Objective-To observe the effects of introducing an acute pain service to the general surgical wards of a large teaching hospital.

A randomized controlled trial has been performed to assess the value of plastic wound drapes in the prevention of surgical wound infection. One hundred and forty-four patients undergoing abdominal surgery were allocated to one of three groups; a control group (A) in which standard cloth towels were applied to the abdominal wound, group B in which an adhesive plastic drape was added and group C in which a plastic ring protector was inserted into the wound. There were 26 cases (18 per cent) of wound infection. The wound infection rate in the plastic drape groups did not differ significantly from that in the control group. Bacteriological culture from a wound swab taken at operation was positive in 32 per cent of the cases. The presence of a plastic wound drape did not influence the positive culture rate. In 68 per cent of wounds which became infected the operative swab was positive as compared with 24 per cent in those not developing a wound infection. Thirteen of the 33 patients (39 per cent) with a positive wound swab subsequently developed a wound infection. In 10 of these 13 cases of infection the operative swab permitted an accurate prediction of the organism responsible for the subsequent infection.

than likely, the success of surufatinib is attributable to both its novel mechanism of action and favourable business decisions around its development. In addition, we do not yet know how surufatinib will fit into the complex treatment algorithm for NETs. Evidence regarding sequence of therapies is a crucial need in the field, although might be impractical to study in prospective clinical trials. We also need to study mechanisms of resistance to tyrosine kinase inhibitors, develop and validate predictive biomarkers, understand reasons for heterogeneity in objective response, and identify better quantitative radiological response criteria in the setting of angiogenesis inhibition. Last, but not least, we must also keep patients with NETs at the core of how we think about optimal treatment strategies. Given the chronicity of well differentiated NETs, these patients will experience an accumulation of toxicities over years that include non-trivial drug side-effects, particularly with tyrosine kinase inhibitors.PLK reports receiving research funding to her institution from Advanced Accelerator Applications, Brahms (Thermo-Fisher Scientific), Ipsen, Lexicon Pharmaceuticals, and Xencor; and reports serving on scientific advisory board meetings for and receiving honorarium from Advance Accelerator Applications and Ipsen.

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IMPORTANCEVaccine-derived and wild-type rubella virus (RuV) has been identified within granulomas in patients with inborn errors of immunity, but has not been described in granulomas of healthy adults.OBJECTIVE To determine the association between RuV and atypical granulomatous inflammation in immune-competent adults.DESIGN, SETTING, AND PARTICIPANTS This case series, conducted in US academic dermatology clinics from January 2019 to January 2021, investigated the presence of RuV in skin specimens using RuV immunofluorescent staining of paraffin-embedded tissue sections, real-time reverse-transcription polymerase chain reaction, whole-genome sequencing with phylogenetic analyses, and cell culture by the US Centers for Disease Control and Prevention. Rubella immunoglobulin G, immunoglobulin M enzyme-linked immunoassay, and viral neutralization assays were performed for the sera of immunocompetent individuals with treatment refractory cutaneous granulomas and histopathology demonstrating atypical palisaded and necrotizing granulomas. Clinical immune evaluation was performed.MAIN OUTCOMES AND MEASURES Identification, genotyping, and culture of vaccine-derived and wild-type RuV within granulomatous dermatitis of otherwise clinically immune competent adults. RESULTSOf the 4 total immunocompetent participants, 3 (75%) were women, and the mean (range) age was 61.5 (49.0-73.0) years. The RuV capsid protein was detected by immunohistochemistry in cutaneous granulomas. The presence of RuV RNA was confirmed by real-time reverse-transcription polymerase chain reaction in fresh-frozen skin biopsies and whole-genome sequencing. Phylogenetic analysis of the RuV sequences showed vaccine-derived RuV in 3 cases and wild-type RuV in 1. Live RuV was recovered from the affected skin in 2 participants. Immunology workup results demonstrated no primary immune deficiencies. CONCLUSIONS AND RELEVANCEThe case series study results suggest that RuV (vaccine derived and wild type) can persist for years in cutaneous granulomas in clinically immunocompetent adults and is associated with atypical (palisaded and necrotizing type) chronic cutaneous granulomas. These findings represent a potential paradigm shift in the evaluation, workup, and management of atypical granulomatous dermatitis and raises questions regarding the potential transmissibility of persistent live RuV.