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)

Diversity and ethics in trauma and acute care surgery teams: results from an international survey

Background Investigating the context of trauma and acute care surgery, the article aims at understanding the factors that can enhance some ethical aspects, namely the importance of patient consent, the perceptiveness of the ethical role of the trauma leader, and the perceived importance of ethics as an educational subject. Methods The article employs an international questionnaire promoted by the World Society of Emergency Surgery. Results Through the analysis of 402 fully filled questionnaires by surgeons from 72 different countries, the three main ethical topics are investigated through the lens of gender, membership of an academic or non-academic institution, an official trauma team, and a diverse group. In general terms, results highlight greater attention paid by surgeons belonging to academic institutions, official trauma teams, and diverse groups. Conclusions Our results underline that some organizational factors (e.g., the fact that the team belongs to a university context or is more diverse) might lead to the development of a higher sensibility on ethical matters. Embracing cultural diversity forces trauma teams to deal with different mindsets. Organizations should, therefore, consider those elements in defining their organizational procedures. Level of evidence Trauma and acute care teams work under tremendous pressure and complex circumstances, with their members needing to make ethical decisions quickly. The international survey allowed to shed light on how team assembly decisions might represent an opportunity to coordinate team member actions and increase performance

Outgassing rates of PEEK, Kapton® and Vespel® polymers

In this study commissioned by CERN, the outgassing behaviour of PEEK, Kapton® and Vespel® polymers has been investigated for potential use in the vacuum systems of particle accelerators. Polymeric materials are in general avoided in high vacuum (HV) and ultra-high vacuum (UHV) applications due to their high outgassing rates, which cannot be effectively reduced via bakeout procedures typically used with metals because of their usually low melting points and loss of mechanical performance above the glass transition temperature. The selected polymers have greater usability potential due to their superior thermal resistance and relatively low outgassing rates compared to most other polymers. Pump-down measurements were conducted on at least 5 samples of different thicknesses for each material, exposed to normal levels of moisture in the air (30-60% R.H.) prior to the tests. The data collected allowed to establish that diffusion of H2O molecules from the bulk to the surface of these materials represents their main source of outgassing when under vacuum; the concurrent release of other atmospheric species such as N2, O2, CO and Ar above normal levels, detected through spectrometric analysis of the residual gases, suggested that PEEK and Vespel® can also trap relevant amounts of air simply upon exposure. The decay of the outgassing rates of all three polymers, initially proportional to the inverse of the square root of time, was characterized by a time constant τ that depended on the diffusion coefficient of water inside the material and the square of its thickness; the diffusive process exhibited Fickian characteristics during pumping times up to 3τ, but diverged considerably from the expected behaviour when extending the pumping beyond this limit, indicating the occurrence of a secondary diffusive mechanism becoming manifest at low concentrations of the diffusing species in the bulk. An empirical model consisting of a 3-step equation was obtained through regression analysis of the data and the values of diffusion coefficients D and initial moisture contents c0 of each material were estimated by optimizing the parameters in the equations during the fitting procedure. The computed diffusion coefficients were 4.2∙10-9 cm2 s-1 for PEEK, 1.7∙10-9 cm2 s-1 for Kapton® and 1.8∙10-9 cm2 s-1 for Vespel, while the initial moisture content was estimated to be ca 0.3% in PEEK and ca. 1% in the other two materials. These values were found in good agreement with the information retrieved from the available sources