ABSTRACT
AIM: Routine elective colectomy after acute diverticulitis is not recommended, yet significant numbers are still being performed. Amidst global concern over the rising costs of surgery and the value of healthcare, acute diverticulitis is a disease that is amenable to optimization of strategies for operative intervention. We aim to compare rates of elective colectomy after acute diverticulitis in the USA, England and Australia. METHOD: Index unplanned admissions for acute diverticulitis were found from an international administrative dataset between 2008 and 2012 for hospitals in the USA, England and Australia. Recurrent unplanned admissions for acute diverticulitis and any subsequent elective admissions for colectomy were found between 2008 and 2014 to allow a minimum 2-year follow-up period. The primary outcome measured was elective colectomy rate. Secondary outcomes included rates of emergency operative intervention and recurrence. Multivariable analysis was performed to control for patient and disease factors. RESULTS: There were 7842 index unplanned admissions for acute diverticulitis over 4 years in selected hospitals from the USA, England and Australia. The elective colectomy rates were 13%, 5.4% and 3.4% for the USA, England and Australia, respectively. The propensity for elective colectomy was higher in the USA (OR 4.2, P < 0.001) and England (OR 1.8, P < 0.001) than in Australia. The recurrence rate in all patients with acute diverticulitis was 10% across the countries. CONCLUSION: There is a higher propensity for elective colectomy after acute diverticulitis in the USA than in England and Australia. This highlights the possibilities for a less aggressive surgical approach to reduce resource utilization, but prospective analysis of information on quality of life is required to support this.
Subject(s)
Colectomy , Diverticulitis, Colonic/surgery , Elective Surgical Procedures , Practice Patterns, Physicians'/statistics & numerical data , Acute Disease , Aged , Australia , England , Female , Humans , Male , Middle Aged , Retrospective Studies , United StatesABSTRACT
Whole exome sequencing detected novel likely pathogenic variants in LRP2 gene in 2 patients presenting with hearing and vision loss, and the Dent disease (DD) classical renal phenotype, that is, low molecular weight proteinuria (LMWP), hypercalciuria and nephrocalcinosis/nephrolithiasis. We propose that a subset of patients presenting as DD may represent unrecognized cases or mild forms of Donnai-Barrow/facio-oculo-acustico-renal (DB/FOAR) syndrome or be on the phenotypic continuum between the 2 conditions.
Subject(s)
Agenesis of Corpus Callosum/diagnosis , Hearing Loss, Sensorineural/diagnosis , Hernias, Diaphragmatic, Congenital/diagnosis , Hypercalciuria/diagnosis , Myopia/diagnosis , Nephrolithiasis/diagnosis , Phenotype , Proteinuria/diagnosis , Renal Tubular Transport, Inborn Errors/diagnosis , Adolescent , Aged , Agenesis of Corpus Callosum/genetics , Alleles , Diagnosis, Differential , Genetic Association Studies , Genetic Predisposition to Disease , Hearing Loss, Sensorineural/genetics , Hernias, Diaphragmatic, Congenital/genetics , Humans , Hypercalciuria/genetics , Low Density Lipoprotein Receptor-Related Protein-2/genetics , Male , Myopia/genetics , Nephrolithiasis/genetics , Proteinuria/genetics , Renal Tubular Transport, Inborn Errors/geneticsABSTRACT
The development of effective biological scaffold materials for tissue engineering and regenerative medicine applications hinges on the ability to present precise environmental cues to specific cell populations to guide their position and function. Natural extracellular matrices have an ordered nano-scale structure that can modulate cell behaviors critical for developmental control, including directional cell motility. Here we describe a method for fabricating fibrin gels with defined architecture on the nanometer scale in which magnetic forces are used to position thrombin-coated magnetic micro-beads in a defined 2-dimensional array and thereby guide the self-assembly of fibrin fibrils through catalytic cleavage of soluble fibrinogen substrate. Time-lapse and confocal microscopy confirmed that fibrin fibrils nucleate near the surface of the thrombin-coated beads and extend out in a radial direction to form these gels. When controlled magnetic fields were used to position the beads in hexagonal arrays, the fibrin nano-fibrils that polymerized from the beads oriented preferentially along the bead--bead axes in a geodesic (minimal path) pattern. These biocompatible scaffolds supported adhesion and spreading of human microvascular endothelial cells, which exhibited co-alignment of internal actin stress fibers with underlying fibrin nano-fibrils within some membrane extensions at the cell periphery. This magnetically-guided, biologically-inspired microfabrication system is unique in that large scaffolds may be formed with little starting material, and thus it may be useful for in vivo tissue engineering applications in the future.
Subject(s)
Extracellular Matrix/physiology , Fibrin/physiology , Magnetics , Nanostructures , Nanotechnology , Tissue Engineering/methods , Animals , Capillaries/cytology , Cattle , Cell Adhesion , Cell Culture Techniques , Cells, Cultured , Coated Materials, Biocompatible/chemistry , Dermis/blood supply , Endothelial Cells/cytology , Endothelial Cells/physiology , Endothelium, Vascular/cytology , Extracellular Matrix/chemistry , Fibrin/chemistry , Fibrinogen/metabolism , Humans , Infant, Newborn , Materials Testing , Microscopy, Confocal , Microscopy, Video , Microspheres , Solubility , Stress Fibers/chemistry , Substrate Specificity , Thrombin/chemistry , Tissue Engineering/instrumentationABSTRACT
Rapid staining of ultrasound guided aspirates is an accepted procedure for evaluation of adequacy and rapid diagnosis (RD). We have assessed the reliability of Toluidine blue stain in this regard, which has not been previously reported. 295 ultrasound guided aspirates performed over a 13 month period were studied. 59 aspirates were inadequate for RD. 103 cases were called malignant on RD of which 101 were confirmed, and 2 cases were considered highly suspicious on final diagnosis. Of 34 cases considered suspicious on RD, 32 were either signed out as malignant or considered highly suspicious while 2 cases were benign. Of 56 cases considered benign on RD, 49 were confirmed, 2 were suspicious for malignancy and 5 cases had inadequate material on final diagnosis. All 43 inflammatory lesions on RD were confirmed. The overall sensitivity for a malignant/suspicious for malignancy diagnosis was 98.54% on RD while specificity was 97.99%. Sensitivity and specificity for an inflammatory condition was 100%. Toluidine blue staining is not only a reliable method for rapid staining and diagnosis, it also permits preservation of cytological material by destaining and restaining with permanent stains.
Subject(s)
Cytodiagnosis/methods , Staining and Labeling/methods , Tolonium Chloride , Biopsy, Fine-Needle , Coloring Agents , Cytodiagnosis/statistics & numerical data , Retrospective Studies , Sensitivity and Specificity , UltrasonicsABSTRACT
We study evolving networks where new nodes when attached to the network form links with other nodes of preferred distances. A particular case is where always the shortest distances are selected ("make friends with the friends of your present friends"). We present simulation results for network parameters like the first eigenvalue of the graph Laplacian (synchronizability), clustering coefficients, average distances, and degree distributions for different distance preferences and compare them with the parameter values for random and scale-free networks. We find that for the shortest distance rule we obtain a power-law degree distribution as in scale-free networks, while the other parameters are significantly different, especially the clustering coefficient.
ABSTRACT
Spectral properties of coupled map lattices are described. Conditions for the stability of spatially homogeneous chaotic solutions are derived using linear stability analysis. Global stability analysis results are also presented. The analytical results are supplemented with numerical examples. The quadratic map is used for the site dynamics with different coupling schemes such as global coupling, nearest neighbor coupling, intermediate range coupling, random coupling, small world coupling and scale free coupling.
