Assessment of intraoperative use of indocyanine green fluorescence imaging on the incidence of anastomotic leakage after rectal cancer surgery: a PRISMA-compliant systematic review and meta-analysis.

BACKGROUND: The current data on the intraoperative use of indocyanine green (ICG) fluorescence imaging to reduce the anastomotic leak (AL) rate in rectal cancer surgery remain controversial. The aim of this systematic review and meta-analysis was to evaluate the efficacy of ICG fluorescence imaging in decreasing the AL rate after rectal cancer surgery. METHODS: Studies comparing ICG fluorescence imaging with standard care in patients with rectal cancer were systematically searched from PubMed, Embase, Web of Science and Cochrane Library through January 2020. The current meta-analysis was performed according to the preferred reporting items for systematic review and meta-analysis guidelines. A pooled analysis was performed for the available data regarding the baseline features, AL rate and other surgical outcomes. RevMan version 5.3 software was used for the present meta-analysis. RESULTS: Nine studies with a total of 2088 patients with rectal cancer (926 in the ICG group and 1162 in the control group) were included in the present study. In the pooled analysis, the available patient and tumour-related baseline data were all comparable and without significant heterogeneity. In the present pooled analysis, the AL rate in the ICG group was significantly lower (OR 0.34; 95% CI 0.22-0.52; p < 0.0001) than that in the control group. Additionally, intraoperative use of ICG was associated with a decreased overall complication rate (OR 0.57; 95% CI 0.42-0.78; p = 0.0003) and reduced reoperation rate (OR 0.26; 95% CI 0.08-0.86; p = 0.03) in patients who had rectal cancer surgery. CONCLUSIONS: The present study demonstrated the superiority of the intraoperative use of ICG in reducing the AL rate. However, considering the limitations of the included studies, more high-quality prospective studies and randomized controlled trials are needed.

Assessment of plant availability and environmental risk of biosolids-phosphorus in a U.S. Midwest Corn-Belt Soil.

A field experiment was conducted from 2005 to 2008 in Fulton County, Western Illinois with biosolids from conventional wastewater treatment applied as corn fertilizer in a series of P rates (0, 163, 325, 488, 650 kg P ha(-1)) along with commercial P fertilizer - triple superphosphate P (TSP) as reference to assess biosolids-P plant availability and potential loss to waterbodies through runoff. Air-dried biosolids and TSP were incorporated into surface soil at end of 2005, and corn (Zea mays) was planted for three consecutive years (2006-2008). Concentrations of soil extractable P except for Mehlich-3 P were always lower in the biosolids than TSP treatments at the same P rates. The soil potentially available P in water extractable P (WEP) and Olsen P derived from biosolids-P estimated by the exponential depletion model was 2-4% and 15-24% of total P in the applied biosolids, respectively. The residence time of biosolids-induced WEP and Olsen P in Midwest soil under annual corn cropping was 5 and 2 years, respectively. Corn tissue analysis showed lower increase in P concentration by biosolids-P than TSP. The elevation rate of soluble reactive P (SRP) concentration in simulated runoff was less by biosolids than TSP. Based on the data in this study, the plant availability and environmental risk of biosolids-P are lower than those of TSP in the Midwest soil, thus use of biosolids as P nutrient for corn would not cause a major impairment to water sources even P applied through biosolids was not completely used by annual crop.

Incremental cost-effectiveness of improving treatment results among migrant tuberculosis patients in Shanghai.

SETTING: Two projects were introduced in October 2007 to improve treatment completion among rural-to-urban migrant tuberculosis (TB) patients in Shanghai. The Communicable Disease Research Consortium (COMDIS) project provided financial incentives to poor patients, whereas the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) project provided incentives to all patients and increased staff time. OBJECTIVE: To assess the incremental cost-effectiveness of these two projects. METHODS: Case study. Costs were assessed from a societal perspective. The primary measure of effectiveness was the treatment completion rate. The incremental cost-effectiveness ratio was calculated as the additional cost of the intervention divided by the additional percentage of patients completing treatment compared to controls. RESULTS: Post intervention, the treatment completion rates in the COMDIS and Global Fund projects were respectively 89% and 88%, 17% and 16% higher than in the control district (76%). For one additional per cent of patients to complete treatment, the additional cost of the COMDIS intervention was US$1891, 91% lower than that of the Global Fund intervention (US$21,904). CONCLUSION: The intervention that addressed the financial barriers of poor patients was more cost-effective than the comprehensive intervention that provided assistance to both patients and providers. Further study is needed to understand the process of interventions prior to wider scale-up.

Multi-step magnetization of the Ising model on a Shastry-Sutherland lattice: a Monte Carlo simulation.

The magnetization behaviors and spin configurations of the classical Ising model on a Shastry-Sutherland lattice are investigated using Monte Carlo simulations, in order to understand the fascinating magnetization plateaus observed in TmB(4) and other rare-earth tetraborides. The simulations reproduce the 1/2 magnetization plateau by taking into account the dipole-dipole interaction. In addition, a narrow 2/3 magnetization step at low temperature is predicted in our simulation. The multi-step magnetization can be understood as the consequence of the competitions among the spin-exchange interaction, the dipole-dipole interaction, and the static magnetic energy.

Ex vivo perfusion of the swine heart as a method for pre-transplant assessment.

We describe a cost-effective, reproducible circuit in a porcine, ex vivo, continuous warm-blood, bi-ventricular, working heart model that has future possibilities for pre-transplant assessment of marginal hearts donated from brain stem dead donors and hearts donated after circulatory determination of death (DCDD). In five consecutive experiments over five days, pressure volume loops were performed. During working mode, the left ventricular end systolic pressure volume relationship (LV ESPVR) was 23.1±11.1 mmHg/ml and the LV preload recruitable stroke work (PRSW) was 67.8±7.2. (Standard PVAN analysis software) (Millar Instruments, Houston, TX, USA) All five hearts were perfused for 219±64 minutes and regained normal cardiac function on the perfusion system.They displayed a significant upward and leftward shift of the end systolic pressure volume relationship, a significant increase in preload recruitable stroke work and minimal stiffness. These hearts could potentially be considered for transplantation. The circuit was effective during reperfusion and working modes whilst proving to be successful in maintaining cardiac function in excess of four hours. Using an autologous prime of approximately 20% haematocrit (Hct), electrolytes and blood gases were easy to control within this period using standard perfusion techniques.

Assessment of retrograde cardioplegia with magnetic resonance imaging and localized 31P spectroscopy in isolated pig hearts.

OBJECTIVE: This study was done to determine whether retrograde delivery of cardioplegic solution provides uniform blood flow to the myocardium supplied by an occluded coronary artery and whether it maintains myocardial energy levels beyond the coronary occlusion. METHODS: Isolated pig hearts were used. A hydraulic occluder was placed at the origin of the left anterior descending coronary artery. The perfusion pressure for retrograde delivery of cardioplegic solution was controlled at 40 to 50 mm Hg. Magnetic resonance imaging and localized 31P magnetic resonance spectroscopy were used to assess myocardial perfusion and energy metabolism, respectively. RESULTS: Magnetic resonance perfusion images (n = 7) showed that the perfusion defect that occurred during antegrade delivery of cardioplegic solution (as a result of the occlusion of the left anterior descending coronary artery) resolved during retrograde delivery of cardioplegic solution. Retrograde perfusion delivered similar amounts of flow to the jeopardized myocardium as it did to other areas of the myocardium. However, the distribution of cardioplegic solution by the retrograde route was heterogeneous (cloudlike) across both ventricular walls. 31P magnetic resonance spectra showed that the ischemic changes induced by occlusion of the left anterior descending artery during antegrade perfusion were greatly alleviated by retrograde perfusion; however, it took longer for retrograde cardioplegia (n = 7, 17.08 minutes) to restore the levels of inorganic phosphate/phosphocreatine relative to the effect of releasing the left anterior descending artery occluder during antegrade delivery of cardioplegic solution (n = 7, 5.3 minutes). CONCLUSIONS: First, retrograde delivery of cardioplegic solution provides sufficient flow to the myocardium beyond a coronary occlusion to maintain near normal levels of energy metabolites, and second, the efficacy of the retrograde route of cardioplegic solution delivery (in terms of distribution of the solution and rate of myocardial energy recovery) is significantly lower than that of the antegrade route.

Evaluation of hydroxyethyl-starch-ferrioxamine as an intravascular MR contrast agent for assessment of myocardial perfusion.

PURPOSE: The present study was carried out to evaluate a new intravascular contrast agent hydroxyethyl-starch-ferrioxamine (HES-FO) for assessment of myocardial perfusion. MATERIAL AND METHODS: Isolated pig hearts were perfused with a crystalloid cardioplegic solution in a Langendorff apparatus. MR images were acquired along the short cardiac axis using T1- and T2*-weighted methods. Gd-DTPA and HES-FO were used as the standard extracellular and test contrast agents, respectively. RESULTS: We found that T1-weighted signal intensity was not significantly affected by HES-FO, but increased significantly in presence of Gd-DTPA. On the other hand, HES-FO resulted in a rapid, transient but significant decrease in T2*-weighted signal intensity. Although Gd-DTPA also decreased T2*-weighted signal intensity considerably, it took much longer for the T2*-weighted signal intensity to return to its initial steady-state with Gd-DTPA than with HES-FO. Moreover, increasing the dose of HES-FO (from 0.0023-0.0138 mmol/kg b.w.) had no effect on the time at which the T2* effect reached its maximum or on the duration of the T2* effect. However, these times and durations were affected significantly by increasing the dose of Gd-DTPA (0.0023-0.027 mmol/kg b.w.). CONCLUSION: The results suggest that HES-FO provides information regarding myocardial vascular flow which cannot be obtained using Gd-DTPA. It is expected that the combined use of intravascular and extracellular type contrast agents will allow more complete assessment of tissue perfusion.