2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias

Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.Peer reviewe

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

BMC Public Health

BACKGROUND: Connected health devices and applications (referred to hereafter as "SDApps" - Smart devices and applications) are being portrayed as a new way for prevention, with the promise of accessibility, effectiveness and personalization. Many effectiveness evaluations (experimental designs) with strong internal validity exist. While effectiveness does appear to vary, the mechanisms used by these devices have not yet been thoroughly investigated. This article seeks to unpack this black box, and describes the process of elaboration of an intervention theory for healthy eating and physical activity SDApps. It includes a set of requirements relative to their impact on social health inequalities. METHODS: To build this theory, we drew on theory-driven approaches and in particular on the theory of change (ToC) method. To this end, we developed a cumulative and iterative process combining scientific data from the literature with knowledge from experts (researchers and practitioners) and from patients or users. It was a 3-step process, as follows: 1 - identifying the evidence base; 2 - developing the theory through design intervention and creating realistic expectations, including in our case specific work on social health inequalities (SHIs); 3 - modeling process and outcome. RESULTS: We produced an evidence-based theory according to the ToC model, based on scientific evidence and knowledge from experts and users. It sets out a causal pathway leveraging 11 key mechanisms - theoretical domains - with which 50 behavior change techniques can be used towards 3 ultimate goals: Capacity, Opportunity, Motivation - Behavior (COM-B). Furthermore, the theory specifically integrates requirements relative to the impact on SHIs. CONCLUSIONS: This theory is an aid to SDAapp design and evaluation and it can be used to consider the question of the possible impact of SDApps on the increase in inequalities. Firstly, it enables developers to adopt a more overarching and thorough approach to supporting behavior change, and secondly it encourages comprehensive and contributive evaluations of existing SDApps. Lastly, it allows health inequalities to be fully considered

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.Peer reviewe

Victoriomyces antarcticus gen. nov., sp. nov., a distinct evolutionary lineage of the Cephalothecaceae (Ascomycota) based on sequence-based phylogeny and morphology

In this study, we propose a new genus, Victoriomyces, with a new species, Victoriomyces antarcticus, isolated from soil samples collected in Victoria Land, Antarctica. To determine its taxonomic status and evolutionary relationships, a phylogenetic analysis was performed on DNA sequences from the nuclear 18S rRNA, 28S rRNA, and the second largest subunit of RNA polymerase II (RPB2) genes. Victoriomyces antarcticus constitutes one well-supported distinct lineage within the Cephalothecaceae (family incertae sedis in Sordariomycetes), in which the only recognised anamorphs belong to the genus Phialemonium and to Acremonium thermophilum. Victoriomyces antarcticus can be clearly distinguished from these taxa by means of a DNA sequence analysis and its morphological traits that consist in having a Metarhizium-like anamorph, dark red-coloured like-disk structures, immature bodies, and the production of an intense red pigment in the growth media. Finally, we inferred the divergence time of V. antarcticus and the Cephalothecaceae using Bayesian analysis and secondary calibration. The type strain of V. antarcticus is FBL 165T = MUT 3686 = CCF (number pending); an additional strain of the species is FBL 577. The MycoBank number is MB 823713 for the genus and MB 823714 for the species

Dynamics of fungi and fungivorous microarthropods in a Mediterranean maquis soil affected by experimental fire

In a Mediterranean area of Southern Italy, affected by low- and high-severity experimental fires, burned and unburned soils were analysed, at 245, 364 and 728 days after fire, for total and active fungal mycelium mass, abundance, species density and species composition of total, xerotolerant and heat-stimulated culturable fungi, oribatid mites and springtails. Principal Component Analysis was used to compare species composition of fungal community and faunal groups in burned and unburned plots. Independently of severity, fire generally caused a decrease in fungal mass, an increase in culturable total, xerotolerant and heat-stimulated fungi abundance (CFU), and minor changes in fungal species density. In parallel, fire induced a reduction in abundance and species density of studied faunal groups, generally correlated with fungal changes, and was consistently associated with the appearance of fungal and faunal species not present in control. Moreover, qualitative and quantitative changes in fungal community and faunal groups were recorded in association with sampling time. The results also suggested that the mosaic of burned and unburned areas, typical of a Mediterranean maquis affected by fire, could promote biodiversity in soil by favouring the contemporary presence of species typical of disturbed and undisturbed areas. © 2013