Is laparoscopic ileocecal resection a safe option for Crohn's disease? Best evidence topic

AbstractA best evidence topic was constructed according to a structured protocol. The question addressed was whether laparoscopic ileocecal resection for Crohn's disease is associated with higher morbidity rates in comparison to open surgery. From a total of 123 articles, 11 studies provided the best available evidence on this topic. Five observational studies, two randomized trials, three follow up studies and a meta-analysis were identified. The primary author, date and country of publication, study type, patient group characteristics, relevant outcome parameters and results of these papers were tabulated. Perioperative morbidity was either similar between the laparoscopic and the open group, or favored the laparoscopic approach. Convalescence was consistently reported to be shorter in the laparoscopic treatment arm, at cost of longer duration of surgery. Limited evidence suggests lower incidence of small bowel obstruction and disease recurrence for laparoscopy, although follow up data are of poor quality. It may be concluded that laparoscopic ileocecal resection is a safe alternative approach to open surgery for uncomplicated Crohn's disease, provided laparoscopic expertise is available

Updated guideline for closure of abdominal wall incisions from the European and American Hernia Societies

Abdominal wall; HerniaParet abdominal; HèrniaPared abdominal; HerniaBackground Incisional hernia is a frequent complication of abdominal wall incision. Surgical technique is an important risk factor for the development of incisional hernia. The aim of these updated guidelines was to provide recommendations to decrease the incidence of incisional hernia. Methods A systematic literature search of MEDLINE, Embase, and Cochrane CENTRAL was performed on 22 January 2022. The Scottish Intercollegiate Guidelines Network instrument was used to evaluate systematic reviews and meta-analyses, RCTs, and cohort studies. The GRADE approach (Grading of Recommendations, Assessment, Development and Evaluation) was used to appraise the certainty of the evidence. The guidelines group consisted of surgical specialists, a biomedical information specialist, certified guideline methodologist, and patient representative. Results Thirty-nine papers were included covering seven key questions, and weak recommendations were made for all of these. Laparoscopic surgery and non-midline incisions are suggested to be preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10 mm and larger is advised, especially after single-incision laparoscopic surgery and at the umbilicus. For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered to reduce the risk of incisional hernia; a permanent synthetic mesh in either the onlay or retromuscular position is advised. Conclusion These updated guidelines may help surgeons in selecting the optimal approach and location of abdominal wall incisions.The EHS provided meeting expenses for the guidelines group. The EHS did not have an influence on the content of the guidelines

Pharmacological treatment of idiopathic pulmonary fibrosis: from the past to the future

During the past decade important progress has been made regarding the pathogenesis of idiopathic pulmonary fibrosis (IPF), which is the most devastating form of idiopathic interstitial pneumonia with a median survival of 3 years. The knowledge gained has been used to design multicentre, randomised, placebo-controlled trials in order to investigate agents with different mechanisms of action. Encouraging results have led to licensing of the first IPF-specific drug, pirfenidone. However, the road to successful treatment is still long. The main aim for the future should be the careful design of clinical trials, by choosing the most clinically meaningful end-point and keeping in mind that combination of various agents may be more effective. This approach has been used in the treatment of lung cancer with which IPF presents many similarities

Detection of herpes simplex virus Type-1 in patients with fibrotic lung diseases

The current study intends to investigate i) the incidence of herpes viruses including Herpes Simplex Virus type-1 (HSV-1), Cytomegalovirus (CMV) and Human Herpes Virus -6, -7, -8 (HHV6, HHV7, HHV8) in two biological samples, bronchoalveolar lavage fluid (BALF) and lung tissue biopsy, in different forms of pulmonary fibrosis, and ii) the induction of molecular pathways involved in fibrosis by herpesvirus infection in primary cell cultures. PCR was employed for the detection of CMV, HHV6-8 and HSV-1 DNA in lung specimens (4 controls and 11 IPF specimens) and BALF pellet [6 controls and 20 fibrotic Idiopathic Intestitial Pneumonias (f-IIPs) samples: 13 idiopathic pulmonary fibrosis (IPF) and 7 nonspecific idiopathic interstitial pneumonia (NSIP)] samples. Among all herpesviruses tested, HSV-1 was detected in 1/11 (9%) specimens from IPF lung tissue and in 2/20 (10%) samples of f-IIPs BALF whereas the control group was negative. Primary cell cultures from BALF of patients with IPF and healthy controls were infected in vitro with wild-type HSV-1 virus and Real Time PCR was employed for the detection of gene transcription of specific axes implicated in lung fibrosis. Primary cell cultures were permissive to HSV-1, resulting in an upregulation of the fibrotic growth factors TGFβ1 and FGF, the angiogenetic markers SDF1a, SDF1b, VEGF, FGF and the regulators of tissue wound healing MMP9 and CCR7. Downregulation was noted for the CXCR4 and MMP2 genes, while a different response has been detected in healthy donors regarding the expression of the aforementioned markers. These results implicate for the first time the HSV-1 with Fibrotic Idiopathic Interstitial Pneumonias since the virus presented similar incidence in two different biological samples

A Statistical Shape Model of the Morphological Variation of the Infrarenal Abdominal Aortic Aneurysm Neck

Hostile aortic neck characteristics, such as short length and large diameter, have been associated with type Ia endoleaks and reintervention after endovascular aneurysm repair (EVAR). However, such characteristics partially describe the complex aortic neck morphology. A more comprehensive quantitative description of 3D neck shape might lead to new insights into the relationship between aortic neck morphology and EVAR outcomes in individual patients. This study identifies the 3D morphological shape components that describe the infrarenal aortic neck through a statistical shape model (SSM). Pre-EVAR CT scans of 97 patients were used to develop the SSM. Parameterization of the morphology was based on the center lumen line reconstruction, a triangular surface mesh of the aortic lumen, 3D coordinates of the renal arteries, and the distal end of the aortic neck. A principal component analysis of the parametrization of the aortic neck coordinates was used as input for the SSM. The SSM consisted of 96 principal components (PCs) that each described a unique shape feature. The first five PCs represented 95% of the total morphological variation in the dataset. The SSM is an objective model that provides a quantitative description of the neck morphology of an individual patient

Self-eating: Friend or foe? The emerging role of autophagy in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis is the most common and severe form of idiopathic interstitial pneumonias. Despite an exponential increase in our understanding of potentially important mediators and mechanisms, the pathogenesis remains elusive, and little therapeutic progress has been made in the last few years. Mortality in 3-5 years is still 50%. Autophagy, a highly conserved homeostatic mechanism necessary for cell survival, has been recently implicated in the pathogenesis of pulmonary disorders. In this paper we aim to highlight some key issues regarding the process of autophagy and its possible association with the pathogenesis of idiopathic pulmonary fibrosis

INTRINSIC MECHANISM FOR ENTROPY CHANGE IN CLASSICAL AND QUANTUM EVOLUTION

It is shown that the existence of a time operator in the Liouville space representation of both classical and quantum evolution provides a mechanism for effective entropy change of physical states. In particular, an initially effectively pure state can evolve under the usual unitary evolution to an effectively mixed state.Comment: 20 pages. For more information or comments contact E. Eisenberg at [email protected] (internet)