THE AFTERCARE SURVEY:Assessment and intervention practices after brain tumour surgery in Europe

Introduction People with gliomas need specialized neurosurgical, neuro-oncological, psycho-oncological, and neuropsychological care. The role of language and cognitive recovery and rehabilitation in patients’ well-being and resumption of work is crucial, but there are no clear guidelines for the ideal timing and character of assessments and interventions. The goal of the present work was to describe representative (neuro)psychological practices implemented after brain surgery in Europe. Methods An online survey was addressed to professionals working with individuals after brain surgery. We inquired about the assessments and interventions and the involvement of caregivers. Additionally, we asked about recommendations for an ideal assessment and intervention plan. Results Thirty-eight European centres completed the survey. Thirty of them offered at least one post-surgical (neuro)psychological assessment, mainly for language and cognition, especially during the early recovery stage and at long-term. Twenty-eight of the participating centres offered post-surgical therapies. Patients who stand the highest chances of being included in evaluation and therapy post-surgically are those who underwent awake brain surgery, harboured a low-grade glioma, or showed poor recovery. Nearly half of the respondents offer support programs to caregivers, and all teams recommend them. Treatments differed between these offered to individuals with low-grade glioma versus those with high-grade glioma. The figure of caregiver is not yet fully recognized in the recovery phase. Conclusion We stress the need for more complete rehabilitation plans, including the emotional and health-related aspects of recovery. In respondents´ opinions, assessment and rehabilitation plans should also be individually tailored and goal-directed (e.g., professional reinsertion)

Three-row versus two-row circular staplers for left-sided colorectal anastomosis: a propensity score-matched analysis of the iCral 2 and 3 prospective cohorts

Background: Since most anastomoses after left-sided colorectal resections are performed with a circular stapler, any technological change in stapling devices may influence the incidence of anastomotic adverse events. The aim of the present study was to analyze the effect of a three-row circular stapler on anastomotic leakage and related morbidity after left-sided colorectal resections. Materials and methods: A circular stapled anastomosis was performed in 4255 (50.9%) out of 8359 patients enrolled in two prospective multicenter studies in Italy, and, after exclusion criteria to reduce heterogeneity, 2799 (65.8%) cases were retrospectively analyzed through a 1:1 propensity score-matching model including 20 covariates relative to patient characteristics, to surgery and to perioperative management. Two well-balanced groups of 425 patients each were obtained: group (A) – true population of interest, anastomosis performed with a three-row circular stapler; group (B) – control population, anastomosis performed with a two-row circular stapler. The target of inferences was the average treatment effect in the treated (ATT). The primary endpoints were overall and major anastomotic leakage and overall anastomotic bleeding; the secondary endpoints were overall and major morbidity and mortality rates. The results of multiple logistic regression analyses for the outcomes, including the 20 covariates selected for matching, were presented as odds ratios (OR) and 95% confidence intervals (95% CI). Results: Group A versus group B showed a significantly lower risk of overall anastomotic leakage (2.1 vs. 6.1%; OR 0.33; 95% CI 0.15–0.73; P = 0.006), major anastomotic leakage (2.1 vs. 5.2%; OR 0.39; 95% CI 0.17–0.87; P = 0.022), and major morbidity (3.5 vs. 6.6% events; OR 0.47; 95% CI 0.24–0.91; P = 0.026). Conclusion: The use of three-row circular staplers independently reduced the risk of anastomotic leakage and related morbidity after left-sided colorectal resection. Twenty-five patients were required to avoid one leakage

Acute diverticulitis management: evolving trends among Italian surgeons. A survey of the Italian Society of Colorectal Surgery (SICCR)

Acute diverticulitis (AD) is associated with relevant morbidity/mortality and is increasing worldwide, thus becoming a major issue for national health systems. AD may be challenging, as clinical relevance varies widely, ranging from asymptomatic picture to life-threatening conditions, with continuously evolving diagnostic tools, classifications, and management. A 33-item-questionnaire was administered to residents and surgeons to analyze the actual clinical practice and to verify the real spread of recent recommendations, also by stratifying surgeons by experience. CT-scan remains the mainstay of AD assessment, including cases presenting with recurrent mild episodes or women of child-bearing age. Outpatient management of mild AD is slowly gaining acceptance. A conservative management is preferred in non-severe cases with extradigestive air or small/non-radiologically drainable abscesses. In severe cases, a laparoscopic approach is preferred, with a non-negligible number of surgeons confident in performing emergency complex procedures. Surgeons are seemingly aware of several options during emergency surgery for AD, since the rate of Hartmann procedures does not exceed 50% in most environments and damage control surgery is spreading in life-threatening cases. Quality of life and history of complicated AD are the main indications for delayed colectomy, which is mostly performed avoiding the proximal vessel ligation, mobilizing the splenic flexure and performing a colorectal anastomosis. ICG is spreading to check anastomotic stumps’ vascularization. Differences between the two experience groups were found about the type of investigation to exclude colon cancer (considering the experience only in terms of number of colectomies performed), the size of the peritoneal abscess to be drained, practice of damage control surgery and the attitude towards colovesical fistula

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The impact of synchronous liver resection on the risk of anastomotic leakage following elective colorectal resection. A propensity score match analysis on behalf of the iCral study group

Introduction: how best to manage patients with colorectal cancer and synchronous liver metastasis is still controversial, with specific concerns of increased risk of postoperative complications following combined resection. We aimed at analyzing the influence of combined liver resection on the risk of anastomotic leak (AL) following colorectal resection. Methods: we reviewed the iCral prospectively maintained database to compare the relative risk of AL of patients undergoing colorectal resection for cancer to that of patients receiving simultaneous liver and colorectal resection for cancer with isolated hepatic metastases. The incidence of AL was the primary outcome of the analysis. Perioperative details and postoperative complications were also appraised. Results: out of a total of 996 patients who underwent colorectal resection for cancer, 206 receiving isolated colorectal resection were compared with a matched group of 53 patients undergoing simultaneous liver and colorectal resection. Combined surgery had greater operative time and resulted in longer postoperative hospitalization compared to colorectal resection alone. The proportion of overall morbidity following combined resection was significantly higher than after isolated colorectal resection (56.6% vs. 37.9%, p = 0.021). Overall, the two groups of patients did not differ neither on the rate of major postoperative complications, nor in terms of AL (9.4% vs. 6.3%, p = 0.381). At specific multivariate analysis, the duration of surgery was the only risk factor independently associated with the likelihood of AL. Conclusions: combining hepatic with colorectal resection for the treatment of synchronous liver metastasis from colorectal cancer does not increase significantly the incidence of AL

Gastrobronchial Fistula After Re-Sleeve Gastrectomy: Case Report and Review of Literature

Introduction: Gastro-bronchial fistula (GBF) is a rare and challenging complication of sleeve gastrectomy as it is the result of a chronic gastric leak and subsequent long-standing sub-phrenic abscess. In this article we report the first case of GBF after a re-sleeve gastrectomy. Case Presentation: a 42-years-old patient was admitted to our Unit because of the arise of sepsis, hypothension and cough with expectoration of enteral nutrition. The patient had a history of sleeve (2010) and re-sleeve gastrectomy (2017) for weight regain. On admission radiological signs of consolidation of the left pulmonary lobe and, after the swallowing of oral contrast, a little backward trans-diaphragmatic opacification of the main bronchus was described. An open total gastrectomy with a trans-abdominal atypical lower pulmonary lobe resection were performed. A post-operative ERAS protocol was adopted, and the patient was discharged in POD 9 in good conditions, after an uneventful recovery and feeding per os. Conclusions: To our knowledge this is the first case of a GBF after a re-sleeve gastrectomy, more evidences are needed before routinely advice a re-sleeve gastrectomy after a failed sleeve gastrectomy. Indeed, given that in revisional bariatric surgery the risk of gastric leak may be higher due to a greater tension applied on the staple line, the incidence of rare but serious complications such GBF may consequently increase.</jats:p

Micropropagação de Salvia officinalis L. com avaliação do teor de fenóis totais e atividade antioxidante

Stem cuts and seeds of Salvia officinalis were incubated on nutrient media for plantlets production and analysis of the total phenolic compounds, total flanovoids and antioxidant activity in micropropagated plants. Explants were obtained from seedlings and inoculated on MS with different concentrations of benzylaminopurine (BAP) and indolbutyric acid (IBA). After 30 and 60 days of incubation, the explants were scored for percentage of contaminated, dead and oxidized explants and mean bud numbers. For bud formation, the most efficient treatment was the medium containing BAP at 1 mg L-1, for the plantlet height the better medium was the control without the addition of plant regulator. IBA promoted the formation of few roots. Our results indicated that stem cuts incubated on media containing BAP and/or IBA did not increase the total flavonoid contents, but increased the total phenolics' by BAP and high antioxidant activity by 1 mg L-1 BAP

Micropropagação de Salvia officinalis L. com avaliação do teor de fenóis totais e atividade antioxidante

Stem cuts and seeds of Salvia officinalis were incubated on nutrient media for plantlets production and analysis of the total phenolic compounds, total flanovoids and antioxidant activity in micropropagated plants. Explants were obtained from seedlings and inoculated on MS with different concentrations of benzylaminopurine (BAP) and indolbutyric acid (IBA). After 30 and 60 days of incubation, the explants were scored for percentage of contaminated, dead and oxidized explants and mean bud numbers. For bud formation, the most efficient treatment was the medium containing BAP at 1 mg L-1, for the plantlet height the better medium was the control without the addition of plant regulator. IBA promoted the formation of few roots. Our results indicated that stem cuts incubated on media containing BAP and/or IBA did not increase the total flavonoid contents, but increased the total phenolics' by BAP and high antioxidant activity by 1 mg L-1 BAP

Micropropagation of Salvia officinalis L. with evaluation of phenolics compounds and antioxidant activity

Stem cuts and seeds of Salvia officinalis were incubated on nutrient media for plantlets production and analysis of the total phenolic compounds, total flanovoids and antioxidant activity in micropropagated plants. Explants were obtained from seedlings and inoculated on MS with different concentrations of benzylaminopurine (BAP) and indolbutyric acid (IBA). After 30 and 60 days of incubation, the explants were scored for percentage of contaminated, dead and oxidized explants and mean bud numbers. For bud formation, the most efficient treatment was the medium containing BAP at 1 mg L-1, for the plantlet height the better medium was the control without the addition of plant regulator. IBA promoted the formation of few roots. Our results indicated that stem cuts incubated on media containing BAP and/or IBA did not increase the total flavonoid contents, but increased the total phenolics' by BAP and high antioxidant activity by 1 mg L-1 BAP.Universidade Estadual Paulista Júlio de Mesquita Filho/UNESP Departamento de Química e Bioquímica IB, Caixa Postal 510 - Distrito de Rubião Junior, CEP18.618-000, Botucatu, SPUniversidade Estadual Paulista Júlio de Mesquita Filho/UNESP Departamento de Botânica - UNESP, CP 199, Rio Claro, CEP 13506-900 SPUniversidade Estadual Paulista Júlio de Mesquita Filho/UNESP Departamento de Química e Bioquímica IB, Caixa Postal 510 - Distrito de Rubião Junior, CEP18.618-000, Botucatu, SPUniversidade Estadual Paulista Júlio de Mesquita Filho/UNESP Departamento de Botânica - UNESP, CP 199, Rio Claro, CEP 13506-900 S