Effect of different head position during tracheal intubation on postoperative sore throat: a randomized clinical trial

INTRODUCTION

Postoperative sore throat is the most frequently complaint after tracheal intubation. We aimed to determine whether changing patients' head position during intubation reduces the incidence of postoperative sore throat.

METHODS

We randomized 130 patients receiving oral tracheal intubation into one of the two groups: the sniffing position group and elevation position group. Patients in the sniffing position group maintained sniffing position consistently during intubation, while those in the elevation position group transitioned from the sniffing position to the elevation position during tube advancement to the trachea. The primary outcome was incidence of airway trauma and postoperative sore throat (none/mild/moderate/severe) 1 h after surgery. The secondary outcomes were the incidence of postoperative sore throat at 6 h,12 h and 24 h, and hoarseness at 1 h, 6 h,12 h and 24 h postoperatively.

RESULTS

One hundred twenty-eight patients completed our trial. There were no differences in the baseline characteristics of the patients between the sniffing position and elevation position group [51 (14.8) vs 53 (15.5) for age, 25/39 vs 26/38 for sex (male/female)]. No difference in basic airway condition was observed. Transitioning patient's head from sniffing to elevation position during tube advancement to tracheal resulted in a significantly lower incidence of airway trauma [10/64 vs 23/64, risk ratio (95% CI): 0.76 (0.61-0.94), p = 0.009], postoperative sore throat and hoarseness compared with maintaining the sniffing position at 1 h [10/64 vs 30/64, risk ratio (95% CI): 0.63 (0.49-0.81), p < 0.001 for sore throat; 22/64 vs 34/64, risk ratio (95% CI): 0.71 (0.52-0.98), p = 0.044 for hoarseness] and 6 h [4/64 vs 17/64, risk ratio (95% CI): 0.78 (0.67-0.92), p = 0.006 for sore throat; 12/64 vs 27/64, risk ratio (95% CI): 0.71 (0.56-0.91), p = 0.002 for hoarseness]. There were no significant differences in postoperative sore throat and hoarseness at 12 and 24 h between the two groups.

CONCLUSIONS

Transitioning patients' head position from the sniffing position to a head elevation position during tube advancement into tracheal could significantly reduce the incidence of airway trauma, postoperative sore throat and hoarseness.

TRIAL REGISTRATION NUMBER

ChiCTR2300073198.

The immune-reinforcements of Lenvatinib plus anti-PD-1 and their rationale to unite with TACE for unresectable hepatocellular carcinoma treatment

BACKGROUND

Despite encouraging clinical benefits have gained by anti-PD-1 and Lenvatinib combination, in-depth characterizations about the mechanisms of action remain poorly characterized. Furthermore, although the combination of systemic anti-PD-1 or Lenvatinib treatment and locoregional transcatheter arterial chemoembolization (TACE) is widely carried out to treat unresectable HCC in clinical, the efficacies of different combination regimens are uncertain due to limited researches.

METHODS

We firstly generated murine HCC models to validate the enhanced anti-tumor effects of anti-PD-1 and Lenvatinib combination therapy. Then single cell mass cytometry (CyTOF) was employed to phenotypically reveal their mechanisms of action. After that, we further compared the effectiveness of TACE plus Lenvatinib (i.e., TACE-Len) dual therapy with TACE, Lenvatinib plus anti-PD-1 (i.e., TACE-Len-PD-1) triple therapy as conversion therapy for unresectable HCC.

RESULTS

Lenvatinib and anti-PD-1 combination could generate activated immune profiles not only by increasing systemic CD4+, CD8+T cells and B cells proportions, but also by weakening the immune-tolerance functions derived from both immunosuppressive cells (i.e., MDSCs) and co-inhibitory mediators (i.e., PD-L1 and LAG-3). Meanwhile, our study also suggested that TACE-Len-PD-1 triple therapy could achieve better clinical responses with powerful immune profiles for unresectable HCC compared to TACE-Len dual therapy.

CONCLUSIONS

Our study provided a delicate immune landscape of anti-PD-1and Lenvatinib combination, and we also offered scientific evidences that TACE-Len-PD-1 triple therapy could fulfill better clinical benefits than TACE-Len dual therapy, which is anticipated to provide objective and effective evidences for clinical use.

Recent advancements in magnetic starch-based composites for biomedical applications: A review

The increasing demand for biomedical materials to address various diseases has highlighted the need for advanced biocompatible materials with improved biofunctionality for smart diagnostics and clinical therapies. Starch, a natural polymer, is an ideal starting material for the development of multifunctional biomedical materials due to its biocompatibility, low toxicity, and biodegradability. However, native starch lacks certain properties, particularly magnetic properties. By strategically modifying the structure of starch or its derivatives and incorporating different types of magnetic nanoparticles (MNPs), magnetic starch-based composites (MSBCs) can be developed. These composites take the advantages of both the magnetic materials and natural polysaccharides, enhancing the mechanical strength of starch and imparting additional properties, such as magneto-thermal effects, targeting ability, stimulus-responsive drug delivery, and easy separation. As a result, MSBCs have widespread applications in fields such as wound dressing and magneto-thermal therapy. This review highlights the types of MSBCs, their synthesis methods, and their current applications in biomedicine. Additionally, this review describes the major challenges faced by MSBCs in biomedical applications and provides an outlook on their potential for further development. This review aims to improve the understanding of magnetic starches and optimize their synthetic strategies, positioning MSBCs as promising platforms for biomedical applications.

Adult ileo cecal intussusception as a manifestation of colon carcinoma: A case report

BACKGROUND

Intussusception is the invagination of a segment of the bowel into an adjacent segment. It is the most common cause of intestinal obstruction in children, but in adults, it is rare, accounting for 1% of all intestinal obstructions and 5% of all intussusceptions, with malignancy being the most common cause. In the past, it was typically diagnosed intraoperatively. However, with the availability of computed tomography for abdominal imaging, recognizing the condition's signs has become crucial. Surgical intervention is essential for managing neoplastic cases and their complications.

CASE SUMMARY

A 45-year-old female presented with severe abdominal pain encompassing her entire abdomen, abdominal distension, vomiting, and persistent constipation. Over the past two months, she has also experienced considerable weight loss. After an initial history review, examination, and imaging investigations, the patient was diagnosed with ileo cecal intussusception resulting from a colo rectal mass located in the cecum and ascending colon. This condition was surgically managed through an extended right hemi colectomy.

CONCLUSION

Intussusception is uncommon in adults, but it should be considered in patients with intestinal obstruction. Surgical intervention is essential.

Impact of a prophylactic mesh on the biomechanics of abdominal wall closure: an animal study

BACKGROUND

The use of a prophylactic prosthetic mesh (PPM) to reinforce a midline laparotomy suture closure improves the clinical outcomes, in comparison with primary suture technique. However, understanding how a PPM impacts the biomechanics of the repair is crucial for gaining a deeper comprehension and ultimately improving clinical outcome by decreasing incisional hernia (IH) rates post midline laparotomy. Based on a porcine IH model, this study aimed to assess the biomechanical characteristics of the abdominal wall (AW) midline over time post midline laparotomy, considering sthree repair modalities: no repair, primary suture and onlay mesh reinforcement coupled with suture.

METHODS

31 pigs were enrolled in the study and the repair was characterized using CT-scans based on the distance between the right and left Rectus Abdominis Muscle (RAM). The AW of each animal was explanted at 48 h, 4 and 12 weeks postoperatively and a Stereo Digital Image Correlation (s-DIC)-based method was used to assess the response of the repaired AW (e.g., strain, compliance) when subjected to an inflation test mimicking an increase in intra-abdominal pressure (IAP). Intact AW were included in the study and served as controls.

RESULTS

AWs repaired with a primary suture exhibited a higher RAM distance compared to healthy animals, along with an increased compliance of the repair along the transverse direction over time. AWs repaired with primary suture and reinforced with a PPM exhibited a biomechanical response similar to that of healthy animals in terms of repair strain and compliance.

CONCLUSION

The use of a PPM to reinforce suture was found to better restore the biomechanical properties to the midline of the AW post midline incision. Further investigations are needed to correlate the findings of this study with clinical outcomes, especially long-term recurrence rates.

Unusual foreign body in the buccal mucosa: A case report

BACKGROUND

Intraoral honeybee stings are very rare. Stings by these insects occur 25% of the time in the head and neck region. In addition, a stinger intraorally can lead to persistent irritation, inflammation, and secondary infections if not promptly excised.

CASE SUMMARY

We report the case of a 52-year-old female patient who was stung in her mouth by a honeybee, causing a local irritation. The patient presented with a one-month history of pain, swelling, and redness in the left buccal mucosa. Inadvertently retained, the stinger was discovered during a clinical evaluation following initial treatment for facial swelling and erythema. After the stinger was removed, the patient’s symptoms resolved without complications.

CONCLUSION

This case emphasizes the importance of thorough examination and prompt management of insect stings to prevent prolonged discomfort and potential complications.

Allergic-related skin diseases: Global disease burden from 1990 to 2021 and future trends

Background

Allergic-related skin diseases, including atopic dermatitis (AD), urticaria, and contact dermatitis (CD), are significant global public health challenges. Currently, there is a lack of systematic analysis of allergic-related skin diseases globally.

Methods

This study aimed to quantify the global burden of AD, CD, and urticaria and evaluate their global epidemiology patterns. The Global Burden of Diseases (GBD) database was used to assess incidence, prevalence, and disability-adjusted life years (DALYs) for these allergic-related skin diseases. Additionally, the Bayesian Age-Period-Cohort (BAPC) model was employed to predict disease burden for the next 15 years.

Results

From 1990 to 2021, cases of AD, CD, and urticaria rose steadily. In 2021, AD prevalence reached 129 million, a 20.02% increase from 1990. However, average annual percentage change (AAPC) values for the age-standardized prevalence rate (ASPR) of AD declined constantly (AAPC = -0.28). CD had the highest incidence, with 253 million new cases in 2021, though AAPC for ASPR of CD showed minimal changes. AD and urticaria peaked in early life, while CD peaked at ages 75-79. Moreover, AD had the strongest positive correlation with the Socio-demographic Index (SDI) (p = 2.2e-16, ρ = 0.626). AD, CD, and urticaria show the highest age-standardized rate in high, middle, and low-middle SDI regions, respectively, with all 3 conditions declining in high SDI. Health inequality analysis showed AD's burden is now more evenly distributed across SDI groups, while the global burden gap for urticaria and CD change limitedly.

Conclusion

Although the global disease burden of allergic-related skin diseases continues to rise, the overall age-standardized rates of AD have steadily declined and are projected to decrease further. In contrast, CD and urticaria require increased attention.

Comprehensive comparison of technical performance, surgical outcomes, and oncologic prognosis between remnant gastric cancer and primary upper-third gastric cancer in the era of minimally invasive surgery: A pooled analysis of 3 prospective trials

BACKGROUND AND OBJECTIVE

To compare the technical performances and short- and long-term outcomes of laparoscopic total gastrectomy for remnant gastric cancer and primary upper gastric cancer.

METHODS

This prospective study (FUGES-004 study) enrolled 50 remnant gastric cancer patients who underwent laparoscopic total gastrectomy at Fujian Medical University Union Hospital between June 2016 and June 2020 (ClinicalTrials.gov identifier: NCT02792881). Propensity score matching (1:2) was used to select upper gastric cancer patients who underwent laparoscopic total gastrectomy in the FUGES-001 and FUGES-002 studies. Technical performance was assessed using the General Error Reporting Tool, Objective Structured Assessment of Technical Skills (OSATS), and Intraoperative Complication Classification.

RESULTS

After matching, 46 remnant gastric cancer and 92 upper gastric cancer patients were included in the final analysis. Abdominal adhesions in the epigastrium, central abdomen, and bowel-to-bowel regions were more severe in the remnant gastric cancer group (P < .001). The remnant gastric cancer group had more technical errors and intraoperative adverse events (especially grade I bleeding) during surgery (P < .05). However, the Objective Structured Assessment of Technical Skills scores were comparable between the remnant gastric cancer and upper gastric cancer groups (30.8 vs 31.0, P = .799). Although the severe postoperative complication rates were similar between the 2 groups (P = .333), the postoperative complication rate was significantly higher in the remnant gastric cancer group (28.3% vs 7.6%, P = .001). Additionally, the long-term oncologic outcomes (including 3-year disease-free survival, overall survival, and recurrence pattern) were comparable between the remnant gastric cancer and upper gastric cancer groups (log-rank P > .05).

CONCLUSIONS

Although the long-term oncologic outcomes were comparable between the groups, the remnant gastric cancer group had more intraoperative errors and adverse events and higher postoperative complication rates than the upper gastric cancer group. For complex remnant gastric cancer cases, laparoscopic total gastrectomy may serve as an effective therapeutic option. However, experienced surgeons at high-volume centers should exercise caution when performing laparoscopic total gastrectomy and implement more rigorous perioperative management strategies.

Comparative analysis of gastrectomy vs endoscopic therapy for T1b gastric cancer: long-term outcomes from a population-based propensity score matched cohort study

BACKGROUND

Endoscopic therapy is emerging as a viable treatment for early-stage gastric cancer, but its long-term survival benefits for T1b gastric cancer remain unclear. This study aimed to investigate the efficacy of endoscopic therapy vs gastrectomy in T1bN0M0 gastric cancer.

METHODS

Patients with T1bN0M0 gastric cancer were identified, and demographic characteristics were compared between those undergoing endoscopic therapy and gastrectomy. Kaplan-Meier analysis and Cox regression models were used to assess clinical outcomes and prognostic factors. Propensity score matching (PSM) was used to compare overall survival (OS) and disease-specific survival (DSS) between the 2 groups, with subgroup analysis identifying the beneficiary population.

RESULTS

Among 1519 patients with T1bN0M0 gastric cancer, endoscopic therapy utilization increased notably from 3.8% in 2010 to 19.0% in 2019. Overall, 159 underwent endoscopic therapy, whereas 1360 underwent gastrectomy. Patients opting for endoscopic therapy tended to be older (61%), were White (76.1%), had lesions in the cardia/fundus region (67.9%), had lower pathologic grades (74.8%), and had tumors measuring 2 cm or less (83%). Although patients undergoing gastrectomy were associated with longer OS than those undergoing endoscopic therapy, no significant difference was observed in DSS (P =.381). After PSM, DSS remained similar between the 2 groups (P =.703), with consistent results in subgroup analysis, except for lesions located in the middle of the stomach.

CONCLUSION

The utilization of endoscopic therapy for T1bN0M0 gastric cancer is on the rise, with comparable DSS outcomes with gastrectomy. This approach may offer a safe alternative for select high-risk surgical candidates and patients with low-risk cancers, aiming to reduce the need for unnecessary interventions.

Remission of type 2 diabetes one year after esophagectomy with gastric conduit reconstruction: A prospective cohort study

BACKGROUND

Type 2 diabetes (T2D) remission has been widely reported after bariatric surgery, but rarely reported after esophagectomy.

AIM

To explore the incidence and predictors of T2D remission 1 year after esophagectomy with gastric conduit reconstruction.

METHODS

In this prospective study, consecutive patients from 2 tertiary hospitals who had esophageal cancer and T2D and underwent esophagectomy with gastric conduit reconstruction were studied preoperatively and at 3 months, 6 months, and 12 months postoperatively. Remission of T2D is defined as glycated hemoglobin (HbA1c) values below 6.5% without glucose-lowering medications. Related clinical information were recorded and analyzed.

RESULTS

A total of 187 patients were included. Of these patients, 24 (12.8%) discontinued antidiabetic drugs and maintained HbA1c values below 6.5% 1 year after surgery. At baseline, patients with T2D remission were younger (63.0 ± 5.2 years vs 67.0 ± 6.1 years, P = 0.002), had higher body mass index values (body weight 68.6 ± 11.1 kg vs 61.2 ± 9.3 kg, P = 0.001; body mass index 25.5 ± 2.4 kg/m²vs 23.8 ± 3 kg/m², P = 0.011), shorter duration of T2D (4.9 ± 3.9 years vs 7.1 ± 3.7 years, P = 0.008) and higher preoperative HbA1c (8.5% ± 1.7% vs 7.7% ± 1.3%, P = 0.042). Multivariate logistic regression analysis showed that younger age and greater body weight were independent predictors of T2D remission after surgery.

CONCLUSION

This study reveals a significant incidence of T2D remission after esophagectomy with gastric conduit reconstruction, and remission is more frequent in patients with younger age and greater body weight.

Artificial intelligence and machine learning-driven design of self-healing biomedical composites

INTRODUCTION

The integration of Artificial Intelligence (AI) and Machine Learning (ML) has significantly enhanced the development of self-healing composites, especially in biomedical fields including tissue engineering, medication delivery, and implantable devices. These materials are designed to self-repair damage, enhancing durability, patient safety, and operational reliability. Considering that traditional materials may deteriorate under physiological conditions, intelligent self-healing composites augmented by AI/ML offer a revolutionary alternative.

AREAS COVERED

This work examines current progress in AI- and ML-facilitated design, selection, and optimization of self-healing composites for biomedical applications. Attention is directed toward the application of supervised and unsupervised learning methodologies - such as Bayesian optimization, neural networks, and support vector machines to improve healing efficiency by 30-50%, decrease formulation time by approximately 40%, and achieve predictive accuracies of over 90% regarding failure or healing behavior in specific studies.

EXPERT OPINION

The research examines ethical aspects, encompassing data protection, algorithmic transparency, and adherence to regulatory standards such as FDA and ISO 10,993. The paper emphasizes the transformational potential of AI/ML in facilitating intelligent, responsive, and patient-specific composite designs, while also addressing possible issues such as dataset bias and algorithmic opacity. The results indicate that AI-enhanced self-healing systems will be pivotal in the future of customized medicine.

Identification and validation of serum amino acids as diagnostic biomarkers for diabetic peripheral neuropathy

BACKGROUND

Diabetic peripheral neuropathy (DPN) is the most prevalent complication of type 2 diabetes mellitus (T2DM). Due to a lack of specific biomarkers, the early diagnosis of this disorder is limited.

AIM

To identify and validate serum amino acids that could discriminate T2DM patients with DPN from those without DPN.

METHODS

T2DM patients with DPN, T2DM patients without DPN, and healthy controls were recruited for this study. The participants comprised two nonoverlapping cohorts: A training cohort (DPN = 84 participants, T2DM = 82 participants, normal = 50 participants) and a validation cohort (DPN = 112 participants, T2DM = 93 participants, normal = 58 participants). A prediction model of the ability of serum amino acids to distinguish DPN from T2DM was established using a logistic regression model, and area under the curve (AUC) analysis was used to evaluate the diagnostic ability of the model. In addition, the serum amino acid levels of 13 DPN patients were also detected before treatment and after 3 months of treatment.

RESULTS

A clinical detection method for the diagnosis of DPN based on a biomarker panel of three serum amino acids and diabetes duration was developed. The diagnostic model demonstrated AUC values of 0.805 (95%CI: 0.739-0.871) and 0.810 (95%CI: 0.750-0.870) in the training and verification cohorts, respectively. In the identification of T2DM patients and normal controls, the AUC values were 0.891 (95%CI: 0.836-0.945) and 0.883 (95%CI: 0.832-0.934) in the training and validation cohorts, respectively. Arginine and tyrosine levels were increased after treatment, whereas aspartic acid levels were decreased after treatment.

CONCLUSION

This study successfully identified and validated the metabolomic significance of arginine, tyrosine, and glutamic acid as potential biomarkers for diagnosing DPN. These findings are particularly valuable, as they establish a foundational step toward developing the first routine laboratory test for DPN. Moreover, the diagnostic model that was constructed in this study effectively distinguishes DPN patients from those with T2DM without neuropathy, thereby potentially facilitating early diagnosis and intervention.

Assessing the prognosis mortality in patients with cutaneous verrucous carcinoma using Lasso-cox regression model: a retrospective study

Elucidating risk factors and prognostic indicators for cutaneous verrucous carcinoma (CVC) is crucial for rapid medical intervention. This study examined CVC incidence risk and prognostic factors, emphasizing sex disparities. Utilizing SEER Database records, we analyzed patients diagnosed with primary CVC from 2004 to 2015. Multivariate logistic regression identified risk factors for the incidence model, while multivariate Cox regression developed the mortality prognosis model. Lasso regression and lasso Cox models determined key factors for respective models. Restricted cubic spline (RCS) models measured age-related risk associated with CVC presence and survival. The study included 1,125 CVC patients (668 males, 59.4%; 457 females, 40.6%) at the time of diagnosis. Lasso regression identified independent risk factors including age, sex, race, marital status, AJCC Stage, Combined Summary Stage, radiation, surgery, tumor size, chemotherapy, and regional lymph node involvement. The Age, sex, marital status, AJCC stage, combined summary stage, and surgery were independently associated with overall survival (OS) and statistically significant. Kaplan-Meier analysis revealed significantly shorter OS in female CVC patients compared to males (P < 0.05). The RCS model demonstrated a U-shaped pattern, indicating a significant nonlinear relationship between age and CVC incidence. The current study uncovered sex-related variations in incident risk and mortality prognostic factors, prediction of complications among CVC patients, offering valued insights for healthcare professionals in clinical assessments and interventions.

Differential expression of capecitabine-related metabolic enzymes in hepatocellular carcinoma and its clinical value: a retrospective cohort study

BACKGROUND

Capecitabine (CAP) is widely used in cancer treatment for its oral convenience and tumor targeting. However, its effectiveness in hepatocellular carcinoma (HCC) is suboptimal, possibly due to metabolic enzyme expression differences. This study aims to analyze these enzymes' expression differences and explore their correlation with clinical pathological factors, to inform personalized CAP treatment.

METHODS

This retrospective study used Immunohistochemistry (IHC) to analyze tumor and non-tumorous samples from HCC patients for CAP metabolic enzyme expression. PRM protein quantification was performed on 10% of samples to validate IHC results. Clinical and pathological data were collected, and multivariable linear regression was used to identify independent risk factors.

RESULTS

This study analyzed 60 HCC patients with hepatitis B and cirrhosis, revealing significant differences in CAP metabolic enzymes expression between tumor and non-tumorous tissues, with greater individual differences in tumors. Cytidine deaminase (CDA) levels in tumors decreased as liver function deteriorated (P = 0.023), while thymidine phosphorylase (TP) levels increased (P < 0.001). Tumor tissue had lower levels of carboxylesterase 1-2 (CES1-2), CDA, and dihydropyrimidine dehydrogenase (DPYD) but higher TP levels than non-tumorous and normal liver tissues. In tumor tissue, CDA (CV: 118.70%, SD: 3.897) and CES2 (CV: 94.90%, SD: 2.910) showed the greatest individual variability. Multivariable linear regression identified independent risk factors affecting CAP metabolic enzyme expression.

CONCLUSION

This study has found significant variability in the expression of CAP metabolic enzymes across individuals and tissues. Developing a treatment flowchart based on metabolic enzymes provides a foundation for personalized HCC treatment and enhances the effectiveness of CAP therapy.

CLINICAL TRIAL NUMBER

Not applicable.

Functional Amyloid Phenol-Soluble Modulin α1-Targeting Photothermal Nanoplatform for Effective Elimination of Biofilm-Associated Infections

Biofilm-associated infections (BAIs) often lead to chronic infections and implant failure and are challenging to treat due to their resilience and complex structure, especially the extracellular polymeric substance (EPS). Phenol-soluble modulin α1 (PSMα1), a key biofilm-forming protein in methicillin-resistant Staphylococcus aureus (MRSA), can assemble into amyloid fibrils through self/cross-fibrillation and thus function as a scaffold that contributes to the integrity of the biofilm matrix. Here, using a phage display library-based biopanning strategy, we identified KG7, a PSMα1-targeting peptide that binds specifically to the fibrillation-dependent sequence in PSMα1, significantly inhibiting the amyloid fibrillation of PSMα1 and the subsequent biofilm formation in vitro. Further, the KG7 peptide was conjugated to the surface of polydopamine (PDA)-modified hollow copper sulfide (CuS) nanoparticles to develop an EPS-targeting photothermal nanoplatform (CuS@PPDA). This nanoplatform achieved a 94.7% biofilm inhibition rate and cleared 56.8% of mature biofilms through the regulation of PSMα1 fibrillation and the destruction of extracellular DNA, thanks to the synergistic effect of KG7-mediated inhibition and photothermal capability. Additionally, Cu2+ release from the nanoplatform regulated macrophage polarization toward the M2 phenotype. In vivo studies also demonstrated that this nanoplatform significantly accelerated diabetic wound healing and prevented biofilm formation on implants, along with excellent antibacterial performance and tissue regeneration efficiency. This work introduces a proof-of-concept of photothermal nanoplatform targeting biofilm-scaffolding amyloid PSMα1, offering a promising treatment for BAIs.

Postoperative outcome and clinical management of tumor-induced osteomalacia: a single-center retrospective cohort study on 117 patients

We reported a single-center retrospective cohort study on 117 patients of Tumor-induced osteomalacia (TIO) to summarize our experience with TIO over the past decade. The clinical characteristics, diagnosis, treatment and postoperative outcomes were analyzed. Together, our data demonstrate the characteristics and prognosis of TIO and unveil a possible TIO management process.

INTRODUCTION

TIO is a rare paraneoplastic syndrome that ultimately results in debilitating musculoskeletal deficits and regressive activity obstacles due to hypophosphatemia. The diagnosis and treatment of TIO are challenging owing to nonspecific symptoms, occult tumors and the lack of awareness. We aimed to summarize our experience with TIO over the past decade and to optimize its clinical management.

METHODS

A retrospective analysis was conducted of all patients with TIO admitted to our department and underwent surgical treatment at our hospital between 2012 and 2023. Clinical characteristics and postoperative outcomes were evaluated.

RESULTS

A total of 117 patients with typical clinical characteristics were enrolled, manifesting diffuse bone pain, decreased serum phosphate and elevated serum intact fibroblast growth factor-23 (iFGF23). All the patients were managed using a stepwise pathway detailing diagnosis, identification of the causative tumors, operations and postoperative surveillance. The causative tumors were equally located in bone and soft tissues, and the main sites were the lower extremities and pelvis (63.2%). 117 cases were caused by phosphaturic mesenchymal tumors (PMTs), which were usually small and benign, with a median volume of 1.45cm3 (IQR 0.70-4.17 cm3) and low Ki67 labeling indices (< 10%, 91.7%). After surgery, the serum P became normal within 7 days in 82.7% of the cured patients; serum iFGF23 decreased rapidly in one day and then gradually increased to normal with other laboratory indices and bone mineral density. The median follow-up period was 12 months (range, 1-144), during which 19 patients remained uncured. Among them, 5 patients experienced local recurrence and 2 suffered distant metastases. Younger age, bone-derived tumors and malignant tumors were risk factors for adverse outcomes. Tumors located in the femoral head, acetabulum, and spine showed a higher risk of obstinacy among bone-derived tumors.

CONCLUSION

TIO patients were able to benefit from the management including early recognition and diagnosis of the disease, identification and complete removal of the causative tumors, followed by regular postoperative surveillance. Of particular concern were patients with bone-derived tumors, who had high non-remission and recurrence rates.

CLINICAL TRIAL REGISTRATION

This study was registered with CHICTR.ORG.CN (ChiCTR2100042796).

Saving exposed titanium mesh cranioplasty using adipocutaneous anterolateral thigh flap: A case series

Introduction

Scalp thinning and soft tissue atrophy are significant risk factors for prosthetic material exposure after cranioplasty surgery. Reconstruction of the forehead and scalp to ensure functional coverage and aesthetics continues to be challenging.

Patients and Methods

This prospective study assessed 15 patients with titanium mesh material exposure, scalp thinning, and soft tissue atrophy following cranioplasty from 2020 to 2023 to identify contributory factors. All patients underwent reconstruction with free adipocutaneous anterolateral thigh flap to cover skin defects and fill soft tissue. The results were evaluated based on flap survival, coverage, and symmetry after surgery.

Results

The average age in the study was 40.46 (range 11-68) years, and the male/female ratio was 9/6. From 2020 to 2023, 15 free adipocutaneous anterolateral thigh flaps were used for reconstruction. Complete flap survival was achieved in 93.3 % (14/15) patients with all titanium mesh implants retained. Symmetry and soft tissue hypoplasia correction was achieved in all 15 cases.

Conclusion

Adipocutaneous anterior lateral thigh (ALT) flap is a versatile flap to treat complications following cranioplasty with titanium mesh. The ALT flap provides extensive coverage, reduce the risk of recurrent infections, and create an implant for soft tissue atrophy or skin thinning to restore the scalp's aesthetics.

Optimizing pancreatic enucleation for benign tumors: the role of pre-placed pancreatic duct stents-a retrospective cohort study

OBJECTIVE

To investigate the effectiveness of pre-placed pancreatic duct stents on improving outcomes of pancreatic enucleation for benign tumors, a procedure often discouraged by postoperative complications, such as pancreatic fistulae.

METHODS

This single-center retrospective cohort study analyzed 148 patients with benign tumors located in the head, neck, and body of the pancreas between February 2021 and February 2024. Thirty-four patients received stent placement by endoscopic retrograde cholangiopancreatography 1-2 days before surgery, while 114 did not. Propensity score matching resulted in two groups: stent (n = 30) and non-stent (n = 60). Outcomes compared included enucleation success rate, incidence of pancreatic fistulae, hospital stay, procedural costs, pancreatic function deficiency, and quality of life.

RESULTS

Pre-placement of stents significantly increased enucleation success rate (86.7% vs. 28.3%, p = 1.763 × 10-7), facilitated more laparoscopic surgeries (86.7% vs. 41.7%, p = 4.9 × 10-5), and shortened hospital stays (median 7.5 days vs. 11 days, p = 0.001). The stent group also showed a lower incidence of pancreatic exocrine dysfunction (10.3% vs. 35.7%, p = 0.016) and higher quality of life scores (91.2 ± 5.8 vs. 85.5 ± 13.6, p = 0.019). No significant differences were observed in postoperative complications or overall costs. Additionally, the distance between tumor and main pancreatic duct was shorter in the stent group (4.2 ± 2.2 mm vs. 6.2 ± 2.5 mm, p = 0.008).

CONCLUSION

Pre-placement of pancreatic duct stents significantly enhances enucleation success rate, reduces hospital stays, preserves pancreatic function, and improves quality of life. These findings advocate the use of pre-placed stents in enucleation procedures. Further prospective studies are warranted to validate these outcomes.

Significant in-Vitro and in-Vivo Antimicrobial and Antibiofilm Activity of Colloidal Silver Nanoparticles (cAgNPs) in Chronic Diabetic Foot Ulcers

Infection is a foremost challenge in the cases of wound care, especially in cases of chronic wounds. The present study was conducted to determine the antimicrobial and antibiofilm activity of the colloidal silver nanoparticles (cAgNPs) on Gram positive organisms and to evaluate the in-vivo response of cAgNPs on patients of chronic diabetic foot ulcers (DFUs). cAgNPs were tested against selected Gram-positive organisms like methicillin-sensitive and resistant Staphylococcus aureus (MSSA, MRSA), Enterococcus faecalis and vancomycin resistant enterococci (VRE) using microbroth dilution assay to estimate minimum inhibitory/bactericidal concentration (MIC/MBC). Biofilm inhibition capacity and time kill assay was performed. Further, the in-vivo response of topical application of cAgNPs was evaluated on patients of DFUs. The susceptibility testing demonstrated the MIC and MBC values of the cAgNPs ranging from 0.5μg/ml to 1.0 μg/ml and 1.0 μg/ml to 8 μg/ml against the tested organisms respectively. The cAgNPs showed inhibition of biofilm formation in the low, medium and high biofilm producers by 91%, 83% and 75% respectively at the highest concentration (52ppm). The time kill kinetics showed significant reduction in the number of viable cells (p < 0.0001). Significant reduction in microbial load (p = 0.0062) and in the number of moderate to strong biofilm producing organisms (p = 0.0069) after treatment with cAgNPs was seen. cAgNPs exhibited significant in-vitro bactericidal and bacteriostatic activity against MRSA, MSSA and VRE respectively along with anti-biofilm activity. Additionally, cAgNPs showed significant reduction in microbial load of the chronic DFUs.

Incidental appendiceal mucocele discovery: A case series and literature review

INTRODUCTION

Low-grade appendiceal mucinous neoplasms (LAMNs) are rare entities that can present significant challenges when discovered incidentally by general surgeons during surgery or through postoperative pathology. These lesions may mimic common abdominal conditions and are often not suspected preoperatively.

METHODS

We present a case series of five patients in whom appendiceal mucoceles were incidentally identified either intraoperatively or on postoperative pathological examination. The patients ranged from 36 to 79 years old and presented with symptoms such as right lower quadrant pain, initially attributed to appendicitis, ovarian torsion, or other gynecological conditions. Intraoperative findings varied from dilated appendices with mucinous content to large cystic masses involving adjacent structures.

RESULTS

In each case, the general surgeon had to make immediate decisions regarding management. Surgical interventions included laparoscopic appendectomy and open right hemicolectomy, with an emphasis on careful handling to prevent rupture and spillage of mucin. Postoperative pathology confirmed LAMNs, with tumor stages ranging from pTis to pT4a. Some patients required additional procedures, such as cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC), due to the presence of acellular mucin or peritoneal involvement. The discussion focuses on practical guidance for general surgeons when faced with an incidental appendiceal mucocele. Key recommendations include avoiding intraoperative rupture by gentle handling, assessing the need for extended resection based on intraoperative findings, and ensuring thorough communication with pathology for accurate staging. Postoperative management should involve reviewing pathology reports carefully, considering referral to a multidisciplinary team for higher-stage tumors, and implementing long-term surveillance protocols due to the risk of recurrence.

CONCLUSION

General surgeons play a critical role in the initial management of incidentally discovered appendiceal mucoceles. Prompt recognition and appropriate intraoperative decision-making are essential to optimize patient outcomes. By adhering to careful surgical techniques and collaborating with multidisciplinary teams, surgeons can effectively manage these unexpected findings and mitigate potential complications associated with LAMNs.

Survival benefit of adjuvant chemotherapy in high-risk patients with colon cancer regardless of microsatellite instability

INTRODUCTION

The predictive utility of high-risk features (HRFs) and microsatellite instability (MSI) status for adjuvant chemotherapy (ACT) in patients with stage II colon cancer remains unclear. We examined the impact of HRFs and MSI in predicting the benefits of adjuvant ACT in patients with stage II colon cancer.

MATERIALS AND METHODS

We included 1801 patients with resected stage II colon cancer who underwent ACT (5-fluorouracil [FU] and oxaliplatin) or surgery alone between January 2010 and December 2017. The primary outcomes were overall survival (OS) and disease-free survival (DFS).

RESULTS

Among MSI-high patients with HRFs, patients who received 5- FU and oxaliplatin-based ACT had significantly higher OS and DFS than patients who did not, with no significant difference between those who received 5-FU and oxaliplatin as ACT. Among MSI-low/microsatellite stable patients with HRFs, patients who received 5-FU and oxaliplatin as ACT had significantly higher OS and DFS than patients who did not, with no significant differences between those who received 5-FU and oxaliplatin as ACT. Among patients who did not receive ACT, OS and DFS were 95.0 % and 91.2 % for patients without HRFs, respectively, and 84.4 % and 75.0 % for patients with HRFs, respectively. ACT improved the survival rates of patients with HRFs (OS: 84.4 %→95.9 %, DFS: 75.0 %→88.9 %).

CONCLUSIONS

ACT can be recommended for patients having stage II colon cancer with one or more HRF(s) for recurrence, regardless of the MSI status. In patients with HRFs, we observed no significant difference regarding survival between those who received 5-FU and oxaliplatin-based ACT.

Integrating cuproptosis and immunosenescence: A novel therapeutic strategy in cancer treatment

Recent advancements in our understanding of cell death mechanisms have progressed beyond traditional apoptosis to encompass various forms of regulated cell death, notably cuproptosis. This copper-dependent cell death occurs when copper interacts with lipoylated enzymes in the tricarboxylic acid cycle, leading to protein aggregation and subsequent cell death. Alongside this, immunosenescence the gradual decline in immune function due to aging has emerged as a significant factor in cancer progression and response to treatment. Innovative strategies that integrate cuproptosis and immunosenescence are showing considerable promise in cancer therapy. By leveraging the altered copper metabolism in cancer cells, cuproptosis can selectively induce cell death, effectively targeting and eliminating tumors. Simultaneously, addressing immunosenescence can rejuvenate the aging immune system, enhancing its capacity to identify and destroy cancer cells. This dual approach creates a synergistic effect, optimizing therapeutic efficacy by directly attacking tumor cells while revitalizing the immune response. Such integration bolsters the defense against cancer progression and recurrence and holds great potential for advancing cancer treatment modalities and improving patient outcomes. This paper delves into the interactions between cuproptosis and immunosenescence, emphasizing their implications for developing innovative cancer therapies.

What matters in laparoscopic hepatectomy for lesions located in posterosuperior segments? Initial experiences and analysis of risk factors for postoperative complications: a retrospective cohort study

BACKGROUND

Laparoscopic liver resection (LLR) for lesions in the posterosuperior segments (PSS) is challenging. Identifying and minimizing risk factors for postoperative morbidity and mortality is crucial. This retrospective cohort study shares initial experiences with LLR of the PSS (VII, VIII, IVa) and wants to identify risk factors for clinically relevant postoperative complications (Clavien-Dindo grade ≥ III) in these patients.

METHODS

We reviewed our prospective database for all patients who underwent LLR with at least one lesion in the PSS (April 2018-October 2022). Uni- and multivariate analyses were carried out using binary logistic regression analysis.

RESULTS

110 patients underwent LLR of the PSS. Median age was 67 years (IQR 59-76); 62% were male (n = 68), with a median BMI of 26 (IQR 23-30). The most frequent indications for LLR were primary liver cancer (37%) and colorectal liver metastasis (36%). Median operating time was 211 min (IQR 135-281) with a median blood loss of 460 mL (IQR 240-1200). Postoperative length of stay was 6 days (IQR 4-8). Clinically relevant postoperative complications were present in 20 patients (18%) with a 90-day mortality rate of 5% (n = 6). Multivariate analyses identified ASA ≥ III (OR 3.23 [95%CI 1.03-10.09]; p = 0.043), diabetes (OR 4.31 [95%CI 1.20-15.49]; p = 0.025), and intraoperative transfusion of packed red blood cells (PRBC) (OR 4.80 [95%CI 1.01-22.86]; p = 0.049) as risk factors for Clavien-Dindo grade ≥ III complications.

CONCLUSION

ASA ≥ III status, diabetes, and intraoperative PRBC transfusion are associated with an increased risk of Clavien-Dindo grade ≥ III complications in patients undergoing LLR in PSS. Preoperative optimization should include diabetes management, screening for anemia with appropriate supplementation, and comprehensive risk counseling for ASA ≥ III patients. Additionally, minimizing intraoperative PRBC transfusion should remain a key perioperative goal.

Association between the generation of cephalosporins for perioperative prophylaxis and postoperative surgical site infections in open fractures: a prospective cohort study

BACKGROUND

The use of cephalosporins for surgical site infection (SSI) prevention has become a clinical routine, however, high-level evidence regarding the optimal generation for open fractures is currently limited. This study aims to investigate the association between the generation of cephalosporins and SSI risk in open fractures.

METHODS

This prospective cohort study used data from the Surgical Site Infection in Orthopedic Surgery (SSIOS), a prospectively maintained database, conducted at a tertiary orthopedic university hospital from October 2014 to December 2020. The primary outcome was occurrence of SSI within 1 year after operation, and its association with the generation of cephalosporins was examined using multivariable logistic regressions and generalized estimating equations. Generalized additive models were used to calculate the relative contribution of potential factors likely influencing SSI.

RESULTS

A total of 3582 eligible patients, 74.6% males, with a mean age of 43.7 ± 14.1 years, were included. First-, second-, and third-generation cephalosporins were used in 1957 (54.6%), 1219 (34.0%), and 406 (11.3%) patients. Compared to first-generation cephalosporins, the use of second-generation cephalosporins was significantly associated with a higher risk of SSI (absolute risk difference [ARD] = 3.70%; 95% CI, 1.90%-5.51%; adjusted OR [aOR] = 1.604; 95% CI, 1.212-2.124), whereas third-generation cephalosporins were not (ARD = 1.02%; 95% CI, -1.78% to 3.82%; aOR = 1.234; 95% CI, 0.790-1.880). Among the 28 potential factors considered, the generation of cephalosporins was ranked 9th in terms of its impact on the risk of SSI.

CONCLUSION

Perioperative use of higher-generation cephalosporins was not associated with a reduction in postoperative surgical site infections in open fractures. Our study supports existing guidelines that recommend the use of first-generation cephalosporins as the preferred agents for preventing SSIs in open fractures.

Perioperative management and outcomes of surgical pulmonary valve replacement following tetralogy of fallot repair: A retrospective study

BACKGROUND

While the long-term prognosis of Tetralogy of Fallot (TOF) repair is favourable, the frequency of interventions for pulmonary valve insufficiency during follow-up remains high, raising concerns regarding its invasiveness. This study aimed to evaluate the safety measures and strategies for the perioperative management of pulmonary valve interventions following TOF repair.

METHODS

From November 2022 to December 2023, interventions in the pulmonary artery for TOF were performed in 17 patients; a retrospective analysis was conducted on all patients. Preoperative haemodynamic evaluation was performed using 4D-flow magnetic resonance imaging in all cases.

RESULTS

The 17 patients included in the study had a mean age of 24.1 ± 14 years. The mean duration from repair to re-intervention was 18.2 ± 12 years, with a preoperative right ventricular ejection fraction of 42.3 ± 12 %. The mean surgical time, cardiopulmonary bypass time, and aortic cross-clamp time were 389 ± 96, 210 ± 67, and 106 ± 48 min, respectively. Pulmonary valve replacement was performed in eight patients, with seven using porcine aortic valves and one using a bovine pericardial valve. The Rastelli-type procedure was performed in nine cases, with seven using expanded polytetrafluoroethylene valved conduits and two using composite grafts of a porcine bioprosthetic valve and Valsalva graft. Additional procedures included right ventricular outflow tract myectomy in nine patients, pulmonary artery reconstruction in five, cryoablation in four, coronary artery bypass grafting in three, tricuspid valve repair in three, and ventricular septal defect closure in one. There were no cases of early mortality, stroke, or re-operation within 30 days.

CONCLUSION

Interventions on the pulmonary valves following TOF repair can be safely performed with appropriate perioperative management. The primary goal of surgical pulmonary valve replacement is to preserve the right ventricular function and reconstruct a smooth pathway from the right ventricle to the pulmonary artery, considering future transcatheter interventions. Further long-term follow-up is necessary to assess outcomes, such as remote mortality, right ventricular function, and arrhythmia occurrence.

Evaluation of blood flow in arteritic anterior ischemic optic neuropathy using laser speckle flowgraphy: A case series

Background

Arteritic anterior ischemic optic neuropathy (AAION), primarily caused by giant cell arteritis, is a leading cause of blindness. This disease results in significant ocular blood flow (BF) impairment, though data on ocular hemodynamics are limited.

Methods

This observational case series enrolled four patients treated for AAION (age: 81.8 ± 7.8 years; male to female ratio: 3:1) who underwent laser speckle flowgraphy (LSFG) scanning at the initial visit and after steroid treatment in both eyes. Mean blur rate (MBR), an LSFG parameter that represents BF velocity, was obtained in the optic nerve head vessel area (ONH-MV), ONH tissue area (ONH-MT), and peripapillary choroid, in addition to common ophthalmologic parameters.

Results

At the initial visit, all affected eyes had no light perception in best-corrected visual acuity (BCVA) testing, and three cases had a severe increase in circumpapillary retinal nerve fiber layer thickness (cpRNFLT; 191.00 ± 42.03 μm). Pre-treatment, all affected eyes showed decreases in ONH-MV, ONH-MT, and choroidal MBR; this improved after steroid treatment by 80.3 ± 107.6 %, 39.1 ± 79.7 %, and 289.4 ± 303.4 %, respectively. Pre-treatment, all fellow eyes showed no impairment in BCVA or changes in the cpRNFLT. Post-treatment, two fellow eyes showed an increase in ONH-MV and ONH-MT parameters (72.8 ± 32.6 % and 82.2 ± 22.3 %, respectively), while all fellow eyes showed an increase in choroidal MBR (152.7 ± 126.1 %).

Conclusion

LSFG could be useful for monitoring ocular BF changes in eyes with AAION and asymptomatic fellow eyes before and after steroid treatment.

Comprehensive Surgical Management of Thoracic Schwannomas: A Retrospective Multicenter Study on 98 Lesions

BACKGROUND AND OBJECTIVES

The optimal surgical management of thoracic schwannomas (TSs) remains contentious, with various approaches proposed. Video-assisted thoracoscopic surgery (VATS) and combined VATS with neurosurgical procedures have shown promise, particularly for Eden type IV and III lesions. However, unanimous consent on the most effective surgical intervention and understanding of prognostic factors for tumor recurrence needs to be improved. The aim of this study was to elucidate the optimal surgical approach according to the Eden type and investigate predictive factors for TS recurrence.

METHODS

This retrospective, multicentric, observational study analyzed 98 surgically treated patients with TS from 2011 to 2023, assessing preoperative and 6-month follow-up clinical (recurrences, pain, and myelopathy recovery) and surgical parameters (operative time, intraoperative blood loss, extent of resection). Surgical procedures included thoracic laminectomy or hemilaminectomy for type I, laminectomy or thoracic transpedicular (TPD) approach for type II, laminectomy alone or combined laminectomy with VATS for type III, and VATS or thoracotomy (open thoracotomy [OT]) for type IV. Descriptive and deductive analyses were conducted between and within the 4 cohorts, with multivariate analysis assessing the contribution of predictor variables.

RESULTS

No significant differences were found between hemilaminectomy and laminectomy for all analyzed parameters for type I. Type II lesions treated with TPD exhibited similar outcomes to laminectomy, albeit with longer procedure times. Type III lesions benefited from combined approaches compared with neurosurgical-only approaches. Video-assisted thoracoscopic surgery emerged as more favorable than OT for type IV lesions. Multivariate analysis revealed that patient sex, tumor location, extent of resection, and pathology significantly influenced recurrence rates.

CONCLUSION

For Eden type III TSs, neurosurgical and VATS combined surgery achieved better outcomes than neurosurgery alone; for Eden type IV TSs, VATS achieved better results than OT. For Eden types I and II, hemilaminectomy and bilateral laminectomy and laminectomy and TPD achieved similar outcomes, respectively.

PErioperative respiratory care aNd outcomes for patients underGoing hIgh risk abdomiNal surgery (PENGUIN): a randomised international internal pilot trial

Background

Infections are a common complication of abdominal surgery in low- and middle-income countries (LMICs). The role of a high fraction of inspired oxygen (FiO2) and chlorhexidine mouthwash in preventing post-operative infections is unconfirmed.

Methods

Internal pilot phase of an international outcome assessor-blinded, 2x2 factorial randomised trial of patients aged ≥10-years undergoing midline laparotomy in LMIC hospitals. The main trial objectives are to compare the clinical effectiveness of preoperative 0.2% chlorhexidine mouthwash in preventing pneumonia versus no mouthwash, and 80-100% perioperative FiO2 to prevent surgical site infection (SSI) versus 21-35% FiO2. This 12-month internal pilot assessed feasibility of hospital site opening, patient recruitment, intervention adherence, patient follow-up and safety. Patients were randomised in a 1:1:1:1 ratio to the four intervention group combinations and followed up for 30 days.

Results

We recruited 927 patients from seven hospitals in India and South Africa over 12 months from November 2020. There were 907 adults (97.8%) and 20 children aged ten or over (2.2%): 89/927 (9.6%) patients died. Site opening reached 70% of our target (7/10) hospitals, and patient recruitment 107% (927/870). 917/927 (99%) patients in the mouthwash arm, and 840/927 (91%) patients in the oxygen arm received the allocated intervention. Lower adherence to the oxygen intervention related mainly to clinically necessary FiO2 increases in the 21-35% FiO2 arm. 30-day follow-up was completed appropriately for 924/927 (99%) patients. and was performed by a masked assessor for all patients. There were no reported safety events.

Conclusion

This pilot showed the feasibility and safety of a major phase III trial in post-operative infection prevention in LMICs.

Trial registration

ClinicalTrials.gov NCT04256798.

Intraluminal causes of mechanical small bowel obstruction: CT findings and diagnostic approach

Intraluminal causes of small bowel obstruction (SBO) are less common than mural or extrinsic etiologies. This review categorizes intraluminal causes of SBO into four broad categories to provide a diagnostic framework for radiologic interpretation: 1) ingested contents, 2) bowel stasis, 3) inflammatory causes, and 4) neoplasms. Ingested materials can result in SBO when individual or accumulated contents are too large to pass, such as in the case of foreign bodies or bezoars. Bowel stasis causing SBO can be secondary to abnormal bowel function, such as in cystic fibrosis, reduced transit of contents at sites of narrowing such as surgical anastomoses, or the formation of enteroliths in diverticula which may subsequently dislodge and result in luminal obstruction. Inflammatory causes of SBO include strictures or fistulas that allow foreign bodies (such as gallstones) formed outside the bowel to enter the bowel lumen and cause obstruction. Finally, neoplasms can present as endophytic masses that occlude the bowel lumen through a ball-valve mechanism or serve as a lead point for intussusception. Recognizing the imaging features that are suggestive of intraluminal SBO is critical for accurate diagnosis and timely patient care.

Unmasking vestibular schwannoma: A series of unusual cases

INTRODUCTION

Vestibular schwannoma (VS) is a benign, slow-growing tumor that accounts for 80-90 % of cerebellopontine angle (CPA) tumors. While classic symptoms like hearing loss, tinnitus, and vertigo are well-recognized, atypical presentations can delay diagnosis.

CASE PRESENTATION

We present four unusual cases of VS. The first patient, a 33-year-old woman, initially presented with transient tinnitus and later developed peripheral vertigo. The second case involved a 52-year-old man with sudden hearing loss, vertigo, and aural fullness. The third case was a 17-year-old female with unilateral auditory neuropathy. The fourth patient, a 39-year-old woman, presented with intermittent tinnitus, balance disturbances, and facial stiffness.

DISCUSSION

Detailed history, physical examination, and audiological evaluation are crucial for identifying patients at risk for vestibular schwannoma, especially with atypical audiological findings, to avoid misdiagnosis.

CONCLUSION

This case series emphasizes the significance of considering VS as a differential diagnosis for atypical symptoms. Early recognition and proper practice can lead to optimal outcomes for patients and contribute valuable insights to the scientific field by broadening the understanding of the diverse spectrum of VS symptoms.

Short-term outcomes of modified Lapidus procedure using the InCore® Lapidus System for hallux valgus: Case series of four cases

INTRODUCTION

Hallux valgus is a common foot deformity often associated with first tarsometatarsal (TMT) joint instability. The Lapidus procedure, involving first TMT joint arthrodesis, is a well-established surgical procedure for severe cases, but the issue lies in the method of fixation. The InCore® Lapidus System is a novel intramedullary fixation system for modified Lapidus procedure. We here report the clinical experience of this system.

CASE PRESENTATION

We retrospectively reviewed four cases who underwent a modified Lapidus procedure using the InCore® Lapidus System and followed up at least 6 months. Surgical outcomes were evaluated by the hallux valgus (HV) and intermetatarsal (M1M2) angles on radiographs, bone union status on computed tomography (CT), postoperative pain levels, and the occurrence of complications. The HV angle improved in all four cases, ranging from 51° to 59° preoperatively and decreasing to 4° to 25° at the final follow-up. Similarly, the M1M2 angle improved in all four cases, with values decreasing from a preoperative range of 23° to 26° to a final range of 4° to 13°. All patients achieved bone union within three months, and postoperative pain was minimal (Numerical Rating Scale: 0-1) at six weeks postoperatively. No complications were observed.

CLINICAL DISCUSSION

Theoretical advantages of the InCore® Lapidus System include the ability to achieve joint compression using the device and the intramedullary fixation design, which may provide robust stability and a high rate of bone union. The system's design potentially reduces the risk of skin irritation, a common issue with plate fixation. Our clinical experiences supported these theoretical advantages.

CONCLUSION

The modified Lapidus procedure using the InCore® Lapidus System provided favorable short-term outcomes for hallux valgus without complications.

Early Outcomes on Triple-Branch Arch Device With Retrograde Left Common Carotid Branch: A Case Series

INTRODUCTION

Endovascular aortic arch repair using multibranch devices has been applied in patients considered at high risk for open repair. The aim of this case series was to report the early outcomes in patients managed with a new design 3 branch arch custom-made device, including a retrograde left common carotid artery (LCCA) branch.

METHODS

The Preferred Reporting Of CaSe Series in Surgery (PROCESS) guidelines were followed. All consecutive patients undergoing endovascular repair of an aortic arch lesion with a custom-made triple-branch device, including a retrograde LCCA branch (Cook Medical, Bloomington, IN, USA), between October 27, 2022, and February 28, 2023, were included. The presence of an arch aneurysm (degenerative or post-dissection) with diameter ≥55 mm and high risk for a conventional open repair set the indication for treatment. The primary outcomes were technical success and mortality at 30 days. Early morbidity and reinterventions were considered as secondary outcomes.

RESULTS

Eight elective patients (87.5% men, mean age 72.3±27.0 years) were included. Five of them (62.5%) had undergone a previous ascending aorta repair of an acute type A aortic dissection. All patients were asymptomatic, except one, with left recurrent laryngeal nerve compression. The mean maximum aortic diameter was 70.4±21.0 mm. Percutaneous femoral and axillary access was used in all cases except three in which a cut down for right carotid access was performed. Technical success was 100%. Femoral access to the LCCA and implantation of the bridging stent was performed without technical challenges. No death nor cerebrovascular event was recorded during the 30 day follow-up. Five patients (62.5%) presented major complications, 3 related to access needing reintervention and the remaining related to congestive heart failure (CHF), which were managed successfully with medical treatment. Follow-up (range 1-4 month) was uneventful, except for one patient who presented a secondary type Ia endoleak.

CONCLUSIONS

According to our early experience, the presence of a retrograde branch facilitated the revascularization of the LCCA through femoral access, decreasing the risk of cerebrovascular morbidity. Further analyses with longer follow-up are needed to evaluate the safety and efficacy of the device.Clinical ImpactData arising mainly from the retrograde branch for the revascularization of the LSA are encouraging from a variety of devices. The premiminary experience with a triple-branched arch device, with a retrograde branche for the LSA but also for the LCCA, was associated with no 30 day mortality and 100% technical success.The device's design allowed swift catheterization and completion of the LCCA revascularization using femoral access exclusively.

An Australian regional hospital's oesophagectomy experience: A 10-year case series from Tasmania

Introduction

Oesophagectomy is recommended as part of curative treatment for oesophageal cancer but is associated with substantial morbidity. Centralization has been recommended to improve outcomes, but this has not been widely applied in Australia. This study aimed to audit a regional hospital's experience over ten years and compare it to outcomes from national and international centres to support the view that oesophagectomy can be performed safely in select regional centres in Australia.

Methods

Patients undergoing oesophagectomy at a single regional hospital in North-East Tasmania, Australia between January 2014 and December 2023 were retrospectively identified. Preoperative patient and tumour characteristics, and outcomes (mortality, anastomotic leak, length of stay, respiratory complications, long-term complications and survival) were compared to other centres.

Results

65 patients were identified. 53 % were male, mean age was 65.2 years, 29.2 % had respiratory disease and 18.5 % were current smokers. The anastomotic leak rate was 7.7 %. 25 % developed pneumonia postoperatively. Average ICU length of stay was 4.6 days, median acute inpatient length of stay was 15 days. There was one in-hospital mortality and one 30-day mortality. 2 patients (3 %) required diaphragmatic hernia repair; 12 patients (18.5 %) required endoscopic dilatation of anastomotic strictures. The 5-year survival rate was 66 %. Our results compare favourably to published rates of anastomotic leak (10-15 %), inpatient stay (15 days), pneumonia (20-30 %), 30-day mortality (1-4 %) and anastomotic stricture (20 %).

Conclusions

Oesophagectomies can be safely performed in regional centres in Australia that routinely undertake a higher volume of cases per year, provided services required to manage complications are readily available.

Cellulose nanocrystal-based intelligent hydrogels: Innovations, challenges, and prospective application in advanced wound healing

Cellulose nanocrystals (CNCs) have emerged as a transformative material in biomedical engineering due to their exceptional mechanical properties, high aspect ratio, and biocompatibility. Recent advances in CNC-based smart hydrogels show great potential in wound care through responsive drug delivery, moisture retention, and infection control. This review critically evaluates CNC-reinforced hydrogels' synthesis, functionalization, and biomedical applications, emphasizing their role in addressing chronic wound healing challenges. Despite promising results, clinical use is limited by scalability, cost, and long-term biocompatibility. Future research should optimize sustainable CNC extraction, integrate smart sensing, and explore cellular mechanisms. Collaboration with industry and pilot projects will provide insights, while workshops can train professionals in smart sensing and CNC optimization. Incorporating Internet of Things (IoT) sensors in CNC machines enables real-time monitoring of key parameters like temperature, vibration, and tool wear, facilitating predictive maintenance and process optimization through data analytics. Developing closed-loop control systems to adjust machining parameters based on real-time data enhances precision and reduces waste. CNC extraction optimization should include determining ideal process parameters, exploring advanced tooling materials, and using simulation software to streamline machining processes. This comprehensive analysis underscores the potential of CNC-based hydrogels to redefine regenerative medicine and personalized wound care.

Short-term and long-term outcomes of pancreas preserving total duodenectomy: A case series from a single center with 13 years' experience and complimentary meta-analysis

Backgrounds/Aims

To determine short-term and long-term outcomes after pancreas preserving total duodenectomy (PPTD).

Methods

A case series and a complementary meta-analysis were conducted. All patients with (pre)neoplastic lesions of duodenum who underwent PPTD in a tertiary center for pancreatic surgery between May 2009 and October 2022 were included for the case series. All studies in the literature with a sample size of 10 or more patients reporting outcomes of PPTD were included for the meta-analysis.

Results

A total of 439 patients (18 from case series and 421 from literature) were analyzed. Clavien-Dindo (CD) I complications in 2.9% (95% confidence interval [CI] 0.6%-5.2%), CD II complications in 21.1% (14.6%-27.6%), CD III complications in 18.1% (9.3%-26.9%), CD IV complications in 2.7% (0.5%-4.9%), and CD V complications in 2.2% (0.2%-4.2%) of patients were found. Probabilities of overall survival and recurrence-free survival at 15 years were 87% and 86%, respectively. There was no significant difference in the risk of mortality (odds ratio [OR]: 0.82, p = 0.830), total complications (OR: 0.77, p = 0.440), postoperative pancreatic fistula (OR: 0.43, p = 0.140), delayed gastric emptying (OR: 0.70, p = 0.450), or postoperative bleeding (OR: 0.97, p = 0.960) between PPTD and pancreaticoduodenectomy.

Conclusions

PPTD is safe and feasible for (pre)neoplastic lesions of duodenum not involving the pancreatic head. The risk of severe complications (CD > III) is low and long-term outcomes are favorable. Whether PPTD provides advantages over more radical techniques in terms of long-term outcomes remains controversial and requires further research.

A comprehensive study on postoperative complications and postoperative pancreatic fistula in sporadic non-functional pancreatic neuroendocrine tumors: A retrospective cohort study

Backgrounds/Aims

Balancing surgical risks and benefits is crucial for managing non-functional pancreatic neuroendocrine tumors (NF-PNETs). Despite high postoperative pancreatic fistula (POPF) rates, studies on postoperative complications of sporadic NF-PNETs are scarce. Thus, this study aimed to investigate postoperative complications and identify risk factors for POPF.

Methods

A retrospective review of 166 NF-PNET surgeries performed at Severance Hospital between February 2000 and August 2023 was conducted.

Results

Age > 65 years and higher American Society of Anesthesiology (ASA) grade were not significantly correlated with severe complications (odds ratio [OR]: 1.10, p = 0.871 and OR: 1.47, p = 0.491, respectively). Surgical procedures included enucleation (13.9%), distal pancreatectomy (50.0%), central pancreatectomy (4.8%), pancreaticoduodenectomy (PD) (26.5%), and total pancreatectomy (4.8%). Severe complications occurred in 12.05% of surgeries. The overall incidence of all POPFs including biochemical leaks was 53%, while clinically relevant POPF (grade B or C) occurred in 7.8% of patients. Logistic regression showed that PD (OR: 3.94, p = 0.092) tended to be risk factor for POPF and that diameter of the main pancreatic duct (MPD) ≤ 3 mm was a significant risk factor for POPF (OR: 0.22, p = 0.008). A pancreas thickness (PT)/MPD ratio > 4.47 on preoperative computed tomography predicted all POPFs in PD patients (OR: 11.70, p = 0.001).

Conclusions

Age and comorbidities had no significant impact on surgical outcomes. PD was associated with higher serious complications and POPF rates. The PT/MPD ratio is a valuable preoperative tool for predicting POPF risk in PD patients.

Multicenter external validation of a nomogram predicting conversion to open cholecystectomy during laparoscopic surgery for acute calculous cholecystitis: a cross-sectional study

This study aimed to investigate risk factors associated with conversion from early laparoscopic cholecystectomy (ELC) to open cholecystectomy in patients diagnosed with acute calculous cholecystitis (ACC). A retrospective analysis was conducted on 3,191 ACC patients who underwent ELC at eight clinical centers between January 2013 and December 2023. To evaluate risk factors for conversion during ELC, least absolute shrinkage and selection operator (LASSO) regression with ten-fold cross-validation was employed to identify and select the most relevant variables. Subsequently, a binary logistic regression model was built using the variables selected from LASSO regression to develop a nomogram for prediction. The model's performance was evaluated using external validation through receiver operating characteristic (ROC) curves for discrimination, Hosmer-Lemeshow test and calibration curves for calibration, and decision curve analysis (DCA) for clinical practicality. LASSO regression analysis identified five optimal variables from a total of twenty-nine for model development: preoperative C-reactive protein (CRP) level, anesthesia American Society of Anesthesiologists (ASA) classification, calculus location, Tokyo Guidelines 2018 (TG18) classification, and surgeon seniority. External validation of the model using the area under the curve (AUC) from ROC curves yielded moderate discrimination in both the training set (AUC = 0.868) and validation set (AUC = 0.833). Calibration plots indicated good agreement between predicted and observed probabilities, suggesting good calibration of the nomogram. Additionally, DCA analysis supported the model's potential clinical usefulness. This study identified high preoperative CRP level, presence of gallbladder neck calculus, high grades in both anesthesia ASA and TG18 classifications, and junior surgeon as factors that can be used to predict the need for conversion to open surgery during ELC procedures for ACC patients.

Laparoscopic surgery in acute perforated gastroduodenal ulcers: an underutilized technique despite favorable short-term outcomes

BACKGROUND

Acute perforation is a serious complication associated with peptic ulcer disease (PUD). Laparotomy remains the traditional operative intervention for repair. However, the laparoscopic approach has gained popularity over the last two decades. This study aims to evaluate the 30-day outcomes of laparoscopic and open approach in patients with acute PUD perforation.

METHODS

Patients who presented emergently with acute gastroduodenal ulcer perforation between 2005 and 2017 were identified from the ACS-NSQIP database. Patients were stratified based on whether they underwent laparoscopic repair (LR) or open repair (OR) and selected using one-to-one propensity score matching (PSM). Primary outcomes included 30-day mortality, morbidity, readmission and reoperation rates, operative time, and total length of hospital stay (LOS). Categorical variables were assessed using Pearson's chi-squared or Fischer's exact tests. Continuous variables were tested with parametric or non-parametric tests.

RESULTS

7099 patients were identified; 775 (11%) underwent LR and 6324 (89%) underwent OR. 1534 patients were matched (767 patients per group); matched groups had similar demographic, comorbidity, and perioperative characteristics. There were no differences between LR and OR regarding 30-day mortality (5.6% vs. 6.9%, p = 0.292), overall morbidity (38.9% vs. 43.3%, p = 0.078), serious morbidity (36.1% vs. 37.3%, p = 0.634), and reoperation rate (5.5% vs. 6.5%, p = 0.454). LR had a lower 30-day readmission rate (6.5% vs. 7.3%, p = 0.002), lower overall minor morbidities (14.3% vs. 19.9%, p = 0.004), shorter median (IQR) LOS (6 [5,10] vs. 7 [5,11], p < 0.001). Median (IQR) operative time was longer in the LR group (83 [61, 109) vs. 63 [47, 86] minutes, p < 0.001).

CONCLUSION

LR of gastroduodenal ulcers is currently underutilized. Patients who underwent LR tended to have longer operative time, but shorter LOS, and lower readmission rates. There were no differences in 30-day mortality between LR and OR groups. Therefore, a laparoscopic approach should be attempted for patients presenting with acute perforation of gastroduodenal ulcers.

Rat Hair Follicle Stem Cell-Derived Exosomes: Isolation, Characterization and Comparative Analysis of Their In Vitro Wound Healing Potential

Stem cell-derived secretome and exosomes present a promising cell-free strategy for tissue repair and wound healing. This study aimed to isolate and characterize, for the first time, exosomes derived from rat hair follicle stem cells (rHFSCs) and to evaluate their wound-healing potential alongside rHFSC secretome. Exosomes were isolated via ultracentrifugation and characterized using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR), biomarker profiling and protein quantification. Scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS) confirmed their spherical morphology, diameter and elemental composition. Protein quantification showed higher protein content in the secretome than in exosomes. RT-PCR and biomarker profiling highlighted the therapeutic relevance of the exosomal cargo compared to parent rHFSCs. Functional analysis of 30 wound-healing biomolecules validated their pro-regenerative potential. Cytocompatibility was confirmed via the PrestoBlue™ viability assay, while scratch assays demonstrated significant wound closure in the treated groups, both with and without mitomycin C. These findings highlight the potential of rHFSC-derived exosomes and secretome as innovative, cell-free therapeutic agents for cutaneous regeneration. This study advances our understanding of their role in wound healing and underscores their broader applicability in regenerative medicine.

The Effect of Quercetin Loading in Polylactic Acid-Based Electrospun Fibers on Their Antioxidant, Antibacterial and Antitumor Properties

Quercetin (QUE) is a bioactive flavonoid that is naturally present in various fruits and possesses many pharmacological activities. Despite its health benefits, the bioavailability of quercetin is relatively low due to its crystalline form and hydrophobic structure. An approach to overcoming these drawbacks is its incorporation into amorphous polymer matrices. PLA and PLA/PEG fibrous materials loaded with QUE were obtained by electrospinning. The XRD analysis revealed a visible decrease in the crystallinity of QUE after its incorporation into PLA and PLA/PEG fibers. The obtained fibrous materials and, especially, the PLA/PEG mat loaded with the flavonoid exhibited high antioxidant activity due to the better wettability and higher release rate of the bioactive compound. Moreover, the PLA/QUE and PLA/PEG/QUE mats possessed antibacterial properties against Staphylococcus aureus and Pseudomonas aeruginosa. Furthermore, the antitumor activity of the prepared mats was tested against SH-4 cancer cells and HaCaT keratinocytes. The obtained results reveal that the QUE-loaded fibrous mats exhibited high anticancer activity against cancer cells but lower toxicity to normal keratinocytes. The combined antioxidant, antibacterial and in vitro antitumor activities render these novel PLA-based materials loaded with QUE promising candidates for wound dressing applications and for application in local tumor treatment.

The impact of depression on healing outcomes in people with diabetes-related foot ulcers: A systematic review

This systematic review examined the impact of depression on healing outcomes among people with diabetes-related foot ulcers (DFUs). A comprehensive search of MEDLINE, APA PsycINFO, CINAHL, Embase, and The Cochrane Library was conducted from inception (1976) to 11 March 2024 to identify eligible studies. The Mixed Methods Appraisal Tool (MMAT) was used to assess study quality, and a narrative synthesis was conducted. We identified 1403 articles, of which 11 were included in the final analysis and included a total of 1392 participants with DFUs. The included studies used diagnostic interviews and screening tools to assess depression, and healing outcomes were described as healed ulcer, change in ulcer size, and/or changes in ulcer severity classification tool scores. Of the 11 studies, five studies (45.5 %) found that there was a significant negative impact (or association) of depression on healing outcomes of DFUs. On the other hand, six studies (54.5 %) showed there was no significant impact or association. Three studies were considered high quality, four studies medium quality, and four studies low quality. Depression may have a significant negative impact on healing outcomes in people with DFUs. However, the existing evidence is still unclear, and further high-quality studies are needed to investigate this impact.

Impact of Coronavirus Disease (COVID)-19 on the Indigenous Population of Brazil: A Systematic Review

BACKGROUND

Indigenous peoples in Brazil were severely impacted by coronavirus disease (COVID)-19 pandemic, experiencing high rates of infection and mortality. Geographic isolation, limited access to healthcare, socio-economic disparities, and cultural factors, such as communal living and mistrust of state-led initiatives, heightened their vulnerability. Territorial invasions and oxygen shortages further exacerbated the crisis. Therefore, this systematic review aimed to explore the progression of COVID-19 in this population.

METHODS

A systematic review was conducted in PubMed-MEDLINE, SciELO (Scientific Electronic Library Online), and LILACS (Latin America and the Caribbean Health Sciences Literature) from the beginning of the pandemic in Brazil (2020) to March 2025. Studies addressing COVID-19 vaccination and epidemiological, social, and economic aspects among Indigenous populations in Brazil were included. Reviews and irrelevant studies were excluded. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 50 relevant studies were included, grouped into thematic blocks: mortality/infection, symptoms, vaccination/testing, social impacts, and birth outcomes. Several studies highlighted that being male, of Indigenous or other racial minority background, and having comorbidities increased mortality risk. In contrast, asthma was associated with reduced mortality. Pregnant Indigenous women in rural areas had 33 times higher odds of dying than their urban counterparts. Furthermore, there is a higher likelihood of very low birth weight and inadequate prenatal care among Indigenous mothers. Vaccination reduced the risk of death, particularly after full immunization, though it did not prevent hospitalization. A cohort study of 389,753 Indigenous people showed a lower full vaccination rate (48.7%) compared to the general population (74.8%). Complete vaccination reduced the risk of death by 96% among hospitalized patients. Regarding seroprevalence, Indigenous people had a 5.4% positivity rate, much higher than other racial groups, and were 4.71 times more likely to test positive than White, Black, or Mixed Individuals. Socioeconomic disparities also correlated with increased infection risk.

CONCLUSIONS

The COVID-19 pandemic worsened health disparities among Indigenous peoples in Brazil, revealing systemic inequalities, weak public policies, and limited healthcare access. This review urges culturally sensitive, community-led responses and highlights the need for disaggregated data and equitable, inclusive health strategies.

Impact of Tumor Characteristics on Endoscopic Endonasal Approach to Tuberculum Sellae and Planum Sphenoidale Meningiomas: Single Center Experience

BACKGROUND AND OBJECTIVES

The expanded endoscopic endonasal approach (EEA) has emerged as a viable alternative technique for the removal of tuberculum sellae meningioma (TSM) and planum sphenoidale meningioma (PSM), offering early tumor devascularization, wide optic canal decompression, while avoiding brain manipulation. The authors present 13-year experience with retrospective analysis evaluating the impact of tumor characteristics on the outcomes of TSM and PSM resections using the expanded EEA.

METHODS

Patients who underwent expanded EEA for TSMs or PSMs from 2010 to 2022 were analyzed. Patient's demographics, preoperative evaluations, tumor features, previous treatments, surgical outcomes, complications, follow-up, and recurrence rates were reviewed. Meningiomas were classified using the Sekhar-Mortazavi classification.

RESULTS

The study included 52 patients (32 with TSMs and 20 with PSMs). Visual impairment was the most common presenting symptom, occurring in 41 patients (78.8%). Gross-total resection (GTR) was achieved in 42 patients (80.7%), reaching 92% for Sekhar-Mortazavi class I tumors. GTR rates decreased with larger tumor size, optic pathway involvement, and vascular encasement. Fibrous and fibroelastic tumors had lower resection rates. The postoperative cerebrospinal fluid leak rate decreased from 23.3% (2010-2017) to 9% (2018-2022), and 34 patients (79%) experienced visual improvement after surgery.

CONCLUSION

The expanded EEA is a safe and effective technique for the resection of TSM and PSM, facilitating GTR and improving visual outcomes.

Natural orifice specimen extraction for diverticular disease: technique, outcomes and role of inflammatory markers

BACKGROUND

Minimally invasive colectomy is common for diverticular disease. Natural orifice specimen extraction (NOSE) is an innovative adjunct that avoids the morbidity of abdominal incisions. The aim of this study is to evaluate the outcome of NOSE in laparoscopic surgery for complications of diverticular disease, and assess the role of post-operative inflammatory markers.

METHODS

A multi-centre prospective study was conducted from 2012 to 2024. Consecutive patients who underwent emergency and elective NOSE colectomy for diverticular disease were included. Demographics, surgical techniques, post-operative complications and biochemical results were analysed.

RESULTS

NOSE colectomy was successful in 99.4% of patients (171/172), with a mean age of 59.9 years. Indications for surgery were phlegmon (35%), recurrent diverticulitis (27%), stricture (21%), fistulae (14%) and haemorrhage (2%). Mean length of stay was 5.7 days (SD 3.8), and anastomotic leak rate was 1.8%. Specimen longitudinal splitting increased operative time (254 vs. 220 min, p < 0.01) and length of stay (6.6 vs. 5.3 days, p = 0.02). Significantly higher inflammatory markers were observed in the longitudinal split group on post-operative days 2-4 without increased complication or anastomotic leak rates.

CONCLUSION

NOSE colectomy demonstrates excellent perioperative outcomes in this large series and is an effective approach for diverticular disease. Specimen debulking facilitates successful NOSE procedures, with expected increases in inflammatory markers which are not associated with higher complication rates.

3D Printed Human Amnion-Based Bioactive Hybrid Dressings for Effective Management of Complex Infected Wounds

Chronic wounds are often afflicted with persistent infection, excessive exudate accumulation, and delayed healing, leading to prolonged hospitalization. Excess moisture overhydrates the wound, promotes infection, and causes edema. Peri-wound skin may develop rashes, immersion injuries, and epidermal detachment. Nutrient-rich exudates foster microbial growth, increasing the infection risk. High bacterial loads lead to crust formation, continuous leakage, and foul odor, further complicating healing. To address this challenge, we developed a 3D printed amnion-based hybrid dressing comprising a regenerative layer integrated with a laminated silver-embedded polyurethane foam layer for partial and full thickness (thickness 0.12 mm-4 mm) infected wounds and burns. This dressing can suffice the varied clinical requirements of wound management by augmenting tissue regeneration, reducing bacterial load, and managing wound exudate. Human amnion was processed through decellularization and lyopreservation. Key angiogenic growth factors VEGF-A (54.12 ± 2.31 pg/mg) and PDGF-BB (3.760 ± 0.14 pg/mg) were quantified. Long-term in vitro cell viability was assessed for 20 days (as per ISO 10993-5 standards). Bioink was formulated using cryo-milled amnion particles and excipients optimized through rheology. Hybrid dressing was developed using an extrusion-based 3D printer, layering the amnion bioink onto the physical substrate, followed by lyophilization and gamma sterilization. Preclinical efficacy was assessed using a rodent Staphylococcus aureus-infected wound model, comparing the hybrid dressing to an in-house-developed amnion-mupirocin (AM) powder formulation with standard of care dressing. Both treatments demonstrated comparable wound closure rates and a significant bacterial load reduction. However, hybrid dressing offered superior healed tissue quality, increased CD31 expression, and improved neovascularization compared to AM powder treatment with a temporally regulated CD31 expression pattern mirroring the natural healing progression. This can be attributed to the hybrid construct of the dressing that provides effective exudate management, preventing its accumulation that could otherwise hinder angiogenesis, along with replenishment of wound bed with regenerative factors, aiding in mimicking the natural healing cascades.

Perioperative SARS-CoV-2 infection and postoperative complications: a single-centre retrospective cohort study in China

OBJECTIVE

To explore the association between perioperative SARS-CoV-2 infection and the postoperative complications during the breakout of the Omicron epidemic wave.

DESIGN

Observational retrospective cohort study. Multivariable logistic regression was performed to explore the association between the duration from surgery to COVID-19 diagnosis and the likelihood of postoperative complications.

SETTING

A general hospital in China.

PARTICIPANTS

7927 patients aged 18 years and older who underwent surgical treatment between 1 December 2022 and 28 February 2023.

PRIMARY OUTCOME MEASURES

The outcome was a composite of postoperative adverse events that occurred within the initial 30 postoperative days.

RESULTS

Of all patients, 420 (11.76%) experienced postoperative complications. Compared with No COVID-19, preoperative COVID-19 within 1 week (pre-1w) exhibited a high risk of postoperative complications (adjusted OR (aOR), 2.67; 95% CI 1.50 to 4.78), followed by patients with pre-2w (aOR, 2.14; 95% CI 1.20 to 3.80). For patients with postoperative COVID-19 within 1 week (post-1w), the aOR was 2.48 (95% CI 1.48 to 4.13), followed by patients with post-2w (aOR 1.95; 95% CI 1.10 to 3.45), and those with post-3w (aOR 2.25; 95% CI 1.27 to 3.98). The risks of postoperative complications decreased roughly with the increase of the time interval between the surgery date and SARS-CoV-2 infection. Stratification analyses suggested that perioperative COVID-19 increased the risk of postoperative complications in older patients, smokers, those with comorbidities or experiencing moderate or severe COVID-19 symptoms.

CONCLUSIONS

Our findings reveal a significant time-dependent relationship between perioperative COVID-19 and postoperative complications, highlighting the importance of tailored preoperative risk evaluations, enhanced postoperative surveillance, and the implementation of effective postoperative COVID-19 prevention measures.

TRIAL REGISTRATION NUMBER

ChiCTR2300072473.

Elevated albumin: a protective factor against mortality in geriatric hip fracture patients

INTRODUCTION

To evaluate the association between albumin concentration at admission and mortality in elderly patients with hip fractures.

METHODS

Elderly patients with hip fractures were screened between Jan 2015 and Sep 2019. Demographic and clinical characteristics of the patients were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between albumin concentration at admission and mortality. All analyses were performed using EmpowerStats and the R software.

RESULTS

This retrospective cohort study included 2387 patients who met the study criteria. The mean follow-up was 37.64 months. The albumin concentration was 37.72 ± 4.03 g/L. Multivariate Cox regression showed that albumin concentration was associated with mortality in geriatric patients with hip fracture (Hazard Ratio [HR] = 0.94, 95% confidence intervals [CI]:0.92-0.96, P < 0.0001). Compared to the low albumin group (< 35 g/L), the medium group (≥ 35 g/L and < 40 g/L) decreased mortality risk by 29% (HR = 0.71, 95%CI:0.59-0.86, P = 0.0003), and the high group (≥ 40 g/L) decreased mortality risk by 38% (HR = 0.62, 95%CI:0.49-0.79, P < 0.0001). In addition, the test for a linear trend (P for trend) also showed a linear correlation in the different models. No saturation or threshold effect was observed in the nonlinear association. The sensitivity analysis used propensity score matching, and the results were stable.

CONCLUSION

The albumin concentrations at admission were associated with mortality in geriatric hip fractures, and it could be considered a predictor for the risk of mortality. (ChiCTR2200057323).

Comparison of carpal tunnel release with double mini-incision approach and traditional approach: A retrospective study

The aim of this study was to investigate the safety and efficacy of the double mini-incision approach, and to clarify its surgical details. We retrospectively enrolled 82 patients with primary carpal tunnel syndrome. Among them, 30 patients with conventional approach were enrolled in group A, and the other 52 patients with double mini-incision approach were enrolled in group B. Objective tests were performed on patients, and basic information and subjective evaluation of patients were collected. The surgical effects and complications of the 2 approaches were compared. In addition, the surgical details of double mini-incision were further explored. The incision length of group B (26.1 ± 6.1 mm) was significantly shorter than that of group A (45.7 ± 5.9 mm, P ＜ .001). Patients in group B (93.7 ± 5.4) had significantly higher satisfaction with incision appearance than those in group A (84.3 ± 6.1, P ＜ .001). At the 12-month follow-up, no statistically significant difference in clinical outcomes were observed between the 2 groups (P > .05). However, there were 2 cases with wound pain and 1 case with pillar pain in group A, but none in group B. Two patients in group B who underwent the distal incision 1st were transferred to the conventional approach because of the epineurium and perineurium injury. The double mini-incision approach offers a sufficient range of release and surgical field, resulting in favorable surgical outcomes. The proximal incision made 1st helps to reduce the risk of nerve injury.

AMPEC4: Naja ashei Venom-Derived Peptide as a Stimulator of Fibroblast Migration with Antibacterial Activity

The treatment of proctological conditions, including hemorrhoids, anal fissures, and perianal abscesses, is often complicated by bacterial infections, particularly those involving multidrug-resistant Escherichia coli. This study presents the synthesis, characterization, and biological evaluation of the newly designed synthetic peptide AMPEC4, inspired by cytotoxin 5 from Naja ashei snake venom. AMPEC4 demonstrated potent antimicrobial properties with MIC values of 100 and 200 µg/mL, effectively inhibiting biofilm formation (up to 84%) and eradicating the pre-formed biofilm by up to 35%. The antibacterial activity of AMPEC4 was further supported by a membrane permeabilization assay, demonstrating its capacity to disrupt bacterial membrane integrity in a dose-dependent manner. Furthermore, AMPEC4 significantly promoted fibroblast migration, a critical step in tissue regeneration, while exhibiting notable biocompatibility, as evidenced by the absence of hemolytic, cytotoxic, and genotoxic effects. By addressing both infection control and tissue regeneration, AMPEC4 represents a promising therapeutic strategy for managing chronic wounds, particularly in the challenging environment of the anorectal region. Its ability to target Escherichia coli reference and clinical strains while accelerating the wound-healing process underscores its potential for future clinical applications.