Characteristics of emergency general surgery services in Switzerland: a nationwide survey.

OBJECTIVE Running an emergency general surgery (EGS) service is challenging and requires significant personnel and institutional resources. The aim of this study was to achieve a nationwide overview of the individual EGS service organizations in public hospitals in Switzerland. METHODS All Swiss public hospitals with a surgical and emergency department were included and contacted by telephone. General surgeons were interviewed between December 2021 and January 2022 using a standardized questionnaire. RESULTS Seventy-two out of 79 public hospitals in Switzerland (91.1%) agreed to the survey. They employed 1,581 surgeons in 19 (26.4%) hospitals with  600 beds. The median number of surgeons per hospital was 20.5 (IQR 13.0-29.0). Higher level of care (intermediate or intensive care unit) was significantly less available in small hospitals ( 600 beds). With increasing hospital size, there was a significant increase in the number of surgical units where EGS and orthopedic trauma surgery were covered by two separate teams (21.1% vs. 43.6% vs. 85.7% vs. 100%, p = 0.035). The median number of surgeons on-call per hospital and per 24 h was 5.0 (IQR 3.3-6.0). CONCLUSION Lack of higher level of care in small hospitals, limited emergency OR capacity and short rotations of on-call teams are major drawbacks of many current EGS systems in Switzerland. Centralization of critically ill EGS patients and reorganization of surgical on-call systems to designated acute care surgery teams should be considered

Cellular uptake and localization of inhaled gold nanoparticles in lungs of mice with chronic obstructive pulmonary disease

Background: Inhalative nanocarriers for local or systemic therapy are promising. Gold nanoparticles (AuNP) have been widely considered as candidate material. Knowledge about their interaction with the lungs is required, foremost their uptake by surface macrophages and epithelial cells. Diseased lungs are of specific interest, since these are the main recipients of inhalation therapy. We, therefore, used Scnn1b-transgenic (Tg) mice as a model of chronic obstructive pulmonary disease (COPD) and compared uptake and localization of inhaled AuNP in surface macrophages and lung tissue to wild-type (Wt) mice. Methods: Scnn1b-Tg and Wt mice inhaled a 21-nm AuNP aerosol for 2 h. Immediately (0 h) or 24 h thereafter, bronchoalveolar lavage (BAL) macrophages and whole lungs were prepared for stereological analysis of AuNP by electron microscopy. Results: AuNP were mainly found as singlets or small agglomerates of ≤ 100 nm diameter, at the epithelial surface and within lung-surface structures. Macrophages contained also large AuNP agglomerates (> 100 nm). At 0 h after aerosol inhalation, 69.2±4.9% AuNP were luminal, i.e. attached to the epithelial surface and 24.0±5.9% in macrophages in Scnn1b-Tg mice. In Wt mice, 35.3±32.2% AuNP were on the epithelium and 58.3±41.4% in macrophages. The percentage of luminal AuNP decreased from 0 h to 24 h in both groups. At 24 h, 15.5±4.8% AuNP were luminal, 21.4±14.2% within epithelial cells and 63.0±18.9% in macrophages in Scnn1b-Tg mice. In Wt mice, 9.5±5.0% AuNP were luminal, 2.2±1.6% within epithelial cells and 82.8±0.2% in macrophages. BAL-macrophage analysis revealed enhanced AuNP uptake in Wt animals at 0 h and in Scnn1b-Tg mice at 24 h, confirming less efficient macrophage uptake and delayed clearance of AuNP in Scnn1b-Tg mice. Conclusions: Inhaled AuNP rapidly bound to the alveolar epithelium in both Wt and Scnn1b-Tg mice. Scnn1b-Tg mice showed less efficient AuNP uptake by surface macrophages and concomitant higher particle internalization by alveolar type I epithelial cells compared to Wt mice. This likely promotes AuNP depth translocation in Scnn1b-Tg mice, including enhanced epithelial targeting. These results suggest AuNP nanocarrier delivery as successful strategy for therapeutic targeting of alveolar epithelial cells and macrophages in COPD

23 Stuhlinkontinenz. 23.1 Analer Sphinkter-Repair

Der anteriore anale Sphinkter-Repair gilt als operatives Standardverfahren bei analer Inkontinenz aufgrund eines anterioren Sphinkterdefekts. Er wird heutzutage jedoch meist durch die sakrale Neurostimulation (SNS) ersetzt. Eine palpatorisch und endosonografisch nachgewiesene Sphinkterläsion kann mit diesem Verfahren mittels End-zu-End-Naht oder in überlappender Technik adaptiert werden. Dadurch kommt es zu einer funktionellen und subjektiven Verbesserung der Kontinenz bei mehr als 60 % der Patienten. Mit der Zeit lässt dieser Effekt aber nach, so dass nach 5 Jahren nur noch 40–50 % der Patienten keine Inkontinenzsymptome zeigen. Die Prognose verschlechtert sich im höheren Lebensalter bei gleichzeitiger Beckenbodensenkung, bei Adipositas und bei ausgeprägtem Defekt nach Geburtstraum

5 Stuhlinkontinenz

Die Stuhlinkontinenz ist eine häufige Erkrankung mit teilweise weitreichenden Konsequenzen für die Betroffenen. Dabei werden Prävalenz und sozioökonomische Folgen häufig unterschätzt. Die vielseitigen Ursachen der Stuhlinkontinenz und die damit verbundenen Abklärungen und Therapiemöglichkeiten setzen eine interdisziplinäre Zusammenarbeit zwischen den Grundversorgern und spezialisierten Fachdisziplinen voraus. Die Stuhlinkontinenz ist prinzipiell ein behandelbares Krankheitsbild. Eine konservative Therapie führt oft bereits zu einer relevanten Symptomverbesserung, womit weitergehende Abklärungen häufig entfallen. Meist genügt daher eine Anamnese mit einer Score-Erhebung zur späteren Erfolgskontrolle, um dann bereits eine entsprechende Basistherapie einleiten zu können

Damage Control Surgery in Patients with Non-traumatic Abdominal Emergencies: A Systematic Review and Meta-Analysis.

BACKGROUND After the successful implementation in trauma, damage control surgery (DCS) is being increasingly used in patients with non-traumatic emergencies. However, the role of DCS in the non-trauma setting is not well defined. The aim of this study was to investigate the effect of DCS on mortality in patients with non-traumatic abdominal emergencies. METHODS Systematic literature search using PubMed. Original articles addressing non-trauma DCS were included. Two meta-analyses were performed, comparing (#1) mortality in patients undergoing non-trauma DCS vs. conventional surgery (CS) and (#2) the observed vs. expected mortality rate in the DCS group. Expected mortality was derived from APACHE, SAPS, and P-POSSUM scores. RESULTS A total of five non-randomized prospective and 16 retrospective studies were included. NontraumaDCS was performed in 1,238 and non-trauma CS in 936 patients. Frequent indications for surgery in the DCS group were (weighted proportions) hollow viscus perforation (28.5%), mesenteric ischemia (26.5%), anastomotic leak and postoperative peritonitis (19.6%), nontraumatic hemorrhage (18.4%), abdominal compartment syndrome (17.8%), bowel obstruction (15.5%), and pancreatitis (12.9%). In meta-analysis #1, including eight studies, mortality was not significantly different between the non-trauma DCS and CS group (risk difference [RD] 0.09, 95% CI -0.06/0.24). Meta-analysis #2, including 14 studies, revealed a significantly lower observed than expected mortality rate in patients undergoing non-trauma DCS (RD -0.18, 95% CI -0.29/-0.06). CONCLUSION This meta-analysis revealed no significantly different mortality in patients undergoing nontrauma DCS vs. CS. However, observed mortality was significantly lower than the expected mortality rate in the DCS group, suggesting a benefit of the DCS approach. Based on these two findings, the effect of DCS on mortality in patients with non-traumatic abdominal emergencies remains unclear. Further prospective investigation into this topic is warranted. LEVEL OF EVIDENCE III, systematic review and meta-analysis

Population Size, Local Autonomy, and Support for the Political System

Does size of democracy shape citizens' support for the democratic regime? Previous literature demonstrates that a variety of political contexts are associated with the level of system support among citizens, yet none has tested the effect of a fundamental contextual feature of contemporary societies-size of democracy-on system support from a cross-national perspective. Copyright (c) 2007 by the Southwestern Social Science Association.