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Abstract Background Despite the advances of cardiac surgery in the last decades, the incidence of acute kidney insufficiency (AKI) post isolated coronary artery bypass grafting surgery (iCABG) is increasing. The purpose of this study was to identify the potential predictors of postoperative AKI in iCABG in order to implement measures to reduce its incidence. Results We reviewed the data of 1914 patients who had on-pump iCABG from January 2008 to December 2015, using the cardiothoracic surgery unit database of Liverpool Hospital, Sydney, New South Wales, Australia. Patients were divided into two groups according to the occurrence of postoperative AKI. The incidence of postoperative AKI was 5.3% in 8 years (n = 101/1914 patients). Multivariable analysis has identified the following independent predictors of postoperative AKI; age older than 80 years (OR 4.27; 95% CI 1.6–11.81) (p

Abstract Objectives There is an increased interest in enhanced recovery after surgery (ERAS) minimizing adverse events after orthopedic surgery. Little consensus supports the effectiveness of these interventions. The purpose of present systematic review and meta-analysis is to comprehensively analyze and evaluate the significance of ERAS interventions for postoperative outcomes after orthopedic surgery. Methods PubMed, EMBASE, and Cochrane databases were totally searched from the inception dates to May 31, 2018. Two reviewers independently extracted the data from the selected articles using a standardized form and assessed the risk of bias. The analysis was performed using STATA 12.0. Results A total of 15 published studies fulfilled the requirements of inclusion criteria. We found that the ERAS group showed a significant association with lower incidence of postoperative complications (OR, 0.70; 95% CI, 0.64 to 0.78). Meanwhile, ERAS was also associated with the decline in 30-day mortality rate and Oswestry Disability Index (ODI). However, no significant differences were identified between the two groups regarding the 30-day readmission rate (P = 0.397). Conclusions Our meta-analysis suggested that the ERAS group had more advantages in reducing incidence of postoperative complications, 30-day mortality rate, and ODI after orthopedic surgery, but not of 30-day readmission rate. However, further research with standardized, unbiased methods and larger sample sizes is required for deeper analysis.

Background Total hip and total knee replacement (THR/TKR) are common and effective surgeries to reduce the pain and disability associated with arthritis but are associated with small but significant risks of preventable complications such as surgical site infection (SSI) and venous-thrombo-embolism (VTE). This study aims to determine the degree to which hospital care was compliant with clinical guidelines for the prevention of SSI and VTE after THR/TKR; and whether non-compliant prophylaxis is associated with increased risk of complications. Methods and findings A prospective multi-centre cohort study was undertaken in consenting adults with osteoarthritis undergoing elective primary TKR/THR at one of 19 high-volume Australian public or private hospitals. Data were collected prior to surgery and for one-year post-surgery. Four adjusted logistic regression analyses were undertaken to explore associations between binary non-compliance and the risk of surgical complications: (1) composite (simultaneous) non-compliance with both (VTE and antibiotic) guidelines and composite complications [all-cause mortality, VTE, readmission/reoperation for joint-related reasons (one-year) and non-joint-related reasons (35-days)], (2) VTE non-compliance and VTE outcomes, (3) antibiotic non-compliance and any SSI, and (4) antibiotic non-compliance and deep SSI. Data were analysed for 1875 participants. Guideline non-compliance rates were high: 65% (VTE), 87% (antibiotics) and 95% (composite guideline). Composite non-compliance was not associated with composite complication (12.8% vs 8.3%, adjusted odds ratio [AOR] = 1.41, 95%CI 0.68–3.45, p = 0.40). Non-compliance with VTE guidelines was associated with VTE outcomes (5% vs 2.4%, AOR = 2.83, 95%CI 1.59–5.28,p < 0.001). Non-compliance with antibiotic guidelines was associated with any SSI (14.8% vs 6.1%, AOR = 1.98, 95%CI 1.17–3.62,p = 0.02) but not deep infection (3.7% vs 1.2%,AOR = 2.39, 95%CI 0.85–10.00, p = 0.15). Conclusions We found high rates of clinical variation and statistically significant associations between non-compliance with VTE and antibiotic guidelines and increased risk of VTE and SSI, respectively. Complications after THR/TKR surgery may be decreased by improving compliance with clinical guidelines.

ObjectivePre- and post-operative neutrophil to lymphocyte ratio (NLR) and prognostic nutritional index (PNI) and other prognostic clinicopathological variables were correlated with progression free survival (PFS) and overall survival (OS) of Glioblastoma Multiforme (GBM) patients.MethodsGBM patients (n = 87, single-centre, recruited 2013-2019) were retrospectively divided into low and high groups using literature-derived cut-offs (NLR = 5.07, PNI = 46.97). Kaplan-Meier survival curves and log rank tests assessed PFS and OS. Univariate and multivariate analyses identified PFS and OS prognosticators.ResultsHigh vs low post-operative PNI cohort was associated with longer PFS (279 vs 136 days, p = 0.009), but significance was lost on multivariate analysis. Post-operative ECOG (p = 0.043), daily dexamethasone (p = 0.023) and IDH mutation (p = 0.046) were significant on multivariate analysis for PFS. High pre- and post-operative PNI were associated with improved OS (384 vs 114 days, p = 0.034 and 516 vs 245 days, p = 0.001, respectively). Low postoperative NLR correlated with OS (408 vs 249 days, p = 0.029). On multivariate analysis using forward selection process, extent of resection (EOR) (GTR vs biopsy, p = 0.004 and STR vs biopsy, p = 0.011), and any previous surgery (p = 0.014) were independent prognostic biomarkers for OS. On multivariate analysis of these latter variables with literature-derived prognostic biomarkers, EOR remained significantly associated with OS (p = 0.037).ConclusionsEOR, followed by having any surgery prior to GBM, are the most significant independent predictors of GBM patient's OS. Post-operative ECOG, daily dexamethasone and IDH mutation are independent prognostic biomarkers for PFS. PNI may be superior to NLR. Post- vs pre-operative serum inflammatory marker levels may be associated with survival.

To mitigate the environmental impact induced by CO2 emissions and nonrenewable resource consumption, which are typically associated with Portland cement production, ground granulated blast furnace slags (GGBSs) are usually added to the cement. In this study, the stabilisation effect of alkali-activated GGBS on saline soil and the hydration products of alkali-activated GGBS were investigated by unconfined compressive strength tests and scanning electron microscopy, respectively. The results show that Ca(OH)2 and NaOH as alkaline activators for GGBS significantly improve the unconfined compressive strength of saline soils. This strength is also enhanced by Na2SO4; however, the increase is considerably less than that provided by Ca(OH)2 and NaOH. In contrast, Na2CO3 is not a suitable alkaline activator for GGBS and has no significant effect on the unconfined compressive strength of saline soils. The study results further show that the morphology of hydration products varies because of the different alkaline activators involved in the hydration reaction with GGBS in saline soils.

Abstract Plant root architecture dynamically adapts to various environmental conditions, such as salt‐containing soil. The phytohormone abscisic acid (ABA) is involved among others also in these developmental adaptations, but the underlying molecular mechanism remains elusive. Here, a novel branch of the ABA signaling pathway in Arabidopsis involving PYR/PYL/RCAR (abbreviated as PYLs) receptor‐protein phosphatase 2A (PP2A) complex that acts in parallel to the canonical PYLs‐protein phosphatase 2C (PP2C) mechanism is identified. The PYLs‐PP2A signaling modulates root gravitropism and lateral root formation through regulating phytohormone auxin transport. In optimal conditions, PYLs ABA receptor interacts with the catalytic subunits of PP2A, increasing their phosphatase activity and thus counteracting PINOID (PID) kinase‐mediated phosphorylation of PIN‐FORMED (PIN) auxin transporters. By contrast, in salt and osmotic stress conditions, ABA binds to PYLs, inhibiting the PP2A activity, which leads to increased PIN phosphorylation and consequently modulated directional auxin transport leading to adapted root architecture. This work reveals an adaptive mechanism that may flexibly adjust plant root growth to withstand saline and osmotic stresses. It occurs via the cross‐talk between the stress hormone ABA and the versatile developmental regulator auxin.

A series of unconfined compression tests were performed to investigate the influence of wheat straws on the unconfined compression strength for saline-alkaline soils and saline-alkaline soils mixed with cement. In unconfined compression tests, 20 groups of soil specimens were prepared at five different percentages of wheat straws content (i.e., 0.0%, 0.1%, 0.15%, 0.2%, and 0.25% by weight of saline-alkaline soils) and four different percentages of cement content (i.e., 0%, 3%, 6%, and 9% by weight of saline-alkaline soils), and unconfined compression tests were carried out after 3-, 7-, 14-, 28-, and 56-day curing periods. Test results indicated that the inclusion of wheat straws within saline-alkaline soils and saline-alkaline soils mixed with cement leads to an increase in the unconfined compressive strength of specimens and also changed the brittle behavior to a more ductile one for specimens. In addition, based on the results from unconfined compression tests, a formula for predicting the unconfined compression strength of specimens related to cement content, wheat straw content, curing periods, etc., was determined, and comparing with the results from unconfined compression tests, it had higher precision in predicting the unconfined compression strength of specimens.

Compared to vendor-provided data, Transaction Log Analysis (TLA) can provide unique benefits to a library in analyzing database usage. Meanwhile, it also requires librarians to have a broad knowledge of Information Technology in order to implement a TLA. This article will present an in-house database system developed at the University of Manitoba Libraries to analyze EZProxy’s Starting Point Uniform Resource Locator logs. The database visits that happened in the past two years have been imported into this system and are split into two categories, on-campus and off-campus visits. Unique statistical information from each category is also discussed.

Abstract Background Inpatient rehabilitation is an expensive option following total hip arthroplasty (THA). We aimed to determine if THA patients who receive inpatient rehabilitation report better hip and quality of life scores post-surgery compared to those discharged directly home. Methods Prospective, propensity score matched cohort involving 12 private hospitals across five Australian States. Patients undergoing THA secondary to osteoarthritis were included. Those receiving inpatient rehabilitation for reasons other than choice or who experienced significant health events within 90-days post-surgery were excluded. Comparisons were made between those who did and did not receive inpatient rehabilitation for patient-reported hip pain and function (Oxford Hip Score, OHS) and ‘today’ health rating (EuroQol 0–100 scale). Rehabilitation provider charges were also estimated and compared. Results Two hundred forty-six patients (123 pairs, mean age 67 (10) yr., 66% female) were matched on 19 covariates for their propensity to receive inpatient rehabilitation. No statistically nor clinically significant between-group differences were observed [OHS median difference (IQR): 0 (− 3, 3), P = 0.60; 0 (− 1 to 1), P = 0.91, at 90 and 365-days, respectively; EuroQol scale median difference 0 (− 10, 12), P = 0.24; 0 (− 10, 10), P = 0.49; 5 (− 10, 15), P = 0.09, at 35-, 90- and 365-days, respectively]. Median rehabilitation provider charges were 10-fold higher for those who received inpatient rehabilitation [median difference $7582 (5649, 10,249), P

Electromagnetically driven elastic magnetic microfluidic mixers were investigated for their performance in air, water and glycerol filled chambers. They were fabricated by embedding flexible magnets in polydimethylsiloxane (PDMS) membrane. At a driving frequency of 100 Hz, oscillating fluid flow was induced and mixing was achieved. Three designs were fabricated and studied: a) concentric type with the magnetic material in the center of the membrane, b) eccentric type with the magnetic material offset from the center of the membrane and c) split type with two regions of magnetic materials with opposing polarities. The split configuration provides additional fluid folding, facilitating mixing of the 20 μL fluorescent dye in 60 μL of solvent. Simulation and experimental results show that the eccentric and split designs were able to achieve a 20–30% reduction in mixing time compared to the concentric design. At the same magnetic flux density, the eccentric type design exhibited the greatest deflection, explaining the better mixing achieved over the concentric type design. The split type design, having the lowest deflection, was able to perform better and more consistently than the eccentric type design by creating a “micro rocker mixer” effect. We postulated that the shapes of the deflection profiles in the eccentric and split designs contributed to the mixing efficiency by promoting better chaotic advection than the concentric design.