The significant impact of age on the clinical outcomes of laparoscopic appendectomy : results from the Polish Laparoscopic Appendectomy multicenter large cohort study

Acute appendicitis (AA) is the most common surgical emergency and can occur at any age. Nearly all of the studies comparing outcomes of appendectomy between younger and older patients set cut-off point at 65 years. In this multicenter observational study, we aimed to compare laparoscopic appendectomy for AA in various groups of patients with particular interest in the elderly and very elderly in comparison to younger adults. Our multicenter observational study of 18 surgical units assessed the outcomes of 4618 laparoscopic appendectomies for AA. Patients were divided in 4 groups according to their age: Group 1- 8 days. Logistic regression models comparing perioperative results of each of the 3 oldest groups compared with the youngest one showed significant differences in odds ratios of symptoms lasting >48hours, presence of complicated appendicitis, perioperative morbidity, conversion rate, prolonged LOS (>8 days). The findings of this study confirm that the outcomes of laparoscopic approach to AA in different age groups are not the same regarding outcomes and the clinical picture. Older patients are at high risk both in the preoperative, intraoperative, and postoperative period. The differences are visible already at the age of 40 years old. Since delayed diagnosis and postponed surgery result in the development of complicated appendicitis, more effort should be placed in improving treatment patterns for the elderly and their clinical outcome

Risk factors for serious morbidity, prolonged length of stay and hospital readmission after laparoscopic appendectomy : results from Pol-LA (Polish Laparoscopic Appendectomy) multicenter large cohort study

Laparoscopic appendectomy (LA) for treatment of acute appendicitis has gained acceptance with its considerable benefits over open appendectomy. LA, however, can involve some adverse outcomes: morbidity, prolonged length of hospital stay (LOS) and hospital readmission. Identification of predictive factors may help to identify and tailor treatment for patients with higher risk of these adverse events. Our aim was to identify risk factors for serious morbidity, prolonged LOS and hospital readmission after LA. A database compiled information of patients admitted for acute appendicitis from eighteen Polish and German surgical centers. It included factors related to the patient characteristics, peri- and postoperative period. Univariate and multivariate logistic regression models were used to identify risk factors for serious perioperative complications, prolonged LOS, and hospital readmissions in acute appendicitis cases. 4618 laparoscopic appendectomy patients were included. First, although several risk factors for serious perioperative complications (C-D III-V) were found in the univariate analysis, in the multivariate model only the presence of intraoperative adverse events (OR 4.09, 95% CI 1.32-12.65, p = 0.014) and complicated appendicitis (OR 3.63, 95% CI 1.74-7.61, p = 0.001) was statistically significant. Second, prolonged LOS was associated with the presence of complicated appendicitis (OR 2.8, 95%CI: 1.53-5.12, p = 0.001), postoperative morbidity (OR 5.01, 95% CI: 2.33-10.75, p < 0.001), conversions (OR 6.48, 95% CI: 3.48-12.08, p < 0.001) and reinterventions after primary procedure (OR 8.79, 95% CI: 3.2-24.14, p < 0.001) in the multivariate model. Third, although several risk factors for hospital readmissions were found in univariate analysis, in the multivariate model only the presence of postoperative complications (OR 10.33, 95% CI: 4.27-25.00), reintervention after primary procedure (OR 5.62, 95% CI: 2.17-14.54), and LA performed by resident (OR 1.96, 95%CI: 1.03-3.70) remained significant. Laparoscopic appendectomy is a safe procedure associated with low rates of complications, prolonged LOS, and readmissions. Risk factors for these adverse events include complicated appendicitis, postoperative morbidity, conversion, and re-intervention after the primary procedure. Any occurrence of these factors during treatment should alert the healthcare team to identify the patients that require more customized treatment to minimize the risk for adverse outcomes

The use of salicylic acid in cosmetics and dermatology - the new face of the old medicine

Coraz większa część społeczeństwa boryka się z problemem chorób skórnych, a przede wszystkim trądzikiem. Problem jakim jest trądzik zaczyna się pojawiać we wczesnym wieku szkolnym ale również może występować u osób po 30 roku życia. Wpływa na to zarówno styl życia np. aktywność fizyczna, zła dieta, tryb pracy najczęściej siedzący, jak również nadmierny stres oraz ekspozycja na promieniowanie słoneczne. Na wygląd naszej skóry wpływa także środowisko zewnętrzne i sposób, w jaki dbamy o jej blask i kondycję. Nieodpowiedni dobór kosmetyków bez konsultacji z kosmetologiem oraz źle dobrane zabiegi kosmetyczne skutkują określoną kondycją skóry. Ponadto nagromadzenie sebum, zrogowaciałego naskórka i brak jego złuszczenia oraz oczyszczania stwarza lepsze warunki do rozwoju trądziku. Odpowiednim preparatem do pielęgnacji i walki z trądzikiem jest stosowanie peelingu chemicznego zawierającego kwas salicylowy. Ważnym jest aby pamiętać, że nie należy poddawać się tego typu zabiegom w okresie letnim, gdy skóra jest bardziej narażona na ekspozycję słoneczną. O mocy kwasu salicylowego decyduje jego wartość pKa oraz pH. Równie ważnym aspektem przy tego typu zabiegach jest odpowiednia pielęgnacja skóry po ich wykonaniu, dobór odpowiednich kremów nawilżających, toników i płynów do mycia twarzy oraz stosowanie zabiegów w seriach. Odpowiednia opieka wykwalifikowanego kosmetologa sprawia, że pacjent czuje się bezpiecznie, a efekty po stosowaniu peelingu z użyciem kwasu salicylowego przyniosą na nowo pewność siebie i zadowolenie ze zdrowego wyglądu skóry.An increasing number of people are struggling with the problem of skin diseases and, above all, of acne. The problem which is acne begins to appear in early school age but also in people over 30 years of age. This is influenced by lifestyle, such as physical activity, poor diet, most frequently sedentary work, and above all, excessive stress and exposure to solar radiation. The appearance of our skin is also affected by the external environment and the way we care for the brightness of our skin. Inappropriate selection of cosmetics, without consultation with a cosmetologist, poorly selected cosmetic treatments all result in the condition of the skin. In addition, the accumulation of sebum, callous epidermis and lack of exfoliation and purification creates better conditions for the development of acne. A suitable preparation for the care and fight against acne is the use of chemical peeling which is salicylic acid. However, it should be remembered that this type of treatment if not recommended during the summer, when we are more exposed to solar exposure. The power salicylic acid of depends on pKa and pH. An equally important aspect in this type of treatment is proper care after the procedure, the selection of appropriate moisturizing creams, toners and facial cleansers, and the use of treatments in series. Proper care by a qualified cosmetologist will make the patient feel safe and the effects after using peeling with salicylic acid will bring self-confidence and satisfaction with the healthy appearance of the skin

Characteristics of block copolymers of methyl oxirane and oxirane derivatives of 2-ethylhexanol as obtained with KOH and dimetalcyanide type catalyst

Two series of block copolymers of methyloxirane and oxirane, derivatives of 2-ethylhexanol, were obtained with the use of KOH as a conventional homogeneous alkaline catalyst and a coordinative dimetalcyanide catalyst (DMC), respectively. The DMC type catalyst showed much higher kinetic activities and its reaction exhibited a narrower distribution of homologues, as compared with those obtained in the presence of KOH. The thermo-gravimetric technique was proposed for the characterization of the fractional content of products. The pluming phenomenon and VOCs content were discussed as a practical aspect of the differences in fractional compositions of the products examined

High maternal-fetal HLA eplet compatibility is associated with severe manifestation of preeclampsia

IntroductionPreeclampsia is responsible for more than 70 000 and 500 000 maternal and fetal deaths, respectively each year. Incomplete remodelling of the spiral arteries in placenta is the most accepted theory of preeclampsia pathogenesis. However, the process is complexed with immunological background, as pregnancy resembles allograft transplantation. Fetus expresses human leukocyte antigens (HLA) inherited from both parents, thus is semiallogeneic to the maternal immune system. Therefore, induction of fetal tolerance is crucial for physiological outcome of pregnancy. Noteworthy, the immunogenicity of discordant HLA antigens is determined by functional epitopes called eplets, which are continuous and discontinuous short sequences of amino acids. This way various HLA molecules may express the same eplet and some HLA incompatibilities can be more immunogenic due to different eplet combination. Therefore, we hypothesized that maternal- fetal HLA incompatibility may be involved in the pathogenesis of gestational hypertension and its progression to preeclampsia. We also aimed to test if particular maternal-fetal eplet mismatches are more prone for induction of anti- fetal HLA antibodies in gestational hypertension and preeclampsia.MethodsHigh resolution next-generation sequencing of HLA-A, -B, -C, -DQB1 and -DRB1 antigens was performed in mothers and children from physiological pregnancies (12 pairs) and from pregnancies complicated with gestational hypertension (22 pairs) and preeclampsia (27 pairs). In the next step HLA eplet identification and analysis of HLA eplet incompatibilities was performed with in silico approach HLAMatchmaker algorithm. Simultaneously maternal sera were screened for anti-fetal HLA class I, class II and anti-MICA antibodies with Luminex, and data were analyzed with HLA-Fusion software.ResultsWe observed that high HLA-C, -B, and DQB1 maternal-fetal eplet compatibility was associated with severe preeclampsia (PE) manifestation. Both quantity and quality of HLA epletmismatches affected the severity of PE. Mismatches in HLA-B eplets: 65QIA+76ESN, 70IAO, 180E, HLA-C eplets: 193PL3, 267QE, and HLA-DRB1 eplet: 16Y were associated with a mild outcome of preeclampsia if the complication occurred.ConclusionsHigh HLA-C, HLA-DQB1 and HLA-B eplet compatibility between mother and child is associated with severe manifestation of preeclampsia. Both quantity and quality of maternal-fetal HLA eplet mismatches affects severity of preeclampsia