Background
Emergency abdominal surgery carries a considerable risk of death and postoperative complications. Early detection and timely management of complications may reduce mortality. The aim was ...to evaluate the effect and feasibility of intermediate care compared with standard ward care in patients who had emergency abdominal surgery.
Methods
This was a randomized clinical trial carried out in seven Danish hospitals. Eligible for inclusion were patients with an Acute Physiology And Chronic Health Evaluation (APACHE) II score of at least 10 who were ready to be transferred to the surgical ward within 24 h of emergency abdominal surgery. Participants were randomized to either intermediate care or standard surgical ward care after surgery. The primary outcome was 30‐day mortality.
Results
In total, 286 patients were included in the modified intention‐to‐treat analysis. The trial was terminated after the interim analysis owing to slow recruitment and a lower than expected mortality rate. Eleven (7·6 per cent) of 144 patients assigned to intermediate care and 12 (8·5 per cent) of 142 patients assigned to ward care died within 30 days of surgery (odds ratio 0·91, 95 per cent c.i. 0·38 to 2·16; P = 0·828). Thirty (20·8 per cent) of 144 patients assigned to intermediate care and 37 (26·1 per cent) of 142 assigned to ward care died within the total observation period (hazard ratio 0·78, 95 per cent c.i. 0·48 to 1·26; P = 0·310).
Conclusion
Postoperative intermediate care had no statistically significant effect on 30‐day mortality after emergency abdominal surgery, nor any effect on secondary outcomes. The trial was stopped prematurely owing to slow recruitment and a much lower than expected mortality rate among the enrolled patients. Registration number: NCT01209663 (http://www.clinicaltrials.gov).
Trial closed early, no effect on mortality
Twelve methadone-maintained HIV-negative subjects were given saquinavir/ritonavir (SQV/rtv) 1600 mg/100 mg once daily for 14 days. Pharmacokinetic evaluations of total and unbound methadone ...enantiomers (R and S) were conducted before and after SQV/rtv. SQV/rtv was well tolerated, with no ACTG Grade 3-4 adverse events, no evidence of sedation, and no changes in methadone dose. For R-methadone (active isomer), C(max), AUC(0-24 h), and C(min) were unchanged, but percent unbound 4 hours after dosing was reduced by 12%. For S-methadone, no differences in pharmacokinetic parameters of total drug were seen, but unbound concentrations were reduced by 15% and 21% at 4 and 24 hours after dosing, respectively. SQV trough concentrations exceeded the anticipated EC(50) (50 ng/mL) in 10/12 subjects, persisting for at least 6 hours after the final dose in 4/6 subjects. Once-daily SQV/rtv in methadone-maintained subjects is safe and not associated with any clinically significant interaction with methadone during 14 days of concomitant administration.
The charmed strange baryon Xi_c^0 was searched for in the decay channel Xi_c^0 -> Xi- pi+, and the beauty strange baryon Xi_b in the inclusive channel Xi_b -> Xi- l- anti-nu X, using the 3.5 million ...hadronic Z events collected by the DELPHI experiment in the years 1992--1995. The Xi- was reconstructed through the decay Xi- -> Lambda pi-, using a constrained fit method for cascade decays. An iterative discriminant analysis was used for the Xi_c^0 and Xi_b selection. The production rates were measured to be f_{Xi_c^0} x BR(Xi_c^0 -> Xi- pi+)= (4.7 +/- 1.4 (stat.) +/- 1.1 (syst.))10^{-4} per hadronic Z decay, and BR(b -> Xi_b) x BR(Xi_b -> Xi- l- X)= (3.0 +/- 1.0 (stat.) +/- 0.3 (syst.))10^{-4} for each lepton species (electron or muon). The lifetime of the Xi_b baryon was measured to be tau_{Xi_b} = 1.45{^{+0.55}_{-0.43}} (stat.) +/- 0.13 (syst.) ps. A combination with the previous DELPHI lifetime measurement gives tau_{Xi_b} = 1.48{^{+0.40}_{-0.31}} (stat.) +/- 0.12 (syst.) ps.
Searches for pair-production of supersymmetric particles under the assumption of non-conservation of R-parity with a dominant LLEbar or UbarDbarDbar term have been performed using the data collected ...by the DELPHI experiment at LEP in e+e- collisions at centre-of-mass energies from 192 up to 208 GeV. No excess of data above Standard Model expectations was observed. The results were used to constrain the MSSM parameter space and to derive limits on the masses of supersymmetric particles.
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