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Background International professional bodies have been quick to disseminate initial guidance documents during the COVID-19 pandemic. In the absence of firm evidence, these have been developed by expert committees, limited in participant number. This study aimed to validate international COVID-19 surgical guidance using a rapid Delphi consensus exercise. Methods Delphi statements were directly mapped to guidance from surgical professional bodies in the US and Europe (SAGES/EAES), the UK (Joint RCS), and Australasia (RACS), to validate content against international consensus. Agreement from ≥70% participants was determined as consensus agreement. Results The Delphi exercise was completed by 339 individuals from 41 countries and 52 statements were mapped to the guidance, 47 (90.4%) reaching consensus agreement. Of these, 27 statements were mapped to SAGES/EAES guidance, 21 to the Joint RCS document, and 33 to the RACS document. Within the SAGES/EAES document, 92.9% of items reached consensus agreement (median 89.0%, range 60.5–99.2%), 90.4% within the Joint RCS document (87.6%, 63.4–97.9%), and 90.9% within the RACS document (85.5%, 18.7–98.8%). Statements lacking consensus related to the surgical approach (open vs. laparoscopic), dual consultant operating, separate instrument decontamination, and stoma formation rather than anastomosis. Conclusion Initial surgical COVID-19 guidance from the US, Europe and Australasia was widely supported by an international expert community, although a small number of contentious areas emerged. These findings should be addressed in future guidance iterations, and should stimulate urgent investigation of non-consensus areas., Highlights • 339 international experts across 41 countries participated in this Delphi process on surgical practice in COVID-19. • 90–93% agreement with guidance from SAGES/EAES (US/Europe), Joint UK Royal Colleges, Royal Australasian College of Surgery. • This study validates the guidance issued by these bodies. • A small number of contentious issues require urgent attention.

To assess the etiologic role of C. trachomatis and other micro-organisms in "idiopathic" epididymitis, 23 men underwent microbiologic studies, including cultures of epididymal aspirates in 16. Eleven of 13 men under the age of 35 years had C. trachomatis infection whereas eight of 10 over 35 had coliform urinary-tract infection. Cultures of epididymal aspirates yielded C. trachomatis alone in five of six men under 35, and coliform bacteria alone in five of 10 over 35. These results suggest that C. trachomatis is the major cause of "idiopathic" epididymitis, and coliform bacteria the major cause of epididymitis in older men. Expressible urethral discharge and inguinal pain were more common in the chlamydial cases, whereas concurrent genitourinary abnormality and scrotal edema and erythema occurred more commonly in the coliform cases. The morbidity attributable to C. trachomatis is as serious as that attributable to Neisseria gonorrhoeae.To assess the etiologic role of C. trachomatis and other microorganisms in idiopathic epididymitis, 23 men underwent microbiologic studies, including cultures of epididymal aspirates in 16. 11 of 13 men under age 35 had C. trachomatis infection whereas 8 of 10 over age 35 had coliform urinary tract infection. Cultures of epididymal aspirates yielded C. trachomatis alone in 5 of 6 men under 35, and coliform bacteria alone in 5 of 10 over 35. These results suggests that C. trachomatis is the major cause of idiopathic epididymitis, and coliform bacteria the major cause of epididymitis in older men. Expressible urethral discharge and inguinal pain were more common in the chlamydial cases, whereas concurrent genitourinary abnormality and scrotal edema and erythema occurred more commonly in the coliform cases. The morbidity attributable to C. trachomatis is as serious as that attributable to Neisseria gonorrhoeae.

In October 2012, a group of scientists met at the 10th Meeting of the International Scientific Association of Probiotics and Prebiotics (ISAPP) in Cork, Ireland to discuss issues surrounding prebiotics and their development. This article summarises outputs from the meeting. Various prebiotic definitions were discussed and how the concept has evolved from targeting the colonic microbiome, through to the entire gastrointestinal tract and finally the ISAPP definition, which specifies fermentation as a key criterion. Structure and function relationships are becoming clearer with effects upon microbial diversity, determinations of selectivity and enhanced biological activity being major outcomes. Immune modulation and metal chelation were further facets. Biomass can be a useful, and economic, means of generating new prebiotics. Pectic oligomers from citrus are model examples. Testing aspects range from in vitro batch culture fermenters to multiple stage models, immobilized systems, animal, cellular studies and human trials. Analytical processes around microbiota characterization and functionality were compared. Human studies were seen as the definitive outcome, including 13C labeling of key interventions. For extra intestinal effects, atopic disease, respiratory infections, vaginal issues, oral disease, adiposity, liver damage and skin infections are all feasible. The general outcome was that microbiota modulation was the key mechanism that linked these interactions. In pet food applications, the market potential for prebiotics is huge. Health targets are similar to those of humans. Issues include monomeric composition, chain length, linkages, branching, microbiota beyond bifidobacteria, metabolic function, mechanisms of health effects. Molecular biology has unraveled some of the explanations for prebiotic influences e.g. gene clusters to show transporters, regulators, permeases, hydrolases, lacS. In Lactobacillus ruminis, fermentation studies have been aligned to genome annotations, showing an energy efficient and rapid transport of GOS. In bifidobacteria, functional genome analyses have demonstrated uptake of trisaccharides. Questions relating to patients were then raised. For example, are prebiotics related to disease treatment or health maintenance? If a prebiotic does not change the microbiota, then how does it operate? Case study trials in Inflammatory Bowel Disease were presented on patient access to prebiotics and information. These showed that their knowledge of prebiotics was poor, compared to probiotics. The group then discussed the next generation of prebiotics (e.g. anti-adhesive activities). The comparator was Human Milk Oligosaccharides, which both reduce adherence of pathogens and act as prebiotics. Studies with galactooligosacchardes (GOS) have used pyrosequencing to demonstrate varying species level effects. This has relevance for infant formulae. Prebiotic aspects of whole foods and their complexity was covered. Trials were described where cross feeding and co-metabolism had been investigated. Suggestions on other prebiotic influences, aside from bifidobacteria, were made and included metagenomics, metabonomics, gene expression, mRNA global sequencing, bile deconjugation, enzyme profiles, lipids, phenolics. The discussion suggested how prebiotics could move forward with a wider expansion of the concept, target populations, expanded microorganisms, health benefits, application of new technologies and improved consumer understanding being the main goals. Copyright © 2013 by New Century Health Publishers, LLC. Chemicals/CAS: pectin, 9000-69-5