The microcirculation comprising of arterioles, capillaries and post-capillary venules is the terminal vascular network of the systemic circulation. Microvascular homeostasis, comprising of a balance between vasoconstriction, vasodilation and endothelial permeability in healthy states, regulates tissue perfusion. In severe infections, systemic inflammation occurs irrespective of the infecting microorganism(s), resulting in microcirculatory dysregulation and dysfunction, which impairs tissue perfusion and often precedes end-organ failure. The common hallmarks of microvascular dysfunction in both septic shock and dengue shock, are endothelial cell activation, glycocalyx degradation and plasma leak through a disrupted endothelial barrier. Microvascular tone is also impaired by a reduced bioavailability of nitric oxide. In vitro and in vivo studies have however demonstrated that the nature and extent of microvascular dysfunction as well as responses to volume expansion resuscitation differ in these two clinical syndromes. This review compares and contrasts the pathophysiology of microcirculatory dysfunction in septic versus dengue shock and the attendant effects of fluid administration during resuscitation.

Current practice to only prioritize hepatocellular carcinoma (HCC) that fulfill the Milan criteria (IN

) is changing, since it causes the exclusion of patients who could benefit from liver transplantation. To select patients outside MC (OUT

) for transplantation, we implemented extended selection criteria without up-front morphometric restrictions containing surrogate parameters of tumor biology.

OUT

patients were considered without restrictions of morphometrics and received locoregional treatment after interdisciplinary consultation. Our dynamic selection criteria for OUT

patients required (IN

) (1) treatment response over (2) at least 6 months and (3) alpha-fetoprotein ≤400 ng/mL over the entire evaluation period. Patients with IN

tumors served as control and internal validation cohort.

31 of 170 liver transplant candidates were OUT

. Of these, 8 dropped out. The remaining 23 patients met the selection criteria and underwent transplantation. Recurrence-free survival was higher in patients transplanted IN

compared to those OUT

IN

(92.2% vs. 70.8%;

= 0.026) after 5 years of follow-up. Overall survival showed no significant difference (

= 0.552). With dynamic selection of transplant candidates, recurrence could also be predicted for the IN

patients as internal validation cohort (c-index 0.896; CI 0.588-0.981,

= 0.005).

Dynamic selection criteria for the stratification of patients with OUT

HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to IN

patients.

Dynamic selection criteria for the stratification of patients with OUTMC HCCs is feasible and allows for excellent long-term results and acceptable tumor recurrence rates comparable to INMC patients.

As a result of well-publicized studies, the nonsurgical antibiotic therapy of uncomplicated acute appendicitis has been propagated since 2006. A final assessment regarding efficiency and long-term results is not possible; however, nonoperative therapy of acute appendicitis is actually being discussed more diversely and receives a lot of attention. It is still unknown how far this therapy has found its way into everyday clinical care.

An online questionnaire was sent to 1,400 randomly selected specialists for general/visceral surgery in Germany. Representativeness was achieved by a preselection according to the geographical origin and the care level of the hospitals.

14% of surgeons stated that they methodically treat appendicitis conservatively. 38.1% do so in exceptional cases, while 48.8% reject this therapy. For methodically use, sonography or computed tomography is demanded beforehand. Nonoperative therapy is performed more often in metropolitan areas and maximum-care/university hospitals. Patients’ request for antibiotic therapy is an important factor for conservative treatment. The main argument against this therapy is “medical doubts.” 26% of the surgeons would treat their own appendicitis conservatively. There are distinct associations between the application of conservative therapy, satisfaction with it, and expectations about future development. The response rate was 19.9%.

The nonoperative antibiotic therapy of appendicitis is part of clinical practice in Germany. There are differences in preconditions as well as in the acceptance of this therapeutic option with a high proportion of general rejection.

The nonoperative antibiotic therapy of appendicitis is part of clinical practice in Germany. There are differences in preconditions as well as in the acceptance of this therapeutic option with a high proportion of general rejection.

Little is known about the improvement in defecation frequently reported by women around menses. We aimed to describe clinical, physiological, and psychological correlates of this improvement in those with functional bowel disorders.

We recruited 478 consecutive premenopausal adult females with no indication of gynecologic or psychiatric disease, who were attending an outpatient functional bowel disorders clinic. Patients completed a Rome III questionnaire, psychological evaluation stool form, and a 10-point Likert scale for constipation, diarrhea, bloating, and abdominal pain. These patients underwent physiological tests, anorectal manometry, and colonic transit time and were classified according to the presence or the absence of improvement in defecation during menses. The reverse selection procedure was used for model selection during multivariate logistic regression where statistically significant variables (

< 0.01) remained in the adjusted model.

Ninety-seven patients (20%) reported easier defecation during menstruation. These patients were younger (

< 0.001) but had similar body mass indices and psychological profiles as the other patients. Semaglutide Clinically, they only reported more frequent irritable bowel syndrome (IBS) with constipation (

= 0.007), with harder stools (

= 0.005) and delayed left colon transit time (

= 0.002). No anorectal manometric parameter was different between the 2 groups.

Improvement of constipation during menses is mainly associated with younger age and constipation-IBS phenotype and not with functional constipation.

Improvement of constipation during menses is mainly associated with younger age and constipation-IBS phenotype and not with functional constipation.