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Our understanding of pilonidal sinus disease (PSD) is based on a paper published 29 years ago by Karydakis. Since then, surgeons have been taught that hair more easily penetrates wet skin, leading to the assumption that sweating promotes PSD. This postulate, however, has never been proven. Thus we used pilocarpine iontophoresis to assess sweating in the glabella sacralis. 100 patients treated for PSD and 100 controls were matched for sex, age and body mass index (BMI). Pilocarpine iontophoresis was performed for 5 min, followed by 15 min of sweat collection. PSD patients sweated less than their matched pairs (18.4 ± 1.6 µl vs. 24.2 ± 2.1 µl, p  = 0.03). Men sweated more than women (22.2 ± 1.2 µl vs. 15.0 ± 1.0 µl in non-PSD patients ( p  < 0.0001) and 20.0 ± 1.9 µl vs. 11.9 ± 2.0 µl in PSD patients ( p  = 0.051)). And regular exercisers sweated more than non-exercisers (29.1 ± 2.9 µl vs. 18.5 ± 1.6 µl, p  = 0.0006 for men and 20.7 ± 2.3 µl vs. 11.4 ± 1.4 µl, p  = 0.0005 for women). PSD patients sweat less than matched controls. Thus sweating may have a protective effect in PSD rather than being a risk factor.

Purpose of Review We review the relevance of quantitative sensory testing (QST) in light of acute and chronic postoperative pain and associated challenges. Recent Findings Predicting the occurrence of acute and chronic postoperative pain with QST can help identify patients at risk and allows proactive preventive management. Generally, central QST testing, such as temporal summation of pain (TSP) and conditioned pain modulation (CPM), appear to be the most promising modalities for reliable prediction of postoperative pain by QST. Overall, QST testing has the best predictive value in patients undergoing orthopedic procedures. Summary Current evidence underlines the potential of preoperative QST to predict postoperative pain in patients undergoing elective surgery. Implementing QST in routine preoperative screening can help advancing traditional pain therapy toward personalized perioperative pain medicine.

In this letter to the editor, we discuss the article by Bigdon et al., published recently in the Journal of Orthopaedic Surgery and Research, about their accurate single-centre cohort study of 8000 vertebral fractures in 4772 patients. As the complication rate of this cohort is low, it seems that severe trauma patients needing damage control resuscitation/procedures may have undergone damage control in the first treating hospital before being transferred to the trauma centre. It will be interesting to see how both activity and health trends within the ageing population will change osteoporotic occurrence of fractures and enable more conservative trends versus operative stabilization to continue an active life even in the seventh or eighth decade.

Due to an unfavorable prognosis using the usual therapy, patients with anaplastic thyroid cancer (ATC) are in desperate need of new therapeutic strategies. The objective of this study was to evaluate the effects of MLN8054, an inhibitor of the Aurora serine/threonine kinases, on ATC cells in vitro and on ATC xenografts as a new therapeutic strategy for ATC. Three anaplastic (Hth74, C643, Kat4) and one follicular (FTC133) thyroid cancer cell lines were evaluated in vitro and Kat4 xenografts in vivo. The antiproliferative effect of MLN8054 (0.1–10 μM) on thyroid cancer cells was quantified by sulphorhodamine B‐assay. The proapoptotic effect and the effects on the cell cycle were evaluated by flow cytometry after Annexin‐V‐FITC staining. Further Histone H3 phosphorylation was analysed. In vivo, antiproliferative and antiangiogenic effects were assessed by tumor volume and morphometric analysis following immunohistochemical staining (Ki‐67, pHisH3, CD31). Treatment of the different TC cells with MLN8054 inhibited proliferation in a time‐ and dose‐dependent manner, with IC50 values between 0.1 and 10 μM. Administration of MLN8054 resulted in an increase of apoptotic cells, decreased Histone H3 phosphorylation and induced cell cycle arrest. In vivo, treatment of ATC by MLN8054 resulted in an up to 86% reduced tumor volume and 89% reduced tumor vascularity. In conclusion, our data demonstrated that Aurora kinase inhibition is effective in reducing cell growth and inducing apoptosis of ATC in vitro and tumor growth and vascularity in vivo. Controlled clinical studies on MLN8054 or comparable compounds would be worthwhile to evaluate its potential therapeutic value for treatment of ATC. (Cancer Sci 2011; 102: 762–768)

AimObesity has been suspected of influencing sweating and constituting a risk factor for pilonidal sinus disease (PSD), given the parallel rise in both obesity and PSD incidence in developed countries. This study, therefore, examined the relationship between sweating and body mass index (BMI).MethodsA total of 322 individuals from a large northern German cohort, all without PSD, were assessed. A questionnaire was designed to evaluate BMI and engagement in sports activities. Standardized pilocarpine iontophoresis sweat testing was performed in the glabella sacralis region, 5-10 cm cephalad to the intergluteal fold.ResultsThe normal BMI group had significantly higher sweat production (20.74±2.5 µl) than the high BMI group (17.10±2.8 µl) (p<0.001). Individuals who regularly participated in sports more than twice a week exhibited significantly higher sweat production than those who did not exercise (27.2±2.9 µl vs. 24.4±1.6 µl, p<0.001).ConclusionIncreased BMI was not associated with increased pilocarpine iontophoresis-induced glabella sacralis sweat output. Engagement in sports increased sweat production in both normal and high BMI individuals. Increased sweating may play a protective role, potentially contributing to weight reduction and, consequently, a lower incidence of PSD through mechanisms yet to be elucidated.

Background and Objectives: Pilonidal Sinus Disease shows an increasing incidence. Surgical interventions are often necessary; thus, we wanted to analyze whether the usage of methylene blue (MB) for staining the PSD fistulas for better visualization during surgery shows an effect concerning recurrence rates. Materials and Methods: A thorough data search and cross-study data synthesis of publications in the time period of 1833 to 2023 lead to a total of 7936 studies focusing on PSD. The data sets were scanned for the eligibility criteria, namely treatment information, follow-up, recurrence data, and the use of MB in surgery. The data were sorted into different surgical treatment groups, and the recurrence rates were analyzed using Kaplan–Meier-survival curves. Results: A total of 1192 studies involving 130,677 patients were eligible for analysis. A total of 263 studies were performed with MB (22.1%, n = 25,602 patients) and 929 studies without MB (77.9%, n = 105,075 patients). Overall, there was a highly significant difference in RR between the group of MB-stained patients and those without (p < 0.0001), even if analyzed separately for treatments. Primary open approach, primary midline closure, primary asymmetric closure, and Limberg/Dufourmentel all showed a significantly lower RR when MB was used (p < 0.0001). The use of MB in Bascom/Karydakis-Flap showed a statistically significant disadvantage concerning RR (p < 0.0001), and Other Flaps showed less RR with the use of MB (p = 0.011); both groups showed a notable loss of follow-up data, diminishing the meaning of these p values. Conclusions: This study shows that the use of MB as a staining technique in PSD surgery may be beneficial regarding recurrence rates. Therefore, the routinely use of MB staining in PSD surgery should be considered.

Background Even though the post-operative outcome varies greatly among patients with nodal positive colon cancer (UICC stage III), personalized prediction of systemic disease recurrence is currently insufficient. We investigated in a retrospective setting whether genetic and immunological biomarkers can be applied for stratification of distant metastasis occurrence risk. Methods Eighty four patients with complete resection (R0) of stage III colon cancer from two clinical centres were analysed for genetic biomarkers: microsatellite instability, oncogenic mutations in KRAS exon2 and BRAF exon15, expression of osteopontin and the metastasis-associated genes SASH1 and MACC1. Tumor-infiltrating CD3 and CD8 positive T-cells were quantified by immunocytochemistry. Results were correlated with outcome and response to 5-FU based adjuvant chemotherapy, using Cox’s proportional hazard models and integrative two-step cluster analysis. Results Distant metastasis risk was significantly correlated with oncogenic KRAS mutations ( p  = 0.015), expression of SASH1 ( p  = 0.016), and the density of CD8-positive T-cells ( p  = 0.007) in Kaplan-Meier analysis. Upon multivariate Cox-regression analysis, KRAS mutation ( p  = 0.008) and density of CD8-positive TILs ( p  = 0.009) were retained as prognostic parameters for metachronous distant metastasis. Integrative two-step cluster analysis was used to combine all genetic markers, allowing stratification of patient subgroups. Post-operative distant metastasis risk ranged from 31% (low-risk) to 41% (intermediate), and 57% (high-risk) ( p  = 0.032). Increased expression of osteopontin ( p  = 0.019) and low density of CD8-positive T-cells ( p  = 0.043) were significantly associated with unfavourable response to 5-FU. Conclusions Integrative biomarker analysis allows stratification of stage III colon cancer patients for the risk of metastatic disease recurrence and may indicate response to 5-FU. Thus, biomarker analysis might facilitate the use of adjuvant therapy for high risk patients.

Background and objective: No current nationwide consensus exists on pilonidal disease (PD) treatment in Switzerland and Austria. The objective of this study was to assess and compare the spectrum of PD treatment strategies in Switzerland and Austria. Materials and Methods: A survey including 196 certified institutions (Switzerland, N = 99 and Austria, N = 97) was performed. Treatment strategies for both chronic and acute pilonidal disease were investigated, as well as evolution of treatment over the last 20 years. Results: In total, 92 of 196 (47%) hospitals participated in the survey. Recurrence rate (20%) was similar between the two countries. In acute pilonidal disease, a two-stage approach with incision and drainage as the first step was preferred over a one-stage procedure in both countries. In Austria, all patients with chronic pilonidal disease were treated as inpatients, whereas 28% of patients in Switzerland were treated on an outpatient basis (p = 0.0019). Median length of hospital stay was double in Austria (four days) compared to Switzerland (two days; p < 0.001). Primary resection and off-midline closure (p = 0.017) and the use of tissue flaps (p = 0.023) were performed more commonly in Austria than in Switzerland. Minimally invasive techniques were performed more often in Switzerland than in Austria (52% vs. 4%, p < 0.001). Overall, wide excision with secondary wound healing or midline closures declined over the last 20 years. Conclusion: Treatment strategies for chronic PD differ between Austria and Switzerland with more and longer inpatient care in Austria, increasingly minimally invasive approaches in Switzerland, and outdated procedures still being performed in both countries. Overall, heterogeneity of practice dominates in both countries.