PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol.

Background: Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices. Methods: This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using QualtricsXM Platform™ through national and international surgical colleges and societies, in addition to social media and snowballing. Data collection will be open for 3 months with reminders, and raking will be used to ascertain the sample. Responses will be analyzed, and the chi-square test used to evaluate the impact of SSI prevention variables on responses. Discussion: Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.

Asymptomatic bacteriuria in candidates for active treatment of renal stones: results from an international multicentric study on more than 2600 patients.

The occurrence of asymptomatic bacteriuria concomitant to urolithiasis is an issue for patients undergoing renal stone treatment. Disposing of a preoperative urine culture is essential to reduce the risk of septic events. The endpoint of the study is to report which characteristics of candidates for renal stone treatment are frequently associated with positive urine culture. 2605 patients were retrospectively enrolled from 14 centers; inclusion criteria were age > 18 and presence of a single renal stone 1-2 cm in size. The variables collected included age, gender, previous renal surgery, comorbidities, skin-to-stone distance, stone size, location, density, presence of hydronephrosis. After a descriptive analysis, the association between continuous and categorical variables and the presence of positive urine culture was assessed using a logistic regression model. Overall, 240/2605 patients (9%) had preoperative bacteriuria. Positive urine culture was more frequent in females, patients with previous renal interventions, chronic kidney disease, congenital anomalies, larger stones, increased density. Multivariate analysis demonstrated that previous renal interventions (OR 2.6; 95% CI 1.9-3.4; p < 0.001), renal-related comorbidities (OR 1.31; 95% CI 1.19-1.4; p < 0.001), higher stone size (OR 1.06; 95% CI 1.02-1.1; p = 0.01) and density (OR 1.00; 95% CI 1.0-1.00; p = 0.02) were associated with bacteriuria; male gender and lower caliceal location were inversely related to it. Beyond expected risk factors, such as female gender, other parameters are seemingly favoring the presence of positive urine culture. The awareness of variables associated with bacteriuria allows to assess which individuals are at increased risk of presenting bacteriuria and reduce the rate of septic complications.

Current approaches to avoid the culling of day-old male chicks in the layer industry, with special reference to spectroscopic methods.

The negative correlation between fattening and laying performance prevents breeding improvement in both laying performance and meat yield. Therefore, specialized chicken lines have been bred in order to achieve either an efficient production of high-quality eggs or high growth rates. As a result, day-old male chicks are culled in the layer hatchery, which poses animal welfare and ethical problems. Breeding companies, scientific groups, and hatcheries are attempting to resolve this issue, with a common aim to find feasible alternatives for the routine killing of male layer chicks. Some approaches aim to influence the sex ratio, while others target at the economically feasible use of the male layer offspring, such as the fattening of "laying hen brothers" or crossbreedings of layers and broilers to create "dual-purpose chickens." Another approach is the sex determination prior to hatch. One of the prerequisites of in ovo sex determination is a practicable method that can be used in industry. The analysis needs to be rapid, cost-efficient, and highly precise; in addition, negative impacts on hatching rate, animal health, and/or performance parameters should be limited. Furthermore, sex determination should be performed before the sensory nervous system's response of the chick embryo to certain or potentially harmful stimuli is developed, which according to current knowledge is before the d 7 of incubation.

Sialidase NEU4 is involved in glioblastoma stem cell survival.

The human sialidase, NEU4, has emerged as a possible regulator of neuronal differentiation and its overexpression has been demonstrated to promote the acquisition of a stem cell-like phenotype in neuroblastoma cells. In this paper, we demonstrated that glioblastoma stem cells (GSCs) isolated from glioblastoma multiforme (GBM) cell lines and patients' specimens as neurospheres are specifically marked by the upregulation of NEU4; in contrast, the expression of NEU4 is very low in non-neurosphere-differentiated GBM cells. We showed that NEU4 silencing by miRNA or a chemical inhibitor of its catalytic activity triggered key events in GSCs, including (a) the activation of the glycogen synthase kinase 3ß, with the consequent inhibition of Sonic Hedgehog and Wnt/ß-catenin signalling pathways; (b) the decrease of the stem cell-like gene expression and marker signatures, evidenced by the reduction of NANOG, OCT-4, SOX-2, CD133 expression, ganglioside GD3 synthesis, and an altered protein glycosylation profile; and (c) a significant decrease in GSCs survival. Consistent with this finding, increased NEU4 activity and expression induced in the more differentiated GBM cells by the NEU4 agonist thymoquinone increased the expression of OCT-4 and GLI-1. Thus, NEU4 expression and activity appeared to help to determine the molecular signature of GSCs and to be closely connected with their survival properties. Given the pivotal role played by GSCs in GBM lethality, our results strongly suggest that NEU4 inhibition could significantly improve current therapies against this tumour.

Laparoscopic approach in perforated appendicitis: increased incidence of surgical site infection?

BACKGROUND: The role of laparoscopy in the setting of perforated appendicitis remains controversial. A retrospective study was conducted to evaluate the early postoperative outcomes of laparoscopic appendectomy (LA) compared to open appendectomy (OA) in patients with perforated appendicitis. METHODS: A total of 1,032 patients required an appendectomy between January 2005 and December 2009. Among these patients, 169 presented with perforated appendicitis. Operation times, length of hospital stay, overall complication rates within 30 days, and surgical site infection (SSI) rates were analyzed. RESULTS: Out of the 169 evaluated patients, 106 required LA and 63 OA. Although operation times were similar in both groups (92 ± 31 min for LA vs. 98 ± 45 for OA, p = 0.338), length of hospital stay was shorter in the LA group (6.9 ± 3.8 days vs. 11.5 ± 9.2, p < 0.001). Overall complication rates were significantly lower in the LA group (32.1 vs. 52.4 %, p < 0.001), as were incisional SSI (1.9 vs. 22.2 %, p < 0.001). Organ/space SSI rates were similar in both groups (23.6 % after LA vs. 20.6 % after OA, p = 0.657). CONCLUSIONS: For perforated appendicitis, LA results in a significantly shorter hospital stay, fewer overall postoperative complications, and fewer wound infections compared to OA. Organ/space SSI rates were similar for both procedures. LA provides a safe option for treating patients with perforated appendicitis.

Effects of low- and high-intensity exercise training on body composition and substrate metabolism in obese adolescents.

The objective was to investigate the effects of a 3- week weight-management program including moderate energy restriction and exercise training at 2 intensities [low intensity (LI): 40% and high intensity (HI): 70% maximal oxygen uptake (V'O(2)max)] on body composition, energy expenditure, and fat oxidation rate in severely obese adolescents. Twenty obese adolescents, aged 15-17 yr (body mass index: 37.5 kg/m(2); 38.2% fat mass) participated in this study. Before starting (week 0, W0) and at the end of the weight-management period (week 3,W3), body composition was assessed by a multifrequency tetrapolar impedancemeter; basal metabolic rate (BMR), energy expenditure, and substrate oxidation rate during exercise and post-exercise recovery by indirect calorimetry. At W3, body mass and fat mass decreased significantly (p<0.005) in all groups, and the decreases were significantly greater in the LI than in the HI group (-8.1±1.6 vs -5.9±1.6 kg and -4.2±1.9 vs -2.3±1.7 kg, p<0.05, respectively). Predicted V'O(2)max, expressed in relative values, changed significantly only in the HI group by +0.010±0.006 l/(kg fat-free mass × min) (p=0.010). By contrast, no significant changes were observed at W3 in BMR, energy expenditure, and substrate oxidation rate during exercise and post-exercise recovery. In conclusion, LI (40% of V'O(2)max) physical activity favors fat oxidation and it seems advisable to encourage obese adolescents to perform LI physical activity which is more feasible and acceptable than intense exercise.

Mastectomia bilateral de limpieza: complicación a distancia de los implantes mamarios: revisión literaria acerca de un caso clínico / Cleaning bilateral mastectomy: remote complication of breast implants: literature review on a case

En la actualidad los implantes mamarios son utilizados como material médico para la corrección quirúrgica de malformaciones congénitas, como método de reconstrucción total en cáncer y por motivos estéticos para dar mayor volumen a los mismos. Como alternativa luego de una mastectomia las prótesis anatómicas o asimétricas sin superar a los colgajos autólogos, ofrecen resultados cosméticos aceptables. Debido a su comprobada tolerancia, adaptabilidad e índices despreciables de complicaciones, los resultados en términos de satisfacción han popularizado su uso en todo el mundo. En general las complicaciones inmediatas como hematomas o infección en condiciones quirúrgicas óptimas rondaría el 2 %, así mismo los eventos a largo plazo como encapsulamiento, rotura contenidao con migración de partículas dependen de factores inherentes a la calidad del producto y las condiciones del organismo. Las consecuencias de las mismas exigen en la mayoría de los casos una corrección local y cambio del o los implantes. No existe correlación biológica comprobadaentre el desarrollo de cáncer mamario o enfermedades auto inmunes y los componentes químicos de las prótesis.Sin embargo un cáncer “de novo” en mujeres portadoras de implantes o los hallazgos fortuitos de focos neoplásicos al momento de una cirugía estética, son bien probados aunque estadísticamente despreciables. El caso presentado, aislado y anecdótico se trata de una mujer de 62 años con el antecedente de cirugía estética mamaria hacía 36 años. Consulta con los senos aumentados de tamaño, deformados y de aspecto inflamatorio tumoral. Cuadro de rápida evolución que indica una mastectomiabilateral. La anatomía patológica no evidencia proceso maligno, más que una extensa reacción inflamatoria a cuerpo extraño. A partir de este caso, una revisión histórica acerca de la evolución de los materiales y métodos de aumentación mamaria hemos llevado a cabo.

[Rotator cuff diseases in occupational medicine between occupational diseases and accidents: medical-legal considerations]. / La patologia della cuffia dei rotatori in Medicina del Lavoro tra tecnopatia ed infortunio: considerazioni medico-legali.

The authors have gone through the complaints concerning all the cases of shoulder accidents at work filed by the Genoa office of the Italian Workers' National compensation Agency (INAIL) during the two years' period 2006-2007, reviewing in particular those somehow affecting rotator components. The aim of this paper is to assess the real role played by the occupational trauma in the rotator cuff tear. The data gathered so far have shown, on the one hand, a high prevalence of pre-existing inflammatory and degenerative diseases and, on the other, a rather modest influence of the trauma which, for this reason, has usually borne, as an immediate medico-legal consequence, the rejection of a cause-effect relationship between the accident and the rotator cuff lesion, without taking into any account whether the worker was likely to be affected by an occupational disease (ex table Ministerial Decree n. 81 April 9th 2008- item 78). In such cases a systematic and in-depth investigation of the occupational case history is suggested, in order to highlight the possible pre-existence of a former biomechanical overload of the upper limbs, so as to allow the physician to detect a pathology often misdiagnosed.

Metabolic responses to submaximal treadmill walking and cycle ergometer pedalling in obese adolescents.

Physical activity is essential in obesity management because of the impact of exercise-related energy expenditure (EE) and fat oxidation (Fox) rate on a daily balance, but the specific physiological effects of different exercise modalities are scarcely known in obese individuals. The objective of the study was to compare the metabolic responses to treadmill (TM) and cycle ergometer (CE) exercise in obese adolescents. Gas exchange, heart rate (HR), blood lactate (LA) concentration, EE and Fox were determined at different intensity levels (up to about 85% of maximal oxygen uptake) during TM and CE in 14 pubertal (Tanner stage: >3) obese (BMI SDS: 2.15-3.86) male adolescents (age: 13-18 years). At comparable HR, oxygen uptake, EE and Fox were higher, and LA lower, during TM than CE (P<0.05-0.001), suggesting that cycling imposes a metabolic involvement at the level of the single active muscles greater than walking. Therefore, due to different physiological responses to TM and CE, walking was more convenient than cycling in obese adolescents, permitting to attain the same EE at lower HR, with lower blood LA concentration and with greater Fox. These conclusions seem clinically relevant when using exercise as a part of multidisciplinary treatment for juvenile obesity and amelioration of related metabolic disturbances.

The energy cost of cycling and aerobic performance of obese adolescent girls.

In order to assess the energy cost of cycling and aerobic capacity in juvenile obesity, responses to cycle ergometer exercise were studied in 10 pubertal obese (OB) [body mass index (BMI) SD score (SDS): 3.40+/-0.58 SD] adolescent girls (age: 16.0+/-1.2 yr) and in 10 normal-weight (NW, BMI SDS: -0.30+/-0.54) girls of the same age (15.1+/-1.9). To this aim, gas exchange, heart rate (HR), and energy expenditure (EE) were studied during graded cycle ergometer test at 40, 60, 80, 100, and 120 W. The energy cost of cycling was higher in OB, being oxygen uptake (VO2) higher (about 20%) in OB than in NW girls at all workloads (p<0.01-0.001). Estimated maximal VO2 and VO2 at anaerobic threshold were significantly (p<0.05) higher in OB girls [although lower per unit body mass (p<0.01) and similar for unit fat-free mass], and explained the higher oxygen pulse and lower HR for any EE observed during submaximal exercise in OB. While net mechanical efficiency (ME) was significantly lower in OB (p<0.01), delta ME was similar in both groups, indicating no substantial derangement of muscle intrinsic efficiency. It is concluded that, despite a higher cost of cycling, OB girls can rely on a larger aerobic capacity which makes them able to sustain this kind of exercise within a wide range of work loads, with relevant implications when planning protocols of physical activity in the context of interventions for the reduction of juvenile obesity.

Physical activity ratios for various commonly performed sedentary and physical activities in obese adolescents.

The physical activity ratio (PAR) values are commonly used to convert subjects' physical activity recalls into estimates of daily energy expenditure (DEE). A PAR is defined as the ratio between energy expenditure corresponding to a sedentary or a physical activity (kJ/min) and basal metabolic rate [(BMR) kJ/min]. The objective of the present study was to determine the PAR for different sedentary and physical activities in obese adolescents. Thirty-three obese adolescents [mean body mass index: 35.1 kg/m2; 40.3 % fat mass] aged 11 to 17 yr participated in this study. BMR was assessed by indirect calorimetry after an overnight fast by means of an open-circuit, indirect computerised calorimetry with a rigid, transparent, ventilated canopy. Energy expenditures corresponding to various sedentary and physical activities in free-living conditions were determined using a portable metabolic unit, and body composition by bioelectrical impedance analysis (BIA). The PAR of each activity was obtained by dividing the assessed energy expenditure by BMR. In this study, the PAR of various sedentary and physical activities did not vary significantly with sex, age, and body mass. Thus, the data for boys and girls were combined and the PAR for 27 sedentary and physical activities were determined. The PAR values can be applied to determine the mean DEE (kJ) using the specific equation considering BMR (kJ/min), PAR, and duration (min) of each activity performed by the subject during the 24 h. This information will be useful to health-care professionals because estimation of DEE in obese adolescents is necessary in order to prescribe an adequate dietary therapy to induce a desired level of energy deficit.

Indicators of theory of mind in narrative production: a comparison between individuals with genetic syndromes and typically developing children.

It is a matter of debate whether the development of theory of mind (ToM) depends on linguistic development or is, rather, an expression of cognitive development. The study of genetic syndromes, which are characterized by intellectual impairment as well as by different linguistic profiles, may provide useful information with respect to this issue. The present study compares indicators of ToM in the narrative production of individuals with Cornelia de Lange syndrome, Down syndrome, Williams syndrome and typically developing children, matched on sex and mental age. Statistical comparisons of data obtained from a qualitative analysis of the narrative production of the different groups confirm the presence of distinctive patterns, mainly related to the effective use of personal pronouns. The analysis of correlations among story-telling variables and other cognitive and linguistic variables suggests that the relationship between language development, cognitive development, and the emergence of ToM cannot be reduced to unidirectional causal links.

Epilepsy and limb girdle muscular dystrophy type 2A: double trouble, serendipitous finding or new phenotype?

Autosomal recessive limb girdle muscular dystrophies (LGMD) type 2A are a group of disorders characterised by progressive involvement of proximal limb girdle muscles and caused by changes in the CAPN3 gene. Involvement of tissues other than the skeletal muscle has not been reported so far. Here we describe the unusual association of LGMD2A and idiopathic generalised epilepsy in a 14-year-old girl.

Detección de infección por VIH a través de test rápido en mujeres embarazadas: una estrategia exitosa para disminuir su transmisión vertical / Detection of HIV infection in pregnant women by rapid testing: a successful strategy to reduce its vertical transmission

En Uruguay existe un gran porcentaje de mujeres que no controlan su embarazo y donde la transmisión vertical de la infección por VIH alcanza al 50 por ciento. Objetivo: conocer la prevalencia de infección por VIH en mujeres embarazadas que desconocen su estado serológico, y que no controlan o controlan mal su gestación, y disminuir la transmisión vertical. Pacientes y métodos: entre enero de 2002 y enero de 2004 se realizó el test rápido para detectar infección por VIH a toda mujer embarazada que no supiera su condición serológica y que consultara en el Servicio Gineco-Obstétrico del Centro Hospitalario Pereira Rossell. De acuerdo a la edad gestacional se tomaban las medidas profilácticas consideradas más adecuadas. Se calculó la prevalencia de infección por VIH en esas mujeres y el porcentaje de transmisión a sus hijos. Resultados: hubo 34.338 consultas obstétricas y se realizaron 4.599 tests rápidos. Se detectaron 58 mujeres positivas, 8 de ellas conocían previamente su condición serológica. La prevalencia de infección por VIH fue de 1,1 por ciento (IC95 por ciento 0,8-1,4). Hubo un falso positivo y cuatro abortos. Diez mujeres abandonaron los controles. Doce recibieron antiretrovirales durante el embarazo por más de una semana. Se controlaron 39 niños y 2 fueron infectados. El porcentaje de transmisión fue de 5,1 por ciento. Como algunas mujeres y niños se perdieron en el seguimiento, es necesario complementar la estrategia de un screening de test rápido para infección por VIH con otras medidas como consejería y entrevista con asistente social para optimizar estos resultados.

[Labeling of leukocytes using stannous 99mTc-colloid in whole blood samples]. / Marcación de leucocitos utilizando coloide estannoso-99mTc a partir de muestras de sangre entera.

This paper presents the preparation of a radiocolloid that still makes it possible to label leukocytes using its phagocytosis capacity. Given that this function is exclusively of the white blood cells, not being exercised by other blood cells, the use of a stannous fluoride radiocolloid labeled with 99mTc (F2Sn-99mTc) was tested in order to label leukocytes in whole blood samples. Using cellular separation techniques in density gradients and acquisition of images in gamma camera of radioactivity distribution in Percol, it was observed that the white cells labeling achieved was selective and with high efficiency for leukocytes (in all cases, it was superior to 70%), optimal reproducibility, low cost and low cellular toxicity.

[Characterization of the difference between filtered back projection and ordered subsets expectation maximization in spect images using the Wavelet Transform]. / Caracterización de la diferencia entre retroproyección filtrada y Ordered Subsets Expectation Maximization, en imágenes SPECT, utilizando la transformada Wavelet.

Efficiency of reconstruction algorithms is important to guarantee quality of Nuclear Medicine tomographic images. The algorithms belong to one of two types: analytical or statistical. The Filtered Back Projection (BP) algorithm belongs to the first group and the Ordered Subsets Expectation Maximization (OSEM) algorithm belongs to the second group. The aim of the present paper was to compare both algorithms by means of the Wavelet Transform (WT). This tool was selected because of its capability to divide the image into different frequency levels without losing information about their spatial position. The WT was applied on the Haar basis without decimation in order to compare matrixes of the same size. Attention was drawn to the relative presence of three typical perturbations: Poisson noise, annular artifacts that express a deficient correction to the planar uniformity and attenuation phenomenon. With these purposes, we studied homologue transversal slices of images of homogeneous distribution of activity. The OSEM algorithm not only greatly improves the filtering of the Poisson noise, but also diminishes the annular artifacts, mainly at the image zone that coincides with the rotation center. The intensity of the attenuation phenomenon was the same with both algorithms, except in the peripheral zone where OSEM showed a slightly higher activity than BP. These observations encourage our interest to continue applying the WT not only to identify the artifacts, but also to try to decrease their deleterious influence on Nuclear Medicine images.

Marcación de leucocitos utilizando coloide estannoso-99mTc a partir de muestras de sangre entera / Labeling of leukocytes using stannous 99mtc-colloid in whole blood samples

Se presenta la preparación de un radiocoloide que permite la marcación de leucocitos utilizando su capacidad de fagocitosis. Dado que esta función es exclusiva de los glóbulos blancos, no ejerciéndola otras células sanguíneas, se probó la utilización de un coloide de fluoruro estannoso marcado con 99mTc (F2Sn-99mTc) a fin de marcar dichas células en muestras de sangre entera. Mediante técnicas de separación celular en gradientes de densidad y adquisición de imágenes en cámara gamma de la distribución de radioactividad en tubos con Percol 90 por ciento, se observó que la marcación lograda es selectiva y de alta eficiencia para leucocitos (en todos los casos fue mayor del 70 por ciento), óptima reproducibilidad, bajo costo y baja toxicidad celular (AU)