Intraoperative surgical site infection control and prevention: a position paper and future addendum to WSES intra-abdominal infections guidelines.

BACKGROUND: Surgical site infections (SSI) represent a considerable burden for healthcare systems. They are largely preventable and multiple interventions have been proposed over past years in an attempt to prevent SSI. We aim to provide a position paper on Operative Room (OR) prevention of SSI in patients presenting with intra-abdominal infection to be considered a future addendum to the well-known World Society of Emergency Surgery (WSES) Guidelines on the management of intra-abdominal infections. METHODS: The literature was searched for focused publications on SSI until March 2019. Critical analysis and grading of the literature has been performed by a working group of experts; the literature review and the statements were evaluated by a Steering Committee of the WSES. RESULTS: Wound protectors and antibacterial sutures seem to have effective roles to prevent SSI in intra-abdominal infections. The application of negative-pressure wound therapy in preventing SSI can be useful in reducing postoperative wound complications. It is important to pursue normothermia with the available resources in the intraoperative period to decrease SSI rate. The optimal knowledge of the pharmacokinetic/pharmacodynamic characteristics of antibiotics helps to decide when additional intraoperative antibiotic doses should be administered in patients with intra-abdominal infections undergoing emergency surgery to prevent SSI. CONCLUSIONS: The current position paper offers an extensive overview of the available evidence regarding surgical site infection control and prevention in patients having intra-abdominal infections.

Desmocollin 1 and desmoglein 1 expression in human epidermis and keratinizing oral mucosa: a comparative immunohistochemical and molecular study.

Epidermis and keratinizing oral mucosa (KOM) are effective barriers against a wide spectrum of insults. The optimal form of protection provided by each epithelium is determined also by the molecular composition of desmosomes. Up to now, the expression of the "skin type" desmosomal cadherins, i.e. desmocollin 1 (Dsc1) and desmoglein 1 (Dsg1), was correlated with the morphological features of keratinocyte terminal differentiation in epidermis, but not in KOM. The aim of the present study was to investigate Dsc1 and Dsg1 expression in adult human KOM compared to epidermis. Biopsies of epidermis and KOM were obtained from young healthy adults (n=6) and simultaneously processed for immunofluorescence analysis, post-embedding immunogold electron microscopy (immunogold EM), and RT-PCR analysis. For molecular biology analysis, as a negative control, we considered human fibroblasts. By immunofluorescence and immunogold EM, Dsc1 labeling was not detected in any suprabasal layer of KOM, but it was present in the upper spinous/granular layers of epidermis. Immunofluorescence and transmission electron microscopy analysis showed that (i) Dsg1 expression was evident in the spinous, granular, and horny layer of the oral epithelium and (ii) Dsg1 immunoreactivity was always lower in desmosomes between oral keratinocytes than in all epidermal junctions. RT-PCR analysis confirmed that in KOM Dsc1 gene expression was undetectable. On the whole, these observations suggest a weakened adhesion in KOM, allowing oral keratinocytes to undergo a faster transition throughout the living layers of the epithelium. The intrinsic and specific regulation of the molecular composition of desmosomes can contribute in defining a specific keratinocyte phenotype in KOM and in epidermis.

Desmocollin 1 expression and desmosomal remodeling during terminal differentiation of human anagen hair follicle: an electron microscopic study.

The terminal differentiation (TD) program of keratinocytes of the human hair follicle (HF) occurs with specific temporal and spatial features in the various layers of the inner root sheath (IRS) and in the innermost layer of the outer root sheath (companion layer). This process is characterized by complex nuclear and cytoplasmic morphological changes, accompanied by profound modifications in intercellular junctions. As no correlation exists between the structure and the molecular composition of desmosomes during TD of the IRS/companion unit, the aim of our study was to investigate by transmission electron microscopy the remodeling of desmosomes in keratinizing cells of these compartments. By immunogold post embedding technique, we studied in anagen HFs the modulation of the synthesis of desmocollin 1 (Dsc1), a transmembrane glycoprotein specifically synthesized in the IRS and in the companion layer. Dsc1 immunoreactivity was actually confined to these compartments and tended to increase just before the level of TD, particularly in the Henle's layer and in the IRS cuticle. In Huxley's layer, the immunolabeling was patchy and in the companion layer Dsc1 synthesis was detected above the level of keratinization of Huxley's layer. In the whole IRS, concomitantly with TD, there was an abrupt and almost complete disappearance of Dsc1 synthesis. An asymmetric distribution of Dsc1 was noticed (i) between cells at different stages of differentiation and (ii) between cells belonging to layers with different spatial/temporal features of TD. Our results show that the ultrastructural modifications of desmosomes during TD of HF are paralleled by the modulation of the synthesis of desmocollin 1.