Two Sides of One Coin: A Comparison of Clinical and Neurobiological Characteristics of Convicted and Non-Convicted Pedophilic Child Sexual Offenders

High prevalence of child sexual offending stand in contradiction to low conviction rates (one-tenth at most) of child sexual offenders (CSOs). Little is known about possible differences between convicted and non-convicted pedophilic CSOs and why only some become known to the judicial system. This investigation takes a closer look at the two sides of "child sexual offending" by focusing on clinical and neurobiological characteristics of convicted and non-convicted pedophilic CSOs as presented in the Neural Mechanisms Underlying Pedophilia and sexual offending against children (NeMUP)*-study. Seventy-nine male pedophilic CSOs were examined, 48 of them convicted. All participants received a thorough clinical examination including the structured clinical interview (SCID), intelligence, empathy, impulsivity, and criminal history. Sixty-one participants (38 convicted) underwent an inhibition performance task (Go/No-go paradigm) combined with functional magnetic resonance imaging (fMRI). Convicted and non-convicted pedophilic CSOs revealed similar clinical characteristics, inhibition performances, and neuronal activation. However, convicted subjects' age preference was lower (i.e., higher interest in prepubescent children) and they had committed a significantly higher number of sexual offenses against children compared to non-convicted subjects. In conclusion, sexual age preference may represent one of the major driving forces for elevated rates of sexual offenses against children in this sample, and careful clinical assessment thereof should be incorporated in every preventive approach

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

Untersuchung des perioperativen Risikos des Reaortenklappenersatzes

INTRODUCTION: The aim of this study was to evaluate the perioprerative risk of redo aortic valve replacement (AVR). MATERIALS AND METHODS: Sixty-three patients underwent redo aortic valve replacement between 1994 and 2005 in the department of Thoracic-, Cardiac- and Vacular-Surgery at the University hospital of the University of Aachen, Germany. Only persons with an isolated primary AVR in whom a insolated redo-AVR was performed were included in this retrospective study. All the date was collected by reviewing the patient charts. The statistical analysis was performed with help of the SAS software. For dependent variables for quantitative data we performed the t-test, for qualitative data we used McNemar test. A p value of less than 0.05 was considered as significant.RESULTS: From the 63 patients (53 males, 10 females) 41 received a biological (group1), 18 a mechanical AVR as initial surgery(group 2). Four underwent an initial aortic valve repair (group 3). After a mean time of 10,4 +/- 4 years the biological valve replacements needed a redo-AVR because of leaflet tears, valve degeneration, calcification endocarditis or paravalvular leakage. For the mechanical valve group this was 6,2 +/- 6,1 years because of paravalvular leakage, endocarditis, aortic dissection, valve thrombosis or valve dysfunction. The group 3 needed AVR after 23 +/- 11,3 years. At the redo-AVR 48 patients received a mechanical, 8 a biological valve replacement, 7 underwent a reconstruction. For the initial-AVR 57 were elective vs. 48 for redo (p = 0,0495), 1 vs. 13 urgent (p = 0,0013) and 5 vs. 2 emergency operations (p > 0,05). The duration of surgery (192 +/- 32 min vs. 262 +/- 50 min), the cardiopulmonary-bypass (101 +/- 28 min vs. 130 1/- 37 min) and cross-clamping ( 66 +/- 21 min vs. 80 +/- 23 min) were significantly longer in the redo-AVR. The postoperative ventilation ( 14,2 +/- 5,1 min vs. 17,0 +/- 13,8 min), the ICU stay (2,3 +/- 1,2 days vs. 2,9 +/- 2,2 days) and the normal care station stay (10,7 +/- 4,7 days vs. 10,3 +/- 2,3) did not show a significant difference. Rexploration was needed in 1 vs. 4 operations, 2 for bleeding, 1 for bleeding an pericard tamponade?? and one for low-cardiac-output-syndrome. Following complications appeared: need for permanent pacemaker 3 initial AVR vs. 10 redo-AVR, renal insufficiency had 3 vs. 4, cerebral confusion 0 vs 5, low-cardiac-output-syndrome 0 vs. 4, wound healing deficiency 1 vs. 2 and intestinal ischemia in 0 vs. 1 patient after redo-AVR. Four patients expired after redo AVR one because of respiratory deficiency, one because of cardiac decompensation on after aortic rupture during rescucitation and one after intestinal ischemia. CONCLUSION: Redo AVR is associated with enhanced perioperative risk. Therefore these patients should be referred early for reoperation to avoid high-risk emergency operation

Comment on: Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence

Latest evidence indicates that patients with acute diverticulitis have higher prevalence of colorectal cancer than reference patients. Therefore, colonoscopy should be offered after an episode of acute diverticulitis

What is the role of stem cell therapy in the treatment of anal incontinence?

Cell-based therapies for anal incontinence have been investigated for over a decade with preclinical and clinical studies reporting encouraging results (1-7). We read with great interest the new report of de la Portilla et al. (8). In this well-conducted triple blinded randomized controlled trial, the authors did not demonstrate any statistically significant differences in functional scores (Jorge-Wexner score being the primary outcome), manometric, or ultrasonographic parameters between patients injected (under ultrasound control) with autologous adipose-derived mesenchymal stem cells or a placebo for an anal sphincter defect

Préservation de la fonction sexuelle : un défi pour le chirurgien colorectal

Les patients atteints d’un cancer du rectum présentent un risque accru de développer ou d’aggraver des troubles de la sexualité. Ces dysfonctions sont causées par la maladie (impact psychologique négatif, compression nerveuse dans le petit bassin) d’une part, et par les traitements (radio, chimiothérapie et chirurgie) d’autre part. Parmi ceux-ci, la chirurgie est responsable de la plupart des troubles sexuels, par lésion des plexus neurovégétatifs. Une évaluation de la sexualité des patients avant et après traitement, une connaissance précise de l’anatomie du petit bassin par le chirurgien ainsi qu’une prise en charge adaptée par des spécialistes (gynécologues, urologues, sexologues) constituent les étapes essentielles afin de diminuer le risque de survenue de troubles sexuels et leur impact sur la qualité de vie globale des patients

Does near-infrared (NIR) fluorescence angiography modify operative strategy during emergency procedures?

Bowel viability can be difficult to evaluate during emergency surgery. Near-infrared (NIR) fluorescence angiography allows an intraoperative assessment of organ perfusion during elective surgery and might help to evaluate intestinal perfusion during emergency procedures. The aim of this study was to assess if NIR modified operative strategy during emergency surgery