Search

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., (© 2024. The Author(s).)

Objective: This study aimed to investigate the influence of sarcopenic obesity on anastomotic leak following elective colon resection for non-metastatic colon cancer. Secondary outcomes included overall morbidity, mortality and length of hospital stay., Methods: This retrospective observational study, conducted at a colorectal surgery referral centre, spanned from January 1, 2015, to January 1, 2020. A total of 544 consecutive patients who underwent elective colon resection were included in the analysis, excluding patients with rectal cancer, urgent surgery, absence of anastomosis, lack of imaging, multivisceral resections and synchronic tumours., Results: Postoperative complications were observed in 177 (32.3%) patients, with 51 (9.31%) classified as severe (Clavien-Dindo > II). Sarcopenic obesity was identified in 9.39% of the sample and emerged as an independent predictor of increased overall morbidity [OR 2.15 (1.14-3.69); p = 0.016] and 30-day mortality [OR 5.07 (1.22-20.93); p = 0.03] and was significantly associated with the development of anastomotic leak [OR 2.95 (1.41-6.18); p = 0.007]. Furthermore, it increased the risk of reoperation and was linked to a prolonged length of hospital stay., Conclusions: CT-measured sarcopenic obesity demonstrates a discernible correlation with an elevated risk of postoperative morbidity and mortality in the context of colon cancer surgery., (© 2024. The Author(s).)

Merkel cell carcinoma (MCC) is a rare neuroendocrine malignancy of the skin that is highly aggressive and often metastasizes early. MCC is diagnosed based on histopathological findings and is most commonly treated with surgical resection, which may be accompanied by chemotherapy and/or radiation. This report describes a 55-year-old male patient with the history of recurrent malignant melanoma of the right pinna and subsequent excision. Three years following the excision of melanoma, he presented with a lesion to the right forehead as well as a right-sided neck mass that were found to be metastatic Merkel cell carcinoma., Competing Interests: The authors declare that there are no competing financial or personal interests that may have influenced the production of this case report., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Eagle syndrome is a rare clinical condition that is characterized by either an elongated styloid process or a calcified stylohyoid ligament. This report describes the case of a 35-year-old woman who presented with Eagle syndrome following the treatment of recurrent laryngeal carcinoma with ionizing radiation., Competing Interests: The authors declare that there are no competing financial or personal interests that may have influenced the production of this case report., (© 2022 The Authors. Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: Early laparoscopic cholecystectomy (ELC) is the gold standard treatment for patients with acute calculous cholecystitis (ACC); however, it is still related to significant postoperative complications. The aim of this study is to identify factors associated with an increased risk of postoperative complications and develop a preoperative score able to predict them., Methods: Multicentric retrospective analysis of 1868 patients with ACC submitted to ELC. Included patients were divided into two groups according to the presentation of increased postoperative complications defined as postoperative complications ≥ Clavien-Dindo IIIa, length of stay greater than 10 days and readmissions within 30 days of discharge. Variables that were independently predictive of increased postoperative complications were combined determining the Chole-Risk Score, which was validated through a correlation analysis., Results: We included 282 (15.1%) patients with postoperative complications. The multivariate analysis predictors of increased morbidity were previous percutaneous cholecystostomy (OR 2.95, p=0.001), previous abdominal surgery (OR 1.57, p=0.031) and diabetes (OR 1.62, p=0.005); Charlson Comorbidity Index >6 (OR 2.48, p=0.003), increased total bilirubin > 2 mg/dL (OR 1.88, p=0.002), dilated bile duct (OR 1.79, p=0.027), perforated gallbladder (OR 2.62, p<0.001) and severity grade (OR 1.93, p=0.001). The Chole-Risk Score was generated by grouping these variables into four categories, with scores ranging from 0 to 4. It presented a progressive increase in postoperative complications ranging from 5.8% of patients scoring 0 to 47.8% of patients scoring 4 (p<0.001)., Conclusion: The Chole-Risk Score represents an intuitive tool capable of predicting postoperative complications in patients with ACC., (© 2021. The Society for Surgery of the Alimentary Tract.)

Various asymptotic methods of obtaining a confidence interval (CI) for the odds ratio ( OR ) have been proposed. Surprisingly, insofar as we know, the behavior of these methods has not been evaluated for data proceeding from a cross-sectional study (multinomial sampling), but only for data that originate in a prospective or retrospective study (two independent binomials sampling). The paper evaluates 15 different methods (10 classic ones and 5 new ones). Because the CI is obtained by inversion in θ of the two-tailed test for H 0(θ) : OR  =[Formula: see text] (null hypothesis), this paper evaluates the tests for various values of θ , more than the CIs that are obtained. The following statements are valid only for the two-tailed inferences based on 20 ≤  n ≤ 200 and 0.05≤  OR ≤20, since these are the limitations of the study. The two best methods are the classic Cornfield chi-squared method for 0.2≤  OR ≤5 and, in other cases, the new method of Sterne for chi-squared; but the adjusted likelihood ratio method is a good alternative to the two previous methods, especially to the first when the sample size is large. The three methods require iterative calculations to obtain the CI. If one is looking for methods that are simple to apply (that is, ones that admit a simple, explicit solution), the best option is the Gart logit method for 1/3≤  OR ≤3 and, if in other cases, the Agresti logit method. The Cornfield chi-squared and Gart logit methods should not be used outside the specified interval OR . The paper also selects the best methods for realizing the classic independence test ( θ  = 1).

Introduction: Clinical trials often suffer from significant recruitment barriers, poor adherence, and dropouts, which increase costs and negatively affect trial outcomes. The aim of this study was to examine whether making it virtual and reward-based would enable nationwide recruitment, identify patients with variable disease severity, achieve high adherence, and reduce dropouts., Methods: In a siteless, virtual feasibility study, individuals with atopic dermatitis (AD) were recruited online. During the 8-week study, subjects used their smartphones weekly to photograph target AD lesions, and completed patient-oriented eczema measure (POEM) and treatment use questionnaires. In return, subjects were rewarded every week with personalized lifestyle reports based on their DNA., Results: Over the course of the 11 day recruitment period, 164 (82% women and 18% men) filled in the form to participate, of which 65 fulfilled the inclusion criteria and signed the informed consent. Ten were excluded as they did not complete the mandatory study task of returning the DNA sample. 55 (91% women, 9% men) subjects returned the DNA sample and were enrolled throughout Denmark, the majority outside the Copenhagen capital region in rural areas with relatively low physician coverage. The mean age was 28.5 (SD ±9.5 years, range 18-52 years). The baseline POEM score was 14.5±5.6 (range 6-28). Based on the POEM, 7 individuals had mild, 28 had moderate, 17 had severe, and 3 had very severe eczema. The retention rate was 96% as 53 out of 55 enrolled completed the study. The adherence was very high, and more than 90% of all study tasks were completed. Follow up of 41 subjects showed that 90% would take part again or continue if the study had been longer., Conclusion: A virtual trial design enables recruitment with broad geographic reach and throughout the full spectrum of disease severity. Providing personalized genetic reports as a reward seems to contribute to high adherence and retention., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: Kathryn Anderson, Andrei Chiriac, Anders Daniel Andersen, Ari Pall Isberg, Fernando Gesto Moreno, Aleksander Eiken, and John Robert Zibert are employed by LEO Innovation Lab, an independently established unit of LEO Pharma A/S. There are no patents, products in development, or marketed products to declare. SFT and ZA have NO competing declaration of interest in terms of commercial affiliation, employment, consultancy, patents, in-progress products or marketed products. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

A heterogeneous group of diseases is included under the term acute transverse myelitis (ATM); these have the common factor of producing an inflammatory focal injury of the spinal cord in an acute form. Understanding of ATM is being constantly improved with the arrival of new diagnostic techniques and theories about its immune origin. Responsibility for making an early diagnosis lies primarily in the field of primary care and must always be based on the completion of a detailed clinical report together with a thorough neurological examination. Once detected, correct handling of the clinical situation will require an urgent referral to a hospital for evaluation and treatment at an early stage by multidisciplinary teams. Early intervention in many of these diseases is vital, because it improves the prognosis of these patients and significantly reduces injuries.

A mutant of Bacillus subtilis unable to adsorb phage phi29 efficiently has been isolated. This mutant can be infected by host range mutants of the phage. Since the host range mutations map in cistron 12, which codes for neck appendage protein, this would tend to confirm that these organelles are involved in viral adsorption.