Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis

Background: According to the Italian Society of Colorectal Surgery guidelines, the most effective approach to the pilonidal abscess is adequate surgical drainage, concerning incision and drainage of the pilonidal cavity. Few recent studies have demonstrated that endoscopic approach could be a valid treatment option even in the case of acute pilonidal abscess. The aim of our study is to assess if video-assisted ablation of pilonidal sinus (VAAPS) could be an alternative to treat an acute pilonidal abscess and to evaluate if an immediate endoscopic approach to the pilonidal abscess is preferable to a delayed procedure after incision and drainage. Methods: All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled in our propensity score-matched analysis and divided into two groups: the early VAAPS group and the delayed VAAPS group. Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up. Secondary outcomes were time off, time to wound healing, incomplete wound healing, perioperative infection, patients’ satisfaction 1 month after the complete wound healing, and their health status before surgery and 6 months after complete wound healing. Results: After the propensity score matching, 82 patients were included in the final analysis (41 in each group). No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients’ satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001). Conclusions: Our results encouraged to perform an immediate endoscopic approach to an acute pilonidal abscess

Endoscopic Treatment of Pilonidal Sinus Disease: State of Art and Review of the Literature

Background: Pilonidal sinus disease (PSD) is a chronic troublesome pathology of the natal cleft of the sacrococcygeal region, with an estimated incidence of 26 cases in every 100,000 inhabitants. The aim of this review is to give a snapshot of the current literature on the endoscopic approach to PSD. Methods: A search on endoscopic treatment of pilonidal disease was performed according to PRISMA guidelines, adopting the following search terms: (pilonidal OR sacrococcygeal) and (endoscopic OR VAAPS OR EPSiT OR minimally invasive OR video-assisted OR video assisted). Results: Thirty-four articles were included in the final analysis, among which 23 were on adults and 11 were on pediatric population. The endoscopic approach is associated with painless postoperative pain, good aesthetic results, short time off work, and high patient satisfaction. Despite these advantages in short-term outcomes, results on recurrence rate in a long-term follow up are needed to definitively confirm the importance of this technique. Conclusions: The endoscopic approach is associated with significant postoperative advantages over other standard surgical approaches, and it should be included in the surgical portfolio for the treatment of PSD. According to the Italian guidelines, this technique could be considered as the gold standard for limited PSD. However, the favorable short-term-outcomes and lack of reliable data on long-term follow-up must be a stimulus to perform further high-quality studies to give definitive conclusions on this technique

Minimally invasive pilonidal sinus treatment: A narrative review

The management of chronic pilonidal disease remains controversial, but recently, new minimal invasive approaches have been proposed. Whereas in the conventional surgical treatment an elliptical wedge of skin and subcutaneous tissue is created to remove the sinus and its lateral tracks, the basis for our new treatment is to create a minimal elliptical wedge of the subcutaneous tissue, including all the inflamed tissue and debris while leaving the overlying skin intact. The mechanism of an endoscopic approach relies on use of the endoscope without cutaneous tissue damage. Advantages include shorter operative time and time to discharge, which impact resource management in both primary and secondary care: patients undergoing endoscopic technique have a high satisfaction rate, probably due to the low level of postoperative pain and early return to work and daily activities. However, it is mandatory that further studies would analyze surgical approaches to pilonidal sinus disease (PSD) with a consistent and adequate follow-up of at least 5 years. Both sinusectomy and endoscopic approach to PSD were found to be safe and effective compared with conventional techniques. Publishedresults of studies of newer approaches have demonstrated a low short-term complication rate, comparable to conventional surgery results

Search for squarks and gluinos in events with isolated leptons, jets and missing transverse momentum at s√=8 TeV with the ATLAS detector

The results of a search for supersymmetry in final states containing at least one isolated lepton (electron or muon), jets and large missing transverse momentum with the ATLAS detector at the Large Hadron Collider are reported. The search is based on proton-proton collision data at a centre-of-mass energy s√=8 TeV collected in 2012, corresponding to an integrated luminosity of 20 fb−1. No significant excess above the Standard Model expectation is observed. Limits are set on supersymmetric particle masses for various supersymmetric models. Depending on the model, the search excludes gluino masses up to 1.32 TeV and squark masses up to 840 GeV. Limits are also set on the parameters of a minimal universal extra dimension model, excluding a compactification radius of 1/R c = 950 GeV for a cut-off scale times radius (ΛR c) of approximately 30

Comparación en los resultados de pacientes con bronquiolitis manejados con dos diferentes métodos de administrar oxígeno. Informe preliminar de avance del Hospital General de Niños Dr. Pedro de Elizalde

Introducción: La oxigenoterapia en el tratamiento de niños con bronquiolitis puede ser administrada mediantes cánulas nasales con bajo o alto flujo (CNAF). Las CNAF podrían ser una alternativa a la ventilación no invasiva, requiriendo menos recursos que los cuidados intensivos (UCIP). Objetivo: Evaluar si existe diferencia en la proporción de sujetos hospitalizados por bronquiolitis que requiere UCIP o en la duración de su hospitalización, según oxigenoterapia (convencional o CNAF). Métodos: Estudio observacional incluyendo lactantes hospitalizados por bronquiolitis en los meses de junio a agosto de 2017. Los pacientes fueron tratados según el servicio donde se encontraban (las unidades 1, 2 y 3 con oxigenoterapia convencional, y las unidades 4 y 5 con CNAF), al que fueron asignados según disponibilidad de cama. Resultados: Se incluyeron 329 pacientes, con edad promedio de 7,2 meses, que permanecieron hospitalizados 5,9 días y recibieron 4,6 días de oxigenoterapia. Todos recibieron oxigenoterapia, 84 (25,5%) CNAF y 245 (74,5%) convencional. Sólo 10 (3,1%) requirieron UCIP. De los que ingresaron a UCIP 5/84 recibieron CNAF y 5/245 recibieron terapia convencional (OR: 3,1; IC 95%: 0,8-10,7; p=0,07). Los pacientes con CNAF permanecieron significativamente más tiempo hospitalizados (6,9 ± 3,9 días vs. 5,6 ±3,2; p=0,003), luego de controlar por edad, la etiología viral y requerimiento de UCIP. Conclusión: En la población analizada no se observó diferencia en la proporción de pacientes que requirieron UTIP según hubieran recibido oxigenoterapia por CNAF o en forma convencional.Background: Oxygen in bronchiolitis treatment can be delivered by nasal cannulas using low or high flow (HFNC). HFNC can be an alternative to non-invasive ventilation or intensive care (PICU). Objective: To evaluate PICU requirement and length of stay (LOS) according to oxygen delivery method in children hospitalized for bronchiolitis. Methods: Observational study including infants hospitalized for bronchiolitis from June to August 2017. Patients received oxygen based on to the unit in which they were hospitalized (units 1, 2 and 3 received conventional oxygen therapy, while units 4 and 5 received HFNC), assigned according to bed availability. Results: We included 329 patients, aged 7.2 months, with a LOS of 5.9 days, and receiving oxygen for 4.6 days. All of them received oxygen, 84 (25.5%) HFNC and 245 (74,5%) conventional therapy. Only 10 (3.1%) required PICU, 5 using HFNC and 5 on conventional therapy (OR: 3,1; 95%IC: 0.8-10.7; p=0.07). After controlling for age, viral etiology and PICU requirement, patients on HFNC showed a significantly longer LOS (6.9 ± 3.9 vs. 5.6 ± 3.2 days; p=0.003). Conclusion: Patients who received oxygen trough HFNC required PICU less frequently than those in conventional therapy but showed a longer length of stay.Fil: Potasnik, J.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Golubicki, A.. Ministerio de Salud de la Nación; ArgentinaFil: Fernandez, A.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital General de Agudos Carlos Durand.; ArgentinaFil: Raiden, Silvina Claudia. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Sosa, R.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Gonzalez, N.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Cairoli, H.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: De Lillo, L.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Sanluis Fenelli, G.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Planovsky, H.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Checacci, E.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Lopez, M.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Gigliotti, E.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Torres, F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); ArgentinaFil: Ferrero, F.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentin

Constraints on the χ_(c1) versus χ_(c2) polarizations in proton-proton collisions at √s = 8 TeV

The polarizations of promptly produced χ_(c1) and χ_(c2) mesons are studied using data collected by the CMS experiment at the LHC, in proton-proton collisions at √s=8  TeV. The χ_c states are reconstructed via their radiative decays χ_c → J/ψγ, with the photons being measured through conversions to e⁺e⁻, which allows the two states to be well resolved. The polarizations are measured in the helicity frame, through the analysis of the χ_(c2) to χ_(c1) yield ratio as a function of the polar or azimuthal angle of the positive muon emitted in the J/ψ → μ⁺μ⁻ decay, in three bins of J/ψ transverse momentum. While no differences are seen between the two states in terms of azimuthal decay angle distributions, they are observed to have significantly different polar anisotropies. The measurement favors a scenario where at least one of the two states is strongly polarized along the helicity quantization axis, in agreement with nonrelativistic quantum chromodynamics predictions. This is the first measurement of significantly polarized quarkonia produced at high transverse momentum

The ESSnuSB design study: overview and future prospects

ESSnuSB is a design study for an experiment to measure the CP violation in the leptonic sector at the second neutrino oscillation maximum using a neutrino beam driven by the uniquely powerful ESS linear accelerator. The reduced impact of systematic errors on sensitivity at the second maximum allows for a very precise measurement of the CP violating parameter. This review describes the fundamental advantages of measurement at the 2nd maximum, the necessary upgrades to the ESS linac in order to produce a neutrino beam, the near and far detector complexes, the expected physics reach of the proposed ESSnuSB experiment, concluding with the near future developments aimed at the project realization.Comment: 19 pages, 11 figures; Corrected minor error in alphabetical ordering of the authors: the author list is now fully alphabetical w.r.t. author surnames as was intended. Corrected an incorrect affiliation for two authors per their reques

Directionality of nuclear recoils in a liquid argon time projection chamber

The direct search for dark matter in the form of weakly interacting massive particles (WIMP) is performed by detecting nuclear recoils (NR) produced in a target material from the WIMP elastic scattering. A promising experimental strategy for direct dark matter search employs argon dual-phase time projection chambers (TPC). One of the advantages of the TPC is the capability to detect both the scintillation and charge signals produced by NRs. Furthermore, the existence of a drift electric field in the TPC breaks the rotational symmetry: the angle between the drift field and the momentum of the recoiling nucleus can potentially affect the charge recombination probability in liquid argon and then the relative balance between the two signal channels. This fact could make the detector sensitive to the directionality of the WIMP-induced signal, enabling unmistakable annual and daily modulation signatures for future searches aiming for discovery. The Recoil Directionality (ReD) experiment was designed to probe for such directional sensitivity. The TPC of ReD was irradiated with neutrons at the INFN Laboratori Nazionali del Sud, and data were taken with 72 keV NRs of known recoil directions. The direction-dependent liquid argon charge recombination model by Cataudella et al. was adopted and a likelihood statistical analysis was performed, which gave no indications of significant dependence of the detector response to the recoil direction. The aspect ratio R of the initial ionization cloud is estimated to be 1.037 +/- 0.027 and the upper limit is R < 1.072 with 90% confidence levelComment: 20 pages, 10 figures, submitted to Eur. Phys. J.

Effect of SGLT2 inhibitors on stroke and atrial fibrillation in diabetic kidney disease: Results from the CREDENCE trial and meta-analysis

BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-Analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus. METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-Analysis. RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: Total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]). CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms