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Tertiary hospitals are increasingly called on by smaller hospitals and free-standing emergency rooms (ERs) to provide surgical care for complex patients. This study assesses patients transferred to an acute care surgery service. The ER and transfer center logs, as well as billing data, were reviewed for 12 months for all cases evaluated by acute care surgery. The charts were reviewed for demographics, comorbidities, and outcomes. A total of 111 transferred patients with complete data were identified, with 59 transferred from another hospital and 52 from a free-standing ER. The hospital transfer patients were older with more comorbidities, had a longer length of stay, and were more likely discharged to skilled care. There was no difference in the percent of patients requiring a procedure; however, significantly more procedures in the hospital transfer group were done by nonsurgical specialties Better infrastructure to monitor the impact of hospital transfers is warranted in the setting of the complex patient population transferred to tertiary hospitals. [ABSTRACT FROM AUTHOR]

Glyphosate is the most used herbicide in agriculture. Its major metabolite is AMPA (aminomethylphosphonic acid), but N-acetyl-AMPA and N-acetylglyphosate are also metabolites of interest. For risk assessment, a general residue definition was proposed as the sum of glyphosate, AMPA, N-acetyl-glyphosate and N-acetyl-AMPA, expressed as glyphosate. A confirmatory method for glyphosate in fat, liver and kidneys, as well as a confirmatory method for AMPA and N-acetyl-glyphosate in all matrices, are still missing. In this paper, we present a method for the quantitative determination of glyphosate residues and its metabolites AMPA, N-acetyl-AMPA and N-acetyl-glyphosate by liquid chromatography-mass spectrometry (LC-MS/MS) in adipose tissue, liver, eggs, milk and honey without derivatization. Different chromatographic columns were tested, with the Hypercarb column providing the best results. The analytes were eluted with mobile phases of acidified water with 1.2% formic acid and 0.5% formic acid in acetonitrile. Sample purification procedures were also optimized by varying the solvent extraction mixtures (water, methanol and mixture ψ (methanol, water) = 1:1, each with the addition of 1% formic acid ( v / v )), using different sorbents in solid phase extraction (SPE) (polymeric cationic (PCX) and anionic (PAX)) and using dispersive solid phase extraction (dSPE) (C18 and PSA) by modifying the extraction procedures. Finally, the analytes were extracted from the samples with 1% formic acid in water ( v / v ). Milk and adipose tissue were purified by the addition of dichloromethane, while liver and egg samples were purified by SPE with a mixed cation exchange sorbent and ultrafiltration with cut-off filters. The proposed analytical procedures were validated according to SANTE/11312/2021 guidelines: linearity, limits of quantification, precision and accuracy were determined for all matrices. The limits of quantification (LOQs) ranged from 0.025 to 0.2 mg kg -1 . Precision, expressed as relative standard deviation, was <20%, while accuracy, expressed as analytical recovery, ranged from 70% to 120%. During method validation, the measurement uncertainty was estimated to be <50% for all analytes. Good validation parameters according to the SANTE document were achieved for all analytes. Therefore, the method can be considered reliable and sensitive enough for routine monitoring of polar pesticides. The application of the accredited method in routine analysis will provide data that are useful for the re-evaluation of risk assessment studies in foods of animal origin.

Intraoperative cholangiogram (IOC) is a useful tool for surgeons to assess anatomy of the biliary tree and diagnose biliary pathology. Many surgeons utilize cholangiography in most cases in hopes of preventing ductal injuries and are deemed routine cholangiographers. There is little data on the success rate and reasons why IOC is not performed. The purpose of this study was to evaluate the use of routine cholangiography and to determine reasons why cholangiography was not performed. 693 cholecystectomies were analyzed. Intraoperative cholangiogram was attempted in 553 (79.8%) of these cases. The success rate of performing cholangiograms in those attempted was 93.3%. Intraoperative cholangiogram was not attempted in 140 patients (20.2%) for various reasons. Although many surgeons consider themselves routine cholangiographers, there are times when IOC is not feasible. Knowledge of these reasons may help clarify indications for IOC. For most cases, routine cholangiography appears to be feasible.

In March 2018, a landslide in Hrvatska Kostajnica completely destroyed multiple households. The damage was extensive, and lives were endangered. The question remains: Can it happen again? To enhance the knowledge and understanding of the soil and rock behaviour before, during, and after this geo-hazard event, multi-level sensing technologies in landslide research were applied. Day after the event field mapping and unmanned aerial vehicle (UAV) data were collected with the inspection of available orthophoto and "geo" data. For the landslide, a new geological column was developed with mineralogical and geochemical analyses. The application of differential interferometric synthetic aperture radar (DInSAR) for detecting ground surface displacement was undertaken in order to determine pre-failure behaviour and to give indications about post-failure deformations. In 2020, electrical resistivity tomography (ERT) in the landslide body was undertaken to determine the depth of the landslide surface, and in 2021 ERT measurements in the vicinity of the landslide area were performed to obtain undisturbed material properties. Moreover, in 2021, detailed light detection and ranging (LIDAR) data were acquired for the area. All these different level data sets are being analyzed in order to develop a reliable landslide model as a first step towards answering the aforementioned question. Based on applied multi-level sensing technologies and acquired data, the landslide model is taking shape. However, further detailed research is still recommended.

Parathyroid carcinoma is a very rare disease that is accompanied by a poor prognosis. Diagnosis is based on laboratory tests (calcium, parathyroid hormone), sonography, and scintigraphy. Complete surgical resection is the treatment of choice. Adjuvant therapy is controversial. The lack of treatment guidelines and experience with this disease often delay timely therapy. In the following article, we report on two female patients with parathyroid carcinoma who underwent surgery in our clinic., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Chelating 1,4-disubstituted mono- (8a-8d) and bis-1,2,3-triazole-based (9a-11a) ligands were prepared by regioselective copper(i)-catalysed 1,3-dipolar cycloaddition of terminal alkynes with aromatic azides, together with bioconjugate 13a synthesized by amide coupling of l-phenylalanine methyl ester to 11a. Cu(ii) and Zn(ii) complexes were prepared and single crystal structures were determined for complexes 8aCu, 8dCu, 9cCu and 10cCu, as well as the free ligands 10a and 10c. The in situ prepared Zn(ii) complexes were studied by NMR spectroscopy, while the stoichiometry of the Cu(ii) complexes in solution was determined by UV-Vis titrations and confirmed by the electronic structure DFT calculations at the (SMD)/M05-2X/6-31+G(d)/LanL2DZ+ECP level of theory.

Aim: To ensure a more reliable classification system for the femur neck fractures by estimating pressure and tensile force on the fracture crevice., Methods: The study compared the kappa coefficient for the inter and intraobserver agreement of the same five observers on the same radiographic sample of the femur neck fracture with a time gap of one year for the AO group and original proposal of estimated dominant pressure and tensile force on the femur neck fracture's crevice., Results: The kappa coefficient for the AO group was 0.49 and for the system for estimating the dominant force on the fracture's crevice it was 0.78. For the observer our proposal is easier to use than the AO system., Conclusion: The estimation system of the dominant force on the fracture's crevice is more reliable and thus more acceptable than the AO group system for femoral neck fractures.

Objectives: Since thyroglobulin, no new blood tests for differentiated thyroid cancer (DTC) have been introduced into routine clinical practice. In initial studies, the detection of circulating DTC cells by thyrotropin receptor (TSHR) mRNA measurement distinguished benign from malignant thyroid diseases. This prospective validation study tests the ability of TSHR mRNA to diagnose DTC preoperatively and to detect cancer recurrence., Methods: TSHR mRNA was measured by quantitative RT-PCR from blood drawn perioperatively in patients undergoing thyroid surgery (n = 526), postoperatively in patients undergoing DTC follow-up (n = 418) and in patients monitored for known benign disease (n = 151). The reference range and applications for TSHR mRNA were previously defined from 663 samples from patients with normal, benign, and malignant thyroid disease., Results: In patients with follicular neoplasms or suspicious cytology, preoperative TSHR mRNA >1 ng/μg had 96% predictive value for DTC, whereas 95% of patients with undetectable mRNA and benign thyroid sonography had benign disease. In patients with DTC, elevated TSHR mRNA levels became undetectable in all patients (n = 64) on the first postoperative day, except in 5 who manifested persistent or recurrent cervical disease within the year. In long-term follow-up of DTC patients with thyroglobulin antibodies, 96% with undetectable TSHR mRNA also had no evidence of cancer recurrence., Conclusions: TSHR mRNA provides an additional clinical tool for the evaluation of patients with thyroid nodules. It is particularly useful in guiding appropriate initial surgery for follicular neoplasms. TSHR mRNA also represents a new blood test to aid assessment of disease status in thyroid cancer follow-up.

Background: Circulating thyroid cancer cells detected by peripheral blood thyroid-stimulating hormone receptor (TSHR) mRNA have demonstrated usefulness for thyroid cancer diagnosis and long-term surveillance. The aim of this study was to determine detectability and clinical importance of TSHR mRNA in patients with microcarcinomas., Methods: We compared clinical characteristics of 37 patients with papillary thyroid microcarcinomas (PTMC; tumor size 1 cm (72%; P = NS) and distinctly higher than false (+) rates in benign goiters (15%; P < .001). All patients with (-)TSHR mRNA had classical PTMC, whereas variants (32%) occurred with (+)mRNA (P = .001). Mean tumor size (5 mm) and multifocality rates (45%) were similar in both mRNA groups. Of the PTMC patients, 35% had concurrent cervical nodal metastases, which occurred more frequently with tumors >/=5 mm (P = .04) and with (+)TSHR mRNA in pre-operatively known PTMC (P < .05). No patients with incidentally detected PTMC and (-)TSHR mRNA had metastases., Conclusion: This study is the first to demonstrate that TSHR mRNA, reflecting circulating thyroid cancer cells, is detectable even with thyroid microcarcinomas. PTMC with (+)TSHR mRNA may characterize patients with potentially more aggressive histology at initial operation.

Background: Ventilator-associated pneumonia (VAP) remains a major source of morbidity, mortality, and expense in the ICU despite therapies directed against it., Study Design: A retrospective review of a prospectively developed performance-improvement project monitoring the incidence of VAP in two adjacent ICUs was conducted. In response to an excessive VAP rate, weekly multidisciplinary team meetings were instituted to review data, develop care protocols, and modify care routines. Protocol compliance was monitored daily and feedback provided weekly to the care teams. VAP rates were determined by the institutional Infection Control Committee and reviewed monthly with the ICU multidisciplinary team. Duration of the investigational period was 10 years., Results: A standardized ventilator-weaning protocol was instituted with confirmed 95% use. Additional modifications of care, such as patient positioning, use of specific endotracheal tubes to minimize aspiration of supraglottic secretions, an oral-care regimen, and aggressive antibiotic stewardship were standardized, with a compliance rate >90%. VAP rates dropped from 12.8 per 1,000 patient-days in 1998 to 1.1 in 2007 in the burn trauma ICU and from 21.2 to <1 in the neurotrauma ICU in the same time frame. Also, mean ventilator length of stay decreased from 6 days to 4.2 and from 5.8 days to 4.75 simultaneously in the respective ICUs. Such performance improvement has been sustained since implementation of the program., Conclusion: A systematic, monitored program of standardized care protocols can markedly reduce VAP rate in the ICU.

Background: This study was designed to evaluate whether resident performance of placing central lines improved after simulation training on newly available partial-task simulators., Methods: This study was designed as a prospective, randomized controlled trial of standard training versus simulated training using CentralLine Man (SimuLab, Seattle, WA, USA). After receiving a lecture on central line placement, all junior residents on the trauma rotation were randomized on a monthly alternating schedule. Equivalency of groups was determined with a self-reported survey. All lines placed by the participants were monitored, and data were collected on performance and complications., Results: The 2 groups (n = 34; 21 standard and 13 simulated) were equivalent at baseline. The simulated training group had a significantly higher level of comfort and ability than the standard training group. The simulated group outperformed the standard group on 12 of the 15 specific variables monitored, although this did not reach statistical significance. There were significantly more complications in the standard group., Conclusions: Simulation for central line placement using a partial-task simulator does positively impact resident performance.