Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Electrochemical cross-linking of carbazole derivatives: a new route for bulk heterojunction based on semi-interpenetrating polymer networks

Electrochemical behaviors of different pendant carbazole based oligomers have been studied for the realization of electroactive tridimensional structures. 3-substitution by hydrazone functional groups onto the pendant carbazole moieties increases the electron donor properties of the electroactive units. Electrochemical oxidation of thin films of the oligomer precursors deposited onto electrode ensures the formation of a cross-linked structure by in situ anodic coupling with the formation of biscarbazole redox sites. When the electrochemical cross-linking of the oligomers is realized in the presence of the electron acceptor polyimide (perylene based), we form a semi-interpenetrating polymer network (semi-IPN) coated as a thin layer. The electrochemical behavior of the semi-IPN shows two reversible oxidations and two reversible reduction peaks indicating respectively the p-doping of the biscarbazole entity and the n-doping of the perylene one. The presence of hydrazone substituents modifies the electron donor properties of the semi-IPN and should influence the electron transfer properties from biscarbazole to perylene units in bulk heterojunction solar cells

Microwave-assisted cationic ring-opening polymerization of 2-oxazolines

More than any other polymer class, the synthesis of (co-) poly (2-oxazoline) s has benefited tremendously from the introduction of microwave reactors into chemical laboratories. This review focuses on research activities in the area of (co-) poly(2-oxazoline) s prepared by microwave-assisted syntheses and summarizes the current state-of-the-art for microwave-assisted syntheses of 2-oxazoline monomers, microwave-assisted ring-opening (co-)polymerizations of 2-oxazolines, and prominent examples of post-polymerization modifications of (co-)poly(2-oxazoline) s. Special attention is paid to kinetic analyses of the microwave-assisted polymerization of 2-oxazolines and to the discussion of non-thermal microwave effects