Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p < 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

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

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Approche organométallique de la synthèse de nanoparticules métalliques magnétiques en solution et sur des substrats

Cette thèse concerne une nouvelle méthode chimique de croissance par germes qui peut produire des assemblés de nanostructures métalliques epitaxiées sur des surfaces macroscopiques cristallines qui agissent comme germes. Cette approche permet d’obtenir des assemblés bien organisées en échelle centimétrique de nanofils métalliques de Co, qui sontmonocristallins, monodisperses de diamètres inferieurs à 10nm et qui ont une orientation perpendiculaire. Ils ont une anisotropie magnétique perpendiculaire et sont intéressantes pour des applications d’enregistrement magnétique à très haute densité. L’extension de cette méthode au fer donne des films nanostructurés de fer. L’orientation des nanostructures sur le support solide dépend de l’orientation cristallographique du substrat, alors que leur morphologie est dictée par la composition de la solution. Cet objectif a été atteint grâce à des études parallèles sur le mécanisme de croissance de nano-cristaux de cobalt en solution qui ont révélées une influence inattendue de la procédure de préparation de la solution mère sur la morphologie des nanocristaux. En plus,l’utilisation des germes nanoscopiques pour la croissance de Co et de Fe a rendu des nanofils longs de Co et des altères de Co-Fe et elle a contribué à la définition et l’amélioration des conditions expérimentales pour la croissance par germes de Co et de Fe sur les substrats solides.This thesis concerns a new wet chemical seeded growth method that can produce arrays of metal nanostructures epitaxially grown on crystalline macroscopic surfaces which act as seeds. This approach produces wafer-scale organized 2D hexagonal arrays of perpendicularly oriented, monodisperse and monocrystalline metallic Co nanowires with diameters below 10 nm which exhibit perpendicular magnetic anisotropy and are interesting for applications in ultra high density magnetic recording. Extension of this approach to iron gives rise to nanostructured iron films. The orientation of the nanostructures on the solid substrate depends on the substrate crystallographic orientation, whereas their morphology is dictated by the solution composition. This objective was attained through parallel studies on the growth mechanism of cobalt nano-crystals in solution which revealed an unexpected influence of the stock solution preparation procedure on the nanocrystal morphology. In addition, the use of nanoscopicseeds for the overgrowth of cobalt and iron gave rise to long Co nanowires and Co-Fe dumbbells and contributed to the definition and the improvement of the experimental conditions for the seeded growth of Co and Fe on the solid substrate

Approche organométallique de la synthèse de nanoparticules métalliques magnétiques en solution et sur des substrats

Cette thèse concerne une nouvelle méthode chimique de croissance par germes qui peut produire des assemblés de nanostructures métalliques epitaxiées sur des surfaces macroscopiques cristallines qui agissent comme germes. Cette approche permet d’obtenir des assemblés bien organisées en échelle centimétrique de nanofils métalliques de Co, qui sontmonocristallins, monodisperses de diamètres inferieurs à 10nm et qui ont une orientation perpendiculaire. Ils ont une anisotropie magnétique perpendiculaire et sont intéressantes pour des applications d’enregistrement magnétique à très haute densité. L’extension de cette méthode au fer donne des films nanostructurés de fer. L’orientation des nanostructures sur le support solide dépend de l’orientation cristallographique du substrat, alors que leur morphologie est dictée par la composition de la solution. Cet objectif a été atteint grâce à des études parallèles sur le mécanisme de croissance de nano-cristaux de cobalt en solution qui ont révélées une influence inattendue de la procédure de préparation de la solution mère sur la morphologie des nanocristaux. En plus,l’utilisation des germes nanoscopiques pour la croissance de Co et de Fe a rendu des nanofils longs de Co et des altères de Co-Fe et elle a contribué à la définition et l’amélioration des conditions expérimentales pour la croissance par germes de Co et de Fe sur les substrats solides.This thesis concerns a new wet chemical seeded growth method that can produce arrays of metal nanostructures epitaxially grown on crystalline macroscopic surfaces which act as seeds. This approach produces wafer-scale organized 2D hexagonal arrays of perpendicularly oriented, monodisperse and monocrystalline metallic Co nanowires with diameters below 10 nm which exhibit perpendicular magnetic anisotropy and are interesting for applications in ultra high density magnetic recording. Extension of this approach to iron gives rise to nanostructured iron films. The orientation of the nanostructures on the solid substrate depends on the substrate crystallographic orientation, whereas their morphology is dictated by the solution composition. This objective was attained through parallel studies on the growth mechanism of cobalt nano-crystals in solution which revealed an unexpected influence of the stock solution preparation procedure on the nanocrystal morphology. In addition, the use of nanoscopicseeds for the overgrowth of cobalt and iron gave rise to long Co nanowires and Co-Fe dumbbells and contributed to the definition and the improvement of the experimental conditions for the seeded growth of Co and Fe on the solid substrate

Aortic Graft Infection: Graphene Shows the Way to an Infection-Resistant Vascular Graft

Aortic graft infection is a potentially lethal complication of open and endovascular repair of aortic aneurysms. Graphene is the only existing two-dimensional material, and its unique structure gives graphene and its derivatives a plethora of original characteristics. Among other characteristics, graphene demonstrates bacteriostatic and bactericidal effects that could potentially resolve the problem of graft infection in the future. Data already exist in literature supporting this antibacterial effect of graphene oxide and reduced graphene oxide. Combining these materials with other substances enhances the antibacterial effect. Additionally, it looks feasible to expect antibiotic-delivering graphene-based graft materials in the future. Based on already published data, we could conclude that regarding graphene and its derivatives, the blessing of bactericidal effect comes with the curse of human cells toxicity. Therefore, it is important to find a fine balance between the desired antibacterial and the adverse cytotoxic effect before graphene is used in graft materials for humans

Management of primary retroperitoneal synovial sarcoma: A case report and review of literature

BACKGROUND Synovial sarcoma (SS) is a rare type of soft tissue sarcoma that is usually developed from areas where synovial tissue exists, especially at the extremities. Nevertheless, several cases of retroperitoneal SS (RSS) have been described. We herein report a case of RSS presented in our institution. CASE SUMMARY A 69-year-old female patient was admitted with a large, palpable, firm mass in the right abdominal space SS. Computerized tomography scan depicted a concentric, sharply marinated retro-peritoneal lesion which was displacing the right kidney and the lower edge of the liver. Subsequently, the patient underwent surgical excision of the mass with additional right nephrectomy and resection of the right adrenal gland and a part of the diaphragm. The final histological diagnosis of the tumour was grade II monophasic RSS. CONCLUSION RSS is encountered in the biphasic type, the monophasic fibrous, and the monophasic epithelial category as well. Relevant clinical manifestations are not always documented at early stages. Therefore, the final diagnosis is posed after complete histological examination taking into consideration the results of immunochemistry and genetic analysis. Therapeutic approach happens often late when metastases at the lungs and the liver are apparent. Thus, 5-year survival rates remain low