European Surgical Research最新文献

Introduction The shortage of donor grafts for kidney transplantation remains a critical challenge. En bloc kidney transplantation (EBKT) from small deceased pediatric donors can potentially expand the donor pool. This study aimed to investigate the safety of pediatric-donor EBKT in adults compared with the standard deceased kidney transplantation (SDKT). Methods This retrospective study was performed to compare outcomes after pediatric-donor EBKT (n = 17; donor weight, 9.8  4.0 kg) and SDKT (n = 72; donor weight, 79.6  18.4 kg) in adult recipients at our center. Outcomes of EBKT from donors weighing 10 kg were compared with those from donors weighing ≥10 kg. The primary outcome was death-censored graft survival. Secondary outcomes included patient survival, serum creatinine, and the incidence of postoperative complications. Results The death-censored graft survival rates at 1, 5, and 10 years were 0.86 ± 0.09, 0.86 ± 0.09, and 0.86 ± 0.09, respectively, for pediatric-donor EBKTs, and 0.84 ± 0.05, 0.76 ± 0.07, and 0.64 ± 0.13, respectively, for SDKTs (P > 0.05). The patient survival rates at 1, 5, and 10 years were 0.93 ± 0.06, 0.67 ± 0.16, and 0.24 ± 0.20, respectively, for pediatric-donor EBKTs, and 0.86 ± 0.04, 0.60 ± 0.08, and 0.42 ± 0.10, respectively, for SDKTs (P > 0.05). No significant differences were observed between pediatric-donor EBKT and SDKT groups in postoperative complications (P > 0.05). Subgroup analysis of pediatric-donor EBKT by donor body weight revealed no significant differences (P > 0.05) in long-term graft and patient survival. Conclusion Pediatric-donor EBKT in adults is a safe approach, with outcomes comparable to those of SDKT in our study. Moreover, EBKT from donors weighing <10 kg demonstrated comparable long-term graft and patient survival to that from donors weighing ≥10 kg. Considering the small sample size and the increased mortality observed over time, further research involving larger cohorts is necessary to validate these findings and to refine criteria for optimal recipient selection.

Purpose: To identify independent risk factors for bile leakage and incisional infection after choledocholithotomy and to explore the potential association between bile leakage and incisional infection.

Methods: A retrospective study was conducted on 621 patients who underwent laparoscopic or open choledocholithotomy combined with cholecystectomy between January 2017 and October 2024. Clinical data were collected, and univariate analysis followed by binary logistic regression was used to identify independent risk factors for postoperative bile leakage and incisional infection.

Results: Bile leakage occurred in 60 patients (9.7%). Multivariate analysis showed that open surgery (OR = 1.672), acute biliary inflammation (OR = 2.469), advanced age (OR = 1.061), continuous suturing (OR = 4.991), prolonged operative time (OR = 1.005), and bile pathogen infection (OR = 2.37) were independent risk factors (all P < 0.05). Among 181 patients who underwent open or converted surgery, 40 (22.1%) developed incisional infections. Independent risk factors for incisional infection included advanced age (OR = 1.055), prolonged operation time (OR = 1.006), elevated postoperative WBC count within 24 hours (OR = 1.149), emergency surgery (OR = 3.745), longer incision length (OR = 1.141), and postoperative bile leakage (OR = 14.027) (all P < 0.05), indicating a strong association between bile leakage and subsequent wound infection.

Conclusion: Open surgery, acute inflammation, older age, continuous suturing, and intra-biliary infection significantly increase the risk of postoperative bile leakage. Moreover, bile leakage was identified as a strong independent predictor of incisional infection. In addition, prolonged operative time, elevated early postoperative leukocyte count, emergency surgery, and longer incisions were also associated with increased infection risk.

Introduction: Pressure injuries (PIs) in patients with diabetes mellitus (DM) still impacts patients' health and places a heavy burden on healthcare systems. Stage I and stage II PIs are particularly prevalent among individuals with diabetes. Without timely and appropriate interventions, these injuries can progress to more severe stages, requiring prolonged recovery periods. Thus, the development of preclinical animal models that can mimic stage I or II pressure injuries in diabetic patients is urgently needed to understand the mechanisms of injury formation and healing.

Methods: In this study, magnets were used to compress the dorsal sides of mice for 2 hours (h), 4 h, 8 h, or 16 h according to the ischaemia-reperfusion principle, and the changes in compressed skin in diabetic (db/db) and nondiabetic (WT) mice were compared at different ischaemia exposure times and cycle times.

Results: After 2 h of ischemia, there was no significant injury in WT and db/db mice. On the third day following 4 h of ischemia, both db/db and WT mice exhibited characteristics resembling human stage II pressure injuries, with damage primarily confined to the epidermis and upper dermis. Ischemia durations of 8 and 16 h resulted in more severe full-thickness skin defects, including exposed subcutaneous adipose tissue and inward contraction of wound margins. After ischaemia (I) for 4 h and reperfusion (R) for 24 h, the morphology of fibroblasts in the compressed skin area of db/db mice changed, and the expression of TGF-β1 decreased significantly compared with those in WT mice. On day 5, epidermal-dermal separation and pronounced infiltration of inflammatory cells were evident in both groups. On day 10, db/db mice exhibited delayed wound closure, as well as impaired regeneration of the panniculus carnosus and dermis, with significantly decreased mRNA levels of VEGF and HSP90.

Conclusion: Ischaemia lasting 4 h is the appropriate duration for generating stage II pressure injuries in diabetic mice, which may be applicable to generate a reproducible model of stage II pressure injury caused by ischaemia-reperfusion injury. This model offers a valuable experimental tool for in-depth investigation of the pathogenesis of diabetic pressure injuries and for the development of novel therapeutic strategies.

Banna miniature inbred pigs (BNs) are highly inbred strains derived from Diannan miniature pigs (DNs) through full-sibling or parent‒offspring mating protocols developed in 1980. BNs could be potentially used as organ donors for xenotransplantation, but the biological characteristics of BNs have not yet been systematically reported. In this study, the body growth, organ development, reproductive performance, and blood chemistry of BNs were evaluated and compared with those of Göttingen minipigs (GMs) and other Chinese native mini-pig breeds to provide a fundamental basis for their application. The results revealed that the birth weight of BNs was 0.49±0.12 kg and that the body weight at 6 months of age was less than 30 kg. From 4 months of age, the body weight of BN sows was significantly greater than that of boars (P<0.05), which remained consistent until 10 months of age. The ages of the sexual and body maturity of BNs was 4~5 and 10 months, respectively. The number of live piglets per litter, birth weight, weaning weight, litter weight at birth, and weaning weight were significantly lower than those of DNs (P<0.01). The physiological parameters of BNs, including hematocrit, mean cell volume, hemoglobin concentrations, reticulocyte count, basophils, platelet count, and fibrinogens, and the biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total protein, albumin, total bilirubin, carbamide, creatinine, triglyceride, total cholesterol, lactate dehydrogenase, glucose, and ion levels, were significantly different from those of GMs. Organ weights and coefficients for different ranges of body weights were obtained. The reference values of the blood physiological and biochemical parameters of BNs were established, and some indices were different from those of GMs and other breeds. This information could be helpful in selecting BNs for preclinical and clinical trials of xenotransplantation, thereby promoting their application in biomedical research.

Background: Videos of clinical interventions (VoCIs) demonstrating surgical and interventional procedures have become a mainstay in clinical practice and peer-reviewed academic literature. Despite the widespread availability of VoCI in the literature, there remain no established guidelines regarding the reporting of VoCI. We undertook a scoping review to investigate the current utilisation, application, and quality in VoCI reporting.

Summary: A comprehensive literature search of Medline, Embase, Emcare, and CINAHL databases was performed to retrieve articles presenting VoCI, from January 2020 to December 2023. A customised data extraction tool assessed video characteristics (e.g., case presentation, outcomes), utility (e.g., target audience, reproducibility of procedure), and quality (subjective and objective). A total of 624 VoCIs were included (mean length 06:06), with over 62 h of VoCI reviewed. The most common VoCI perspectives were endoscopic (n = 153; 25%) and laparoscopic (n = 140; 22%). The clinical background and outcomes were described in 480 (76.9%) and 403 cases (64.6%), respectively, with disclosures (n = 23; 3.8%) rarely presented. VoCI primarily targeted trainees (n = 547; 87.7%) with most videos providing technical guidance (n = 394; 63.1%). In total, 248 videos (40%) were rated as medium or low quality on subjective assessment.

Key messages: There are significant heterogeneity and notably poor-quality control in VoCI reporting in peer-reviewed literature resulting in the omission of critical procedural steps and suboptimal visual quality. VoCI reporting guidelines are therefore urgently required to provide a set of minimum items that should be reported by clinicians when uploading VoCI.

Background: Nonhuman primates (NHPs) play a unique role in translational science by bridging the gap between basic and clinical investigations and are often seen as a last step before clinical application. They are widely utilized in biomedical research due to their anatomical and physiological similarities to humans. Examples of commonly used species include the genera Macaca (macaques), Papio (baboons), Aotus (owl monkeys), Callithrix (marmosets), Saimiri (squirrel monkeys), and Chlorocebus (vervet monkeys).

Summary: NHP models have played an instrumental role in the development of surgical techniques, each being balanced with a unique set of advantages and shortcomings. With the appropriate selection of species and anatomy, animal models can be used to provide insight into the pathophysiology of diseases, to confirm the feasibility of new surgery technologies, to assess the potential efficacy of new surgical techniques for specific clinical outcomes, and to establish reasonable safety of new techniques for specified clinical use. Robotics have augmented surgical precision for microinjections and a brain-spine robotic interface used in gait restoration, illustrating the translational potential of NHP models in human neurological research. Recent studies highlight protocols for procedures such as tubectomy and spinal cord access with minimal postoperative risk, expanding surgical possibilities.

Key messages: This review provides an overview of the recent advancements made in surgery in NHP models and the translation of these techniques to the clinical setting. Surgical refinements not only enhance animal welfare but also improve the quality of experimental outcomes. The integration of robotics, imaging, and personalized approaches signifies a transformative shift in NHP surgical models, encouraging collaboration among veterinary and research staff for continuous progress.

Introduction: Appendicolith can be incidentally detected on abdominal computer tomography (CT) without any signs of appendicitis. However, it has also been found to be a risk factor for failure of nonoperative management in acute appendicitis. The present retrospective study aimed to evaluate whether appendicolith predicts complicated appendicitis in patients with any appendicitis.

Methods: A retrospective chart review was conducted for patients undergoing appendectomy from January 2016 to December 2018. Appendicolith was considered to be present when it was described in a CT scan.

Results: Of the 267 patients, appendicolith was found in 120 cases, while there were no in 147 cases in preoperative CT scans. In the case of complicated appendicitis (gangrenous or gangrenous perforated appendicitis), appendicolith was visible in CT scans in 57.7% of the patients. Of the patients with uncomplicated appendicitis, 38.3% had appendicolith in CT scan (p = 0.002). In univariate logistic regression analysis, based on the finding of the histological specimen, appendicolith was associated with complicated appendicitis (OR: 2.12; 95% CI: 1.28-3.51; p = 0.004). When adjusting for sex, age group (age ≤50 vs. >50 years), and duration of symptoms (≤24 vs. >24 h), the odds ratio was 3.52 (95% CI: 1.88-6.58; p < 0.001).

Conclusion: Our study found that appendicolith can be considered an independent risk factor for complicated appendicitis. Therefore, in the presence of appendicolith, surgical treatment should probably be preferred over nonsurgical treatment in acute appendicitis.

Background: Because rodents are too small to perform surgical procedures on people, large mammals are frequently required for surgical studies. Because of its similar overall anatomy and physiology, the pig has a very high translational value and is thus frequently used as the first choice in surgical research.

Summary: In cardiovascular treatments, it helped design stents, improve coronary bypass grafting, and perform heart valve xenotransplants. Future efforts will be concentrated on improving the models and, as a result, the trustworthiness of the preclinical findings. Pigs have been used in gastro-intestinal surgery for a variety of purposes, including the development of meshes for abdominal defect repair and the enhancement of surgical methods aimed at compensating functional impairments. A special application has been made in liver regeneration and transplantation procedures, which have promising future prospects, as well as in metabolic surgical research for metabolic illness interventional treatment. Pigs have mostly been used in endocrine surgery to develop pancreatic and islets transplantation for type 1 diabetes therapy, with little research on the other glands. Osteoarticular and neurosurgery are two fields where the pig is increasingly being used: for ethical reasons rather than non-human primate models in neurosurgery, and because this species' rapid growth allows for the testing of the biomechanical properties of orthopedic devices in the context of skeletal growth. In general, the pig has a current and future role in testing novel surgical equipment or bioengineering solutions, establishing new minimally invasive techniques, and training in robotic surgery, regardless of discipline. Finally, pig-to-human organ xenotransplantation poses a significant translational surgical hurdle. If the research has reached a milestone with some alive patients receiving heart or kidney transplants from pigs with various genetic alterations, more evidence is needed to demonstrate the safety and long-term effectiveness of the procedure, as well as to expand it to other organs such as the liver.

Key messages: In conclusion, the pig model has resulted in significant breakthroughs in surgical research, with future prospects centered mostly on xenotransplantation. The use of the pig in biomedical research will have to deal with rising societal ethical standards.