Time interval between self-expandable metal stent placement or creation of a decompressing stoma and elective resection of left-sided obstructive colon cancer

Background The optimal timing of resection after decompression of left-sided obstructive colon cancer is unknown. Revised expert-based guideline recommendations have shifted from an interval of 5-10 days to approximately 2 weeks following self-expandable metal stent (SEMS) placement, and recommendations after decompressing stoma are lacking. We aimed to evaluate the recommended bridging intervals after SEMS and explore the timing of resection after decompressing stoma.Methods This nationwide study included patients registered between 2009 and 2016 in the prospective, mandatory Dutch ColoRectal Audit. Additional data were collected through patient records in 75 hospitals. Only patients who underwent either SEMS placement or decompressing stoma as a bridge to surgery were selected. Technical SEMS failure and unsuccessful decompression within 48 hours were exclusion criteria.Results 510 patients were included (182 SEMS, 328 decompressing stoma). Median bridging interval was 23 days (interquartile range [IQR] 13-31) for SEMS and 36 days (IQR 22-65) for decompressing stoma. Following SEMS placement, no significant differences in post-resection complications, hospital stay, or laparoscopic resections were observed with resection after 11-17 days compared with 5-10 days. Of SEMS-related complications, 48% occurred in patients operated on beyond 17 days. Compared with resection within 14 days, an interval of 14-28 days following decompressing stoma resulted in significantly more laparoscopic resections, more primary anastomoses, and shorter hospital stays. No impact of bridging interval on mortality, disease-free survival, or overall survival was demonstrated.Conclusions Based on an overview of the data with balancing of surgical outcomes and timing of adverse events, a bridging interval of approximately 2 weeks seems appropriate after SEMS placement, while waiting 2-4 weeks after decompressing stoma further optimizes surgical conditions for laparoscopic resection with restoration of bowel continuity.Cellular mechanisms in basic and clinical gastroenterology and hepatolog

Pulse-analysis-pulse investigation of femtosecond laser-induced periodic surface structures on silicon in air

A new approach to experimentally investigate laser-induced periodic surface structures (LIPSSs) is introduced. Silicon was iteratively exposed to femtosecond laser pulses at λ = 800 nm and normal incidence in ambient air and at a fluence slightly over the single-pulse modification threshold. After each laser pulse, the topography of the surface was inspected by confocal microscopy. Subsequently, the sample was reproducibly repositioned in the laser setup, to be exposed to the next laser pulse. By this approach, the initiation and spatial evolution (“growth”) of the LIPSSs were analyzed as function of the number of pulses applied. It was found that, after the first laser pulses, the ridges of the LIPSSs elevate, and valleys between the ridges deepen, by a few tens of nanometers relative to the initial surface. An electromagnetic model, discussed in earlier works, predicted that the spatial periodicity of LIPSSs decreases with the number of laser pulses applied. This implies material transport and reorganization of the irradiated material on the surface, due to each laser pulse. However, our experiments show a negligible shift of the lateral positions of the LIPSSs on the surfac

The efficacy of a brief intervention to reduce alcohol misuse in patients with HIV in South Africa: study protocol for a randomized controlled trial

Alcohol abuse comes with risks for increased morbidity and mortality among patients with HIV. This study aims to determine the prevalence of alcohol use and other risk factors in a sample of primary care patients with HIV in South Africa and to assess a brief intervention to reduce the use of alcohol in this group. A single-blinded randomized controlled trial is designed to determine the efficacy of a brief intervention to reduce hazardous alcohol use in patients with HIV. The study will be carried out on out-patients with HIV in two primary healthcare HIV clinics near Pretoria, South Africa. Alcohol use will be assessed with the Alcohol Use Disorder Identification Test questionnaire. Other data that will be collected relate to health-related quality of life, depression, sexual behavior, internalized AIDS stigma, HIV-related information and adherence to antiretroviral therapy (self-reported 7-day recall of missed doses, Visual Analog Scale and pill count). The intervention consists of a brief counseling session to reduce alcohol risk; the control group receives a health education leaflet. The findings will be important in the public health setting. If the intervention proves to be efficient, it could potentially be incorporated into the HIV care policy of the Ministry of Health.

Properties of High-Frequency Sub-Wavelength Ripples on Stainless Steel 304L under Ultra Short Pulse Laser Irradiation

The paper concentrates on surface texturing on sub-micro meter scale with ultra short laser pulses that has several applications, e.g. changing the hydrophilic/hydrophobic performance, optical or tribological properties of materials. In general, the formations of wavy structures, or ripples on a surface irradiated by short pulse lasers has been observed experimentally since 1965, and are usually referred to as Laser Induced Periodic Surface Structures (LIPSS). Generally Low Spatial Frequency LIPSS (LSFL) and High Spatial Frequency LIPSS (HSFL) are observed. The existing theoretical models do not describe the origin, nor growth of the ripples satisfactorily. That is why the experimental approach still plays a leading role in the investigation of ripple formation. In this paper we study the development of HSFL and LSFL as a result of picosecond laser pulses on a surface of stainless steel. Influences of number of pulses and pulse overlap on ripples growth were examined.

Melting of copper surface by ultrashort laser pulses

The main advantage of ultrashort laser pulses in manufacturing technology is their very high removal rate of material and high quality of microstructures with the smallest dimensions at 1 μm level. The accuracy is mainly due to an almost absence of thermal diffusion into bulk material. In this paper we report the investigation on polycrystalline Cu sample surface treated by 6.7 ps laser pulses with 1030 nm laser light wavelength. Scanning electron microscopy micrographs reveal the presence of jet-like structures with spherical drop-like endings, solidified spheres and many bubble bursts at even lower fluence than the threshold value for the ablation is. Within the molten material the jet-like features are due to an explosion of bubbles originated in solid-liquid-vapor transitions. In the case of below-threshold irradiation, the same objects can be seen along surface scratches, dot contaminations etc., which indicate an increase of the laser light absorption on these inhomogeneities. © 2011 WIT Press

Risk factors for a permanent stoma after resection of left-sided obstructive colon cancer - A prediction model.

INTRODUCTION: In patients with left-sided obstructive colon cancer (LSOCC), a stoma is often constructed as part of primary treatment, but with a considerable risk of becoming a permanent stoma (PS). The aim of this retrospective multicentre cohort is to identify risk factors for a PS in LSOCC and to develop a pre- and postoperative prediction model for PS. MATERIALS AND METHODS: Data was retrospectively obtained from 75 hospitals in the Netherlands. Patients who had curative resection of LSOCC between January 1, 2009 to December 31, 2016 were included with a minimum follow-up of 6 months after resection. The interventions analysed were emergency resection, decompressing stoma or stent as bridge-to-elective resection. Main outcome measure was presence of PS at the end of follow-up. Multivariable logistic regression analysis was performed to identify risk factors for PS at primary presentation (T(0)) and after resection, in patients having a stoma in situ (T(1)). These risk factors were used to construct a web-based prediction tool. RESULTS: Of 2099 patients included in the study (T(0)), 779 had a PS (37%). A total of 1275 patients had a stoma in situ directly after resection (T(1)), of whom 674 had a PS (53%). Median follow-up was 34 months. Multivariable analysis showed that older patients, female sex, high ASA-score and open approach were independent predictors for PS in both the T(0) and T(1) population. Other predictors at T(0) were sigmoid location, low Hb, high CRP, cM1 stage, and emergency resection. At T(1), subtotal colectomy, no primary anastomosis, not receiving adjuvant chemotherapy and high pTNM stage were additional predictors. Two predictive models were built, with an AUC of 0.74 for T(0) and an AUC of 0.81 for T(1). CONCLUSIONS: PS is seen in 37% of the patients who have resection of LSOCC. In patients with a stoma in situ directly after resection, 53% PS are seen due to non-reversal. Not only baseline characteristics, but also treatment strategies determine the risk of a PS in patients with LSOCC. The developed predictive models will give physicians insight in the role of the individual variables on the risk of a PS and help in informing the patient about the probability of a PS

Comparison of Decompressing Stoma vs Stent as a Bridge to Surgery for Left-Sided Obstructive Colon Cancer

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