surgical treatment), for all intervention studies in TN. Four hundred and sixty-seven studies were selected for data extraction on TN classification, data collection method, intervention, and treatment outcomes mapped to the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT guidelines). Results Most studies collected data on pain (n = 459) and side effects (n = 386) domains; however, very few collected data on the impact of treatment on physical (n = 46) and emotional functioning (n = 17) and on patient satisfaction (n = 35). There was high variability on outcome measures used for pain relief (n = 10), pain intensity (n = 9), and frequency of pain episodes (n = 3). Conclusions A clear definition of what are the important outcomes for patients with TN is essential. The choice of standardized outcome measures allowing for consistent reporting in TN treatment will allow for comparison of studies and facilitate treatment choice for patients and clinicians thus, improving health outcomes and reducing health care cost

Balanço de energia em vinhedo de 'Niagara Rosada' Energy balance on 'Niagara Rosada' vineyard

O método do balanço de energia foi utilizado para caracterizar a variação horária do saldo de radiação e dos fluxos de calor latente, sensível e no solo, em vinhedo cultivado com a cultivar NiagaraRosada', conduzida no sistema de espaldeira, em Jundiaí (SP). Além disso, foram determinadas as relações entre o saldo de radiação (SR) no vinhedo e a radiação solar global (RG) e a partição da energia disponível ao sistema nos fluxos de calor latente (LE), sensível (H) e no solo (G). Em um dia característico de período seco, o LE representou 44% do SR e o H, 48%. Em um dia chuvoso, o LE representou 86% do SR e o H, 21%. Em um dia ensolarado, após um período de chuvas, LE e H foram, respectivamente, 68% e 29% do SR. O G foi, em média, 5,7% e 1,3% do SR para as ruas mantidas capinadas e com forro, respectivamente.<br>The energy balance method was used to characterize the hourly variation of the net radiation, latent and sensible fluxes and soil heat flux on a mature vineyard grown at Jundiaí, São Paulo, Brazil. The grapevines, cv. Niagara Rosada, in the vineyard were wrapped to trellis wires, creating compact hedgerows 2 m apart, 1.7 m height and 0.4 wide, with the foliage 1m above the soil surface. Also, the net and incoming radiation relationships and the partioning of the available energy to the system into latent and heat flux, and soil heat flux were determined for the vineyard. During a sunny day (dry period) the latent heat flux was 44% of the net radiation and the sensible heat flux, 48%. However during a rainy day, the latent heat flux was 86% of the net radiation and the sensible heat flux, 21%. During a sunny day, after the occurrence of rain, the latent and sensible heat fluxes were, respectively, 68% and 29% of the net radiation. The soil heat flux was 5.7 an 1.3% of the net radiation, for bare soil and mulched rows, respectively

Predictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: Results from an international snapshot audit

Background: A right hemicolectomy is among the most commonly performed operations for colon cancer, but modern high-quality, multination data addressing the morbidity and mortality rates are lacking. Objective: This study reports the morbidity and mortality rates for right-sided colon cancer and identifies predictors for unfavorable short-term outcome after right hemicolectomy. Design: This was a snapshot observational prospective study. Setting: The study was conducted as a multicenter international study. Patients: The 2015 European Society of Coloproctology snapshot study was a prospective multicenter international series that included all patients undergoing elective or emergency right hemicolectomy or ileocecal resection over a 2-month period in early 2015. This is a subanalysis of the colon cancer cohort of patients. Main Outcome Measures: Predictors for anastomotic leak and 30-day postoperative morbidity and mortality were assessed using multivariable mixed-effect logistic regression models after variables selection with the Lasso method. Results: Of the 2515 included patients, an anastomosis was performed in 97.2% (n = 2444), handsewn in 38.5% (n = 940) and stapled in 61.5% (n = 1504) cases. The overall anastomotic leak rate was 7.4% (180/2444), 30-day morbidity was 38.0% (n = 956), and mortality was 2.6% (n = 66). Patients with anastomotic leak had a significantly increased mortality rate (10.6% vs 1.6% no-leak patients; p 65 0.001). At multivariable analysis the following variables were associated with anastomotic leak: longer duration of surgery (OR = 1.007 per min; p = 0.0037), open approach (OR = 1.9; p = 0.0037), and stapled anastomosis (OR = 1.5; p = 0.041). Limitations: This is an observational study, and therefore selection bias could be present. For this reason, a multivariable logistic regression model was performed, trying to correct possible confounding factors. Conclusions: Anastomotic leak after oncologic right hemicolectomy is a frequent complication, and it is associated with increased mortality. The key contributing surgical factors for anastomotic leak were anastomotic technique, surgical approach, and duration of surgery