The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Drilling Technology: Fundamentals and Recent Advances De Gruyter series in advanced mechanical engineering ;, v. 3./ J. Paulo Davim.

In English.Includes bibliographical references and index.This book aims to provide recent information on advances in drilling technology. The use of advanced machines, appropriate strategies and special drilling tools can signifi cantly reduce the machining time required for drilling operations, and consequently the production costs, and improve the quality of the holes produced. For these reasons an improvement of the drilling technology is very important for the modern manufacturing industries. This book can be used as a research book for fi nal undergraduate engineering course or at postgraduate level. It can also serve as a useful reference for academics, researchers, mechanical, industrial, production, manufacturing and materials engineers, professionals in drilling technology and related matters.Astakhov, Viktor P. / Patel, Swapnil -- Woon, Keng Soon / Tnay, Guan Leong / Yeo, Swee Hock -- Vijayan, Krishnaraj / Nasseri, Simin / Castellano, Vitale Kyle / Sobtaguim, Herve / Hilderbrand, Joshua / Chealvan, Hari -- Babu, J. / Paul, Lijo / Davim, J. Paulo -- Hejjaji, Akshay / Zitoune, Redouane / Fayçal, Ameur Mohamed / Habiba, Bougherara -- Gaitonde, V. N. / Shashikant / Lakkundi, Anand / Karnik, S. R. / Deshpande, A. S. / Davim, J. Paulo -- Frontmatter -- Preface -- About the Editor -- Contents -- List of contributing authors -- 1. Efficient drilling of high-silicon aluminum alloys / 2 Deep hole gun drilling of nickel-based superalloys / 3. A new model pertaining to highspeed drilling of titanium alloy (Ti-6Al-4V) / 4. Drilling of composite materials: methods and tools / 5. Challenges of machining natural fiber-reinforced composites: A review / 6. Analysis and optimization of hole quality parameters in cenosphere-multiwall carbon nanotube hybrid composites drilling using artificial neural network and gravitational search technique / Index1 online resource (205 p.)

Hepatic 5′-monodeiodinase activity in teleosts in vitro: A survey of thirty-three species

10.1007/BF00004426Fish Physiology and Biochemistry811-10FPBI

The chromatin landscape of healthy and injured cell types in the human kidney

There is a need to define regions of gene activation or repression that control human kidney cells in states of health, injury, and repair to understand the molecular pathogenesis of kidney disease and design therapeutic strategies. Comprehensive integration of gene expression with epigenetic features that define regulatory elements remains a significant challenge. We measure dual single nucleus RNA expression and chromatin accessibility, DNA methylation, and H3K27ac, H3K4me1, H3K4me3, and H3K27me3 histone modifications to decipher the chromatin landscape and gene regulation of the kidney in reference and adaptive injury states. We establish a spatially-anchored epigenomic atlas to define the kidney’s active, silent, and regulatory accessible chromatin regions across the genome. Using this atlas, we note distinct control of adaptive injury in different epithelial cell types. A proximal tubule cell transcription factor network of ELF3, KLF6, and KLF10 regulates the transition between health and injury, while in thick ascending limb cells this transition is regulated by NR2F1. Further, combined perturbation of ELF3, KLF6, and KLF10 distinguishes two adaptive proximal tubular cell subtypes, one of which manifested a repair trajectory after knockout. This atlas will serve as a foundation to facilitate targeted cell-specific therapeutics by reprogramming gene regulatory networks. © 2024, The Author(s).Open access journalThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]

Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system

Background: The prediction of a difficult cholecystectomy has traditionally been based on certain pre-operative clinical and imaging factors. Most of the previous literature reported small patient cohorts and have not used an objective measure of operative difficulty. The aim of this study was to develop a pre-operative score to predict difficult cholecystectomy, as defined by a validated intra-operative difficulty grading scale. Method: Two cohorts from prospectively maintained databases of patients who underwent laparoscopic cholecystectomy were analysed: the CholeS Study (8755 patients) and a single surgeon series (4089 patients). Factors potentially predictive of difficulty were correlated to the Nassar intra-operative difficulty scale. A multivariable binary logistic regression analysis was then used to identify factors that were independently associated with difficult laparoscopic cholecystectomy, defined as operative difficulty grades 3 to 5. The resulting model was then converted to a risk score, and validated on both internal and external datasets. Result: Increasing age and ASA classification, male gender, diagnosis of CBD stone or cholecystitis, thick-walled gallbladders, CBD dilation, use of pre-operative ERCP and non-elective operations were found to be significant independent predictors of difficult cases. A risk score based on these factors returned an area under the ROC curve of 0.789 (95% CI 0.773–0.806, p &lt; 0.001) on external validation, with 11.0% versus 80.0% of patients classified as low versus high risk having difficult surgeries. Conclusion: We have developed and validated a pre-operative scoring system that uses easily available pre-operative variables to predict difficult laparoscopic cholecystectomies. This scoring system should assist in patient selection for day case surgery, optimising pre-operative surgical planning (e.g. allocation of the procedure to a suitably trained surgeon) and counselling patients during the consent process. The score could also be used to risk adjust outcomes in future research