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promoting comprehensive medical care for diabetic individuals.Where surgery forms the primary curative modality in surgical oncology trials the quality of this intervention has the potential to directly influence outcomes. Many trials however lack a robust framework to ensure surgical quality. We aim to report existing published challenges to quality assurance of surgical interventions within oncological trials. A systematic on-line literature search of Embase and Medline identified 34 relevant studies, including 19 RCTs, 11 further analyses of the primary RCTs, and 4 trial protocols. Inclusion criteria oncological RCTs with a surgical intervention and/or associated publications relevant to the research question; 'Challenges to quality assurance of surgery in clinical oncology trials'. Selected articles were assessed by two reviewers to identify reported challenges to quality assurance of surgical intervention within these trials. Reported challenges to surgical quality could be classified as those affecting credentialing, standardisation and monitoring of surgical interventions. Constraints of using case volume for credentialing surgeons; inter-centre variation in the definition and execution of interventions; insufficient training, and monitoring of surgical quality, were the most commonly encountered challenges within each of these three domains. Findings confirmed an inadequacy in the implementation and reporting of effective surgical quality assurance measures. The surgical community should enable implementation of agreed upon mitigating strategies to overcome challenges to surgical quality in oncology trials.

The purpose of the study is to analyze patient outcomes following CT guided drainage of colonic diverticular abscesses and identify the factors associated with development of fistulous communication to the drain.

All patients undergoing CT guided abscess drainage, from 2009 to 2017, were included in this single institutional study. Clinical and demographic variables associated with development of colonic fistula were investigated.

One-hundred-and-five patients (55% female), mean abscess size and BMI of 6.3cm and 30.28kg/m

, respectively, underwent CT guided abscess drainage. Patients with fistula had longer operative times (p=0.03). On multivariable analysis, females (p=0.02) and higher BMI (p=0.01) were protective against, while increasing size (p=0.01) was predictive of developing fistulous communication to the drain.

More than half of patients developed colonic fistula after CT guided drainage. Male sex, lower BMI and increasing abscess size were predictive of developing colonic fistula.

More than half of patients developed colonic fistula after CT guided drainage. Male sex, lower BMI and increasing abscess size were predictive of developing colonic fistula.This article has been withdrawn please see Elsevier Policy on Article Withdrawal (http//www.elsevier.com/locate/withdrawalpolicy). This article has been withdrawn at the request of the editor and publisher. The Editor and Publisher regret that this Commentary has been removed, because the article it refers to has been withdrawn during the review process. The full Elsevier Policy on Article Withdrawal can be found at https//www.elsevier.com/about/our-business/policies/article-withdrawal.

Elevated blood urea nitrogen to serum albumin (BUN/ALB) ratio had been identified as an independent risk factor related to mortality in community-acquired and hospital-acquired pneumonia. This study aimed to investigate whether this clinical index can predict the clinical outcomes of E. coli bacteraemia.

Clinical data were collected from patients with E. check details coli bacteraemia attended at our hospital between January 2012 and December 2018. The endpoints were mortality within 30 days after the diagnosis of E. coli bacteraemia and intensive care (IC) requirement. Cox regression analysis was performed to evaluate the risk factors.

A total of 398 patients with E. coli bacteraemia were enrolled in this study and 56 patients died within 30 days after bacteraemia onset. Multivariate Cox regression analysis showed that age greater than 65 years, lymphocyte count<.8×10e9/L, elevated BUN/ALB ratio, increased SOFA score, carbapenem resistance, central venous catheterization before onset of bacteraemia, and infection originating from abdominal cavity were independent risk factors for 30-day mortality (P<.05). The risk factors associated with IC requirement were similar to those for 30-day mortality except central venous catheterization before onset of bacteraemia. The area under the receiver-operating characteristic curve for BUN/ALB ratio predicting 30-day mortality and IC requirement was similar to that for SOFA score, but higher than that for lymphocyte count. The cut-off points of BUN/ALB ratio to predict 30-day mortality and IC requirement were both .3.

BUN/ALB ratio is a simple but independent predictor of 30-day mortality and severity in E. coli bacteraemia. A higher BUN/ALB ratio at the onset of bacteraemia predicts a higher mortality rate and IC requirement.

BUN/ALB ratio is a simple but independent predictor of 30-day mortality and severity in E. coli bacteraemia. A higher BUN/ALB ratio at the onset of bacteraemia predicts a higher mortality rate and IC requirement.

There are no population data on bone mass in individuals with HIV in Spain, adjusted for age and sex.

Bone mineral density (BMD) data were obtained by dual X-ray absorptiometry in a cohort of individuals with HIV infection compared with cohort data from the general population in Spain and the United States of America.

Of 928 individuals (mean 46 years, 25% women), the prevalence of osteoporosis in the lumbar spine/femoral neck was 18%/5% in men, and 17%/10% in women, respectively. The rate increased from the age of 40 in men and from 50 in women (osteoporosis in 20% and 27%, respectively). BMD was lower than that observed in the general population in almost all age groups (mean, -6%; between 0%-11% lower compared to the Spanish cohort, and -8%; between 0%-14% lower than the American cohort).

Our cohort of individuals with HIV had a lower BMD in all age groups after adjustment for age and sex, compared with the general population. This fact must be considered when making recommendations.

Our cohort of individuals with HIV had a lower BMD in all age groups after adjustment for age and sex, compared with the general population.