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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. [ABSTRACT FROM AUTHOR]

Patients with intra-abdominal sepsis suffer from significant mortality and morbidity. The main pillars of treatment for intra-abdominal infections are (1) source control and (2) early delivery of antibiotics. Antibiotic therapy should be started as soon as possible. However, the duration of antibiotics remains a matter of debate. Prolonged antibiotic delivery can lead to increased microbial resistance and the development of nosocomial infections. There has been much research on biomarkers and their ability to aid the decision on when to stop antibiotics. Some of these biomarkers include interleukins, C-reactive protein (CRP) and procalcitonin (PCT). PCT's value as a biomarker has been a focus area of research in recent years. Most studies use either a cut-off value of 0.50 ng/mL or an >80% reduction in PCT levels to determine when to stop antibiotics. This paper performs a literature review and provides a synthesized up-to-date global overview on the value of PCT in managing intra-abdominal infections. [ABSTRACT FROM AUTHOR]

The article focuses on the rise of acute care surgery (ACS) as a specialized model of care and the challenges it faces in establishing a universal gold standard for its implementation worldwide. Topics discussed include the proposed ideal characteristics of ACS surgeons, variations in ACS systems globally, and the potential benefits of ACS in reducing time to surgery and complication rates for common conditions.

Background Achieving a good seal for the application of the vacuum-assisted closure (VAC) system in complex head and neck wounds is difficult. Methods A case series of 4 patients who developed postoperative orocutaneous or pharyngocutaneous fistulas were studied. A sterile green glove was used as a sealant together with the VAC system. Results With utilization of a green glove, a good seal for the VAC system was obtained. This gave ample time to cleanse the wound and allow granulation tissue to form before proceeding on to the next stage of treatment. Conclusion A green glove technique allows for a good seal for the VAC system to work, especially when applied to complex head and neck wounds. © 2016 Wiley Periodicals, Inc. Head Neck 38: E2523-E2526, 2016 [ABSTRACT FROM AUTHOR]

Melasma is a common pigmentation in Asian women. Lasers have been used to lighten melasma, although with variable outcomes and complications. In Asia, laser toning is a common technique used to safely lighten melasma. However, no large studies have been performed to validate efficacy. In our study, we demonstrate that in 38 970 Asian women, at least 35 890 patients (92.1%) had noticeable to excellent improvement in their melasma. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The purpose of this study was to demonstrate a novel, effective, and safe way to utilize the Erb:YAG laser to clear freckles in Type III/IV Asian skin. DESIGN: This was a prospective study. SETTING: The setting was a Singapore-based clinic. PARTICIPANTS: Participants included five women, aged 25 to 38 years, three with Skin Type III and two with Skin Type IV. All of them had freckles. MEASUREMENTS: Photographs were taken pretreatment and one month after laser treatment. Three independent physicians evaluated the photographs using a grading system. Patients were followed clinically for a total of six months post-laser treatment to monitor for post-inflammatory hyperpigmentation and recurrence. RESULTS: At one month post-laser treatment, all five patients were evaluated. The three independent physicians agreed that all five patients had greater than 90-percent clearance of their freckles. During the subsequent follow-up visits (up to 6 months post-laser treatment), no post-inflammatory hyperpigmentation, hypopigmentation, or recurrence was seen. CONCLUSION: The Erb:Yag laser might be considered an effective and safe treatment for freckles in Asian patients., Competing Interests: FUNDING:No funding was provided for this article. DISCLOSURES:The author has no conflicts of interest relevant to the contents of this article.

In recent years, laser toning or laser facial to treat melasma has become increasingly popular in Asia. It is common to see patients undergoing lasers three times a week, or even daily. This is part of a growing trend and is sometimes recommended in the user manuals from laser manufacturers. In our study, we report on 23 Chinese patients who had lasers performed three times a week for two consecutive months, followed by rest. All 23 of them developed bilateral confetti-like hypopigmentation at the end of two months. During the four-month follow-up and rest, 10 patients were lost to follow-up. Of the remaining 13 patients, none of them had repigmentation. We conclude that frequent laser facials or laser toning at regular intervals may result in undesirable outcomes and thus should not be performed in regular intervals., Competing Interests: FUNDING:No funding was provided for this study. DISCLOSURES:The author has no conflicts of interest relevant to the content of this article.

Objective: To demonstrate a novel low fluence combination laser technique [Erbium-doped yttrium aluminum garnet (Erb:YAG) and neodymium-doped yttrium aluminum garnet (Nd:YAG)] to effectively treat solar lentigines in type III Asian skin in a single session., Design: A prospective study., Setting: A Singapore-based clinic., Participants: Five patients (all females) were enrolled into the study. The ages ranged 35-60 years; all patients had Fitzpatrick skin type III., Measurements: Photographs were taken at baseline and at 1-month follow-up. These were reviewed by two independent physicians who were blinded to the study. Changes in pigment severity were assessed by a 5-point scale (1: Aggravation of pigment, 2: No change, 3: 25-50% improvement, 4: 51-75% improvement, and 5: 76-100% improvement)., Results: All patients received a single treatment session. At 1-month follow-up, a reduction in pigment was observed in all patients. Both physicians' reports were independently agreeable. All patients scored 5, having >90% improvement in pigment severity. No hypopigmentation, postinflammatory hyperpigmentation (PIH), or recurrence was seen., Conclusion: Low fluence combination laser is effective and safe for clearance of solar lentigines in type III Asian skin.

Objective: To demonstrate a combination laser therapy to treat Hori's nevus., Design: A prospective study., Setting: A Singapore-based clinic., Participants: Five female patients, aged 30-46 years, with bilateral malar Hori's nevus., Measurements: Photographs were taken before treatment and 1 month after laser treatment was completed. These were graded by three independent physicians. The patients were also asked to grade their treatment response subjectively. They were followed up for a total of 3 months after laser treatment to monitor recurrence., Materials and Methods: The fractional nonablative 2,940-nm Er:YAG laser with a fluence of 0.7 J/cm(2), spot size 12 mm, and frequency 15 Hz was used to perform a full-face single-pass treatment. Subsequently, a second pass and third pass over Hori's nevi were done bilaterally till the clinical endpoint of skin whitening. The 1,064-nm Q-switched (QS) Nd:YAG at a fluence of 2.0 J/cm(2), frequency 2 Hz, and 4-mm spot size was used to deliver multiple passes over Hori's nevus till erythema with mild petechiae appeared. We repeated the treatment once a week for 3 more consecutive weeks., Results: All five patients had above 80% improvement in their pigmentation and two (skin type III) achieved complete 100% clearance. Based on the patients' subjective assessments, all five of them expressed satisfaction and felt that their pigmentation had improved. There were no complications noted., Conclusion: The fractional nonablative 2940 nm Er:YAG laser and Q-switched 1064nm laser Nd:YAG combination is an effective and safe treatment for Hori's nevus.