Decompressing Stoma as Bridge to Elective Surgery is an Effective Strategy for Left-sided Obstructive Colon Cancer:A National, Propensity-score Matched Study

OBJECTIVE: The purpose of this population-based study was to compare decompressing stoma (DS) as bridge to surgery (BTS) with emergency resection (ER) for left-sided obstructive colon cancer (LSOCC) using propensity-score matching. SUMMARY BACKGROUND DATA: Recently, an increased use of DS as BTS for LSOCC has been observed in the Netherlands. Unfortunately, good quality comparative analyses with ER are scarce. METHODS: Patients diagnosed with nonlocally advanced LSOCC between 2009 and 2016 in 75 Dutch hospitals, who underwent DS or ER in the curative setting, were propensity-score matched in a 1:2 ratio. The primary outcome measure was 90-day mortality, and main secondary outcomes were 3-year overall survival and permanent stoma rate. RESULTS: Of 2048 eligible patients, 236 patients who underwent DS were matched with 472 patients undergoing ER. After DS, more laparoscopic resections were performed (56.8% vs 9.2%, P < 0.001) and more primary anastomoses were constructed (88.5% vs 40.7%, P < 0.001). DS resulted in significantly lower 90-day mortality compared to ER (1.7% vs 7.2%, P = 0.006), and this effect could be mainly attributed to the subgroup of patients over 70 years (3.5% vs 13.7%, P = 0.027). Patients treated with DS as BTS had better 3-year overall survival (79.4% vs 73.3%, hazard ratio 0.36, 95% confidence interval 0.20-0.65) and fewer permanent stomas (23.4% vs 42.4%, P < 0.001). CONCLUSIONS: In this nationwide propensity-score matched study, DS as a BTS for LSOCC was associated with lower 90-day mortality and better 3-year overall survival compared to ER, especially in patients over 70 years of age

Foamed Articles Based on Potato Starch, Corn Fibers and Poly(vinyl alcohol)

Single-use packaging materials made of expanded polystyrene (EPS) have been identified as suitable items to be replaced by biodegradable materials. Plates made with EPS represent a source of non-degradable waste that is difficult to collect and to recycle. Potato starch based foamed plates have been prepared by a baking process. Presently, foam plates have been prepared by baking aqueous mixtures of potato starch, corn fibers, and poly(vinyl alcohol) (PVA) inside a hot mold. The effects of the addition of corn fibers, a co-product of bio-ethanol production, on mechanical properties and moisture resistance of potato starch based foamed plates were investigated. The addition of corn fiber to potato starch batter increased baking time and an increased batter volume is needed to form a complete tray. The mechanical properties of the trays decreased with added corn fiber. In previous studies PVA has been added as aqueous solution to improve strength, flexibility, and water resistance of baked starch trays. In this study, 88% hydrolyzed PVA was added as a powder in the mixture, avoiding the time consuming and costly step of pre-dissolving the PVA. The addition of PVA to potato starch batters containing corn fiber mitigated the reduction in tensile properties seen in trays with added corn fiber. Starch-based trays produced with a high fiber ratio and PVA, showed improved water resistance

Properties of Injection Molded Composites Containing Corn Fiber and Poly(Vinyl Alcohol)

Composites based on natural polymers alone are extremely sensitive to moisture and their mechanical properties deteriorate upon the absorption of water, limiting their usefulness in practical applications. Ongoing research cooperation between USDA and the University of Pisa, Italy, has yielded several composites based on poly(vinyl alcohol) (PVA) and corn fibers (CF). In this study, variable amounts of CF and PVA were processed in the presence of both dry and liquid plasticizers, glycerol and pentaerythritol. Cornstarch was introduced in the formulation to reduce the cost and to further increase the composition of natural components in the composites. Composites made with as low as 30% PVA were injection molded into tensile bars and evaluated. The addition of starch moderately reduced the tensile properties of the composites, lowering the elongation (∼600% to 400%) and increasing Young's modulus (∼36 MPa to ∼100 MPa) while the ultimate tensile strength remained constant at about 8 MPa. Composites prepared from CF and PVA showed little change in their mechanical properties even after conditioning them at various relative humidities, or after soaking in water. Composites tested after storage for one year, at 50% relative humidity and 23°C, exhibited mechanical properties similar to those of freshly prepared composites

Balanced Lines, Halving Triangles, and the Generalized Lower Bound Theorem

The following three facts are related to each other. Fact A Let R and B be two disjoint finite planar sets, so that |R ∪ B | is even and R ∪ B is in general position (i.e., no three points are collinear). Points in R and B are referred to as ‘red ’ and ‘blue, ’ respectively. A line ℓ is balanced (w.r.t. (R,B)) if ℓ passes through a re

Environmentally Compatible Foamed Articles Containing Potato Starch, Corn Fiber and Poly(Vinyl Alcohol)

Potato starch foam trays based on blends of poly(vinyl alcohol) and corn fibers (CFs), co-product of the corn-wheat wet-milling process, are prepared by baking the blended mixtures in a preheated mold. Materials are evaluated for processing parameters, foam strength, flexibility, and water resistance as a function of fibers content. Addition of CF in formulations improved not only moisture resistance of foam, but has a potential to lower the overall cost of the foamed materials substantially. Interestingly, addition of up to 45% fiber in formulations was possible without compromising the foaming process. Degradability is evaluated both in compost than simulating a disposal in the environment (soil burying and soil surface). Trays are biodegraded within 30-60 days in compost and soil. Particularly, trays containing starch and fiber degraded at much faster rates than trays prepared using starch without natural fillers

Injection Molded hybrid Composites Based on Corn Fibers and Poly(vinyl alcohol)

Ongoing research cooperation between USDA and the University of Pisa, Italy has yielded several composite blends of poly(vinyl alcohol) (PVA) and corn fibers (CF). The USA is the largest producer of ethanol from cereal grains. Composites based on natural fibers alone are extremely sensitive to water. Their mechanical properties deteriorated upon the absorption of water, thus suggesting a limited usefulness of such formulations in practical applications. In this study, corn-fibers produced during the wet milling process of corn for fuel ethanol were used to prepare composites. CIF and PVA were processed in variable amounts in the presence of both dry/fluid plasticizers, such as glycerol and pentaerythritol. Composites prepared from CF in combination with PVA showed little change in their mechanical properties even after conditioning at variable relative humidities, as well as complete soaking in water. Composites tested after storage for one year under 50% relative humidity and 23degreesC exhibited mechanical properties similar to those of freshly prepared composites. Cornstarch was introduced in the formulation for the purpose of reducing the cost of the final product and to further increase the composition of natural components in the composites. Addition of starch moderately reduced the mechanical properties of the composites

An ω-Complete equational specification of interleaving

We consider the process theory PA that includes an operation for parallel composition, based on the interleaving paradigm. We prove that the standard set of axioms of PA is not ω-complete by providing a set of axioms that are valid in PA, but not derivable from the standard ones. We prove that extending PA with this set yields an ω-complete specification, which is finite in a setting with finitely many actions

More fluorous surface modifier makes it less oleophobic: fluorinated-siloxane copolymer/PDMS coatings

A copolyacrylate with semifluorinated and polydimethylsiloxane side chains (D5-3) was used as a surface modifier for a condensation-cured PDMS coating. The decyl fluorous group is represented by “D”; “5” is a 5 kDa silicone, and “3” is the mole ratio of fluorous to silicone side chains. Wetting behavior was assessed by dynamic contact angle (DCA) analysis using isopropanol, which differentiates silicone and fluorous wetting behavior. Interestingly, a maximum in surface oleophobicity was found at low D5-3 concentration (0.4 wt %). Higher concentrations result in decreased oleophobicity, as reflected in decreased contact angles. To understand this unexpected observation, dynamic light scattering (DLS) studies were initiated on a model system consisting of hydroxyl-terminated PDMS (18 kDa) containing varying amounts of D5-3. DLS revealed D5-3 aggregation to be a function of temperature and concentration. A model is proposed by which D5-3 surface concentration is depleted via phase separation favoring D5-3 aggregation at concentrations >0.4 wt %, that is, the cmc. This model suggests increasing aggregate/micelle concentrations at increased D5-3 concentration. Bulk morphologies studied by scanning electron microscopy (SEM) and atomic force microscopy (AFM) support this model by showing increased aggregate concentrations with increased D5-3 >0.4 wt %

Stent placement for benign esophageal leaks, perforations, and fistulae: A clinical prediction rule for successful leakage control

Background and study aims Sealing esophageal leaks by stent placement allows healing in 44%-94% of patients. We aimed to develop a prediction rule to predict the chance of successful stent therapy. Patients and methods In this multicenter retrospective cohort study, patients with benign upper gastrointestinal leakage treated with stent placement were included. We used logistic regression analysis including four known clinical predictors of stent therapy outcome. The model performance to predict successful stent therapy was evaluated in an independent validation sample. Results We included etiology, location, C-reactive protein, and size of the leak as clinical predictors. The model was estimated from 145 patients (derivation sample), and 59 patients were included in the validation sample. Stent therapy was successful in 55.9% and 67.8% of cases, respectively. The predicted probability of successful stent therapy was significantly higher in success patients compared with failure patients in both the derivation (P <0.001) and validation (P <0.001) samples. The area under the receiver operating characteristic curve was 74.1% in the derivation sample and 84.7% in the validation sample. When the model predicted≥70% chance of success, the positive predictive value was 79% in the derivation sample and 87% in the validation sample. When the model predicted≤50% chance of success, the negative predictive value was 64% and 86%, respectively. Conclusions This prediction rule, consisting of four clinical predictors, could identify patients with esophageal leaks who were likely to benefit from or fail on stent therapy. The prediction rule can support clinical decision-making when the predicted probability of success is≥70% or≤50%