Association of Obesity With Septic Complications After Major Abdominal Surgery: A Secondary Analysis of the RELIEF Randomized Clinical Trial.

Importance: Body mass index (BMI) has been the most common obesity measure to assess perioperative risk; however, cardiometabolic risk is associated with the burden of visceral fat. Definitive evidence on the association of visceral fat measures, such as waist circumference and waist-to-hip ratio (WHR), with postoperative complications is lacking. Objective: To compare the value of waist circumference with the value WHR and BMI in predicting adverse outcomes, including major septic complications and persistent disability, following major abdominal surgery. Design, Setting, and Participants: This planned secondary analysis of the Restrictive vs Liberal Fluid Therapy for Major Abdominal Surgery (RELIEF) randomized clinical trial took place at 47 centers in 7 countries between October 2013 and September 2016, with 90-day follow-up. A total of 2954 adult RELIEF participants were coenrolled in this secondary analysis. Data analysis took place from December 2018 to September 2019. Exposures: Waist circumference, WHR, and BMI measurements. Main Outcomes and Measures: The primary outcomes were 30-day major septic complications and 90-day persistent disability or death. Results: Of 2954 eligible participants, 2755 were included (mean [SD] age, 65.9 [12.9] years; 1426 [51.8%] men) in the final analysis. A total of 564 participants (20.6%) experienced at least 1 major septic complication within 30 days after surgery (sepsis, 265 [9.7%]; surgical site infection, 409 [14.9%]; anastomotic leak, 78 [2.8%]; pneumonia, 104 [3.8%]). Waist circumference had a statistically significantly larger odds ratio (OR) and discrimination indices as well as a smaller prediction error than WHR or BMI for 30-day major septic complications or death (waist circumference: OR, 1.44; 95% CI, 1.28-1.62; P < .001; area under the receiver operating characteristic curve, 0.641; net reclassification index, 0.266; integrated discrimination improvement [score × 104], 152.98; Brier score, 0.162; WHR: OR, 1.15; 95% CI, 1.03-1.28; P = .01; area under the receiver operating characteristic curve, 0.621; net classification index, 0.199; integrated discrimination improvement [score × 104], 28.47; Brier score, 0.164; BMI: OR, 1.33; 95% CI, 1.17-1.50; P < .001; area under the receiver operating characteristic curve, 0.629; net reclassification index, 0.205; integrated discrimination improvement [score × 104], 85.61; Brier score, 0.163) but not for any other outcomes. Conclusions and Relevance: In this secondary analysis of the RELIEF randomized clinical trial, waist circumference was observed to be superior to other adiposity indices in predicting 30-day major septic complications alone or in conjunction with death following elective major abdominal surgery. Findings suggest that waist circumference is a useful adiposity measure that should be incorporated in preoperative risk assessment for such complications. Trial Registration: ClinicalTrials.gov identifier: NCT01424150.

Development of a pelvic exenteration service at a tertiary referral centre.

BACKGROUND: Over one-third of primary rectal cancers are locally advanced at diagnosis, and local recurrence of rectal cancer occurs at a rate of 3-10% following primary curative resection. Extended resectional surgery, including pelvic exenteration, is the only proven therapy with curative potential in the treatment of these cancers along with many other pelvic malignancies. A microscopically clear resection margin (R0 resection) is the predominant prognostic factor affecting overall and disease-free survival. The extent and complexity of surgery required to achieve an R0 resection is associated with significant risk of morbidity and mortality. The aim of this paper is to show that pelvic exenterations can be performed with acceptable oncological and safe perioperative results in an appropriately resourced specialist centre. METHODS: Data was collected retrospectively for 61 consecutive patients treated between June 2012 and February 2017. This included patient demographics, tumour characteristics, operative, clinical and histological data, length of hospital stay, morbidity and mortality data. RESULTS: A total of 61 patients underwent surgery. Median age was 57 years (range 27-78 years). Median length of stay was 41 days (range 6-288 days). Median operative time was 624 min (range 239-1035 min); 30-day mortality was 3.3% (n = 2). Resection rates were 91.5% - R0, 6.8% - R1 and 1.7% - R2 resections. Histologically, 86.9% - adenocarcinomas, 3.3% - squamous cell carcinomas and 9.8% - represented by leiomyosarcoma, melanoma, myxoid chondrosarcoma, non-neoplastic processes and undifferentiated carcinoma. CONCLUSION: Our experience confirms that radical resectional pelvic surgery can be safely performed with acceptable results during the establishment phase of a dedicated tertiary service.

Cohort study on emergency general surgery patients and an observation unit.

BACKGROUND: Medium-sized, non-trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients. METHODS: To assess the unit's effect, a prospective analysis was completed of the patients who came through the RAMS unit over a 6-month period and compared with a retrospective analysis of patients presenting in the same 6-month period the year prior to the unit's instigation. RESULTS: The RAMS unit was effective in providing an avenue for faster review by the surgical team. This resulted in patients leaving the emergency department faster, decreased the number of patients that breached emergency department time-targets and increased the number of patients discharged after a period of observation or basic treatments. CONCLUSION: General surgery patients were managed more efficiently with the RAMS unit in place. However, a full cost analysis is required to determine if such units are cost-effective.

General practitioners' perceptions of and involvement in health behaviour change: can computer-tailored interventions help?

AIM: To explore GPs' perceptions of their role in primary prevention, barriers experienced and willingness to accommodate an automated, computer-tailored intervention. BACKGROUND: General practice is an attractive setting for primary prevention of chronic disease. Due to constraints in time and knowledge it is underutilised. METHODS: Telephone interviews of 13 GPs in Brisbane, Australia, whose patients were previously involved in a lifestyle change research project. Qualitative responses were grouped into themes. FINDINGS: GPs perceived their role in lifestyle change as 'educators', 'supporters' and 'prompters'. Smoking and physical activity were addressed more often than alcohol and salt intake. Longer lifestyle-focussed consultations and computer-generated reminders were suggested to overcome barriers. A computer-tailored approach was appreciated due to its minimal impact on practice routine. GPs understand their role in primary prevention but need help to overcome barriers. GP initiated consultations focusing on lifestyle and prevention along with computer support systems could improve capability for prevention in general practice.

An ovarian torsion around a remnant of the urachus.

We report a case of ovarian torsion around a remnant of the urachus. Though it usually develops into the median umbilical ligament, abnormalities in urachal development can occur which can lead to remnants being present in the adult abdomen. This case describes a young female who had intermittent lower abdominal pain over a period of three weeks. During this period several ultrasound scans were performed which reported different anatomy and possible causes of the pain. Only on diagnostic laparoscopy and confirmed via histology, was it found that she had experienced ovarian torsion around an urachal remnant. Unfortunately due to the delay from symptom onset to her operation, her ovary was not salvageable. This case highlights the variability of ultrasound findings and demonstrates how a remnant can contribute to ovarian torsion and subsequent infarction.

Characterisation of Ni silicate-bearing minerals by UV-vis-NIR spectroscopy. Effect of Ni substitution in hydrous Ni-Mg silicates.

Three Ni silicate-bearing pimelite, nepouite and pecoraite minerals, from Australia have been investigated by UV-vis-NIR spectroscopy to study the effect of Ni-Mg substitution. The observation of three major absorption bands at 9205-9095, 15,600-15,190 and 26,550-25,660 cm(-1) are the characteristic features of Ni(2+) in sixfold coordination. The effect of cation substitution like Mg(2+) for Ni(2+) on band shifts in electronic and vibrational spectra enable the distinction between the Ni-bearing silicates.

Raman spectroscopic study of the uranyl minerals vanmeersscheite U(OH)4[(UO2)3(PO4)2(OH)2].4H2O and arsenouranylite Ca(UO2)[(UO2)3(AsO4)2(OH)2].(OH)2.6H2O.

Raman and infrared spectra of secondary uranyl phosphate vanmeersscheite and Raman spectrum of secondary uranyl arsenate arsenuranylite were recorded and interpreted, and the spectra related to the structure of the minerals. Observed bands were attributed to the stretching and bending vibrations of uranyl, phosphate and/or arsenate units and OH (H(2)O and OH(-)) units. Phosphuranylite sheet topology is characteristic for both minerals. U-O bond lengths in uranyl were calculated from the spectra and compared with those inferred for vanmeersscheite from the X-ray single crystal structure analysis. O-H...O hydrogen bonds in both minerals were also inferred using the Libowitzky empirical relation.

Raman spectroscopic study of the tellurite minerals: carlfriesite and spiroffite.

Raman spectroscopy has been used to study the tellurite minerals spiroffite and carlfriesite, which are minerals of formula type A(2)(X(3)O(8)) where A is Ca(2+) for the mineral carlfriesite and is Zn(2+) and Mn(2+) for the mineral spiroffite. Raman bands for spiroffite observed at 721 and 743 cm(-1), and 650 cm(-1) are attributed to the nu(1) (Te(3)O(8))(2-) symmetric stretching mode and the nu(3) (Te(3)O(8))(2-) antisymmetric stretching modes, respectively. A second spiroffite mineral sample provided a Raman spectrum with bands at 727 cm(-1) assigned to the nu(1) (Te(3)O(8))(2-) symmetric stretching modes and the band at 640cm(-1) accounted for by the nu(3) (Te(3)O(8))(2-) antisymmetric stretching mode. The Raman spectrum of carlfriesite showed an intense band at 721 cm(-1). Raman bands for spiroffite, observed at (346, 394) and 466 cm(-1) are assigned to the (Te(3)O(8))(2-)nu(2) (A(1)) bending mode and nu(4) (E) bending modes. The Raman spectroscopy of the minerals carlfriesite and spiroffite are difficult because of the presence of impurities and other diagenetically related tellurite minerals.

Raman spectroscopic study of the tellurite minerals: mackayite and quetzalcoatlite.

Tellurites may be subdivided according to formula and structure. There are five groups based upon the formulae: (a) A(XO(3)), (b) A(XO(3)).xH(2)O, (c) A(2)(XO(3))(3).x(2)O, (d) A(2)(X(2)O(5)) and (e) A(X(3)O(8)). Raman spectroscopy has been used to study mackayite and quetzalcoatlite are examples of tellurites containing OH units Raman bands for mackayite observed at 732, 782 and 579, 635cm(-1) are assigned to the nu(1) (Te(2)O(5))(2-) symmetric stretching and nu(3) (Te(2)O(5))(2-) antisymmetric stretching modes. The Raman spectral profile of quetzalcoatlite is more complex with a considerable number of overlapping bands. Two bands may be resolved at 719 and 754cm(-1) which may be attributed to nu(1) (Te(2)O(5))(2-) symmetric stretching mode. The two Raman bands of quetzalcoatlite at 602 and 606cm(-1) are accounted for by the nu(3) (Te(2)O(5))(2-) antisymmetric stretching mode. Raman bands for mackayite, observed at 306, 349, 379 and 424, 436cm(-1) are assigned to the (Te(2)O(5))(2-) nu(2) (A(1)) bending mode and nu(4) (E) bending modes. This research shows that Raman spectroscopy may be applied to tellurite minerals successfully.

Raman spectroscopic study of the tellurite minerals: rajite and denningite.

Tellurites may be subdivided according to formula and structure. There are five groups based upon the formulae (a) A(XO3), (b) A(XO3).xH2O, (c) A2(XO3)3.xH2O, (d) A2(X2O5) and (e) A(X3O8). Raman spectroscopy has been used to study rajite and denningite, examples of group (d). Minerals of the tellurite group are porous zeolite-like materials. Raman bands for rajite observed at 740, and 676 and 667 cm(-1) are attributed to the nu1 (Te2O5)(2-) symmetric stretching mode and the nu3 (TeO3)(2-) antisymmetric stretching modes, respectively. A second rajite mineral sample provided a more complex Raman spectrum with Raman bands at 754 and 731 cm(-1) assigned to the nu1 (Te2O5)(2-) symmetric stretching modes and two bands at 652 and 603 cm(-1) are accounted for by the nu3 (Te2O5)(2-) antisymmetric stretching mode. The Raman spectrum of dennigite displays an intense band at 734 cm(-1) attributed to the nu1 (Te2O5)(2-) symmetric stretching mode with a second Raman band at 674 cm(-1) assigned to the nu3 (Te2O5)(2-) antisymmetric stretching mode. Raman bands for rajite, observed at (346, 370) and 438 cm(-1) are assigned to the (Te2O5)(2-)nu2 (A1) bending mode and nu4 (E) bending modes.

Raman and infrared spectroscopic study of the anhydrous carbonate minerals shortite and barytocalcite.

The Raman spectra of shortite and barytocalcite complimented with infrared spectra have been used to characterise the structure of these carbonate minerals. The Raman spectrum of barytocalcite shows a single band at 1086 cm(-1) attributed to the (CO3)(2-) symmetric stretching mode, in contrast to shortite where two bands are observed. The observation of two bands for shortite confirms the concept of more than one crystallographically distinct carbonate unit in the unit cell. Multiple bands are observed for the antisymmetric stretching and bending region for these minerals proving that the carbonate unit is distorted in the structure of both shortite and barytocalcite.