Foregut caustic injuries: results of the world society of emergency surgery consensus conference

Introduction: Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. Purpose of the study: The aim of this study was to provide an evidence-based international consensus on primary and secondary prevention, diagnosis, staging, and treatment of this life-threatening and potentially disabling condition. Methods: An extensive literature search was performed by an international panel of experts under the auspices of the World Society of Emergency Surgery (WSES). The level of evidence of the screened publications was graded using the Oxford 2011 criteria. The level of evidence of the literature and the main topics regarding foregut caustic injuries were discussed during a dedicated meeting in Milan, Italy (April 2015), and during the 3rd Annual Congress of the World Society of Emergency Surgery in Jerusalem, Israel (July 2015). Results: One-hundred-forty-seven full papers which addressed the relevant clinical questions of the research were admitted to the consensus conference. There was an unanimous consensus on the fact that the current literature on foregut caustic injuries lacks homogeneous classification systems and prospective methodology. Moreover, the non-standardized definition of technical and clinical success precludes any accurate comparison of therapeutic modalities. Key recommendations and algorithms based on expert opinions, retrospective studies and literature reviews were proposed and approved during the final consensus conference. The clinical practice guidelines resulting from the consensus conference were approved by the WSES council. Conclusions: The recommendations emerging from this consensus conference, although based on a low level of evidence, have important clinical implications. A world registry of foregut caustic injuries could be useful to collect a homogeneous data-base for prospective clinical studies that may help improving the current clinical practice guidelines.Lesions of the upper digestive tract due to ingestion of caustic agents still represent a major medical and surgical emergency worldwide. The work-up of these patients is poorly defined and no clear therapeutic guidelines are available. Purpose of the stu1044110sem informaçãosem informaçã

A new attraction-detachment model for explaining flow sliding in clay-rich tephras

Altered pyroclastic (tephra) deposits are highly susceptible to landsliding, leading to fatalities and property damage every year. Halloysite, a low-activity clay mineral, is commonly associated with landslide-prone layers within altered tephra successions, especially in deposits with high sensitivity, which describes the post-failure strength loss. However, the precise role of halloysite in the development of sensitivity, and thus in sudden and unpredictable landsliding, is unknown. Here we show that an abundance of mushroom cap–shaped (MCS) spheroidal halloysite governs the development of sensitivity, and hence proneness to landsliding, in altered rhyolitic tephras, North Island, New Zealand. We found that a highly sensitive layer, which was involved in a flow slide, has a remarkably high content of aggregated MCS spheroids with substantial openings on one side. We suggest that short-range electrostatic and van der Waals interactions enabled the MCS spheroids to form interconnected aggregates by attraction between the edges of numerous paired silanol and aluminol sheets that are exposed in the openings and the convex silanol faces on the exterior surfaces of adjacent MCS spheroids. If these weak attractions are overcome during slope failure, multiple, weakly attracted MCS spheroids can be separated from one another, and the prevailing repulsion between exterior MCS surfaces results in a low remolded shear strength, a high sensitivity, and a high propensity for flow sliding. The evidence indicates that the attraction-detachment model explains the high sensitivity and contributes to an improved understanding of the mechanisms of flow sliding in sensitive, altered tephras rich in spheroidal halloysite

Depression and sickness behavior are Janus-faced responses to shared inflammatory pathways

It is of considerable translational importance whether depression is a form or a consequence of sickness behavior. Sickness behavior is a behavioral complex induced by infections and immune trauma and mediated by pro-inflammatory cytokines. It is an adaptive response that enhances recovery by conserving energy to combat acute inflammation. There are considerable phenomenological similarities between sickness behavior and depression, for example, behavioral inhibition, anorexia and weight loss, and melancholic (anhedonia), physio-somatic (fatigue, hyperalgesia, malaise), anxiety and neurocognitive symptoms. In clinical depression, however, a transition occurs to sensitization of immuno-inflammatory pathways, progressive damage by oxidative and nitrosative stress to lipids, proteins, and DNA, and autoimmune responses directed against self-epitopes. The latter mechanisms are the substrate of a neuroprogressive process, whereby multiple depressive episodes cause neural tissue damage and consequent functional and cognitive sequelae. Thus, shared immuno-inflammatory pathways underpin the physiology of sickness behavior and the pathophysiology of clinical depression explaining their partially overlapping phenomenology. Inflammation may provoke a Janus-faced response with a good, acute side, generating protective inflammation through sickness behavior and a bad, chronic side, for example, clinical depression, a lifelong disorder with positive feedback loops between (neuro)inflammation and (neuro)degenerative processes following less well defined triggers

DCC dynamics with the SU(3) linear sigma model

The SU(3) extension of the linear sigma model is employed to elucidate the effect of including strangeness on the formation of disoriented chiral condensates. By means of a Hartree factorization, approximate dispersion relations for the 18 scalar and pseudoscalar meson species are derived and their self-consistent solution makes it possible to trace out the thermal path of the two order parameters as well as delineate the region of instability within which spontaneous pair creation becomes possible. The results depend significantly on the employed sigma mass, with the highest values yielding the largest regions of instability. An approximate solution of the equations of motion for the order parameter in scenarios emulating uniform scaling expansions show that even with a rapid quench only the pionic modes grow unstable. Nevertheless, the rapid and oscillatory relaxation of the order parameters leads to enhanced production of both pions and (to a lesser degree) kaons.Comment: 29 pages, RevTeX, 11 postscript figures, discussion about anomaly term adde

World society of emergency surgery study group initiative on Timing of Acute Care Surgery classification (TACS).

Timing of surgical intervention is critical for outcomes of patients diagnosed with surgical emergencies. Facing the challenge of multiple patients requiring emergency surgery, or of limited resource availability, the acute care surgeon must triage patients according to their disease process and physiological state. Emergency operations from all surgical disciplines should be scheduled by an agreed time frame that is based on accumulated data of outcomes related to time elapsed from diagnosis to surgery. Although literature exists regarding the optimal timing of various surgical interventions, implementation of protocols for triage of surgical emergencies is lacking. For institutions of a repetitive triage mechanism, further discussion on optimal timing of surgery in diverse surgical emergencies should be encouraged. Standardizing timing of interventions in surgical emergencies will promote clinical investigation as well as a commitment by administrative authorities to proper operating theater provision for acute care surgery