Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study.

BACKGROUND: Appendicitis is the most common abdominal surgical emergency worldwide. Differences between high- and low-income settings in the availability of laparoscopic appendectomy, alternative management choices, and outcomes are poorly described. The aim was to identify variation in surgical management and outcomes of appendicitis within low-, middle-, and high-Human Development Index (HDI) countries worldwide. METHODS: This is a multicenter, international prospective cohort study. Consecutive sampling of patients undergoing emergency appendectomy over 6 months was conducted. Follow-up lasted 30 days. RESULTS: 4546 patients from 52 countries underwent appendectomy (2499 high-, 1540 middle-, and 507 low-HDI groups). Surgical site infection (SSI) rates were higher in low-HDI (OR 2.57, 95% CI 1.33-4.99, p = 0.005) but not middle-HDI countries (OR 1.38, 95% CI 0.76-2.52, p = 0.291), compared with high-HDI countries after adjustment. A laparoscopic approach was common in high-HDI countries (1693/2499, 67.7%), but infrequent in low-HDI (41/507, 8.1%) and middle-HDI (132/1540, 8.6%) groups. After accounting for case-mix, laparoscopy was still associated with fewer overall complications (OR 0.55, 95% CI 0.42-0.71, p < 0.001) and SSIs (OR 0.22, 95% CI 0.14-0.33, p < 0.001). In propensity-score matched groups within low-/middle-HDI countries, laparoscopy was still associated with fewer overall complications (OR 0.23 95% CI 0.11-0.44) and SSI (OR 0.21 95% CI 0.09-0.45). CONCLUSION: A laparoscopic approach is associated with better outcomes and availability appears to differ by country HDI. Despite the profound clinical, operational, and financial barriers to its widespread introduction, laparoscopy could significantly improve outcomes for patients in low-resource environments. TRIAL REGISTRATION: NCT02179112

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Application of photoacoustic spectroscopy in the study of optical absorption in n-type porous silicon

The application of the photoacoustic spectroscopy technique in the study of the optical absorption spectrum in samples of porous silicon n-type is reported. A spectral range of 250 to 800 nm and modulation frequencies of 200 Hz were used. The differential optical absorption spectrum obtained shows two significant absorption bands, one in the visible region and the other in the UV region, which is consistent with the quantum confinement model. These optical absorption remarkable properties give porous silicon a particular importance for its application as a photothermal material.Se reporta la aplicación de la técnica de espectroscopía fotoacústica en el estudio del espectro de absorción óptico en muestras de silicio poroso tipo n. Se utilizó un rango espectral de 250 a 800 nm y frecuencias de modulación del haz monocromático de 200 Hz. El espectro de absorción óptico diferencial obtenido muestra dos importantes bandas de absorción, una en la región visible y la otra en la región UV, que es consistente con el modelo de confinamiento cuántico. Estas notables propiedades de absorción óptica dan al silicio poroso una importancia particular para su aplicación como material fototérmico

Spectral analysis of the photoacoustic spectroscopy measurements

It is shown that by calculating and analyzing the projection of the photoacoustic signal in each phase or direction, the particular phase angles in which the contributions to the optical absorption spectrum are isolated can be determined. The method for obtaining the projection of the photoacoustic signal as a function of the phase angle and the corresponding spectrum analysis is discussed. This methodology is applied in measurements of mango fruit (Mangifera indica L.) skin obtaining the isolated contributions corresponding to their photoprotective pigments in the epidermis and the hypodermis.Se muestra que mediante el cálculo y el análisis de la proyección de la señal fotoacústica en cada fase o dirección pueden ser determinados los ángulos de fase particulares en los que aparecen aisladas las contribuciones al espectro de absorción óptico obtenido mediante la técnica de espectroscopía fotoacústica. Se discute el método para obtener la proyección de la señal fotoacústica en función del ángulo de fase y el análisis del espectro correspondiente. Se aplica esta metodología en mediciones de piel de mango (Mangifera indica L.) obteniendo las contribuciones aisladas correspondientes a los pigmentos fotoprotectores en la epidermis y la hipodermi