Abdominal surgical site infections(SSIs)are infections that occur after abdominal surgery.They can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and impl...Abdominal surgical site infections(SSIs)are infections that occur after abdominal surgery.They can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and implanted materials.Currently,SSIs are large global health problem with an incidence that varies significantly depending on the United Nations’Human Development Index.The purpose of this review is to provide a practical update on the latest available literature on SSIs,focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.展开更多
This article examines the complex relationship between disease perception,negative emotions,and their impact on postoperative recovery in patients with perianal diseases.These conditions not only cause physical discom...This article examines the complex relationship between disease perception,negative emotions,and their impact on postoperative recovery in patients with perianal diseases.These conditions not only cause physical discomfort,but also carry a significant emotional burden,often exacerbated by social stigma.Psycho-logical factors,including stress,anxiety,and depression,activate neuroendocrine pathways,such as the hypothalamic–pituitary–adrenal axis,disrupting the gut microbiota and leading to dysbiosis.This disruption can delay wound healing,prolong hospital stay,and intensify pain.Drawing on the findings of Hou et al,our article highlights the critical role of illness perception and negative emotions in shaping recovery outcomes.It advocates for a holistic approach that integrates psychological support and gut microbiota modulation,to enhance healing and improve overall patient outcomes.展开更多
BACKGROUND Patients who have undergone pancreaticoduodenectomy(Whipple procedure)often develop complex late complications that may be diagnostically challenging.We report a rare cause of recurrent fever and abdominal ...BACKGROUND Patients who have undergone pancreaticoduodenectomy(Whipple procedure)often develop complex late complications that may be diagnostically challenging.We report a rare cause of recurrent fever and abdominal pain in such a patient:Fish bone-induced jejunal perforation.This case emphasizes the importance of maintaining suspicion for atypical,non-biliary causes in post-Whipple patients with recurrent symptoms,particularly when conventional tests suggest no biliary obstruction.A thorough linear diagnostic approach and multidisciplinary collaboration are essential.The delay in diagnosis highlights the challenges of interpreting subtle imaging findings and correlating them with clinical symptoms mimicking cholangitis.CASE SUMMARY A 55-year-old female with a Whipple procedure history 10 years earlier presented with recurrent fever and severe abdominal pain.An initial extensive workup,including imaging and laboratory tests,was inconclusive.Only after detailed reevaluation of the computed tomography images revealed a subtle linear hyperdensity and subsequent deep push enteroscopy was an embedded fish bone in the efferent jejunal limb identified and removed endoscopically.CONCLUSION Clinicians should consider gastrointestinal foreign body perforation in the differential diagnosis of recurrent fever and abdominal pain in patients with altered anatomy after Whipple procedure.Critical image review and advanced enteroscopic techniques are invaluable for diagnosing obscure causes in complex cases.展开更多
Colorectal cancer(CRC)is one of the most prevalent cancers globally,with a high recurrence rate following curative surgery,especially within the first 3 to 5 years.Post-surgical follow-up plays a vital role in detecti...Colorectal cancer(CRC)is one of the most prevalent cancers globally,with a high recurrence rate following curative surgery,especially within the first 3 to 5 years.Post-surgical follow-up plays a vital role in detecting local and distant recurrences,significantly influencing survival rates.However,despite established guidelines recommending surveillance strategies,discrepancies persist regarding the optimal surveillance modality and patient adherence to follow protocols.Sala-Miquel et al’s study emphasize the superiority of computed tomography in detecting metastasis and recurrence,while also shedding light on the critical role of adherence to surveillance protocols in improving patient outcomes.This editorial discusses the implications of these findings for clinical practice,providing a comprehensive overview of the current landscape of CRC surveillance and the path forward for improving patient outcomes.展开更多
The objective of this study was to analyze the current evidence for the use of pancreatic enzyme replacement therapy (PERT) in affecting survival and quality of life in patients with pancreatic exocrine insufficiency ...The objective of this study was to analyze the current evidence for the use of pancreatic enzyme replacement therapy (PERT) in affecting survival and quality of life in patients with pancreatic exocrine insufficiency (PEI). Systematic searches of the literature were performed using the PubMed database. Articles were selected for inclusion if they reported findings from trials assessing the effects of PERT on quality of life, survival, malabsorption, growth parameters (such as height, body weight and body mass index), or gastrointestinal symptoms (such as abdominal pain, stool consistency and flatulence). PERT improved PEI-related malabsorption and weight maintenance in patients with cystic fibrosis, chronic pancreatitis, pancreatic cancer, and post-surgical states. In patients with chronic pancreatitis, PERT improved PEI-related symptoms and quality of life measures. Several small retrospective studies have also suggested that PERT may have a positive impact on survival, but long-term studies assessing this effect were not identified. PERT is effective for treating malnutrition and supporting weight maintenance, and it is associated with improved quality of life and possibly with enhanced survival in patients with PEI. However, there is evidence that not all patients with PEI receive adequate PERT. Future work should aim to assess the long-term effects of PERT on the survival of patients with PEI.展开更多
Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transp...Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.展开更多
Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks...Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks for complications and by planned post-surgical interventions. Therefore, the aim of this study was to develop a clinical care algorithm for vulvar cancer to assess risk for complications and prevent and control post-surgical complications. Methods: Key elements of the algorithm were identified via a literature review, structured chart review, a survey of care team members and interviews with stakeholders including healthcare team, patients and their family. Results: An algorithm for the management of wound and psychosocial complications was developed, based on internal and external evidence and was vetted by expert reviewers. Conclusion: Describing the process and defining the roles of health care professionals contributes to purposeful, systematic prevention and treatment of post-surgical complications. The care algorithm provides structured reference points for healthcare professionals with regard to multidisciplinary post-surgical management of vulvar cancer patients.展开更多
Background In clinical practice, the mechanisms underlying chronic post-surgical pain （CPSP） remain insufficiently understood. The primary goals of this study were to determine the incidence of chronic pain after th...Background In clinical practice, the mechanisms underlying chronic post-surgical pain （CPSP） remain insufficiently understood. The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients. The secondary goal was to determine whether the difference between pre- and post-operative white blood cell （WBC） counts could predict the prevalence of CPSP after thoracotomy. The impact of chronic pain on daily life was also investigated. Methods We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010. Statistical comparisons were made between patients with or without CPSP. Results Results were ultimately analyzed from 466 qualified patients. The overall incidence of CPSP was 64.5%. Difference between pre- and post-operative WBC counts differed significantly between patients with or without CPSP （P 〈0.001） and was considered as an independent risk factor for the development of CPSP following thoracotomy （P 〈0.001）. Other predictive factors for chronic pain included younger age （〈60 years, P 〈0.001）, diabetes mellitus （P=0.023）, acute post-operative pain （P=0.005） and the duration of chest tube drainage （P 〈0.001）. At the time of interviews, the pain resulted in at least moderate restriction of daily activities in 15% of the patients, of which only 16 patients had paid a visit to the doctor and only three of them were satisfied with the therapeutic effects, Conclusions Chronic pain is common after thoracotomy. WBC count may be a new independent risk factoring surgical patients during peri-operative period. Besides, age, diabetes mellitus, acute post-operative pain, and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.展开更多
Tumor recurrence after surgery is the main cause of treatment failure.However,the initial stage of recurrence is not easy to detect,and it is difficult to cure in the late stage.In order to improve the life quality of...Tumor recurrence after surgery is the main cause of treatment failure.However,the initial stage of recurrence is not easy to detect,and it is difficult to cure in the late stage.In order to improve the life quality of postoperative patients,an efficient synergistic immunotherapy was developed to achieve early diagnosis and treatment of post-surgical tumor recurrence,simultaneously.In this paper,two kinds of theranostic agents based on gold nanorods(AuNRs)platform were prepared.AuNRs and quantum dots(QDs)in one agent was used for the detection of carcinoembryonic antigen(CEA),using fluorescence resonance energy transfer(FRET)technology to indicate the occurrence of in situ recurrence,while AuNRs in the other agent was used for photothermal therapy(PTT),together with antiPDL1 mediated immunotherapy to alleviate the process of tumor metastasis.A series of assays indicated that this synergistic immunotherapy could induce tumor cell death and the increased generation of CD3;/CD4;T-lymphocytes and CD3+;CD8;T-lymphocytes.Besides,more immune factors(IL-2,IL-6,and IFN-γ)produced by synergistic immunotherapy were secreted than mono-immunotherapy.This cooperative immunotherapy strategy could be utilized for diagnosis and treatment of postoperative tumor recurrence at the same time,providing a new perspective for basic and clinical research.展开更多
Wounds, characterized by the disruption of the continuity of body tissues resulting from external trauma,manifest in diverse types and locations. Although numerous wound dressings are available for various woundscenar...Wounds, characterized by the disruption of the continuity of body tissues resulting from external trauma,manifest in diverse types and locations. Although numerous wound dressings are available for various woundscenarios, it remains challenging to find an integrative wound dressing capable of addressing diverse woundsituations. We focused on utilizing sulfated hyaluronan (sHA), known for its anti-inflammatory properties andcapacity to load cationic drugs. By conjugating catechol groups to sHA (sHA-CA), we achieved several advantagesin wound healing: 1) Fabrication of patches through crosslinking with catechol-modified high-molecularweighthyaluronan (HA(HMW)-CA), 2) Adhesiveness that enabled stable localization, 3) Radical scavenging thatcould synergize with the immunomodulation of sHA. The sHA-CA patches demonstrated therapeutic efficacy inthree distinct murine wound models: diabetic wound, hepatic hemorrhage, and post-surgical adhesion. Collectively,these findings underscore the potential of the sHA-CA patch as a promising candidate for the nextgenerationwound dressing.展开更多
Post-operative adhesions,a common complication of surgery,cause pain,impair organ functionality,and often require additional surgical interventions.Control of inflammation,protection of injured tissue,and rapid tissue...Post-operative adhesions,a common complication of surgery,cause pain,impair organ functionality,and often require additional surgical interventions.Control of inflammation,protection of injured tissue,and rapid tissue repair are critical for adhesion prevention.Adhesion barriers are biomaterials used to prevent adhesions by physical separation of opposing injured tissues.Current adhesion barriers have poor anti-inflammatory and tissue regenerative properties.Umbilical cord tissue(UT),a part of the placenta,is inherently soft,conforming,biocompatible,and biodegradable,with antimicrobial,anti-inflammatory,and antifibrotic properties,making it an attractive alternative to currently available adhesion barriers.While use of fresh tissue is preferable,availability and short storage time limit its clinical use.A viable cryopreserved UT(vCUT)“point of care”allograft has recently become available.vCUT retains the extracellular matrix,growth factors,and native viable cells with the added advantage of a long shelf life at−80℃.In this study,vCUT's anti-adhesion property was evaluated in a rabbit abdominal adhesion model.The cecum was abraded on two opposing sides,and vCUT was sutured to the abdominal wall on the treatment side;whereas the contralateral side of the abdomen served as an internal untreated control.Gross and histological evaluation was performed at 7,28,and 67 days post-surgery.No adhesions were detectable on the vCUT treated side at all time points.Histological scores for adhesion,inflammation,and fibrosis were lower on the vCUT treated side as compared to the control side.In conclusion,the data supports the use of vCUT as an adhesion barrier in surgical procedures.展开更多
Background In this study,we aimed to assess the efcacy of surgical treatment in children with drug-refractory infantile epileptic spasms syndrome(IESS)and examine the factors infuencing the post-surgical outcomes.Meth...Background In this study,we aimed to assess the efcacy of surgical treatment in children with drug-refractory infantile epileptic spasms syndrome(IESS)and examine the factors infuencing the post-surgical outcomes.Methods The clinical data of 30 children(18 males and 12 females)with epileptic spasms(ES)who underwent surgery at the Epilepsy Center of Shenzhen Children’s Hospital between June 2018 and June 2020 were retrospectively analyzed.Post-surgical outcomes were evaluated using the Engel Epilepsy Surgery Outcome Scale.Scalp electroencephalography and developmental quotient were assessed preoperatively and postoperatively.Univariate analysis and exact logistic regression analyses were used to identify the factors afecting the postoperative efcacy.Results Of the 30 patients who underwent surgical resection,22(73.3%)achieved Engel’s classⅠ-Ⅱoutcomes.Additionally,motor and cognitive functions improved in 14 patients(46.7%).The development of 12(40%)patients remained at the preoperative development level.The median number of antiseizure medications taken preoperatively was 5.27(range 2-10),which decreased to 1.90(range 0-4)at the last follow-up.Seizure duration,etiology,positive positron emission tomography-magnetic resonance imaging(PET-MRI),surgery type,and lesion location were signifcantly correlated with the postoperative efcacy(P<0.05).Positive PET/MRI fndings and lesion location predicted independently the postoperative outcomes.Permanent impairments of motor or language function were rare,with only two cases reporting hydrocephalus and one reporting hemiplegia.Conclusions Surgery is an efective treatment option for children with IESS.Early referral and comprehensive preoperative evaluation are essential for identifcation of surgically treatable structural lesions.The primary surgically treatable cause is cortical malformation,followed by perinatal brain injury.Hemispheric disconnection is a preferred surgical approach.Positive PET/MRI fndings and lesion location predicted the postoperative outcomes.展开更多
文摘Abdominal surgical site infections(SSIs)are infections that occur after abdominal surgery.They can be superficial,involving the skin tissue only,or more profound,involving deeper skin tissues including organs and implanted materials.Currently,SSIs are large global health problem with an incidence that varies significantly depending on the United Nations’Human Development Index.The purpose of this review is to provide a practical update on the latest available literature on SSIs,focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.
文摘This article examines the complex relationship between disease perception,negative emotions,and their impact on postoperative recovery in patients with perianal diseases.These conditions not only cause physical discomfort,but also carry a significant emotional burden,often exacerbated by social stigma.Psycho-logical factors,including stress,anxiety,and depression,activate neuroendocrine pathways,such as the hypothalamic–pituitary–adrenal axis,disrupting the gut microbiota and leading to dysbiosis.This disruption can delay wound healing,prolong hospital stay,and intensify pain.Drawing on the findings of Hou et al,our article highlights the critical role of illness perception and negative emotions in shaping recovery outcomes.It advocates for a holistic approach that integrates psychological support and gut microbiota modulation,to enhance healing and improve overall patient outcomes.
文摘BACKGROUND Patients who have undergone pancreaticoduodenectomy(Whipple procedure)often develop complex late complications that may be diagnostically challenging.We report a rare cause of recurrent fever and abdominal pain in such a patient:Fish bone-induced jejunal perforation.This case emphasizes the importance of maintaining suspicion for atypical,non-biliary causes in post-Whipple patients with recurrent symptoms,particularly when conventional tests suggest no biliary obstruction.A thorough linear diagnostic approach and multidisciplinary collaboration are essential.The delay in diagnosis highlights the challenges of interpreting subtle imaging findings and correlating them with clinical symptoms mimicking cholangitis.CASE SUMMARY A 55-year-old female with a Whipple procedure history 10 years earlier presented with recurrent fever and severe abdominal pain.An initial extensive workup,including imaging and laboratory tests,was inconclusive.Only after detailed reevaluation of the computed tomography images revealed a subtle linear hyperdensity and subsequent deep push enteroscopy was an embedded fish bone in the efferent jejunal limb identified and removed endoscopically.CONCLUSION Clinicians should consider gastrointestinal foreign body perforation in the differential diagnosis of recurrent fever and abdominal pain in patients with altered anatomy after Whipple procedure.Critical image review and advanced enteroscopic techniques are invaluable for diagnosing obscure causes in complex cases.
基金Supported by Shandong Province Medical and Health Science and Technology Development Plan Project,No.202203030713Science and Technology Program of Yantai Affiliated Hospital of Binzhou Medical University,No.YTFY2022KYQD06.
文摘Colorectal cancer(CRC)is one of the most prevalent cancers globally,with a high recurrence rate following curative surgery,especially within the first 3 to 5 years.Post-surgical follow-up plays a vital role in detecting local and distant recurrences,significantly influencing survival rates.However,despite established guidelines recommending surveillance strategies,discrepancies persist regarding the optimal surveillance modality and patient adherence to follow protocols.Sala-Miquel et al’s study emphasize the superiority of computed tomography in detecting metastasis and recurrence,while also shedding light on the critical role of adherence to surveillance protocols in improving patient outcomes.This editorial discusses the implications of these findings for clinical practice,providing a comprehensive overview of the current landscape of CRC surveillance and the path forward for improving patient outcomes.
文摘The objective of this study was to analyze the current evidence for the use of pancreatic enzyme replacement therapy (PERT) in affecting survival and quality of life in patients with pancreatic exocrine insufficiency (PEI). Systematic searches of the literature were performed using the PubMed database. Articles were selected for inclusion if they reported findings from trials assessing the effects of PERT on quality of life, survival, malabsorption, growth parameters (such as height, body weight and body mass index), or gastrointestinal symptoms (such as abdominal pain, stool consistency and flatulence). PERT improved PEI-related malabsorption and weight maintenance in patients with cystic fibrosis, chronic pancreatitis, pancreatic cancer, and post-surgical states. In patients with chronic pancreatitis, PERT improved PEI-related symptoms and quality of life measures. Several small retrospective studies have also suggested that PERT may have a positive impact on survival, but long-term studies assessing this effect were not identified. PERT is effective for treating malnutrition and supporting weight maintenance, and it is associated with improved quality of life and possibly with enhanced survival in patients with PEI. However, there is evidence that not all patients with PEI receive adequate PERT. Future work should aim to assess the long-term effects of PERT on the survival of patients with PEI.
文摘Lung transplantation has been a method for treating end stage lung disease for decades. Despite improvements in the preoperative assessment of recipients and donors as well as improved surgical techniques, lung transplant recipients are still at a high risk of developing postoperative complications which tend to impact negatively the patients' outcome if not recognised early. The recognised complications post lung transplantation can be broadly categorised into acute and chronic complications. Recognising the radiological features of these complications has a significant positive impact on patients' survival post transplantation. This manuscript provides a comprehensive review of the radiological features of post lung transplantations complications over a time continuum.
文摘Purpose: Women who are surgically treated for vulvar cancer often have complications leading to substantial patient morbidity. Post-surgical complications could be minimized by the identification of pre-surgical risks for complications and by planned post-surgical interventions. Therefore, the aim of this study was to develop a clinical care algorithm for vulvar cancer to assess risk for complications and prevent and control post-surgical complications. Methods: Key elements of the algorithm were identified via a literature review, structured chart review, a survey of care team members and interviews with stakeholders including healthcare team, patients and their family. Results: An algorithm for the management of wound and psychosocial complications was developed, based on internal and external evidence and was vetted by expert reviewers. Conclusion: Describing the process and defining the roles of health care professionals contributes to purposeful, systematic prevention and treatment of post-surgical complications. The care algorithm provides structured reference points for healthcare professionals with regard to multidisciplinary post-surgical management of vulvar cancer patients.
文摘Background In clinical practice, the mechanisms underlying chronic post-surgical pain （CPSP） remain insufficiently understood. The primary goals of this study were to determine the incidence of chronic pain after thoracic surgery and to identify possible risk factors associated with the development of chronic post-thoracotomy pain in Chinese patients. The secondary goal was to determine whether the difference between pre- and post-operative white blood cell （WBC） counts could predict the prevalence of CPSP after thoracotomy. The impact of chronic pain on daily life was also investigated. Methods We contacted by phone 607 patients who had undergone thoracotomy at our hospital during the period February 2009 to May 2010. Statistical comparisons were made between patients with or without CPSP. Results Results were ultimately analyzed from 466 qualified patients. The overall incidence of CPSP was 64.5%. Difference between pre- and post-operative WBC counts differed significantly between patients with or without CPSP （P 〈0.001） and was considered as an independent risk factor for the development of CPSP following thoracotomy （P 〈0.001）. Other predictive factors for chronic pain included younger age （〈60 years, P 〈0.001）, diabetes mellitus （P=0.023）, acute post-operative pain （P=0.005） and the duration of chest tube drainage （P 〈0.001）. At the time of interviews, the pain resulted in at least moderate restriction of daily activities in 15% of the patients, of which only 16 patients had paid a visit to the doctor and only three of them were satisfied with the therapeutic effects, Conclusions Chronic pain is common after thoracotomy. WBC count may be a new independent risk factoring surgical patients during peri-operative period. Besides, age, diabetes mellitus, acute post-operative pain, and duration of chest tube drainage may also play a role in chronic post-surgical pain occurrence.
基金sponsored by National Key Research and Development Program of China(2017YFA0205104 and 2019YFA0906500)National Natural Science Foundation of China(51873150,31971300 and 817719709)+2 种基金Tianjin Natural Science Foundation(19JCYBJC28800)Young Elite Scientists Sponsorship Program by Tianjinthe Key project of Tianjin Foundational Research(Jing Jin Ji)Program,China(19JCZDJC64100)
文摘Tumor recurrence after surgery is the main cause of treatment failure.However,the initial stage of recurrence is not easy to detect,and it is difficult to cure in the late stage.In order to improve the life quality of postoperative patients,an efficient synergistic immunotherapy was developed to achieve early diagnosis and treatment of post-surgical tumor recurrence,simultaneously.In this paper,two kinds of theranostic agents based on gold nanorods(AuNRs)platform were prepared.AuNRs and quantum dots(QDs)in one agent was used for the detection of carcinoembryonic antigen(CEA),using fluorescence resonance energy transfer(FRET)technology to indicate the occurrence of in situ recurrence,while AuNRs in the other agent was used for photothermal therapy(PTT),together with antiPDL1 mediated immunotherapy to alleviate the process of tumor metastasis.A series of assays indicated that this synergistic immunotherapy could induce tumor cell death and the increased generation of CD3;/CD4;T-lymphocytes and CD3+;CD8;T-lymphocytes.Besides,more immune factors(IL-2,IL-6,and IFN-γ)produced by synergistic immunotherapy were secreted than mono-immunotherapy.This cooperative immunotherapy strategy could be utilized for diagnosis and treatment of postoperative tumor recurrence at the same time,providing a new perspective for basic and clinical research.
基金support from the Ministry of Science and ICT of Korea(NRF-2021R1A2C2008821 and 2022H1D3A2A02093385)the Korean Fund for Regenerative Medicine(KFRM)grant funded by the Korean government(21A0301L1-21)The Institute of Engineering Research at Seoul National University provided research facilities,and additional support came from the SNU Engineering-Medicine Collaboration grant.
文摘Wounds, characterized by the disruption of the continuity of body tissues resulting from external trauma,manifest in diverse types and locations. Although numerous wound dressings are available for various woundscenarios, it remains challenging to find an integrative wound dressing capable of addressing diverse woundsituations. We focused on utilizing sulfated hyaluronan (sHA), known for its anti-inflammatory properties andcapacity to load cationic drugs. By conjugating catechol groups to sHA (sHA-CA), we achieved several advantagesin wound healing: 1) Fabrication of patches through crosslinking with catechol-modified high-molecularweighthyaluronan (HA(HMW)-CA), 2) Adhesiveness that enabled stable localization, 3) Radical scavenging thatcould synergize with the immunomodulation of sHA. The sHA-CA patches demonstrated therapeutic efficacy inthree distinct murine wound models: diabetic wound, hepatic hemorrhage, and post-surgical adhesion. Collectively,these findings underscore the potential of the sHA-CA patch as a promising candidate for the nextgenerationwound dressing.
文摘Post-operative adhesions,a common complication of surgery,cause pain,impair organ functionality,and often require additional surgical interventions.Control of inflammation,protection of injured tissue,and rapid tissue repair are critical for adhesion prevention.Adhesion barriers are biomaterials used to prevent adhesions by physical separation of opposing injured tissues.Current adhesion barriers have poor anti-inflammatory and tissue regenerative properties.Umbilical cord tissue(UT),a part of the placenta,is inherently soft,conforming,biocompatible,and biodegradable,with antimicrobial,anti-inflammatory,and antifibrotic properties,making it an attractive alternative to currently available adhesion barriers.While use of fresh tissue is preferable,availability and short storage time limit its clinical use.A viable cryopreserved UT(vCUT)“point of care”allograft has recently become available.vCUT retains the extracellular matrix,growth factors,and native viable cells with the added advantage of a long shelf life at−80℃.In this study,vCUT's anti-adhesion property was evaluated in a rabbit abdominal adhesion model.The cecum was abraded on two opposing sides,and vCUT was sutured to the abdominal wall on the treatment side;whereas the contralateral side of the abdomen served as an internal untreated control.Gross and histological evaluation was performed at 7,28,and 67 days post-surgery.No adhesions were detectable on the vCUT treated side at all time points.Histological scores for adhesion,inflammation,and fibrosis were lower on the vCUT treated side as compared to the control side.In conclusion,the data supports the use of vCUT as an adhesion barrier in surgical procedures.
基金supported by grants from the Shenzhen Health and Family Planning Commission(SZSM201812005)the Shenzhen Key Discipline Fund(SZXK033)the Shenzhen Science and Technology Plan Project(JCY20210324135211030).
文摘Background In this study,we aimed to assess the efcacy of surgical treatment in children with drug-refractory infantile epileptic spasms syndrome(IESS)and examine the factors infuencing the post-surgical outcomes.Methods The clinical data of 30 children(18 males and 12 females)with epileptic spasms(ES)who underwent surgery at the Epilepsy Center of Shenzhen Children’s Hospital between June 2018 and June 2020 were retrospectively analyzed.Post-surgical outcomes were evaluated using the Engel Epilepsy Surgery Outcome Scale.Scalp electroencephalography and developmental quotient were assessed preoperatively and postoperatively.Univariate analysis and exact logistic regression analyses were used to identify the factors afecting the postoperative efcacy.Results Of the 30 patients who underwent surgical resection,22(73.3%)achieved Engel’s classⅠ-Ⅱoutcomes.Additionally,motor and cognitive functions improved in 14 patients(46.7%).The development of 12(40%)patients remained at the preoperative development level.The median number of antiseizure medications taken preoperatively was 5.27(range 2-10),which decreased to 1.90(range 0-4)at the last follow-up.Seizure duration,etiology,positive positron emission tomography-magnetic resonance imaging(PET-MRI),surgery type,and lesion location were signifcantly correlated with the postoperative efcacy(P<0.05).Positive PET/MRI fndings and lesion location predicted independently the postoperative outcomes.Permanent impairments of motor or language function were rare,with only two cases reporting hydrocephalus and one reporting hemiplegia.Conclusions Surgery is an efective treatment option for children with IESS.Early referral and comprehensive preoperative evaluation are essential for identifcation of surgically treatable structural lesions.The primary surgically treatable cause is cortical malformation,followed by perinatal brain injury.Hemispheric disconnection is a preferred surgical approach.Positive PET/MRI fndings and lesion location predicted the postoperative outcomes.
