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
Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented d...Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo Over Stitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty.展开更多
Exposed endoscopic full-thickness resection(EFTR)without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alt...Exposed endoscopic full-thickness resection(EFTR)without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors.To date,various techniques have been used for the closure of the transmural postEFTR defect,mainly consisting in clip-and endoloop-assisted closure methods.However,the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure.The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance,also considering the recent advent of flexible endoscopic suturing.展开更多
AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a ...AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct.The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side,and a total of 7 stitches were put on the posterior wall,followed by the 5 stitches on the anterior wall.Using this technique,twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct.In all cases the amylase activity of the drain were measured.A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading.RESULTS:From March 2007 to July 2008,29 consecutive cases underwent pancreaticojejunostomy using this technique.Pathologic examination results showed pancreatic carcinoma(n=14),intraductal papillary-mucinous neoplasm(n=10),intraductal papillary-mucinous carcinoma(n=1),carcinoma of ampulla of Vater(n=1),carcinoma of extrahepatic bile duct(n=1),metastasis of renal cell carcinoma(n=1),and duodenal carcinoma(n=1).Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure.The mean diameter of main pancreatic duct was 3.4 mm(range 2-7 mm).Three patients were recognized as having an amylase level greater than 3 times the serum amylase level,but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment.None of the cases developed complications such as hemorrhage,abdominal abscess,and pulmonary infection.There was no postoperative mortality.CONCLUSION:Our technique is less complicated than other methods and very secure,providing reliable anastomosis for any size of pancreatic duct.展开更多
Abstract: The Kazakhstanian plate was near the Tarim, Sino-Korean and South China-Southeast Asian plates in the Middle-Late Cambrian and Late Ordovician, and approached the Siberian plate in the other periods of the E...Abstract: The Kazakhstanian plate was near the Tarim, Sino-Korean and South China-Southeast Asian plates in the Middle-Late Cambrian and Late Ordovician, and approached the Siberian plate in the other periods of the Early Palaeozoic. The Ili and Toksun-Yamansu terranes had been split from the Tarim plate before the Middle Devonian and then went close to Angaraland in the late Early Permian. The Beishan area on the northeastern margin of the Tarim plate came close to Angaraland first in the early Early Permian. The suturing age between the Tarim and Kazakhstanian-Siberian plates is generally the same as that between the Turkey-Central Iran-Gangdise and South China-Southeast Asian plates. The suturing event took place in the early Early Permian, while the corresponding tectogeny occurred between the Early and Late Permian.展开更多
BACKGROUND Although endoscopic submucosal dissection(ESD)is becoming more common for early gastric cancer,it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection.Hybrid E...BACKGROUND Although endoscopic submucosal dissection(ESD)is becoming more common for early gastric cancer,it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection.Hybrid ESD using a multifunctional snare(SOUTEN)has been reported to be effective for colorectal lesions,as it can reduce treatment duration.Endoscopic suturing of post-ESD mucosal defects has been reported to reduce the incidence of ESD-related complications.CASE SUMMARY This study reports outpatient hybrid ESD for early gastric cancer using SOUTEN,followed by endoscopic suturing of post-ESD mucosal defects in an 86-year-old man.On referral for ESD,a 10-mm flat,depressed lesion was found on the posterior wall of the gastric antrum,the depth of which was expected to be mucosal.Given his history of delirium,we performed outpatient endoscopic treatment.The procedure used was hybrid ESD using SOUTEN to reduce the duration of treatment and endoscopic suturing of post-ESD mucosal ESD defects to reduce complications.The procedure time was 62 min and the lesion was completely resected based on histopathological examination,with no reported postoperative complications.CONCLUSION This safe and useful procedure may be especially important for outpatient endoscopic treatment.展开更多
This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effectiveness for scar treatment.From June 2017...This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effectiveness for scar treatment.From June 2017 to March 2019,a total of 68 patients with scars were sutured using LBD technique,and recovery was achieved 24 months postoperatively.In all 68 patients,postoperative scars were slightly evident in two cases of cervical scar,one case of leg scar,and one case of chest scar.In addition,the remaining 62 patients were completely satisfied with the outcome.The LBD suturing technique could provide sustained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients.This method is most applicable to incisions with tension.Therefore,it should be more widely used for clinical scar treatment.展开更多
Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of p...Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.展开更多
Two terranes formed since the Late Palaeozoic can be distinguished in southwestern China. One is charac-terized by the Permo-Carboniferous ice-rafted marine gravel-bearing clastic formation and the cold-water faunaof ...Two terranes formed since the Late Palaeozoic can be distinguished in southwestern China. One is charac-terized by the Permo-Carboniferous ice-rafted marine gravel-bearing clastic formation and the cold-water faunaof the Gondwana facies, including the Gangmar Co, Lhasa, Sa' gya, Tengchong and Baoshan terranes and theother is marked by the Upper Palaeozoic of the Yangtze type with the Cathaysian flora and the Pacific-typefusulinids, comprising the Changning-Menglian, Shuangjiang-Lancang, Qamdo and Bayan Har terranes. TheLongmu Co-Shuanghu-Dengqen-North Lancang River-Kejie-Mengding suture zone between the two groups ofterranes is the boundary between Gondwana and Pacifica in southwestern China. On the grounds of thesedimentary formation and successive southwestward migration of the Asian nonmarine Jurassic-Cretaceousendemic bivalves, the ages of the suture and some terranes to the southwest of the suture zone are discussed.The Baoshan terrane and the Nyainrong-Sog terrane in the Lhasa composite terrane were firstly pieced togeth-er with the Asian continent in the early Early Jurassic. The northern Tibet-western Yunnan microplate, in-cluding the Gangmar Co, Lhasa and Tengchong terranes, collided with the Asian continent at the end of theEarly Cretaceous Neocomian.展开更多
Aim: To develop a method for closure of the arthrotomy wound and approximation of the medial periosteum at the level of tibial tuberosity after total knee arthroplasty in severe varus deformity. Method: We describe a ...Aim: To develop a method for closure of the arthrotomy wound and approximation of the medial periosteum at the level of tibial tuberosity after total knee arthroplasty in severe varus deformity. Method: We describe a technique of osteotendinous suturing through the tibial tuberosity for suturing of the medially elevated periosteum. Result: This is an easily reproducible technique which results in very early mobilisation and no additional complications and has several advantages over other methods of closure. Conclusion: The osteotendinous technique can be used for medial arthrotomy closure after correction of severe varus deformities and also after partial patellar tendon avulsions in total knee arthroplasty surgeries.展开更多
AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for ...AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for mitomycin C augmented trabeculectomy.In cases of postoperative high IOP,pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges.By means of this technique,the scleral flap opens up in an ‘‘accordion＇＇ manner,thus preventing flap obstruction and providing adequate aqueous flow.RESULTS：Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma.Mean age of the subjects was 67.42±8.21 y and female/male ratio was 4/4.Mean preoperative IOP was 37±7.48 mm Hg.Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications.The scleral flap closure is performed with three separate sutures;initially,our accordion suture through the center of the flap,and two releasable sutures on both corners.All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture,without any complications.The average traction time was 3.5±0 wk postoperatively.The mean postoperative IOP was 11.37±2.72 mm Hg.No suture related complications were observed.CONCLUSION：This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.展开更多
Minimally invasive surgery(MIS)robots,such as single-arm stapling robots,are key to oral and maxillofacial surgery because they overcome space constraints in the oral cavity and deep throat.However,biodegradable sutur...Minimally invasive surgery(MIS)robots,such as single-arm stapling robots,are key to oral and maxillofacial surgery because they overcome space constraints in the oral cavity and deep throat.However,biodegradable suture staples should be developed for the single-arm stapling robots to avoid a secondary operation.For this aim,a new type of Mg-3Zn-0.2Ca-2Ag biodegradable alloy wire was developed in this study applied as suture staples.Its tensile strength,yield strength,and elongation are 326.1 MPa,314.5 MPa,and 19.6%,respectively.Especially,the alloy wire attains the highest yield strength value reported among all the biodegradable Mg wires,which is mainly attributed to fine grain strengthening and second phase strengthening such as Mg_(2)Zn_(11) nano phase strengthening.Moreover,the corrosion rate of this alloy wire in simulated body fluid(SBF)reaches 26.8 mm/y,the highest value among all the biodegradable Mg alloy wires reported so far,which is mainly from the intensified galvanic corrosion between the Ag17Mg54 phase and the Mg matrix.In vitro studies demonstrate that the alloy wire exhibits good blood compatibility and low cytotoxicity.The cone beam computed tomography(CBCT)data shows that the suture staple made of the Mg alloy wire provides better mechanical support in the early postoperative period.From the single arm robot tests,it confirms that suture staples can close the wound tightly and remain stable over time.This research provides a good material selection for the automated suturing in oral and throat surgery robots.展开更多
BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a th...BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a theoretical physical study to show that this suture receives 50%less tension than conventional sutures,and so a correspondingly greater force must be applied to break it.AIM To determine whether these theoretical levels of resistance were met by the new type of suture.METHODS An observational study was performed to compare three types of sutures,using a device that exerted force on the suture until the breaking point was reached.The tension produced by this traction was measured.The following variables were considered:Tearing stress on entry/exit points,edge separation stress,and suture break stress.The study sample consisted of 30 sutures with simple interrupted stitches(Group 1),30 with continuous stitches(Group 2),and 30 with the“double diabolo”design(Group 3).RESULTS The mean degree of force required to reach the breaking point for each of these variables(tearing,separation,and final breaking)was highest in Group 3(14.56,18.28,and 21.39 kg),followed by Group 1(7.36,10.38,and 12.81 kg)and Group 2(5.77,7.7,and 8.71 kg).These differences were statistically significant(P<0.001)in all cases.CONCLUSION The experimental results show that with the“double diabolo”suture,compared with conventional sutures,greater force must be applied to reach the breaking point(almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture).If these results are confirmed in Phase III(the clinical phase)of our study,we believe the double diabolo technique should be adopted as the standard approach,especially when the suture must withstand significant tension(e.g.,laparotomy closure,thoracotomy closure,diaphragm suture,or hernial orifice closure).展开更多
Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 1...Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.展开更多
Purpose: The purpose of the present study was to determine the effect of peritoneal closure on the formation of abdominal adhesions by verifying their degree of damage on intestinal portions and the omentum with the a...Purpose: The purpose of the present study was to determine the effect of peritoneal closure on the formation of abdominal adhesions by verifying their degree of damage on intestinal portions and the omentum with the abdominal wall. Given the different reports found in the literature concerning peritoneal closure mostly in obstetrics and gynecology, any objective information based on statistically tested results may be of great value in the everyday surgery practice. Material and Method: This is an experimental model on which a laparotomy is performed on the free cavity of the abdominal wall in growing rats. Young Wistar rats (approximately 1 month old) were operated through a long median xipho-umbilical abdominal incision. The animals were divided in 3 groups with fifteen rats each: in Group I, only the peritoneum was left open and all the other layers of the abdominal wall were closed;the rats in Group II had their peritoneums closed with unabsorbable cord (Prolene 4-0, Ethicon?). The abdominal wall of the rats in Group III (control) was only opened up to the musculature. The peritoneum, which remained intact and closed, was carefully prodded with the grip of tweezers to avoid lesions and/or perforations in the peritoneum. Results: There were no deaths nor incisional dehiscence and/or hernias among the animals. Nine animals of Group I presented adhesions (60%), whereas there were adhesions in all the fifteen animals of Group II (100%). In Group III adhesions were found in two animals (13%). The percentage of adhesions in Group II was significantly higher than those observed in Groups I and III (p 0.0001). Adhesions were mostly formed by the abdominal omentum. It was not observed any effect of the procedure on viscera. Conclusion: The experimental model that was suggested is appropriate for the establishment and study of peritoneal adhesions. The rate of adhesions found in the Group II was significantly higher (p 0.0001) than the rate observed in the Group I and Group III, suggesting that peritoneum suture can play a important role in the adhesion processes.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
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
The effectiveness of cranial suture expansion therapy hinges on the timely and adequate regeneration of bone tissue in response to mechanical stimuli.To optimize clinical outcomes and prevent post-expansion relapse,we...The effectiveness of cranial suture expansion therapy hinges on the timely and adequate regeneration of bone tissue in response to mechanical stimuli.To optimize clinical outcomes and prevent post-expansion relapse,we delved into the underlying mechanisms governing bone remodeling during the processes of suture expansion and relapse.Our findings revealed that in vitro stretching bolstered mesenchymal stem cells'antioxidative and osteogenic capacity by orchestrating mitochondrial activities,which governed by force-induced endoplasmic reticulum(ER)stress.Nonetheless,this signal transduction occurred through the activation of protein kinase R-like ER kinase(PERK)at the ER-mitochondria interface,rather than ER-mitochondria calcium flow as previously reported.Subsequently,PERK activation triggered TFEB translocation to the nucleus,thus regulating mitochondrial dynamics transcriptionally.Assessment of the mitochondrial pool during expansion and relapse unveiled a sequential,two-phase regulation governed by the ER stress/p-PERK/TFEB signaling cascade.Initially,PERK activation facilitated TFEB nuclear localization,stimulating mitochondrial biogenesis through PGC1-α,thereby addressing energy demands during the initial phase.Subsequently,TFEB shifted focus towards ensuring adequate mitophagy for mitochondrial quality maintenance during the remodeling process.Premature withdrawal of expanding force disrupted this sequential regulation,leading to compromised mitophagy and the accumulation of dysfunctional mitochondria,culminating in suboptimal bone regeneration and relapse.Notably,pharmacological activation of mitophagy effectively mitigated relapse and attenuated bone loss,while its inhibition impeded anticipated bone growth in remodeling progress.Conclusively,we elucidated the ER stress/p-PERK/TFEB signaling orchestrated sequential mitochondria biogenesis and mitophagy under mechanical stretch,thus ensuring antioxidative capacity and osteogenic potential of cranial suture tissues.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
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Endoscopic suturing had previously been considered an experimental procedure only performed in a few centers and often by surgeons. Now, however, endoscopic suturing has evolved sufficiently to be easily implemented during procedures and is more commonly used by gastroenterologists. We have employed the Apollo Over Stitch suturing device in a variety of ways including closure of perforations, closure of full thickness defects in the gastrointestinal wall created during endoscopic full thickness resection, closure of mucosotomies during peroral endoscopic myotomy, stent fixation, fistula closure, post endoscopic submucosal dissection, endoscopic mucosal resection and Natural Orifice Transluminal Endoscopic Surgery defect closures, post-bariatric surgery gastrojejunal anastomosis revision and primary sleeve gastroplasty.
文摘Exposed endoscopic full-thickness resection(EFTR)without laparoscopic assistance is a minimally invasive natural orifice transluminal endoscopic surgery technique that is emerging as a promising effective and safe alternative to surgery for the treatment of muscularis propria-originating gastric submucosal tumors.To date,various techniques have been used for the closure of the transmural postEFTR defect,mainly consisting in clip-and endoloop-assisted closure methods.However,the recent advent of dedicated tools capable of providing full-thickness defect suture could further improve the efficacy and safety of the exposed EFTR procedure.The aim of our review was to evaluate the efficacy and safety of the different closure methods adopted in gastric-exposed EFTR without laparoscopic assistance,also considering the recent advent of flexible endoscopic suturing.
文摘AIM:To prevent pancreatic leakage after pancreaticoje-junostomy,we designed a new standardized technique that we term the "Pair-Watch suturing technique".METHODS:Before anastomosis,we imagine the faces of a pair of watches on the jejunal hole and pancreatic duct.The first stitch was put between 9 o'clock of the pancreatic side and 3 o'clock of the jejunal side,and a total of 7 stitches were put on the posterior wall,followed by the 5 stitches on the anterior wall.Using this technique,twelve stitches can be sutured on the first layer anastomosis regardless of the caliber of the pancreatic duct.In all cases the amylase activity of the drain were measured.A postoperative pancreatic fistula was diagnosed using postoperative pancreatic fistula grading.RESULTS:From March 2007 to July 2008,29 consecutive cases underwent pancreaticojejunostomy using this technique.Pathologic examination results showed pancreatic carcinoma(n=14),intraductal papillary-mucinous neoplasm(n=10),intraductal papillary-mucinous carcinoma(n=1),carcinoma of ampulla of Vater(n=1),carcinoma of extrahepatic bile duct(n=1),metastasis of renal cell carcinoma(n=1),and duodenal carcinoma(n=1).Pancreaticojejunal anastomoses using this technique were all watertight during the surgical procedure.The mean diameter of main pancreatic duct was 3.4 mm(range 2-7 mm).Three patients were recognized as having an amylase level greater than 3 times the serum amylase level,but all of them were diagnosed as grade A postoperative pancreatic fistula grading and required no treatment.None of the cases developed complications such as hemorrhage,abdominal abscess,and pulmonary infection.There was no postoperative mortality.CONCLUSION:Our technique is less complicated than other methods and very secure,providing reliable anastomosis for any size of pancreatic duct.
文摘Abstract: The Kazakhstanian plate was near the Tarim, Sino-Korean and South China-Southeast Asian plates in the Middle-Late Cambrian and Late Ordovician, and approached the Siberian plate in the other periods of the Early Palaeozoic. The Ili and Toksun-Yamansu terranes had been split from the Tarim plate before the Middle Devonian and then went close to Angaraland in the late Early Permian. The Beishan area on the northeastern margin of the Tarim plate came close to Angaraland first in the early Early Permian. The suturing age between the Tarim and Kazakhstanian-Siberian plates is generally the same as that between the Turkey-Central Iran-Gangdise and South China-Southeast Asian plates. The suturing event took place in the early Early Permian, while the corresponding tectogeny occurred between the Early and Late Permian.
文摘BACKGROUND Although endoscopic submucosal dissection(ESD)is becoming more common for early gastric cancer,it requires more advanced techniques and a longer treatment duration than endoscopic mucosal resection.Hybrid ESD using a multifunctional snare(SOUTEN)has been reported to be effective for colorectal lesions,as it can reduce treatment duration.Endoscopic suturing of post-ESD mucosal defects has been reported to reduce the incidence of ESD-related complications.CASE SUMMARY This study reports outpatient hybrid ESD for early gastric cancer using SOUTEN,followed by endoscopic suturing of post-ESD mucosal defects in an 86-year-old man.On referral for ESD,a 10-mm flat,depressed lesion was found on the posterior wall of the gastric antrum,the depth of which was expected to be mucosal.Given his history of delirium,we performed outpatient endoscopic treatment.The procedure used was hybrid ESD using SOUTEN to reduce the duration of treatment and endoscopic suturing of post-ESD mucosal ESD defects to reduce complications.The procedure time was 62 min and the lesion was completely resected based on histopathological examination,with no reported postoperative complications.CONCLUSION This safe and useful procedure may be especially important for outpatient endoscopic treatment.
文摘This study explores the clinical application of the circular wide and deep(looped,broad,and deep buried,LBD)suture technique for scar resection and examines its clinical effectiveness for scar treatment.From June 2017 to March 2019,a total of 68 patients with scars were sutured using LBD technique,and recovery was achieved 24 months postoperatively.In all 68 patients,postoperative scars were slightly evident in two cases of cervical scar,one case of leg scar,and one case of chest scar.In addition,the remaining 62 patients were completely satisfied with the outcome.The LBD suturing technique could provide sustained and stable tension-reducing effects postoperatively and significantly improve scar formation in patients.This method is most applicable to incisions with tension.Therefore,it should be more widely used for clinical scar treatment.
文摘Keloids are fibroproliferative disorders that can result from cutaneous injuries to the reticular dermis.Recurrence rates as high as 100%have been reported following surgical excision alone.Consequently,a variety of post-surgical techniques have been employed to prevent keloid recurrence,including the use of radiation.Although numerous studies have shown that post-excisional X-rays,electron beams,lasers,and brachytherapy can reduce the rate of keloid recurrence,numerous inconsistencies,including a wide range of definitions for keloid recurrence,render it difficult to compare the outcomes.The treatment of severe keloids in children is much more challenging,and there have been few previous reports.It is generally believed that children with keloids should be treated with nonsurgical treatment such as hormone injections and radiotherapy.For severe keloids,these methods require a long treatment period,and their efficacy is not ideal.Moreover,the side effects of the treatment can affect children’s health.If keloid scars are not effectively treated,they will often seriously affect the physical and mental health of children.The purpose of this review is to discuss case studies of children with severe keloids who were only treated with surgery and their postoperative recovery.In this case,the deep-embedded circular mattress suture technique(LBD,the looped,broad,and deep buried suturing technique)was used in the scar resection.After 18 months of follow-up,the surgical scar was evaluated using the Vancouver Scar Scale(VSS).The scar was stable and did not recur.The child was satisfied.This case shows that it is completely feasible to treat severe keloids with surgery alone,as long as the tension is reduced during the operation to prevent surgical scar hyperplasia.
文摘Two terranes formed since the Late Palaeozoic can be distinguished in southwestern China. One is charac-terized by the Permo-Carboniferous ice-rafted marine gravel-bearing clastic formation and the cold-water faunaof the Gondwana facies, including the Gangmar Co, Lhasa, Sa' gya, Tengchong and Baoshan terranes and theother is marked by the Upper Palaeozoic of the Yangtze type with the Cathaysian flora and the Pacific-typefusulinids, comprising the Changning-Menglian, Shuangjiang-Lancang, Qamdo and Bayan Har terranes. TheLongmu Co-Shuanghu-Dengqen-North Lancang River-Kejie-Mengding suture zone between the two groups ofterranes is the boundary between Gondwana and Pacifica in southwestern China. On the grounds of thesedimentary formation and successive southwestward migration of the Asian nonmarine Jurassic-Cretaceousendemic bivalves, the ages of the suture and some terranes to the southwest of the suture zone are discussed.The Baoshan terrane and the Nyainrong-Sog terrane in the Lhasa composite terrane were firstly pieced togeth-er with the Asian continent in the early Early Jurassic. The northern Tibet-western Yunnan microplate, in-cluding the Gangmar Co, Lhasa and Tengchong terranes, collided with the Asian continent at the end of theEarly Cretaceous Neocomian.
文摘Aim: To develop a method for closure of the arthrotomy wound and approximation of the medial periosteum at the level of tibial tuberosity after total knee arthroplasty in severe varus deformity. Method: We describe a technique of osteotendinous suturing through the tibial tuberosity for suturing of the medially elevated periosteum. Result: This is an easily reproducible technique which results in very early mobilisation and no additional complications and has several advantages over other methods of closure. Conclusion: The osteotendinous technique can be used for medial arthrotomy closure after correction of severe varus deformities and also after partial patellar tendon avulsions in total knee arthroplasty surgeries.
文摘AIM：To present a novel scleral flap suturing technique for filtering glaucoma surgery in order to control high postoperative intraocular pressure（IOP）.METHODS：Description of ‘the accordion suture＇ technique for mitomycin C augmented trabeculectomy.In cases of postoperative high IOP,pulling the loop of the suture helps to lift up the scleral flap by an even pressure on both edges.By means of this technique,the scleral flap opens up in an ‘‘accordion＇＇ manner,thus preventing flap obstruction and providing adequate aqueous flow.RESULTS：Our study group consisted of 8 eyes of 8 patients with neovascular glaucoma.Mean age of the subjects was 67.42±8.21 y and female/male ratio was 4/4.Mean preoperative IOP was 37±7.48 mm Hg.Mitomycin C augmented trabeculectomy was carried out on the subjects without any complications.The scleral flap closure is performed with three separate sutures;initially,our accordion suture through the center of the flap,and two releasable sutures on both corners.All the patients received removal of two side releasable sutures concomitant with pulling the accordion suture,without any complications.The average traction time was 3.5±0 wk postoperatively.The mean postoperative IOP was 11.37±2.72 mm Hg.No suture related complications were observed.CONCLUSION：This technique can be the suture of choice for filtering glaucoma surgery in experienced hands by its easy learning curve for precisely indicated patients.
基金supported by the National Key R&D Program of China(grant number:2020YFB1312801)the National Natural Science Foundation of China(No.51971020,No.52171097)+4 种基金the Opening Research Fund of State Key Laboratory for Advanced Metals and Materials(2021-Z08)the Fundamental Research Funds for the Central Universities(grant number:PKU2022XGK005)the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences(2022-JKCS-24)the Key Scientific Research Project in Shanxi Province(202102050201003)the“Dingxinbeike”Project(G20200001105).
文摘Minimally invasive surgery(MIS)robots,such as single-arm stapling robots,are key to oral and maxillofacial surgery because they overcome space constraints in the oral cavity and deep throat.However,biodegradable suture staples should be developed for the single-arm stapling robots to avoid a secondary operation.For this aim,a new type of Mg-3Zn-0.2Ca-2Ag biodegradable alloy wire was developed in this study applied as suture staples.Its tensile strength,yield strength,and elongation are 326.1 MPa,314.5 MPa,and 19.6%,respectively.Especially,the alloy wire attains the highest yield strength value reported among all the biodegradable Mg wires,which is mainly attributed to fine grain strengthening and second phase strengthening such as Mg_(2)Zn_(11) nano phase strengthening.Moreover,the corrosion rate of this alloy wire in simulated body fluid(SBF)reaches 26.8 mm/y,the highest value among all the biodegradable Mg alloy wires reported so far,which is mainly from the intensified galvanic corrosion between the Ag17Mg54 phase and the Mg matrix.In vitro studies demonstrate that the alloy wire exhibits good blood compatibility and low cytotoxicity.The cone beam computed tomography(CBCT)data shows that the suture staple made of the Mg alloy wire provides better mechanical support in the early postoperative period.From the single arm robot tests,it confirms that suture staples can close the wound tightly and remain stable over time.This research provides a good material selection for the automated suturing in oral and throat surgery robots.
文摘BACKGROUND Sutures have been used to repair wounds since ancient times.However,the basic suture technique has not significantly changed.In Phase I of our project,we proposed a“double diabolo”suture design,using a theoretical physical study to show that this suture receives 50%less tension than conventional sutures,and so a correspondingly greater force must be applied to break it.AIM To determine whether these theoretical levels of resistance were met by the new type of suture.METHODS An observational study was performed to compare three types of sutures,using a device that exerted force on the suture until the breaking point was reached.The tension produced by this traction was measured.The following variables were considered:Tearing stress on entry/exit points,edge separation stress,and suture break stress.The study sample consisted of 30 sutures with simple interrupted stitches(Group 1),30 with continuous stitches(Group 2),and 30 with the“double diabolo”design(Group 3).RESULTS The mean degree of force required to reach the breaking point for each of these variables(tearing,separation,and final breaking)was highest in Group 3(14.56,18.28,and 21.39 kg),followed by Group 1(7.36,10.38,and 12.81 kg)and Group 2(5.77,7.7,and 8.71 kg).These differences were statistically significant(P<0.001)in all cases.CONCLUSION The experimental results show that with the“double diabolo”suture,compared with conventional sutures,greater force must be applied to reach the breaking point(almost twice as much as in the simple interrupted suture and more than double that required for the continuous suture).If these results are confirmed in Phase III(the clinical phase)of our study,we believe the double diabolo technique should be adopted as the standard approach,especially when the suture must withstand significant tension(e.g.,laparotomy closure,thoracotomy closure,diaphragm suture,or hernial orifice closure).
文摘Aims: To describe a technique that uses a transcorneal fixation suture for graft attachment in endothelial keratoplasty in high-risk for graft dislocation eyes. Materials and Methods: Case series included 12 eyes of 12 patients who underwent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) in the presence of high risk for graft dislocation factors. We describe a surgical technique that uses a transcorneal fixation suture to compress the donor graft onto the back surface of the recipient cornea. Outcome measures included intraoperative and postoperative complications, graft attachment and clarity and endothelial cell count at a 12 months follow-up period. Results: No intraoperative complications were noted and 11 grafts remained attached and clear with no suture related complications at a 12-month follow-up period. Partial peripheral graft detachment due to suture related graft folds, accompanied by mild corneal edema was noticed in one patient postoperatively. Reattachment and edema resolution occurred spontaneously after suture removal. The mean endothelial cell loss was 38.21% at 12 months. Conclusions: Temporary transcorneal fixation suture can be helpful in preventing graft detachment in eyes with high risk for graft dislocation.
基金support of a PIBIC-CNPq scholarship,N.122.775/2010-4sponsored with a scholarship by PIBIC-CNPq(122.775/2010-4).
文摘Purpose: The purpose of the present study was to determine the effect of peritoneal closure on the formation of abdominal adhesions by verifying their degree of damage on intestinal portions and the omentum with the abdominal wall. Given the different reports found in the literature concerning peritoneal closure mostly in obstetrics and gynecology, any objective information based on statistically tested results may be of great value in the everyday surgery practice. Material and Method: This is an experimental model on which a laparotomy is performed on the free cavity of the abdominal wall in growing rats. Young Wistar rats (approximately 1 month old) were operated through a long median xipho-umbilical abdominal incision. The animals were divided in 3 groups with fifteen rats each: in Group I, only the peritoneum was left open and all the other layers of the abdominal wall were closed;the rats in Group II had their peritoneums closed with unabsorbable cord (Prolene 4-0, Ethicon?). The abdominal wall of the rats in Group III (control) was only opened up to the musculature. The peritoneum, which remained intact and closed, was carefully prodded with the grip of tweezers to avoid lesions and/or perforations in the peritoneum. Results: There were no deaths nor incisional dehiscence and/or hernias among the animals. Nine animals of Group I presented adhesions (60%), whereas there were adhesions in all the fifteen animals of Group II (100%). In Group III adhesions were found in two animals (13%). The percentage of adhesions in Group II was significantly higher than those observed in Groups I and III (p 0.0001). Adhesions were mostly formed by the abdominal omentum. It was not observed any effect of the procedure on viscera. Conclusion: The experimental model that was suggested is appropriate for the establishment and study of peritoneal adhesions. The rate of adhesions found in the Group II was significantly higher (p 0.0001) than the rate observed in the Group I and Group III, suggesting that peritoneum suture can play a important role in the adhesion processes.
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.
基金supported by National Natural Science Foundation of China(No.82370988,32271416,81870743,82170934)Sichuan Province Science and Technology Support Program(2024YFHZ0043)。
文摘The effectiveness of cranial suture expansion therapy hinges on the timely and adequate regeneration of bone tissue in response to mechanical stimuli.To optimize clinical outcomes and prevent post-expansion relapse,we delved into the underlying mechanisms governing bone remodeling during the processes of suture expansion and relapse.Our findings revealed that in vitro stretching bolstered mesenchymal stem cells'antioxidative and osteogenic capacity by orchestrating mitochondrial activities,which governed by force-induced endoplasmic reticulum(ER)stress.Nonetheless,this signal transduction occurred through the activation of protein kinase R-like ER kinase(PERK)at the ER-mitochondria interface,rather than ER-mitochondria calcium flow as previously reported.Subsequently,PERK activation triggered TFEB translocation to the nucleus,thus regulating mitochondrial dynamics transcriptionally.Assessment of the mitochondrial pool during expansion and relapse unveiled a sequential,two-phase regulation governed by the ER stress/p-PERK/TFEB signaling cascade.Initially,PERK activation facilitated TFEB nuclear localization,stimulating mitochondrial biogenesis through PGC1-α,thereby addressing energy demands during the initial phase.Subsequently,TFEB shifted focus towards ensuring adequate mitophagy for mitochondrial quality maintenance during the remodeling process.Premature withdrawal of expanding force disrupted this sequential regulation,leading to compromised mitophagy and the accumulation of dysfunctional mitochondria,culminating in suboptimal bone regeneration and relapse.Notably,pharmacological activation of mitophagy effectively mitigated relapse and attenuated bone loss,while its inhibition impeded anticipated bone growth in remodeling progress.Conclusively,we elucidated the ER stress/p-PERK/TFEB signaling orchestrated sequential mitochondria biogenesis and mitophagy under mechanical stretch,thus ensuring antioxidative capacity and osteogenic potential of cranial suture tissues.
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.
