Leakage Rate Research Articles

Outcomes of Colectomy for Nonmalignant Polyps and Colon Cancer: A Propensity Score-Matched Analysis.

In the United States, while most nonmalignant polyps are effectively treated through endoscopic removal, colectomy remains a treatment option for selected cases of nonmalignant polyps (NMPs) and colon cancer. This study aimed to compare postoperative outcomes for colectomies in these two conditions, hypothesizing similar complication rates. We conducted a retrospective review of the American College of Surgeons National Surgical Quality Improvement Program database from 2015 to 2021, including patients who underwent elective colectomies for colon cancer or NMPs. Using a 2:1 propensity score matching for demographics, American Society of Anesthesiologists classification, surgical methods, and comorbidities, we evaluated outcomes such as 30-d mortality, complications, anastomotic leakage, and hospital stay duration. A total of 47,960 patients, including 30,549 colon cancer patients and 17,411 NMP patients, were included after propensity score matching analysis. We concluded that there was no significant difference in mortality and reoperation rates which were 0.6% and 3.3% in patients undergoing colectomy with colon cancer, compared to 0.5% and 3.1% in those with NMP, respectively [P=0.64, P=0.21,]. In addition, the anastomotic leak rates were remarkably similar in both the colon cancer (2.4%) and NMP (2.2%) groups. [P=0.13]. Most of the 30-d postoperative surgical complications, such as sepsis, septic shock, wound disruption, and urinary tract infection exhibited similar incidence rates, however, some of them, such as readmission, pulmonary embolism, and length of stay, varied between the groups. Our findings underscore the similar postoperative outcomes between colon cancer and NMP groups, advocating for consideration of advanced endoscopic techniques for NMPs to potentially enhance patient care and outcomes.

Does Cerebrospinal Fluid Leak in Pituitary Surgery Affect Patient Reported Quality of Life?

Endoscopic techniques allow for improved visualization and tumor debulking of pituitary adenomas. More thorough tumor resection, however, can be associated with higher rates of CSF leaks. We set out to determine if CSF leaks influenced patient perceived quality of life outcomes. This retrospective study included 152 patients who underwent endoscopic pituitary tumor resection over a 10-year period. QoL was assessed using the SF-36 questionnaire and completed before surgery, 6 weeks and 6 months post-operatively. Statistical analysis was conducted using a equivalence test and a two-way mixed model ANOVA to assess intraoperative CSF leak, postoperative CSF leak, redo surgery, and the use of a lumbar drain. Of the 152 patients, 98 had a potential intraoperative CSF leak. Intra- and postoperative CSF leaks did not significantly impact patient reported QoL outcomes at 6 months following surgery. There was clinical equivalence in mental scores as early as 6 weeks and 6 months for physical scores. There was no statistically significant difference in physical (p-value = 0.975) and mental (p = 0.204) scores for patients who experienced a postoperative CSF leak. There was no statistically significant difference in QoL in the mental and physical scores for patients that received a lumbar drain (physical score p = 0.832; mental score p = 0.915) or redo surgery (physical score p = 0.830; mental score p = 0.204). This article demonstrates that CSF leaks do not impact patient-reported QoL outcomes at 6 months post-surgery. This will allow surgeons to better provide insight and counsel patients regarding the relevance of CSF leaks in the setting of pituitary procedures. III Laryngoscope, 2025.

The impact of indocyanine green fluorescence angiography (ICG-FA) on anastomotic leak rates and postoperative outcomes in colorectal anastomoses: a systematic review.

Anastomotic leak (AL) is a major complication in colorectal surgery, significantly contributing to perioperative morbidity and mortality. Among strategies to prevent AL, Indocyanine Green Fluorescence Angiography (ICG-FA) has emerged as a promising method for assessing bowel perfusion intraoperatively. This systematic review evaluates the impact of ICG-FA on AL rates and other postoperative outcomes following colorectal anastomoses. A systematic search was conducted in PubMed, PubMed Central, MEDLINE, and Google Scholar, following PRISMA guidelines. Eligible studies included randomized controlled trials (RCTs), prospective cohort studies, and retrospective cohort studies comparing ICG-FA to controls in adult patients undergoing colorectal resections and anastomoses. Data on AL rates, intraoperative characteristics, and postoperative outcomes were extracted. Quality assessment was performed using the Newcastle-Ottawa Scale and the Revised Cochrane Risk-of-Bias Tool. Sixteen studies (12 retrospective, 1 prospective, and 3 RCTs) involving 3231 patients (1562 ICG-FA and 1669 controls) were included. AL rates were significantly lower in the ICG-FA group (5.18%) compared to controls (11.50%) (p < 0.01). ICG-FA influenced surgical plans in 16.31% of cases. Operative time and ileostomy formation rates were comparable between groups. Reoperation, ileus, and wound infection rates showed minimal differences. Mortality rates were low in both groups (ICG-FA: 0.55%, control: 0.51%). ICG-FA significantly reduces AL rates without increasing operative time or postoperative complications. This technique provides a reliable and safe assessment of bowel perfusion, supporting its integration into colorectal surgery protocols. Further high-quality RCTs are needed to confirm these findings and optimise its application.

Personalized optimization of systematic prostate biopsy core number based on mpMRI radiomics features: a large-sample retrospective analysis

BackgroundProstate cancer (PCa) is definitively diagnosed by systematic prostate biopsy (SBx) with 13 cores. This method, however, can increase the risk of urinary retention, infection and bleeding due to the excessive number of biopsy cores.MethodsWe retrospectively analyzed 622 patients who underwent SBx with prostate multiparametric MRI (mpMRI) from two centers between January 2014 to June 2022. The MRI data were collected to manually segment Regions of Interest (ROI) of the tumor layer by layer. ROI reconstructions were fused to form outline of the volume of interest (VOI), which were exported and applied to subsequent extraction of radiomics features. The t-tests, Mann-Whitney U-tests and chi-squared tests were performed to evaluate the significance of features. The logistic regression was used for calculating the PCa risk score (PCS). The PCS model was trained to optimize the SBx core number, utilizing both mpMRI radiomics and clinical features.ResultsThe predicted number of SBx cores was determined by PCS model. Optimal core numbers of SBx for PCS subgroups 1–5 were calculated as 13, 10, 8, 6, and 6, respectively. Accuracies of predicted core numbers were high: 100%, 95.8%, 91.7%, 90.6%, and 92.7% for PCS subgroups 1–5. Optimized SBx reduced core rate by 41.9%. Leakage rates for PCa and clinically significant PCa were 8.2% and 3.4%, respectively. The optimized SBx also demonstrated high accuracy on the validation set.ConclusionThe optimization PCS model described in this study could therefore effectively reduce the number of systematic biopsy cores obtained from patients with high PCS, especially for biopsy cores far away from suspicious lesions. This method can enhance patient experience without reducing tumor detection rate.

Outcomes Following Fenestrated/Branched Endovascular Aortic Repair for Failed Open Infrarenal Aortic Repair Compared with Primary Fenestrated/Branched Endovascular Aortic Repair.

As aneurysmal disease is progressive, proximal disease progression and para-anastomotic aneurysms are complications experienced after open infrarenal abdominal aortic aneurysm repair (AAA). As such, fenestrated or branched endovascular repair (F/BEVAR) may be indicated in these patients. Data describing fenestrated endovascular aneurysm repair after prior open repair are limited to institutional databases. The aim of our study is to describe the safety and efficacy of fenestrated/branched endovascular aneurysm repair (F/BEVAR) in patients with prior open repair (OSR) compared with primary F/BEVAR using the Vascular Quality Initiative. Using the VQI complex endovascular AAA module from 2014-2022, we identified all single-staged F/BEVAR repair in patients having prior OSR or no prior aortic surgery (primary F/BEVAR). The primary outcomes were perioperative mortality and completion endoleaks. Secondary outcomes were 5-year survival and one-year sac dynamics. Between the two cohorts, differences in the primary and secondary outcomes were evaluated using Wilcoxon-Rank Sum tests for continuous variables and Chi-squared analysis for categorical variables. Kaplan-Meier methods and Cox-regression were used to examine 5-year mortality. We identified 3,331 primary F/BEVAR patients and 102 prior OSR patients. Patients with prior OSR were more likely to have peripheral arterial disease (22% vs. 7.4%), prior smoking (67% vs 56%), undergo F/BEVAR with medium/high volume physicians (74% vs 62%), but less likely to be female (8.8% vs 23%) (all p<0.05). Patients with prior OSR were also more likely to have a more proximal aneurysm extent (median zone 7[6-8] vs. 8[7-8]), larger AAA diameters (62[56-66] mm vs 58[55-63] mm), receive a physician modified endograft (PMEG) vs commercial custom-made device (CCMD) (36% vs 20% PMEG), have longer surgery times (240[186-308] min vs. 206[155-272] min), and have a higher rate of celiac (51% vs 26%) and SMA (86% v 73%) artery involvement (all p < 0.05). Patients with prior OSR had lower rates of completion endoleaks (25% vs 36%) driven by lower rates of type II leaks (11% vs 20%) despite higher rates of indeterminate leaks (11% vs. 5.1%) (all p<0.01). There was, however, no difference in perioperative mortality (2% vs. 2.9%; p = 0.78). They had similar one-year sac dynamics (48% vs. 50% regression; 12% vs 8% expansion, p>0.5) and 5-year mortality (23% vs 18%, HR: 1.44[0.89-2.31]; p=0.13). Based on VQI data, F/BEVAR after prior OSR seems to be well-tolerated and safe. Prior open repair patients also had lower rates of completion type II endoleaks and similar sac dynamics and 5-year mortality compared to primary F/BEVAR patients.

Simulation and experiment investigation on leakage rate of composite materials with the consideration of curing defects

Simulation and experiment investigation on leakage rate of composite materials with the consideration of curing defects

Effects of aortic valve calcification on transcatheter aortic valve replacement for low-flow, low-gradient aortic stenosis.

Patients with low-flow, low-gradient (LFLG) aortic stenosis (AS) have precarious hemodynamics and are a fragile population for intervention. Quantification of aortic valve calcification (AVC) severity is a critical component of the evaluation for transcatheter aortic valve replacement (TAVR); this study aims to further clarify its utility for risk stratification in LFLG AS. This retrospective study evaluated 467 patients with LFLG AS undergoing TAVR at a large quaternary-care hospital from January 2019 to December 2021. AVC was quantified with Agatston scores using pre-operative computed tomography angiograms. Primary endpoint was a composite of all-cause mortality and heart failure rehospitalization rates. 51 patients (10.9%) had mild calcification, 137 (29.3%) had moderate, and 279 (59.7%) had severe. Increased AVC severity correlated with increased AS severity by aortic valve area (0.69cm2 for mild AVC vs. 0.63cm2 for severe; p≤0.001), peak velocity (3.1m/s vs. 3.9m/s; p≤0.001), and mean gradient (21mmHg vs. 36mmHg; p≤0.001). Kaplan-Meier analysis showed increased reductions in the primary composite endpoint (p=0.023) and heart failure rehospitalization rates (p=0.005) for patients with greater AVC severity undergoing TAVR. Multivariate adjustments confirmed a significant reduction in heart failure rehospitalizations when comparing TAVR outcomes between mild and severe AVC (HR 0.40, 95% CI 0.18-0.91; p=0.028). Between the 3 groups, there were no significant differences in adjusted rates of paravalvular leak or other periprocedural complications. Increased AVC in LFLG AS does not correlate clinically with more severe AS by echocardiography. Patients with more severe AVC have less heart failure rehospitalizations and derive greater benefit from TAVR.

Current evidence on powered versus manual circular staplers in colorectal surgery: a systematic review and meta-analysis

PurposeThis meta-analysis aims to evaluate the efficacy of powered circular staplers (PCS) compared to manual circular staplers (MCS) in reducing anastomotic leakage (AL) and postoperative bleeding (AB) in colorectal surgery.MethodsExtensive searches were performed in the Embase, PubMed, and SCOPUS electronic bibliographic databases. Most studies were of an observational nature, and only one randomized clinical trial was identified.ResultsTwelve studies met the inclusion criteria for anastomotic leakage and five for anastomotic hemorrhage. The number of patients included for AL analysis was 4524. The leakage rate was 4.6% (208 cases). The number of patients with AB was 2868 with a bleeding rate of 4.99% (143 patients). After identifying outliers and studies with possible selection bias, the odds ratio (OR) for leaks and PCS was 0.38 (95% CI 0.26–0.55), the relative risk was − 0.05 (95% CI − 0.07 to 0.03), and the number needed to treat to prevent one leak was 20. For bleeding, the PCS OR for PCS was 0.20 (95% CI 0.0772–0.5177).ConclusionPowered circular staplers could be associated with a significantly lower risk of leakage and anastomotic bleeding than two-row manual circular staplers. Further prospective randomized trials are needed to validate these findings.

A new small target defect detection algorithm for solar panels based on improved YOLOV7

ABSTRACT Surface Defect Detection (SDD) is an important means to ensure product quality in industrial production. Accompanied by the rapid development of artificial intelligence technology, the surface defect detection algorithm based on convolutional neural network (CNN) has gradually replaced the traditional machine vision and manual inspection methods. However, due to the small morphology of some defects in solar panels, this brings certain challenges to industrial defect detection. Therefore, this paper investigates a surface defect detection based on YOLOV7 for the small target in solar panels. Firstly, the coordinate attention mechanism is used to improve the model’s attention to distinguishable defect features. Secondly, a two-way weighted feature pyramid is utilised to replace the PANet in order to improve the feature fusion effect of the detection model. Finally, Soft Non-Maximum Suppression (Soft NMS) is used in post-processing to reduce the leakage rate of the detection model. The proposed method is tested on a self-built dataset of surface defects detection on solar panels, and the experimental results verify that the accuracy of the model in this paper is better than other advanced methods.

Kadozan Chitosan Formulation Enhances Postharvest Quality of Fresh Indian Jujube Fruit.

Indian jujube fruit is prone to perishing, resulting in a shorter shelf life after harvest. Kadozan is a liquid chitosan formulation that has a significant effect on fruit preservation. In order to explore its efficacy, the quality, and storability indicators of Indian jujube fruit were evaluated during storage at 15 ± 1 °C for 18 days. Results showed that Kadozan-treated fruit exhibited lower respiration rate, relative electrolyte leakage rate, weight loss, and decay index, along with higher firmness and commercially acceptable rate. Furthermore, Kadozan-treated fruit showed higher vitamin C, total sugar, titratable acid, total soluble solids, chlorophyll, and carotenoid contents, L* and h° values, but lower a* and b* values. Principal component analysis and comprehensive score revealed that Kadozan treatment helped preserve the appearance and nutritional qualities of Indian jujube fruit. The best effect was seen with 1:600 Kadozan among three concentrations (1:300, 1:600, 1:900). It was discovered that the commercially acceptable rate of 1:600 Kadozan-treated fruit was 37.5% higher than control fruit while the decay index was 30.5% lower than control fruit at 18 days. Therefore, Kadozan treatment has great substantial implications for the preservation of Indian jujube fruit, providing practical guidance for reducing its postharvest losses.

Optimization of the Effect of Network Information Flow Advertising Based on User Behavior Data Encryption and Deep Learning

Existing network information flow advertising mostly relies on user behavior data, which is easy to cause user privacy leakage and low precision of advertising delivery. This article combines user behavior data encryption and deep learning technology to propose a method for optimizing the effect of network information flow advertising. The user behavior data is encrypted using Paillier homomorphic encryption technology. Then, the stacked auto encoder (SAE) is used to extract high-order nonlinear features, and the shallow features are automatically combined based on Field-aware Factorization Machines (FFM) to construct a SAE-FFM comprehensive model. At the same time, dropout is used to reduce model overfitting, and the advertising effect is optimized through two-stage pre-training and fine-tuning. The experimental results show that when the number of impressions is 10,000, the average advertising click through rate and conversion rate of the SAE-FFM model are 4.50% and 0.59% respectively, and the information leakage rate is 0.052%. The results show that the SAE-FFM model can greatly improve the click through rate and conversion rate of advertisements, prevent privacy leakage, and help the development of the information flow advertising industry.

Fluorescence angiography with indocyanine green for low anterior resection in patients with rectal cancer: a prospective before and after study.

Inadequate bowel perfusion is among risk factors for colorectal anastomotic leaks. Perfusion can be assessed with indocyanine green fluorescence angiography (ICG) during colon resections. Possible benefits from its systematic use in high-risk patients with rectal cancer remain inconsistent. This study aimed to evaluate the surgical modifications induced by ICG assessment during rectal cancer surgery and associated anastomotic leaks. This prospective before and after cohort study was conducted in a single Canadian high-volume colorectal surgery center. Eligible patients were undergoing alow anterior resection for rectal cancer below 15cm from the anal margin. Stapled and handsewn coloanal anastomoses were included. The experimental group was recruited prospectively, undergoing surgery using fluorescence angiography with ICG. The control group was built retrospectively from consecutive patients who had been operated on without ICG, prior to its implementation. Each cohort included 113 patients. The use of ICG led to modifications from initial surgical plan in 10.6% of patients, with no occurrence of anastomotic leaks in this specific group. When comparing leak rates, using ICG seemed to be protective, but this could not be statistically proven, overall (13.3% vs. 6.2%, p = 0.07), nor for handsewn coloanal anastomoses (11.8% vs. 5.9%, p = 0.67). A lack of power could explain such non-significant results, especially with low overall anastomotic leak rates recorded. ICG influenced ultimate proximal resection margin in a clinically relevant proportion of cases. It might be associated with reduced leak rates although not formally proven with this data. This technology is safe and easy to apply in high-volume colorectal centers.

A method for enhancing the accuracy of industrial bearing surface defect detection

ABSTRACT Deep learning models often encounter challenges when detecting surface defects on industrial bearings, including inaccurate feature extraction caused by random shapes and multi-scale defects, as well as high leakage rates of small objects in complex multi-object scenes. To address these challenges, a YOLOv8n-based method (YOLOv8-IWDD) is proposed for detecting bearing surface defects. Firstly, the ImplicitHead detection head is introduced, which utilises implicit addition and multiplication to highlight key features. This enhancement improves feature extraction, resulting in improved detection accuracy for small objects, especially in complex multi-object scenarios, and effectively reduces missed detections. Secondly, the Inner-WIoU loss function optimises bounding box localisation, enabling the model to better handle randomly shaped defects, accelerate convergence, and enhance localisation accuracy. In addition, dynamic label assignment and dynamic sampling strategies are proposed to achieve flexible adjustment of sample assignment and sampling method, which further improves the detection accuracy and robustness. These strategies enhance the model’s robustness in handling multi-scale and complex shape defects. The experimental results show that YOLOv8-IWDD improves mAP0.5 by 2.9%, mAP0.5:0.95 by 9.4%, precision by 2.2%, and recall by 6.5% compared with the YOLOv8n model. The method achieves promising results in detecting surface defects on industrial bearings.

Slower swimming promotes chemotactic encounters between bacteria and small phytoplankton

Chemotaxis enables marine bacteria to increase encounters with phytoplankton cells by reducing their search times, provided that bacteria detect noisy chemical gradients around phytoplankton. Gradient detection depends on bacterial phenotypes and phytoplankton size: large phytoplankton produce spatially extended but shallow gradients, whereas small phytoplankton produce steeper but spatially more confined gradients. To date, it has remained unclear how phytoplankton size and bacterial swimming speed affect bacteria's gradient detection ability and search times for phytoplankton. Here, we compute an upper bound on the increase in bacterial encounter rate with phytoplankton due to chemotaxis over random motility alone. We find that chemotaxis can substantially decrease search times for small phytoplankton, but this advantage is highly sensitive to variations in bacterial phenotypes or phytoplankton leakage rates. By contrast, chemotaxis toward large phytoplankton cells reduces the search time more modestly, but this benefit is more robust to variations in search or environmental parameters. Applying our findings to marine phytoplankton communities, we find that, in productive waters, chemotaxis toward phytoplankton smaller than 2 μm provides little to no benefit, but can decrease average search times for large phytoplankton (∼20 μm) from 2 wk to 2 d, an advantage that is robust to variations and favors bacteria with higher swimming speeds. By contrast, in oligotrophic waters, chemotaxis can reduce search times for picophytoplankton (∼1 μm) up to 10-fold, from a week to half a day, but only for bacteria with low swimming speeds and long sensory timescales. This asymmetry may promote the coexistence of diverse search phenotypes in marine bacterial populations.

HMB/Arg/Gln may improve short-term outcomes after esophagectomy in patients with thoracic esophageal cancer.

The wound healing effects of a specialized amino acid supplement containing calcium beta-hydroxy-beta-methylbutyrate, L-arginine, and L-glutamine (HMB/Arg/Gln) have been reported. This study aimed to investigate the effectiveness of HMB/Arg/Gln in the perioperative management of patients with thoracic esophageal cancer. This retrospective cohort study included 131 patients who underwent esophagectomy for thoracic esophageal cancer between January 2016 and November 2023. Postoperative infectious complications (PICs) were compared between patients who received HMB/Arg/Gln for 7days before surgery (n = 95) and those who did not (control group, n = 36). Among the 111 male and 20 female patients (median age 68years, range 38-84years), stage I disease was found in 37 patients, stage II in 26, stage III in 61, and stage IVa in 7. Of the 131 patients, 36 (27.5%) had PICs, with PICs occurring in 20 (21%) of the HMB/Arg/Gln group and 16 (44.4%) of the control group. The PIC rate was significantly lower in the HMB/Arg/Gln than in the control group (p = 0.007). Propensity score matching analysis showed lower rates of anastomotic leakage (5.5% vs. 22.2%; p = 0.04) and Clavien-Dindo grade III or higher PICs (5.5% vs. 27.8%; p = 0.011) in the HMB/Arg/Gln than in the control group. The healing time for anastomotic leakage was shorter in the HMB/Arg/Gln (18days, range 7-25days) than in the control group (25days, range 21-56days) (p = 0.033). HMB/Arg/Gln supplementation was associated with reduced risk of anastomotic leakage and PIC severity following esophagectomy.

Evaluating the impact of enhanced recovery after surgery protocols following oesophagectomy: a systematic review and meta-analysis of randomised clinical trials.

Enhanced Recovery After Surgery (ERAS) protocols are evidence-based care improvement pathways which are perceived to expedite patient recovery following surgery. Their utility in the setting of oesophagectomy remains unclear. The aim of this study was to perform a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the impact of ERAS protocols on recovery following oesophagectomy compared to standard care. A systematic review was performed in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines. Meta-analysis was performed using Review Manager (Version 5.4). Six RCTs including 850 patients were included in this meta-analysis. Overall complication rate (Odds Ratio (OR): 0.35, Confidence Interval (CI): 0.21, 0.59, P < 0.0001), pulmonary complications (OR: 0.40, CI: 0.24, 0.67, P = 0.0005), post-operative length of stay (LOS) (OR -1.88, CI -2.05, -1.70, P < 0.00001) and time to post-operative flatus (OR: -5.20, CI: -9.46, -0.95, P = 0.02) favoured the ERAS group. There was no difference noted for anastomotic leak (OR: 0.55, CI: 0.24, 1.28, P = 0.17), cardiac complications (OR: 0.86, CI: 0.30, 2.46, P = 0.78), gastrointestinal complications (OR: 0.51, CI: 0.23, 1.17, P = 0.11), wound complications (OR: 0.85, CI: 0.28, 2.58, P = 0.78), mortality (OR: 1.37, CI: 0.26, 7.4, P = 0.71), and 30-day re-admission rate (OR: 1.29, CI: 0.30, 5.47, P = 0.73) between ERAS and standard care groups. ERAS implementation improved post-operative complications, LOS, and time to flatus following oesphagectomy. These results support the robust adoption of ERAS in patients indicated to undergo oesphagectomy.

Treatment Quality of Rectal Cancer Patients in Certified Colorectal Cancer Centers Versus Non-Certified Hospitals: A Comparative Analysis.

Background/Objectives: The certification of hospitals as colorectal cancer centers aims to improve treatment quality, but evidence supporting its effectiveness remains limited. This study evaluated the impact of certification on treatment outcomes for rectal cancer patients in Germany. Methods: We conducted a retrospective analysis of 14,905 patients with primary rectal cancer (UICC Stages I-III) treated at 271 hospitals. Treatment outcomes were compared between certified colorectal cancer centers (3624 patients in 55 hospitals) and non-certified hospitals (11,281 patients in 216 hospitals). Additionally, a subset analysis examined outcomes before and after certification within the same institutions. Results: Certified centers demonstrated higher utilization of preoperative imaging (endorectal ultrasound: 70.7% vs. 58.2%, p < 0.001; pelvic MRI: 39.1% vs. 28.5%, p < 0.001) and lower rates of intraoperative complications (4.6% vs. 6.2%, p < 0.001). Surgical quality indicators, including M.E.R.C.U.R.Y. classification (Grade 1: 86.5% both groups, p = 0.620) and anastomotic leakage rates (11.3% vs. 11.9%, p = 0.407), were comparable between certified and non-certified hospitals. Despite treating patients with more favorable tumor stages, certified centers showed no significant advantage in 5-year overall survival (82.8% vs. 82.0%, p = 0.880) or 30-day mortality (2.6% both groups, p = 0.869). Hospital stays were marginally shorter in certified centers (19.46 vs. 20.24 days, p < 0.001). Conclusions: While certification was associated with improved adherence to diagnostic protocols and reduced intraoperative complications, it did not significantly impact surgical quality or long-term survival outcomes. These findings suggest that certification alone may not guarantee superior treatment quality, as hospitals participating in quality assurance programs achieved comparable results without formal certification.

Experimental setup for labyrinth seals: Pressure, temperature, mass flow rate, rotation velocity, and pressure drop simultaneous measurement.

Labyrinth seals (LSs) in turbomachinery are used to minimize leaks. This study presents an experimental setup designed to test and validate LS designs. The test bench (TB) described in this paper can evaluate different LS designs obtained through various methods to find better solutions to mitigate greenhouse gas (GHG) emissions. Prototypes with conventional geometry, such as straight-through and interlaced LSs, are initially implemented and tested. A measurement procedure and experimental methodology for collecting leakage data are defined. The experimental methodology includes a measurement TB that supports a pressure difference of up to 5bar. The leakage rate is measured in g/s using instrumentation that corrects the mass flow rate based on pressure and temperature measurements. The experimental results are compared to the Computational Fluid Dynamics results. Thus, the setup given in this article is a new and versatile TB setup focused on leakage measurement, which allows being used for analyzing various types of LS (with or without rotor structures) and is effective for evaluating the performance of LSs, helping the development of new LS geometries that can reduce GHG emissions.

Evaluation on H2, N2, He &amp; CH4 diffusivity in rock and leakage rate by diffusion in underground gas storage

Evaluation on H2, N2, He &amp; CH4 diffusivity in rock and leakage rate by diffusion in underground gas storage

Impact of Surgeon Specialization on Outcomes in Emergency Colorectal Surgery: A Systematic Review and Meta-analysis.

Colorectal emergencies represent a large proportion of acute general surgical workload and carry significant mortality. Identify the influence of surgeon specialization on mortality and other outcomes in emergency colorectal surgery. Systematic searches of Ovid MEDLINE, Ovid Embase, and Cochrane electronic databases were performed for studies published from January 1, 1990, to August 27, 2023. Studies investigating outcomes in emergency colorectal surgery for adults, comparing colorectal against noncolorectal surgeon specialization, were included. Exclusion criteria were: 1) publications studying primarily pediatric populations; 2) studies incorporating patients who had undergone surgery before 1990; and 3) studies only published in abstract form or non-English language. Primary outcomes were 30-day mortality and in-hospital mortality. Secondary outcomes were rates of anastomotic leak, reintervention, primary anastomosis, and laparoscopic approach. Of 7676 studies identified, 155 were selected for full-text review and 21 were included for quantitative analysis. Eleven studies showed improved 30-day (OR 0.64; 95% CI, 0.60-0.68; p < 0.0001) and in-hospital mortality (OR 0.66; 95% CI, 0.49-0.89; p = 0.007) with colorectal specialization. There was a significantly higher rate of primary anastomosis (OR 2.95; 95% CI, 2.02-4.31; p < 0.0001) and use of laparoscopic surgery (OR 2.38; 95% CI, 1.42-4.00; p = 0.001) among specialized colorectal surgeons. Specialization was also associated with a significant reduction in any stoma formation (OR 0.52; 95% CI, 0.28-0.98; p = 0.04). No significant difference was observed for anastomotic leak (OR 0.70; 95% CI, 0.45-1.07; p = 0.10) or reintervention rates (OR 0.78; 95% CI, 0.55-1.10; p = 0.16). Heterogeneity exists within the included patient populations and definitions of colorectal specialization observed in different countries. Emergency colorectal surgery undertaken by specialized colorectal surgeons is associated with significantly improved postoperative mortality, lower rates of stoma formation, and increased rates of primary anastomosis and minimally invasive surgery. CRD42022300541.