Grand challenges in colorectal and proctological surgery

Colorectal surgery (CRS) and proctology represent a branch of general surgery that is becoming increasingly important and relevant. In recent decades, there have been so many innovations that have given coloproctological surgery an identity of its own. In recent years, innovations in major CRS have been revolutionizing healthcare and improving patient outcomes ranging from early diagnosis to the most modern treatment options

Head and neck cancer surgery during the COVID-19 pandemic: an international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

A pilot study on the efficacy and safety of preoperative micronized purified flavonoid fraction treatment and sucralfate-based rectal ointment on patients with grade II to IV hemorrhoidal disease

BACKGROUND: Hemorrhoidal disease (HD) is a chronic and extremely common condition that negatively impacts patients’ quality of life. The aim of the present study was to evaluate the changes in symptom severity and the need for further interventions following treatment with the oral micronized purified flavonoid fraction (MPFF) and a topical rectal ointment containing 3% sucralfate and herbal extracts (calendula, witch hazel leaf, chamomile). METHODS: A consecutive series of patients aged 18 to 75 with symptomatic II to IV-degree HD classified according to the Goligher classification were prospectively enrolled between September and December 2023. All patients were proposed a hypothetical surgical strategy at time 0 (T0) based on clinical presentation. At T1 (60 days), 7 days before any subsequent procedure, a different colorectal surgeon from the one who conducted the initial assessment performed a reassessment. All enrolled patients underwent medical therapy with a 500 mg MPFF twice daily and rectal ointment twice daily for a duration of 60 days, in addition to conservative therapy. The primary outcome was the change in symptom severity from T0 to T1, assessed using the Hemorrhoidal Disease Symptom Score (HDSS), Short Health Scale HD (SHS-HD) and Vaizey incontinence score. Secondary outcomes included the rate of downgrading intervention. RESULTS: The present study included 34 patients (15 [44.1%] female) with a median age of 46.5 years (IQR 30-66). Both HDSS and SHS statistically improved from a median value of 11 and 16 at T0 to 2 and 1 at T1, respectively (P<0.00001). In 12 out of 34 (35.3%) of patients, the second colorectal surgeon considered a less invasive treatment due to the downstaging of symptoms. CONCLUSIONS: Combined local and systemic treatment with MPFF and sucralfate-based rectal ointment for HD patients showed clinical advantages both in terms of reducing the severity of the disease and allowing a less invasive treatment in certain cases

Preliminary functional results after transanal irrigation in patients undergoing SHiP procedure for low rectal cancer

The short-stump and high-anastomosis pull-through procedure (SHiP) is a newly introduced technique in the treatment of rectal cancer. This procedure does not involve the creation of a diverting ostomy with great improvement of the patients' quality of life in the post-operative period. However, functional post-operative alterations such as low anterior rectal resection syndrome (LARS) may occur. In this context, trans-anal irrigation (TAI) may represent a viable option in the treatment and management of LARS symptoms. The aim of the present study is to investigate the role of TAI in patients operated on SHiP procedure for low rectal cancer. A prospective database of 17 patients who underwent a SHiP procedure was maintained from April 2019 to December 2021. Anal continence and functional outcomes were assessed through LARS score and Cleveland Clinic Incontinence Score (CCIS), respectively. All patients with a LARS score > 21 underwent TAI in the post-operative period. LARS median value was 36 (IQR = 8) and drastically improved after TAI treatment to 3 (IQR = 3), as the CCIS at a mean follow-up of 9 months (SD +/- 5.02). Good functional result was reached in 12 out of 13 patients (92%). Our study confirms that patients with severe post-operative dysfunction could benefit from the use of TAI

Dual-Pump CARS Measurements in the University of Virginia's Dual-Mode Scramjet: Configuration "A"

In this paper we describe efforts to obtain canonical data sets to assist computational modelers in their development of models for the prediction of mixing and combustion in scramjet combustors operating in the ramjet-scramjet transition regime. The CARS technique is employed to acquire temporally and spatially resolved measurements of temperature and species mole-fraction at four planes, one upstream of an H2 fuel injector and three downstream. The technique is described and results are presented for cases with and without chemical reaction. The vibrational energy mode in the heated airstream of the combustor was observed to be frozen at near facility heater conditions and significant nonuniformities in temperature were observed, attributed to nonuniformities of temperature exiting the heater. The measurements downstream of fuel injection show development of mixing and combustion, and are already proving useful to the modelers

Dual-Pump CARS Measurements in the University of Virginia's Dual-Mode Scramjet: Configuration "C"

Measurements have been conducted at the University of Virginia Supersonic Combustion Facility in configuration C of the dual-mode scramjet. This is a continuation of previously published works on configuration A. The scramjet is hydrogen fueled and operated at two equivalence ratios, one representative of the scram mode and the other of the ram mode. Dual-pump CARS was used to acquire the mole fractions of the major species as well as the rotational and vibrational temperatures of N2. Developments in methods and uncertainties in fitting CARS spectra for vibrational temperature are discussed. Mean quantities and the standard deviation of the turbulent fluctuations at multiple planes in the flow path are presented. In the scram case the combustion of fuel is completed before the end of the measurement domain, while for the ram case the measurement domain extends into the region where the flow is accelerating and combustion is almost completed. Higher vibrational than rotational temperature is observed in those parts of the hot combustion plume where there is substantial H2 (and hence chemical reaction) present

How Blockchain Technology Can Address Circularity and Trace Emission in the Energy Sector

This paper outlines the European perspective on circularity in the energy sector and details how blockchain could support it. Moreover, while the need for raw materials and e-fuels is increasing (due to the economic, industrial, and societal ecological transformation to slow down the pace of climate change), their supply becomes more and more risky. Therefore technologies to support tracing and certification are on the spot. To achieve resilience to new threats, Europe is pointing at circularity in all fields. Circularity requires the need for tracing substances and devices, food, and products, to retrieve and recycle as much as possible. Else than the need to limit the exploitation of the planet’s resources and thus stay within the planetary boundaries, circularity is tightly connected to strategic dependencies from highly unstable or politically distant countries. This issue is further aggravated by the Russia-Ukraine crisis. Digital technologies, like Distributed Ledger Technologies, can well support the implementation of circularity in many fields. The paper identifies challenges and proposes potential solutions related to the implementation of circularity. It also explores the application of circularity principles in the energy sector, with a focus on energy communities. Energy communities involve local stakeholders coming together to generate, consume, and manage renewable energy collectively. Overall, the paper provides insights into the European perspective on ecological transition, highlighting the importance of systemic transformation, resilience, and circularity in addressing climate change and achieving sustainability goals. It explores the role of digital technologies, such as Distributed Ledger Technologies (DLTs), in supporting circular practices and discusses specific applications in the energy sector

Editorial: Management and Treatment of Pilonidal Disease: 189 Years After Mayo

...Pilonidal Disease (PD) was first scientifically reported 189 years ago by Herbert Mayo, back in 1833, as a sinus containing hair follicles located in the sacrococcygeal region of a female patien