Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Evaluation of the Increase in Serum Calcium Levels After Unilateral Adrenalectomy

Introduction This study aims to investigate the prevalence and characteristics of patients with elevated serum calcium due to adrenal insufficiency after unilateral adrenalectomy.Methods The study included 76 patients who underwent unilateral adrenalectomy from January 2012 to November 2021 and did not have an additional etiologic factor for hypercalcemia, During the postoperative period, the highest calcium value in six months was taken into account as the postoperative value. Calcium values were corrected according to the albumin value.Results Of the 76 patients included in the study, serum calcium levels were higher in six patients (7.9%) after adrenalectomy. Unlike the others, a decrease in glomerular filtration rate (GFR) and an increase in serum creatinine values were detected in the postoperative period in this patient group. In this patient group, the corrected calcium level detected an average increase of 1.3 mg/dL. Conclusion After unilateral adrenalectomy, hypercalcemia may occur due to adrenal insufficiency. It should also be considered that there may be a decrease in GFR and increased creatinine in these patients

Factors affecting the recurrence of acute cholecystitis after treatment with percutaneous cholecystostomy

Abstract Background The aim of this study was to determine the recurrence rate of patients who did not have interval cholecystectomy after treatment with percutaneous cholecystostomy and to investigate the factors that may affect the recurrence. Methods Patients who did not undergo interval cholecystectomy after percutaneous cholecystostomy treatment between 2015 and 2021 were retrospectively screened for recurrence. Results 36.3% of the patients had recurrence. Recurrence was found more frequently in patients with fever symptoms at the time of admission to the emergency department (p = 0.003). Recurrence was found to be more frequent in those who had a previous cholecystitis attack (p = 0.016). It was determined that patients with high lipase and procalcitonin levels had statistically more frequent attacks (p = 0.043, p = 0.003). It was observed that the duration of catheter insertion was longer in patients who had relapses (p = 0.019). The cut-off value for lipase was calculated as 15.5, and the cut-off value for procalcitonin as 0.955, in order to identify patients at high risk for recurrence. In the multivariate analysis for the development of recurrence, presence of fever, a history of previous cholecystitis attack, lipase value higher than 15.5 and procalcitonin value higher than 0.955 were found to be risk factors. Conclusions Percutaneous cholecystostomy is an effective treatment method in acute cholecystitis. Insertion of the catheter within the first 24 h may reduce the recurrence rate. Recurrence is more common in the first 3 months following removal of the cholecystostomy catheter. Having a previous history of cholecystitis attack, fever symptom at the time of admission, elevated lipase and procalcitonin are risk factors for recurrence

Active Power Factor Correction Using a Sliding Mode Controller

In this paper, a sliding mode controller is designed for active shaping of the input current in the boost converter. Robustness of the designed controller is tested with variable output voltage references, different loads and network voltage variations. For the simulations, MATLAB/Simulink programme is used. From simulation results, the same phase was provided between input current and input voltage and nearly unity power factor was obtained

The Quaternary Climatic and Tectonic Development of the Murat River Valley (Muş Basin, Eastern Turkey) as Recorded by Fluvial Deposits Dated by Optically Stimulated Luminescence

The paper describes climatic and tectonic effects on fluvial processes of East Anatolia. This study from the Muş Basin contains three alluvial terrace levels (T3-T1) ranging from 30–35 m to 3–5 m above the present Murat River in its middle section. In order to provide a chronology for the evaluation of the significant, effects of climatic changes and tectonic uplift, we used optically stimulated luminescence (OSL) dating of the river deposits of the youngest (T3) and medium terrace (T2). The ages from these terrace deposits show that the T3 has formed approximately 6.5 ka ago, i.e., during the last part of the Holocene (MIS 1) and T2 has formed nearly 25 ka ago, i.e., during MIS 2 at the ending of the last glacial period. According to these results, it appears that the Murat River established its terrace sequences both in cold and warm periods. The variations in climate oriented fluvial evolution between the East Anatolia fluvial system and the temperate-periglacial fluvial systems in Europe may be the conclusion of different vegetation cover and melting thicker snow coverings in cold periods

The first step of patient-specific design calvarial implant: A quantitative analysis of fresh parietal bones

WOS: 000445241400004BackgroundAccurate knowledge of the fracture of cranial bone can provide insight into the prevention of skull fracture injuries and help aid the design of energy-absorbing head protection systems and safety helmets. When cranial bone needs to be removed or is lost, subsequent reconstruction of the defect is necessary to protect the underlying brain, or correct esthetic deformities, or both. Ideal reconstruction of defected bone is possible utilizing a biocompatible implant with a bone-like design individualized for the specific patient. The purpose of this study is to investigate the anatomical and mechanical characteristics of fresh frozen human parietal bones and determine compliance of polylactic acid-based personalized three-dimensional implants in terms of mechanical properties in order to replace such defective bones.MethodsParietal bone specimens were extracted from 19 fresh frozen cadavers. Morphological parameters of individual bone specimens were measured using Image J software. Three-point bend tests were performed to extract Young's modulus and tensile strength of the specimens from the measured force and displacement data by modeling the bone specimens as curved linear elastic beams. Also, three-point bend tests were performed to polylactic acid-based three-dimensional replicas mimicking geometry of the bone specimens in order to determine whether the material's Young's modulus and tensile strength properties comply with parietal bones.ResultsEntire fresh parietal specimens were observed to be comprised of a three-layered structure: external layers consisting of compact, high-density cortical bone and the central layer consisting of low-density, irregularly porous bone structure. Mean thickness of three-layered structure was 6.251.46mm. Mean Young's modulus and tensile strength of the specimens were 1.401.34GPa and 44.56 +/- 21.94MPa, respectively where no statistically significant differences among genders were detected (p>0.05). Mean Young's modulus and tensile strength of the polylactic acid-based three-dimensional implants mimicking geometry of the bone specimens were 1.8 +/- 0.7GPa and 72.8 +/- 2.5MPa, respectively.ConclusionsPolylactic acid-based three-dimensional implants can be considered as acceptable candidates for temporary replacement of parietal defects in terms of mechanical properties.Level of Evidence: Not ratable