Pericardial barrier destruction,inflammatory cell infiltration,and fibrous tissue hyperplasia,trigger adhesions after cardiac surgery.There are few anti-adhesion materials that are both functional and sutureable for p...Pericardial barrier destruction,inflammatory cell infiltration,and fibrous tissue hyperplasia,trigger adhesions after cardiac surgery.There are few anti-adhesion materials that are both functional and sutureable for pericardial reconstruction.Besides,a few studies have reported on the mechanism of preventing pericardial adhesion.Herein,a functional barrier membrane with sutureability was developed via a modified electrospinning method.It was composed of poly(L-lactide-co-caprolactone)(PLCL)nanofibers,poly(vinyl alcohol)(PVA)aerogel,and melatonin,named PPMT.The PPMT had a special microstructure manifested as a staggered arrangement of nanofibers on the surface and a layered macroporous aerogel structure in a cross-section.Besides providing the porosity and hydrophilicity obtained from PVA,the structure also had suitable mechanical properties for stitching due to the addition of PLCL nanofibers.Furthermore,it inhibited the proliferation of fibroblasts by suppressing the activation of Fas and P53,and achieved anti-inflammatory effects by affecting the activity of inflammatory cells and reducing the release of pro-inflammatory factors,such as interleukin 8(IL-8)and tumor necrosis factorα(TNF-α).Finally,in vivo transplantation showed that it up-regulated the expression of matrix metalloproteinase-1(MMP1)and tissue inhibitor of metalloproteinase-1(TIMP1),and down-regulated the expression of Vinculin and transforming growth factorβ(TGF-β)in the myocardium,thereby reducing the formation of adhesions.Collectively,these results demonstrate a great potential of PPMT membrane for practical application to anti-adhesion.展开更多
BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the ab...BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the abdominal cavity,abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections.For patients undergoing ileostomy closure,selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.AIM To investigate the impact of three different skin suturing methods at the ileostomy closure site on patient prognosis.METHODS Thirty patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected based on inclusion and exclusion criteria.The patients were divided into three groups:The purse-string suture group,the cross-suture group,and the vertical interrupted suture group,with 10 cases in each group.The purse-string suture group,cross-suture group,and vertical interrupted suture group used purse-string,cross,and vertical interrupted suturing methods,respectively,for the skin incision at the ileostomy closure site.RESULTS There were no statistically significant differences among the three groups in terms of operative time,intraoperative blood loss,time to resume liquid diet,time to first bowel movement,postoperative hospital stay,hospitalization costs,or levels of white blood cell count,hemoglobin,and albumin on the third postoperative day(P>0.05).Nevertheless,significant differences(P<0.05)were observed in incision suture removal time,wound healing time,C-reactive protein levels on the third postoperative day,visual analog scale pain scores during the first three postoperative days,and the incidence of surgical site infection.Overall,the therapeutic outcomes of the pursestring suture group and the cross-suture group were superior to the vertical interrupted suture group.CONCLUSION Using purse-string or cross-suturing methods for skin incision at the ileostomy closure site can shorten wound healing and suture removal times,reduce surgical site infection incidence and postoperative inflammatory response,alleviate incision pain,and promote rapid postoperative recovery.展开更多
BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate...BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.展开更多
BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patel...BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patella are extremely rare in adults.CASE SUMMARY An 18-year-old male patient fell while running in the morning.The patient had tenderness to palpation at the superior pole of the patella,with a palpable gap over the upper part of the patella in both knees.We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture,augmented by autogenous gracilis through performing the figure-of-eight technique.The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.CONCLUSION Sleeve fractures of the superior pole of the patella are extremely rare in adults,especially bilateral sleeve fractures.Suture anchors,augmented by autogenous gracilis,provided secure fixation and achieved excellent results in this rare injury.展开更多
BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a te...BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a tertiary coloproctology reference center.METHODS Seventy-two patients who underwent surgical intervention for perianal fistula between August 2019 and January 2023 were treated using a modified fistulotomy technique.In this approach,the fistula tract was excised from the external opening up to the external sphincter fibers.The internal orifice was widened,and the septic focus within the inter sphincteric space was curetted.Partial internal sphincterotomy was performed up to the inter sphincteric plane.The anoderm from the internal orifice to the inter sphincteric space was closed with absorbable suture material,and a loose seton was placed at the level of the external sphincter.RESULTS The 72 patients who underwent modified fistulotomy were 77.8%male and 22.2%female,with a mean age of 42.2±11.5 years.The median follow-up period was 19 months.Preoperatively,93.1%of patients had high trans sphincteric fistulas,and 6.9%were females with anterior low trans sphincteric fistulas.In all cases,setons were placed during surgery using vascular tape.A total of 12.5%of patients experienced incontinence,involving gas(6.9%)or soiling(5.6%).There were no reports of solid or liquid incontinences.Complete healing was achieved in 83.3%of the patients,with a recurrence rate of 4.2%and a non-healing rate of 12.5%.CONCLUSION Our preliminary analysis suggests that this modified fistulotomy technique that targets distalization of the internal orifice is a promising alternative management strategy for perianal fistulas.展开更多
BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM ...BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.METHODS During March 2024,the PubMed,EMBASE,and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries.Data regarding patient demographics,pathological characteristics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.RESULTS Eight studies were included.In total,94 patients(94 feet)underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2±10.2 months.The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2±11.8 preoperatively to a post-operative score of 82.8±5.4.The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7±0.6 preoperatively to a post-operative score of 2.0±0.4.In total,100%of patients returned to sport at a mean time of 16.8 weeks.The complication rate was 5%,the most common complication of which was residual midfoot stiffness(3.0%).No failures nor secondary surgical procedures were recorded.CONCLUSION This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up.In addition,there was an excellent return-to-sport rate(100%)at a weighted mean time of 16.8 weeks.This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries;however,caution should be taken when evaluating this data in light of the lack of high quality,comparative studies,and short-term follow-up.展开更多
Regarding the current materials used for suture anchors for rotator cuff repair,there are still limitations in terms of degradability,mechanical properties,and bioactivities in clinical applications.Magnesium alloys h...Regarding the current materials used for suture anchors for rotator cuff repair,there are still limitations in terms of degradability,mechanical properties,and bioactivities in clinical applications.Magnesium alloys have preliminarily been shown to promote tendon-bone healing with good prospects for application as anchor materials.However,the design of anchor structures for the degradation characteristics of magnesium alloy materials has not been considered,which is critical for the practical application of magnesium alloy anchors.The mechanism by which magnesium promotes tendon bone healing remains to be clarified.Here,we proposed a novel split hollowed magnesium alloy suture anchors for the repair of rabbit rotator cuff injury.We found that novel split hollowed magnesium alloy anchors structure effectively solved the problem of failure due to degradation of traditional eyelet structure,providing reliable suture fixation.The open architecture facilitates the metabolic resorption of the degradation products of and promotes the ingrowth of bone tissue.Histological staining showed that magnesium anchors have better ability to promote regeneration at the fibrocartilage interface compared to PLLA anchors.The higher expression of fibrocartilage markers(Aggrecan,COL2A1,and Sox9)at the tendon-bone interface in magnesium anchors,which promotes chondrocyte differentiation at the tendon-bone interface and matrix formation,which is more conducive to achieving regeneration and maturation of fibrocartilage enthesis.Hence,this study provides a basis for further research on the clinical application of degradable magnesium alloy suture anchors.展开更多
BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumul...BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.展开更多
BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic co...BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.展开更多
Currently, animal and clinical research on biomaterials, such as surgical sutures, are mainly performed by removing them from the experiment targets and observing them by microscopy. However, traditional microscopy is...Currently, animal and clinical research on biomaterials, such as surgical sutures, are mainly performed by removing them from the experiment targets and observing them by microscopy. However, traditional microscopy is not able to observe the internal structure, and there is a risk of sacrificing animals to remove the suture and damaging the materials. Therefore, we introduced optical coherence tomography (OCT) to observe and evaluate four different kinds of surgical sutures in vivo (monofilament absorbable and nonabsorbable sutures and braided absorbable and nonabsorbable sutures). As a result, while the monofilament nonabsorbable sutures showed almost no change over time, the absorbable sutures had color fading and it was also confirmed that the internal structure became chaotic due to decomposition, which improved the OCT signal intensity. For the braided sutures, both absorbable and nonabsorbable, we found that the reflection signal improved from week 0 because blood got among the filaments of sutures and dried during recovery which increased OCT signal from week 0 to week 1. We also confirmed that the braided sutures untwisted over time. All four kinds of sutures were pulled due to the movement of rats during recovery. It is expected that OCT technology will be of great help in in vivo experiments on biomaterials such as sutures.展开更多
The Yarlung Zangbo Suture Zone(YZSZ)on the southern margin of the Lhasa block and the Tangjia-Sumdo ultrahigh-pressure metamorphic belt(TSMB)within the block represent natural laboratories for the study of plate tecto...The Yarlung Zangbo Suture Zone(YZSZ)on the southern margin of the Lhasa block and the Tangjia-Sumdo ultrahigh-pressure metamorphic belt(TSMB)within the block represent natural laboratories for the study of plate tectonics and oceanic slab subduction.It is generally believed that these two zones represent the remnants of the ancient oceanic crust and upper mantle of the Yarlung Zangbo Neo-Tethys(YZNT)and the Tangjia-Sumdo Paleo-Tethys(TSPT).However,the evolutionary patterns and spatiotemporal relationships of the TSPT and the YZNT have been debated.展开更多
Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside ...Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.展开更多
The connection efficiency of composite pre-tightened multi-tooth joint is low because of uneven load distribution and single load transmission path.In this paper,based on the principle of bio-tooth(suture)structure,co...The connection efficiency of composite pre-tightened multi-tooth joint is low because of uneven load distribution and single load transmission path.In this paper,based on the principle of bio-tooth(suture)structure,combining soft material with fractal,a composite pre-tightened multi-hierarchy tooth joint is proposed,and the bearing performance and failure process of the joint through experiments and finite element method under tensile load.First,the ultimate bearing capacity,load distribution ratio,and failure process of different hierarchies of teeth joints are studied through experiments.Then,the progressive damage models of different hierarchies of tooth joints are established,and experiments verify the validity of the finite element model.Finally,the effects of soft material and increasing tooth hierarchy on the failure process and bearing capacity of composite pre-tightened tooth joints are analyzed by the finite element method.The following conclusions can be drawn:(1)The embedding of soft materials changed the failure process of the joint.Increasing the tooth hierarchy can give the joint more load transfer paths,but the failure process of the joint is complicated.(2)Embedding soft materials and increasing the tooth hierarchy simultaneously can effectively improve the bearing capacity of composite pre-tightened tooth joints,which is 87.8%higher than that of traditional three-tooth joints.展开更多
This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwent...This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwentexperimental PF0 model creation.All animals received implantationof the transcatheter suture closure system to evaluate procedural success.Comprehensive follow-up over sixmonths included serial ultrasound imaging,histopathological analysis,and gross anatomical exaninationof cardiac specimens.Results:Successful HaloStitch^(®)device implantation was adhieved in 11 of 13 swine.Gross anatomical examination confirrned secure positioning of all sutures in the atrial septum,with noredundancy or thrombus formation.Postoperative ultrasound demonstrated stable suture and staplepositions throughout follow-up,with no evidence of suture breakage,displacement,or thrombus.Stapleswere clearly visualized under ultrasound imaging,Both the atrial septal defect orifice diameter and residualseptal shunt flow velocity decreased significantly during the observation period.Histopathological analysisrevealed partially organized thrombi at the implant head and fibrous connective tissue encapsulation withlocalized inflammatory cell infiltration surrounding the polymer material.Conclsions:The transcathetersuture closure system(HaloStitch^(®))demonstrated feasibility,safety,and biocompatib ility for PFO closure ina swine model,supporting its potential for clinical translation.展开更多
The Yarlung Tsangpo River(YTR),located in the Himalayan orogenic belt,is renowned for its deep gorges and complex tectonic features,as well as its reputation as a landslide-prone region.However,less is known about the...The Yarlung Tsangpo River(YTR),located in the Himalayan orogenic belt,is renowned for its deep gorges and complex tectonic features,as well as its reputation as a landslide-prone region.However,less is known about the distribution of landslides across the entire river basin.To address this gap in knowledge,this study first established a comprehensive landslide inventory across the entire basin using remote sensing mapping and multiple field investigations.Then,a systematic analysis of the spatial and size distributions was conducted.The results indicated that the YTR basin features at least 2390 landslides with areas exceeding 104 m2,spanning a total area and volume of 1087.6 km^(2) and 48.4 km^(3),respectively.These landslides can be classified into eight types,and rockslides are the most common(53.1%).Their distributions are highly asymmetric,with the following notable patterns:(1)the Tsangpo suture zone(53.4%)contains a greater number of landslides than other tectonic units;(2)the landslide size is influenced by the relief and elevation conditions,with positive relationships observed between the local relief and landslide area,as well as between the elevation range and landslide area;and(3)the landslide distribution is not significantly correlated with rainfall,and seasonally frozen ground is associated with a greater concentration of landslides.Alternating slate and shale groups in the Tsangpo suture zone may be the factors responding to landslide concentration.A total of 20.6%of landslide-blocked rivers were observed,with some forming river knickpoints.Due to the limited data,spatial and size analyses are perhaps immature,and further systematic analysis remains necessary.展开更多
Local and global optimization methods are widely used in geophysical inversion but each has its own advantages and disadvantages. The combination of the two methods will make it possible to overcome their weaknesses. ...Local and global optimization methods are widely used in geophysical inversion but each has its own advantages and disadvantages. The combination of the two methods will make it possible to overcome their weaknesses. Based on the simulated annealing genetic algorithm （SAGA） and the simplex algorithm, an efficient and robust 2-D nonlinear method for seismic travel-time inversion is presented in this paper. First we do a global search over a large range by SAGA and then do a rapid local search using the simplex method. A multi-scale tomography method is adopted in order to reduce non-uniqueness. The velocity field is divided into different spatial scales and velocities at the grid nodes are taken as unknown parameters. The model is parameterized by a bi-cubic spline function. The finite-difference method is used to solve the forward problem while the hybrid method combining multi-scale SAGA and simplex algorithms is applied to the inverse problem. The algorithm has been applied to a numerical test and a travel-time perturbation test using an anomalous low-velocity body. For a practical example, it is used in the study of upper crustal velocity structure of the A＇nyemaqen suture zone at the north-east edge of the Qinghai-Tibet Plateau. The model test and practical application both prove that the method is effective and robust.展开更多
Objective To investigate the clinical efficacy of acupuncture combined with medicine for AIzheimer＇s disease. Methods Fifty-five patients of Alzheimer＇s disease were randomly divided into two groups in accordance wi...Objective To investigate the clinical efficacy of acupuncture combined with medicine for AIzheimer＇s disease. Methods Fifty-five patients of Alzheimer＇s disease were randomly divided into two groups in accordance with random number table： the drug group （n=28） was treated with oral donepezil hydrochloride tablets, once a day for 5-10 mg with 10 days as a course of treatment; the combined acupuncture and drug group （n=27） was treated with cranial suture acupuncture combined with donepezil hydrochloride tablets in the above-mentioned way. The cranial suture acupuncture was given once a day for 30 min with 10 days as a course of treatment. Both groups were given treatment for two courses. Mini-mental state examination （MMSE）, Alzheimer＇s disease assessment scale （ADAS-Cog）, activities of daily living scale （Barthel） and electroencephalogram （EEG） were checked before and after treatment, to evaluate the efficacy of each group via integral changes of Barthel. Results MMSE score increased, Barthel index score increased, and ADAS-Cog score decreased in the two groups after treatment （P〈0.05, P〈0.01）, and the efficacy of the combined acupuncture and drug group was more significant （P〈0.01）. The α wave frequency and amplitude and θ wave frequency of EEG increased after treatment in both groups （P〈0.05）, θ wave amplitude decreased （P〈0.01）, and the efficacy of the combined acupuncture and drug group was superior to that of the drug group in terms of EEG improvement （P〈0.05）. The total effective rate of the combined acupuncture and drug group （88.9%, 24/27） was superior to that of drug group （67.9%, 18/28, P〈0.05）. Conclusion The effect of cranial suture acupuncture combined with donepezil hydrochloride tablets for Alzheimer＇s disease is more significant than only medicine therapy.展开更多
基金The National Natural Science Fund of China(81873923)Shanghai Science and Technology Development Fund(20Y11910600,18441901900)supported this study.
文摘Pericardial barrier destruction,inflammatory cell infiltration,and fibrous tissue hyperplasia,trigger adhesions after cardiac surgery.There are few anti-adhesion materials that are both functional and sutureable for pericardial reconstruction.Besides,a few studies have reported on the mechanism of preventing pericardial adhesion.Herein,a functional barrier membrane with sutureability was developed via a modified electrospinning method.It was composed of poly(L-lactide-co-caprolactone)(PLCL)nanofibers,poly(vinyl alcohol)(PVA)aerogel,and melatonin,named PPMT.The PPMT had a special microstructure manifested as a staggered arrangement of nanofibers on the surface and a layered macroporous aerogel structure in a cross-section.Besides providing the porosity and hydrophilicity obtained from PVA,the structure also had suitable mechanical properties for stitching due to the addition of PLCL nanofibers.Furthermore,it inhibited the proliferation of fibroblasts by suppressing the activation of Fas and P53,and achieved anti-inflammatory effects by affecting the activity of inflammatory cells and reducing the release of pro-inflammatory factors,such as interleukin 8(IL-8)and tumor necrosis factorα(TNF-α).Finally,in vivo transplantation showed that it up-regulated the expression of matrix metalloproteinase-1(MMP1)and tissue inhibitor of metalloproteinase-1(TIMP1),and down-regulated the expression of Vinculin and transforming growth factorβ(TGF-β)in the myocardium,thereby reducing the formation of adhesions.Collectively,these results demonstrate a great potential of PPMT membrane for practical application to anti-adhesion.
文摘BACKGROUND At present,prophylactic ileostomy is commonly used to protect distal intestinal anastomoses,particularly during the recovery period following colorectal surgery.However,after the ileum is returned to the abdominal cavity,abdominal closure using traditional vertical interrupted suturing is associated with a higher incidence of wound infections.For patients undergoing ileostomy closure,selecting an appropriate suturing method for the skin incision at the stoma site is crucial for improving patient prognosis.AIM To investigate the impact of three different skin suturing methods at the ileostomy closure site on patient prognosis.METHODS Thirty patients who underwent ileostomy closure at the Affiliated Hospital of Qinghai University between January 2024 and October 2024 were selected based on inclusion and exclusion criteria.The patients were divided into three groups:The purse-string suture group,the cross-suture group,and the vertical interrupted suture group,with 10 cases in each group.The purse-string suture group,cross-suture group,and vertical interrupted suture group used purse-string,cross,and vertical interrupted suturing methods,respectively,for the skin incision at the ileostomy closure site.RESULTS There were no statistically significant differences among the three groups in terms of operative time,intraoperative blood loss,time to resume liquid diet,time to first bowel movement,postoperative hospital stay,hospitalization costs,or levels of white blood cell count,hemoglobin,and albumin on the third postoperative day(P>0.05).Nevertheless,significant differences(P<0.05)were observed in incision suture removal time,wound healing time,C-reactive protein levels on the third postoperative day,visual analog scale pain scores during the first three postoperative days,and the incidence of surgical site infection.Overall,the therapeutic outcomes of the pursestring suture group and the cross-suture group were superior to the vertical interrupted suture group.CONCLUSION Using purse-string or cross-suturing methods for skin incision at the ileostomy closure site can shorten wound healing and suture removal times,reduce surgical site infection incidence and postoperative inflammatory response,alleviate incision pain,and promote rapid postoperative recovery.
文摘BACKGROUND Anastomotic leakage(AL)is a challenging complication following rectal cancer surgery,often leading to increased morbidity and healthcare costs.The use of reinforcement sutures is expected to reduce the rate of AL,their preventive effects are controversial.AIM To determine the efficacy of reinforcing sutures in preventing AL in rectal cancer.METHODS A systematic search of major medical databases was conducted to identify studies up to June 2024.Intraoperative and postoperative outcomes were assessed;the primary outcome assessed was the incidence of AL.Pooled odds ratios(ORs)and mean differences(MDs)with a 95%confidence interval(CI)were calculated using fixed-effect or random-effect models under heterogeneity.RESULTS This meta-analysis incorporated 20 studies involving 3726 patients.Pooled results demonstrated a statistically significant reduction AL incidence in the reinforced suture group(OR:0.26,95%CI:0.19-0.35,P<0.001)than the unreinforced suture group.The reinforced suture group also exhibited a shorter hospital stay(MD:-1.17,95%CI:-1.78 to-0.57,P<0.001),earlier anal exhaust(MD:-0.13,95%CI:-0.22 to-0.05,P=0.002),longer operative time(MD:15.25,95%CI:10.71-19.80,P<0.001),lower infection rate(OR:0.54,95%CI:0.29-1.00,P=0.05)and lower reoperation rate(OR:0.19,95%CI:0.08-0.45,P<0.001).CONCLUSION The results substantiate the clinical value of anastomotic reinforcement sutures in reducing AL incidence postrectal cancer surgery.Nevertheless,these conclusions warrant verification through additional high-quality randomized controlled trials.
文摘BACKGROUND Sleeve fracture of the patella is an unusual fracture,almost unique to children.The majority of sleeve fractures involve the inferior patellar pole.However,sleeve fractures of the superior pole of the patella are extremely rare in adults.CASE SUMMARY An 18-year-old male patient fell while running in the morning.The patient had tenderness to palpation at the superior pole of the patella,with a palpable gap over the upper part of the patella in both knees.We applied two 4.5-mm suture anchors with the Krackow stitch to repair the sleeve fracture,augmented by autogenous gracilis through performing the figure-of-eight technique.The patient regained approximately the full range of motion of the knee joint without any quadriceps weakness and a normal gait 6 weeks after surgery.CONCLUSION Sleeve fractures of the superior pole of the patella are extremely rare in adults,especially bilateral sleeve fractures.Suture anchors,augmented by autogenous gracilis,provided secure fixation and achieved excellent results in this rare injury.
文摘BACKGROUND Both the etiology and treatment of perianal fistulas present challenges,and there is no standard surgical approach.AIM To present the results of a modified fistulotomy technique that was implemented in a tertiary coloproctology reference center.METHODS Seventy-two patients who underwent surgical intervention for perianal fistula between August 2019 and January 2023 were treated using a modified fistulotomy technique.In this approach,the fistula tract was excised from the external opening up to the external sphincter fibers.The internal orifice was widened,and the septic focus within the inter sphincteric space was curetted.Partial internal sphincterotomy was performed up to the inter sphincteric plane.The anoderm from the internal orifice to the inter sphincteric space was closed with absorbable suture material,and a loose seton was placed at the level of the external sphincter.RESULTS The 72 patients who underwent modified fistulotomy were 77.8%male and 22.2%female,with a mean age of 42.2±11.5 years.The median follow-up period was 19 months.Preoperatively,93.1%of patients had high trans sphincteric fistulas,and 6.9%were females with anterior low trans sphincteric fistulas.In all cases,setons were placed during surgery using vascular tape.A total of 12.5%of patients experienced incontinence,involving gas(6.9%)or soiling(5.6%).There were no reports of solid or liquid incontinences.Complete healing was achieved in 83.3%of the patients,with a recurrence rate of 4.2%and a non-healing rate of 12.5%.CONCLUSION Our preliminary analysis suggests that this modified fistulotomy technique that targets distalization of the internal orifice is a promising alternative management strategy for perianal fistulas.
文摘BACKGROUND The purpose of this systematic review was to evaluate the clinical and radiological outcomes at short-term follow-up following suture button fixation for the management of ligamentous Lisfranc injuries.AIM To assess the effectiveness of suture button fixation in managing ligamentous Lisfranc injuries through a systematic evaluation of short-term clinical and radiological outcomes.METHODS During March 2024,the PubMed,EMBASE,and Cochrane library databases were systematically reviewed to identify clinical studies examining outcomes following suture button fixation for the management of ligamentous Lisfranc injuries.Data regarding patient demographics,pathological characteristics,subjective clinical outcomes,radiological outcomes,complications,and failure rates were extracted and analyzed.RESULTS Eight studies were included.In total,94 patients(94 feet)underwent suture button fixation for the management of ligamentous Lisfranc injuries at a weighted mean follow-up of 27.2±10.2 months.The American Orthopaedic Foot and Ankle Society score improved from a weighted mean pre-operative score of 39.2±11.8 preoperatively to a post-operative score of 82.8±5.4.The weighted mean visual analogue scale score improved from a weighted mean pre-operative score of 7.7±0.6 preoperatively to a post-operative score of 2.0±0.4.In total,100%of patients returned to sport at a mean time of 16.8 weeks.The complication rate was 5%,the most common complication of which was residual midfoot stiffness(3.0%).No failures nor secondary surgical procedures were recorded.CONCLUSION This systematic review demonstrated that suture button fixation for ligamentous Lisfranc injuries produced improved clinical outcomes at short-term follow-up.In addition,there was an excellent return-to-sport rate(100%)at a weighted mean time of 16.8 weeks.This review highlights that suture button fixation is a potent surgical treatment strategy for ligamentous Lisfranc injuries;however,caution should be taken when evaluating this data in light of the lack of high quality,comparative studies,and short-term follow-up.
基金supported by Capital Health Development Research Special Project(2022-2-5051)DongGuan Innovative Research Team Program.Basic applied research program of Liaoning Province of China(No.2022020347-JH2/1013)。
文摘Regarding the current materials used for suture anchors for rotator cuff repair,there are still limitations in terms of degradability,mechanical properties,and bioactivities in clinical applications.Magnesium alloys have preliminarily been shown to promote tendon-bone healing with good prospects for application as anchor materials.However,the design of anchor structures for the degradation characteristics of magnesium alloy materials has not been considered,which is critical for the practical application of magnesium alloy anchors.The mechanism by which magnesium promotes tendon bone healing remains to be clarified.Here,we proposed a novel split hollowed magnesium alloy suture anchors for the repair of rabbit rotator cuff injury.We found that novel split hollowed magnesium alloy anchors structure effectively solved the problem of failure due to degradation of traditional eyelet structure,providing reliable suture fixation.The open architecture facilitates the metabolic resorption of the degradation products of and promotes the ingrowth of bone tissue.Histological staining showed that magnesium anchors have better ability to promote regeneration at the fibrocartilage interface compared to PLLA anchors.The higher expression of fibrocartilage markers(Aggrecan,COL2A1,and Sox9)at the tendon-bone interface in magnesium anchors,which promotes chondrocyte differentiation at the tendon-bone interface and matrix formation,which is more conducive to achieving regeneration and maturation of fibrocartilage enthesis.Hence,this study provides a basis for further research on the clinical application of degradable magnesium alloy suture anchors.
基金Supported by Jinhua City Science and Technology Plan Projects“Improve the Polarization of Cancer-related Fatigue:Clinical Efficacy Study”,No.2018-4-049.
文摘BACKGROUND Low-grade appendiceal mucinous neoplasms(LAMNs)are a class of histolo-gically well-differentiated adenomas that can proliferate outside the appendix in the form of malignant tumours,resulting in the accumulation of external appen-diceal mucus.They may present as an extra-appendiceal mass-like bulge,mucus or polypoid tissue at the appendiceal orifice,or even with abdominal dissem-ination.The surgical approach is usually appendectomy,ileocecal resection or right hemicolectomy.It is essential to raise awareness of LAMNs and choose an appropriate treatment.CASE SUMMARY A 68-year-old man underwent a routine physical examination at our hospital on May 17,2022.The patient had no symptoms of abdominal pain,bloating,or weight loss,and his tumour marker levels were normal.The faecal occult blood test was negative,and no abnormalities were identified on physical examination.Colonoscopy revealed a submucosal protrusion at the appendiceal orifice.During endoscopic ultrasound,uneven echoes were observed in the appendix cavity.A contrast-enhanced computed tomography scan of the abdomen revealed a nodular thickening at the base of the appendix,with a diameter of approximately 1 cm.When all the examination results were considered,we suspected the lesion to be an appendiceal mucinous tumour.Laparoscopic surgery was performed using the double purse-string suture method.Postoperative pathology suggested a low-grade mucinous cystadenoma of the appendix with no involvement of the margins.A repeat colonoscopy 18 months after surgery revealed no significant abnormality at the appendiceal orifice.A contrast-enhanced computed tomography scan of the abdomen suggested only postoperative changes.CONCLUSION This study describes a case of LAMN that was treated by resecting the mass at the appendiceal orifice via the double purse-string suture technique and provides new insights on the diagnosis and treatment of LAMNs.
基金Supported by National Natural Science Foundation of China,No.82170555Shanghai Academic/Technology Research Leader,No.22XD1422400+2 种基金Shanghai“Rising Stars of Medical Talent”Youth Development Program,No.20224Z0005the 74th General Support of China Postdoctoral Science Foundation,No.2023M740675Outstanding Resident Clinical Postdoctoral Program of Zhongshan Hospital Affiliated to Fudan University.
文摘BACKGROUND In recent years,endoscopic resection(ER)has been employed for the excision of submucosal tumors(SMTs).Nonetheless,ER in the duodenum is linked to ele-vated risks of both immediate and delayed hemorrhagic complications and perforations.Satisfactory suturing is crucial for reducing the occurrence of complications.AIM To establish a clinical score model for supporting suture decision-making of duodenal SMTs.METHODS This study included 137 individuals diagnosed with duodenal SMTs who under-went ER.Participants were evenly divided into two groups:A training cohort(TC)comprising 95 cases and an internal validation cohort(VC)with 42 cases.Subsequently,a scoring system was formulated utilizing multivariate logistic regression analysis within the TC,which was then subjected to evaluation in the VC.RESULTS The clinical scoring system incorporated two key factors:Extraluminal growth,which was assigned 2 points,and endoscopic full-thickness resection,which was given 3 points.This model demonstrated strong predictive accuracy,as evidenced by the area under the receiver operating characteristic curve of 0.900(95%confidence interval:0.823-0.976).Additionally,the model’s goodness-of-fit was validated by the Hosmer-Lemeshow test(P=0.404).The probability of purse-string suturing in low(score 0-2)and high(score>3)categories were 3.0%and 64.3%in the TC,and 6.1%and 88.9%in the VC,respectively.CONCLUSION This scoring system may function as a beneficial instrumentality for medical practitioners,facilitating the decision-making process concerning suture techniques in the context of duodenal SMTs.
文摘Currently, animal and clinical research on biomaterials, such as surgical sutures, are mainly performed by removing them from the experiment targets and observing them by microscopy. However, traditional microscopy is not able to observe the internal structure, and there is a risk of sacrificing animals to remove the suture and damaging the materials. Therefore, we introduced optical coherence tomography (OCT) to observe and evaluate four different kinds of surgical sutures in vivo (monofilament absorbable and nonabsorbable sutures and braided absorbable and nonabsorbable sutures). As a result, while the monofilament nonabsorbable sutures showed almost no change over time, the absorbable sutures had color fading and it was also confirmed that the internal structure became chaotic due to decomposition, which improved the OCT signal intensity. For the braided sutures, both absorbable and nonabsorbable, we found that the reflection signal improved from week 0 because blood got among the filaments of sutures and dried during recovery which increased OCT signal from week 0 to week 1. We also confirmed that the braided sutures untwisted over time. All four kinds of sutures were pulled due to the movement of rats during recovery. It is expected that OCT technology will be of great help in in vivo experiments on biomaterials such as sutures.
基金supported by the Science and Technology Research Program of Chongqing Municipal Education Commission(Grant No.KJQN202404310,KJQN202304302)National Natural Science Foundation of China(41972118).
文摘The Yarlung Zangbo Suture Zone(YZSZ)on the southern margin of the Lhasa block and the Tangjia-Sumdo ultrahigh-pressure metamorphic belt(TSMB)within the block represent natural laboratories for the study of plate tectonics and oceanic slab subduction.It is generally believed that these two zones represent the remnants of the ancient oceanic crust and upper mantle of the Yarlung Zangbo Neo-Tethys(YZNT)and the Tangjia-Sumdo Paleo-Tethys(TSPT).However,the evolutionary patterns and spatiotemporal relationships of the TSPT and the YZNT have been debated.
文摘Endoscopic submucosal dissection(ESD)has emerged as a safe and sufficient method of treatment of superficial lesions in the gastrointestinal(GI)tract.Advances in endoscopic closure techniques have developed alongside improvements in resection methods.Recent innovations,such as endoscopic hand suturing and new through-the-scope clips and systems,are transforming the field.Along with new devices,the combined methods of closure are developed.Embracing these new techniques can lead to enhanced recovery and reduced complications,marking an important milestone in medical practice.In fact,the European Society of GI Endoscopy recommends against routine closure of the ESD defect,except in duodenal ESD;however,endoscopic closure is strongly advised for immediate perforations.Furthermore,the American Gastroenterology Association provides a detailed expert review on managing perforations in the upper and lower GI tract based on endoscopic closure techniques.On the other hand,the most common postprocedural complications following ESD are delayed bleeding,delayed perforation,and stricture formation.According to recent literature,properly managing the post-ESD defect may reduce the risk of these complications.This review aims to explore novel approaches for managing post-ESD defects and intraprocedural complications to enhance safety and improve long-term outcomes.
基金funded by the National Natural Science Foundation of China(52478138).
文摘The connection efficiency of composite pre-tightened multi-tooth joint is low because of uneven load distribution and single load transmission path.In this paper,based on the principle of bio-tooth(suture)structure,combining soft material with fractal,a composite pre-tightened multi-hierarchy tooth joint is proposed,and the bearing performance and failure process of the joint through experiments and finite element method under tensile load.First,the ultimate bearing capacity,load distribution ratio,and failure process of different hierarchies of teeth joints are studied through experiments.Then,the progressive damage models of different hierarchies of tooth joints are established,and experiments verify the validity of the finite element model.Finally,the effects of soft material and increasing tooth hierarchy on the failure process and bearing capacity of composite pre-tightened tooth joints are analyzed by the finite element method.The following conclusions can be drawn:(1)The embedding of soft materials changed the failure process of the joint.Increasing the tooth hierarchy can give the joint more load transfer paths,but the failure process of the joint is complicated.(2)Embedding soft materials and increasing the tooth hierarchy simultaneously can effectively improve the bearing capacity of composite pre-tightened tooth joints,which is 87.8%higher than that of traditional three-tooth joints.
基金supported by grants from National High-Level Hospital Clinical Research Funding(2023-GSP-RC-04).
文摘This study aimed to evaluate the feasibility,safety,and efficacy of a noveltranscatheter suture closure system(HaloStitch^(®))for patent foramen ovale(PFO)closure in a swine model.Methods:Thirteen swine underwentexperimental PF0 model creation.All animals received implantationof the transcatheter suture closure system to evaluate procedural success.Comprehensive follow-up over sixmonths included serial ultrasound imaging,histopathological analysis,and gross anatomical exaninationof cardiac specimens.Results:Successful HaloStitch^(®)device implantation was adhieved in 11 of 13 swine.Gross anatomical examination confirrned secure positioning of all sutures in the atrial septum,with noredundancy or thrombus formation.Postoperative ultrasound demonstrated stable suture and staplepositions throughout follow-up,with no evidence of suture breakage,displacement,or thrombus.Stapleswere clearly visualized under ultrasound imaging,Both the atrial septal defect orifice diameter and residualseptal shunt flow velocity decreased significantly during the observation period.Histopathological analysisrevealed partially organized thrombi at the implant head and fibrous connective tissue encapsulation withlocalized inflammatory cell infiltration surrounding the polymer material.Conclsions:The transcathetersuture closure system(HaloStitch^(®))demonstrated feasibility,safety,and biocompatib ility for PFO closure ina swine model,supporting its potential for clinical translation.
基金supported by the National Key R&D Program of China(Grant No.2023YFC3008300)the Science and Technology Research Program of the Institute of Mountain Hazards and Environment,Chinese Academy of Sciences,Chinese Academy of Sciences(Grant No.IMHE-ZYTS-03 and IMHE-ZDRW-03).
文摘The Yarlung Tsangpo River(YTR),located in the Himalayan orogenic belt,is renowned for its deep gorges and complex tectonic features,as well as its reputation as a landslide-prone region.However,less is known about the distribution of landslides across the entire river basin.To address this gap in knowledge,this study first established a comprehensive landslide inventory across the entire basin using remote sensing mapping and multiple field investigations.Then,a systematic analysis of the spatial and size distributions was conducted.The results indicated that the YTR basin features at least 2390 landslides with areas exceeding 104 m2,spanning a total area and volume of 1087.6 km^(2) and 48.4 km^(3),respectively.These landslides can be classified into eight types,and rockslides are the most common(53.1%).Their distributions are highly asymmetric,with the following notable patterns:(1)the Tsangpo suture zone(53.4%)contains a greater number of landslides than other tectonic units;(2)the landslide size is influenced by the relief and elevation conditions,with positive relationships observed between the local relief and landslide area,as well as between the elevation range and landslide area;and(3)the landslide distribution is not significantly correlated with rainfall,and seasonally frozen ground is associated with a greater concentration of landslides.Alternating slate and shale groups in the Tsangpo suture zone may be the factors responding to landslide concentration.A total of 20.6%of landslide-blocked rivers were observed,with some forming river knickpoints.Due to the limited data,spatial and size analyses are perhaps immature,and further systematic analysis remains necessary.
基金supported by the National Natural Science Foundation of China (Grant Nos.40334040 and 40974033)the Promoting Foundation for Advanced Persons of Talent of NCWU
文摘Local and global optimization methods are widely used in geophysical inversion but each has its own advantages and disadvantages. The combination of the two methods will make it possible to overcome their weaknesses. Based on the simulated annealing genetic algorithm （SAGA） and the simplex algorithm, an efficient and robust 2-D nonlinear method for seismic travel-time inversion is presented in this paper. First we do a global search over a large range by SAGA and then do a rapid local search using the simplex method. A multi-scale tomography method is adopted in order to reduce non-uniqueness. The velocity field is divided into different spatial scales and velocities at the grid nodes are taken as unknown parameters. The model is parameterized by a bi-cubic spline function. The finite-difference method is used to solve the forward problem while the hybrid method combining multi-scale SAGA and simplex algorithms is applied to the inverse problem. The algorithm has been applied to a numerical test and a travel-time perturbation test using an anomalous low-velocity body. For a practical example, it is used in the study of upper crustal velocity structure of the A＇nyemaqen suture zone at the north-east edge of the Qinghai-Tibet Plateau. The model test and practical application both prove that the method is effective and robust.
文摘Objective To investigate the clinical efficacy of acupuncture combined with medicine for AIzheimer＇s disease. Methods Fifty-five patients of Alzheimer＇s disease were randomly divided into two groups in accordance with random number table： the drug group （n=28） was treated with oral donepezil hydrochloride tablets, once a day for 5-10 mg with 10 days as a course of treatment; the combined acupuncture and drug group （n=27） was treated with cranial suture acupuncture combined with donepezil hydrochloride tablets in the above-mentioned way. The cranial suture acupuncture was given once a day for 30 min with 10 days as a course of treatment. Both groups were given treatment for two courses. Mini-mental state examination （MMSE）, Alzheimer＇s disease assessment scale （ADAS-Cog）, activities of daily living scale （Barthel） and electroencephalogram （EEG） were checked before and after treatment, to evaluate the efficacy of each group via integral changes of Barthel. Results MMSE score increased, Barthel index score increased, and ADAS-Cog score decreased in the two groups after treatment （P〈0.05, P〈0.01）, and the efficacy of the combined acupuncture and drug group was more significant （P〈0.01）. The α wave frequency and amplitude and θ wave frequency of EEG increased after treatment in both groups （P〈0.05）, θ wave amplitude decreased （P〈0.01）, and the efficacy of the combined acupuncture and drug group was superior to that of the drug group in terms of EEG improvement （P〈0.05）. The total effective rate of the combined acupuncture and drug group （88.9%, 24/27） was superior to that of drug group （67.9%, 18/28, P〈0.05）. Conclusion The effect of cranial suture acupuncture combined with donepezil hydrochloride tablets for Alzheimer＇s disease is more significant than only medicine therapy.
