A retrospective analysis of the incidence and risk factors of perioperative urinary tract infections after total hysterectomy.

INTRODUCTION: Perioperative urinary tract infections (PUTIs) are common in the United States and are a significant contributor to high healthcare costs. There is a lack of large studies on the risk factors for PUTIs after total hysterectomy (TH). METHODS: We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. RESULTS: PUTIs were found in 9087 patients overall, showing a 2.0% incidence. There were substantial differences in the incidence of PUTIs based on age group (P < 0.001). Between the two groups, there was consistently a significant difference in the type of insurance, hospital location, hospital bed size, and hospital type (P < 0.001). Patients with PUTIs exhibited a significantly higher number of comorbidities (P < 0.001). Unsurprisingly, patients with PUTIs had a longer median length of stay (5 days vs. 2 days; P < 0.001) and a higher in-hospital death rate (from 0.1 to 1.1%; P < 0.001). Thus, the overall hospitalization expenditures increased by $27,500 in the median ($60,426 vs. $32,926, P < 0.001) as PUTIs increased medical costs. Elective hospitalizations are less common in patients with PUTIs (66.8% vs. 87.6%; P < 0.001). According to multivariate logistic regression study, the following were risk variables for PUTIs following TH: over 45 years old; number of comorbidities (≥ 1); bed size of hospital (medium, large); teaching hospital; region of hospital(south, west); preoperative comorbidities (alcohol abuse, deficiency anemia, chronic blood loss anemia, congestive heart failure, diabetes, drug abuse, hypertension, hypothyroidism, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, valvular disease, weight loss); and complications (sepsis, acute myocardial infarction, deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, wound infection, wound rupture, hemorrhage, pulmonary embolism, blood transfusion, postoperative delirium). CONCLUSIONS: The findings suggest that identifying these risk factors can lead to improved preventive strategies and management of PUTIs in TH patients. Counseling should be done prior to surgery to reduce the incidence of PUTIs. THE MANUSCRIPT ADDS TO CURRENT KNOWLEDGE: In medical practice, the identification of risk factors can lead to improved patient prevention and treatment strategies. We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. PUTIs were found in 9087 patients overall, showing a 2.0% incidence. We found that noted increased length of hospital stay, medical cost, number of pre-existing comorbidities, size of the hospital, teaching hospitals, and region to also a play a role in the risk of UTI's. CLINICAL TOPICS: Urogynecology.

Fluorine-Rich Supramolecular Nano-Container Crosslinked Hydrogel for Lithium Extraction with Super-High Capacity and Extreme Selectivity.

Extraction and recovery of lithium from reserves play a critical role in the sustainable development of energy due to the explosive growth of the lithium-battery market. However, the low efficiency of extraction and recovery seriously threatens the sustainability of lithium supply. In this contribution, we fabricate a novel mechanically robust fluorine-rich hydrogel, showing highly efficient Li+ extraction from Li-containing solutions. The hydrogel was facilely fabricated by simple one-pot polymerization of supramolecular nanosheets of fluorinated monomers, acrylic acid and a small amount of chemical crosslinkers. The hydrogel exhibits a remarkable lithium adsorption capacity (Qm Li+ =122.3 mg g-1 ) and can be reused. Moreover, it can exclusively extract lithium ions from multiple co-existing metal ions. Notably, the separation of Li+ /Na+ in actual wastewater is achieved with a surprising separation factor of 153.72. The detailed characterizations as well as calculation showed that the specific coordination of Li-F plays a central role for both of the striking recovery capability and selectivity for Li+ . Furthermore, an artificial device was constructed, displaying high efficiency of extracting lithium in various complex actual lithium-containing wastewater. This work provides a new and promising avenue for the efficient extraction and recovery of lithium resource from complex lithium-containing solutions.

Estimating the occurrence of labial bone perforation and implantation into the maxillary sinus maxillary premolars based on the morphology of maxillary premolars: A clinical study.

STATEMENT OF PROBLEM: Previous studies have classified the sagittal root position of the maxillary anterior teeth and measured buccal plate thickness to aid treatment planning. A thin labial wall and buccal concavity may cause buccal perforation, dehiscence, or both in maxillary premolars. However, data on the restoration-driven principle to classify the maxillary premolar region are lacking. PURPOSE: The purpose of this clinical study was to investigate the occurrence of labial bone perforation and implantation into the maxillary sinus between various tooth-alveolar classifications with respect to the crown axis in maxillary premolars. MATERIAL AND METHODS: Cone beam computed tomography images of 399 participants (1596 teeth) were analyzed to determine the probability of labial bone perforation and implantation into the maxillary sinus when associated with variables that included tooth position and tooth-alveolar classification. RESULTS: The morphology in the maxillary premolars was classified as straight, oblique, or boot-shaped. The first premolars were 62.3% straight, 37.0% oblique, and 0.8% boot-shaped, and labial bone perforation occurred in 4.2% (21 of 497) of the straight, 54.2% (160 of 295) of the oblique, and 83.3% (5 of 6) of the boot-shaped first premolars when the virtual implant was 3.5×10 mm. When the virtual tapered implant was 4.3×10 mm, labial bone perforation occurred in 8.5% (42 of 497) of the straight, 68.5% (202 of 295) of the oblique, and 83.3% (5 of 6) of the boot-shaped first premolars. The second premolars were 92.4% straight, 7.5% oblique, and 0.1% boot-shaped, and labial bone perforation occurred in 0.5% (4 of 737) of the straight, 33.3% (20 of 60) of the oblique, and 0% (0 of 1) of the boot-shaped, respectively, when the virtual tapered implant was 3.5×10 mm; and labial bone perforation occurred in 1.3% (10/737) of the straight, 53.3% (32/60) of the oblique, and 100% (1/1) of the boot-shaped second premolars when the virtual tapered implant was 4.3×10 mm. CONCLUSIONS: When an implant is placed in the long axis of a maxillary premolar, the tooth position and tooth-alveolar classification should be considered when assessing the risk of labial bone perforation. Attention should be paid to the implant direction, diameter, and length in the oblique and boot-shaped maxillary premolars.

Polyacrylamide-Based Block Copolymer Bearing Pyridine Groups Shows Unexpected Salt-Induced LCST Behavior.

Thermal-responsive block copolymers are a special type of macromolecule that exhibit a wide range of applications in various fields. In this contribution, we report a new type of polyacrylamide-based block copolymer bearing pyridine groups of polyethylene glycol-block-poly(N-(2-methylpyridine)-acrylamide; Px) that display distinct salt-induced lower critical solution temperature (LCST) behavior. Unexpectedly, the phase-transition mechanism of the salt-induced LCST behavior of Px block copolymers is different from that of the reported LCST-featured analogues. Moreover, their thermo-responsive behavior can be significantly regulated by several parameters such as salt species and concentration, urea, polymerization degree, polymer concentration and pH values. This unique thermal behavior of pyridine-containing block copolymers provides a new avenue for the fabrication of smart polymer materials with potential applications in biomedicine.