Adaptation and validation of the Carolinas Comfort Scale: a questionnaire-based cross-sectional study.

PURPOSE: Quality of life (QoL) is an important outcome following surgery. The Carolinas Comfort scale (CCS) is a specific questionnaire used to evaluate QoL in patients who underwent abdominal hernia repair with mesh. The aim of this study was to create a Lithuanian version of the CCS. METHODS: A questionnaire-based cross-sectional study was conducted. A Lithuanian version of the CCS was created by translating the original questionnaire in accordance with the guidelines. The Lithuanian questionnaire was provided to hernia patients at 1 week and at 1 month postoperatively. The main validation characteristics of the Lithuanian CCS were assessed and compared to the original version. RESULTS: The complete response rate of patients was close to 90%. Internal consistency was excellent, with a Cronbach's α of 0.953. Correlation coefficients ranged from 0.361 to 0.703 in the test-retest analysis. In the construct validity analysis, the strongest correlations were observed in the domains of physical functioning and bodily pain (- 0.655 and - 0.584, respectively) and the weakest correlations in role-emotional and mental health (- 0.268 and - 0.230, respectively). The mean scores of all CCS domains and the total score for satisfied patients were significantly lower (p < 0.001) than those of dissatisfied patients. The principal component analysis identified 3 components, with the first accounting for 56% of the variance. CONCLUSIONS: The Lithuanian version of CCS maintains the original validity and is a reliable and valid tool for assessing specific QoL factors after the repair of inguinal hernia with mesh. We recommend using this CCS version in personal, local, and international contexts.

Intracapillary leucocyte accumulation as a novel antihaemorrhagic mechanism in acute pancreatitis in mice.

BACKGROUND: Pancreatic infiltration by leucocytes represents a hallmark in acute pancreatitis. Although leucocytes play an active role in the pathophysiology of this disease, the relation between leucocyte activation, microvascular injury and haemorrhage has not been adequately addressed. METHODS: We investigated intrapancreatic leucocyte migration, leucocyte extravasation and pancreatic microperfusion in different models of oedematous and necrotising acute pancreatitis in lys-EGFP-ki mice using fluorescent imaging and time-lapse intravital microscopy. RESULTS: In contrast to the current paradigm of leucocyte recruitment, the initial event of leucocyte activation in acute pancreatitis was represented through a dose- and time-dependent occlusion of pancreatic capillaries by intraluminally migrating leucocytes. Intracapillary leucocyte accumulation (ILA) resulted in dense filling of almost all capillaries close to the area of inflammation and preceded transvenular leucocyte extravasation. ILA was also initiated by isolated exposure of the pancreas to interleukin 8 or fMLP, demonstrating the causal role of chemotactic stimuli in the induction of ILA. The onset of intracapillary leucocyte accumulation was strongly inhibited in LFA-1(-/-) and ICAM-1(-/-) mice, but not in Mac-1(-/-) mice. Moreover, prevention of intracapillary leucocyte accumulation led to the development of massive capillary haemorrhages and transformed mild pancreatitis into lethal haemorrhagic disease. CONCLUSIONS: ILA represents a novel protective and potentially lifesaving mechanism of haemostasis in acute pancreatitis. This process depends on expression of LFA-1 and ICAM-1 and precedes the classical steps of the leucocyte recruitment cascade.