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Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

According to data from current randomized controlled trials and retrospective studies, light meshes seem to have some advantages with respect to postoperative pain and foreign body sensation. However, their use is associated with increased recurrence rates. Light meshes offer no advantages with respect to alleviating severe chronic groin pain. At the same time, experimental data reveal that material composition and mesh structure may significantly affect foreign body reaction.

OBJECTIVE-␤-Cell regeneration has been proposed as a possible treatment for diabetes, but the capacity for new ␤-cell formation in humans is yet unclear. In young rats, partial pancreatectomy prompts new ␤-cell formation to restore ␤-cell mass. We addressed the following questions: In adult humans: 1) Does partial pancreatectomy provoke new ␤-cell formation and increased ␤-cell mass? 2) Is ␤-cell turnover increased after partial pancreatectomy?RESEARCH DESIGN AND METHODS-Protocol 1: human pancreatic tissue was collected from 13 patients who underwent two consecutive partial pancreas resections, and markers of cell turnover were determined in both tissue samples, respectively. Protocol 2: pancreas volumes were determined from abdominal computer tomography scans, performed in 17 patients on two separate occasions after partial pancreatectomy.RESULTS-Protocol 1: fasting glucose concentrations increased significantly after the 50% pancreatectomy (P ϭ 0.01), but the fractional ␤-cell area of the pancreas remained unchanged (P ϭ 0.11). ␤-Cell proliferation, the overall replication index (Ki67 staining), and the percentage of duct cells expressing insulin were similar before and after the partial pancreatectomy. The overall frequency of apoptosis (terminal deoxynucleotidyl transferase biotin-dUTP nick-end labeling) was slightly increased following the partial pancreatectomy (P ϭ 0.02). Protocol 2: pancreatic volume was ϳ50% reduced to 35.6 Ϯ 2.6 ccm 3 by the partial pancreatectomy. The total pancreatic volume was unchanged after an interval of 247 Ϯ 160 days (35.4 Ϯ 2.7 ccm 3 ; P ϭ 0.51).CONCLUSIONS-Unlike in rodents, a 50% pancreatectomy does not prompt ␤-cell regeneration in adult humans. This explains the high incidence of diabetes after pancreatic resections. Such differences in ␤-cell turnover between rodents and humans should be born in mind when evaluating new treatment options aiming to restore ␤-cell mass in patients with diabetes. Diabetes 57:142-149, 2008 D iabetes develops if ␤-cell mass is diminished below a critical threshold required to sustain adequate insulin secretion at a given level of insulin resistance (1-3). Based on cross-sectional studies (3,4) in human autopsy pancreata, glucose levels start to rise when ␤-cell mass is reduced by more than ϳ50% of normal. Likewise, studies (5,6) in patients with new-onset type 1 diabetes have reported a 50 -70% ␤-cell deficit around the onset of hyperglycemia. The loss of insulin-secreting ␤-cells in both types of diabetes provides a rationale for novel therapeutic approaches aiming to restore ␤-cell mass in diabetic patients.Given the obvious inaccessibility of human pancreas tissue for repeated biopsy sampling in clinical studies, most studies about the dynamics and the mechanisms of ␤-cell regeneration available so far have been carried out in rodent models (7). Among those, the partial pancreatectomy model has been commonly utilized to induce ␤-cell regeneration in mice and rats (8,9). Indeed, following a 90% pancreatectomy in rats, an up to 200% increase ...

This study found worse biocompatibility of LM compared with HM. Thus, the amount of implanted mesh was not the main determinant of biocompatibility (expressed as successful incorporation and diminished foreign-body reaction) but the size of the pores.

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