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

The Importance Of Quality Of Life For Work Outcomes In Patients With Ankylosing Spondylitis: A Cross-Sectional Study

Aims: Work impairment is one of the most important exploration and one of the aims of rheumatologists. We aimed to determine the risk factors for employment state and predictive factors of work outcomes using multi-dimensional measures in patients with ankylosing spondylitis (AS) in this comprehensive study. Methods: One hundred patients with AS (31 females and 69 males) were included into this study. Demographic properties, local factors, disease activity (BASDAI), functionality (BASFI), spinal mobility (BASMI), radiologic stage (BASRI), quality of life (AS-QoL), cardiopulmonary involvement, exercise stress test and work outcomes were investigated and compared in employed and un-employed patients. The work instability scale (AS-WIS) and work productivity activity impairment scale (WPAI:SpA) were selected as work outcomes. The predictive factors were analyzed using multiple stepwise linear regressions. Results: Thirty-two patients (mean age: 42,6 +/- 11.7) were unemployed and the risk factors for unemployment state were female sex, lower annual income le vel, and older age. Work disability was detected only in 5% of patients. Decreased chest mobility (beta:-0.398, p:<0.001), low annual income level (beta:-0.291, p:<0.001), higher co-morbidities (beta:0.237, p:0.004), poorer ASQoL (beta:0.238, p:0,012) and poorer AS-WIS score (beta:0.289, p:0,004) were the predictors of work impairment. The predictive factors for work instability were higher work impairment (beta: 0.533, p<0.001) and poorer AS-QoL (beta: 0.426, p<0.001) scores. Conclusions: Employment state depends on contextual factors including male sex, higher income, and youn ger age. Socioeconomic factors as well as clinical data such as QoL were predictive for work productivity. Poorer AS-QoL was also a predictive factor for work instability. We suggested effective interventions to improve clinical and economic status in patients with AS.Wo

The role of neoangiogenesis and vascular endothelial growth factor in the development of carpal tunnel syndrome in patients with diabetes

Objective: Carpal tunnel syndrome (CTS) is an entrapment neuropathy which is caused by the disruption of blood supply in the median nerve under transverse carpal ligament. Systemic factors facilitate the formation of the syndrome. In this study, neovascularization in the subsynovial tissue and proliferative activity in the stroma are analyzed within the cases of diabetic and idiopathic CTS.Materials and Methods: Subsynovial connective tissue samples of 30 diabetes mellitus patients with CTS and 30 patients with idiopathic CTS were evaluated. Vascular endothelial growth factor (VEGF), CD31, CD34, Factor VIII‑related antigen, and smooth muscle actin (SMA) was used to make a comparative study of neovascularization. Proliferative index was assessed using anti‑Ki‑67 antibody.Results: As a result of the proliferation of endothelial elements, de novo blood vessel formations in the subsynovial tissue were assessed by vascular markers. Significant neovascularization was seen in diabetic group for VEGF, CD31, SMA (P &lt; 0.01); and for CD34 (P &lt; 0.05) when compared with idiopathic CTS group. In addition, more intense positive staining for CD34, SMA (P &lt; 0.01); and for VEGF (P &lt; 0.05) was found at isolated stromal cells of diabetic CTS group against idiopathic CTS group. Significantly high proliferative index in subsynovial connective tissue with Ki‑67 was observed the diabetic group (P &lt; 0.01).Conclusion: VEGF expression has an importance within CTS pathogenesis. Increased ischemia‑reperfusion damage, neoangiogenesis, and VEGF expression has an important role frequently CTS occurrence in diabetic patients. Our study supports enhancement in VEGF expression similar to changes in diabetic nephropathy and retinopathy in the neovascularization within the subsynovial connective tissue in the cases of diabetes.Key words: Carpal tunnel syndrome, diabetes mellitus, ischemia‑reperfusion, neoangiogenesis, vascular endothelial growth facto

The role of neoangiogenesis and vascular endothelial growth factor in the development of carpal tunnel syndrome in patients with diabetes

Objective: Carpal tunnel syndrome (CTS) is an entrapment neuropathy which is caused by the disruption of blood supply in the median nerve under transverse carpal ligament. Systemic factors facilitate the formation of the syndrome. In this study, neovascularization in the subsynovial tissue and proliferative activity in the stroma are analyzed within the cases of diabetic and idiopathic CTS. Materials and Methods: Subsynovial connective tissue samples of 30 diabetes mellitus patients with CTS and 30 patients with idiopathic CTS were evaluated. Vascular endothelial growth factor (VEGF), CD31, CD34, Factor VIII-related antigen, and smooth muscle actin (SMA) was used to make a comparative study of neovascularization. Proliferative index was assessed using anti-Ki-67 antibody. Results: As a result of the proliferation of endothelial elements, de novo blood vessel formations in the subsynovial tissue were assessed by vascular markers. Significant neovascularization was seen in diabetic group for VEGF, CD31, SMA (P 0.01); and for CD34 (P 0.05) when compared with idiopathic CTS group. In addition, more intense positive staining for CD34, SMA (P 0.01); and for VEGF (P 0.05) was found at isolated stromal cells of diabetic CTS group against idiopathic CTS group. Significantly high proliferative index in subsynovial connective tissue with Ki-67 was observed the diabetic group (P 0.01). Conclusion: VEGF expression has an importance within CTS pathogenesis. Increased ischemia-reperfusion damage, neoangiogenesis, and VEGF expression has an important role frequently CTS occurrence in diabetic patients. Our study supports enhancement in VEGF expression similar to changes in diabetic nephropathy and retinopathy in the neovascularization within the subsynovial connective tissue in the cases of diabetes

THE FACTORS AFFECTING WORKPLACE AND HOUSEHOLD LIFE IN ANKYLOSING SPONDYLITIS: A MULTI-DIMENSIONAL STUDY

Annual European Congress of Rheumatology -- JUN 14-17, 2017 -- Madrid, SPAINWOS: 00041318140130

Systematic literature review of photovoltaic output power forecasting

Since the harmful effects of climate warming on our planet were first observed, the use of renewable energy resources has been significantly increasing. Among the potential renewable energy sources, photovoltaic (PV) system installations keep continuously increasing world-wide due to its economic and environmental contributions. Despite its significant benefits, the inherent variability of PV power generation due to meteorological parameters can cause power management/planning problems. Thus, forecasting of PV output data (directly or indirectly) in an accurate manner is a critical task to provide stability, reliability, and optimisation of the grid systems. In considering the literature reviewed, there are various research items utilizing PV output power forecasting. In this study, a systematic literature review based on the search of primary studies (published between 2010 and 2020), which forecast PV power generation using machine learning and deep learning methods, is reported. The studies are evaluated based on the PV material used, their approaches, generated outputs, data set used, and the performance evaluation methods. As a result, gaps and improvable points in the existing literature are revealed, and suggestions which include novelties are offered for future works

Long-term outcomes in haemophilic synovitis after radiosynovectomy using rhenium-186: a single-centre experience

Radiosynovectomy has been performed successfully for more than 10years in our hospital. This study investigated the long-term outcome in the context of time to progression (TTP) analysis and the factors influencing TTP following radiosynovectomy with Re-186 in patients with haemophilic synovitis. Radiosynovectomy performed in 165 joints (81 elbows, 74 ankles, 8 shoulder and 2 hip joints) of 106 patients (median age was 18.0 +/- 7.5years; 91 haemophilia A, 13 haemophilia B and 2 von Willebrand's disease between June 2001 and July 2011. The mean follow-up was 48months (range: 9120months). This study revealed that patients' mean TTP after primary radiosynovectomy was satisfactory for both the ankle and elbow joints. There was no TTP differences between the ankle and elbow joint groups (67 vs. 72months respectively; P=0.22). We did not find a relationship between the TTP and the following variables: age, type and severity of haemophilia, the presence or absence of inhibitor, the radiological score, range of motion (ROM) status of joints and the pretreatment bleeding frequency. In this study, 1820% of the treated joints had improved ROM and 8279% of the treated joints had unchanged ROM after treatment both the ankle and elbow joints respectively. In this report including TTP analysis in the largest series with long-term follow-up, we demonstrated long-term effectiveness of Re-186 radiosynovectomy in haemophilic synovitis. In our experience, the main predictor of outcome following radiosynovectomy is the number of joint bleeding within 6months after therapy