Explore the vast range of titles available.

Guidelines are increasingly determining the decision process in day-to-day clinical work. Guidelines describe the current best possible standard in diagnostics and therapy. They should be developed by an international panel of experts, whereby alongside individual experience, above all, the results of comparative studies are decisive. According to the results of high-ranking scientific studies published in peer-reviewed journals, statements and recommendations are formulated, and these are graded strictly according to the criteria of evidence-based medicine. Guidelines can therefore be valuable in helping particularly the young surgeon in his or her day-to-day work to find the best decision for the patient when confronted with a wide and confusing range of options. However, even experienced surgeons benefit because by virtue of a heavy workload and commitment, they often find it difficult to keep up with the ever-increasing published literature. All guidelines require regular updating, usually every 3 years, in line with progress in the field. The current Guidelines focus on technique and perioperative management of laparoscopic ventral hernia repair and constitute the first comprehensive guidelines on this topic. In this issue of Surgical Endoscopy, the first part of the Guidelines is published including sections on basics, indication for surgery, perioperative management, and key points of technique. The next part (Part 2) of the Guidelines will address complications and comparisons between open and laparoscopic techniques. Part 3 will cover mesh technology, hernia prophylaxis, technique-related issues, new technologic developments, lumbar and other unusual hernias, and training/education.

Egypt is characterized by its hyper-arid desert environment with high temperature, scanty rainfall, high evapotranspiration rate, and patchy scattered precipitation-dependent vegetation. Located in this peculiar ecosystem, the northeastern part of the eastern desert occupies vast areas where this study was conducted. Despite some protection in this area, destruction of plant cover, soil erosion, and degradation of natural habitat are still occurring. Among the complex array of anthropogenic disturbances that directly affect species diversity, over-grazing, road construction, over-collection of plants, salinization, over-cutting, military activities, urbanization, and industrialization were encountered. The aim of this study was to assess the effect on long-lasting anthropopressure on the current floristic and ecological status of the unprotected area in comparison to the protected one. Two areas were chosen for detailed studies: protected (Wadi Degla; WD) and unprotected (Cairo-Suez road, SR). Fourteen soil variables were used to assess the soil–vegetation relationships in the two areas. An assessment of seven human activities (over-grazing, over-collection, introduced species, land degradation, urbanization, solid wastes, and military activities) was carried out at four levels of disturbance intensities. A floristic presence/absence data set of 25 plots × 56 species, including 14 plots for SR and 11 plots for WD, was employed in the analyses. The application of multivariate analysis techniques such as cluster analysis (for classification), indicator species analysis (ISA) and the multi-response permutation procedure (MRPP), canonical correspondence analysis (CCA), and redundancy analysis (RDA) for ordination were performed in the data analysis. Generally, a total of 85 plant species belonging to 68 genera and 30 families was recorded. Asteraceae, Chenopodiaceae, Fabaceae, Zygophyllaceae, Poaceae, Brassicaceae, and Geraniaceae were the largest families, constituting more than 50% of the total flora. Chamaephytes, therophytes, hemicryptophytes, and phanerophytes prevail in the life form spectrum. Chorological analysis showed that the Saharo-Arabian element, whether pure or combined with other chorotypes, dominated the current flora, whereas the Mediterranean chorotype was very poorly represented. Application of cluster analysis yielded eight vegetation groups: I–IV for the Cairo-Suez road, and V–VIII for Wadi Degla. This study indicated the disappearance of several plant communities that were previously of common occurrence such as Retama raetam, Anabasis articulata, Ephedra alata, Artemisia monosperma, Zygophyllum decumbens, Lasiurus hirsutus, and Panicum turgidum. Partial CCA (pCCA) for the unprotected area revealed that most of the variance (45.7%) was attributed to the anthropogenic variables more than soil factors (14.5%). Like what was revealed in other unprotected areas, a clear relationship between anthropogenic pressure and habitat fragmentation was observed. Long-term, intensive human activities caused vegetation degradation, species loss, and a decline in plant richness. Hence, the highest species richness value was recorded in the protected area. Over-grazing, land degradation, and military activities were not correlated with the diversity indices, whereas over-collection of plant species, urbanization, and solid wastes were significantly negatively correlated with both α-diversity and the Shannon–Wiener index. Suitable protection measures should be taken to reduce the anthropogenic pressures in this ecosystem as well as some conservation programs and management plans should be implemented to save biodiversity.

BackgroundThe 21-gene recurrence score (RS) predicts outcome and benefit from adjuvant chemotherapy benefit in breast cancer patients treated with adjuvant endocrine therapy. In the NSABP B-28 study, we evaluated the 21-gene RS for its prognostic impact and its ability to predict benefit from paclitaxel (P) in node-positive, estrogen receptor-positive (ER+) breast cancer patients treated with adjuvant chemotherapy plus tamoxifen.MethodsThe B-28 trial compared doxorubicin/cyclophosphamide (AC) with AC followed by P in 3060 patients. Tamoxifen for 5 years was also given to patients > 50 years and those < 50 years with ER+ and/or progesterone receptor-positive (PR+) tumors. The present study includes 1065 ER-positive, tamoxifen-treated patients with RS assessment. Median follow-up time was 11.2 years.ResultsIn univariate analyses, RS was a significant predictor of outcome. In multivariate analyses, RS remained a significant independent predictor of outcome beyond clinico-pathologic factors, age, and type of surgery (p < 0.001). In the study population (n = 1065), the disease-free survival (DFS) hazard ratio (HR) with adding P to AC was 0.87 (95% CI 0.72–1.05; p = 0.14). RS was not a significant predictor of P benefit: for DFS, HRs for adding P to AC in RS low, intermediate, and high subgroups were 1.01 (95% CI 0.69–1.47; p = 0.99), 0.84 (95% CI 0.62–1.14; p = 0.26), and 0.81 (95% CI 0.60–1.10; p = 0.21), respectively (interaction p = 0.64). Similar findings were observed for the other study endpoints.ConclusionsRS maintains significant prognostic impact in ER-positive, node-positive patients treated with adjuvant chemotherapy plus tamoxifen. However, RS did not significantly predict benefit from adding paclitaxel to AC chemotherapy. (Trial Registration: PDQ: NSABP-B-28).

IntroductionIn the past few years, there has been a considerable amount of evidence that cannabis use can cause structural and functional brain abnormalities.Structural imaging studies of cannabis users have revealed reduced prefrontal cortex volumes and white matter damage that may be involved with impulsivity.Objectives: To Determine the level of dependence on cannabis among cannabis users consulting the detoxification center of Sfax, Tunisia To assess in addition the impact of cannabis on impulsivity and motor control.MethodsThis is a cross-sectional, descriptive and analytical study that was conducted over a period of 13 months between September 15, 2020 and October 1, 2021 among cannabis users consulting the detoxification center of Sfax, Tunisia.A short form of the Barratt Impulsiveness Scale (the BIS-15) and a Cannabis Abuse Screening Test (CAST) were used to assess impulsivity and to determine cannabis abuse.Results: Thirty Eight cannabis users agreed to participate in this study. The distribution of CAST scores showed that 36 users (94.7%) had problematic cannabis use at the time of the study. The mean BIS 15 score was 38.2. In our sample, The level of impulsivity was highest in people with a high level of cannabis dependence. A higher level of impulsivity was found in younger subjects. However, a greater level of impulsivity was found in subjects with a lower socio-economic level. Concerning employment status, unemployment was significantly correlated with a higher level of impulsivity.ConclusionsImpulsivity is often associated with a variety of problematic behaviors such as aggressive behavior, smoking, drug abuse, pathological gambling or compulsive buying.A higher frequency of cannabis use and earlier age of onset use have been shown to be associated with the highest rates of impulsivity.Therefore, cannabis addiction represents a real public health problem, both because of the serious complications and heavy repercussions that it causes.Disclosure of InterestNone Declared

Multiple independent studies have shown that tumor-infiltrating lymphocytes (TIL) are prognostic in breast cancer with potential relevance for response to immune-checkpoint inhibitor therapy. Although many groups are currently evaluating TIL, there is no standardized system for diagnostic applications. This study reports the results of two ring studies investigating TIL conducted by the International Working Group on Immuno-oncology Biomarkers. The study aim was to determine the intraclass correlation coefficient (ICC) for evaluation of TIL by different pathologists. A total of 120 slides were evaluated by a large group of pathologists with a web-based system in ring study 1 and a more advanced software-system in ring study 2 that included an integrated feedback with standardized reference images. The predefined aim for successful ring studies 1 and 2 was an ICC above 0.7 (lower limit of 95% confidence interval (CI)). In ring study 1 the prespecified endpoint was not reached (ICC: 0.70; 95% CI: 0.62–0.78). On the basis of an analysis of sources of variation, we developed a more advanced digital image evaluation system for ring study 2, which improved the ICC to 0.89 (95% CI: 0.85–0.92). The Fleiss' kappa value for <60 vs ≥60% TIL improved from 0.45 (ring study 1) to 0.63 in RS2 and the mean concordance improved from 88 to 92%. This large international standardization project shows that reproducible evaluation of TIL is feasible in breast cancer. This opens the way for standardized reporting of tumor immunological parameters in clinical studies and diagnostic practice. The software-guided image evaluation approach used in ring study 2 may be of value as a tool for evaluation of TIL in clinical trials and diagnostic practice. The experience gained from this approach might be applicable to the standardization of other diagnostic parameters in histopathology.

Pyoderma gangrenosum (PG) and Sweet’s syndrome (SS) are skin diseases usually presenting with recurrent ulcers and erythematous plaques, respectively. The accumulation of neutrophils in the skin, characteristic of these conditions, led to coin the term of neutrophilic dermatoses to define them. Recently, neutrophilic dermatoses have been included in the group of autoinflammatory diseases, which classically comprises genetically determined forms due to mutations of genes regulating the innate immune response. Both PG and SS are frequently associated with inflammatory bowel diseases (IBDs); however, IBD patients develop PG in 1–3 % of cases, whereas SS is rarer. Clinically, PG presents with deep erythematous-to-violaceous painful ulcers with well-defined borders; bullous, pustular, and vegetative variants can also occur. SS is characterized by the abrupt onset of fever, peripheral neutrophilia, tender erythematous skin lesions, and a diffuse neutrophilic dermal infiltrate. It is also known as acute febrile neutrophilic dermatosis. Treatment of PG involves a combination of wound care, topical medications, antibiotics for secondary infections, and treatment of the underlying IBD. Topical therapies include corticosteroids and the calcineurin inhibitor tacrolimus. The most frequently used systemic medications are corticosteroids and cyclosporine, in monotherapy or in combination. Dapsone, azathioprine, cyclophosphamide, methotrexate, intravenous immunoglobulins, mycophenolate mofetil, and plasmapheresis are considered second-line agents. Hyperbaric oxygen, as supportive therapy, can be added. Anti-TNF-α agents such as etanercept, infliximab, and adalimumab are used in refractory cases. SS is usually responsive to oral corticosteroids, and the above-mentioned immunosuppressants should be considered in resistant or highly relapsing cases.

For the first time, an updated checklist of Acacia, Senegalia and Vachellia species in Egypt is provided, focusing on the exotic species. Taking into consideration the retypification of genus Acacia ratified at the Melbourne International Botanical Congress (IBC, 2011), a process of reclassification has taken place worldwide in recent years. The review of Acacia and its segregates in Egypt became necessary in light of the available information cited in classical works during the last century. In Egypt, various taxa formerly placed in Acacia s.l., have been transferred to Acacia s.s., Acaciella, Senegalia, Parasenegalia and Vachellia. The present study is a contribution towards clarifying the nomenclatural status of all recorded species of Acacia and its segregate genera. This study recorded 144 taxa (125 species and 19 infraspecific taxa). Only 14 taxa (four species and 10 infraspecific taxa) are indigenous to Egypt (included now under Senegalia and Vachellia). The other 130 taxa had been introduced to Egypt during the last century. Out of the 130 taxa, 79 taxa have been recorded in literature. The focus of this study is the remaining 51 exotic taxa that have been traced as living species in Egyptian gardens or as herbarium specimens in Egyptian herbaria. The studied exotic taxa are accommodated under Acacia s.s. (24 taxa), Senegalia (14 taxa) and Vachellia (13 taxa). Identification keys for the studied genera, generic groups and species have been provided using different taxonomic criteria. For each taxon, the validated name with the first citation followed by relevant Egyptian citations, typification, synonyms, distinctive features, origin, ecology (when available), utilisation and selected specimens are provided. The study revealed the presence of 22 newly recorded taxa in Egypt. Additionally, a list of excluded, unvalidated and unresolved names is given.

Chronic obstructive pulmonary disease (COPD) is characterized by an irreversible loss of lung function and is one of the most prevalent and severe diseases worldwide. A major feature of COPD is emphysema, which is the progressive loss of alveolar tissue. Coactivator-associated arginine methyltransferase-1 (CARM1) regulates histone methylation and the transcription of genes involved in senescence, proliferation, and differentiation. Complete loss of CARM1 leads to disrupted differentiation and maturation of alveolar epithelial type II (ATII) cells. We thus hypothesized that CARM1 regulates the development and progression of emphysema. To address this, we investigated the contribution of CARM1 to alveolar rarefication using the mouse model of elastase-induced emphysema in vivo and small interfering (si)RNA-mediated knockdown in ATII-like LA4 cells in vitro. We demonstrate that emphysema progression in vivo is associated with a time-dependent down-regulation of CARM1. Importantly, elastase-treated CARM1 haploinsufficient mice show significantly increased airspace enlargement (52.5 ± 9.6 μm versus 38.8 ± 5.5 μm; P < 0.01) and lung compliance (2.8 ± 0.32 μl/cm H2O versus 2.4 ± 0.4 μl/cm H2O; P < 0.04) compared with controls. The knockdown of CARM1 in LA4 cells led to decreased sirtuin 1 expression (0.034 ± 0.003 versus 0.022 ± 0.001; P < 0.05) but increased expression of p16 (0.27 ± 0.013 versus 0.31 ± 0.010; P < 0.5) and p21 (0.81 ± 0.088 versus 1.28 ± 0.063; P < 0.01) and higher β-galactosidase–positive senescent cells (50.57 ± 7.36% versus 2.21 ± 0.34%; P < 0.001) compared with scrambled siRNA. We further demonstrated that CARM1 haploinsufficiency impairs transdifferentiation and wound healing (32.18 ± 0.9512% versus 8.769 ± 1.967%; P < 0.001) of alveolar epithelial cells. Overall, these results reveal a novel function of CARM1 in regulating emphysema development and premature lung aging via alveolar senescence as well as impaired regeneration, repair, and differentiation of ATII cells.