Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members

Background: The SARS-CoV-2 pandemic is still ongoing and a major challenge for health care services worldwide. In the first WSES COVID-19 emergency surgery survey, a strong negative impact on emergency surgery (ES) had been described already early in the pandemic situation. However, the knowledge is limited about current effects of the pandemic on patient flow through emergency rooms, daily routine and decision making in ES as well as their changes over time during the last two pandemic years. This second WSES COVID-19 emergency surgery survey investigates the impact of the SARS-CoV-2 pandemic on ES during the course of the pandemic. Methods: A web survey had been distributed to medical specialists in ES during a four-week period from January 2022, investigating the impact of the pandemic on patients and septic diseases both requiring ES, structural problems due to the pandemic and time-to-intervention in ES routine. Results: 367 collaborators from 59 countries responded to the survey. The majority indicated that the pandemic still significantly impacts on treatment and outcome of surgical emergency patients (83.1% and 78.5%, respectively). As reasons, the collaborators reported decreased case load in ES (44.7%), but patients presenting with more prolonged and severe diseases, especially concerning perforated appendicitis (62.1%) and diverticulitis (57.5%). Otherwise, approximately 50% of the participants still observe a delay in time-to-intervention in ES compared with the situation before the pandemic. Relevant causes leading to enlarged time-to-intervention in ES during the pandemic are persistent problems with in-hospital logistics, lacks in medical staff as well as operating room and intensive care capacities during the pandemic. This leads not only to the need for triage or transferring of ES patients to other hospitals, reported by 64.0% and 48.8% of the collaborators, respectively, but also to paradigm shifts in treatment modalities to non-operative approaches reported by 67.3% of the participants, especially in uncomplicated appendicitis, cholecystitis and multiple-recurrent diverticulitis. Conclusions: The SARS-CoV-2 pandemic still significantly impacts on care and outcome of patients in ES. Well-known problems with in-hospital logistics are not sufficiently resolved by now; however, medical staff shortages and reduced capacities have been dramatically aggravated over last two pandemic years

How future surgery will benefit from SARS-COV-2-related measures: a SPIGC survey conveying the perspective of Italian surgeons

COVID-19 negatively affected surgical activity, but the potential benefits resulting from adopted measures remain unclear. The aim of this study was to evaluate the change in surgical activity and potential benefit from COVID-19 measures in perspective of Italian surgeons on behalf of SPIGC. A nationwide online survey on surgical practice before, during, and after COVID-19 pandemic was conducted in March-April 2022 (NCT:05323851). Effects of COVID-19 hospital-related measures on surgical patients' management and personal professional development across surgical specialties were explored. Data on demographics, pre-operative/peri-operative/post-operative management, and professional development were collected. Outcomes were matched with the corresponding volume. Four hundred and seventy-three respondents were included in final analysis across 14 surgical specialties. Since SARS-CoV-2 pandemic, application of telematic consultations (4.1% vs. 21.6%; p < 0.0001) and diagnostic evaluations (16.4% vs. 42.2%; p < 0.0001) increased. Elective surgical activities significantly reduced and surgeons opted more frequently for conservative management with a possible indication for elective (26.3% vs. 35.7%; p < 0.0001) or urgent (20.4% vs. 38.5%; p < 0.0001) surgery. All new COVID-related measures are perceived to be maintained in the future. Surgeons' personal education online increased from 12.6% (pre-COVID) to 86.6% (post-COVID; p < 0.0001). Online educational activities are considered a beneficial effect from COVID pandemic (56.4%). COVID-19 had a great impact on surgical specialties, with significant reduction of operation volume. However, some forced changes turned out to be benefits. Isolation measures pushed the use of telemedicine and telemetric devices for outpatient practice and favored communication for educational purposes and surgeon-patient/family communication. From the Italian surgeons' perspective, COVID-related measures will continue to influence future surgical clinical practice

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)

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

Factors affecting somatic embryogenesis in eight Italian grapevine cultivars and the genetic stability of embryo-derived regenerants as assessed by molecular markers

Embryogenic cultures have been used in cryopreservation, genetic transformation, propagation, virus elimination, induced mutagenesis and in many other biotechnological applications, providing excellent opportunities for biotechnology advances in grapevine. Unfortunately the efficiency of somatic embryo- genesis (SE) is genotype-dependent in addition to showing interaction with explant type used and the plant growth regulator (PGR) composition. In order to identify the interaction of these parameters in SE, we tested eight wine grapevine cultivars, three explant types (ovary, anther/filament and stigma/style) and four PGR combinations in a statistically designed experiment. The genotype was the major deter- mining factor, with embryogenic response varying from 0.1 to 5.1% (about 50-fold difference). For PGR composition of the medium, embryogenesis ranged between 0.5 and 3.3% (a ≈7-fold difference). The explant type was the least important factor with embryogenesis ranging between 0.8% (anther/filament) and 2.3% (ovary)—only a ≈3-fold change. Anther/filament, that had generally been considered to be the most promising explant, surprisingly gave the lowest embryogenesis percentage. Genetic homo- geneity of plants developed from in vitro SE was assessed in comparison to mother plants using six inter-simple sequence repeat and ten random amplified polymorphic DNA primers that produced repro- ducible and clear bands ranging from 150 to 3500 bp. The amplification products were monomorphic across all the regenerated plants and their respective mother plants confirming the genetic homogeneity of the regenerants and demonstrating the suitability of SE for in vitro grapevine germplasm conservation and propagation

Pheno-morphological, agronomic and genetic diversity among natural populations of sulla (Hedysarum coronarium L.) collected in Sicily, Italy.

Sulla (Hedysarum coronarium L.) is a short-lived perennial forage legume that plays a key role in cereal-based systems in semi-arid Mediterranean regions, particularly in organic production and low-input oriented agriculture. In Sicily, the species is widespread both as a wild and cultivated plant. The present study assessed the phenotypic and genetic variation among natural populations of sulla collected from different environments throughout Sicily and analysed how the patterns of phenotypic diversity varied according to the environmental parameters of each collection site. Two commercial varieties and two Sicilian agro-ecotypes were also included in the study as controls. Principal components analysis (PCA) was performed on the sites using geographic, climatic, and pedological data to assess the differences in types of collection sites. PCA was also performed on the accessions (using pheno-morphological and agronomic data) to establish the importance of different traits in explaining multivariate polymorphisms. The results showed a large degree of genetic diversity (based on ISSR markers) and variability in pheno-morphological and agronomic traits. PCA did not clearly differentiate the accessions according to their habitats of origin, but in some cases accessions from the same habitat had a tendency to group together. The agronomic attributes of several populations were more pronounced than those of the controls. The observed variability may be valuable when selecting for H. coronarium varieties suitable for various uses (e.g., hay production, grazing, soil protection)

Characterization of secretory proteins using LC-ESI-MS/MS.

<p>Left lane: EU07 proteins, right lane: FZB24 proteins, the numbering of the 3 excised gel slices is shown on the right. The representative non-redundant protein identifications are shown on the gel slice.</p

Characterization of secretory proteins of EU07 using LC-ESI-MS/MS.

<p>Characterization of secretory proteins of EU07 using LC-ESI-MS/MS.</p

The homologues of unknown proteins.

<p>BLASTp (<a href="http://www.ncbi.nlm.nih.gov/BLAST/" target="_blank">http://www.ncbi.nlm.nih.gov/BLAST/</a>) was used to search for homologues of the unknown proteins (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053182#pone-0053182-t001" target="_blank">Table 1</a>). The homologues with the highest homology are shown.</p>a<p>Acc. no., The accession number of the unknown proteins in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0053182#pone-0053182-t001" target="_blank">Table 1</a>.</p>b<p>Acc. no., The accession number of the homologues.</p>c<p>Ident., identities.</p>d<p>Simil., similarity.</p

Molecular analysis of QST713, EU07 and FZB24, and their genetic comparison with antibotic genes in three strains.

<p>Fengycin (Fen D), bacillomycin Bmy A and Iturin (Itu C) genes were amplified from the three strains EU07, QST713, FZB24. The same results on PCR amplifications were also observed with three other independent replicates.</p