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Background: The use of robotic-assisted surgery (RAS) has increased considerably since its introduction in 2001, with RAS now being widely accepted as a surgical modality. Current literature surrounding RAS focuses on the surgical team's experience rather than the patient's perspective, with limited qualitative research on post-RAS patient experience. Aim: To explore patient-reported experience following RAS. Methods: Twelve semi-structured telephone interviews were conducted. Interviews were audio recorded with data transcribed verbatim and analysed using thematic analysis. Findings: Themes included: factors specific to the robotic modality and psychological factors. Participant concerns emanated from their experience of a lack of pre-operative preparation, resulting in feelings of anxiety and some negative perceptions of RAS. Conclusion: Given the limited time for patient preparation for RAS, work developing patient information that is also patient-led would be of benefit. Pre-operative preparation is a key nursing role' and further research could explore nurses' experiences of preparing patients for RAS, facilitators and barriers to providing optimum patient preparation in this context. [ABSTRACT FROM AUTHOR]

Background: There is increasing evidence that uncomplicated appendicitis (UA) may be treated nonoperatively in cases of UA. This study aimed to evaluate and compare the diagnostic accuracy of circulating fibrocyte percentage (CFP), white blood cell count, C-reactive protein, and neutrophil-lymphocyte ratio (NLR) in diagnosing uncomplicated and complicated appendicitis. Materials and methods: Eighty consecutive adult patients presenting with suspected appendicitis were recruited in a cohort- based prospective study between June 2015 and February 2016 at University Hospital Limerick in Ireland. Peripheral venous samples were obtained at the presentation. Clinical, biochemical, radiological, and histopathological parameters were recorded. The CFP was determined by dual-staining for CD45 and collagen-I using flow cytometry analysis and correlated with histopathological diagnoses. Results: Of the 46 patients who underwent appendicectomy, 34 (73.9%) had histologically proven acute appendicitis. A comparison of the diagnostic accuracy of biomarkers demonstrated the CFP had the highest diagnostic accuracy for UA (area under the curve = 0.83, sensitivity = 72.7%, specificity = 83.3%, P = 0.002). The NLR had the highest diagnostic accuracy in relation to complicated appendicitis (area under the curve = 0.84, sensitivity = 75.5%, specificity = 83.3%, P = 0.005). Conclusions: CFP and NLR are accurate biomarkers of UA and complicated appendicitis. [ABSTRACT FROM AUTHOR]

Background: There are reported variations in the intraoperative management of Crohn's disease. This consensus statement aimed to develop a standardised protocol for photographic documentation of intraoperative findings and critical procedural steps in ileocolonic Crohn's disease surgery. Methods: Colorectal surgeons with a specialist interest in minimally invasive surgery and inflammatory bowel disease were invited as committee members to develop a survey on the use of photo‐documentation in Crohn's disease surgery. A 15 item survey was developed on ethical considerations and applications of photo‐documentation in audit and quality control, research, and training. Results: There was strong agreement on the potential application of intraoperative photo‐documentation in Crohn's disease for training, research, quality control and tertiary referrals. Reviewers agreed that intraoperative staging required photo‐documentation of strictures, skip lesions, perforations, fat wrapping and mesenteric disease. The necessary steps to be photo‐documented were very specific to Crohn's disease surgery, such as views of anastomosis and strictureplasties, and extent of resection(s). Conclusions: Our consensus statement identified several items for appropriate intraoperative photo‐documentation in Crohn's disease surgery, to be used as an adjunct to accurate annotation of intraoperative findings and procedures. [ABSTRACT FROM AUTHOR]

Background and Aims Inclusion of the mesentery during resection for colorectal cancer is associated with improved outcomes but has yet to be evaluated in Crohn's disease. This study aimed to determine the rate of surgical recurrence after inclusion of mesentery during ileocolic resection for Crohn's disease. Methods Surgical recurrence rates were compared between two cohorts. Cohort A [n = 30] underwent conventional ileocolic resection where the mesentery was divided flush with the intestine. Cohort B [n = 34] underwent resection which included excision of the mesentery. The relationship between mesenteric disease severity and surgical recurrence was determined in a separate cohort [n = 94]. A mesenteric disease activity index was developed to quantify disease severity. This was correlated with the Crohn's disease activity index and the fibrocyte percentage in circulating white cells. Results Cumulative reoperation rates were 40% and 2.9% in cohorts A and B [ P = 0.003], respectively. Surgical technique was an independent determinant of outcome [ P = 0.007]. Length of resected intestine was shorter in cohort B, whilst lymph node yield was higher [12.25 ± 13 versus 2.4 ± 2.9, P = 0.002]. Advanced mesenteric disease predicted increased surgical recurrence [Hazard Ratio 4.7, 95% Confidence Interval: 1.71–13.01, P = 0.003]. The mesenteric disease activity index correlated with the mucosal disease activity index [r = 0.76, p < 0.0001] and the Crohn's disease activity index [r = 0.70, p < 0.0001]. The mesenteric disease activity index was significantly worse in smokers and correlated with increases in circulating fibrocytes. Conclusions Inclusion of mesentery in ileocolic resection for Crohn's disease is associated with reduced recurrence requiring reoperation. [ABSTRACT FROM AUTHOR]

BACKGROUND: We undertook a systematic review and meta-analysis to compare surgeon-performed ultrasound (SPUS) for suspected appendicitis or gallstone disease to the "gold standard" of pathological examination or radiologist-performed ultrasound (RPUS). DATA SOURCES: MEDLINE, Embase, trial registries, conference proceedings, and article reference lists were searched to identify trials and/or studies comparing SPUS with pathology or RPUS as the reference standard. Data were abstracted from eligible studies to produce 2 x 2 contingency tables, permitting the calculation of pooled sensitivity and specificity values. RESULTS: Eight studies (1,268 patients) evaluated SPUS for appendicitis. For appendicitis, SPUS had a pooled sensitivity of .92 (95% confidence interval [CI], .887-.939) and a pooled specificity of .96 (95% CI, .946 -.974). SPUS for gallstones was evaluated in 8 studies (1,019 patients). The pooled sensitivity was .96 (95% CI, .934 -.979), and the specificity was .99 (95% CI .983-.998). CONCLUSIONS: SPUS achieves acceptable sensitivity and specificity for both gallstones and appendicitis. However, there was some evidence of heterogeneity. Data regarding cost-effectiveness are lacking. [ABSTRACT FROM AUTHOR]

Focal adhesion kinase (FAK) is a tyrosine kinase with prominent roles in protein scaffolding, migration, angiogenesis, and anchorage-independent cell survival and is an attractive target for the development of cancer therapeutics. However, current FAK inhibitors display dual kinase inhibition and/or significant activity on several kinases. Although multitargeted activity is at times therapeutically advantageous, such behavior can also lead to toxicity and confound chemical-biology studies. We report a novel series of small molecules based on a tricyclic pyrimidothiazolodiazepinone core that displays both high potency and selectivity for FAK. Structure-activity relationship (SAR) studies explored modifications to the thiazole, diazepinone, and aniline "tail," which identified lead compound BJG-03-025. BJG-03-025 displays potent biochemical FAK inhibition (IC 50 = 20 nM), excellent kinome selectivity, activity in 3D-culture breast and gastric cancer models, and favorable pharmacokinetic properties in mice. BJG-03-025 is a valuable chemical probe for evaluation of FAK-dependent biology., Competing Interests: The authors declare the following competing financial interest(s): FAK inhibitors noted in this study are subject to patent applications filed by Dana-Farber Cancer Institute. N.S.G. is a Scientific Founder, member of the SAB and equity holder in C4 Therapeutics, Syros, Soltego (board member), B2S, Allorion, Gatekeeper and Petra Pharmaceuticals. J.C. is a consultant for Soltego and equity holder of M3 bioinformatics & technology Inc. The Gray lab receives or has received research funding from Novartis, Takeda, Astellas, Taiho, Janssen, Kinogen, Voroni, Arbella, Deerfield and Sanofi. A.J.B receives funding from Bayer, Merck and Novartis and is a co-founder of Signet Therapeutics., (© 2020 American Chemical Society.)