Two-row, three-row or powered circular stapler, which to choose when performing colorectal anastomosis? A systematic review and meta-analysis.

PURPOSE: Three types of circular staplers can be used to perform a colorectal anastomosis: two-row (MCS), three-row (TRCS) and powered (PCS) devices. The objective of this meta-analysis has been to provide the existing evidence on which of these circular staplers would have a lower risk of presenting a leak (AL) and/or anastomotic bleeding (AB). METHODS: An in-depth search was carried out in the electronic bibliographic databases Embase, PubMed and SCOPUS. Observational studies were included, since randomized clinical trials comparing circular staplers were not found. RESULTS: In the case of AL, seven studies met the inclusion criteria in the PCS group and four in the TRCS group. In the case of AB, only four studies could be included in the analysis in the PCS group. The AL OR reported for PCS was 0.402 (95%-confidence interval (95%-CI): 0.266-0.608) and for AB: 0.2 (95% CI: 0.08-0.52). The OR obtained for AL in TRCS was 0.446 (95%-CI: 0.217 to 0.916). Risk difference for AL in PCS was - 0.06 (95% CI: - 0.07 to - 0.04) and in TRCS was - 0.04 (95%-CI: - 0.08 to - 0.01). Subgroup analysis did not report significant differences between groups. On the other hand, the AB OR obtained for PCS was 0.2 (95% CI: 0.08-0.52). In this case, no significant differences were observed in subgroup analysis. CONCLUSION: PCS presented a significantly lower risk of leakage and anastomotic bleeding while TRCS only demonstrated a risk reduction in AL. Risk difference of AL was superior in the PCS than in TRCS.

Green Synthesis for Carbon Quantum Dots via Opuntia ficus-indica and Agave maximiliana: Surface-Enhanced Raman Scattering Sensing Applications.

In this study, we present an alternative method for synthesizing carbon quantum dots (CQDs) using a green synthesis approach via extracts from Agave maximiliana and Opuntia ficus-indica(Ofi). The extracts from both plants were used as the carbon source for the CQDs. The synthesis method employs mesoporous zeolite 4A as a refractory for the thermal treatment of the samples. Transmission electron microscopy analysis established that the size of the CQDs shows a narrow distribution centered around 2 nm with a maximum size of less than 3 nm for both cases. The CQDs exhibit absorption bands associated with π-π* transitions located around 220 nm. In both cases, photoluminescence (PL) phenomenon was detected by irradiating the samples with a UV wavelength and detecting emissions close to the blue wavelength. Additionally, both kinds of CQDs were tested as surface-enhanced Raman scattering (SERS) substrates against methylene blue (MB), indicating an enhancement associated with ring deformation and stretching modes of the v(C-C) and v(C-N) bonds located around 1400 and 1620 cm-1, respectively. Complementarily, in the framework of density functional theory, H2nC2(2m+1) structures (with n = 3-5 and m = 1-3) were used as a theoretical representation of CQDs in interaction with the MB molecule. It is used for developing the analysis of charge transfer effects between both systems and for specifying elements that generate the SERS effect associated with the chemical enhancement mechanism.

Nanomechanical properties of kidney stones, gallstones and oral stones compared with tap water scale by depth sensing indentation.

This article focuses on a description of research performed to identify structural and mechanical properties differences between calculi in stones, such as gallstones, kidney stones, dental tartar, and saliva gland sialolite, were analyzed and compared with tap water stone, in order to set interrelations. In this study, biological hard pebble-like structures were analyzed and compared among them using Scanning Electron Microscopy (SEM), X-Ray diffraction (XRD), and Atomic Force Microscopy (AFM). In addition, Nanoindentation was used to obtain values as example in kidney stones the in; stiffness S = 27,827 ± 620 N/nm elastic modulus E = 27.3 ± 4.5 GPa, hardness H = 1.5 ± 0.5 GPa. Samples with the highest amounts of calcium and magnesium oxides were; Tap water stone (39.60%), followed by dental tartar (39.40%), saliva gland sialolite (29.20%), kidney stones (27.70%), and lastly the gallstones (0.30%). Kidney stones showed in particular, whewellite and kaoulinite crystallographic phases, that confers characteristics of greater crystallization with respect to the other stones. Kidney stones positioned in the major hardness stone in human body with 1.5 GPa. In general, samples with the highest amount of calcium oxides, also showed the highest mechanical properties of H and E. Microstructural characteristics and nano-hardness of tap water stone from drinking water where similar to those of dental tartar and saliva gland sialolite, more research still required to associate health concerns and tap water scale derived from drinking water known as hardwater.

Structural Analysis of Cu+ and Cu2+ Ions in Zeolite as a Nanoreactor with Antibacterial Applications.

In this work, we report the structural analysis of Cu+ and Cu2+ ions in zeolite as a nanoreactor with antibacterial applications. A simple one-step process was implemented to obtain Cu ions in zeolite A (ZA4) by controlling the temperature in the solutions to guarantee the ions' stability. Samples were characterized by scanning electron microscopy, energy-dispersive X-ray spectroscopy, and Fourier transform infrared (FT-IR) spectroscopy, showing the characteristic zeolite elements as well as the characteristic bands with slight modifications in the chemical environment of the zeolite nanoreactor attributed to Cu ions by FT-IR spectroscopy. In addition, a shift of the characteristic peaks of ZA4 in X-ray diffraction was observed as well as a decrease in relative peak intensity. On the other hand, the antibacterial activity of Cu ions in the zeolite nanoreactor was evaluated.

Anisotropic behavior of mechanical properties for thea- andc-domains in a (001) BaTiO3single crystal.

Barium titanate (BaTiO3) single crystal with a tetragonal phase was characterized by nanoindentation. Elastic and elastic-plastic deformation regimes were obtained. The main objective was the evaluation of the anisotropic behavior related to mechanical properties associated with the cross-section of the ferroelectrica- andc-domains (In-plane and out-of-plane) in (001) configuration domains. This behavior was evaluated along a line perpendicular to the between domains, which demonstrated that the mechanical properties of the BaTiO3single crystal depend on the distance from due to the effect of the influence of the neighbor domain. A three-dimensional (3D) finite element (FE) model was developed to simulate mechanical effects revealed by the nanoindentations test. The FE simulation demonstrated that there is no simple isotropic mechanical behavior associated with the domain type. Numerical simulations and experiments performed to study ferroelastic switching domains in BaTiO3crystals revealed the interaction of the 90°-cadomain with the indentation position.

Three-dimensional endoanal ultrasound to assess the validity of Goodsall's Rule and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening.

BACKGROUND: Correct identification of the internal opening is essential in the management of perianal fistulae. The aim of this study was to assess the validity of Goodsall's Law and the Midline Rule in predicting the path of perianal fistula-in-ano and the location of the internal opening using 3-dimensional endoanal ultrasound. METHODS: An observational study including patients diagnosed with fistula-in-ano, at our institution from January 2006 to December 2020 was performed. Location and distance from the anal verge of the external opening, internal opening, and the path of the fistulous tract were recorded during physical examination and endoanal ultrasound. Goodsall's and Midline rules were applied to all fistulae according to the location of the external opening. The location of the internal opening as predicted by either rule was then compared to the real location of the internal opening identified during endoanal ultrasound examination. RESULTS: Nine hundred and nine patients [657 (72.3%) males, mean age 50.78 (49.84-51.72) years] were included. 665 (73.2%) of fistulae were transsphinteric. Concordance between predicted internal opening site and the true internal opening location was 0.601 (good match) for Goodsall's rule, and 0.416 (moderate match) for the Midline rule. Goodsall's rule proved to be more predictive in the anterior plane (p < 0.001). Both rules were more likely to make a correct diagnosis in posterior fistulae located 4.5-7.5 mm from the anal verge. CONCLUSIONS: Both Midline and Goodsall's rules are highly predictive of the course of fistula tracts located in the posterior plane, and are lower for anterior located fistulae, female patients and when the external opening is located further from the anal verge.

Time resolved plasma diagnostics for pulsed 2.45 GHz hydrogen discharges.

A review of the last ten years of advances in temporal resolved plasma diagnostics for pulsed operated 2.45 GHz microwave-driven hydrogen discharges is presented. Special attention has been paid to the study of breakdown and decay processes where some particular phenomena are explored for application in ion sources. Measurements of plasma temperature and density using vacuum ultraviolet spectroscopy, ultra-fast photography, and ion mass spectroscopy are performed in detail, including examples and results.

Prótesis total de rodilla primaria en un paciente con ruptura no reciente del tendón rotuliano, tratado en 2 tiempos quirúrgicos / Total primary knee prosthesis in a patient with non-recent rupture of the patellar tendon, treated in 2 surgical times

Resumen: Introducción: La ruptura de tendón rotuliano en pacientes mayores se relaciona con enfermedades sistémicas como la artritis reumatoide, el lupus eritematoso y aquéllos con tratamiento prolongado con corticoides o antibioticoterapia. Es ocasionado por traumatismo con la rodilla en flexión acompañado de una contracción del cuádriceps o fuerza excéntrica, su diagnóstico puede omitirse hasta en 38% de los casos. El tratamiento en las rupturas no recientes es más complejo ya que después de 45 días de la lesión ocurre retracción del cuádriceps, fibrosis, formación de adherencias e hipotrofia muscular. Las opciones de tratamiento son variadas utilizando desde autoinjertos hasta injertos sintéticos con túneles óseos y anclas de fijación. Reporte de caso: Hombre de 71 años con ruptura del tendón rotuliano de 18 años de evolución tratado en dos tiempos, comenzando por la reparación del aparato extensor con tendones de la pata de ganso preservando la inserción de los mismos y realizando después prótesis total de rodilla en un segundo tiempo quirúrgico y mostramos su evolución.

Abstract: Introduction: Patellar tendon rupture has a higher prevalence in older patients related to systemic diseases such as rheumatoid arthritis, lupus erythematosus and those with prolonged treatment with corticosteroids or antibiotic therapy. It is caused by trauma with the knee in flexion accompanied by a contraction of the quadriceps or eccentric force, the diagnosis can be omitted in up to 38% of cases. Treatment of non-recent tendon ruptures is more difficult with end-to-end techniques are complicated and difficult to perform 45 days after injury due to quadriceps retraction, fibrosis, adhesion formation, and muscle hypotrophy. Treatment options are varied, ranging from autografts to synthetic grafts using bone tunnels and fixation anchors. Case report: Our case is a 71-year-old patient with an 18-year-old patellar tendon rupture treated in two stages, starting with repairing the extensor apparatus with pes anserinus tendons, preserving their insertion and subsequently performing total knee replacement in a second surgical time and we show its evolution.

Does delaying curative surgery for colorectal cancer influence long-term disease-free survival? A cohort study.

BACKGROUND: Surgical wait list time is a major problem in many health-care systems and its influence on survival is unclear. The aim of this study is to assess the impact of wait list time on long-term disease-free survival in patients scheduled for colorectal cancer resection. MATERIALS AND METHODS: A prospective study was carried out in patients with colorectal cancer scheduled for surgery at a tertiary care center. Wait list time was defined as the time from completion of diagnostic workup to definitive surgery and divided into 2-week intervals from 0 to 6 weeks. The outcome variables were 2-year and 5-year disease-free survival. RESULTS: A total of 602 patients, 364 (60.5%) male, median age 73 years (range = 71) were defined. The median wait list time was 28 days (range = 99). Two and 5-year disease-free survival rates were 521 (86.5%) and 500 (83.1%) respectively. There were no differences in 2-year or 5-year disease-free survival for the whole cohort or by tumor stage between wait list time intervals except for AJCC stage II tumors which showed a higher 5-year disease-free survival for the 2-4 and 4-6-week wait list time interval (p = 0.021). CONCLUSIONS: Time from diagnosis to definitive surgery up to 6 weeks is not associated with a decrease in 2-year or 5-year disease-free survival (DFS) in AJCC stage I through III colorectal cancer patients. These are important findings in the light of the COVID-19 pandemic and offer a window of opportunity for preoperative optimization and prehabilitation.

[Total primary knee prosthesis in a patient with non-recent rupture of the patellar tendon, treated in 2 surgical times]. / Prótesis total de rodilla primaria en un paciente con ruptura no reciente del tendón rotuliano, tratado en 2 tiempos quirúrgicos.

INTRODUCTION: Patellar tendon rupture has a higher prevalence in older patients related to systemic diseases such as rheumatoid arthritis, lupus erythematosus and those with prolonged treatment with corticosteroids or antibiotic therapy. It is caused by trauma with the knee in flexion accompanied by a contraction of the quadriceps or eccentric force, the diagnosis can be omitted in up to 38% of cases. Treatment of non-recent tendon ruptures is more difficult with end-to-end techniques are complicated and difficult to perform 45 days after injury due to quadriceps retraction, fibrosis, adhesion formation, and muscle hypotrophy. Treatment options are varied, ranging from autografts to synthetic grafts using bone tunnels and fixation anchors. CASE REPORT: Our case is a 71-year-old patient with an 18-year-old patellar tendon rupture treated in two stages, starting with repairing the extensor apparatus with pes anserinus tendons, preserving their insertion and subsequently performing total knee replacement in a second surgical time and we show its evolution.

INTRODUCCIÓN: La ruptura de tendón rotuliano en pacientes mayores se relaciona con enfermedades sistémicas como la artritis reumatoide, el lupus eritematoso y aquéllos con tratamiento prolongado con corticoides o antibioticoterapia. Es ocasionado por traumatismo con la rodilla en flexión acompañado de una contracción del cuádriceps o fuerza excéntrica, su diagnóstico puede omitirse hasta en 38% de los casos. El tratamiento en las rupturas no recientes es más complejo ya que después de 45 días de la lesión ocurre retracción del cuádriceps, fibrosis, formación de adherencias e hipotrofia muscular. Las opciones de tratamiento son variadas utilizando desde autoinjertos hasta injertos sintéticos con túneles óseos y anclas de fijación. REPORTE DE CASO: Hombre de 71 años con ruptura del tendón rotuliano de 18 años de evolución tratado en dos tiempos, comenzando por la reparación del aparato extensor con tendones de la pata de ganso preservando la inserción de los mismos y realizando después prótesis total de rodilla en un segundo tiempo quirúrgico y mostramos su evolución.

Impact of the novel powered circular stapler on risk of anastomotic leakage in colorectal anastomosis: a propensity score-matched study.

BACKGROUND: Several risk factors for anastomotic leakage (AL) following colorectal surgery have been described. Improvement in devices for performing anastomosis is a modifiable factor that could reduce AL rates. The aim of this study was to assess the impact of technical improvements in the Echelon Circular™ powered stapler (ECPS) on the left-sided colorectal AL rate compared to current manual circular staplers (MCS). METHODS: A cohort study was carried out on consecutive patients between January 2017 and February 2020 in whom left-sided stapled colorectal anastomosis above 5 cm from anal verge was performed. The primary end point was the risk of AL depending on the type of circular stapler used. The ECPS cases were matched to MCS cases by propensity score matching to obtain comparable groups of patients. RESULTS: Two hundred seventy-nine patients met the inclusion criteria. A MCS anastomosis was performed in 218 patients and ECPS anastomosis in 61 (21.9%). Overall, AL was observed in 25 (9%) cases. Factors significantly associated with AL were American Society of Anesthesiologists score (p = 0.025) and type of circular stapler used (p = 0.021). After adjusting the cases with propensity score matching (119 cases MCS versus 60 ECPS), AL was observed in 14 (11.8%) patients in MCS group and in 1 (1.7%) patient in the ECPS group (p = 0.022). AL in the MCS group required reoperation in seven cases (5.8%), the remaining seven patients were treated conservatively. The patient in the ECSP group required an urgent Hartmann's procedure CONCLUSIONS: The ECPS device could have a positive impact by reducing AL rates in left-sided colorectal anastomosis. Multicenter controlled trials are needed for stronger evidence to change practice.

Polymorphisms of the melatonin receptor 1A (MTNR1A) gene influence the age at first mating in autumn-born ram-lambs and sexual activity of adult rams in spring.

The aim of this study was to determine whether polymorphisms of the melatonin receptor 1A (MTNR1A) gene influence the age at first mating in autumn-born ram-lambs and influence the out-of-season sexual activity of adult rams. In experiment 1, 24 Rasa Aragonesa ram-lambs born in September were genotyped for their RsaI and MnlI allelic variants of the MTNR1A gene, and the date of their first mounting with ejaculation after a period of semen collection training was documented. In experiment 2, the reproductive behavior, testicle size, and plasma testosterone concentrations of 18 adult rams (6 rams for each RsaI genotype) were recorded at the beginning (March) and end (May) of the seasonal anestrus. The number of days of training to achieve the first mating with ejaculation in T/T (C/C: 85.17 ± 12.08 C/T: 86.60 ± 18.87; T/T; 26.50 ± 24.50 d; P < 0.05), and G/G ram-lambs (G/G: 51.57 ± 14.99; A/G: 95.58 ± 10.95 d; P < 0.05) was significantly fewer than it was in the other genotypes. Likewise, for the RsaI genotype, 55% of the vulva-sniffing (P < 0.001), 48% of the approaches (P < 0.01), 48% of the mountings (P < 0.05) and 49% total activities (P < 0.001) were performed by T/T rams in March, and 50% of the sexual events in May (P < 0.001). For the Mnll variant, G/G rams performed a significantly (P < 0.001) larger proportion of the vulva-sniffing (41%), approaches (46%) and total activities (40%) in March, and 52% of the vulva-sniffing (P < 0.001), 43%, of the approaches (P < 0.001), 46% of the mountings (P < 0.05), and 47% of the total activities (P < 0.001) in May. Scrotal circumference, testicular volume, and plasma testosterone concentrations did not differ significantly among genotypes. Results confirmed that the polymorphisms of the MTNR1A gene sequence can influence reproductive performance in young and adult rams. Autumn-born ram-lambs that carried the T/T or G/G genotype had an advanced ability to reproduce, and T/T or G/G adult rams exhibited the most intense reproductive behavior. Genotyping might be a useful procedure for identifying the correct and rational use of rams in modern sheep farming.

BoLA-DRB3 exon2 polymorphisms among tuberculous cattle: Nucleotide and functional variability and their association with bovine tuberculosis pathology.

Bovine tuberculosis (bTB) is caused by Mycobacterium bovis and disseminated worldwide. In Argentina, the highest prevalence occurs in dairy areas. BoLA DRB3.2 is related to the adaptive immunity in mycobacterial infections. Genetic polymorphisms of this marker have been associated with resistance or susceptibility to bovine diseases. We evaluated the association between BoLA DRB3.2 polymorphisms and bTB pathology scores in dairy and beef cattle breeds of Argentina. Most bovines exhibited visible lesions compatible with tuberculosis and, furthermore, 150 (85.7%) were also positive by bacteriology. A pathology index showed a variable degree of disease, from 3 to 76 (median pathology score = 9 (IQR: 7-15)). Thirty-five BoLA DRB3.2 alleles were identified with an associated frequency from 16% to 0.3%, distributed 73% (n = 128) in heterozygosis and 27% (n = 47) in homozygosis, with 12 BoLA DRB3.2 alleles (*0101, *1101, *1501, *0201, *2707 *1001, *1002, *1201, *14011, *0501 *0902 and *0701) representing the 74.7% of the population variability. A functional analysis grouped them in 4 out of 5 clusters (A-D), suggesting a functional overlapping. Among the 90 identified genotypes, *1101/*1101, *1101/*1501 and *0101/*0101 were the most frequent (10%, 8.9% and 8.9%, respectively). No association was detected between the pathology scores and a specific DRB3.2 allele (p > .05). Animals infected with M. bovis spoligotype SB0153 showed a significantly higher pathology score than those affected by the spoligotype SB0145 (p = .018). Furthermore, the Aberdeen Angus breed exhibited highest pathological scores (p < .0001), which were associated with disseminated lesion, thus suggesting that the host component could be important to the disease progression.

Probable benign paroxysmal positional vertigo, spontaneously resolved: Incidence in medical practice, patients' characteristics and the natural course.

BACKGROUND: Probable benign paroxysmal positional vertigo, spontaneously resolved (pBPPVsr), is a variant of benign paroxysmal positional vertigo (BPPV) in which there is no observable nystagmus and no vertigo with any positional maneuver. OBJECTIVES: To calculate the incidence pBPPVsr, compare the characteristics of the patients with pBPPVsr and BPPV not spontaneously resolved and describe the spontaneous resolution in the natural course of BPPV. METHODS: Multicenter prospective descriptive study. During a one-year period, all patients with suspected BPPV that presented to the Neurotology Units of five participating centers were recruited. The incidence of pBPPVsr was calculated as a percentage of the total number of patients with BPPV. The prevalence of several variables was compared between pBPPVsr and BPPV not spontaneously resolved. The timing of spontaneous resolution was estimated using Kaplan-Meier curves. RESULTS: 457 patients met the inclusion criteria. The incidence of pBPPVsr was 33.5%. It was significantly higher in males, in patients with normal bone mass and in patients who were not taking sulpiride. A rate of 18% of spontaneous resolution after the first month and 51% after the first year was found. This percentage did not change in a significant way after this moment. The curves for males, patients under 50 and patients with normal blood pressure decreased significantly faster. CONCLUSIONS: In our serie, BPPV spontaneously resolved in half of the patients with BPPV during the first year. This seemed to occur more commonly in males and could have been hindered by sulpiride intake, osteoporosis, advanced age and high blood pressure.

Outcomes of Hartmann's procedure and subsequent intestinal restoration. Which patients are most likely to undergo reversal?

BACKGROUND: Aim of the study was to describe characteristics and outcomes of Hartmann's procedure (HP) and subsequent intestinal restoration. METHODS: Retrospective study including all patients who underwent HP over a period of 16 consecutive years. We propose a classification and regression tree for a more accurate view of the relationship between the variables related to intestinal restoration and their weighting in the decision to reverse HP. RESULTS: 533 patients were included. Overall morbidity rate of HP was 53.5% and mortality 21.0%. Overall morbidity of the intestinal continuity reconstruction was 47.3% and mortality 0.9%. Patients with a benign disease, aged under 69 years and with low comorbidity, had an 84.4% probability of undergoing intestinal reconstruction. CONCLUSIONS: HP is associated with high morbidity and mortality. Restoration of intestinal continuity involves minor, but frequent, morbidity and a low mortality rate. Age and comorbidities can decrease, and even override, the decision to reverse HP.

Healing criteria: How should an episode of benign paroxistic positional vertigo of posterior semicircular canal's resolution be defined? Prospective observational study.

OBJECTIVES: To compare the outcome of the Epley maneuver (EM) in benign paroxysmal positional vertigo of the posterior canal (CSP-BPPV) depending on the definition used for recovery. DESIGN: Multicenter observational prospective study. SETTING: Otoneurology Units of 5 tertiary reference hospitals. PARTICIPANTS: All patients presenting with unilateral CSP-BPPV assisted for 1-year period. EXCLUSION CRITERIA: Spontaneous nystagmus, positive McClure-Pagnini maneuver, positive bilateral Dix-Hallpike maneuver (DHM), positive DHM for vertigo but negative for nystagmus and atypical nystagmus. MAIN OUTCOME MEASURES: Response to EM was measured after 7 days in 3 different outcomes: disappearance of nystagmus during the DHM in the follow-up visit, disappearance of vertigo during the DHM and general status (GS) during daily life activities. RESULTS: 264 patients were recruited (68 male/166 female, mean age 62 years). After the EM, nystagmus disappeared in 67% of them, vertigo in 54% and 36% were asymptomatic in their daily life. These outcomes were strongly correlated, but they were not concordant in a clinically significant group of cases; only the 26% of patients met all of them. The healing process follows the next sequence: negativization of positional nystagmus, then disappearance of positional vertigo and, finally, the improvement of GS during daily life activities. CONCLUSION: Nowadays, healing criteria for the resolution of an PSC-BPPV episode have not been specifically defined yet. Provided that other otoneurological disorders have been ruled out, the next resolution criterion is proposed: absence of nystagmus and specifically during control DHM and disappearance of symptoms during daily life activities.