Evolving trends in the management of acute appendicitis during COVID-19 waves. The ACIE appy II study

Background: In 2020, ACIE Appy study showed that COVID-19 pandemic heavily affected the management of patients with acute appendicitis (AA) worldwide, with an increased rate of non-operative management (NOM) strategies and a trend toward open surgery due to concern of virus transmission by laparoscopy and controversial recommendations on this issue. The aim of this study was to survey again the same group of surgeons to assess if any difference in management attitudes of AA had occurred in the later stages of the outbreak. Methods: From August 15 to September 30, 2021, an online questionnaire was sent to all 709 participants of the ACIE Appy study. The questionnaire included questions on personal protective equipment (PPE), local policies and screening for SARS-CoV-2 infection, NOM, surgical approach and disease presentations in 2021. The results were compared with the results from the previous study. Results: A total of 476 answers were collected (response rate 67.1%). Screening policies were significatively improved with most patients screened regardless of symptoms (89.5% vs. 37.4%) with PCR and antigenic test as the preferred test (74.1% vs. 26.3%). More patients tested positive before surgery and commercial systems were the preferred ones to filter smoke plumes during laparoscopy. Laparoscopic appendicectomy was the first option in the treatment of AA, with a declined use of NOM. Conclusion: Management of AA has improved in the last waves of pandemic. Increased evidence regarding SARS-COV-2 infection along with a timely healthcare systems response has been translated into tailored attitudes and a better care for patients with AA worldwide

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/ Dirty Infected Laparotomy Wounds

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, &amp; Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems. </jats:p

Biomechanical evaluation of suture materials used for abdominal fascial closure

Background. While there are clear recommendations for the technique and suture material for abdominal fascial closure, surgeons may have personal preferences arising from prevoius experiences or influenced during training. The decision of which suture material to use should not influence the outcome of fascial closure. The objective of this study is to analyze the influence of time and tension on the mechanical properties of sutures used for abdominal fascial closure. Methods. Polyglactin 910, polypropylene, and polydioxanone sutures were exposed to 8 and 10 newtons of constant tensile strain during a period of 7 and 14 days. They were then mechanically tested to assess changes in their properties regarding strength and deformation. Results. No significant changes were observed in maximum tensile force or extension within the different suture groups. Regarding deformation, polypropylene and polydioxanone did not exhibit alterations in their curve behavior, while polyglactin 910 did exhibit changes compared to the control group, as seen by the elevation in its Young modulus when manipulated. Conclusions. Our study finds that while different sutures behave differently, nor time or tension have a negative effect on their biomechanical resilience and can withstand tensile strengths well above any physiological or pathological condition

Biomechanical evaluation of suture materials used for abdominal fascial closure

Abstract Background. While there are clear recommendations for the technique and suture material for abdominal fascial closure, surgeons may have personal preferences arising from prevoius experiences or influenced during training. The decision of which suture material to use should not influence the outcome of fascial closure. The objective of this study is to analyze the influence of time and tension on the mechanical properties of sutures used for abdominal fascial closure. Methods. Polyglactin 910, polypropylene, and polydioxanone sutures were exposed to 8 and 10 newtons of constant tensile strain during a period of 7 and 14 days. They were then mechanically tested to assess changes in their properties regarding strength and deformation. Results. No significant changes were observed in maximum tensile force or extension within the different suture groups. Regarding deformation, polypropylene and polydioxanone did not exhibit alterations in their curve behavior, while polyglactin 910 did exhibit changes compared to the control group, as seen by the elevation in its Young modulus when manipulated. Conclusions. Our study finds that while different sutures behave differently, nor time or tension have a negative effect on their biomechanical resilience and can withstand tensile strengths well above any physiological or pathological condition.</jats:p

Acute-onset of superior mesenteric artery syndrome following surgical correction of scoliosis: Case report and review of literature

Superior mesenteric artery (SMA) syndrome is a rare condition caused by compression of the third portion of duodenum by the angle between the superior mesenteric artery against the aorta. A rare presentation of SMA syndrome is following scoliosis repair and spinal fusion with a low incidence and most of these patients present with symptoms within one to two weeks or even more after the surgical repair. A high suspicion index after surgical correction of scoliosis with well-known risk factors (low BMI, low percentile of weight for height, and a high degree of change in the Cobb's angles) can anticipate the postoperative diagnosis. Management has been described for postsurgical scoliosis repair with a late onset presentation of SMA syndrome with nutritional support with good success rates, but there is no data for best treatment management for acute onset especially when the surgical correction of the spine causes complete duodenal obstruction and a surgical intervention might be warranted. Here in, we present a 14 year-old boy with an acute 24-h postoperative SMA syndrome following surgical correction of scoliosis

Versatile implementation of a hardware–software architecture for development and testing of brain–computer interfaces

Brain–computer interfaces (BCI) have been focused on improving people’s lifestyles with motor or communication disabilities. However, the utilization of this technology has found news applications, such as increasing human capacities. Nowadays, several researchers are working on probing human capabilities to control several robotic devices simultaneously. The design of BCI is an intricate work that needs a long time to its implementation. For this reason, an architecture to design and implement different types of BCIs is presented in this article. The architecture has a modular design capable of reading various electroencephalography (EEG) sensors and controlling several robotic devices similar to the plug-and-play paradigm. To test the proposed architecture, a BCI was able to manage a hexapod robot and a drone was implemented. Firstly, a mobile robotic platform was designed and implemented. The BCI is based on eye blinking, where a single blinking represents a robot command. The command orders the robot to initiate or stops their locomotion for the hexapod robot. For the drone, a blink represents the takeoff or landing order. The blinking signals are obtained from the prefrontal and frontal regions of the head by EEG sensors. The signals are then filtered using temporal filters, with cutoff frequencies based on delta, theta, alpha, and beta waves. The filtered signals were labeled and used to train a classifier based on the multilayer perceptron (MLP) model. To generate the robot command, the proposal BCI used two models of MLP to ensure the classifier prediction. So, when the two classifiers make the same prediction, within a defined time interval, send the signal to the robot to start or stop its movement. The obtained results show that it is possible to get high precision to control the hexapod robot with a precision of 91.7% and an average of 81.4%. </jats:p