Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

There was no funding support for this study. Disclosure. The authors declare no conflict of interest.Peer reviewedPublisher PD

Mechanisms of bacterial internalization in the stressed enterocyte

The 'leaky gut' hypothesiS proposes that disruption of the intestinal barrier is critical to the development of inflammatory bowel disease, and characterises the response to severe injury and infection, where local release of inflammatory mediators arid increased gut permeability lead to multiple organ failure. The mechanisms by which commensal gut bacteria enter entehocytes during inflammatory stress and the consequences for enterocyte function are unclear. The purpose of this study was to define the mechanisms by which inflammatory stimuli induce internalization of commensal bacteria within enterocytes, the signalling pathways involved, and the effects of internalized bacteria on the t~nterocyte. Caco-2 monolayers were exposed to an inflammatory stimulus in the form of IFN-y and then incubated with a variety of non-pathogenic commensal microflora. Bacterial internalization and translocation across these monolayers was .quantified by serial dilution culture, signalling mechanisms were investigated using signalling inhibitors, and US~l integrin antibody was used to determine the role of inte.grins. DNA was extracted from the different strains and screened for common bacterial adhesins. The effect of commensal E. coli strains on enterocyte IL-8 secretion was also investigated using ELISA. The translocation of bacteria appears to be strain-specific and depends on a change in the enterocyte brought about by exposure. to IFN-y. It involves interaction with US~l integrin, and utilises a Src-kinase and PI3-kinase dependent process. IFN·y does not appear to increase the expression of usn. integrin but may stimulate redistribution from the basolateral to apical membrane. Most bacterial strains possess the Type 1 fimbrial adhesin, but there appears to be nIJ difference between translocating and nontranslocating strains of E. coli. Most E. coli strains stimulate IL-8 secretion by enterocytes however, E. coli C25 inhi.bits the secretion of IL-8 in all enterocyte cell lines which is a novel finding and is worthy of further investigation. The in vitro model appears consistent and will allow the n1echanistic pathway of bacterial translocation to be elucidated.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Teaching to transform surgical culture: an educational programme and thematic analysis in a general surgery department

Abstract Introduction General surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department. Methods Twelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery. Discussion Teaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the ‘community of practice’ was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum. Conclusion Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future. </jats:sec

Teaching to transform surgical culture: An educational programme and thematic analysis in a general surgery department

Abstract IntroductionGeneral surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department. MethodsTwelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery. DiscussionTeaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the ‘community of practice’ was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum.Conclusion Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future.</jats:p

Teaching to transform surgical culture: an educational programme and thematic analysis in a general surgery department

INTRODUCTION: General surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department. METHODS: Twelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery. DISCUSSION: Teaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the ‘community of practice’ was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum. CONCLUSION: Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12909-022-03941-3

Characterisation of Escherichia coli strains involved in transcytosis across gut epithelial cells exposed to metabolic and inflammatory stress

Translocation of normally non-pathogenic bacteria across the gut may drive inflammatory responses associated with sepsis and inflammatory bowel disease. Recent evidence suggests translocation may not be purely passive, but occurs via novel transcellular pathways activated in enterocytes by inflammatory and metabolic stress. The specificity of this pathway with respect to different E. coli strains and other bacterial species, and possible molecular determinants of the "translocating" phenotype have been investigated. Translocation of E. coli strains and other bacteria was studied across Caco-2 monolayers exposed to different forms of cellular stress. All bacteria, apart from the pathogen Shigella sonnei, exhibited low levels of translocation in untreated monolayers. However, following enterocyte stress, translocation of E. coli strains C25 and HBTEC-1 was markedly stimulated, accompanied by increased internalisation into enterocytes. C25 and HBTEC-1 were typed to ECOR group A and group D respectively. Pathoarray analysis showed both strains had profiles quite different to those predicted for typical ExPEC isolates, lacking many of the genes associated with pathogenicity, although they contained several ORFs in common with ExPEC isolates. These data suggest translocating E. coli strains associated with infections are not opportunistic ExPEC strains but may comprise a separate group of E. coli strains. © 2008 Elsevier Masson SAS. All rights reserved

Additional file 1 of Teaching to transform surgical culture: an educational programme and thematic analysis in a general surgery department

Additional file 1

Calculating the risk of a pancreatic fistula after a pancreaticoduodenectomy: a systematic review

AbstractBackgroundA post‐operative pancreatic fistula (POPF) is a major cause of morbidity and mortality after a pancreaticoduodenectomy (PD). This systematic review aimed to identify all scoring systems to predict POPF after a PD, consider their clinical applicability and assess the study quality.MethodAn electronic search was performed of Medline (1946–2014) and EMBASE (1996–2014) databases. Results were screened according to Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines, and quality assessed according to the QUIPS (quality in prognostic studies) tool.ResultsSix eligible scoring systems were identified. Five studies used the International Study Group on Pancreatic Fistula (ISGPF) definition. The proposed scores feature between two and five variables and of the 16 total variables, the majority (12) featured in only one score. Three scores could be fully completed pre‐operatively whereas 1 score included intra‐operative and two studies post‐operative variables. Four scores were internally validated and of these, two scores have been subject to subsequent multicentre review. The median QUIPS score was 38 out of 50 (range 16–50).ConclusionThese scores show potential in calculating the individualized patient risk of POPF. There is, however, much variation in current scoring systems and further validation in large multicentre cohorts is now needed