Management of Anastomotic Leakage after Low Anterior Rectal Resections with Total Mesorectal Excision - A Retrospective Study.

Background: This study sought to investigate the diagnostic procedures, treatment modalities, and consequences of anastomotic leakage (AL) in low anterior resection rectal cancer patients. Methods: A retrospective analysis was conducted on 186 patients consecutively admitted and treated in the 1st Department of Surgery in Craiova, between January 2018 and June 2022, all of whom had undergone surgical interventions for adenocarcinoma of the rectum. Among this cohort, 106 patients who had undergone scheduled low and ultralow anterior rectal resections with total mesorectal excision were selected for further analysis. Twenty-four patients were diagnosed with postoperative AL and underwent diverse management strategies based on the severity of their condition. Results: The study revealed an incidence of 22.6% for postoperative AL, with all of them being classified as grade B and C, according to the 2010 International Study Group of Rectal Cancer Classification, which were associated with significant morbidity and mortality. Notably, patients exhibited various comorbidities, including obesity, arterial hypertension, type 2 diabetes mellitus, and kidney failure. The management approach depended on the severity of the clinical presentation and the availability of treatment options. Early diagnosis and conservative management constituted the initial therapeutic strategy for grade B AL, with surgical reintervention or transanal vacuum therapy being used in grade C AL. Conclusions: The incidence and mortality associated with AF following low anterior resections were notably elevated. Grade B AL were successfully managed through conservative treatment, whereas grade C AL required either surgical reintervention for drainage or diversion procedures, or transanal vacuum therapy.

The Antioxidant and Prebiotic Activities of Mixtures Honey/Biomimetic NaDES and Polyphenols Show Differences between Honeysuckle and Raspberry Extracts.

In our previous research, we demonstrated that honey and its biomimetic natural deep eutectic solvent (NaDES) modulate the antioxidant activity (AOA) of the raspberry extract (RE). In this study, we evaluated the AOA behaviour of the mixture honey/NaDES-honeysuckle (Lonicera caprifolium, LFL) extract and compared it with the mixture honey/NaDES-RE. These two extracts have similar major flavonoids and hydroxycinnamic acid compounds but differ in their total content and the presence of anthocyanins in RE. Therefore, it was of interest to see if the modulation of the LFL polyphenols by honey/NaDES was similar to that of RE. We also evaluated the prebiotic activity of these mixtures and individual components on Limosilactobacillus reuteri DSM 20016. Although honey/NaDES modulated the AOA of both extracts, from synergism to antagonism, the modulation was different between the two extracts for some AOA activities. Honey/NaDES mixtures enriched with LFL and RE did not show significant differences in bacterial growth stimulation. However, at a concentration of 45 mg/mL, the honey -LFL mixture exhibited a higher effect compared to the honey-RE mixture. The antioxidant and prebiotic properties of mixtures between honey and polyphenol-rich extracts are determined by multiple interactions in complex chemical systems.

Comparison of Different Laparoscopic Sacrocolpopexy Procedures: A Retrospective Dual Center Analysis.

Introduction: Pelvic organ prolapse (POP) affects up to 50% of women and has a significant impact on quality of life. Abdominal sacrocolpopexy is the gold standard treatment for vault prolapse and laparoscopic sacrocolpopexy has many advantages. This study aimed to compare the results of two laparoscopic sacrocolpopexy procedures performed at two different surgical centers. Materials and Methods: The primary objective of this retrospective study was to assess surgical feasibility and complication rates associated with sacrocolpopexy procedures performed at Center A (using self-fixating mesh) and Center B (using sutured mesh). Secondary objectives included assessment of length of hospital stay, readmission rates, and surgical outcomes. The study included patients treated between January 2019 and October 2023. Results: Thirteen patients, six from Center A and seven from Center B, were included. Patient characteristics, such as age and body mass index, were similar between the two groups. Operative time and length of stay were not significantly different. Center A reported one postoperative complication (mesh erosion), which occurred two years after surgery and required laparoscopic intervention. Center B also reported one conversion to laparotomy because of metabolic acidosis and hypercapnia. Conclusion: The two laparoscopic sacrocolpopexy techniques were safe and effective for treating POP and our study confirmed the importance of mesh and fixation choices. Further research is needed to improve understanding of these surgical techniques.

Honey and Its Biomimetic Deep Eutectic Solvent Modulate the Antioxidant Activity of Polyphenols.

Honey is a highly valued natural product with antioxidant, antimicrobial and anti-inflammatory properties. However, its antioxidant activity (AOA) is not as high as that of other honeybee products, such as propolis. Several polyphenol-honey formulations have been proposed up to now, most of them using maceration of biomass in honey or mixtures with liquid extracts, which either limit polyphenols bioavailability or destroy the characteristics of honey. To improve the health benefits of honey by increasing AOA and keeping its structural and sensory properties, we propose its enrichment in a polyphenol extract of raspberry after solvent evaporation. A honey-biomimetic natural deep eutectic solvent (NaDES) was prepared and compared with honey. The main polyphenols found in the raspberry extract were tested in combination with honey and NaDES, respectively. The AOA was determined by DPPH, ABTS, CUPRAC, and FRAP methods. The AOA behaviour of honey-polyphenol mixtures varied from synergism to antagonism, being influenced by the AOA method, polyphenol type, and/or mixture concentration. The honey-biomimetic NaDES resulted in similar AOA behaviour as with honey mixed with polyphenols. Honey seems to have additional properties that increase synergism or reduce antagonism in some cases. Honey and its biomimetic NaDES modulate AOA of polyphenols extract.

EAES rapid guideline: systematic review, meta-analysis, GRADE assessment, and evidence-informed European recommendations on appendicitis in pregnancy.

BACKGROUND: Clinical practice recommendations for the management of acute appendicitis in pregnancy are lacking. OBJECTIVE: To develop an evidence-informed, trustworthy guideline on the management of appendicitis in pregnancy. We aimed to address the questions of conservative or surgical management, and laparoscopic or open surgery for acute appendicitis. METHODS: We performed a systematic review, meta-analysis, and evidence appraisal using the GRADE methodology. A European, multidisciplinary panel of surgeons, obstetricians/gynecologists, a midwife, and 3 patient representatives reached consensus through an evidence-to-decision framework and a Delphi process to formulate the recommendations. The project was developed in an online authoring and publication platform (MAGICapp). RESULTS: Research evidence was of very low certainty. We recommend operative treatment over conservative management in pregnant patients with complicated appendicitis or appendicolith on imaging studies (strong recommendation). We suggest operative treatment over conservative management in pregnant patients with uncomplicated appendicitis and no appendicolith on imaging studies (weak recommendation). We suggest laparoscopic appendectomy in patients with acute appendicitis until the 20th week of gestation, or when the fundus of the uterus is below the level of the umbilicus; and laparoscopic or open appendectomy in patients with acute appendicitis beyond the 20th week of gestation, or when the fundus of the uterus is above the level of the umbilicus, depending on the preference and expertise of the surgeon. CONCLUSION: Through a structured, evidence-informed approach, an interdisciplinary panel provides a strong recommendation to perform appendectomy for complicated appendicitis or appendicolith, and laparoscopic or open appendectomy beyond the 20th week, based on the surgeon's preference and expertise. GUIDELINE REGISTRATION NUMBER: IPGRP-2022CN210.

Enhancement of laccase immobilization onto wet chitosan microspheres using an iterative protocol and its potential to remove micropollutants.

This study was focused on creating a new and effective immobilization method for Trametes versicolor laccase (Lc) by using chitosan (CS) microspheres activated with 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide hydrochloride. The activation of the support alternated with immobilization of the enzyme, in repetitive procedures, led to obtaining three different products. Also, the physicochemical properties of the new products were investigated and compared with those of free laccase. The discoloration and reusability properties of the immobilized Lc were evaluated using indigo carmine (IC) as a model micropollutant. The ESEM and FT-IR methods demonstrated that the Lc was successfully immobilized. The relative reaction rate and the total amount of immobilized Lc were tripled using the iterative protocol as proved by specific and Bradford assays. The maximum amount of immobilized Lc was 8.4 mg Lc/g CS corresponding to the third immobilization procedure. Compared to the free Lc, the operational stability of the immobilized Lc was significantly improved, presenting a maximum activity plateau over a pH range of 3-5 and a temperature range of 25-50 °C. The thermal inactivation study at 55 °C proved that the immobilized enzyme is three times more stable than the free Lc. The isoconversional and Michaelis-Menten methods showed that the immobilization did not affect the enzyme catalytic properties. After 32 days of storage, the residual activities are 85% for the immobilized laccase and 40% for the free one. In similar conditions, the free and immobilized Lc (2.12 x 10-6 M) completely decolorized IC (7.15 x 10-5 M) within 14 min. The immobilized Lc activity remained almost constant (80%) during 10 reusability cycles. All these results highlight the substantial advantages of the new immobilization protocol and demonstrate that immobilized Lc can be used as a promising micropollutant removal from real wastewater.

Surgical challenges and research priorities in the era of the COVID-19 pandemic: EAES membership survey.

BACKGROUND: Healthcare systems and general surgeons are being challenged by the current pandemic. The European Association for Endoscopic Surgery (EAES) aimed to evaluate surgeons' experiences and perspectives, to identify gaps in knowledge, to record shortcomings in resources and to register research priorities. METHODS: An ad hoc web-based survey of EAES members and affiliates was developed by the EAES Research Committee. The questionnaire consisted of 69 items divided into the following sections: (Ι) demographics, (II) institutional burdens and management strategies, and (III) analysis of resource, knowledge, and evidence gaps. Descriptive statistics were summarized as frequencies, medians, ranges,, and interquartile ranges, as appropriate. RESULTS: The survey took place between March 25th and April 16th with a total of 550 surgeons from 79 countries. Eighty-one percent had to postpone elective cases or suspend their practice and 35% assumed roles not related to their primary expertise. One-fourth of respondents reported having encountered abdominal pathologies in COVID-19-positive patients, most frequently acute appendicitis (47% of respondents). The effect of protective measures in surgical or endoscopic procedures on infected patients, the effect of endoscopic surgery on infected patients, and the infectivity of positive patients undergoing laparoscopic surgery were prioritized as knowledge gaps and research priorities. CONCLUSIONS: Perspectives and priorities of EAES members in the era of the pandemic are hereto summarized. Research evidence is urgently needed to effectively respond to challenges arisen from the pandemic.