8 years cohort study on short term outcome of sutureless thyroidectomy in Hospital Raja Perempuan Zainab II

Background: Thyroid surgery is one of the most common surgery performed now days with very low complication rates. The introduction of vessel sealing technology have assisted surgeon in securing hemostasis in limited operative field and shortened the operative time. However, surgeons are still skeptical in using this technology as there are many important structures in close proximity to the thyroid gland. Therefore, this study is performed to evaluate the outcome of sutureless thyroidectomy as compared to conventional knot tying technique. Methods: This is a retrospective cohort study of case record of patients who underwent total thyroidectomy from 1st January 2007 to 31st December 2014 in Hospital Raja Perempuan Zainab II, Kota Bharu, Kelantan. Those who met the inclusion criteria will be recruited in the study. Patients were divided into two groups based on conventional or sutureless thyroidectomy. The short term outcome post thyroidectomy were studied. The data were analyzed using Statistical Package for the Social Sciences (SPSS). Results: Total of 495 patients were included in this study aged between 8 and 76 years old with mean age of 44.7(13.29) years. It comprises 70 males and 425 female. Majority were Malays (96.6%), followed by Chinese (2.2%) and Indian (0.4%). From the total of 495 patients, 71 of them underwent sutureless thyroidectomy and 424 patients underwent conventional thyroidectomy. The mean operative time was significantly lower in the sutureless group (100.71 versus 121.73 min, p < 0.01). There were no significant difference in the post-operative outcome of sutureless thyroidectomy compared to conventional thyroidectomy in term of transient hypocalcemia (21.1% versus 25.7%), permanent hypocalcemia (0% versus 3.1%), transient recurrent laryngeal nerve injury (0% versus 2.8%), permanent recurrent laryngeal nerve injury (0% versus 1.4%), hematoma (0% versus 1.2%), reoperation (0% versus 0.2%), surgical site infection (0% versus 0.5%) and tracheostomy (0% versus 0.2%). There were no statistical significant comparing the post-operative length of stay between these 2 groups. Conclusion: Post-operative complications in sutureless thyroidectomy were similar if not better than conventional thyroidectomy. Therefore, sutureless thyroidectomy can be safely practiced as it have the advantage of shorter operative time thus indirectly improving the operating room efficiency

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics

High-throughput assay for determining enantiomeric excess of chiral diols, amino alcohols, and amines and for direct asymmetric reaction screening

Determining enantiomeric excess (e.e.) in chiral compounds is key to development of chiral catalyst auxiliaries and chiral drugs. Here we describe a sensitive and robust fluorescence-based assay for determining e.e. in mixtures of enantiomers of 1,2- and 1,3-diols, chiral amines, amino alcohols, and amino-acid esters. The method is based on dynamic self-assembly of commercially available chiral amines, 2-formylphenylboronic acid, and chiral diols in acetonitrile to form fluorescent diastereomeric complexes. Each analyte enantiomer engenders a diastereomer with distinct fluorescence wavelength/intensity originating from enantiopure fluorescent ligands. In this assay, enantiomers of amines and amine derivatives assemble with diol-type ligands containing a binaphthol moiety (BINOL and VANOL), whereas diol enantiomers form complexes with the enantiopure amine-type fluorescent ligand tryptophanol. The differential fluorescence is utilized to determine the amount of each enantiomer in the mixture with an error of &lt;1% e.e. This method enables high-throughput real-time evaluation of enantiomeric/diastereomeric excess (e.e./d.e.) and product yield of crude asymmetric reaction products. The procedure comprises high-throughput liquid dispensing of three components into 384-well plates and recording of fluorescence using an automated plate reader. The approach enables scaling up the screening of combinatorial libraries and, together with parallel synthesis, creates a robust platform for discovering chiral catalysts or auxiliaries for asymmetric transformations and chiral drug development. The procedure takes ~4–6 h and requires 10–20 ng of substrate per well. Our fluorescence-based assay offers distinct advantages over existing methods because it is not sensitive to the presence of common additives/impurities or unreacted/incompletely utilized reagents or catalysts.</p

Adenosine A1 receptor: Functional receptor-receptor interactions in the brain

Over the past decade, many lines of investigation have shown that receptor-mediated signaling exhibits greater diversity than previously appreciated. Signal diversity arises from numerous factors, which include the formation of receptor dimers and interplay between different receptors. Using adenosine A1 receptors as a paradigm of G protein-coupled receptors, this review focuses on how receptor-receptor interactions may contribute to regulation of the synaptic transmission within the central nervous system. The interactions with metabotropic dopamine, adenosine A2A, A3, neuropeptide Y, and purinergic P2Y1 receptors will be described in the first part. The second part deals with interactions between A1Rs and ionotropic receptors, especially GABAA, NMDA, and P2X receptors as well as ATP-sensitive K+ channels. Finally, the review will discuss new approaches towards treating neurological disorders

Conductivity/activation energy relationships for cement-based materials undergoing cyclic thermal excursions

The electrical conductivity of a range of concrete mixes, with and without supplementary cementitious materials (SCM), is studied through multiple cycles of heating and cooling over the extended temperature range -30/?70 C. When presented in an Arrhenius format, the experimental results display hysteresis effects at the lowtemperature end of the thermal cycle and, in those concretes containing supplementary cementitious materials at higher water/binder ratios, hysteresis effects were evident over the entire temperature range becoming more discernible with increasing number of thermal cycles. The depression in both the freezing and thawing point could be clearly identified and was used to estimate pore-neck and pore-cavity radii. A simplified approach is presented to evaluate the volumetric ratio of frozen pore water in terms of conductivity measurements. The results also show that the conductivity and activation energy of the concrete specimens were related to the water/binder ratio, type of SCM, physical state of the pore water and the thermal cycling regime

Downstream assessment of chlorinated organic compounds in the bed-sediment of Aiba Stream, Iwo, South-Western, Nigeria

This study investigated levels and distribution pattern of chlorinated organic compounds (COCs) otherwise known as organochlorine pesticides in sediment samples at downstream of Aiba watercourse in Iwo, South-western Nigeria. Soxhlet extraction method followed by GC–ECD analysis were used to ascertain levels of COCs in the sediment samples collected from four different locations along the stream. Eighteen COCs were detected with trans permethrin and endosulfan sulfate having highest and lowest concentrations of 375.70 ± 689.41 and 0.03 ± 0.05 µg/g, respectively. The varying levels of COCs as obtained in this study were attributed to organochlorine pesticides contamination emanated from different agricultural practices and domestic sewage loads of the study area

The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy