Reverse Rate Research Articles

Prevalence and outcomes of Hartmann's reversal following Hartmann's procedure in a regional center, a retrospective cohort study.

Hartmann's procedure (sigmoid resection with end colostomy) is a commonly performed emergency procedure for diseases of the sigmoid colon. To determine the proportion of patients undergoing Hartmann's reversal (restoration of GI continuity) following Hartmann's procedure, the clinical and demographic factors associated with reversal, and the reasons for non-reversal. This is a single center, retrospective audit of patients undergoing Hartmann's procedure between June 2011 and May 2020. Age, sex, American Society of Anesthesiologists classification (ASA), indication for Hartmann's, surgical approach, specialty of responsible surgeon (General or Colorectal), 30-day reoperation, requirement for radiologically-guided drain, and reason for non-reversal were recorded. The association between these factors and reversal was determined with Fischer's exact test and logistic regression. Cumulative reversal proportions were calculated with the Kaplan-Meier method. Data was obtained for 114/117 patients, of whom 31% (35/114) underwent Hartmann's reversal. The median (IQR) time to reversal was 372 (188-500) days. Patients with restoration of GI continuity were younger (median 67 versus 73 years, P < 0.001) with fewer co-morbidities, (ASA ≤ 2 34% versus 9% P = 0.002). The estimated cumulative 24-month reversal incidence was 37%. Patients who had a Hartmann's procedure performed for diverticulitis had an increased odds of being reversed (OR 4.1 (95% CI 1.6, 10.5) P = 0.001); Hartmann's for malignancy was associated with decreased odds of reversal (OR 0.37 (95% CI 0.12, 1) P = 0.035). Of patients who underwent Hartmann's procedure, the majority retained a permanent stoma. Older patients, those with high ASA, and those who underwent index procedures for malignancy had lower rates of reversal.

Early use of low-dose hydrocortisone can reduce in-hospital mortality in patients with septic shock: A systematic review and meta-analysis.

This study aimed to assess the impact of the timing of low-dose hydrocortisone adjuvant therapy initiation on clinical outcomes in patients with septic shock by a systematic review and meta-analysis. We conducted a comprehensive search of all randomized controlled trials (RCTs) and cohort studies available in the PubMed, Web of Science, and Embase databases. The search included articles published from the founding of these databases until August 1, 2024. The purpose of the search was to compare the results of initiating low-dose hydrocortisone (HC) adjuvant therapy at different time periods. The main reported results included short-term mortality (ICU mortality and hospital mortality) as key outcomes, and secondary outcomes such as the rate of renal replacement treatment continuous renal replacement therapy (CRRT), length of stay in the intensive care unit (ICU), and rate of shock reversal. Seven trials, with a total of 3063 patients, were included. The main finding of this meta-analysis indicates that the early treatment group, which received low-dose hydrocortisone, had a lower ICU mortality rate compared to the late treatment group. Additionally, the hospital mortality rate in the early treatment group was lower than that in the late treatment group. There was a correlation between the timing of beginning of HC and the short-term mortality of patients with septic shock. The secondary findings indicated that there were no notable disparities in the rates of CRRT, the rate of reversing shock, and the duration of stay in the ICU. Administering low doses of HC early on can decrease the risk of death in septic shock patients in the short-term mortality. There were no substantial disparities observed in the rate of CRRT, the rate of reversal of shock, and the duration of stay in the ICU. Additional extensive RCTs are required to validate this conclusion.

Quality improvement initiative: use of the STOP-BANG score and monitoring to reduce adverse events in hospitalised patients at risk of obstructive sleep apnoea

BackgroundObstructive sleep apnoea increases risk of respiratory depression with administration of sedatives, narcotics or anxiolytics. To reduce adverse events during hospital admission, we implemented STOP-BANG screening to prompt respiratory monitoring...

Self-assembly of polyoxometalate-based metal-organic framework with trefoil sign structural feature as efficient anode for lithium ion batteries

To extend the practical applications of polyoxometalates (POMs) based metal–organic frameworks (POMOFs) in the most cut-ting-edge (lithium ion batteries) LIBs, a new crystalline POMOFs, [Ag6(H2trz)6]·[H4SiW12O40]·6H2O (SiW12-Ag-trz), was successfully synthesized and well characterized in the work. Crystal analysis reveals that Keggin-typed POMs [H4SiW12O40] (SiW12) are inserted into the Ag-trz helical chain to construct 3D POMOFs with open pore channels with trefoil sign structural feature, in which SiW12 polyoxoanion exhibiting the most diverse coordination modes in the reported crystalline POMOFs, to the best our knowledge. Because the pore channels facilitate the storage and release of lithium ions, and the SiW12 polyoxoanion growing on the framework serves as an excellent electron sponge, crystalline SiW12-Ag-trz as an anode material for lithium-ion batteries (LIBs) exhibits highly reversible capacity and rate capability. Moreover, to illustrate the lithium storage, the impedance spectra and cyclic voltammetry (CV) with different scan rates during the first and 50th charge process were studied in details.

On the rate of aneuploidy reversion in a wild yeast model.

Aneuploidy, arising from gain or loss of chromosomes due to nondisjunction, is a special class of mutation. It can create significant phenotypic changes by altering abundance of hundreds of genes in a single event, providing material for adaptive evolution. But it can also incur large fitness costs relative to other types of mutations. Understanding mutational dynamics of aneuploidy is important for modeling its impact in nature, but aneuploidy rates are difficult to measure accurately. One challenge is that aneuploid karyotypes may revert back to euploidy, biasing forward mutation rate estimates - yet the rate of aneuploidy reversion is largely uncharacterized. Furthermore, current rate estimates are confounded because fitness differences between euploids and aneuploids are typically not accounted for in rate calculations. We developed a unique fluctuation assay in a wild-yeast model to measure the rate of extra-chromosome loss across three aneuploid chromosomes, while accounting for fitness differences between aneuploid and euploid cells. We show that incorporating fitness effects is essential to obtain accurate estimates of aneuploidy rates. Furthermore, the rate of extra-chromosome loss, separate from karyotype fitness differences, varies across chromosomes. We also measured rates in a strain lacking RNA-binding protein Ssd1, important for aneuploidy tolerance and implicated in chromosome segregation. We found no role for Ssd1 in the loss of native aneuploid chromosomes, although it did impact an engineered chromosome XV with a perturbed centromeric sequence. We discuss the impacts and challenges of modeling aneuploidy dynamics in real world situations.

Attentional capacity matters for visuomotor adaptation to a virtual reality driving simulator

Studies have shown that adaptation to a virtual reality driving simulator takes time and that individuals differ widely in the time they need to adapt. The present study examined the relationship between attentional capacity and driving-simulator adaptation, with the hypothesis that individuals with better attentional capacity would exhibit more efficient adaptation to novel virtual driving circumstances. To this end, participants were asked to steer in a driving simulator through a series of 100 bends while keeping within a central demarcated zone. Adaptation was assessed from changes in steering behavior (steering performance: time spent within the zone, steering stability, steering reversal rate) over the course of the bends. Attentional capacity was assessed with two dynamic visual attention tasks (Multiple Object Tracking, MOT; Multiple Object Avoidance, MOA). Results showed effective adaptation to the simulator with repetition, as all steering-behavior variables improved. Both MOT and MOA scores significantly predicted adaptation, with MOT being a stronger predictor. Further analyses revealed that higher-capacity participants, but not their lower-capacity counterparts, produced more low-amplitude steering-wheel corrections early in the task, resulting in finer vehicle control and better performance later on. These findings provide new insights into adaptation to virtual reality simulators through the lens of attentional capacity.

Longitudinal Patterns and Predictors of Cognitive Impairment Classification Stability.

Classifications such as Cognitive Impairment, No Dementia (CIND) are thought to represent the transitory, pre-clinical phase of dementia. However, increasing research demonstrates that CIND represents a nonlinear, unstable entity that does not always lead to imminent dementia. The present study utilizes a longitudinal repeated measures design to gain a thorough understanding of CIND classification stability patterns and identify predictors of future stability. The objectives were to i) explore patterns of longitudinal stability in cognitive status across multiple assessments and ii) investigate whether select baseline variables could predict 6-year CIND stability patterns. Participants (N = 259) included older adults (aged 65-90years) from Project MIND, a six-year longitudinal repeated measures design in which participants were classified as either normal cognition (NC) or CIND at each annual assessment. A latent transition analysis approach was adapted in order to identify and characterize transitions in CIND status across annual assessments. Participants were classified as either Stable NC, Stable CIND, Progressers, Reverters, or Fluctuaters. Multinomial logistic regression was employed to test whether baseline predictors were associated with cognitive status stability patterns. The sample demonstrated high rates of reversion and fluctuation in CIND status across annual assessments. Additionally, premorbid IQ and CIND severity (i.e., single vs. multi-domain impairment) at baseline were significantly associated with select stability outcomes. CIND status was unstable for several years following baseline assessment and cognitive reserve may delay or protect against demonstrable cognitive impairment. Further, consideration of cognitive impairment severity at the time of initial classification may improve CIND classifications.

Synthesis of nano cubic microstructure LiNi0.8Co0.1Mn0.1O2 cathode materials via rapid precipitation assisted with hydrothermal treatment

In this work, a modified Ni-rich cathode material LiNi0.8Co0.1Mn0.1O2 with a unique nano cubic microstructure is successfully synthesized via a rapid precipitation assisted with hydrothermal treatment. The formation of this distinctive microstructure is attributed to the homogeneous rapid precipitation in microreactor, which predominantly generates uniform crystal nuclei. The as-prepared material with nano-/microstructure shows superior initial reversible capacity (205.3 mAh·g−1 at 2.7–4.3 V) and rate capability (163.9 mAh·g−1 at 5 C). Additionally, it maintains a high capacity (188.2 mAh·g−1) with a retention of 87.2 % at 1 C after 200 cycles, demonstrating outstanding cycling stability. Our work presents a straightforward and efficient approach for producing nano-cubic microstructure layered cathode materials.

Mitigating Slow Reverse ISC Rates in TAPC-PBD Exciplex via Rapid Förster Energy Transfer to TTPA

There have been many advances in the development of thermally activated delayed fluorescence (TADF) materials for organic light emitting diode (OLED) applications in recent years. In particular, intramolecular exciplex systems have been highly studied and found to produce OLED devices of high external quantum efficiency (EQE) due to triplet harvesting via TADF. The proposed next generation of OLEDs uses hyperfluorescence to overcome the problem of broad emission associated with exciplexes. This process involves Förster resonance energy transfer (FRET) from the TADF host to a fluorescent dopant. In this work we revisited the photophysics of the TAPC:PBD exciplex (formed between the electron donor di-[4-(N,N-di-p-tolyl-amino)-phenyl]cyclohexane (TAPC) and the electron acceptor, 2-(4-biphenyl)-5-(4-tert-butylphenyl)-1,3,4-oxadiazole (PBD)) as a host capable of simultaneously performing triplet harvesting and work as a donor transferring energy to a bright fluorescent emitter. The aim is to investigate the interplay between energy transfer and intersystem crossing in this hyperfluorescence system. Contrarily to previous findings, films of the TAPC:PBD blend show relatively slow reverse intersystem crossing rate (RISC) and weak luminescence efficiency (PLQY). Despite this, when doped with the strong fluorescent emitter TTPA, the luminescence quantum yield is greatly improved due to the highly efficient energy transfer rate from TAPC:PBD to TTPA. The rapid FRET from the exciplex to the fluorescent emitter overcomes the non-radiative losses affecting the luminescence efficiency of the blend. This study shows that the hyperfluorescence mechanism not only allows colour purity in OLEDs to be optimised, but also facilitates suppressing major loss mechanisms affecting luminescence efficiency, thus creating conditions to maximizing EQE.

Combining motivational and exercise intervention components to reverse pre-frailty and promote self-efficacy among community-dwelling pre-frail older adults: a randomized controlled trial

BackgroundExercise is effective in preventing frailty status in older adults, but the effect of an exercise program based on Wellness Motivation Theory (WMT) on the frailty status, self-efficacy for exercise, and quality of life for older adults with pre-frailty remains unclear. Our objective was to examine the efficacy of a multicomponent exercise program based on WMT on frailty status, self-efficacy, and quality of life among pre-frail older adults.MethodsThis was a randomized controlled trial of pre-frail older adults aged from 60 years to 85 years. Participants in the intervention group performed exercise three times a week for 24 weeks, once at a community health service station instructed by two researchers and two times at home. Participants in the control group were given one-time advice on physical activity. The assessor was the only one blinded. The primary outcome was the reversal rate of pre-frailty. The secondary outcomes included self-efficacy and quality of life.ResultsOne hundred and forty-four participants were randomized into two groups (n = 72 in the intervention group and n = 72 in the control group) and analyzed. After 24 weeks, the proportion of pre-frailty was significantly lower in the intervention group than in control (31.8% versus 74.6%, P < 0.001). The absolute risk reduction was 42.8% [95% CI, 25.1–57.1]. In the 8th week and the 24th week, the frailty score of the intervention group was significantly lower than that of the control group. There were significant improvements in self-efficacy at week 2, week 8, and week 24. In weeks 8 and 24, participants in the intervention group reported a higher quality of life than the control group. There were no exercise-related injuries or falls among the participants.ConclusionsThe exercise intervention based on WMT for pre-frail older adults could reverse pre-frailty, increase self-efficacy for exercise, and improve the quality of life in older Chinese.Study registration detailsThis study was registered in www.ClinicalTrials.gov on the 25th of July, 2024, with the identifier NCT06519695.Reporting methodThe Consolidated Standards of Reporting Trials (CONSORT) checklist was used in this study for properly reporting how the randomized trial was conducted.

Complexity in Chick‐a‐Dee Calls of Mountain Chickadees (Poecile gambeli): Call Variation Associated With Flock Size and Flight

ABSTRACTThe chick‐a‐dee call of chickadees, tits, and titmice is a vocal system used in a wide range of social contexts by both sexes throughout the year and is one of the more structurally complicated vocal systems outside of human language. Relatively little is known about the chick‐a‐dee calls of mountain chickadees, Poecile gambeli, however. This is an important species for increasing our comparative understanding of variation in chick‐a‐dee calls as they are one of the chickadee species with the largest naturally occurring flock sizes. Flock size relates to the social complexity of flocks, and the social complexity hypothesis for communication predicts that individuals in more complex social groups should communicate with greater complexity than individuals in simpler social groups. Correlational and experimental evidence in support of the hypothesis has been found in the calls of a wide range of species, including Carolina chickadees, P. carolinensis. Here, we provide the first description of the variation in note composition and note‐ordering rules in calls from mountain chickadee flocks in California and Colorado. California flocks were found to be significantly larger than Colorado flocks. Analysis of note‐type usage and transition probabilities between note types found that calls of California birds were more complex than calls of Colorado birds, supporting a key prediction of the social complexity hypothesis for communication. We also found relatively high rates of reversals of note‐ordering rules in mountain chickadee calls, which might help explain the complexity of the chick‐a‐dee calls of this species. Additionally, birds in flight produced calls with different note compositions when compared to perched birds. Generally, the note‐type ordering and transition probabilities of calls of mountain chickadees seem comparable to other better‐studied chickadee species, although their frequent note‐type order rule reversals suggest potential syntax‐like properties in this call system.

METODE MEAN-SEMIVARIANCE DALAM PEMBENTUKAN PORTOFOLIO REKSA DANA SAHAM TERBAIK BAROMETER BAREKSA

The most popular investment product today is mutual funds. One of the factors in selecting mutual funds is the low investment risk. This risk can be minimized again by combining several assets and then compiling them into a portfolio. The portfolio formation method used in this study is the Mean-Semivariance method and the Sharpe Index to calculate portfolio performance. The data used is the daily net asset value per unit of Mandiri Investa Atraktif Syariah, Rencana Cerdas, Manulife Saham SMC Plus and BNP Paribas Solaris for the period January 3 2022 to March 9 2023, Jakarta Composite Index (IHSG) data as a benchmark and BI-7 Day Reverse Repo Rate as a riskfree interest rate. The minimum risk of the portfolio will be achieved by compiling a portfolio of two mutual funds, namely Mandiri Investa Atraktif Syariah with a weight of 92,50% and the Smart Plan with a weight of 7,50% with an expected return rate of 0,00019 and a risk of 0,000000663. The Sharpe Index is 0.08971 indicating that the portfolio formed has good performance and can be used as a choice of investment assets by investors.

Is It Worth Performing Intersphincteric Resection in Patients Having Rectal Adenocarcinoma with Oligometastasis

AbstractIntersphincteric resection (ISR) is being increasingly performed in metastatic rectal adenocarcinoma (with oligometastasis) patients. There has been a trend towards worse prognosis in this group. This study compares the oncological and surgical outcomes of patients with and without pre-operative oligometastasis who underwent ISR. The outcomes compared include prognostic factors like margin positivity, recurrence rates, stoma reversal rate, and surgical failure rate (defined as a combination of one or more of the aforestated factors). The demographic pattern, American Society of Anaesthesia grade (ASA), treatment received, clinical and histopathological T and N stage, grade, type of minimally invasive surgery (MIS) approach, neoadjuvant therapy, and pathological high-risk features are also studied. Patients who underwent minimally invasive ISR over 10 years at a high-volume tertiary cancer center were selected for the study. Factors used for the assessment of oncological outcomes were margin positivity (circumferential resection and distal margin), recurrence (both local and systemic), and stoma reversal rate. A descriptive and comparative analyses were performed. Four hundred and eight patients underwent minimally invasive ISR of which 25 (6.12%) patients were oligometastatic. While R0 resection was similar in both groups, higher overall recurrence (24% versus 18.5%) and low stoma reversal rate (36.8% versus 67.3%) were observed in the oligometastatic group with statistically significant differences. No local recurrence was seen in the oligometastatic group, and the difference compared to non-metastatic group was not statistically different. This study indicates that oligometastatic patients who underwent ISR experienced lower stoma reversal rates, maintaining similar local control but facing higher rates of systemic recurrence.

Charge transfer between layers of polymeric carbon nitride driven by surface grafting phosphotungstic polyanions toward efficient photocatalytic hydrogen evolution

It is a challenging issue to achieve efficient charge transfer between layers for the layered polymer photocatalysts, because the photogenerated carriers would prefer random migration within layers and thus have high reverse recombination rate due to their inherent anisotropy and high exciton binding energy. Herein, an innovative surface grafting strategy is developed to modify the layered polymeric carbon nitride (PCN) making use of phosphotungstic (PWO) polyanions. The surface coupling effect of PWO on PCN effectively improves reduction ability and utility rate of luminous energy through shifting the conduction band (CB) upward and broadening light absorption range to cover near infrared region up to 1000 nm, respectively. In especial, the strong electron-withdrawing effect of surface PWO moieties can reduce layer spacing to shorten electron transfer path and attract the photogenerated electrons transfer from PCN matrix to surface, thus conquering the charge transfer restriction between layers to improve the carrier separation efficiency. As a result, the photocatalytic hydrogen evolution (PHE) performance is dramatically enhanced. The optimal PWO-PCN-1% sample achieves an average PHE rate of 9.6 times that of PCN, stable operation for a total of 28 h on 7 cycles, and an AQY up to 22.3% at 400 nm. This contribution affords a viable modification avenue to overcome the limitation of charge transfer between layers for layered polymer photocatalysts.

A novel merocyanine photoacid for visible light-controlled pH modulation

Merocyanine-based photoacids generate high proton concentrations under visible light irradiation. In the past decade, it has been established that these photoacids offer significant advantages over photoacid generators (PAGs) and hydroxyaryl photoacids, enabling better spatiotemporal control of proton transfer reactions in bulk media. In this study, we modified the core structure of the first generation of meroyanine photoacids. We developed a novel photoacid with color tuning capabilities and high solubility in polar organic solvents. Specifically, by incorporating a cationic benzoindolium moiety as an acceptor, we have altered the photoacid’s light absorption properties. Unlike the first generation of indolium-based merocyanine photoacids, this photoacid can now be activated with green light (λmax = 525 nm) as well as blue (λmax = 450 nm) and ultraviolet (λmax = 365 nm) lights. Furthermore, the novel photoacid exhibits high photo stability, photo-acidity (Π = 3.28 ± 0.08) and moderate reverse reaction rate (k = 1.08 × 10−3 ± 0.00017 s−1) in solution. We envision that with improved color tuning capabilities, this class of photoacids will be a more versatile tool for controlling proton-induced reactions in different systems, including biological reactions.

HIV-1 Reverse Transcriptase Error Rates and Transcriptional Thresholds Based on Single-strand Consensus Sequencing of Target RNA Derived From In Vitro-transcription and HIV-infected Cells

Nucleotide incorporation and lacZ-based forward mutation assays have been widely used to determine the accuracy of reverse transcriptases (RTs) in RNA-dependent DNA polymerization reactions. However, they involve quite complex and laborious procedures, and cannot provide accurate error rates. Recently, NGS-based methods using barcodes opened the possibility of detecting all errors introduced by the RT, although their widespread use is limited by cost, due to the large size of libraries to be sequenced. In this study, we describe a novel and relatively simple NGS assay based on single-strand consensus sequencing that provides robust results with a relatively small number of raw sequences (around 60 Mb). The method has been validated by determining the error rate of HIV-1 (BH10 strain) RT using the HIV-1 protease-coding sequence as target. HIV-1 reverse transcription error rates in standard conditions (37 °C/3 mM Mg2+) using an in vitro-transcribed RNA were around 7.3 × 10−5. In agreement with previous reports, an 8-fold increase in RT’s accuracy was observed after reducing Mg2+ concentration to 0.5 mM. The fidelity of HIV-1 RT was also higher at 50 °C than at 37 °C (error rate 1.5 × 10−5). Interestingly, error rates obtained with HIV-1 RNA from infected cells as template of the reverse transcription at 3 mM Mg2+ (7.4 × 10−5) were similar to those determined with the in vitro-transcribed RNA, and were reduced to 1.8 × 10−5 in the presence of 0.5 mM Mg2+. Values obtained at low magnesium concentrations were modestly higher than the transcription error rates calculated for human cells, thereby suggesting a realistic transcriptional threshold for our NGS-based error rate determinations.

Effectiveness of a Triple Antiarrhythmic Drug Strategy for Arrhythmia Recurrence after Persistent Atrial Fibrillation Ablation.

Treating recurrent atrial arrhythmias after persistent atrial fibrillation (PeAF) ablation is often challenging. This single-center, prospective study aimed to observe the effectiveness of different combinations of oral antiarrhythmic drugs (AADs) in reverting to sinus rhythm (SR) in patients with recurrent atrial arrhythmias after PeAF ablation. Forty-five patients who experienced recurrent atrial arrhythmias after PeAF ablation were included. Based on their medication regimens, patients were divided into two groups, with the study group being a triple-drug group (digoxin combined with amiodarone/ propafenone and β-blocker), and the control group being a non-triple-drug group. The rate of reversion to SR was significantly higher in the study group (n = 29) than in the control group (n = 16) at 3 weeks (34.48% vs. 0%, p<0.01) and 1 month (44.84% vs. 6.25%, p = 0.02) after initiating AADs. No patients with asymptomatic bradycardia were observed in either group. For patients with recurrent atrial arrhythmias after PeAF ablation, a regimen of low-dose digoxin combined with amiodarone/propafenone and β-blocker may effectively improve short-term reversion rates.

FROM CALENDAR TIME TO BUSINESS TIME: THE CASE OF COMMODITY MARKETS

We address the problem of modeling commodity forward curves, while preserving empirical features observed in commodity markets. By letting a commodity market to “ live” in the tempo of a business rather than calendar clock, we create a model with a rich but realistic set of features, such as stochastic volatility, stochastic rate of mean reversion and various shapes of forward curves such as backwardation and contango. The model, when applied to extensive historical datasets of crude oil and natural gas forward curves, shows a remarkably good fit to the observed futures prices, also in periods of high volatility and negative prices. The model is developed in such a way that it can be used for a wide variety of applications, ranging from exotic derivatives pricing to risk management of commodity portfolios.

Comparing optimum prosthesis combinations of total stemmed, stemless and reverse shoulder arthroplasty revision rates for men and women with glenohumeral osteoarthritis

BackgroundThis study investigated prostheses from a large national arthroplasty registry with the lowest rates of revision, defined as optimum. We compared optimum shoulder arthroplasty revision rates for osteoarthritis (OA) to determine the most suitable/effective procedure for men and women. MethodsThere were three cohort groups of optimum primary shoulder arthroplasties for OA undertaken between 1st January 2008 and 31 December 2022: stemless shoulder arthroplasty with cemented polyethylene glenoids (slTSA), stemmed shoulder arthroplasty with modified central peg polyethylene glenoids (stTSA), and cementless reverse shoulder arthroplasty (rTSA). The cumulative percent revision (CPR) was determined using Kaplan-Meier estimates of survivorship and hazard ratios (HR) from Cox proportional hazard models adjusted for age, gender, humeral head/glenosphere size, polyethylene type, and surgeon volume. Possible interactions were examined. A sub-analysis from 1 January 2017 captured additional patient demographics, ASA score, BMI and glenoid morphology. ResultsThe CPR at 7 years was 4.0%(95% confidence interval (CI) 3.1, 5.1) for slTSA (n=3,041), 3.8%(95%CI 2.7, 5.5) for stTSA (n=1,259) and 4.1%(95%CI 3.7, 4.6) for rTSA (n=12,341). slTSA had a higher rate of revision compared to rTSA after the first 9 months (p<0.001). rTSA had a lower revision rate compared to stTSA from 3 months on (p=0.004). After adjusting for other confounders, prosthesis type and gender were associated with revision rates (p<0.001) whereas surgeon volume was not. Additionally, gender and prosthesis type strongly interacted (p=0.013) and the combined model exhibited greater predictive performance when including this interaction. Women had lower rates of revision than men for both stTSA and rTSA, but not slTSA. Most revisions were for infection in men, especially rTSA. After 3 months, the rate of revision for slTSA vs rTSA for women was increased (p<0.001) and revision rates for men did not significantly differ. However, in a sub-analysis of procedures in males since 2017 with additional adjustments, slTSA had a lower revision rate than stTSA (p=0.010). ConclusionsThe optimum shoulder arthroplasty revision rates vary for both the gender and implant type for the diagnosis of OA. A model combining optimum prostheses and gender predicted revision better than optimum implants alone. After 3 months, rTSA was associated with lower revision rates compared to slTSA in women, whereas there were no significant differences between optimum prostheses in men. However, surgeons may also consider lower revision risk of optimum slTSA at sub analysis and increased cumulative incidence of infection for rTSA requiring revision to resolve decision making for male patients.

Factors Limiting Ostomy Reversal After Cytoreductive Surgery for Ovarian Cancer: A Retrospective Study.

To investigate the factors related to non-reversal of ostomy after cytoreductive surgery in ovarian cancer. In many women with ovarian cancer, transitory ostomies are performed to limit the consequences of anastomotic leak. Although intended to be temporary, a proportion of these ostomies might never be reversed. This was a retrospective study of patients with 2014 International Federation of Obstetrics and Gynecology stage IIB-IVB ovarian cancer requiring a transitory ostomy during primary or secondary cytoreductive surgery at the Bergonie Institute, France, and the University Hospital of Las Palmas, Spain, between January 2012 and December 2022. Rate of ostomy reversal, its timing (weeks) and postoperative complications were assessed. Multivariate logistic regression analysis was performed to identify limiting factors for ostomy reversal. During the study period, we reviewed data on 181 consecutive patients with ovarian cancer with transitory ostomy creation; 89 (49.2%) patients were not candidates for an ostomy reversal surgery because of disease progression (n=65), death (n=16), and patient's refusal of surgery (n=8). A total of 92 patients were candidates for reversal surgery and were therefore included in the final analysis. In total, 57 (62%) patients had their ostomy reversed. The mean time from ostomy creation to ostomy closure was 47.7 (standard deviation=33.1) weeks. Hartmann's procedure (leaving a rectal stump of 5-6 cm) was identified as an independent predictive factor for non-reversal of ostomy (odds ratio=6.42, 95% confidence interval=1.61-25.53; p=0.008). Complications after ostomy reversal occurred in 32 patients (34.8%). Hartmann's procedure is a limiting factor for ostomy reversal in patients with ovarian cancer. We recommend avoiding Hartmann's procedure during cytoreductive surgery, even after colorectal anastomotic leak.