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Simple Summary: Ovarian cancer is still the most lethal gynecologic malignancy with a median 5-year survival of less than 50%. Most cases are diagnosed at the advanced stages and only limited improvements in overall survival are achieved by standard treatments. Despite the paucity of randomized clinical trials, combined cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) show encouraging survival outcomes in primary ovarian cancer with peritoneal metastases. It gives rise to the definite need to redefine not only the best treatment option, but also the optimal treatment sequence based on the primary tumor and the extent of disease. Ovarian cancer is the eighth most common neoplasm in women with a high mortality rate mainly due to a marked propensity for peritoneal spread directly at diagnosis, as well as tumor recurrence after radical surgical treatment. Treatments for peritoneal metastases have to be designed from a patient's perspective and focus on meaningful measures of benefit. Hyperthermic intraperitoneal chemotherapy (HIPEC), a strategy combining maximal cytoreductive surgery with regional chemotherapy, has been proposed to treat advanced ovarian cancer. Preliminary results to date have shown promising results, with improved survival outcomes and tumor regression. As knowledge about the disease process increases, practice guidelines will continue to evolve. In this review, we have reported a broad overview of advanced ovarian cancer management, and an update of the current evidence. The future perspectives of the Italian Society of Surgical Oncology (SICO) are discussed conclusively. [ABSTRACT FROM AUTHOR]

In the present work, the high-temperature and long-term hydrothermal stability of novel polyPOSS-imide membranes for high-temperature hydrogen separation is investigated. The polyPOSS-imide membranes are found to exhibit an appropriate stability up to 300 °C. Above this temperature the membrane selectivity rapidly decreases, which is seemingly related to changes in the molecular structure coupled to silanol condensation forming siloxane groups. Surprisingly, the exposure of the membrane to temperatures of up to 300 °C even increases the H 2 permeance together with the selective feature of the polyPOSS-imide layer. Subsequently, the long-term hydrothermal stability of the polyPOSS-imide membranes was investigated over a period of close to 1000 h at 250 °C exposing the membrane to 10 mol% steam in the feed. An increase in H 2 /CH 4 selectivity was observed upon water addition, and even though a minor drop was noticed over time during the hydrothermal operation, the selectivity exceeds the initial selectivity obtained in the dry feed atmosphere. After the removal of steam from the feed the performance returns to its original state prior to the exposure to any steam showing an appropriate steam stability of the polyPOSS-imide membranes. A conceptual process design and assessment was performed for application of these membranes involving a combination of carbon reuse and electrification of the steel making process with co-production of hydrogen. The results indicate a CO 2 avoidance of 14%. The CO 2 reduction achieved using renewable electricity in the proposed scheme is a factor 2.76 higher compared to a situation where the same renewable electricity would be fed in the electricity grid. • Exposure of the polyPOSS-imide membrane to 300 °C increases the H 2 permeance. • Long-term hydrothermal stability of polyPOSS-imide membranes proven. • Membranes were operated over a period of 1000 h. • Process evaluation for implementation in the steel industry performed. [ABSTRACT FROM AUTHOR]

Procalcitonin (PCT) is widely considered as a highly sensitive biomarker of bacterial infection, offering general and emergency surgeons a key tool in the management of surgical infections. A multidisciplinary task force of experts met in Bologna, Italy, on April 4, 2019, to clarify the key issues in the use of PCT across the surgical pathway. The panelists presented the statements developed for each of the main questions regarding the use of PCT across the surgical pathway. An agreement on the statements was reached by the Delphi method, and this document reports the executive summary of the final recommendations approved by the expert panel. [ABSTRACT FROM AUTHOR]

Nanofibrillated cellulose (NFC) represents an important class of bio-based nanomaterials that possess favorable properties including hydrophilicity, 1D structure, biodegradability, and surface tunability. Although widely known for its effective gas-barrier attributes due to its inherent crystallinity and hydrogen-bonding capability, the ability of NFC to form dense films has been of considerable interest in selective gas-separation applications as a viable replacement for synthetic polymers. With precise control of targeted properties at the nanoscale, NFC can likewise be used to enable selective removal of greenhouse gases such as CO2. Herein we report a class of "green" hybrid membranes composed of NFC and an ionic liquid (IL), 1-ethyl-3-methylimidazolium acetate ([Emim][OAc]), that together exhibit exceptional separation properties arising from controllable nanoscopic design. With this new class of green membranes, CO2/N2 selectivities as high as ∼370 and CO2 permeabilities as high as ∼330 Barrer have been obtained at optimal IL loadings and/or humidity levels. The current work demonstrates that size exclusion of a molecular penetrant in a water-swollen NFC membrane matrix relies on the network architecture of partially swollen nanocellulose fibrils to selectively permeate CO2 through enhanced diffusive pathways. Additionally, the gas-transport and rheological properties of these NFC-fabricated membranes can be precisely tuned through the independent use of humidity as an external control parameter. [ABSTRACT FROM AUTHOR]

Background: The number of bariatric procedures is increasing worldwide. No consensus or guidelines about the emergency management of long-term complications following bariatric surgery are currently available. The aim of this study is to investigate by a web survey how an emergency surgeon approaches this unique group of patients in an emergency medical scenario and to report their personal experience. Method: An international web survey was sent to 197 emergency surgeons with the aim to collect data about emergency surgeons' experience in the management of patients admitted in the emergency department for acute abdominal pain after bariatric surgery. The survey was conceived as a questionnaire composed by 26 (multiple choice and open) questions and approved by a steering committee. Results: One hundred seventeen international emergency surgeons decided to join the project and answered to the web survey with a response rate of 59.39%. Conclusions: The aim of this WSES web survey was to highlight the current management of patients previously submitted to bariatric surgical procedures by ES. Emergency surgeons must be mindful of postoperative bariatric surgery complications. CT scan with oral intestinal opacification may be useful in making a diagnosis if carefully interpreted by the radiologist and the surgeon. In case of inconclusive clinical and radiological findings, when symptoms fail to improve, surgical exploration for bariatric patients presenting acute abdominal pain, by laparoscopy if expertise is available, is mandatory in the first 12–24 h, to have good outcomes and decrease morbidity rate. [ABSTRACT FROM AUTHOR]

Background: Trauma victims could be an important source of organs. This article presents two cases of successful organ donation and transplant, after Maastricht category III cardiac death in patients with successfully repaired AAST grade V traumatic cardiac injuries. Case presentation: The first donor was an adult patient with self-inflicted heart stab wound and non-survivable burn injury. The second one was an adult patient with blunt cardiac and abdominal trauma and an anoxic brain injury due to a car accident. The cardiac injury was promptly repaired in both patients. In the first case, adequate organ perfusion ante-mortem was achieved thanks to venoarterial extracorporeal membrane oxygenation and intensive care unit support. The above procedure allowed successful organ donation and transplantation even after Maastricht category III cardiac death. This is the first case reported where, for organ donation purposes, it was made necessary first thing to avoid the immediate death of the patient, due to a rare and frequently not survivable cardiac injury. The challenge of preserving organ perfusion, due to major burn injury effects, was faced afterwards. Conclusions: The outcomes of these two cases suggest that a repaired heart injury should not be considered as an absolute contraindication to organ donation, even if it is associated with non-survivable major burns. Therefore, cardiac death could provide an opportunity for these kinds of patients to contribute to the pool of potential organ donors. [ABSTRACT FROM AUTHOR]

• The viscosity effect on the performance of a membrane contactor was studied. • Sugar and glycerol were used as viscosifiers to 30 wt% MEA and 3.9 wt% NaOH. • K ov decreased with increasing concentration of viscosifier. • Viscous solutions may create an extra resistance on the membrane/liquid interface. The effect of liquid viscosity on the performance of a non-porous membrane contactor is important to study for a proper solvent selection and process design. In this work, the overall mass transfer coefficient for MEA- and NaOH-based solutions was studied using a string of discs contactor in the temperature range 28–64 °C and a thin composite membrane contactor at 40 °C. Also, viscosity, density and N 2 O solubility of the aqueous solutions were measured in the temperature range 30–70 °C. The solvent viscosity of MEA and NaOH solutions was artificially adjusted from 0.5 to 54.7 mPa s by addition of sugar and/or glycerol. The overall mass transfer coefficient was found to decrease with increasing amount of viscosifier and the decrease seemed to be independent of the solvent system. In the membrane contactor, the decrease in the overall mass transfer coefficient was attributed to the decreasing CO 2 solubility and CO 2 diffusion coefficient, but as these properties alone were not able to describe the experimental values, the reason was attributed also to the establishment of an additional resistance at the membrane/liquid interface. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • CO 2 capture in non-porous membrane contactors using new amine solvents was evaluated. • Solvent viscosity significantly affects the performance of the system. • The mass transfer coefficient decreases with at higher CO 2 content in the feed gas. • Liquid flow rate has limited impact on the membrane contactor performance. • The liquid boundary layer resistance is significant for highly viscous absorbents. Abstract New amine blends have shown a promising potential to reduce the energy penalty for CO 2 capture in post combustion, making the deployment of carbon capture technologies one-step closer. However, their application at the industrial scale is threaten by their high volatility. Non-porous membrane contactors offer a viable solution to properly control amine emissions from these absorbents. In the present work, the CO 2 capture performance of non-porous membrane contactors using new amine blends as liquid phase was investigated in a temperature range typical for the absorption step (25–60 °C). Different amine blends with promising features in terms of cycling capacity and regeneration energy requirement were selected as liquid absorbents. Thin composite membranes fabricated by coating a perfluoropolymer on the top of a porous polypropylene layer were used as the interface between the gas and the liquid. At room temperature, membrane contactors using new absorbents exhibit a lower CO 2 mass transfer coefficient compared to the benchmark (30 wt% MEA), possibly due to the high viscosity of these liquids. The modelling analysis suggests that the liquid boundary layer dominates the mass transfer resistance in the temperature range up to 40 °C, but at higher temperatures, the decrease of the solvent viscosity makes the mass transfer dominated by the membrane phase. Interestingly, the new amine blends show better performance compared to the benchmark at higher CO 2 concentrations in feed gas, highlighting a good potential to capture CO 2 from concentrated flue gas from steel/cement industry or to upgrade biogas. [ABSTRACT FROM AUTHOR]

The Acute Abdomen Decision Making course® (AADM®) was developed by the World Society of Emergency Surgeons (WSES) members with the purpose to teach a systematic and concise method for approaching acute abdomen patient. It was first introduced in 2016. The course explains step by step the clinical reasoning to follow for immediate managing of the acute abdomen in emergency department with a safe and reliable method. We developed this original decision making model AADM following the Advanced Trauma Life Support (ATLS) philosophy in evaluating non-traumatic abdominal pain patient. The A-B-C-D-E-F management of non-traumatic acute abdominal pain is conceived by WSES to make easy and systematic the evaluation of patients in Emergency Department. AADM course teaches how to assess an acute abdomen patient's diagnosis and determine the therapeutic approach to reduce unnecessary exams and hospitalizations. [ABSTRACT FROM AUTHOR]

Surgeons in their daily practice are at the forefront in preventing and managing infections. However, among surgeons, appropriate measures of infection prevention and management are often disregarded. The lack of awareness of infection and prevention measures has marginalized surgeons from this battle. Together, the Global Alliance for Infections in Surgery (GAIS), the World Society of Emergency Surgery (WSES), the Surgical Infection Society (SIS), the Surgical Infection Society-Europe (SIS-E), the World Surgical Infection Society (WSIS), the American Association for the Surgery of Trauma (AAST), and the Panamerican Trauma Society (PTS) have jointly completed an international declaration, highlighting the threat posed by antimicrobial resistance globally and the need for preventing and managing infections appropriately across the surgical pathway. The authors representing these surgical societies call all surgeons around the world to participate in this global cause by pledging support for this declaration for maintaining the effectiveness of current and future antibiotics. [ABSTRACT FROM AUTHOR]

Polyelectrolytes have been reported to display gas permeation properties that can be of significant interest for CO2 capture applications, especially when they are fully hydrated. In this work, hybrid membranes prepared by co-casting an ionic liquid (IL), 1-butyl-3-methylimidazolium tetrafluoroborate ([Bmim][BF4]), with Nafion have been investigated for use in carbon capture. Gas permeabilities of different gaseous species have been measured for IL concentrations up to 40 wt%. Moreover, the effect of water vapor on gas permeation is examined with humidified CO2/N2 gas mixtures at various relative humidity (RH) levels. These experiments reveal that CO2 permeability is greatly enhanced upon addition of the IL and in the presence of water in the gas stream, most likely due to the formation of IL nanochannels in the Nafion matrix. Small-angle X-ray scattering confirms changes in the nanostructure at different IL loading levels. Hybrid membranes containing 40 wt% [Bmim][BF4] exhibit a mixed-gas CO2 permeability of 390 Barrer with a corresponding CO2/N2 selectivity of ∼30 at 100% RH, which is more than 3× that of the permeability measured from the same IL-containing membrane in the dry state and more than 200× higher than that of dry Nafion. Such improvements suggest the existence of a synergetic relationship between the IL and water vapor with regard to Nafion gas-transport properties, yielding superior separation performance with an enhanced gas flux compared to extruded Nafion membranes. These results represent a viable fabrication strategy for the production of thin Nafion-based membranes for CO2 capture. [ABSTRACT FROM AUTHOR]

Non-porous membrane contactor offers the possibility to reduce the amine emissions if the membrane layer is specifically designed to act as a barrier for the amine transport. In the present paper, the amine permeation through an AF2400 self-standing membrane, previously identified as the best dense layer material, have been investigated to evaluate the amine-emission preventing capacity of the membrane for the first time. The transport properties of different amine-based aqueous solutions (monoethanolamine, 3-methylaminopropylamine and diethylethanolamine) through a 10 µm-thick self-standing AF2400 membrane have been characterized through pervaporation experiments in a temperature range of a typical amine absorption step (25–60 ºC). Humid CO 2 permeation tests were also carried out to simulate the real gas membrane absorption separation conditions. A limited decrease (up to 25%) of the CO 2 permeability was observed from dry state to fully humidified conditions, suggesting that the membrane contactor can be operated with humid flue gas to prevent solvent dehydration. The amine fluxes were found at least two orders of magnitude lower compared with CO 2 , demonstrating the ability of the membrane to favor the transport of CO 2 over the amines. [ABSTRACT FROM AUTHOR]

In this study, a new family of poly(ethylene glycol) (PEG)-based membranes for CO 2 separation was developed using PEG diglycidyl ether (PEGDE) cross-linked with a low-molecular-weight diamine (2,2′-(ethylenedioxy)bis(ethylamine)) and a polyamine-based ionic liquid (triethylenetetramine trifluoroacetate, [TETA][Tfa]) in a solvent-free process. A mass fraction up to 80% PEG dimethyl ether (PEGDME, average M n ~250) was added to the cross-linked matrix to enhance the gas transport properties. The cross-linking reaction mechanism, thermal stability of the resulting membranes, as well as water uptakes of the formed membranes were systematically investigated. The CO 2 , N 2 , and CH 4 gas transport properties of these new membranes were studied. Both CO 2 /N 2 and CO 2 /CH 4 binary mixed gas separation performances of the membranes at various humidity levels were tested. The gas permeation results showed that the free PEGDME additive acts as plasticizer in the polymeric matrix, resulting in excellent CO 2 / N 2 and CO 2 /CH 4 separation properties. [ABSTRACT FROM AUTHOR]

A new type of hydrophilic polymeric membrane based on microfibrillated cellulose (MFC) has been investigated to determine its potential in the field of gas separation, with special reference to carbon capture and natural gas sweetening. In particular, pure MFC films and MFC/Lupamin ® (a commercial polyvinylamine produced by BASF) nanocomposite membrane have been synthesized and characterized. The effect of relative humidity on gas permeability was considered and independent water vapor sorption experiments were also carried out in order to correlate the permeation results to the actual water content in the materials. The experimental results showed that very good CO 2 /N 2 and CO 2 /CH 4 selectivity (in the order of 500 and 350 respectively) could be reached by using pure MFC films, which however showed limited CO 2 permeability, never exceeding 25 Barrer, even at the highest relative humidity investigated. To increase the transmembrane flux, a hydrophilic polyvinylamine (Lupamin ® ) has been added to the pure MFC: the addition caused a marked increase in permeability of up to one order of magnitude but decreased the selectivity to about the same extent, thus decreasing the overall membrane performance. The reason of such behavior seems to be related to the amount of water absorbed by the membrane as the MFC/Lupamin nanocomposite resulted to be highly swollen by water vapor. Nonetheless, both the investigated materials showed separation performances that are above the 2008 Robeson's upper bound for CO 2 /N 2 and CO 2 /CH 4 systems, disclosing an attractive potential for the production of advanced gas separation membranes. [ABSTRACT FROM AUTHOR]

Phase change solvents represent a new class of CO2 absorbents with a promising potential to reduce the energy penalty associated with CO2 capture. However, their high volatility is a major concern for their use at the industrial scale. It is believed that membrane absorption offers a solution to overcome this issue, particularly if the membrane can prevent amine evaporation. In the present work a compatibility study is carried out in order to identify suitable membranes in a membrane contactor using phase change solvents as liquid absorbent. Several porous and dense polymeric samples have been studied, and their chemical stability and ability to prevent amine evaporation have been investigated through immersion tests and amine permeation experiments. The experimental results indicate that to use the blend solvents based on DEEA/MAPA (diethyl-ethanolamine/3-methylamino-propylamine) in a membrane contactor requires a membrane with excellent stability. Porous membranes typically used for membrane contactors with MEA aqueous solution, such as polytetrafluoroethylene (PTFE) and polypropylene (PP) membranes, are not suitable to be used as a membrane interface with this new class of absorbents. A selection of membrane materials for the fabrication of thin composite membranes suitable for this application has been identified and their CO2 and amine transport properties have been determined. Finally, the wettability of the most suitable polymer for the dense layer has been measured for different absorbent concentrations in order to ensure a good interfacial contact in the membrane contactor. [ABSTRACT FROM AUTHOR]

In the present work, membrane contactors using both porous and nonporous polymeric hollow fiber membranes with ionic liquids as absorbent were developed for precombustion CO2 capture at elevated temperature and pressures. 1-Butyl-3-methylimidazolium tricyanomethanide [Bmim][TCM] was selected as the ILs absorbent. The compatibility and stability of six different polymeric membranes were evaluated, while the porous PTFE membrane and nonporous Teflon-PP composite membrane were considered to be the most suitable membranes for this application. Both membrane configurations were tested and showed comparable separation performances: CO2 flux values of 4.86 × 10-4 and 4.75 × 10-4 mol m-2 s-1 were obtained for the porous PTFE and nonporous Teflon-PP membrane contactor at 20 bar with a gas flow rate of 200 mL min-1, respectively. The Teflon-PP composite membrane exhibited better stability as compared to the porous PTFE membrane in a 14 day test. [ABSTRACT FROM AUTHOR]

In the present work, high-performance mixed matrix membranes containing amines have been developed for effective CO 2 removal at high pressures (15–28 bar) and high temperatures (103–121 °C). The membrane was synthesized by compatibly embedding amino-functionalized multi-walled carbon nanotubes (AF-MWNTs) as mechanical reinforcing fillers in the crosslinked polyvinylalcohol–polysiloxane/amine blend. The surface functionalization of MWNTs allows strong coupling with the hydrophilic membrane matrix to form a nano-reinforced facilitated transport membrane, which achieved exceptional CO 2 selectivity and permeability via the facilitated transport mechanism as well as attractive membrane stability via the incorporation of MWNTs. The synthesized membranes exhibited an average CO 2 permeability of 957 Barrers coupled with high selectivities vs. H 2 (56), CH 4 (264), and N 2 (384) at 107 °C and 15 bar. The effects of AF-MWNT loading, high molecular weight species content, selective layer thickness, feed pressure, relative humidity, and temperature on membrane performance were thoroughly studied for a fundamental understanding of membrane properties. Furthermore, a mathematical model has been used to describe and explain the thickness-dependent CO 2 transport behavior in the membrane. The combination of high CO 2 permeability and good selectivities vs. CH 4 , H 2 , and N 2 , along with enhanced mechanical stability, makes the membrane a promising candidate for the gas separation applications at high pressures. [ABSTRACT FROM AUTHOR]

The gas transport properties of two different polymerized ionic liquids (PILs), a homopolymer poly(1-[(2-methacryloyloxy)ethyl]-3-butylimidazolium bis(trifluoromethanesulfonyl)imide) [poly(MEBIm-TFSI)] and a diblock copolymer poly(methyl methacrylate- block -1-[(2-methacryloyloxy)undecyl]-3-butylimidazolium bis(trifluoromethanesulfonyl) imide) [poly(MMA- b -MUBIm-TFSI)], were investigated at different temperatures and humidities to determine the effect of water vapor on the separation efficacy of these PIL membranes. In addition, pure water sorption experiments were performed to quantify the water content in the PILs under these different experimental conditions. Under dry conditions, the permeabilities and selectivities of different gaseous penetrants were tested (CO 2 , CH 4 , N 2 and He), where both PIL membranes showed suitable features for CO 2 /CH 4 and CO 2 /N 2 separation: a CO 2 permeability of 33 Barrer at 35 °C and selectivities up to 17 and 24 for CO 2 /CH 4 and CO 2 /N 2 separation, respectively. Under humid conditions, the CO 2 and CH 4 permeabilities increased linearly with increasing water concentration within the PIL membranes. At 90% RH, 80% and 40% enhancements were observed for the hompolymer and block copolymer, respectively, compared to dry conditions. Interestingly, water uptake was observed to be rather limited, never exceeding 2.5 wt% for both PILs under the experimental conditions in this study. Since the permeability enhancement appeared to be similar for both CO 2 and CH 4 , a negligible effect on the gas selectivity was observed under humid conditions, thus leading to an overall improvement in both PIL membrane gas separation performances. [ABSTRACT FROM AUTHOR]

Appendectomy is one of the most frequently performed operative procedures in general surgery departments of every size and category. Laparoscopic Appendectomy -- LA - as compared to Open Appendectomy -- OA - was very controversial at first but has found increasing acceptance all over the World, although the percentage of its acceptance is different in the various single National setting. Various meta-analyses and Cochrane reviews have compared LA with OA and different technical details. Furthermore, new surgical methods have recently emerged, namely, the single-port/incision laparoscopic appendectomy and NOTES technique. Their distribution among the hospitals, however, is unclear. Using laparoscopic mini-instruments with trocars of 2-3.5 mm diameter is proposed as a reliable alternative due to less postoperative pain and improved aesthetics. How to proceed in case of an inconspicuous appendix during a procedure planned as an appendectomy remains controversial despite existing study results. But the main question still is: operate or not operate an acute appendicitis, in the meaning of an attempt of a conservative antibiotic therapy. Therefore, we have done a literature survey on the performance of appendectomies and their technical details as well as the management of the intraoperative finding of an inconspicuous appendix in order to write down -- under the light of the latest evidence -- a position paper. [ABSTRACT FROM AUTHOR]

Peritoneal adhesions describe a condition in which pathological bonds form between the omentum, the small and large bowels, the abdominal wall, and other intra-abdominal organs. Different classification systems have been proposed, but they do not resolve the underlying problem of ambiguity in the quantification and definition of adhesions. We therefore propose a standardized classification system of adhesions to universalize their definition based on the macroscopic appearance of adhesions and their diffusion to different regions of the abdomen. By scoring with these criteria, the peritoneal adhesion index (PAI) can range from 0 to 30, unambiguously specifying precise adhesion scenarios. The standardized classification and quantification of adhesions would enable different studies to more meaningfully integrate their results, thereby facilitating a more comprehensive approach to the treatment and management of this pathology. [ABSTRACT FROM AUTHOR]

Background: In January 2010, the SICE (Italian Society of Endoscopic Surgery), under the auspices of the EAES, decided to revisit the clinical recommendations for the role of laparoscopy in abdominal emergencies in adults, with the primary intent being to update the 2006 EAES indications and supplement the existing guidelines on specific diseases. Methods: Other Italian surgical societies were invited into the Consensus to form a panel of 12 expert surgeons. In order to get a multidisciplinary panel, other stakeholders involved in abdominal emergencies were invited along with a patient's association. In November 2010, the panel met in Rome to discuss each chapter according to the Delphi method, producing key statements with a grade of recommendations followed by commentary to explain the rationale and the level of evidence behind the statements. Thereafter, the statements were presented to the Annual Congress of the EAES in June 2011. Results: A thorough literature review was necessary to assess whether the recommendations issued in 2006 are still current. In many cases new studies allowed us to better clarify some issues (such as for diverticulitis, small bowel obstruction, pancreatitis, hernias, trauma), to confirm the key role of laparoscopy (such as for cholecystitis, gynecological disorders, nonspecific abdominal pain, appendicitis), but occasionally previous strong recommendations have to be challenged after review of recent research (such as for perforated peptic ulcer). Conclusions: Every surgeon has to develop his or her own approach, taking into account the clinical situation, her/his proficiency (and the experience of the team) with the various techniques, and the specific organizational setting in which she/he is working. This guideline has been developed bearing in mind that every surgeon could use the data reported to support her/his judgment. [ABSTRACT FROM AUTHOR]

Simple Summary: As ovarian cancer represents the most lethal gynecological malignancy, the diagnostic process represents a crucial step in order to select the appropriate treatment strategy. Indeed, the association of tumor marker levels with radiological imaging and an evaluation of tumor load with diagnostic laparoscopy are essential to assess whether the patients are best treated by upfront surgery or neo-adjuvant chemotherapy followed by interval debulking surgery. With this review, we aim to provide most relevant available evidence on the diagnostic and treatment pathway of advanced ovarian cancer. Over two thirds of ovarian cancer patients present with advanced stage disease at the time of diagnosis. In this scenario, standard treatment includes a combination of cytoreductive surgery and carboplatinum–paclitaxel-based chemotherapy. Despite the survival advantage of patients treated with upfront cytoreductive surgery compared to women undergoing neo-adjuvant chemotherapy (NACT) and interval debulking surgery (IDS) due to high tumor load or poor performance status has been demonstrated by multiple studies, this topic is still a matter of debate. As a consequence, selecting the adequate treatment through an appropriate diagnostic pathway represents a crucial step. Aiming to assess the likelihood of leaving no residual disease at the end of surgery, the role of the CT scan as a predictor of cytoreductive outcomes has shown controversial results. Similarly, CA 125 level as an expression of tumor load demonstrated limited applicability. On the contrary, laparoscopic assessment of disease distribution through a validated scoring system was able to identify, with the highest specificity, patients undergoing suboptimal cytoreduction and therefore best suitable for NACT-IDS. Against this background, with this article, we aim to provide a comprehensive review of available evidence on the diagnostic and treatment pathways of advanced ovarian cancer. [ABSTRACT FROM AUTHOR]

Background: Adhesive small bowel obstruction (ASBO) is an important cause of hospital admission, is associated with significant morbidity and mortality, and therefore is a substantial burden for healthcare systems worldwide. Icodextrin 4% solution (Adept, Shire Pharmaceuticals, UK) is a high-molecular-weight a-1,4 glucose polymer approved in Europe for use as intraoperative lavage and postoperative instillation to reduce the occurrence of post-surgery intra-abdominal adhesions. The present clinical study aimed to evaluate the safety and effectiveness of icodextrin 4% in decreasing the incidence, extent, and severity of adhesions in patients after abdominal surgery for ASBO. Methods: The study was a single-center prospective, randomized investigation. The study is designed and conducted in compliance with the principles of Good Clinical Practice regulations. Safety and efficacy of icodextrin 4% in the study group are compared to no anti-adhesion treatment in a parallel control group with blinded evaluation of primary endpoints. Primary endpoints are the evaluation of the therapeutic role of icodextrin 4% in reducing ASBO recurrence incidence and the need of laparotomies for ASBO recurrence, as well as adhesion formation (with evaluation of their incidence, extent, and severity). A sum of 181 patients with ASBO and surgical indication to laparotomy were enrolled and randomized in two groups. Patients were submitted to adhesiolysis with bowel resection if required with or without anastomosis. The first group received traditional treatment (control group), whereas the second group was treated with the addition of icodextrin 4% solution before the abdominal closure. Results: Ninety-one patients were randomized to have icodextrin 4% solution administered intraperitoneally, and 90 patients were randomized to have the traditional treatment. The two study groups were homogeneous regarding their baseline characteristics. The ASBO recurrence rate was 2.19% (2/91) in the icodextrin groups vs 11.11% (10/90) in the control group after a mean follow-up period of 41.4 months ( p < 0.05). No differences were found in the need of laparotomies for ASBO recurrence in the studied groups. The adhesion severity score seems lower in the group treated with the addition of icodextrin ( p = n.s.). Conclusions: The data resulting from this RCT showed that the use of icodextrin 4% solution in ASBO is safe and reduces intra-abdominal adhesion formation and the risk of re-obstruction. [ABSTRACT FROM AUTHOR]

Background/Aims: Although standard treatment typically consists of an early appendectomy, there has recently been an increase in the use of antibiotic therapy as primary treatment for acute appendicitis (AA). The aim of this analysis is to systematically evaluate the evidence available in relevant literature in order to compare the relative effectiveness of antibiotic therapy as a viable alternative to appendectomies in the treatment of AA. Methods: Literature was searched for randomized clinical trials (RCTs) comparing the efficacy of surgery versus antibiotic therapy. Differences in pooled odds ratios (OR) for outcomes within 95% confidence intervals (CI) were calculated. Results: Four RCTs were identified including 741 patients. Efficacy was significantly higher for surgery (OR = 6.01, 95% CI = 4.27-8.46). No differences were found in the numbers of perforated appendices (OR = 0.73, 95% CI = 0.29-1.84) and patients treated with antibiotics (OR = 0.04, 95% CI = 0.00-3.27). Complication rates were significantly higher for surgery (OR = 1.92, 95% CI = 1.30-2.85). Conclusion: Although a nonsurgical approach in AA can reduce the complications rate, the lower efficacy prevents antibiotic treatment from being a viable alternative to surgery. Since only a small number of RCTs of poor methodological quality are available, well-designed RCTs are needed for further investigation. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background: Obstructive left colon carcinoma (OLCC) is a challenging matter in terms of obstruction release as well of oncological issues. Several options are available and no guidelines are established. The paper aims to generate evidenced based recommendations on management of OLCC. Methods: The PubMed and Cochrane Library databases were queried for publications focusing on OLCC published prior to April 2010. A extensive retrieval, analyses, and grading of the literature was undertaken. The findings of the research were presented and largely discussed among panellist and audience at the Consensus Conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society held in Bologna July 2010. Comparisons of techniques are presented and final committee recommendation are enounced. Results: Hartmann's procedure should be preferred to loop colostomy (Grade 2B). Hartmann's procedure offers no survival benefit compared to segmental colonic resection with primary anastomosis (Grade 2C+); Hartmann's procedure should be considered in patients with high surgical risk (Grade 2C). Total colectomy and segmental colectomy with intraoperative colonic irrigation are associated with same mortality/morbidity, however total colectomy is associated with higher rates impaired bowel function (Grade 1A). Segmental resection and primary anastomosis either with manual decompression or intraoperative colonic irrigation are associated with same mortality/morbidity rate (Grade 1A). In palliation stent placement is associated with similar mortality/morbidity rates and shorter hospital stay (Grade 2B). Stents as a bridge to surgery seems associated with lower mortality rate, shorter hospital stay, and a lower colostomy formation rate (Grade 1B). Conclusions: Loop colostomy and staged procedure should be adopted in case of dramatic scenario, when neoadjuvant therapy could be expected. Hartmann's procedure should be performed in case of high risk of anastomotic dehiscence. Subtotal and total colectomy should be attempted when cecal perforation or in case of synchronous colonic neoplasm. Primary resection and anastomosis with manual decompression seems the procedure of choice. Colonic stents represent the best option when skills are available. The literature power is relatively poor and the existing RCT are often not sufficiently robust in design thus, among 6 possible treatment modalities, only 2 reached the Grade A. * Correspondence: mpisano@ospedaliriuniti.bergamo.it 11st Unit of General Surgery, Ospedali Riuniti di Bergamo, Italy Full list of author information is available at the end of the article Ansaloni et al. World Journal of Emergency Surgery 2010, 5:29 http://www.wjes.org/content/5/1/29 WORLD JOURNAL OF EMERGENCY SURGERY © 2010 Ansaloni et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. [ABSTRACT FROM AUTHOR]

Abstract: Background: The aim of this study was to evaluate the safety and efficacy of Lichtenstein''s hernioplasty using Surgisis Inguinal Hernia Matrix (SIHM; Cook, Bloomington, Indiana) compared with polypropylene (PP; Angiologica, Pavia, Italy). Methods: This was a prospective, randomized, double-blind trial comparing Lichtenstein''s inguinal hernioplasty using SIHM versus PP. Results: Seventy male patients underwent Lichtenstein''s hernioplasty (n = 35 in the SIHM group and n = 35 in the PP group). At 3 years after surgery, there were 2 deaths (5.7%) in the PP group and 1 death (2.9%) in the SIHM group (not significant [NS]). Although the study was underpowered to evaluate the recurrence rate, only 1 recurrence (2.9%) was seen in the PP group (NS). Although a significant decrease in postsurgical pain incidence was never observed among patients in the SIHM group, a significantly lower degree of pain was detected at rest and on coughing at 1, 3, and 6 months and on movement at 1, 3, and 6 months and 1, 2, and 3 years. A significant decrease in postsurgical incidence and degree of discomfort when coughing and moving were observed among patients in the SIHM group at 3 and 6 months and at 1, 2, and 3 years after surgery. Comments: SIHM hernioplasty seems to be a safe and effective procedure. [Copyright &y& Elsevier]

Systemic cytokines (SC) are accepted mediators of host immune response. It is debated if long-term survival is influenced by emergency presentation of colorectal cancer, and the role of immunitary response is still unknown. The aim of this prospective study was to compare the SC response after emergency resection with that after elective resections of colorectal carcinoma. One hundred six consecutive subjects with colorectal cancer were submitted to emergency (complete bowel obstruction; EMS, n = 50) or elective resection (ELS, n = 56) of the tumour. Sera were collected before surgery and at appropriate time points afterward and assayed for interleukin-1beta (IL-1β), tumour necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP). Five-year survival was analysed according to Kaplan–Meier test. The Cox proportional hazard model was used for the multivariate analysis. Pre-operative levels of IL-1β, IL-6 and CRP were statistically higher in the EMS group. Levels of TNF-α were not elevated after surgery and there was no difference between the groups. Five-year survival was significantly lower in the EMS group ( p < 0.05). Immunitary response, as reflected by SC, was better after elective resection than after emergency resection of colorectal carcinoma and this difference may have implication in the long-term survival. [ABSTRACT FROM AUTHOR]

Background: Frequently, hernia repair requires polypropylene (PP) meshes, which carry a well-known adhesiogenic risk when placed in contact to the intestine. The aim of this experimental study in a rat model was to assess the role of some materials, when combined with PP, in preventing the adhesions' formation. Materials and Methods: Sixty male Sprague-Dawley rats were assigned to five groups for intraperitoneal mesh placement: untreated PP, PP+polyurethane (PP+PU), PP+Surgisis (PP+SIS), PP+expanded polytetrafluoroethylene (PP+ePTFE), and a control group without mesh. Twenty-one days and 3 and 6 months after the operation, an assessment of adhesion formation was performed, scoring adhesions in terms of extent and type and the adhesion index (AI; product of adhesions' extent and type). Results: No significant difference was seen between PP+SIS, PP+PU, and control groups in adhesions extent/quality and in AI. The PP+SIS group had significantly lower adhesions' quality value and AI than PP+ePTFE. PP+PU had significantly lower adhesions' extent/quality value and AI than PP+ePTFE. The control group had adhesions with significantly lower extent/quality and AI than PP+ePTFE. The PP group had significantly more and denser adhesions, compared to PP+ePTFE, as well as a significantly higher AI. Conclusions: Adhesions' incidence is reduced by using treated PP meshes. PP+PU and PP+SIS were superior to PP+ePTFE in adhesion prevention. [ABSTRACT FROM AUTHOR]

Background: In the developmental stage of laparoscopic cholecystectomy (LC) it was considered 'unsafe' or 'technically difficult' to perform laparoscopic cholecystectomy for acute cholecystitis (AC). With increasing experience in laparoscopic surgery, a number of centers have reported on the use of laparoscopic cholecystectomy for acute cholecystitis, suggesting that it is technically feasible but at the expense of a high conversion rate, which can be up to 35 per cent and common bile duct lesions. The HARMONIC SCALPEL(R) (H) is the leading ultrasonic cutting and coagulating surgical device, offering surgeons important benefits including: minimal lateral thermal tissue damage, minimal charring and desiccation. Harmonic Scalpel technology reduces the need for ligatures with simultaneous cutting and coagulation: moreover there is not electricity to or through the patient Harmonic Scalpel has a greater precision near vital structures and it produces minimal smoke with improved visibility in the surgical field. In retrospective series LC performed with H was demonstrated feasible and effective with minimal operating time and blood loss: it was reported also a low conversion rate (3.9%). However there are not prospective randomized controlled trials showing the advantages of H compared to MD (the commonly used electrical scalpel) in LC. Methods/Design: Aim of this RCT is to demonstrate that H can decrease the conversion rate compared to MD in LC for AC, without a significant increase of morbidity. The patients will be allocated in two groups: in the first group the patient will be submitted to early LC within 72 hours after the diagnosis with H while in the second group will be submitted to early LC within 72 hours with MD. Trial Registration: ClinicalTrials.gov Identifier: NCT00746850 [ABSTRACT FROM AUTHOR]

Background: In some randomized trials successful laparoscopic cholecystectomy for cholecystitis is associated with an earlier recovery and shorter hospital stay when compared with open cholecystectomy. Other studies did not confirm these results and showed that the potential advantages of laparoscopic cholecystectomy for cholecystitis can be offset by a high conversion rate to open surgery. Moreover in these studies a similar postoperative programme to optimize recovery comparing laparoscopic and open approaches was not standardized. These studies also do not report all eligible patients and are not double blinded. Design: The present study project is a prospective, randomized investigation. The study will be performed in the Department of General, Emergency and Transplant Surgery St Orsola-Malpighi University Hospital (Bologna, Italy), a large teaching institutions, with the participation of all surgeons who accept to be involved in (and together with other selected centers). The patients will be divided in two groups: in the first group the patient will be submitted to laparoscopic cholecystectomy within 72 hours after the diagnosis while in the second group will be submitted to laparotomic cholecystectomy within 72 hours after the diagnosis. [ABSTRACT FROM AUTHOR]

Surgisis IHM is an acellular biomaterial derived from porcine small intestinal submucosa (SIS) that induces site-specific remodeling in the organ or tissue into which it is placed. Previous animal studies have shown that the graft recipient mounts a helper T type 2-restricted immune response to the SIS xenograft without signs of rejection. The aims of this study were to evaluate the immune response to the SIS implant in a small series of humans and to examine the long-term clinical acceptance of the xenograft in these patients. Five consecutive male patients (mean age 56 years, range 34-68) who underwent inguinal hernioplasty with Surgisis IHM were assessed at 2 weeks, 6 weeks, and 6 months after implant for SIS-specific, α -1,3-galactose (α -gal) epitope and type I collagen specific antibodies. All five patients were also clinically assessed up to 2 years for signs of clinical rejection, hernia recurrence, and other complications. All 5 patients implanted with Surgisis IHM produced antibodies specific for SIS and α -gal with a peak between 2 and 6 weeks after implantation. By 6 months, all patients showed decreasing levels of anti-SIS antibodies. Two patients developed a transient, mild local seroma that resolved spontaneously. None of the patients showed any clinical signs of rejection, wound infection, hernia recurrence, or other complications in the follow-up out to 2 years. Thus, this study showed that in a small series of patients the SIS elicits an antibody response without clinical rejection of the xenograft and minimal postoperative complications. [ABSTRACT FROM AUTHOR]

Abstract: Study Objective: To evaluate the analgesic efficacy and safety of ropivacaine 0.2% when administered continuously via elastomeric pump after appendectomy. Design: Prospective, randomized, double-blinded study. Setting: Surgical ward of a university hospital. Patients: 96 ASA physical status I and II patients of at least 14 years of age, undergoing appendectomy through a McBurney incision. Interventions: Patients were randomly assigned into two groups: 500 mg of ropivacaine in 48 hours (10 mL of 0.2% ropivacaine 20 mg, starter dose plus 5 mL/h continuous wound infusion via elastomeric pump device; n = 48) in the experimental group and 250 mL of normal saline, as placebo, in the control group. Measurements: Postappendectomy pain, measured either with a simple verbal scale or with a visual analog scale, parenteral analgesic consumption, and global satisfaction were all measured. Main Results: A reduction in postoperative pain was observed in the ropivacaine group. Degree of pain, with a simple verbal scale measurement of severe and unbearable, was significantly lower in the ropivacaine group than in the normal saline group from time 0 to 24 hours at rest and from time 0 to 36 hours on coughing. A significant lower pain intensity (visual analog scale) was found in the ropivacaine group both at rest and on coughing, beginning at three hours and continuing to 36 hours postoperatively. The mean number of rescue analgesic doses was significantly lower in the ropivacaine group. There were no statistically significant differences in the frequency of adverse events between the two groups. Conclusions: Wound instillation with ropivacaine 0.2% is a useful, practical, and safe method for management of postoperative pain after appendectomy. [Copyright &y& Elsevier]

The authors reflect on case reports (CR) in the journal "World Journal of Emergency Surgery." They discuss that CR comprises the collections of reports concerning on the diagnosis and treatment of patients wherein 39.2% of all articles submitted are CR. They emphasize the importance of evidence based medicine and the guidelines for the publication of CR. Furthermore, they also presented the criteria and format in publishing and writing CR.

Intra-abdominal infections (IAIs) are common surgical emergencies and are an important cause of morbidity and mortality in hospital settings, particularly if poorly managed. The cornerstones of effective IAIs management include early diagnosis, adequate source control, appropriate antimicrobial therapy, and early physiologic stabilization using intravenous fluids and vasopressor agents in critically ill patients. Adequate empiric antimicrobial therapy in patients with IAIs is of paramount importance because inappropriate antimicrobial therapy is associated with poor outcomes. Optimizing antimicrobial prescriptions improves treatment effectiveness, increases patients' safety, and minimizes the risk of opportunistic infections (such as Clostridioides difficile) and antimicrobial resistance selection. The growing emergence of multi-drug resistant organisms has caused an impending crisis with alarming implications, especially regarding Gram-negative bacteria. The Multidisciplinary and Intersociety Italian Council for the Optimization of Antimicrobial Use promoted a consensus conference on the antimicrobial management of IAIs, including emergency medicine specialists, radiologists, surgeons, intensivists, infectious disease specialists, clinical pharmacologists, hospital pharmacists, microbiologists and public health specialists. Relevant clinical questions were constructed by the Organizational Committee in order to investigate the topic. The expert panel produced recommendation statements based on the best scientific evidence from PubMed and EMBASE Library and experts' opinions. The statements were planned and graded according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence. On November 10, 2023, the experts met in Mestre (Italy) to debate the statements. After the approval of the statements, the expert panel met via email and virtual meetings to prepare and revise the definitive document. This document represents the executive summary of the consensus conference and comprises three sections. The first section focuses on the general principles of diagnosis and treatment of IAIs. The second section provides twenty-three evidence-based recommendations for the antimicrobial therapy of IAIs. The third section presents eight clinical diagnostic-therapeutic pathways for the most common IAIs. The document has been endorsed by the Italian Society of Surgery. [ABSTRACT FROM AUTHOR]

Intra-abdominal infections (IAIs) are an important cause of morbidity and mortality in hospital settings worldwide. The cornerstones of IAI management include rapid, accurate diagnostics; timely, adequate source control; appropriate, short-duration antimicrobial therapy administered according to the principles of pharmacokinetics/pharmacodynamics and antimicrobial stewardship; and hemodynamic and organ functional support with intravenous fluid and adjunctive vasopressor agents for critical illness (sepsis/organ dysfunction or septic shock after correction of hypovolemia). In patients with IAIs, a personalized approach is crucial to optimize outcomes and should be based on multiple aspects that require careful clinical assessment. The anatomic extent of infection, the presumed pathogens involved and risk factors for antimicrobial resistance, the origin and extent of the infection, the patient's clinical condition, and the host's immune status should be assessed continuously to optimize the management of patients with complicated IAIs. [ABSTRACT FROM AUTHOR]

Background: Robotic surgery has gained widespread acceptance in elective interventions, yet its role in emergency procedures remains underexplored. While the 2021 WSES position paper discussed limited studies on the application of robotics in emergency general surgery, it recommended strict patient selection, adequate training, and improved platform accessibility. This prospective study aims to define the role of robotic surgery in emergency settings, evaluating intraoperative and postoperative outcomes and assessing its feasibility and safety. Methods: The ROEM study is an observational, prospective, multicentre, international analysis of clinically stable adult patients undergoing robotic surgery for emergency treatment of acute pathologies including diverticulitis, cholecystitis, and obstructed hernias. Data collection includes patient demographics and intervention details. Furthermore, data relating to the operating theatre team and the surgical instruments used will be collected in order to conduct a cost analysis. The study plans to enrol at least 500 patients from 50 participating centres, with each centre having a local lead and collaborators. All data will be collected and stored online through a secure server running the Research Electronic Data Capture (REDCap) web application. Ethical considerations and data governance will be paramount, requiring local ethical committee approvals from participating centres. Discussion: Current literature and expert consensus suggest the feasibility of robotic surgery in emergencies with proper support. However, challenges include staff training, scheduling conflicts with elective surgeries, and increased costs. The ROEM study seeks to contribute valuable data on the safety, feasibility, and cost-effectiveness of robotic surgery in emergency settings, focusing on specific pathologies. Previous studies on cholecystitis, abdominal hernias, and diverticulitis provide insights into the benefits and challenges of robotic approaches. It is necessary to identify patient populations that benefit most from robotic emergency surgery to optimize outcomes and justify costs. [ABSTRACT FROM AUTHOR]

In the present work, the potential of polyPOSS-imide membranes designed for the purification of H 2 from a coke gas (utilized in the steelmaking industry) is investigated. Aiming at upscaling the membrane fabrication, tubular single-channel and multi-channel membranes were prepared, using polyhedral oligomeric silsesquioxane (POSS) nanostructures and 6FDA as reactive precursors. The gas separation performance has been investigated by means of single gas and quaternary (H 2 , CH 4 , CO 2 , N 2) mixtures, the latter used to simulate the conditions expected at the membrane module inlet in the process of upgrading H 2 from a coke oven gas. Preliminary results obtained on tubular membranes showed that the fabricated membranes can achieve high H 2 permeance (>2000 GPU), displaying also suitable selectivity towards CO 2 , N 2 and CH 4. The selectivity of these upscaled tubular membrane samples meets the performance of those previously obtained for the disc-shaped lab-scale membranes. These results revealed the promising potential in the upscaling of polyPOSS-imide membranes fabricated via interfacial polymerization on ceramic porous supports for H 2 upgrading. Image 1 • Fabrication of ultrathin polyPOSS-imide layer is upscaled from disks to tubular membranes. • The fabricated polyPOSS-imide membranes showed good stability up to 10 bar and 300 °C. • The influence of the porous support on the gas transport properties is highlighted. • H 2 permeance above 2000 GPU is obtained while showing good gas selectivity. • Multi-channel membrane performances are close to the ones obtained for single-channel. [ABSTRACT FROM AUTHOR]

The original article [1] contained an error in authorship whereby author, Fausto Catena was mistakenly listed as part of the institutional authorship of the OBA trial supporters instead of in the correct position of final author. [ABSTRACT FROM AUTHOR]

In the present work, hybrid block ionomer/ionic liquid (IL) membranes containing up to 40 wt% IL are prepared by incorporating 1-butyl-3-methylimidazolium tetrafluoroborate ([Bmim][BF 4 ]) into a midblock-sulfonated pentablock polymer (Nexar) that behaves as a thermoplastic elastomer. Various analytical techniques, including thermogravimetric analysis (TGA), Fourier-transform infrared (FTIR) spectroscopy, small-angle X-ray scattering (SAXS), and water sorption have been employed to characterize the resultant membrane materials. Single- and mixed-gas permeation tests have been performed at different relative humidity conditions to evaluate membrane gas-separation performance and interrogate the molecular transport of CO 2 through these membranes. Addition of IL to Nexar systematically enhances CO 2 permeability through membranes in the dry state. Introduction of water vapor into the gas feed further promotes CO 2 transport, yielding a maximum permeability of 194 Barrers and a maximum CO 2 /N 2 selectivity of 128 under different test conditions. These results confirm that humidified Nexar/IL hybrid membranes constitute promising candidates for the selective removal, and subsequent capture, of CO 2 from mixed gas streams to reduce the environmental contamination largely responsible for global climate change. Image 1 • Novel Nexar/IL membranes containing up to 40 wt% IL have been successfully prepared. • Adding IL to Nexar promotes a morphological change from a lamellar to a cylindrical nanostructure. • The IL-induced morphological transformation is accompanied by a substantial change in gas-transport properties. • The presence of IL and water vapor simultaneously improve CO 2 permeability and CO 2 /N 2 selectivity in Nexar/IL membranes. • A CO 2 permeability of ca. 200 Barrers and a CO 2 /N 2 selectivity of up to 130 have been documented. [ABSTRACT FROM AUTHOR]

Background: Despite advances in diagnostic modalities, small bowel tumours are notoriously difficult to diagnose and are often advanced at the time of definitive treatment. These malignancies can cause insidious abdominal pain and weight loss, or create surgical emergencies including haemorrhage, obstruction or perforation. The aim of the present study was to describe the clinical presentation, diagnostic work-up, surgical therapy and short-term outcome of 34 patients with primary and secondary small bowel tumours submitted for surgical procedures in an emergency setting and to look for a correlation between clinical presentation and the type of tumours. Methods: From 1995 to 2005, 34 consecutive surgical cases of small bowel tumours were treated at the Department of Emergency Surgery of St Orsola-Malpighi University Hospital, Bologna, Italy. Clinical and radiological charts of these patients were reviewed retrospectively from the department database. Results: All patients presented as surgical emergencies: intestinal obstruction was the most common clinical presentation (15 cases), followed by perforation (11 cases) and gastrointestinal bleeding (eight cases). Lymphoma was the most frequent histologic type (nine patients), followed by stromal tumours (eight patients), carcinoids (seven patients), adenocarcinoma (seven patients) and metastasis (three patients). Of the nine patients with lymphoma, eight were perforated, all patients with stromal tumours had bleeding, and all carcinoids patients had bowel obstruction. There were two patients with melanoma metastasis, both had bowel intussusception. Resection of the neoplasm was carried out in 32 patients and two patients were deemed unresectable and received a palliative procedure. Conclusions: The present study shows that there is a correlation between small bowel tumours and clinical emergency presentation: gastrointestinal stromal tumours (GIST) mostly bleed; carcinoids make an obstruction; lymphomas cause a perforation; and melanoma metastasis causes intussusception. [ABSTRACT FROM AUTHOR]

Introduction: A textbook outcome patient is one in which the operative course passes uneventful, without complications, readmission or mortality. There is a lack of publications in terms of TO on acute cholecystitis. Objetive: The objective of this study is to analyze the achievement of TO in patients with urgent early cholecystectomy (UEC) for Acute Cholecystitis. and to identify which factors are related to achieving TO. Materials and methods: This is a post hoc study of the SPRiMACC study. It´s a prospective multicenter observational study run by WSES. The criteria to define TO in urgent early cholecystectomy (TOUEC) were no 30-day mortality, no 30-day postoperative complications, no readmission within 30 days, and hospital stay ≤ 7 days (75th percentile), and full laparoscopic surgery. Patients who met all these conditions were taken as presenting a TOUEC. Outcomes: 1246 urgent early cholecystectomies for ACC were included. In all, 789 patients (63.3%) achieved all TOUEC parameters, while 457 (36.6%) failed to achieve one or more parameters and were considered non-TOUEC. The patients who achieved TOUEC were younger had significantly lower scores on all the risk scales analyzed. In the serological tests, TOUEC patients had lower values for in a lot of variables than non-TOUEC patients. The TOUEC group had lower rates of complicated cholecystitis. Considering operative time, a shorter duration was also associated with a higher probability of reaching TOUEC. Conclusion: Knowledge of the factors that influence the TOUEC can allow us to improve our results in terms of textbook outcome. [ABSTRACT FROM AUTHOR]

Critically ill patients treated in the intensive care unit (ICU) can present with many abdominal conditions that need a prompt diagnosis and timely treatment because of their general frailty. Clinical evaluation and diagnostic tools like ultrasound or CT scans are not reliable or feasible in these patients. Bedside laparoscopy (BSL) is a minimally invasive procedure that allows surgeons to assess the abdominal cavity directly in the ICU, thus avoiding unnecessary exploratory laparotomy or incidents related to intra-hospital transfer. We conducted a review of the literature to summarize the state-of-the-art of BSL. The Medline, Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus databases were utilized to identify all relevant publications. Indications, contraindications, technical aspects, and outcomes are discussed. The procedure is safe, feasible, and effective. When other diagnostic tools fail to diagnose or exclude an intra-abdominal condition in ICU patients, BSL should be preferred over exploratory laparotomy. [ABSTRACT FROM AUTHOR]

Background and study aim: The development of a new cholangioscope, the SpyGlass™ Discover (Boston Scientific), has allowed the laparoscopic transcystic common bile duct exploration and stone clearance. The possibility of simultaneous treatment of choledocholithiasis during early laparoscopic cholecystectomy offers the opportunity to enormously reduce the time between acute cholecystitis diagnosis and the execution of cholecystectomy with better outcomes for patients. Furthermore, an altered anatomy of the gastrointestinal tract is not an obstacle to this technique. The aim of the study was to determine whether this new procedure is feasible, safe, and effective. Patients and methods: The investigation employs a retrospective case series study including all consecutive patients with a diagnosis of common bile duct stones undergoing cholecystectomy and intraoperative laparoscopic common bile duct clearance using SpyGlass™ Discover at IRCCS Policlinico San Matteo in Pavia (Italy). Eighteen patients were included from May 2022 to May 2023. Results: A complete clearance of the common bile duct was obtained in 88.9% of patients. The mean postoperative length of stay was 3 days. No major complications occurred. After a median follow-up of 8 months, no recurrence of biliary events or readmissions occurred. Conclusion: This procedure has proven to be feasible, safe, and effective. [ABSTRACT FROM AUTHOR]

Ventral incisional hernias are common indications for elective repair and frequently complicated by recurrence. Surgical meshes, which may be synthetic, bio-synthetic, or biological, decrease recurrence and, resultingly, their use has become standard. While most patients are greatly benefited, mesh represents a permanently implanted foreign body. Mesh may be implanted within the intra-peritoneal, preperitoneal, retrorectus, inlay, or onlay anatomic positions. Meshes may be associated with complications that may be early or late and range from minor to severe. Long-term complications with intra-peritoneal synthetic mesh (IPSM) in apposition to the viscera are particularly at risk for adhesions and potential enteric fistula formation. The overall rate of such complications is difficult to appreciate due to poor long-term follow-up data, although it behooves surgeons to understand these risks as they are the ones who implant these devices. All surgeons need to be aware that meshes are commercial devices that are delivered into their operating room without scientific evidence of efficacy or even safety due to the unique regulatory practices that distinguish medical devices from medications. Thus, surgeons must continue to advocate for more stringent oversight and improved scientific evaluation to serve our patients properly and protect the patient–surgeon relationship as the only rationale long-term strategy to avoid ongoing complications. [ABSTRACT FROM AUTHOR]

Simple Summary: Acute colonic obstruction is one of the most common manifestations of locally advanced colorectal cancer. Endoscopic stenting has become by far the minimally invasive treatment of choice for malignant colonic obstruction especially in the palliative setting. However, there are still controversies in the literature about the usefulness and safety of endoscopic stenting as a bridge-to-surgery approach or in patients on antiangiogenic therapy. Moreover, endoscopic colonic stenting is an operative procedure that requires adequate pre-interventional management and specific endoscopic knowledge. The present review aimed to summarize the optimization of endoscopic management of patients with malignant acute colonic obstruction based on a multimodal connection with the various medical specialties involved in managing this urgent clinical scenario. Patients presenting with acute colonic obstruction are usually evaluated in the emergency department and multiple specialties are involved in the patients' management. Pre-treatment evaluation is essential in order to establish the correct endoscopic indication for stent implantation. Contrast-enhanced imaging could allow the exclusion of benign causes of colonic obstruction and evaluation of the length of malignant stricture. Endoscopic stenting is the gold standard of treatment for palliative indications whereas there are still concerns about its use as a bridge to surgery. Different meta-analyses showed that stenting as a bridge to surgery improves short-term surgical outcomes but has no role in improving long-term outcomes. Multidisciplinary evaluation is also essential in patients that may be started on or are currently receiving antiangiogenic agents because endoscopic stenting may increase the risk of perforation. Evidence in the literature is weak and based on retrospective data. Here we report on how to correctly evaluate a patient with acute colonic malignant obstruction in collaboration with other essential specialists including a radiologist, surgeon and oncologist, and how to optimize the technique of endoscopic stenting. [ABSTRACT FROM AUTHOR]

Background: The aim of this manuscript is to illustrate a new method permitting safe cholecystectomy in terms of complications with respect to the common bile duct (CBD). Methods: The core of this new technique is identification of the continuity of the cystic duct with the infundibulum. The cystic duct can be identified between the inner gallbladder wall and inflamed outer wall. Results: In the last 2 years, from January 2019 until December 2021, 3 patients have been treated with the reported technique without complications. Conclusions: Among the various cholecystectomy procedures, this is a new approach that ensures the safety of the structures of Calot's triangle while providing the advantages gained from total removal of the gallbladder. [ABSTRACT FROM AUTHOR]