Persistent Increased Enteric Glial Expression of S100ß is Associated With Low-grade Inflammation in Patients With Diverticular Disease.

BACKGROUND: Diverticular disease (DD) is a common gastrointestinal inflammatory disorder associated with an enteric neuropathy. Although enteric glial cells (EGCs) are essential regulators of intestinal inflammation and motility functions, their contribution to the pathophysiology of DD remains unclear. Therefore, we analyzed the expression of specific EGC markers in patients with DD. MATERIALS AND METHODS: Expression of the glial markers S100ß, GFAP, Sox10, and Connexin 43 was analyzed by real-time quantitative PCR in colonic specimens of patients with DD and in that of controls. Protein expression levels of S100ß, GFAP, and Connexin 43 were further analyzed using immunohistochemistry in the submucosal and myenteric plexus of patients with DD and in that of controls. Expression of the inflammatory cytokines tumor necrosis factor-α and interleukin-6 was quantified using qPCR, and infiltration of CD3+ lymphocytes was determined using immunohistochemistry. RESULTS: Expression of S100ß was increased in the submucosal and myenteric plexus of patients with DD compared with that in controls, whereas expression of other glial factors remained unchanged. This increased expression of S100ß was correlated to CD3+ lymphocytic infiltrates in patients with DD, whereas no correlation was observed in controls. CONCLUSIONS: DD is associated with limited but significant alterations of the enteric glial network. The increased expression of S100ß is associated with a persistent low-grade inflammation reported in patients with DD, further emphasizing the role of EGCs in intestinal inflammation.

Non-technical skills training in the operating theatre: A meta-analysis of patient outcomes.

BACKGROUND: Non-technical skills (NTS) failures have been implicated in a large proportion of surgical errors. The objective of this meta-analysis was to investigate whether NTS training of theatre staff improves patient outcomes. METHODS: In a systematic literature search all interventional studies evaluating the effects of NTS training of theatre staff were identified. Primary outcomes included mortality, morbidity, readmission rate and length of hospital stay. Secondary outcomes included staff NTS, checklist use and technical surgical performance. Pooled odds ratios (OR) were determined for event rates and weighted mean differences (WMD) for continuous data. An inverse variance method in a random effects model was used for meta-analysis. RESULTS: A total of 1381 records were identified and nine studies were included. Meta-analysis of mortality was not carried out because only two controlled studies with different study designs were identified. No statistically significant differences were seen in complication rate (5 studies, OR 0.91 [0.73, 1.14]; p = 0.43), readmission rate (3 studies, OR 0.90 [0.63, 1.28], p = 0.56) and length of hospital stay (3 studies, WMD -0.88 days [-2.06, 0.31], p = 0.31) after NTS training. Of the secondary outcomes, an improvement of whole team NOTECHS II scores was observed in the intervention group (3 studies, WMD 6.97 [3.88, 10.06], p < 0.0001). Technical performance and checklist use were unchanged. CONCLUSIONS: This meta-analysis failed to find a statistically significant improvement of patient outcomes. These conclusions are based on a small number of heterogeneous studies. Further appropriately powered studies are likely to improve our understanding of the effects of NTS training.

Burn depth assessment using hyperspectral imaging in a prospective single center study.

BACKGROUND: The assessment of thermal burn depth remains challenging. Over the last decades, several optical systems were developed to determine burn depth. So far, only laser doppler imaging (LDI) has been shown to be reliable while others such as infrared thermography or spectrophotometric intracutaneous analysis have been less accurate. The aim of our study is to evaluate hyperspectral imaging (HSI) as a new optical device. METHODS: Patients suffering thermal trauma treated in a burn unit in Germany between November 2019 and September 2020 were included. Inclusion criteria were age ≥18 years, 2nd or 3rd degree thermal burns, written informed consent and presentation within 24 h after injury. Clinical assessment and hyperspectral imaging were performed 24, 48 and 72 h after the injury. Patients in whom secondary wound closure was complete within 21 days (group A) were compared to patients in whom secondary wound closure took more than 21 days or where skin grafting was indicated (group B). Demographic data and the primary parameters generated by HSI were documented. A Mann Whitney-U test was performed to compare the groups. A p-value below 0.05 was considered to be statistically significant. The data generated using HSI were combined to create the HSI burn index (BI). Using a logistic regression and receiver operating characteristics curve (ROC) sensitivity and specificity of the BI were calculated. The trial was officially registered on DRKS (registration number: DRKS00022843). RESULTS: Overall, 59 patients with burn wounds were eligible for inclusion. Ten patients were excluded because of a poor data quality. Group A comprised 36 patients with a mean age of 41.5 years and a mean burnt body surface area of 2.7%. In comparison, 13 patients were allocated to group B because of the need for a skin graft (n = 10) or protracted secondary wound closure lasting more than 21 days. The mean age of these patients was 46.8 years. They had a mean affected body surface area of 4.0%. 24, 48, and 72 h after trauma the BI was 1.0 ± 0.28, 1.2 ± 0.29 and 1.55 ± 0.27 in group A and 0.78 ± 0.14, 1.05 ± 0.23 and 1.23 ± 0.27 in group B. At every time point significant differences were demonstrated between the groups. At 24 h, ROC analysis demonstrated BI threshold of 0.95 (sensitivity 0.61/specificity 1.0), on the second day of 1.17 (sensitivity 0.51/specificity 0.81) and on the third day of 1.27 (sensitivity 0.92/specificity 0.71). CONCLUSION: Changes in microcirculation within the first 72 h after thermal trauma were reflected by an increasing BI in both groups. After 72 h, the BI is able to predict the need for a skin graft with a sensitivity of 92% and a specificity of 71%.