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Retrospective studies suggest that coronavirus disease (COVID-19) commonly involves gastrointestinal (GI) symptoms and complications. Our aim was to prospectively evaluate GI manifestations in patients hospitalized for COVID-19.This international multicentre prospective cohort study recruited COVID-19 patients hospitalized at 31 centres in Spain, Mexico, Chile, and Poland, between May and September 2020. Patients were followed-up until 15 days post-discharge and completed comprehensive questionnaires assessing GI symptoms and complications. A descriptive analysis as well as a bivariate and multivariate analysis were performer using binary logistic regression. p0.05 was considered significant.Eight hundred twenty-nine patients were enrolled; 129 (15.6%) had severe COVID-19, 113 (13.7%) required ICU admission, and 43 (5.2%) died. Upon admission, the most prevalent GI symptoms were anorexia (n=413; 49.8%), diarrhoea (n=327; 39.4%), nausea/vomiting (n=227; 27.4%), and abdominal pain (n=172; 20.7%), which were mild/moderate throughout the disease and resolved during follow-up. One-third of patients exhibited liver injury. Non-severe COVID-19 was associated with ≥2 GI symptoms upon admission (OR 0.679; 95% CI 0.464-0.995; p=0.046) or diarrhoea during hospitalization (OR 0.531; 95% CI 0.328-0.860; p=0.009). Multivariate analysis revealed that worse hospital outcomes were not independently associated with liver injury or GI symptoms.GI symptoms were more common than previously documented, and were mild, rapidly resolved, and not independently associated with COVID-19 severity. Liver injury was a frequent complication in hospitalized patients not independently associated with COVID-19 severity.

Introduction Intragastric balloon (IGB) insertion and endoscopic sleeve gastroplasty (ESG) are known to be effective and safe in achieving weight loss. The aim of this study was to compare the effects of a 6-month IGB therapy, a 12-month IGB therapy, and ESG. Methods We retrospectively analyzed the weight loss at IGB (Orbera) removal after 6 months (124 patients), at IGB (Orbera365) removal after 12 months (61 patients) and at 6 and 12 months after ESG (42 and 34 patients, respectively). Postprocedural care, including medication and diet, was the same for all procedures. Results Mean TBWL in patients undergoing IGB placement for 6 and 12 months and ESG after 6 and 12 months were 15.2, 15.8, 26.5, and 28.7 kg, respectively. There was no significant difference in the mean %TBWL in patients undergoing IGB placement for 6 or for 12 months (15.3% vs. 14.7%, P = 0.7). ESG patients showed a significantly higher mean %TBWL than IGB patients after 6 months (15.3 vs. 19.8, P = 0.005) and 12 months (14.7 vs. 22.5, P Conclusion All three studied methods were effective for achieving weight loss. However, there was no significant difference between 6-month and 12-month IGB therapies outcomes. ESG appeared to be a more effective obesity treatment modality than IGB. Graphical Abstract

Background: Endoscopic Ultrasound (EUS) is widely used for the diagnosis of bilio-pancreatic and gastrointestinal (GI) tract diseases, for the evaluation of subepithelial lesions, and for sampling of lymph nodes and solid masses lo-cated next to the GI tract. The role of Artificial Intelligence in healthcare in growing. This review aimed to provide an overview of the current state of AI in EUS from imaging to pathological diagnosis and training. Methods: AI algorithms can assist in lesion detection and characterization in EUS by analysing EUS images and identifying suspicious areas that may require further clinical evaluation or biopsy sampling. Deep learning tech-niques, such as convolutional neural networks (CNNs), have shown great potential for tumour identification and subepithelial lesion (SEL) evaluation by extracting important features from EUS images and using them to classify or segment the images. Results: AI models with new features can increase the accuracy of diagnoses, provide faster diagnoses, identify subtle differences in disease presentation that may be missed by human eyes, and provide more information and in-sights into disease pathology. Conclusions: The integration of AI in EUS images and biopsies has the potential to improve the diagnostic accura-cy, leading to better patient outcomes and to a reduction of repeated procedures in case of non-diagnostic biopsies.

Aim The aim of this study was to assess the problem of hernia occurrence in patients after transverse rectus abdominis flap in breast reconstructive surgery and the influence of using donor site reinforcement with mesh to prevent bulging and hernia. Method Literature searches were performed using databases, using key terms to include related articles in the last ten years. Results Out of 65 articles found by the research, 7 articles included in this review, risk factors were identified as obesity, smoking, unipedicule vs bipedicle, mesh vs non-mesh repair. 5 of the included articles involved retrospective study with 6 to 160 patients and follow up period 6 to 48 months, one double blinded study and one was cost utility study retrospective. it is showed that TRAM reconstruction associated with hernia in 18% and 63% had abdominal bulging. using mesh reinforcement reducing bulging 2% to 6% and hernia to 1% to 2%, Consideration should be given particularly in high-risk populations. Conclusion Although the literature about the best way to deal with TRAM defect has not been published yet, this review shows the important of mesh augmentation, it magnified the effect of that on patient with high risk for hernia or bulging.

Aim To discuss appendicitis as a cause of chronic mesh infection. Methods This study reports two patients with previous inguinal hernia repair who presented with recurrent groin infections resulting from appendicitis. Results Patient 1 had a history of laparoscopic bilateral inguinal hernia repair, followed by an open repair of a unilateral recurrence. He presented twice with groin pain and discharge. Sinugram demonstrated a superficial tract, but intra-operatively the sinus tract extended to the deep ring where the appendix was adherent and inflamed. There was also a meshoma of the preperitoneal mesh. He underwent appendicectomy and excision of meshoma. Patient 2 presented with perforated appendicitis with a large pelvic collection extending into the anterior abdominal wall. This was treated with percutaneous drainage and antibiotics. Further presentations with recurrent abscesses prompted a laparoscopy where an inflamed appendix was found adherent to the previous mesh through a hole in the peritoneum in a pre-peritoneal abscess cavity. He underwent appendicectomy and washout without mesh removal. Both patients remain symptom free at 10 months and 1 month respectively. Conclusion Literature review found reports of mesh-related appendicitis but no cases of appendicitis causing chronic mesh infection. Whilst rare, appendicitis causing chronic mesh infection should be considered in patients presenting with recurrent groin pain and abscesses having previously undergone inguinal hernia repair. Whilst we do not have long term follow up data, our experience indicates that these patients can be managed with or without mesh removal, providing the appendix is removed and the source of sepsis controlled.

Aim/Objective The aim on this presentation is to assess patients’ feedback as well as the outcomes of individualised treatment plans for patients assessed in the multidisciplinary team (MDT) clinic. The primary endpoint was quality of life and pain improvement 3 months after receiving treatment. Material and methods All patients reviewed in MDT CPIP clinic in the Comprehensive Hernia Centre between July 2021 and July 2022 were included in the study. Patients feedback as well as MDT individualised treatment plans were assessed. The outcomes, Visual Analogue Scale (VAS) and modified Activity Assessment Scale (mAAS) 3 months post intervention have been audited against data collected prior to intervention. Results We have received 57 referrals during the investigated period. 40 patients underwent MDT assessment with 55% receiving treatment and entering follow-up stage. In that group 26% had surgery, 35% had invasive non-surgical treatment (local injections and radiofrequency ablation), 39% were qualified for pharmacological treatment, together with physiotherapy and psychological support. Follow up data was collected for 19/22 patients. All patients had reported moderate to significant pain (VAS 4–10) on initial assessment and a significant reduction in pain (> 50% improvement in VAS) after treatment. Mean baseline mAAS score was 20.3± 7.3 (range 8 to 40). Mean change was - 10.6±2.6 with all patients reporting significant improvement (> 50%). Moreover, on a scale from 0 to 5, the average satisfaction score was 4.5. Conclusion Developing a multidisciplinary clinic to assess patients presenting with CPIP improved patients’ experiences and outcomes. Enhancing patient-centred care.

Background Assessment of mucosal visualization during esophagogastroduodenoscopy (EGD) can be improved with a standardized scoring system. To address this need, we created the Toronto Upper Gastrointestinal Cleaning Score (TUGCS). Methods We developed the TUGCS using Delphi methodology, whereby an international group of endoscopy experts iteratively rated their agreement with proposed TUGCS items and anchors on a 5-point Likert scale. After each Delphi round, we analyzed responses and refined the TUGCS using an 80 % agreement threshold for consensus. We used the intraclass correlation coefficient (ICC) to assess inter-rater and test–retest reliability. We assessed internal consistency with Cronbach’s alpha and item-total and inter-item correlations with Pearson’s correlation coefficient. We compared TUGCS ratings with an independent endoscopist’s global rating of mucosal visualization using Spearman’s ρ. Results We achieved consensus with 14 invited participants after three Delphi rounds. Inter-rater reliability was high at 0.79 (95 %CI 0.64–0.88). Test–retest reliability was excellent at 0.83 (95 %CI 0.77–0.87). Cronbach’s α was 0.81, item-total correlation range was 0.52–0.70, and inter-item correlation range was 0.38–0.74. There was a positive correlation between TUGCS ratings and a global rating of visualization (r = 0.41, P = 0.002). TUGCS ratings for EGDs with global ratings of excellent were significantly higher than those for EGDs with global ratings of fair (P = 0.01). Conclusion The TUGCS had strong evidence of validity in the clinical setting. The international group of assessors, broad variety of EGD indications, and minimal assessor training improves the potential for dissemination.

Background Atopic dermatitis (AD) is a chronic inflammatory skin disease with a multifactorial genesis including genetic predispositions and environmental risk and trigger factors. One of the latter possibly is smoking, indicated by an increased prevalence of AD in adults and children that are actively or passively exposed to cigarette smoke. Objectives In this study AD characteristics and its atopic comorbidities are compared in smoking and nonsmoking AD patients. Methods TREATgermany is a non-interventional clinical registry which includes patients with moderate to severe AD in Germany. Baseline data of patients included into TREATgermany from inception in June 2016 to April 2020 in 39 sites across Germany was analyzed comparing AD disease characteristics and comorbidities in smokers versus non-smokers. Results Of 921 patients, 908 (male: 58.7%) with a mean age of 41.9 ± 14.4 reported their smoking status. The objective Scoring of Atopic Dermatitis (oSCORAD) did not differ between smokers (n=352; 38.8%) and nonsmokers, however lesions' intensity of oozing/crusts and excoriations as well as patient global assessment scores (PGA) of AD severity were higher in smoking as opposed to nonsmoking patients. Smokers reported a lower number of weeks with well-controlled AD and more severe pruritus than nonsmokers. Total IgE levels were more elevated in smokers and they displayed a younger age at initial diagnosis of bronchial asthma. After adjustment for potential confounders, the increased intensity of oozing/crusts, the reduced number of weeks with well-controlled AD and the greater pruritus remained different in smokers compared to nonsmokers. In addition, smoking patients with adult-onset AD showed a 2.5 times higher chance of involvement of the feet. Conclusions German registry data indicate that AD patients who smoke have a higher disease burden with a different distribution pattern of lesions in adult-onset AD.

Background and Objectives: Liver metastases might not be detected by computed tomography (CT) and magnetic resonance imaging (MRI) due to their small size, but they can be detected by EUS. Furthermore, EUS-FNA has a significant impact on improving the diagnostic accuracy of EUS. The purpose of this study was to assess the feasibility of EUS in detection of occult small hepatic focal lesions at the time of primary tumor staging, not seen by CT or MRI. Methods: This prospective study included 730 patients who underwent EUS for staging or sampling of gastrointestinal, pancreatic, or thoracic malignancy. The liver was examined thoroughly for detection of occult lesions. CT or MRI was done within 1 week of EUS examination. Results: EUS examination of the liver detected focal lesions in 150 patients (20.5%) and metastases in 118 patients (16.2%); meanwhile, CT and MRI detected focal lesions in 99 patients (13.6%) and metastases in 82 patients (11.2%). EUS missed focal lesions in 7 patients, 6 of which were liver metastases (1.0% and 0.8%, respectively), while CT and MRI missed focal lesions in 58 patients, 42 of which were metastases (7.9% and 5.8%, respectively), which were detected by EUS. Conclusion: Thorough dedicated EUS examination of the liver is a feasible useful tool for detection of small hepatic lesions missed by CT and MRI. It is not considered an extra financial burden to the patient or health-care system because those patients are indicated for EUS examination for evaluation of their original lesion in the first place. Furthermore, EUS-FNA can add another advantage in diagnosing the etiology of such lesions.

Background The COVID-19 pandemic has created unprecedented challenges in all fields of society with social, economic, and health-related consequences worldwide. In this context, gastroenterology patients and healthcare systems and professionals have seen their routines changed and were forced to adapt, adopting measures to minimize the risk of infection while guaranteeing continuous medical care to chronic patients. Objective At this point, it is important to evaluate the impact of the pandemic on this field to further improve the quality of the services provided in this context. Methods/results/conclusion We performed a literature review that summarizes the main aspects to consider in gastroenterology, during the pandemic crisis, and includes a deep discussion on the main changes affecting gastroenterology patients and healthcare systems, anticipating the pandemic recovery scenario with future practices and policies.

Aim Incisional hernias are common and can significantly impact a patient's quality of life. Traditionally, abdominal wall reconstruction (AWR) has been performed by general surgeons, or those with special interest, often working in isolation. However, there is increasing awareness of pre-optimisation, risk stratification, enhanced training, and personalising treatment using a wide range of techniques. Methods & Results For complex and higher-risk procedures, Multidisciplinary team (MDT) management is considered the standard of care for optimising outcomes. The lack of standardised protocols and clear evidence in AWR means that surgical management can vary greatly. This makes the MDT process even more important due to the complexity of the decision-making involved. We describe a successful MDT process for complex abdominal wall reconstruction at a tertiary referral centre. Patients are reviewed at weekly AWR meetings with a multidisciplinary team, which includes consultants, advanced clinical practitioners and trainees. This is an opportunity for objective risk stratification, radiological review and assessment of the patient's goals before preoptimization and operative planning. Prospective data is collected on all patients to allow for quality improvement and service development. Conclusion MDT management of abdominal wall hernia is gaining popularity but remains poorly established in most regions. The involvement of surgical colleagues and other specialists is crucial in developing this growing field of surgery. We hope to expand our team to include Radiologists and Nutritionists, with the possibility of extending to regional networks, as we continue to explore new techniques and methods in managing complex abdominal wall hernias.

Abstract Chronic Post-operative Inguinal Pain (CPIP), is recognised as a long term condition and has a significant effect on patients’ quality of life. CPIP affects 18–30% of patients after an open inguinal hernia repair and 6% of patients after a laparoscopic inguinal hernia repair. CPIP result from several causes such as a pre-operative nerve lesion in other area of the body, an intra-operative nerve injury, or due to the intensity of acute post-operative inflammation and healing. a multidisciplinary clinic would be considered the best approach in order to assess patients’ pain and identify an individual management plan. This review allowed the team to choose which literature could be used to support the implementation of the clinical practice change. Method Literature searches were performed using PubMed and Embase databases were searched using key terms to include all related articles in the last ten years. three independent reviewers to choose included and excluded articles with two steps. Results Out of 25 articles found by the research, 8 articles included in this review including MDT about CPIP, meeting including criteria after the full articles reviewed. it was important to understand the nature and mechanisms of Chronic Post-operative inguinal hernia. several risk factors have been identified, which may be causing CPIP such as young age, recurrent inguinal hernia repair procedure and presence of pain before the procedure. Because of the complexity of CPIP, many authors concluding that a multidisciplinary approach should be considered the more appropriate method to ensure an effective and safe treatment. This include the need of regular follow up after an inguinal hernia repair to identify the chronic pain and establish an appropriate management plan. Conclusions Although the literature review enabled the team to gather useful information about the topic of the clinical practice change; it was evident that more researches and studies need to be completed in order to identify the safest and effective treatment for patients presenting with CPIP.

BACKGROUND AND AIM The proper visibility of mucosa during esophagogastroduodenoscopy (EGD) is crucial for the detection of early upper gastrointestinal tract lesions. In contrast to colonoscopy, no validated scoring system for the assessment of upper gastrointestinal mucosal cleanliness has been developed so far. The aim of the study was to create and validate standardized grading system (POLPREP) to assess the mucosal cleanliness during EGD. METHODS To assess the visibility of mucosa during EGD, 4-point scale was developed (0-3). Twelve operators assessed 18 images of esophagus, stomach, and duodenum twice (in 2 weeks interval). In validation round, the images and endoscopy reports of 443 EGDs performed in six centers were assessed. RESULTS The inter-observer accordance of POLPREP was 0.8 (intra-class correlation coefficient; 0.79 consultants, 0.85 trainees). The intra-observer repeatability was 0.64 (Fleiss kappa value; 0.64 consultants, 0.64 trainees). The lesions detection rate was significantly higher in clean (scores 2 and 3; 19.7%) than in "unclean" segments (score 1; 7.7%, P = 0.049). Score 3 was associated with over three-fold higher lesion detection than score 1 (odds ratio 3.2, 95% confidence interval 1.1-9; P = 0.03). CONCLUSIONS The proposed POLPREP scale allows for unified assessment of upper gastrointestinal tract mucosal cleanliness. The higher cleanliness scores are related with greater upper gastrointestinal pathologies detection.

Background High quality esophagogastroduodenoscopy (EGD) depends on the ability to appropriately visualize upper gastrointestinal (GI) mucosa pathology. Evaluation can be limited by the presence of mucus, foam, bubbles and solid materials. Currently, there is no standardized method to assess mucosal visualization for use in clinical or research settings. Aims To develop and establish the content validity of the Toronto Upper Gastrointestinal Cleaning Score (TUGCS) and evaluate its interrater reliability. Methods An international panel of endoscopy experts rated potential items and their associated anchors for importance as indicators of adequacy of mucosal visualization during EGD. The survey utilized a Likert scale (1 (strongly disagree) to 5 (strongly agree)). The Delphi process was repeated until consensus was reached. Consensus was defined priori as ≥80% of experts in a given round scoring ≥4 on all survey items. To assess content validity, 48 EGD procedures were evaluated in real-time by two endoscopist reviewers using the TUGCS at a single institution. The interrater agreement between assessments was calculated for TUGCS total scores using intraclass correlation coefficient, one-way random effects model (ICC 1,1). Results Fourteen experts agreed to be part of the Delphi panel. An anatomical framework representing the upper GI mucosa and anchors for each mucosal portion representing various levels of visibility was generated through systematic review. Three survey rounds, with response rates of 100%, 100% and 71% respectively, achieved consensus. The final TUGCS includes four anatomical areas (fundus, body, antrum, duodenum) and mucosal visualization anchors ranging from 0 to 3 (Figure 1). TUGCS was used to assess foregut cleaning in 48 procedures (Table 1). The mean TUGCS for staff and trainee were 8.1 (±2.4) and 8.1 (±2.6), respectively. The ICC was 0.78 (95% confidence interval 0.62–0.88) indicating good reliability. Conclusions We developed and generated content validity evidence for the TUGCS through rigorous Delphi methodology, reflective of practice across different centres. Planned as future research is a video survey distributed to endoscopists internationally to further validate the TUGCS to create a tool that may be used to judge mucosal visualization for EGD in research and clinical settings. Funding Agencies None

ispartof: UNITED EUROPEAN GASTROENTEROLOGY JOURNAL vol:10 issue:1 pages:12-14 ispartof: location:England status: published

Chronic pain is one of the most frequent clinical problems after inguinal hernia surgery. Despite more than two decades of research and numerous publications, no evidence exists to allow for chronic postoperative inguinal pain (CPIP) specific treatment algorithms.This narrative review presents the current knowledge of the non-surgical management of CPIP and makes suggestions for daily practice.There is a paucity for high-level evidence of non-surgical options for CPIP. Different treatment options and algorithms have been published for chronic pain patients in the last decades.It is suggested that non-surgical treatment is introduced in the management of all CPIP patients. The overall approach to interventions should be pragmatic, tiered and multi-interventional, starting with least invasive and only moving to more invasive procedures upon lack of effect. Evaluation should be multidisciplinary and should take place in specialized centres. We strongly suggest to follow general guidelines for treatment of persistent pain and to build a database allowing for establishing CPIP specific evidence for optimal analgesic treatments.

Background An acute inguinal hernia remains a common emergency surgical condition worldwide. While emergency surgery has a major role to play in treatment of acute hernias, not all patients are fit for emergency surgery, nor are facilities for such surgery always available. Taxis is the manual reduction of incarcerated tissues from the hernia sack to its natural compartment, and can help delay the need for surgery from days to months. The aim of this study was to prepare a safe algorithm for performing manual reduction of incarcerated inguinal hernias in adults. Methods Medline, Scopus, Ovid and Embase were searched for papers related to emergency inguinal hernias and manual reduction. In addition, the British National Formulary and Safe Sedation Practice for Healthcare Procedures: Standards and Guidance were reviewed. Results A safe technique of manual reduction of an acute inguinal hernia, called GPS (Gentle, Prepared and Safe) Taxis, is described. It should be performed within 24 h from the onset of a painful irreducible lump in groin, and when concomitant symptoms and signs of bowel strangulation are absent. Conscious sedation guidelines should be followed. The most popular drug combination is of intravenous morphine and short-acting benzodiazepine, both titrated carefully for optimal and safe effect. The dose of drugs must be individualised, and the smallest effective dosage should be used to avoid oversedation. Following successful taxis, the patient should undergo a short period of observation. Urgent surgery can be undertaken during the same admission or up to several weeks later. Conclusions Taxis is a benign/non-invasive method for patients with an acute, non-strangulated inguinal hernias. It likely reduces the risk and complications of anaesthesia and surgery in the emergency settings. GPS Taxis should be considered as first line treatment in the majority of patients presenting with an acute inguinal hernia when existing bowel infarction is unlikely. Supplementary Information The online version contains supplementary material available at 10.1007/s10029-021-02429-1.

Primary midline hernias arising in the linea alba are common. While mesh repair has been shown to reduce recurrence rates even in small hernias, many surgeons still use a suture repair for defects of less than 2 cm. The recent European and Americas Hernia Societies Guidelines recommended suture repair only for hernias smaller than 1 cm. A suture repair implies edge-to-edge or overlapping fascial margins, which necessarily involves tension on the repair. A darn is a tension-free repair where, in effect, a “mesh” is hand-woven across the defect in situ. The darn repair is a modification of the darn techniques for inguinal hernia repair. Eligible patients undergoing this repair at the Royal Infirmary of Edinburgh between 1 January 2008 and 31 December 2017 were identified from a prospective computer-based medical record system and their case notes reviewed. Inclusion criteria were adult patients with a primary midline abdominal wall defect smaller than 2 cm in the widest diameter of the hernia defect measured intra-operatively. Patients were followed up by telephone in 2019. Those who reported possible recurrence or other symptoms in the region of their hernia repair were reviewed in the outpatient clinic. 47 suture-darn repairs were undertaken over the 10-year period. Fifteen of the darn repair operations (32%) were performed under local anaesthesia. Forty-one patients were followed up with a mean of 80 ± 35 and median of 87 months after surgery. Six patients (13%) were lost to follow-up. Recurrence was found in two cases (5%) and one patient has since been diagnosed with a new epigastric hernia some 5 cm cranial to the previous repair. The darn repair for small primary midline hernias is quick and inexpensive with promising long-term results. It can be performed under local anaesthesia. It can serve as an alternative to mesh repair for defects less than 2 cm in maximum dimension.

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A detailed analysis on the structural properties of first three ro-vibrational (J = 0, ν = 0, 1, 2; J and ν being the rotational and vibrational quantum numbers, respectively) states of H 2 + ion bound via screened Coulomb interaction has been reported. Generalized Hylleraas type basis set has been considered to construct the trial wave function under the Ritz variational framework. In order to incorporate the localized relative motion of the protons (or nuclei), we have used high powers of the interprotonic (or internuclear) distance in the basis set. The Borromean binding regime or the Borromean window (BW) has been identified for the said three states of H 2 + ion. The energy components contributing to the total energy are estimated as a parametric function of the screening parameter. Different geometrical entities e.g. radial moments 〈 r i p 〉 (p = − 1, 1 and 2), angular moments 〈 cos θ i 〉 [(i) = (1) or (12)], expectation value of the delta function δ ( r ⃗ 1 ) as well as the one-particle density are determined to get a clear view of the structural behaviour of H 2 + ion in its ground state as well as in the excited states, specially within the BW.

TREATgermany is a multicenter academic registry for the long-term observation of patients with moderate-to-severe atopic dermatitis (AD). Eligibility criteria, study procedures, and baseline characteristics including previous treatments have already been described (1). AD is associated with psychosocial disorders such as depression, anxiety, and suicidal ideation (2-4).

Summary Some patients with hypertrophic cardiomyopathy (HCM) are at significant risk of premature sudden death. Identification of the risk factors may enable effective prevention of adverse cardiac events in these patients. Assessment of the microvolt T-wave alternans (MTWA) is a recognized non-invasive diagnostic test used in risk stratification of sudden cardiac death (SCD). However, the number of reports on the frequency of occurrence of MTWA in HCM is small. Aim: Evaluation of the prognostic value of MTWA in predicting the risk of arrhythmic events (sudden cardiac death, documented VT/VF, appropriate ICD discharge) in patients with HCM. Material and methods 122 patients with HCM underwent detailed clinical assessment and ECG- and echocardiographic examination. They underwent 24-hour ambulatory ECG monitoring, and the following elements were analysed: 1) arrhythmias, 2) heart rate variability (HRV) and the QT segment, 3) the presence of ventricular late potentials (LP), 4) heart rate turbulence (HRT). MTWA assessment was made during a test on a treadmill (Cambridge Heart). In accordance with the adopted criteria, the test was interpreted as negative, positive or indeterminate. Subsequently, positive and indeterminate results were described collectively as MTWA(+) and negative results as MTWA(−). Then the patients were divided into two groups: Group 1 – 57 patients (46,7%) with MTWA(−), and Group 2 – 65 patients (53,2%) with MTWA(+). In order to stratify the risk, the following were adopted as composite primary endpoints: sudden cardiac death or hospitalization for life-threatening arrhythmias (VT/VF), and appropriate ICD discharge. Results The mean follow-up period of the patients was 57±8 months; during that time, events that met the criteria for the endpoint occurred in 16 patients. On the basis of univariate analysis, 10 variables with a significant influence on the occurrence of an event were selected (unexplained syncope, NT-proBNP values elevated above 411 pg/ml, size of the left atrium over 44mm, diastolic thickness of the interventricular septum over 25 mm, the presence of MTWA(+), the QRS width >90 msec, QTc >467 msec, QTd >70 msec, SDNN Conclusions 1) Patients with hypertrophic cardiomyopathy had a significant percentage of positive results of the microvolt T-wave alternans test (MTWA+), 2) Positive MTWA test result in patients with hypertrophic cardiomyopathy can help to identify patients at risk of sudden cardiac death. Funding Acknowledgement Type of funding sources: None.

Thiohydantoin and quinolone derivatives have attracted researchers’ attention because of a broad spectrum of their medical applications. The aim of our research was to synthesize and analyze the antimicrobial properties of novel 2-thiohydantoin and 2-quinolone derivatives. For this purpose, two series of hybrid compounds were synthesized. Both series consisted of 2-thiohydantoin core and 2-quinolone derivative ring, however one of them was enriched with an acetic acid group at N3 atom in 2-thiohydantoin core. Antibacterial properties of these compounds were examined against bacteria: Staphylococcus aureus, Bacillus subtilis, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The antimicrobial assay was carried out using a serial dilution method to obtain the MIC. The influence of blue light irradiation on the tested compounds was investigated. The relative yield of singlet oxygen (1O2*, 1Δg) generation upon excitation with 420 nm was determined by a comparative method, employing perinaphthenone (PN) as a standard. Antimicrobial properties were also investigated after blue light irradiation of the suspensions of the hybrids and bacteria placed in microtitrate plates. Preliminary results confirmed that some of the hybrid compounds showed bacteriostatic activity to the reference Gram-positive bacterial strains and a few of them were bacteriostatic towards Gram-negative bacteria, as well. Blue light activation enhanced bacteriostatic effect of the tested compounds.

Einleitung: TREATgermany ist ein Forschungsregister, das deutschlandweit Informationen zu Erkrankungsschwere, Therapieverlauf und Patient Reported Outcomes bei erwachsenen Patienten mit moderater bis schwerer Neurodermitis (AD) dokumentiert. Im Beitrag wird der Zusammenhang der globalen Einschätzung der Erkrankungsschwere der AD durch Ärzte und Patienten zur Baselinevisite und deren Abhängigkeit von Erkrankungssymptomen untersucht. Methoden: Skalen: Globale Einschätzung der Schwere der AD (0 (abgeheilt) - 5 (sehr schwer)) durch Patienten (PGA) und Ärzte (IGA). Symptome: NRS für Schmerzen, Juckreiz und Schlafstörungen der letzten 3 Tage (0 (kein Auftreten des Symptoms) - 10 (schwerst-vorstellbares Auftreten)). Statistik: Stata 15, Wilcoxon-Vorzeichen-Rang-Test. + TREATgermany wird durch Sanofi, LEO, Galderma und Lilly finanziell unterstützt. Ergebnisse: 2016-2020 wurden 1.025 Patienten (Alter 42±15 Jahre; 42% Frauen) in 38 Zentren eingeschlossen. PGA und IGA lagen im Median bei beiden Geschlechtern bei 3 (moderat). Frauen (F) litten stärker unter den erfragten Symptomen als Männer (M) (Mediane: Schmerzen: 4 vs 3, Juckreiz: 7 vs 6, Schlafstörungen: 5 vs 4). PGA und IGA stimmten bei 38,4% der Patienten überein. 30,2 bzw. 31,4% der Frauen sowie 35,1 bzw. 26,5% der Männer schätzten ihre AD leichter bzw. schwerer ein als der Arzt (F: p = 0,9; M: p = 0,002). 50,3% der Patienten litten stark unter Schmerzen, Juckreiz oder Schlafstörungen (mind. 1 Wert ≥7), 14,2% unter allen 3 Symptomen. Je 38,0 bzw. 46,2% dieser Patienten schätzten ihre AD schwerer ein als der Arzt (M 33,8 vs 39,7%; F 42,5 vs 52,0%). Fazit: Arzt- und Patientenbeurteilung der AD stimmen geschlechtsspezifisch insbesondere bei schwerem Symptomerleben nicht immer überein. Dies zeigt den Bedarf an individualisierter Behandlung der AD, die Patientenpräferenzen im Fokus hat.

Carbon fiber reinforced polymer (CFRP) composites are increasingly being used to strengthen structures and to retrofit existing structures. CFRP composites are used in various industries: construction, automotive, and many others. This literature review has shown that CFRP composites find numerous practical applications. Improving structures by reinforcing them with CFRP composite is an innovative approach in design. This review aims to explore the current state of the art in the types of structures that can be reinforced with CFRP, and modifications to the CFRP composite as an additional aspect to increase the strength of the reinforced structure. It has been shown that regardless of the type of reinforced material, the most critical element in this connection is the bonded joint. Proper surface preparation and the use of an appropriate adhesive are also important.

The All-Sky Automated Survey for Supernovae (ASAS-SN) provides long baseline (${\sim}4$ yrs) light curves for sources brighter than V$\lesssim17$ mag across the whole sky. The Transiting Exoplanet Survey Satellite (TESS) has started to produce high-quality light curves with a baseline of at least 27 days, eventually for most of the sky. The combination of ASAS-SN and TESS light curves probes both long and short term variability in great detail, especially towards the TESS continuous viewing zones (CVZ) at the ecliptic poles. We have produced ${\sim}1.3$ million V-band light curves covering a total of ${\sim}1000 \, \rm deg^2$ towards the southern TESS CVZ and have systematically searched these sources for variability. We have identified ${\sim} 11,700$ variables, including ${\sim} 7,000$ new discoveries. The light curves and characteristics of the variables are all available through the ASAS-SN variable stars database (https://asas-sn.osu.edu/variables). We also introduce an online resource to obtain pre-computed ASAS-SN V-band light curves (https://asas-sn.osu.edu/photometry) starting with the light curves of the ${\sim}1.3$ million sources studied in this work. This effort will be extended to provide ASAS-SN light curves for ${\sim}50\;$million sources over the entire sky., Comment: 13 pages, 12 figures. Accepted by MNRAS