Nosocomial SARS-CoV-2 transmission in postoperative infection and mortality: analysis of 14 798 procedures.

This study used a national administrative database to estimate perioperative SARS-CoV-2 infection risk, and associated mortality, relative to nosocomial transmission rates. The impact of nosocomial transmission was greatest after major emergency surgery, whereas laparoscopic surgery may be protective owing to reduced duration of hospital stay. Procedure-specific risk estimates are provided to facilitate surgical decision-making and informed consent. Estimated risks.

Self-reported and actual adherence to the Tokyo guidelines in the European snapshot audit of complicated calculous biliary disease.

BACKGROUND: Complicated acute biliary calculous disease poses clinical challenges. The European Society of Trauma and Emergency Surgery (ESTES) snapshot audit of complicated biliary calculous disease aims to make novel comparisons between self-reported institutional adherence to the Tokyo guidelines (TG18) and 'real-world' contemporary practice across Europe. METHODS: A preplanned analysis of a prospective observational multicentre audit that captured patients undergoing emergency admission for complicated biliary calculous disease (complicated cholecystitis, biliary pancreatitis, or choledocholithiasis with or without cholangitis) between 1 and 31 October 2018 was performed. An anonymized survey was administered to participating sites. RESULTS: Following an open call for participation, 25 centres from nine countries enrolled 338 patients. All centres completed the anonymized survey. Fifteen centres (60 per cent) self-reported that a minority of patients were treated surgically on index admission, favouring interval cholecystectomy. This was replicated in the snapshot audit, in which 152 of 338 patients (45·0 per cent) underwent index admission cholecystectomy, 17 (5·0 per cent) had interval cholecystectomy, and the remaining 169 (50·0 per cent) had not undergone surgery by the end of the 60-day follow-up. Centres that employed a dedicated acute care surgery model of care were more likely to perform index admission cholecystectomy compared with a traditional general surgery 'on call' service (57 versus 38 per cent respectively; odds ratio 2·14 (95 per cent c.i. 1·37 to 3·35), P < 0·001). Six centres (24 per cent) self-reported routinely performing blood cultures in acute cholecystitis; patient-level audit data revealed that blood cultures were done in 47 of 154 patients (30·5 per cent). No centre self-reported omitting antibiotics in the management of acute cholecystitis, and 144 of 154 (93·5 per cent) of patients in the snapshot audit received antibiotics during their index admission. CONCLUSION: Awareness of TG18 recommendations was high, but self-reported adherence and objective snapshot audit data showed low compliance with TG18 in patients with complicated acute biliary calculous disease.

ANTECEDENTES: La complicación aguda de la litiasis biliar (complicated acute biliary calculous disease, CABCD) plantea retos clínicos. Esta auditoría de la Sociedad Europea de Trauma y Cirugía de Urgencias (European Society of Trauma and Emergency Surgery, ESTES) de la CABCD tuvo como objetivo comparar el conocimiento teórico de las recomendaciones de Tokio (TG18) y la "práctica real" en Europa. MÉTODOS: Se efectuó un análisis pre-establecido de los datos de una auditoría prospectiva, observacional y multicéntrica que incluyó los pacientes ingresados de urgencia por CABCD (es decir, colecistitis complicada, pancreatitis biliar o coledocolitiasis con o sin colangitis) entre el 1 y el 31 de octubre de 2018. Además, se realizó una encuesta anónima en los centros participantes. RESULTADOS: Tras una convocatoria abierta, 25 centros de 9 países incluyeron 338 pacientes. Todos los centros completaron la encuesta anónima. El 60% de los centros reconocieron que trataban en el mismo ingreso una minoría de los pacientes y que favorecían la colecistectomía diferida. Ello se reprodujo en la auditoria, donde a 152/338 (44,9%) de los pacientes se realizó la colecistectomía en el mismo ingreso, a 17/338 (5%) se realizó una colecistectomía diferida y que a 169/338 (50%) todavía no se había realizado ninguna intervención en los 60 días de seguimiento. Los centros que seguían el Modelo de Atención Quirúrgica Urgente tenían mayores probabilidades de realizar la colecistectomía en el mismo ingreso en comparación con un servicio de cirugía general tradicional 'de guardia' (57% versus 38,4%, razón de oportunidades, odds ratio, OR 2,14 (i.c. del 95% 1,37-3,35), P < 0,001)). El 24% de los centros afirmaron realizar hemocultivos de rutina en la colecistitis aguda. Sin embargo, los datos de la auditoría revelaron que solamente 47/154 (30,5%) de los pacientes tenían hemocultivos. Ningún centro declaró no administrar antibióticos en el tratamiento de la colecistitis aguda, mientras que 144/154 (93,5%) de los pacientes de la auditoría no recibieron antibióticos durante el ingreso. CONCLUSIONES: El conocimiento de las recomendaciones de TG18 fue alto. Sin embargo, la observancia reconocida por los centros y los datos objetivos de la auditoría muestran que el cumplimiento en los pacientes con CABCD es bajo.

Trends in the Use of Laparoscopic Versus Open Paediatric Appendicectomy: A Regional 12-Year Study and a National Survey.

BACKGROUND: In adult patients, it is generally accepted that laparoscopic appendicectomy (LA) is the predominant operative pathway in treating acute appendicitis. The case for a similar pathway utilising LA in children is less clear. We investigate usage, trends and complications after LA in children in a single co-located adult/paediatric centre with contemporaneous adults as controls. METHODS: A retrospective case-control study was conducted over 12 years including patients who underwent appendicectomy, and the paediatric series (<16 years) was divided into age-groups-based quartiles. An anonymous questionnaire-based national survey was circulated among general and paediatric surgeons. RESULTS: Of the 5784 appendicectomy patients, 2960 were children. LA rate in paediatric appendicitis was 65%. Yearly trends in LA reached a steady state in both groups after 2010 (Δ 0-1%/year). Rates of LA and LA IAA (respectively) differed significantly between age groups: 60, 3% (0-9 years); 65, 1% (10-13 years); 71, 2% (14-16 years) and 93, 3% (>16 years) (p = 0.001, 0.02). The national survey showed respondents believed LA was not superior to OA in paediatric patients except in terms of cosmesis. There was strong support in the use of LA in older children and children >40 kg. CONCLUSION: The use of LA in paediatric appendicectomies in the study region is similar to international rates, but not increasing over time. Irish surgeons still favour OA in younger children and prefer a case-by-case approach rather LA being the preferred pathway. This is despite the regional and international evidence showing favourable outcomes with LA in children.

Bacillus thuringiensis improved isolation methodology from soil samples.

Bacillus thuringiensis is a sporulating bacterium, which produces parasporal inclusions toxic to insects. Widely used methodologies to isolate Bt from soil consist of a thermal shock treatment followed by selective germination of spores. The results presented here suggest that a preliminary 5 h dry-heat treatment largely enhance the selectivity of these procedures.

Improved radiology film library operations.

An interdisciplinary task force at the authors' institution developed a design for a new film library that placed heavy emphasis on service to its customers. The task force established locations and staffing for "satellite" inpatient film libraries organized by clinical specialties. Inpatient films were not permitted to be taken from the radiology department but were available for 24-hour viewing. Film locations were recorded in the radiology information system. Reorganization led to important improvements in film library operations and in the clinical staff's opinion of film library service. Objective measures of performance, such as the fraction of requested films available for conferences, showed significant improvement (P less than .001). Closer working relationships developed between film librarians, radiologists, and their clinical colleagues. Film library personnel were recruited more easily and stayed on the job longer. Several hundred thousand film-tracking transactions per year were recorded. The authors conclude that decentralization of certain film library activities improved many critical aspects of performance.

Marketing CT and MR imaging services in a large urban teaching hospital.

A three-phase marketing program was implemented to increase referrals for examination with computed tomographic (CT) or magnetic resonance (MR) imaging and improve services in an academic radiology department. In the research phase, a data base of 135 referring physicians was developed, and a questionnaire was mailed to 130 physicians. The market research identified three key issues: waiting time to get an appointment, scheduling procedures, and communication of findings. In the implementation phase, additional equipment was installed and a program of expanded appointments, service improvements, and public relations was introduced. In the evaluation phase, 1 year after the completion of phase 2, the effect of the marketing program was measured. The average number of physicians who made referrals per month increased from 609 to 653 (an increase of 7.2% over baseline); the average number of CT and MR examinations performed each month increased by 57.3% and 45.2%, respectively. Referrers' ratings of 10 imaging services improved significantly (P = .02). It is concluded that a well-designed marketing program can boost the productivity of a teaching hospital department.

Radiology department management system: technologists' costs.

We developed a series of management reports to compare actual costs against expected costs for radiology departments on a more detailed level than previously available. We first developed labor standards for the most commonly employed diagnostic examinations and showed that increased patient complexity (resulting from, for example, immobility, precautions status, etc.) also increased the examination times up to 2.6-fold compared with the time required for average patients. Using labor standards and budgeted and actual volumes of average and complex patients, we calculated four types of variances: volume variance, examination mix variance, patient complexity variance, and technologist efficiency variance. Monitoring the technologist efficiency variance over time could be one key piece of information for improving departmental productivity.

Monoclonal antibody directed against interleukin 2. I. Inhibition of T lymphocyte mitogenesis and the in vitro differentiation of alloreactive cytolytic T cells.

Our recent studies have detailed the generation of B cell hybridomas whose IgG product significantly inhibits interleukin 2 (IL-2)-dependent T cell replication. Given the capacity of such hybridoma antibody to interfere with the activity of mouse, rat, and human IL-2, we asked whether anti-IL-2 IgG would mediate similar inhibitory effects on other in vitro immune responses. In this communication, we report that addition of purified anti-IL-2 monoclonal antibody to either mitogen- or alloantigen-stimulated spleen cells exerted markedly deleterious effects on both resultant T cell proliferation and the generation of cytolytic effector cells. These results provide serological evidence in support of the integral role that IL-2 plays in controlling antigen/mitogen-induced T cell proliferation and serves further to define the ability of monoclonal antibody against IL-2 to function as an immunosuppressive agent.

The detection of a spleen focus-forming virus neoantigen by lymphocyte-mediated cytolysis.

The existence of a nonvirion tumor-associated cell surface antigen (TASA) on cells transformed with Friend (FLV) on Rauscher (RLV) leukemia virus has been difficult to demonstrate. Antisera raised against classically defined Friend- Moloney-Rauscher antigenic determinants have been shown to react with virus structural proteins coded for by genetic information contained in the lymphatic leukemia or helper (LLV) virus genome. The recent development of nontrans-formed fibroblast cell lines which contain the replication-defective spleen focus-forming virus (SFFV) genome, free of replicating LLV, has allowed investigation of an SFFV-specific antigen. We have applied the techniques of mixed tumor-lymphocyte culture stimulation followed by lymphocyte-mediated cytolysis assays to search for the cell surface expression of an antigen coded expressly by SFFV genetic information. SFFV nonproducer-immune, in vitro activated spleen cells were capable of effecting the lysis of SFFV-containing BALB/c 3T3 and Fischer rat epithelial, cloned cell lines. Normal BALB/c 3T3 and BALB/c 3T3 cells infected with three types of ecotropic LLV were unaffected. Syngeneic FLV and RLV-induced murine leukemia cells were also killed by SFFV nonproducer-immune lymphocytes. In addition, Kirsten sarcoma virus-transformed, replication-defective and replication-rescued BALB/c 3T3 fibroblasts were not susceptible to SFFV antigen-directed cytolysis. Antibody-dependent complement-mediated cytolysis assays using monospecific goat antisera confirmed that SFFV nonproducers lacked cell surface expression of virion structural proteins. These observations suggest that the antigen detected in LMC experiments was not coded for by genetic information contained in the helper component of FLV, and that it represents a true SFFV-specific cell surface antigen. Based upon the recent molecular evaluation of the SFFV genome as consisting of both xenotropic and ecotropic virus sequences, it appears reasonable that xenotropic genetic information may be responsible for expression of the SFFV- specific antigen. Since the replication-defective SFFV genome is also responsible for the malignant transformation associated with FLV-induced erythroleukemia, one might postulate that gene sequences capable of programming transformation may also code for the TASA detected in these studies.