Diagnostic delay in Crohn's disease is associated with a complicated disease course and increased operation rate

OBJECTIVES The impact of diagnostic delay (a period from appearance of first symptoms to diagnosis) on the clinical course of Crohn's disease (CD) is unknown. We examined whether length of diagnostic delay affects disease outcomes. METHODS Data from the Swiss IBD cohort study were analyzed. Patients were recruited from university centers (68%), regional hospitals (14%), and private practices (18%). The frequencies of occurrence of bowel stenoses, internal fistulas, perianal fistulas, and CD-related surgery (intestinal and perianal) were analyzed. RESULTS A total of 905 CD patients (53.4% female, median age at diagnosis 26 (20-36) years) were stratified into four groups according to the quartiles of diagnostic delay (0-3, 4-9, 10-24, and ≥25 months, respectively). Median diagnostic delay was 9 (3-24) months. The frequency of immunomodulator and/or antitumor necrosis factor drug use did not differ among the four groups. The length of diagnostic delay was positively correlated with the occurrence of bowel stenosis (odds ratio (OR) 1.76, P=0.011 for delay of ≥25 months) and intestinal surgery (OR 1.76, P=0.014 for delay of 10-24 months and OR 2.03, P=0.003 for delay of ≥25 months). Disease duration was positively associated and non-ileal disease location was negatively associated with bowel stenosis (OR 1.07, P<0.001, and OR 0.41, P=0.005, respectively) and intestinal surgery (OR 1.14, P<0.001, and OR 0.23, P<0.001, respectively). CONCLUSIONS The length of diagnostic delay is correlated with an increased risk of bowel stenosis and CD-related intestinal surgery. Efforts should be undertaken to shorten the diagnostic delay.

Design and operation of ARGONTUBE: a 5 m long drift liquid argon TPC

The Liquid Argon Time Projection Chamber (LArTPC) is a prime type of detector for future large-mass neutrino observatories and proton decay searches. In this paper we present the design and operation, as well as experimental results from ARGONTUBE, a LArTPC being operated at the AEC-LHEP, University of Bern. The main goal of this detector is to prove the feasibility of charge drift over very long distances in liquid argon. Many other aspects of the LArTPC technology are also investigated, such as a voltage multiplier to generate high voltage in liquid argon (Greinacher circuit), a cryogenic purification system and the application of multi-photon ionization of liquid argon by a UV laser. For the first time, tracks induced by cosmic muons and UVlaser beam pulses have been observed and studied at drift distances of up to 5 m, the longest reached to date.

Too exhausted for Operation? Anxiety, depleted self-control strength, and perceptual-motor performance

We tested the hypothesis that the interaction of self-control strength and state anxiety predicts perceptual–motor performance in a hand–eye coordination task. We predicted a stronger negative relation between anxiety and performance in a perceptual–motor task for participants whose self-control strength had been temporarily depleted compared to participants whose self-control strength was intact. In an experiment (N = 60), we manipulated self-control strength, measured state anxiety after an evaluative instruction, and assessed performance in the board game Operation as an indicator of perceptual–motor performance. The data supported our hypothesis: Only for participants whose self-control strength was temporarily depleted was there a statistically significant negative relation between anxiety and performance. Boosting self-control strength may help to prevent the potentially negative anxiety effects.

Operation bei asymptomatischer Inguinalhernie – unnötig?

Until recently, the repair of asymptomatic groin hernia has been advocated as a prophylaxis for incarceration. However, incarcerations of inguinal hernias are rare events and can be treated adequately if the patient presents himself early after onset of symptoms. Randomized controlled trials showed, that watchful waiting is not associated with increased incarcerations and can be offered as a save alternative. However, within seven years after randomization 50 % to 70 % of the patients in the watchful waiting groups required surgery, mainly because of new onset or increasing symptoms.

The EPICA Dronning Maud Land deep drilling operation

We report on the EPICA Dronning Maud Land (East Antarctica) deep drilling operation. Starting with the scientific questions that led to the outline of the EPICA project, we introduce the setting of sister drillings at NorthGRIP and EPICA Dome C within the European ice-coring community. The progress of the drilling operation is described within the context of three parallel, deep-drilling operations, the problems that occurred and the solutions we developed. Modified procedures are described, such as the monitoring of penetration rate via cable weight rather than motor torque, and modifications to the system (e.g. closing the openings at the lower end of the outer barrel to reduce the risk of immersing the drill in highly concentrated chip suspension). Parameters of the drilling (e.g. core-break force, cutter pitch, chips balance, liquid level, core production rate and piece number) are discussed. We also review the operational mode, particularly in the context of achieved core length and piece length, which have to be optimized for drilling efficiency and core quality respectively. We conclude with recommendations addressing the design of the chip-collection openings and strictly limiting the cable-load drop with respect to the load at the start of the run.

Risk Factors for Sternal Wound Infection After Open Heart Operations Vary According to Type of Operation

BACKGROUND This study evaluated whether risk factors for sternal wound infections vary with the type of surgical procedure in cardiac operations. METHODS This was a university hospital surveillance study of 3,249 consecutive patients (28% women) from 2006 to 2010 (median age, 69 years [interquartile range, 60 to 76]; median additive European System for Cardiac Operative Risk Evaluation score, 5 [interquartile range, 3 to 8]) after (1) isolated coronary artery bypass grafting (CABG), (2) isolated valve repair or replacement, or (3) combined valve procedures and CABG. All other operations were excluded. Univariate and multivariate binary logistic regression were conducted to identify independent predictors for development of sternal wound infections. RESULTS We detected 122 sternal wound infections (3.8%) in 3,249 patients: 74 of 1,857 patients (4.0%) after CABG, 19 of 799 (2.4%) after valve operations, and 29 of 593 (4.9%) after combined procedures. In CABG patients, bilateral internal thoracic artery harvest, procedural duration exceeding 300 minutes, diabetes, obesity, chronic obstructive pulmonary disease, and female sex (model 1) were independent predictors for sternal wound infection. A second model (model 2), using the European System for Cardiac Operative Risk Evaluation, revealed bilateral internal thoracic artery harvest, diabetes, obesity, and the second and third quartiles of the European System for Cardiac Operative Risk Evaluation were independent predictors. In valve patients, model 1 showed only revision for bleeding as an independent predictor for sternal infection, and model 2 yielded both revision for bleeding and diabetes. For combined valve and CABG operations, both regression models demonstrated revision for bleeding and duration of operation exceeding 300 minutes were independent predictors for sternal infection. CONCLUSIONS Risk factors for sternal wound infections after cardiac operations vary with the type of surgical procedure. In patients undergoing valve operations or combined operations, procedure-related risk factors (revision for bleeding, duration of operation) independently predict infection. In patients undergoing CABG, not only procedure-related risk factors but also bilateral internal thoracic artery harvest and patient characteristics (diabetes, chronic obstructive pulmonary disease, obesity, female sex) are predictive of sternal wound infection. Preventive interventions may be justified according to the type of operation.