Outcomes of Minimally Invasive Colectomy for Perforated Diverticulitis.

BACKGROUND: We hypothesized that a laparoscopic approach to sigmoidectomy for perforated diverticulitis is associated with less morbidity and mortality. METHODS: The NSQIP database was used to investigate adult patients who underwent emergent colectomy with end colostomy for perforated diverticulitis. A multivariate analysis using logistic regression was used to compare outcomes of patients by surgical approach. RESULTS: We found a total of 2937 adult patients who underwent emergent colectomy for perforated diverticulitis during 2012-2017. The rate of minimally invasive surgery (MIS) was 11.4% with 38.6% conversion rate to open. The 30-day mortality and morbidity rates were 8.8% and 65.8%, respectively. Following adjustment using a multivariate analysis, the open approach was associated with higher morbidity (67.2% vs 56.8%, AOR: 1.70, P < .01) and mean hospitalization length of patients (13 days vs 10 days, P < .01) compared to the MIS approach. Respiratory complications of ventilator dependency (14.3% vs 6%, AOR: 2.95, P < .01) and unplanned intubation (7.4% vs 2.4%, AOR: 2.14, P = .03) were significantly higher in the open approach. However, patients who underwent the open approach were older (age >70; 33.5% vs 24%, P < .01) with more comorbid conditions such as COPD (10.8% vs 7.2%, P = .04) and CHF (9% vs 3.1%, P < .0). CONCLUSION: The MIS approach to emergent partial colectomy for perforated diverticulitis is associated with decreased morbidity and hospitalization length of patients. Utilization of the MIS approach for partial colectomy for perforated diverticulitis is 11.4% with a conversion rate of 38.6%. Efforts should be directed toward increasing the utilization of laparoscopic approaches for the surgical treatment of perforated diverticulitis.

Baltimore Ceasefire 365: Estimated Impact of a Recurring Community-Led Ceasefire on Gun Violence.

Objectives. To estimate the impact of recurring community-led, weekend-long ceasefires on gun violence in the City of Baltimore, Maryland.Methods. The City of Baltimore releases detailed data on all crimes occurring in the city. We compiled daily counts of fatal and nonfatal shootings occurring between January 2012 and July 2019 and fit a Bayesian model to estimate the impact of the ceasefires on gun violence during designated weekends after accounting for yearly seasonality, day of the week, calendar days, and overall time trends. We also looked at the 3-day periods following each 3-day ceasefire weekend to test for a possible postponement effect.Results. There was an estimated 52% (95% credible interval [CI] = 33%, 67%) reduction in gun violence during ceasefire days and no evidence of a postponement effect on either the next 3 days or the next 3-day weekend following each ceasefire weekend (incidence rate ratio = 0.88; 95% CI = 0.72, 1.06).Conclusions. The Baltimore Ceasefire weekends may be an effective short-term intervention for reducing gun violence. Future research should aim to understand the key components and transferability of the intervention.

Breast surgery and regional anaesthesia.

Regional anaesthesia techniques are an important adjunct to perioperative care of breast surgery patients. This chapter focuses on the practical application, evidence base and advantages of peripheral nerve block regional anaesthesia in the anaesthetic management of patients undergoing breast surgery. Functional anatomy and fascial plane blocks are discussed alongside paravertebral and paraspinal techniques. Guidance on the performance the range of ultrasound-guided blocks is provided. The role that regional anaesthesia may have in reducing the risk of breast cancer recurrence following mastectomy surgery is explored.

Close and Positive Lumpectomy Margins are Associated with Similar Rates of Residual Disease with Additional Surgery.

BACKGROUND: Current guidelines state that "no ink on tumor" constitutes adequate surgical margins for lumpectomy specimens. However, there remains uncertainty when tumor is close (<1 mm) to multiple inked margins. METHODS: All local excisions for invasive breast cancer during 3 years at one center were reviewed. Tumor characteristics, margin status, patient age, reoperations, and pathology of reexcised specimen were recorded. Chi-square analysis and regression models were used to identify factors associated with residual disease upon reoperation. RESULTS: In 533 lumpectomies for invasive cancer, 60 (11 %) had at least one positive margin, and 106 (20 %) had one or more close margin. Multiple margins were either close or positive in 67 cases. Reoperation was performed in 125 of 533 cases (23 %) for close or positive margins. Positive margins were significantly more likely to undergo reoperation compared with close margins (p < 0.001). On reoperation, 73 of 125 (58 %) demonstrated residual cancer, including 39 of 68 (57 %) with close margins, and 34 of 57 (60 %) with positive margins (p = 0.52). When multiple margins were close or positive, residual cancer was found on reexcision in 45 of 59 (76 %) cases as opposed to 34 of 79 (43 %) cases with only one involved margin (p < 0.001). When controlling for other factors, positive margins were no more associated with residual disease than close margins (p = 0.32), whereas multiple close or positive margins were associated with significantly higher risk of residual disease (odds ratio 6.1; p = 0.002; 95 % confidence interval 2.6-14.45). CONCLUSIONS: The only significant predictor of residual tumor was multiple close or positive margins. It may be appropriate to recommend reexcision for patients with multiple close margins.

Occupational injury among migrant workers in China: a systematic review.

OBJECTIVES: This review considers the state of occupational injury surveillance and prevention among migrant workers in China and suggests areas of focus for future research on the topic. METHODS: Bibliographic databases were searched for qualitative and quantitative studies on surveillance of and interventions to prevent occupational injury among migrant workers in mainland China. Additional abstracts were identified from the citations of relevant articles from the database search. Studies fitting the inclusion criteria were evaluated, and findings were extracted and summarised. RESULTS: The search uncovered 726 studies in the English-language databases searched, and 3109 in the Chinese database. This article analyses a total of 19 research articles that fit the inclusion criteria with qualitative or quantitative data on occupational injury surveillance and prevention of migrant workers in China. Despite evidence of the vulnerability of migrant workers in the workplace, there is little systematic surveillance of occupational injury and few evaluated interventions. CONCLUSIONS: Migrant workers account for a disproportionate burden of occupational injury morbidity and mortality in China. However, data are inconsistent and inadequate to detail injury incidence or to evaluate interventions. The following are suggestions to decrease injury incidence among migrants: strengthen the national system of occupational injury surveillance; focus surveillance and interventions on high-risk occupations employing migrants such as construction, manufacturing and small mining operations; improve occupational safety training and access to appropriate safety equipment; evaluate recent changes in occupational health and safety and evaluate outcome of multi-party interventions to reduce occupational injury among migrant workers.

High sensitivity C-reactive protein associated with different health predictors in middle-aged and oldest old Chinese.

OBJECTIVE: To describe the distribution of plasma high sensitivity C-reactive protein (hsCRP) and explore the relationship between hsCRP and metabolic risk factors among residents living in longevity areas of China. METHODS: 268 individuals aged between 40 and 59 years and 506 individuals aged over 90 years were selected from 5 longevity areas of China to participate in a cross section longitudinal cohort study. The participants were interviewed with general health related questionnaire to collect their demographic, behavioral and lifestyle data, as well as their chronic conditions, and meanwhile their physical and biomedical parameters including waist circumference (WC), blood pressure (BP), hsCRP, plasma lipids, and fasting blood glucose (FBG) were measured. RESULTS: The median of hsCRP was 0.99 mg/L in the middle-aged group and 1.76 mg/L in the oldest old group. No significant gender difference was observed between the above two groups. Among the oldest old individuals, 36.56% had an hsCRP level >3.0 mg/L. The prevalence of high hsCRP was 16.79% in the middle-aged group. The results of stepwise multiple linear regression analyses showed that HDL-C was independently associated with ln (hsCRP) concentration in the middle-aged group, whereas ln (TG), HDL-C and FBG were correlated after adjustment for gender, study site, smoking, drinking, education and BMI in the oldest old group. CONCLUSION: HDL-C is a stronger predictor of elevated hsCRP than other metabolic factors in the middle-aged population. For the oldest old persons, high TG, low HDL-C, and FBG predict elevated plasma hsCRP.

High normal plasma triglycerides are associated with preserved cognitive function in Chinese oldest-old.

OBJECTIVE: to explore the relationship between blood lipids/lipoproteins and cognitive function in the Chinese oldest-old. DESIGN: multivariate statistical analysis using cross-sectional data. SETTING: community-based setting in longevity areas in China. SUBJECTS: eight hundred and thirty-six subjects aged 80 and older were included in the sample. METHODS: plasma total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, blood pressure and fasting plasma glucose were measured and information about demographics and lifestyle was collected. Cognitive status was assessed using the Mini-Mental State Examination (MMSE). RESULTS: cumulative logit model analysis showed that triglyceride was significantly negatively associated with cognitive impairment. By general linear modelling, there was a significant linear trend of MMSE scores with the level of triglyceride, but not with levels of cholesterol after adjustment. The odds ratio (OR) of cognitive impairment (MMSE score < 18) was significantly reduced for the highest quartile of plasma triglyceride concentration (OR: 0.52, 95% CI: 0.33-0.84), but not for the second or third quartile, compared with the lowest quartile (adjusted models). There were no significant associations between cognitive impairment and cholesterol. CONCLUSION: we concluded that high normal plasma triglyceride was associated with preservation of cognitive function while lower concentrations were not in the Chinese oldest-old.

Rapid resonance Raman microspectroscopy to probe carbon dioxide fixation by single cells in microbial communities.

Photosynthetic microorganisms play crucial roles in aquatic ecosystems and are the major primary producers in global marine ecosystems. The discovery of new bacteria and microalgae that play key roles in CO(2) fixation is hampered by the lack of methods to identify hitherto-unculturable microorganisms. To overcome this problem we studied single microbial cells using stable-isotope probing (SIP) together with resonance Raman (RR) microspectroscopy of carotenoids, the light-absorbing pigments present in most photosynthetic microorganisms. We show that fixation of (13)CO(2) into carotenoids produces a red shift in single-cell RR (SCRR) spectra and that this SCRR-SIP technique is sufficiently sensitive to detect as little as 10% of (13)C incorporation. Mass spectrometry (MS) analysis of labelled cellular proteins verifies that the red shift in carotenoid SCRR spectra acts as a reporter of the (13)C content of single cells. Millisecond Raman imaging of cells in mixed cultures and natural seawater samples was used to identify cells actively fixing CO(2), demonstrating that the SCRR-SIP is a noninvasive method for the rapid and quantitative detection of CO(2) fixation at the single cell level in a microbial community. The SCRR-SIP technique may provide a direct method for screening environmental samples, and could help to reveal the ecophysiology of hitherto-unculturable microorganisms, linking microbial species to their ecological function in the natural environment.

[Association of anemia with cognition among senior female in China].

OBJECTIVE: To explore the relationship between anemia and cognitive function among senior female aged 90 years old and above in longevity regions in China. METHODS: 383 senior female in 5 longevity areas from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) 2008 - 2009 were included in the study. The cognitive function was assessed by mini mental state examination (MMSE) scale. All subjects were administered the physical examinations and biochemical testing of blood, including the hemoglobin. The difference of cognitive function between those with and without anemia was analyzed. Logistic regression was used to analyze the relationship between anemia and cognitive function. RESULTS: The 383 subjects were divided into two groups, 141 in anemia group and 242 in group without anemia. The total score of cognitive function was 9.65 ± 9.32 in anemia group, and 13.06 ± 10.25 in group without anemia (χ(2) = 5.59, P < 0.05). The percentage of cognition impairment was 84.4% (119/141) in anemia group, and 72.3% (175/242) in group without anemia (χ(2) = 8.08, P < 0.05). In the multivariable logistic regressions, after adjustment for age, education, marital status, smoking and alcohol drinking, the risk for cognition impairment in anemia group was about twice of that in group without anemia (OR = 2.016, 95%CI: 1.185 - 3.431, P = 0.010). CONCLUSION: Anemia increases the risk of cognition impairment among senior female in Chinese longevity areas.

Infra-red and Raman spectroscopy of free-base and zinc phthalocyanines isolated in matrices.

The infrared absorption spectra of matrix-isolated zinc phthalocyanine (ZnPc) and free-base phthalocyanine (H(2)Pc) have been recorded in the region from 400 to 4000 cm(-1) in solid N(2), Ar, Kr and Xe. Raman spectra have been recorded in doped KBr pellets. The isotopomers HDPc and D(2)Pc have been synthesised in an attempt to resolve the conflicting assignments that currently exist in the literature for the N-H bending modes in H(2)Pc spectra. A complete correlation between the vibrational modes of the three free-base isotopomers and ZnPc has been achieved. Comparison of the IR and Raman spectroscopic results, obtained with isotopic substitution and with predictions from large basis set ab initio calculations, allows identification of the in-plane (IP) and out-of-plane (OP) N-H bending modes. The largest IP isotope shift is observed in the IR at 1046 cm(-1) and at 1026 cm(-1) in Raman spectra while the largest effect in the OP bending modes is at 764 cm(-1). OP bending modes are too weak to be observed in the experimental Raman data. The antisymmetric N-H stretching mode is observed at approximately 3310 cm(-1) in low temperature solids slightly blue shifted from, but entirely consistent with the literature KBr data. With the exception of the N-H stretches, the recorded H/D isotope shifts in all the N-H vibrations are complex, with the IP bending modes exhibiting small nu(H)/nu(D) ratios (the largest value is 1.089) while one of the observed OP modes has a ratio < 1. DFT results reveal that the small ratios arise in particular from strong coupling of the N-H IP bending modes with IP stretching modes of C-N bonds. The unexpected finding of a nu(H)/nu(D) ratio smaller than one was analysed theoretically by examining the evolution of the frequencies of the free base by increasing the mass from H to D in a continuous manner. A consequence of this frequency increase in the heavier isotopomer is that the direction of the N-D OP bend is reversed from the N-H OP bend.

Acetylenic quinoxalinoporphyrazines as photosensitisers for photodynamic therapy.

A range of lipo- and hydrophilic derivatives of the new class of octaalkynyl tetra-[6,7]-quinoxalinoporphyrazines (TQuiPors), analogues of the naphthalocyanines, were prepared in two steps starting from functionalised hexa-1,5-diyne-3,4-diones. Divalent zinc and magnesium ions were introduced into the macrocyclic core. Whereas the triisopropylsilyl-, 3,5-di-tert-butylphenyl- and 4-triisopropylsilyloxyphenyl-terminated acetylenic TQuiPors are lipophilic and hence soluble in standard organic solvents, a polyethylene glycol-substituted derivative was found to dissolve in DMSO as well as in ethanol/water mixtures. The new chromophores are characterised by intense UV/Vis/NIR absorptions, most notably by bands at 770 nm with extinction coefficients exceeding 500 000 M(-1) cm(-1). With a view to possible photodynamic therapy applications, the potency of the chromophores to sensitise the formation of singlet oxygen was examined, both qualitatively using a 1,3-diphenylisobenzofuran assay, and quantitatively by the determination of the singlet oxygen quantum yields. It was found that all TQuiPors produce singlet oxygen when irradiated in the presence of air. In particular, the octaalkynyl Zn-TQuiPor generates singlet oxygen with a quantum yield of 56 %, thereby rivalling, and, in conjunction with its absorption profile, even exceeding the standards set by established PDT agents. The photostabilities of the TQuiPors were assessed and generally found to be satisfactory, but dependent on the solvent and the wavelength of the incident light.

Synthesis of novel phthalocyanine-tetrathiafulvalene hybrids; intramolecular fluorescence quenching related to molecular geometry.

A number of silicon phthalocyanine bis-esters have been synthesized and characterized, with axial ligands containing one or more tetrathiafulvalene groups. Variations in the substitution positions around a central aromatic "hinge" within the ligands lead to different molecular geometries, and the fluorescence of the macrocyclic core is subsequently quenched to varying degrees by the electron-rich tetrathiafulvalene moiety, the magnitude of this effect being dependent upon both the relative separation of the two units and the flexibility of the linking group. Pc derivative 24, with a highly flexible linker group, and pc derivative 28, with a dendritic axial ligand, have the intensity of the macrocycle emission reduced by 99% and 96%, respectively, relative to a similar silicon pc reference compound lacking the TTF moieties. Molecular modeling studies of a series of such hybrids allow the degree of this fluorescence quenching to be related to the intramolecular spacing. Additionally, the potential for rapid electrochemical switching of the phthalocyanine fluorescence by oxidation of the appended tetrathiafulvalene units is explored.

The first genuine observation of fluorescent mononuclear phthalocyanine aggregates.

An initial photophysical study of a tetra-solketal-substituted zinc phthalocyanine is reported; at low temperature this compound exhibits very strong aggregation, and a new red shifted emission peak is observed, lambda max approximately 750 nm, attributed to a fluorescent phthalocyanine dimer.

Fluorescent phthalocyanine dimers--a steady state and flash photolysis study.

Steady state and time resolved studies of a tetrakis[(+/-)-2,2-dimethyl-1,3-dioxan-4-ylmethanol] (solketal) substituted zinc phthalocyanine (1) and its derivatives (4a-c) are reported. These compounds form novel fluorescent dimers (or higher order aggregates) at low temperature, with a red shifted emission band centred at approximately 750 nm. The degree of aggregation has been related to the nature of the peripheral substituents, with bulky groups reducing and long alkyl chains increasing the phenomenon. Fluorescence lifetimes of the dimeric species are reported. Flash photolysis results show complex behaviour of the transient species, and it is possible to identify three main processes, involving decay of the monomer triplet state, the dimer triplet, and dimer disaggregation, with each process having a characteristic transient lifetime.