Outcomes of kidney transplantation using deceased donors with history of diabetes.

Deceased diabetic kidneys are increasingly utilized in transplantation. The relationship of donor's history of diabetes to clinical and histological outcomes was examined. Forty-nine diabetic deceased donor kidneys (D-DM) were transplanted into 26 normal (R-N/D-DM) and 23 diabetic recipients (R-DM/D-DM) and compared to 211 diabetic recipients of normal kidneys(R-DM/D-N) and 466 normal recipients of normal kidneys (R-N/D-N). Patient survival at 5 years was 89.7% in R-N/D-N, 96.2% in R-N/D-DM, 80.1% in R-DM/D-N, and a 71.6% in R-DM/D-DM (P = .008). Death-censored graft survival at 5 years was 86.3% in R-N/D-N, 87.4% in R-N/D-DM, 93.5% in R-DM/D-N, and 87.5% in R-DM/D-DM (P = .24). Multivariable regression analysis showed that compared to non-diabetic recipients, diabetic recipients had a 2- to 3-fold increased risk of mortality. In this cohort, there was no impact on death-censored graft survival of diabetic donor status. Only 6 of 26 post-perfusion biopsies showed evidence of diabetic nephropathy (

Li and Na Adsorption on Graphene and Graphene Oxide Examined by Density Functional Theory, Quantum Theory of Atoms in Molecules, and Electron Localization Function.

Adsorption of Li and Na on pristine and defective graphene and graphene oxide (GO) is studied using density functional theory (DFT) structural and electronic calculations, quantum theory of atoms in molecules (QTAIM), and electron localization function (ELF) analyses. DFT calculations show that Li and Na adsorptions on pristine graphene are not stable at all metal coverages examined here. However, the presence of defects on graphene support stabilizes both Li and Na adsorptions. Increased Li and Na coverages cause metal nucleation and weaken adsorption. Defective graphene is associated with the presence of band gaps and, thus, Li and Na adsorptions can be used to tune these gaps. Electronic calculations show that Li⁻ and Na⁻graphene interactions are Coulombic: as Li and Na coverages increase, the metal valences partially hybridize with the graphene bands and weaken metal⁻graphene support interactions. However, for Li adsorption on single vacancy graphene, QTAIM, ELF, and overlap populations calculations show that the Li-C bond has some covalent character. The Li and Na adsorptions on GO are significantly stronger than on graphene and strengthen upon increased coverages. This is due to Li and Na forming bonds with both carbon and oxygen GO atoms. QTAIM and ELF are used to analyze the metal⁻C and metal⁻metal bonds (when metal nucleation is present). The Li and Na clusters may contain both covalent and metallic intra metal⁻metal bonds: This effect is related to the adsorption support selection. ELF bifurcation diagrams show individual metal⁻C and metal⁻metal interactions, as Li and Na are adsorbed on graphene and GO, at the metal coverages examined here.

Milligan-Morgan (Open) Versus Ferguson Haemorrhoidectomy (Closed): A Systematic Review and Meta-Analysis of Published Randomized, Controlled Trials.

OBJECTIVE: The purpose of this article is to systematically analyse the randomized, controlled trials (RCTs) comparing Ferguson or closed haemorrhoidectomy (CH) versus open haemorrhoidectomy (OH) or Milligan-Morgan haemorrhoidectomy in the management of haemorrhoidal disease (HD). METHODS: RCTs on the effectiveness of CH and OH in the management of HD were analysed systematically using RevMan(®), and combined outcome was expressed as odds ratio (OR) and standardized mean difference. RESULTS: Eleven CRTs encompassing 1326 patients were analysed systematically. There was significant heterogeneity among included trials. Therefore, in the random effects model, CH was associated with a reduced post-operative pain (SMD, -0.36; 95 % CI, -0.64, -0.07; z = 2.45; p = 0.01), faster wound healing (OR, 0.08; 95 % CI, 0.02, 0.24; z = 4.33; p < 0.0001), lesser risk of post-operative bleeding (OR, 0.50; 95 % CI, 0.27, 0.91; z = 2.27; p < 0.02) and prolonged duration of operation (SMD, 6.10; 95 % CI, 3.21, 8.98; z = 4.13; p < 0.0001). But the variables such as pain on defecation (SMD, -0.33; 95 % CI, -0.68, 0.03; z = 1.82; p = 0.07), length of hospital stay, post-operative complications, HD recurrence and risk of surgical site infection were similar in both groups. CONCLUSION: CH has clinically measurable advantages over OH in terms of reduced post-operative pain, lower risk of post-operative bleeding and faster wound healing.

Computational data of molybdenum disulfide/graphene bilayer heterojunction under strain.

The data presented in this paper refer to the research article "Dry and Hydrated Defective Molybdenum Disulfide/Graphene Bilayer Heterojunction Under Strain for Hydrogen Evolution from Water Splitting: A First-principle Study". Here, we present the Density Functional Theory (DFT) data used to generate optimal geometries and electronic structure for the MoS2/graphene heterostructure under strain, for dry and hydrated pristine and defect configurations. We also report DFT data used to obtain hydrogen Gibbs free energies for adsorption on the MoS2 monolayer and on graphene of the heterostructure. The DFT data were calculated using the periodic DFT code CRYSTAL17, which employs Gaussian basis functions, under the hybrid functionals PBE0 and HSE06. Moreover, we also report the data used for Quantum Theory of Atoms in Molecules (QTAIM) and Non-covalent Interaction (NCI) analysis calculations. These data were obtained using the optimized unit cell configurations from the periodic DFT and inputted to Gamess program, thus generating files that could be read by the Multiwfn program used for QTAIM and NCI calculations.

Systematic review and meta-analysis of published randomized controlled trials comparing purse-string vs conventional linear closure of the wound following ileostomy (stoma) closure.

OBJECTIVE: The objective of this article is to systematically analyse the randomized, controlled trials comparing the effectiveness of purse-string closure (PSC) of an ileostomy wound with conventional linear closure (CLC). METHODS: Randomized, controlled trials comparing the effectiveness of purse-string closure vs conventional linear closure (CLC) of ileostomy wound in patients undergoing ileostomy closure were analysed using RevMan®, and the combined outcomes were expressed as risk ratio (RR) and standardized mean difference (SMD). RESULTS: Three randomized, controlled trials, recruiting 206 patients, were retrieved from medical electronic databases. There were 105 patients in the PSC group and 101 patients in the CLC group. There was no heterogeneity among included trials. Duration of operation (SMD: -0.18; 95% CI: -0.45, 0.09; z = 1.28; P < 0.20) and length of hospital stay (SMD: 0.01; 95% CI: -0.26, 0.28; z = 0.07; P < 0.95) was statistically similar following both approaches of ileostomy wound closure. The risk of surgical site infection (OR, 0.10; 95% CI: 0.03, 0.33; z = 3.78; P < 0.0001) was significantly reduced when ileostomy wound was closed using PSC technique. CONCLUSION: PSC technique for ileostomy wound is associated with a reduced risk of surgical site infection apparently without influencing the duration of operation and length of hospital stay.

Use of transanal minimally invasive surgery for endoscopic resection of rectal tumour: a technical note.

BACKGROUND: The aim of this article is to report and discuss a case of lower rectal cancer undergoing endoscopic transanal resection of tumour (ETART) using a transanal minimally invasive surgery (TAMIS) approach. METHODS: A technical note on a case report. An innovative approach for ETART using TAMIS. RESULTS: This is the first-ever case report of lower rectal cancer treated by ETART using a TAMIS approach. The procedure was completed successfully without any operative or peri-operative complication. Peri-operative flexible sigmoidoscopy confirmed a wide and patent rectal lumen. CONCLUSION: Use of a TAMIS approach for ETART to remove lower rectal cancer for palliation can be technically very effective compared with conventional ETART, due to the potential advantages of avoiding contaminant fluid spillage, easy access, better visualization compared with conventional ETART, and being user-friendly. The results from larger cohorts of patients undergoing TAMIS ETART are required before recommending the routine use of this technique. However, until then, this approach may be considered as an alternative to conventional ETART.

Specimen retrieval approaches in patients undergoing laparoscopic colorectal resections: a literature-based review of published studies.

OBJECTIVE: To review the published studies reporting various specimen retrieval incisions being used by colorectal surgeons in patients undergoing laparoscopic colorectal resections (LCR). METHODS: Standard medical electronic databases were searched to find relevant articles and a summary conclusion was generated. RESULTS: There were 43 studies reporting various approaches used for the purpose of specimen retrieval in 2388 patients undergoing LCR. The most common approaches were periumbilical midline incision (1260 reported case in the literature), transverse incision (583 reported cases in the literature) in the right- or left iliac fossa, depending on the side of colonic resection, and Pfannensteil incision (293 reported cases in the literature). Periumbilical midline incision was associated with the higher risk of developing incisional hernia (odds ratio 53.72; 95% confidence interval 7.48-386.04; Z = 3.96; P = 0.0001). In terms of surgical site infection (SSI), there was no difference between the three common approaches to specimen retrieval. Transanal and transvaginal approaches were associated with higher risk of SSI. CONCLUSIONS: Midline, transverse and Pfannensteil incisions were the most commonly used approaches for specimen retrieval following LCR. Midline incision was associated with higher risk of incisional hernia. Risk of SSI was similar in all three common approaches. The transanal and transvaginal approaches pose a higher risk of SSI. These conclusions are based on the combined outcome of published case series, case reports and comparative studies. Randomized, controlled trials with longer follow-up are required before recommending the routine use of any approach for specimen retrieval in patients undergoing LCR.

Laparoscopic repair of paraesophageal hernia requires cautious enthusiasm.

The article tries to address the dilemma confronting the repair of paraesophageal hernia (PEH). The case has been made for repair upon diagnosis. The initial results of laparoscopic repair were projected as successful. However, recurrence and reflux have plagued many studies. Whereas adjunct fundoplication is now consistently performed by most surgeons, the basis is uncertain. Recurrence rate is often higher than that reported if only the 'imaged' follow-up patients are considered. Esophageal lengthening is believed to potentially benefit both the hallmark complications. The worldwide experience with laparoscopic esophageal lengthening is scanty (although it was not uncommon in the days of open surgery). Compared to the open repair, the laparoscopic method has a higher recurrence rate, higher major specific complication rate, comparable symptom outcome and a shorter hospital stay.