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

“We are the soul, pearl and beauty of Hindu Kush Mountains”: exploring resilience and psychological wellbeing of Kalasha, an ethnic and religious minority group in Pakistan

The Kalasha are a marginalized ethnic and religious minority group in northern Pakistan. The Kalasha minority is known for their divergent polytheistic beliefs, and represents the outliers of the collectively monotheistic Muslim population of Pakistan. This study aimed to explore the psychological resilience beliefs and lived experiences of the Kalasha and to identify cultural protective factors and indigenous beliefs that help them maintain psychological wellbeing and resilience. Seven semi-structured interviews and two focus-group discussions were conducted. The total sample consisted of 6 women and 8 men, aged 20–58 years (Mage = 36.29, SD = 12.58). The Interpretative Phenomenological Analysis qualitative method was chosen. Study findings identified that factors contributing to the wellbeing, happiness and resilience enhancement beliefs of Kalasha included five main themes, all influenced by their unique spirituality: contentment, pride in social identity, tolerance, gender collaboration and gratitude. The study also revealed the Kalasha’s perception of their marginalization related to challenges and threats. The Kalasha emphasized bringing these resilience enhancement beliefs into practice, as a mean to buffer against challenges. In conclusion, this study revealed Kalasha’s wellbeing and resilience enhancement factors, which they believed in and practiced as an element of their indigenous culture and religion

Sequence effects in cued task switching modulate response preparedness and repetition priming processes

In task-switching paradigms, reaction time (RT) switch cost is eliminated on trials after a no-go trial (no-go/go sequence effect). We examined the locus of no-go interference on task-switching performance by comparing the event-related potential (ERP) time course of go/go and no-go/go sequences from cue onset to response execution. We also examined whether noninformative trials (i.e., delayed reconfiguration, no response inhibition) produce similar sequence effects. Participants switched using informative and noninformative cues (Experiment 2) intermixed with no-go trials (Experiment 1). Repeat RT was slower for both no-go/informative (pNG/I) and noninformative/informative (pNI/I) than informative/informative sequences. ERPs linked to anticipatory preparation showed no effect of trial sequence. ERPs indicated that pNG/I sequences reduce response readiness whereas pNI/I sequences reduce repetition benefit for repeat trials. Implications for task-switching models are discussed

Motor and non-motor inhibition in the Go/NoGo task: an ERP and fMRI study

The contribution of movement-related activity to Go/NoGo ERP differences has been debated for 25 years. In this study, we examined ERP and fMRI measures of activity in twenty adults performing non-motor (count)and motor (right-handed button press) trials of the Go/NoGo task. Task performance was highly accurate and similar in the ERP and fMRI environments. No significant task-related effects were observed for the N2 component; however, we observed a substantial increase in positivity for Press NoGo compared to Count NoGo trials. The fMRI results also revealed significant deactivations for Press NoGo relative to Count NoGo trials in several left-lateralised motor-related areas, including the inferior frontal gyrus, precentral gyrus and supplementary motor area. Together, the results indicate that the P3 NoGo>Go effect in motor tasks is caused not by movement-related negativity on Go trials but by inhibition-related positivity on NoGo trials, and that this is associated with deactivation of motor areas involved in the Go response

Comparative study of various grading systems in oral squamous cell carcinoma and their value in predicting lymph node metastasis

Background: Regional lymph node (LN) metastasis is the single most prognostic factor for oral squamous cell carcinoma (OSCC). An analysis of the prognostic factors is important for predicting prognosis and reducing the mortality in these patients. Objectives: (1) To compare the value of various grading systems in predicting LN metastasis. (2) To evaluate histopathological parameters, which could help in predicting LN metastasis. Materials and Methods: A total of 20 excisional biopsies of OSCCs, were graded according to the four grading systems that is, Broder′s, Jakobsson′s, Anneroth and Hansen′s, and Brynes. We also evaluated various histopathological parameters, which could help in predicting LN metastasis. Results: Grading at the invasive front was most prognostic of LN metastasis. Tumors with total malignancy score ≥8 showed higher incidence of metastases. Conclusion: The histopathological parameters that could help in predicting lymph node metastases (LNM) are keratinization, nuclear pleomorphism (NP), and the pattern of invasion (POI) when assessed at the invasive front. When the whole tumor was considered, histopathological parameters like NP and POI were significant in predicting LNM

Multiple sources underlie ERP indices of task-switching

Previous investigations of task-switching have reported that cue-related processes are indexed by a differential switch positivity (D-Pos) and that stimulus-related processes are indexed by a differential switch-negativity (D-Neg). The aim of the current study was to use low resolution electromagnetic tomography to localize the sources of D-Pos and D-Neg. Participants switched randomly between simple tasks and showed an increase in reaction time (RT) for switch relative to repeat trials, i.e., an RT switch cost. ERP waveforms showed a D-Pos in the cue-related interval and a D-Neg in the stimulus-related interval. D-Pos was localized to the superior parietal cortex, supporting arguments that D-Pos is associated with activating task rules during anticipatory reconfiguration. D-Neg was localized to the dorsolateral prefrontal cortex, implicating D-Neg in post-stimulus control

The spatial and temporal dynamics of anticipatory preparation and response inhibition in task-switching

We investigated ERP and fMRI correlates of anticipatory preparation and response inhibition in a cued task-switching paradigm with informatively cued, non-informatively cued and no-go trials. Cue-locked ERPs showed evidence for a multicomponent preparation process. An early cue-locked differential positivity was larger for informative vs. non-informative cues and its amplitude correlated with differential activity for informatively vs. non-informatively cued trials in the dorsolateral prefrontal cortex (DLPFC), consistent with a goal activation process. A later differential positivity was larger for informatively cued switch vs. repeat trials and its amplitude correlated with informatively cued switch vs. repeat activity in the posterior parietal cortex (PPC), compatible with a category-response (C-R) rule activation process. No-go trials elicited a frontal P3, whose amplitude was negatively correlated with activity in the ventrolateral prefrontal cortex (VLPFC) and basal ganglia motor network, suggesting that a network responsible for response execution was inhibited in the course of a no-go trial. These findings indicate that anticipatory preparation in task-switching is comprised of at least two processes: goal activation and C-R rule activation. They also support a functional dissociation between DLPFC and VLPFC, with the former involved in top-down biasing and the latter involved in response inhibition

Blood pressure variability and structural brain changes: a systematic review

Background: Blood pressure variability (BPV) has been linked with cognitive impairment and dementia. However, the pathophysiological mechanisms by which BPV affects cognition are unclear. This systematic review aims to assess the links between different BPV measures and white and grey matter structures. Methods and results: The following databases were searched from inception through to January 2021; EMBASE, MEDLINE, EMCARE and SCOPUS. Studies that reported on the relationship between within-individual BPV (short, medium or long-term variability) or a circadian blood pressure (BP) measurement and MRI assessed brain structures were included. Overall, 20 studies met the criteria and were included, of which 11 studies looked at short-term BPV, eight articles investigated visit-to-visit BPV and one study looked at a compositional BPV measurement. Due to heterogeneity in study samples, meta-analysis was not possible. Across the included studies, associations between MRI indices and BP dipping patterns were mixed; higher long-term BPV and higher sleep systolic BPV was found to be associated with lower whole brain volume and hippocampal volume. Conclusion: Increased BPV, in particular systolic long-term and systolic night-time BPV, appears to be associated with lower brain volume and hippocampal volume. This highlights the adverse effect that increased BPV has upon the brain, potentially contributing to cognitive decline, including dementia, in late-life.Gutteridge, Daria S., Tully, Phillip J., Ghezzi, Erica S., Jamadar, Sharna, Smith, Ashleigh E., Commerford, Toby, Keage, Hannah A.D

P O B o x 1 1 7 2 2 1 0 0 L u n d + 4 6 4 6 -2 2 2 0 0 0 0 Intentional suppression can lead to a reduction of memory strength: Behavioral and electrophysiological findings Intentional suppression can lead to a reduction of memory strength: behavioral and

Previous research has shown that the intentional suppression of unwanted memories can lead to forgetting in later memory tests. However, the mechanisms underlying this effect remain unclear. This study employed recognition memory testing and event-related potentials (ERPs) to investigate whether intentional suppression leads to the inhibition of memory representations at an item level. In a think/no-think experiment, participants were cued to either suppress (no-think condition) or retrieve (think condition) previously learned words, 18 or 0 times. Performance in a final recognition test was significantly reduced for repeatedly suppressed no-think items when compared to the baseline, zero-repetition condition. ERPs recorded during the suppression of no-think items were significantly more negativegoing in a time window around 300 ms when compared to ERPs in the think condition. This reduction correlated with later recognition memory impairment. Furthermore, ERPs to no-think items from 225 to 450 ms were more negative-going in later phases of the experiment, suggesting a gradual reduction of memory strength with repeated suppression attempts.These effects were dissociable from correlates of recollection (500-600 ms) and inhibitory control (450-500 ms) that did not vary over the time-course of the experiment and appeared to be under strategic control. Our results give strong evidence that the no-think manipulation involves inhibition of memory representations at an item level

Current standards of surgical management of gastric cancer: an appraisal.

PURPOSE Gastric cancer (GC) is the fifth most common malignancy worldwide and portends a grim prognosis due to a lack of appreciable improvement in 5-year survival. We aimed to analyze the available literature and summarize the current standards of surgical care for curative and palliative intent treatment of GC. METHODS We conducted a systematic search on the PubMed database for studies on the management of GC. RESULTS Endoscopic resection is an acceptable treatment option for T1a tumors. The role of optimal resection margin for GC remains unclear. D2 lymph node dissection remains the standard of care with splenectomy needed selectively for splenic hilum involvement. A distal pancreatic resection should be avoided. The advantage of bursectomy and omentectomy in GC surgery is not clear. Multi-visceral resection may be considered for locally advanced GC in carefully selected patients. Minimally invasive approaches are non-inferior to open surgery. Surgery should be abandoned prior even in metastatic GC within the frame of multimodal therapy approach. CONCLUSION Various trials have conclusively shown improved patient outcomes when well-established surgical standards are followed