Diagnosis and treatment of urticaria and angioedema: a worldwide perspective

Urticaria and angioedema are common clinical conditions representing a major concern for physicians and patients alike. The World Allergy Organization (WAO), recognizing the importance of these diseases, has contributed to previous guidelines for the diagnosis and management of urticaria. The Scientific and Clinical Issues Council of WAO proposed the development of this global Position Paper to further enhance the clinical management of these disorders through the participation of renowned experts from all WAO regions of the world. Sections on definition and classification, prevalence, etiology and pathogenesis, diagnosis, treatment, and prognosis are based on the best scientific evidence presently available. Additional sections devoted to urticaria and angioedema in children and pregnant women, quality of life and patient-reported outcomes, and physical urticarias have been incorporated into this document. It is expected that this article will supplement recent international guidelines with the contribution of an expert panel designated by the WAO, increasing awareness of the importance of urticaria and angioedema in medical practice and will become a useful source of information for optimum patient management worldwide

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

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

Prediction of bending properties for beech lumber using stress wave method

In this study; bending properties of beech wood (Fagus orientalis) were predicted using stress - wave method and compared with static bending tests. First, lumbers which were different in length and cross section were weighed and dimensions were measured. Then, moisture contents were obtained via moisture meter. By using the density, moisture, and dimensions of the samples in MTG Timber Grader device, dynamic modulus of elasticity values were determined. And then, samples were subjected to 3 point bending test. Modulus of elasticity and bending strengths were calculated using load - deformation curves. Regression models were developed to interpret relationships between dynamic modulus elasticity and bending properties. Results showed that there is a high regression coefficient (0,86) between dynamic modulus of elasticity and static modulus of elasticity. Regression coefficient between dynamic modulus of elasticity and static bending strength was measured as (0,72) and regression coefficient between static modulus of elasticity and static bending strength was measured as (0,74). Results indicate that bending properties of beech wood lumber can be predicted using stress wave method

The Efficacy of One Molar Contrast Material in the Evaluation of Breast Lesions with MR Imaging.

To investigate the efficacy of 1 molar (containing 1 mol/mL gadobutrol) contrast material in the differentiation of malignant and benign breast lesions with MRI

Prediction of bending properties for beech lumber using stress wave method

In this study; bending properties of beech wood (Fagus orientalis) were predicted using stress – wave method and compared with static bending tests. First, lumbers which were different in length and cross section were weighed and dimensions were measured. Then, moisture contents were obtained via moisture meter. By using the density, moisture, and dimensions of the samples in MTG Timber Grader device, dynamic modulus of elasticity values were determined. And then, samples were subjected to 3 point bending test. Modulus of elasticity and bending strengths were calculated using load – deformation curves. Regression models were developed to interpret relationships between dynamic modulus elasticity and bending properties. Results showed that there is a high regression coefficient (0,86) between dynamic modulus of elasticity and static modulus of elasticity. Regression coefficient between dynamic modulus of elasticity and static bending strength was measured as (0,72) and regression coefficient between static modulus of elasticity and static bending strength was measured as (0,74). Results indicate that bending properties of beech wood lumber can be predicted using stress wave method

Effects of Pilates exercise on trunk strength, endurance and flexibility in sedentary adult females

The objective of this study was to examine the effects of Pilates exercise on abdominal and lower back strength, abdominal muscular endurance and posterior trunk flexibility of sedentary adult females. The body fat and body mass index (BMI) pre-and post-data were also assessed as secondary outcomes. To assess abdominal and lower back strength, posterior trunk flexion and extension data were obtained concentrically on a Biodex isokinetic dynamometer at speeds of 601 and 120 degrees s(-1). Abdominal muscular endurance was assessed using the crunch test and posterior trunk flexibility was measured using the sit and reach test. Results of multivariate analysis revealed a significant difference (p < .05) between pre-and post-measures of 60 degrees s(-1) flexion/extension and 120 degrees s(-1) flexion, and abdominal muscular endurance and posterior trunk flexibility of the exercise group. It can be concluded that there was a positive effect of Modern Pilates mat exercises on abdominal and lower back muscular strength, abdominal muscular endurance and posterior trunk flexibility in sedentary adult females regardless of the fact that the body weight and fat percentages did not differ significantly. (C) 2007 Elsevier Ltd. All rights reserved

Effect of Erythropoietin on Peripheral Nerve Regeneration

The aim of this study was to identify the effect of erythropoietin (EPO) on a sciatic nerve injury model. The effect of single or repeated doses was also determined. Twenty-one Wistar rats were anesthetised and the sciatic nerve was transected 1 cm above the trifurcation and the nerve was repaired with four epineural 10/0 nylon sutures placed at 90 degrees intervals under microscope magnification. The rats were divided into 4 groups as follows: the sham, the saline, the single dose EPO and the multiple dose EPO. The skin was incised and closed and no treatment was given in sham group. In the saline group, 1 mL saline was given intraperitoneally; in the single EPO group, 5000 U/kg EPO was given intraperitoneally immediately after the procedure. In the multiple EPO group, 5000 U/kg EPO was given after the procedure and the same dose was repeated after the 1st, 2nd, 3rd and 4th weeks. Functional recovery was evaluated by static sciatic functional index(SSI). Single EPO group had greater myofibril size, axon number, diameter, and ratio M than the saline group. The multiple EPO treatment was not found to be more effective than single EPO treatment. However, no significant difference was found between the single EPO, multiple EPO, and saline groups based on the 3rd and 4th postoperative month SSI scores. Thus, EPO treatment increased axonal regeneration in our study. However, repeated dose therapy was not found to be more effective than single dose therapy. The optimum dose and duration should be researched in further studies