Management and patient outcomes following admission with acute cholecystitis in Ireland: A national registry-based study.

INTRODUCTION: Acute cholecystitis is a common general surgical emergency, accounting for 3-10 % of all patients attending with acute abdominal pain. International guidelines suggest that emergency cholecystectomy is the treatment of choice for uncomplicated acute cholecystitis where feasible. There is a paucity of published data on the uptake of emergency cholecystectomy in Ireland. AIM: The aim of this study was to evaluate the management of acute cholecystitis in Ireland and to establish the rate of emergency cholecystectomy performed. METHODS: All patients with acute cholecystitis presenting to public hospitals in Ireland between January 2017 and July 2023 were identified using the National Quality Assurance and Improvement System (NQAIS). Data were collected on patient demographics, co-morbidities, length of stay, operative intervention, endoscopic intervention, critical care admissions, in-patient mortality, and readmissions. Propensity score matched analysis and logistic regression were performed to account for selection bias in comparing patients managed with cholecystectomy and those managed conservatively. RESULTS: 20,886 admission episodes were identified involving 17,958 patients. 3585 (20 %) patients underwent emergency cholecystectomy in total. 3436 (96 %) of these were performed laparoscopically, with 140 (4 %) requiring conversion to an open procedure, and common bile duct injuries occurring in 4 (0.1 %) of patients. In comparison to patients treated conservatively, patients who underwent cholecystectomy were younger (median 50 v 60 years, p < 0.001) and more likely to be female (64 % v 55 % p < 0.001). Following propensity score matched analysis, those who had an emergency cholecystectomy had reduced length of stay (LOS) (median 5 days (IQR 3-8) v 6 days (interquartile range (IQR) 3-10), p < 0.001) and fewer readmissions to hospital (282 (8 %) v 492 (14 %), p < 0.001). On logistic regression, age >65 (OR 1.526), CCI >3 (OR 2.281) and non-operative management (OR 1.136) were significant risk factors for adverse outcome. CONCLUSION: Uptake of emergency cholecystectomy in Ireland remains low, and is carried out on a younger, fitter cohort of patients. In those patients, however, it is associated with improved outcomes for cholecystitis compared to conservative management, including shorter LOS and reduced readmission rates for matched cohorts.

Shortening surgical training through robotics: randomized clinical trial of laparoscopic versus robotic surgical learning curves.

BACKGROUND: Minimally invasive surgery is the standard technique for many operations. Laparoscopic training has a long learning curve. Robotic solutions may shorten the training pathway. The aim of this study was to compare laparoscopic with robotic training in surgical trainees and medical students. METHODS: Surgical trainees (ST group) were randomized to receive 6 h of robotic or laparoscopic simulation training. They then performed three surgical tasks in cadaveric specimens. Medical students (MS group) had 2 h of robotic or laparoscopic simulation training followed by one surgical task. The Global Rating Scale (GRS) score (maximum 30), number of suture errors, and time to complete each procedure were recorded. RESULTS: The median GRS score for the ST group was better for each procedure after robotic training compared with laparoscopic training (total GRS score: 27·00 (i.q.r. 22·25-28·33) versus 18·00 (16·50-19·04) respectively, P < 0·001; 10 participants in each arm). The ST group made fewer errors in robotic than in laparoscopic tasks, for both continuous (7·00 (4·75-9·63) versus 22·25 (20·75-25·25); P < 0·001) and interrupted (8·25 (6·38-10·13) versus 29·50 (23·75-31·50); P < 0·001) sutures. For the MS group, the robotic group completed 8·67 interrupted sutures with 15·50 errors in 40 min, compared with only 3·50 sutures with 40·00 errors in the laparoscopic group (P < 0·001) (10 participants in each arm). Fatigue and physical comfort levels were better after robotic compared with laparoscopic operating for both groups (P < 0·001). CONCLUSION: The acquisition of surgical skills in surgical trainees and the surgically naive takes less time with a robotic compared with a laparoscopic platform.

Evaluation of the transfection efficacies of quaternary ammonium salts prepared from sophorolipids.

Five quaternary ammonium amphiphilic compounds were synthesized from sophorolipid 1. These compounds were formulated in aqueous media and some of them (5 and 6) produced well-defined supramolecular aggregates which were characterized by DLS and zeta measurements. Their capacity to transfect four different eukaryotic cell lines in vitro was assessed. To evaluate the influence of the carbohydrate head group from the sophorolipids on the transfection efficacies, their deglycosylated analogues were also synthesized and tested for gene delivery. For all the compounds, the use of DOPE as a helper lipid in a 1 : 1 molar ratio with the ammonium-based lipids was required to obtain homogeneous formulations. The transfection results indicate that quaternary ammonium-based sophorolipids proved to be more efficient pDNA carriers than their deglycosylated counterparts. Moreover, the presence of the carbohydrate head group clearly contributed to the good biocompatibility of these cationic lipids. These cationic sophorolipid derivatives thus offer good potential for the development of new vectors for gene delivery based on renewable resources.

Challenges and Successes Using Nanomedicines for Aerosol Delivery to the Airways.

Numerous diseases affect the respiratory tract and the aerosol administration has been widely considered as an adapted and non-invasive method for local delivery. This pathway induces a lung concentration and thus also limits, systemic side effects. However, aerosol delivery of active pharmaceutical ingredients represents a real challenge, due to numerous obstacles such as the specific respiratory movement, the presence of mucus or surfactant, and the mucociliary clearance. Nanomedicines, such as liposomes, micelles or nanoparticles, offer the possibility to increase bioavailability and favor intracellular penetration of specific drugs into lung tissue. This review focuses on the description of aerosol formulations and cellular barriers including design, characteristics and progressive adaptation to airways anatomy. Then, aerosolized formulations currently clinically approved, or in clinical trial are summarized according to the encapsulated drug. In a final section, promising aerosol formulations in pre-clinical studies are detailed.

A case of gossypiboma mimicking intrahepatic cholangiocarcinoma.

INTRODUCTION: A gossypiboma refers to a cotton-based foreign body left inadvertently in the human body following a surgical procedure. Although a rare event, they tend to be found in the abdomen but few are known to be intrahepatic. CASE HISTORY: We report the case of a 44 year-old man who presented with recurrent episodes of jaundice and cholangitis, on a background of a right hepatectomy for hydatid cyst excision 20 years previously. This case was discussed at our hepatobiliary multidisciplinary team meetings on several occasions and a presumed diagnosis of intrahepatic cholangiocarcinoma was made. Biopsies of the mass had purely shown inflammation and remained inconclusive. It was decided that the patient should undergo a complete extended right hepatectomy with resection and reconstruction of the left branch of the portal vein. On attempting to obtain intraoperative frozen section specimens prior to resection, open excision revealed two large swabs encased in a calcified cavity. Removal of the swabs resulted in resolution of the mass and obstructive symptoms. CONCLUSIONS: Gossypiboma should be a rare differential diagnosis in all patients following a laparotomy presenting with obstructive symptoms, particularly in countries where strict surgical protocols may not be in place. This case also highlights the need to perform an intraoperative biopsy in any uncertain case of a liver lesion as we have shown that an extensive operation with its increased morbidity can occasionally be avoided.

Mini-probe ultrasonography for the staging of colon cancer: a systematic review and meta-analysis.

AIM: With an increasing array of treatment modalities available for colon cancer, it is increasingly important to stage tumours accurately to allocate the appropriate management. This study evaluated the accuracy of mini-probe endoscopic ultrasound (EUS) in assigning clinical stage to colon cancer. METHOD: An electronic search was performed in January 2013 using the Embase, MEDLINE and Cochrane databases. This was supplemented by a hand search of published abstracts from scientific meetings. Trials evaluating the accuracy of the mini-probe EUS compared with histopathological grade in determining the clinical stage of colon cancer were included in this pooled analysis. The main outcome measures included accuracy, sensitivity and specificity for T and N staging. RESULTS: Ten studies were identified which compared the mini-probe EUS staging of 642 colon or rectal cancers with the histopathological specimen. The pooled sensitivity and specificity for staging were 0.91 and 0.98 for T1 tumours, 0.78 and 0.94 for T2 tumours, 0.97 and 0.90 for T3/T4 tumours and 0.63 and 0.82 for nodal staging. Eight per cent of T1/T2 tumours were upstaged to T3/T4 tumours and 5% of T3/T4 tumours were downstaged. CONCLUSION: Mini-probe EUS is highly effective for assigning clinical stage in colon cancer and in identifying patients who may be suitable for nonsurgical treatment including neoadjuvant chemotherapy or endoscopic resection.

Neoadjuvant chemotherapy and primary-first approach for rectal cancer with synchronous liver metastases.

AIM: Up to a quarter of patients with rectal cancer have synchronous liver metastases at the time of diagnosis. This is a predictor of poor outcome. There are no standardized guidelines for treatment. We reviewed the outcomes of our patients with synchronous rectal liver metastases treated with a curative intent by neoadjuvant chemotherapy with or without chemoradiotherapy followed by resection of the primary tumour and then liver metastases. METHOD: Between 2004 and 2012, patients who presented with rectal cancer and synchronous liver metastasis were treated with curative intent with peri-operative systemic chemotherapy as the first line of treatment. Responders to chemotherapy underwent resection of the primary tumour with or without preoperative chemoradiotherapy followed by hepatic resection. RESULTS: Fifty-three rectal cancer patients with 152 synchronous liver lesions were identified. After a median follow-up of 29.6 months, the median survival was 41.4 months. Overall survival was 59.0% at 3 years and 39.0% at 5 years. CONCLUSION: Rectal resection before hepatic resection combined with neoadjuvant chemotherapy is associated with promising clinical outcome. It allows downstaging of liver lesions and removal of the primary tumour before the progression of further micrometastases. Furthermore, patients who do not respond to chemotherapy can be identified and may avoid major surgical intervention.

Dual-polarization multi-band OFDM versus single-carrier DP-QPSK for 100 Gb/s long-haul WDM transmission over legacy infrastructure.

The transmission performance of coherent dual-polarization multi-band OFDM (DP-MB-OFDM) and QPSK (DP-QPSK) are experimentally compared for 100 Gb/s long-haul transport over legacy infrastructure combining G.652 fiber and 10 Gb/s WDM system. It is shown that DP-MB-OFDM and DP-QPSK have nearly the same performance at 100 Gb/s after transmission over a 10 × 100-km fiber line. Furthermore, the origin of performance degradations and limitations of the DP-MB-OFDM is explored numerically, as well as the impact of transmission distance and sub-band spacing.

An analysis of survey data by size of the breeding herd for the reproductive management practices of North American sow farms.

A survey was performed to assess whether reproductive management differed among small-sized (Sm, <500 sows), medium-sized (M, 501 to 2,000 sows), and large-sized (Lg, 2,001 to 8,000 sows) farms (n=113). Farms with 501 to 4000 sows/barn were most frequent with sows kept in stalls on 90% of farms. More Lg farms (P<0.05) functioned as breed to wean and more Sm and M as farrow to finish. More Sm and Lg farms weaned at >21 d, whereas M farms were more likely to wean at 18 to 21 d (P<0.05). More Lg farms had farrowing rates above 89% than Sm and M farms (P<0.05), and culling rates above 40% were more frequent on M and Lg farms than on S. On M and Lg farms, sows were bred in larger batches, using lower person to sow ratios, and with more people required than on Sm farms (P<0.05). More (P<0.05) M and Lg farms spent time moving sows and on records, but hours devoted to estrous detection, breeding, and other tasks did not differ among farms (P>0.10). More M and Lg farms used more boars for estrus detection, rotated boars, and controlled boar movement than Sm farms (P<0.05). Farm size also influenced semen sourcing, number of doses received, and frequency of semen delivery (P<0.05). More M and Lg farms performed AI in the presence of a boar, left the AI rod in after AI, checked for returns, and diagnosed pregnancy than Sm farms (P<0.05). Start of boar exposure after weaning began on 69% of farms within 2 d, occurring most often in the AM, but with exposure times varying from 1 to 5 min/sow. Semen was thermally protected for 50% of farms receiving shipments, and semen storage was consistent among farms. For AI, service occurred within minutes to hours after detection of estrus on 61% of farms. During AI, procedures such as back-pressure were required, whereas techniques such as hands-free AI were prohibited on most farms. Sow movement was allowed only once at 4 wk after breeding on 50% of farms, and pregnancy diagnosis occurred at 3 to 5 wk on 78% of farms. Most sows were allowed ≥1 chance for breeding after conception failure before culling. Incidence of fail to farrow was <5% and litter size was 10 to 13 pigs on >82% of farms. Summer infertility was observed on 69% of farms with estrus and pregnancy failures the leading causes. Over 70% of farms reported a technician effect on fertility. These results suggest that reproductive management of farms in key areas related to weaning, breeding, gestation, and labor use could be a source of variation in reproductive performance.

Progressive increase of human papillomavirus carriage rates in potentially malignant and malignant oral disorders with increasing malignant potential.

INTRODUCTION: We investigated the potential role of human papillomaviruses (HPVs) in potentially malignant oral disorders, oral leukoplakia (OL) and oral lichen planus (OLP), and in oral squamous cell cancer (OSCC) in an Eastern Hungarian population with a high incidence of OSCC. METHODS: Excised tumor samples (65 OSCC patients) and exfoliated cells from potentially malignant lesions (from 44 and 119 patients with OL and OLP, respectively) as well as from healthy controls (72 individuals) were analysed. OLPs were classified based on clinical appearance, 61 patients had erosive-atrophic lesions (associated with higher malignancy risk, EA-OLP) and 58 had non-erosive non-atrophic lesions (with lower risk of becoming malignant, non-EA-OLP), respectively. Exfoliated cells collected from apparently healthy mucosa accompanied each lesion sample. HPV was detected by MY/GP polymerase chain reaction (PCR) and genotyped by restriction analysis of amplimers. Copy numbers in lesions were determined using real-time PCR. Prevalence rates, copy number distributions, and association with risk factors and diseases were analysed using chi-square test, t-test, and logistic regression, respectively. RESULTS: We detected HPVs significantly more frequently in lesions than in controls (P < or = 0.001 in all comparisons). HPV prevalence increased gradually with increasing severity of lesions (32.8, 40.9, and 47.7% in OLP, OL, and OSCC, respectively). Copy number distribution patterns roughly corresponded to prevalence rates, but OLP and OL were comparable. HPV prevalence differed significantly between EA-OLP and non-EA-OLP groups (42.6 vs. 22.4%); EA-OLP group showed a prevalence similar to that found in OL. CONCLUSION: HPVs may be involved in the development or progression of not only OSCC but also of potentially malignant oral lesions.

Archaeosomes based on synthetic tetraether-like lipids as novel versatile gene delivery systems.

Novel cationic liposomes, termed "archaeosomes", based on mixtures of neutral/cationic bilayer-forming lipids and archaeobacterial synthetic tetraether-type bipolar lipids show efficient in vitro gene transfection properties and represent a new approach for modulating the lipidic membrane fluidity of the complexes they form with DNA.

Facilitating phoneme awareness development in 3- and 4-year-old children with speech impairment.

PURPOSE: This study investigated the phonological awareness and early literacy development of 12 children who presented at 3 years of age with moderate or severe speech impairment. The children's response to early intervention that included specific activities to facilitate phoneme awareness and letter knowledge, in addition to improving speech intelligibility, was examined. METHOD: Using a 3-year longitudinal design, the children's development in phonological awareness was monitored and compared to that of a group of 19 children without speech impairment. During the monitoring period from 3 to 5 years of age, the children with speech impairment received, on average, 25.5 intervention sessions. At 6 years of age, the children's performance on phonological awareness, reading, and spelling measures was also compared to that of the 19 children without impairment as well as to a matched control group of children with speech impairment who had not received any specific instruction in phonological awareness. RESULTS: The results indicated that (a) phoneme awareness can be stimulated in children with speech impairment as young as 3 and 4 years of age, (b) facilitating phoneme awareness development can be achieved concurrently with improvement in speech intelligibility, and (c) enhancing phoneme awareness and letter knowledge during the preschool years is associated with successful early reading and spelling experiences for children with speech impairment. CLINICAL IMPLICATIONS: The data provide evidence to support the clinical practice of integrating activities to develop phoneme awareness and letter knowledge into therapy for 3- and 4-year-old children with moderate or severe speech impairment.

Preparation of alcohols from alkenes via the homologation of boronates with (Trimethylsilyl)diazomethane

Alkylcatecholboranes obtained from alkenes were converted to the corresponding alkylmethanols by reaction with (trimethylsilyl)diazomethane followed by oxidation and treatment with fluoride.

The retirement adjustment process: changes in the well-being of male retirees across time.

The purpose of this prospective study was to (1) evaluate the impact of retirement, (2) monitor the change in adjustment across time, and (3) identify the resources predictive of short- and long-term adjustment in retirement. A sample of 117 male retirees was assessed on indices of physical and psychological health, perceived control, retirement satisfaction, and life satisfaction at 2-4 months preretirement, 1 year post-, and 6-7 years postretirement. The results provided support for a positive impact of retirement, as retirees evidenced increases in well-being during the first year. There was also evidence of a retirement adjustment process, in that aspects of well-being (i.e., psychological health) changed from short- to long-term retirement. Finally, physical health, income, and voluntary retirement status predicted short-term adjustment, while internal locus of control was an additional resource for long-term adjustment. Changes in resources over time also differentially predicted short- and long-term adjustment (e.g., an increase in internal locus of control predicted an increase in activity satisfaction at 1 year but not at 6-7 years postretirement).

Differential effects of dipyrone, ibuprofen, and paracetamol on experimentally induced pain in man.

In a double-blind cross-over study on 22 healthy subjects the analgesic efficacies of the antipyretic analgesic drugs ibuprofen, dipyrone and paracetamol were tested against placebo using a model of experimentally induced pain. To this purpose interdigital webs were pinched repeatedly for 2 min periods. The painfulness of these stimuli was assessed by the subjects on an electronically controlled visual analogue scale at 10 sec intervals. In addition to the subjective pain ratings the stimulus induced reflex diminution of the blood flow in the stimulated hand was measured with photoplethysmography and laser Doppler flow analysis. The flare response around the stimulated area was assessed with infrared thermography. In this assay system ibuprofen and dipyrone, but not paracetamol, showed statistically significant analgesic effects by preventing hyperalgesia which is normally induced by the repeated stimulation of a skin site. This hypoalgesic effect was not related to the subjective impression of the subjects of the analgesic potency of the respective drug. Sympathetic reflex vasoconstriction was not quantitatively related to the drug induced hypoalgesia. Ibuprofen and, to a minor extent, the other antipyretic analgesic drugs also diminished the stimulus induced flare reaction around the stimulated skin sites.

Response specificity revisited: stress and health status.

Numerous authors have obtained significant, but low correlations between life events and specific health status measures. Even with the inclusion of moderating variables, such as coping, the relationship between life stress and health status measures has rarely exceeded .50. It has been argued that failure to enhance the correlation has occurred because response specificity has not been controlled. A representative community sample of 184 adults from London, Ontario, was surveyed with respect to life stress variables, stress-response specificity, and various illness behaviors. First-order factor analysis of the stress-response specificity measure indicated an emotional/psychological response factor, an eating response factor, a drug/alcohol response factor, and several physical response factors. Second-order factor analysis indicated a psychological response and a physical response factor. Each of the illness behaviors was regressed, in a stepwise procedure, upon the life stress measures and related first- and second-order stress-response specificity factors. As predicted, significant relationships were found between the related stress-response specificity and illness behavior measures. These results support the importance of stress-response specificity as a moderator variable in investigations of the relationship between life stress and illness behavior.

The dimensionality of cognitive appraisal and its relationship to physical and psychological well-being.

In current adjustment models, an individual's appraisal of life events has been included as an important determinant in the stress-illness process. In particular, these events have been defined in terms of a variety of unidimensional concepts, such as desirability, controllability, or as having the potential for threat or challenge. The present study investigated the multidimensional nature of cognitive appraisal and its relationship to physical and psychological well-being. Residents of a Canadian community (N = 184) responded to an extensive survey on life-event stress, appraisal, alcohol consumption, health status, and depression. A principal-axis factor analysis of 19 appraisal dimensions revealed five factors accounting for 60% of the variance: Undesirability/Threat, Gain/Challenge, Need for Information, Familiarity, and Need to Accept. Entered with total number of life events and coping behavior as predicted aspects of well-being.

Seminal selenium concentrations and spermatozoal abnormalities in beef bulls.

The relationship between seminal selenium (Se) concentration and spermatozoal abnormalities in 24 Angus and 12 Simmental bulls maintained on a Se adequate diet was studied. Two semen samples were collected by electroejaculation 50 days apart from each bull. Measurements of primary and secondary spermatozoal abnormalities, seminal Se concentration, and blood plasma Se concentration were determined at each semen collection. The mean (chi +/- SD ) Se concentration of semen (0.535 +/- 0.267) was approximately 8 fold greater than the Se concentration of blood plasma (0.069 +/- 0.066) and the values were similar for both collections. Spermatozoa concentration was correlated (r = 0.50; P<.01) with seminal Se concentration; however, seminal Se concentration was not highly correlated (P<.01) with primary spermatozoal abnormalities (r = -0.29) and secondary spermatozoal abnormalities (r = 0.16). This study indicates that the Se concentration of semen is high relative to blood plasma in bulls maintained on a Se adequate diet; however, the seminal Se concentration is not highly correlated with spermatozoal abnormalities.