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Advancing aesthetic outcomes: A critical analysis of autologous free flap reconstruction post-minimally invasive mastectomy. 提高美学效果:对微创乳房切除术后自体游离皮瓣重建的批判性分析。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-08 DOI: 10.1097/JS9.0000000000002087
Qirui Guo, Mohan Liu, Yan Li, Qiang Sun
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引用次数: 0
Establishment and characterization of a rat model of scalp-cranial composite defect for multilayered tissue engineering. 用于多层组织工程的头皮-颅骨复合缺损大鼠模型的建立和特征描述。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-07 DOI: 10.1097/JS9.0000000000002108
Yi Zhu, Ou Mei, Hui Zhang, Wulin You, Jiamin Zhong, Caralyn P Collins, Guowei Shen, Changqi Luo, Xingye Wu, Jingjing Li, Yi Shu, Ya Wen, Hue H Luu, Lewis L Shi, Jiaming Fan, Tong-Chuan He, Guillermo A Ameer, Cheng Sun, Liangyuan Wen, Russell R Reid
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引用次数: 0
Effect of occlusion site on the effectiveness and safety of endovascular thrombectomy for large ischemic cores: A cohort study. 闭塞部位对血管内血栓切除术治疗大面积缺血核心的有效性和安全性的影响:一项队列研究。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-03 DOI: 10.1097/JS9.0000000000002102
Shihai Yang, Lele Wu, Xiaolei Shi, Changwei Guo, Chengsong Yue, Shitao Fan, Jie Yang, Jiaxing Song, Dongsheng Ye, Xu Xu, Zhouzhou Peng, Linyu Li, Jiandi Huang, Chang Liu, Jiacheng Huang, Nizhen Yu, Yan Tian, Jinfu Ma, Dahong Yang, Weilin Kong, Zhixi Wang, Wenzhe Sun, Qingwu Yang, Boyu Chen, Wenjie Zi

Background: Recent clinical trials have shown that patients with large ischemic cores have better outcomes with endovascular thrombectomy (EVT) compared with standard medical treatment (SMT) alone.We aim to assess whether the relationship between EVT and improvements in clinical outcomes varies depending on the location of the occlusive sites.

Methods: This study is a subgroup analysis conducted within a prospective, nationwide, multi-center registry. The cohort included patients with acute large vessel occlusion in the anterior circulation and an Alberta Stroke Program Early Computed Tomography Score of 0 to 5 within 24 hours from last known well. We utilized the adjusted common odds ratio for a shift toward better outcome on the modified Rankin Scale after EVT compared with SMT alone as the primary outcome. Safety outcomes included symptomatic intracranial hemorrhage (sICH).

Results: A total of 745 patients with large ischemic cores were included: 272(36.5%) with internal carotid artery occlusion, 392(52.6%) with M1 segment of the middle cerebral artery occlusion, and 81(11.0%) with M2 segment of the middle cerebral artery occlusion. The adjusted common odds ratios were as follows: 1.98 (95% CI, 1.01-3.89) for ICA occlusions, 2.09 (95% CI, 1.35-3.23) for M1 occlusions, and 1.13 (95% CI, 0.43-2.94) for M2 occlusions. There was no significant treatment-by-occlusion site interaction observed (P=0.69). However, the incidence of sICH was significantly greater in all groups receiving EVT than in those receiving SMT alone. Additionally, we observed that the secondary outcomes and subgroup analyses were generally consistent with the main outcomes.

Conclusions: In this study, we found that patients with internal carotid artery and M1 occlusion demonstrated a better outcome with EVT, while the benefit for patients with M2 occlusion remains uncertain.

背景:最近的临床试验表明,大面积缺血核心的患者接受血管内血栓切除术(EVT)与单纯的标准药物治疗(SMT)相比,疗效更好:本研究是在一项前瞻性、全国性、多中心登记中进行的亚组分析。研究对象包括前循环急性大血管闭塞、阿尔伯塔省卒中项目早期计算机断层扫描评分为 0 至 5 分的患者,这些患者均在 24 小时内死亡。我们将EVT后改良Rankin量表结果转好的调整后常见几率作为主要结果,而不是单纯的SMT。安全性结果包括症状性颅内出血(sICH):结果:共纳入了745名有大面积缺血核心的患者:结果:共纳入了 745 例有大缺血核心的患者:272 例(36.5%)颈内动脉闭塞,392 例(52.6%)大脑中动脉 M1 段闭塞,81 例(11.0%)大脑中动脉 M2 段闭塞。调整后的共同几率如下ICA闭塞为1.98(95% CI,1.01-3.89),M1闭塞为2.09(95% CI,1.35-3.23),M2闭塞为1.13(95% CI,0.43-2.94)。没有观察到治疗与闭塞部位之间的明显交互作用(P=0.69)。然而,所有接受EVT治疗组的sICH发生率都明显高于单纯接受SMT治疗组。此外,我们观察到次要结果和亚组分析与主要结果基本一致:在这项研究中,我们发现颈内动脉和M1闭塞患者接受EVT治疗的疗效更好,而M2闭塞患者的获益仍不确定。
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引用次数: 0
Clinical utility of extracorporeal shock wave therapy in restoring hand function of patients with nerve injury and hypertrophic scars due to burns: A prospective, randomized, double-blinded study. 体外冲击波疗法在恢复烧伤所致神经损伤和增生性疤痕患者手部功能方面的临床效用:一项前瞻性、随机、双盲研究。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/JS9.0000000000002103
Seung Yeol Lee, Yoon Soo Cho, Cheong Hoon Seo, Jisu Seo, So Young Joo

Background: Joint contractures and nerve injuries are common after hand burns. Extracorporeal shock wave therapy (ESWT) is effective not only for the regeneration of various tissues, including scar tissues, but also for reducing pain and pruritus in patients with burns. Researchers have attempted to explore the effects of ESWT on hand dysfunction caused by nerve injury following burns.

Materials and methods: We evaluated the effects of ESWT (compared to sham stimulation) on hands with nerve injury and hypertrophic scars and thereby on hand function. The current study was a double-blind randomized controlled trial involving 120 patients. The ESWT parameters were as follows: energy flux density, 0.05-0.30 mJ/mm2; frequency, 4 Hz; 1000 to 3000 impulses per treatment; and 12 treatments, one/week for 12 weeks. Outcome measures were as follows: 10-point visual analog scale for pain, Jebsen-Taylor hand function test, grip strength, Purdue Pegboard test, ultrasound measurement of scar thickness, and skin characteristics before and immediately after 12 weeks of treatment.

Results: No significant inter-group difference was noted after the initial evaluation (P>0.05). More significant improvements were found in the ESWT group than in the sham group in terms of the VAS score (P=0.004), extension ROMs of hand joints (P=0.02), the JTT scores (writing, small, and light) (P<0.001, P<0.001, and P=0.002), and skin characteristics (melanin, skin distensibility, and biologic skin elasticity) (P=0.004, P<0.001, and P<0.001). Other measured outcomes did not differ between the two groups after the treatment.

Conclusion: We identified the clinically beneficial effects of ESWT in promoting hand function, improving scarring, and alleviating scarring-related pain, thereby highlighting its advantages in improving hand function that has been impaired due to nerve injury and hypertrophic scars after burns.

背景:手部烧伤后常见关节挛缩和神经损伤。体外冲击波疗法(ESWT)不仅能有效促进包括瘢痕组织在内的各种组织的再生,还能减轻烧伤患者的疼痛和瘙痒。研究人员试图探索 ESWT 对烧伤后神经损伤引起的手部功能障碍的影响:我们评估了 ESWT(与假刺激相比)对神经损伤和增生性疤痕手部的影响,以及对手部功能的影响。本研究是一项双盲随机对照试验,共有 120 名患者参与。ESWT 的参数如下:能量通量密度为 0.05-0.30 mJ/mm2;频率为 4 Hz;每次治疗 1000 到 3000 个脉冲;治疗 12 次,每周一次,持续 12 周。结果测量如下10 分疼痛视觉模拟量表、捷布森-泰勒手部功能测试、握力、普渡佩格板测试、超声波测量疤痕厚度以及治疗前和治疗 12 周后的皮肤特征:初步评估后,组间差异不明显(P>0.05)。在 VAS 评分(P=0.004)、手部关节伸展 ROM(P=0.02)、JTT 评分(书写、小和轻)(PConclusion)方面,ESWT 组比假体组有更明显的改善:我们确定了 ESWT 在促进手部功能、改善瘢痕和减轻瘢痕相关疼痛方面的临床有益效果,从而凸显了 ESWT 在改善烧伤后因神经损伤和增生性瘢痕而受损的手部功能方面的优势。
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引用次数: 0
Mapping the evolution of 3D printing in cardio-thoracic diseases: a global bibliometric analysis. 3D打印技术在心胸疾病领域的发展:全球文献计量分析。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/JS9.0000000000002095
Jie Tian, Ying-Xian Dong, Li Wang, Yong-Ming Wu, Zi-Yi Zhao, Guo-Wei Che

Background: Despite the growing research on 3D printing (3DP) in cardio-thoracic diseases, comprehensive bibliometric analyses remain scarce. This study aims to bridge this gap by identifying key research trends and hotspots within the field.

Methods: A bibliometric analysis was conducted on publications from 1991 to 2024 using data from the Web of Science Core Collection, with analysis performed using VOSviewer, CiteSpace, and the R package 'bibliometrix'.

Results: The analysis included 2,836 documents authored by 14,206 researchers across 85 countries. A significant rise in annual publications was observed, with the United States, China, and the United Kingdom leading in contributions. Prominent institutions, including Stanford University, were highlighted, while Scientific Reports and Biomaterials were identified as influential journals. Key research areas encompass cardiovascular, lung, and breast diseases, along with chest wall reconstructions, with emerging trends focusing on advanced materials for drug delivery and tissue engineering.

Conclusion: This comprehensive bibliometric analysis of 3DP in cardio-thoracic diseases reveals global research trends, emerging themes, and the crucial role of 3DP in advancing medical education and personalized treatment, highlighting areas for future research and development.

背景:尽管3D打印(3DP)在心胸疾病方面的研究日益增多,但全面的文献计量分析仍然很少。本研究旨在通过确定该领域的主要研究趋势和热点来弥补这一差距:利用科学网核心数据库中的数据对 1991 年至 2024 年间的出版物进行了文献计量分析,并使用 VOSviewer、CiteSpace 和 R 软件包 "bibliometrix "进行了分析:分析包括 85 个国家 14206 名研究人员撰写的 2836 篇文献。年发表论文量大幅上升,其中美国、中国和英国的贡献率最高。包括斯坦福大学在内的著名机构受到了关注,而《科学报告》和《生物材料》则被认定为有影响力的期刊。主要研究领域包括心血管、肺部和乳腺疾病以及胸壁重建,新兴趋势则集中在用于药物输送和组织工程的先进材料上:这篇关于心胸疾病中 3DP 的综合性文献计量分析揭示了全球研究趋势、新兴主题以及 3DP 在推进医学教育和个性化治疗方面的关键作用,并强调了未来研究和发展的领域。
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引用次数: 0
Multi-site DNA methylation alterations of peripheral blood mononuclear cells serve as novel biomarkers for the diagnosis of AIS/stage I lung adenocarcinoma: A multi-center cohort study. 外周血单核细胞的多位点DNA甲基化改变可作为诊断AIS/I期肺腺癌的新型生物标记物:一项多中心队列研究。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/JS9.0000000000002101
Peilong Li, Shibiao Liu, Tiantian Wang, Fang Wang, Juan Li, Qiuchen Qi, Shujun Zhang, Yan Xie, Jianping Li, Yongcai Zhu, Suli Yang, Guotao Yin, Xiaoyi He, Shijun Li, Huiting Xu, Mengqiu Xiong, Guanghua Li, Yi Zhang, Lutao Du, Chuanxin Wang

Background: Early diagnosis remains an obstacle for improving the outcome of lung adenocarcinoma (LUAD). DNA methylation changes in peripheral blood mononuclear cells (PBMCs) could reflect immune response to tumorigenesis, providing the theoretical basis for early cancer diagnosis based on immune cell profiling.

Methods: This multi-center study evaluated the DNA methylation patterns based on PBMCs samples from 1115 individuals at nine medical centers. Genome-wide DNA methylation profiling of PBMCs in a discovery cohort (35 LUAD patients and 50 healthy controls) was performed using Illumina 850K microarray. Candidate differentially methylated CpG positions (DMPs) were selected and validated in a two-step DMPs screening cohort (65 LUAD patients and 80 healthy controls) by pyrosequencing and multiple target region methylation enrichment sequencing (MTRMES). Then, an early LUAD Diagnostic Panel (LDP score) based on multi-site methylation-specific chip-based digital PCR was constructed in a training set and then confirmed in a validation set from the LDP score development cohort (389 AIS/stage I LUAD patients and 293 healthy controls). Besides, we included 157 other cancer patients, including 52 gastric cancer (GC) patients, 50 breast cancer (BC) patients, and 55 colorectal cancer (CRC) patients to assess the specificity of LDP score. In addition, we also evaluated the early warning ability of LDP score for LUAD in a prospective cohort (46 people who were at high-risk of developing LC).

Results: A total of 1415 LUAD-specific DMPs were identified. Then, six DMPs were selected for validation and three DMPs were finally verified. The LDP score was constructed by combining the three DMPs, age, and gender, and showed an AUC of 0.916, sensitivity of 88.17%, and specificity of 80.20% in combined set, outperforming traditional methods, such as CEA and CT (detection rate: 87.79% vs. 4.69%; 87.79% vs. 35.21%). This diagnostic performance was confirmed in sub-types of LUAD with clinical challenges, such as 6-20 mm LUAD (AUC: 0.914, 95%CI: 0.889-0.934) and ground-glass nodules (AUC: 0.916, 95%CI: 0.889-0.938). Importantly, our LDP score had significant improvement in terms of selecting high-risk individuals who should receive low-dose computed tomography (87.80% vs. 9.28%). Remarkably, LDP score could predict LUAD around two years before clinical diagnosis in our prospective cohort.

Conclusions: The novel developed LDP score represented a convenient and effective assay for the detection of AIS/stage I LUAD with high sensitivity and specificity, and had demonstrated unique advantages over traditional detection methods.

背景:早期诊断仍然是改善肺腺癌(LUAD)预后的障碍。外周血单核细胞(PBMCs)中的 DNA 甲基化变化可反映肿瘤发生过程中的免疫反应,从而为基于免疫细胞图谱的癌症早期诊断提供理论依据:这项多中心研究根据九个医疗中心 1115 人的 PBMCs 样本评估了 DNA 甲基化模式。使用 Illumina 850K 芯片对发现队列(35 名 LUAD 患者和 50 名健康对照)中的 PBMCs 进行了全基因组 DNA 甲基化分析。通过热释光测序和多靶区甲基化富集测序(MTRMES),在两步DMPs筛选队列(65名LUAD患者和80名健康对照)中筛选并验证了候选的差异甲基化CpG位点(DMPs)。然后,在训练集中构建了基于多位点甲基化特异性芯片数字 PCR 的早期 LUAD 诊断面板(LDP 评分),并在 LDP 评分开发队列(389 名 AIS/ I 期 LUAD 患者和 293 名健康对照)的验证集中进行了确认。此外,我们还纳入了 157 例其他癌症患者,包括 52 例胃癌(GC)患者、50 例乳腺癌(BC)患者和 55 例结直肠癌(CRC)患者,以评估 LDP 评分的特异性。此外,我们还在一个前瞻性队列(46名LC高危人群)中评估了LDP评分对LUAD的早期预警能力:结果:共发现了 1415 个 LUAD 特异性 DMPs。结果:共鉴定出 1415 个 LUAD 特异性 DMPs,然后选择了 6 个 DMPs 进行验证,最终验证了 3 个 DMPs。结合三个 DMPs、年龄和性别构建了 LDP 评分,其 AUC 为 0.916,灵敏度为 88.17%,特异度为 80.20%,优于 CEA 和 CT 等传统方法(检出率:87.79% 对 4.69%;87.79% 对 35.21%)。这种诊断性能在具有临床挑战的 LUAD 亚型中得到了证实,如 6-20 mm LUAD(AUC:0.914,95%CI:0.889-0.934)和磨玻璃结节(AUC:0.916,95%CI:0.889-0.938)。重要的是,我们的 LDP 评分在选择应接受低剂量计算机断层扫描的高危人群方面有显著改善(87.80% 对 9.28%)。值得注意的是,在我们的前瞻性队列中,LDP评分可以在临床诊断前两年左右预测LUAD:结论:新开发的 LDP 评分是检测 AIS/ I 期 LUAD 的一种方便有效的检测方法,具有很高的灵敏度和特异性,与传统的检测方法相比具有独特的优势。
{"title":"Multi-site DNA methylation alterations of peripheral blood mononuclear cells serve as novel biomarkers for the diagnosis of AIS/stage I lung adenocarcinoma: A multi-center cohort study.","authors":"Peilong Li, Shibiao Liu, Tiantian Wang, Fang Wang, Juan Li, Qiuchen Qi, Shujun Zhang, Yan Xie, Jianping Li, Yongcai Zhu, Suli Yang, Guotao Yin, Xiaoyi He, Shijun Li, Huiting Xu, Mengqiu Xiong, Guanghua Li, Yi Zhang, Lutao Du, Chuanxin Wang","doi":"10.1097/JS9.0000000000002101","DOIUrl":"10.1097/JS9.0000000000002101","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis remains an obstacle for improving the outcome of lung adenocarcinoma (LUAD). DNA methylation changes in peripheral blood mononuclear cells (PBMCs) could reflect immune response to tumorigenesis, providing the theoretical basis for early cancer diagnosis based on immune cell profiling.</p><p><strong>Methods: </strong>This multi-center study evaluated the DNA methylation patterns based on PBMCs samples from 1115 individuals at nine medical centers. Genome-wide DNA methylation profiling of PBMCs in a discovery cohort (35 LUAD patients and 50 healthy controls) was performed using Illumina 850K microarray. Candidate differentially methylated CpG positions (DMPs) were selected and validated in a two-step DMPs screening cohort (65 LUAD patients and 80 healthy controls) by pyrosequencing and multiple target region methylation enrichment sequencing (MTRMES). Then, an early LUAD Diagnostic Panel (LDP score) based on multi-site methylation-specific chip-based digital PCR was constructed in a training set and then confirmed in a validation set from the LDP score development cohort (389 AIS/stage I LUAD patients and 293 healthy controls). Besides, we included 157 other cancer patients, including 52 gastric cancer (GC) patients, 50 breast cancer (BC) patients, and 55 colorectal cancer (CRC) patients to assess the specificity of LDP score. In addition, we also evaluated the early warning ability of LDP score for LUAD in a prospective cohort (46 people who were at high-risk of developing LC).</p><p><strong>Results: </strong>A total of 1415 LUAD-specific DMPs were identified. Then, six DMPs were selected for validation and three DMPs were finally verified. The LDP score was constructed by combining the three DMPs, age, and gender, and showed an AUC of 0.916, sensitivity of 88.17%, and specificity of 80.20% in combined set, outperforming traditional methods, such as CEA and CT (detection rate: 87.79% vs. 4.69%; 87.79% vs. 35.21%). This diagnostic performance was confirmed in sub-types of LUAD with clinical challenges, such as 6-20 mm LUAD (AUC: 0.914, 95%CI: 0.889-0.934) and ground-glass nodules (AUC: 0.916, 95%CI: 0.889-0.938). Importantly, our LDP score had significant improvement in terms of selecting high-risk individuals who should receive low-dose computed tomography (87.80% vs. 9.28%). Remarkably, LDP score could predict LUAD around two years before clinical diagnosis in our prospective cohort.</p><p><strong>Conclusions: </strong>The novel developed LDP score represented a convenient and effective assay for the detection of AIS/stage I LUAD with high sensitivity and specificity, and had demonstrated unique advantages over traditional detection methods.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":null,"pages":null},"PeriodicalIF":12.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Joint line convergence angle should be considered when constitutional alignment is predicted based on arithmetic hip-knee-ankle angle: a retrospective cross-sectional observational study. 根据算术髋-膝-踝角度预测宪法排列时应考虑关节线会聚角:一项回顾性横断面观察研究。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/JS9.0000000000002097
Yu-Hang Gao, Yu-Meng Qi, Pei-Hong Huang, Xing-Yu Zhao, Xin Qi

Few studies have illustrated the role of the joint line convergence angle (JLCA) in the correlation between the arithmetic hip-knee-ankle angle (aHKA) and mechanical hip-knee-ankle angle (mHKA). We aimed to determine this role and to evaluate the effect of the JLCA in predicting constitutional alignment using the aHKA. A total of 107 normal participants (214 knees) and 246 patients (477 knees) with osteoarthritis(OA) were retrospectively examined using long-leg radiographs. The formula was calculated geometrically on plain radiographs of the knee based on the relationships among the mHKA, aHKA, and JLCA, and the distribution of the JLCA between the groups was determined. The effect of the JLCA on the prediction of constitutional alignment using the aHKA were evaluated. The geometric formula was determined to be 'mHKA=180°+aHKA - JLCA', and was verified. The median (quartile 1, quartile 3) JLCA was 2.0° (1.0°, 3.5°) and 2.5° (1.0°, 4.5°) in the normal and OA groups, respectively. The JLCA affected the prediction of constitutional alignment based on the aHKA. It should be considered when constitutional alignment is predicted based on the aHKA in patients with high JLCA values.

很少有研究说明关节线会聚角(JLCA)在算术髋-膝-踝角度(aHKA)和机械髋-膝-踝角度(mHKA)之间的相关性中的作用。我们的目的是确定这一作用,并评估 JLCA 在使用 aHKA 预测宪法排列方面的效果。我们使用长腿X光片对107名正常人(214个膝关节)和246名骨关节炎(OA)患者(477个膝关节)进行了回顾性检查。根据 mHKA、aHKA 和 JLCA 之间的关系,在膝关节平片上计算出几何公式,并确定了 JLCA 在各组之间的分布情况。评估了 JLCA 对使用 aHKA 预测宪法排列的影响。几何公式确定为 "mHKA=180°+aHKA - JLCA",并进行了验证。正常组和 OA 组的 JLCA 中位数(四分位 1,四分位 3)分别为 2.0°(1.0°,3.5°)和 2.5°(1.0°,4.5°)。JLCA影响了基于aHKA的体位排列预测。在根据 aHKA 预测 JLCA 值较高的患者的体位排列时,应考虑到这一点。
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引用次数: 0
Safety and efficacy of stem cell therapy for Crohn's disease: An umbrella review of systematic reviews. 干细胞疗法治疗克罗恩病的安全性和有效性:系统综述总览。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/JS9.0000000000002104
Lakshmi Thangavelu, Syam Mohan, Hassan Ahmad Alfaifi, Abdullah Farasani, Soumya V Menon, Pooja Bansal, Chhavi Choudhary, M Ravi Kumar, Raghav Vashishth, Afrah Majeed Ahmed Al-Rihaymee, Sarvesh Rustagi, Anil K Malhotra, Muhammed Shabil, Mahalaqua Nazli Khatib, Quazi Syed Zahiruddin, Siddig Ibrahim Abdelwahab, Ganesh Bushi, Saleh Hussain A Almasabi, Hayam A Alrasheed, Ali A Rabaan

Background: Crohn's disease is a chronic, relapsing form of inflammatory bowel disease marked by severe gastrointestinal inflammation and a broad range of debilitating symptoms. Despite advances in medical treatments, achieving sustained remission remains challenging for many patients. This umbrella review aims to consolidate evidence from various systematic reviews to evaluate the efficacy and safety of stem cell therapies in treating Crohn's disease.

Methods: This review followed the Joanna Briggs Institute methodology and adhered to PRISMA guidelines. A literature search of PubMed, Web of Science, Embase, and the Cochrane Library covered records up to April 20, 2024. Only systematic reviews and meta-analyses on stem cell therapy for Crohn's disease were considered. Data were extracted and analyzed for clinical efficacy indicators like remission induction and safety metrics, including adverse events and mortality rates.

Results: Sixteen systematic reviews were included, spanning studies conducted between 2009 and 2023. Stem cell therapy showed a pooled risk ratio (RR) of 1.299 (95% CI: 1.192 to 1.420) for clinical remission, indicating a 29.9% increased likelihood of remission compared to controls. The pooled RR for healing perianal Crohn's disease was 1.358 (95% CI: 1.13 to 1.631), suggesting a 35.8% increased likelihood of healing. A pooled RR of 1.481 (95% CI: 1.036 to 2.116) shows a 48.1% higher immediate fistula closure rate with stem cell therapy. For long-term outcomes, a RR of 1.422 (95% CI: 1.091 to 1.854) indicates a 42.2% increased likelihood of maintaining closure. However, stem cell therapy did not significantly impact Crohn's Disease Activity Index (CDAI) (RR: 1.154, 95% CI: 0.193 to 6.883) and Perianal Disease Activity Index (PDAI) scores (mean difference at 12 weeks: -0.505, 95% CI: -2.481 to 1.471; mean difference at 24 weeks: -0.338, 95% CI: -1.638 to 0.963). The safety profile was comparable to conventional therapies, with a pooled RR of 0.972 (95% CI: 0.739 to 1.278) for adverse events and 1.136 (95% CI: 0.821 to 1.572) for serious adverse events.

Conclusion: Stem cell therapy offers significant progress in treating Crohn's disease, particularly in complex cases, by improving fistula closure rates and suggesting potential as a supplementary therapy. Its safety profile aligns with conventional treatments, yet ongoing clinical trials are crucial to optimize its use. Continual research will enable healthcare providers to tailor more effective treatment strategies for this challenging condition.

背景:克罗恩病是一种慢性、复发性炎症性肠病,以严重的胃肠道炎症和一系列使人衰弱的症状为特征。尽管医学治疗取得了进步,但对于许多患者来说,实现持续缓解仍是一项挑战。本综述旨在整合各种系统综述的证据,评估干细胞疗法治疗克罗恩病的疗效和安全性:本综述采用乔安娜-布里格斯研究所(Joanna Briggs Institute)的方法,并遵守PRISMA指南。PubMed、Web of Science、Embase和Cochrane图书馆的文献检索涵盖了截至2024年4月20日的记录。只考虑了有关干细胞治疗克罗恩病的系统综述和荟萃分析。提取数据并分析临床疗效指标(如缓解诱导)和安全性指标(包括不良事件和死亡率):结果:共纳入16篇系统综述,研究时间跨度为2009年至2023年。干细胞疗法的临床缓解风险比(RR)为 1.299(95% CI:1.192 至 1.420),与对照组相比,缓解的可能性增加了 29.9%。肛周克罗恩病痊愈的总RR为1.358(95% CI:1.13至1.631),表明痊愈的可能性增加了35.8%。综合RR为1.481(95% CI:1.036至2.116),显示干细胞疗法的即时瘘管闭合率提高了48.1%。长期结果的RR为1.422(95% CI:1.091至1.854),显示维持闭合的可能性增加42.2%。不过,干细胞疗法对克罗恩病活动指数(CDAI)(RR:1.154,95% CI:0.193 至 6.883)和肛周疾病活动指数(PDAI)评分(12 周时的平均差异:-0.505,95% CI:0.193 至 6.883)没有明显影响:12周时的平均差异为-0.505,95% CI:-2.481 至 1.471;24周时的平均差异为-0.338,95% CI:-2.481 至 1.471:-0.338,95% CI:-1.638 至 0.963)。安全性与传统疗法相当,不良事件的汇总RR为0.972(95% CI:0.739至1.278),严重不良事件的汇总RR为1.136(95% CI:0.821至1.572):干细胞疗法在治疗克罗恩病(尤其是复杂病例)方面取得了重大进展,提高了瘘管闭合率,并显示出作为辅助疗法的潜力。干细胞疗法的安全性与传统疗法一致,但持续的临床试验对于优化干细胞疗法的使用至关重要。持续的研究将使医疗服务提供者能够为这种具有挑战性的疾病量身定制更有效的治疗策略。
{"title":"Safety and efficacy of stem cell therapy for Crohn's disease: An umbrella review of systematic reviews.","authors":"Lakshmi Thangavelu, Syam Mohan, Hassan Ahmad Alfaifi, Abdullah Farasani, Soumya V Menon, Pooja Bansal, Chhavi Choudhary, M Ravi Kumar, Raghav Vashishth, Afrah Majeed Ahmed Al-Rihaymee, Sarvesh Rustagi, Anil K Malhotra, Muhammed Shabil, Mahalaqua Nazli Khatib, Quazi Syed Zahiruddin, Siddig Ibrahim Abdelwahab, Ganesh Bushi, Saleh Hussain A Almasabi, Hayam A Alrasheed, Ali A Rabaan","doi":"10.1097/JS9.0000000000002104","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002104","url":null,"abstract":"<p><strong>Background: </strong>Crohn's disease is a chronic, relapsing form of inflammatory bowel disease marked by severe gastrointestinal inflammation and a broad range of debilitating symptoms. Despite advances in medical treatments, achieving sustained remission remains challenging for many patients. This umbrella review aims to consolidate evidence from various systematic reviews to evaluate the efficacy and safety of stem cell therapies in treating Crohn's disease.</p><p><strong>Methods: </strong>This review followed the Joanna Briggs Institute methodology and adhered to PRISMA guidelines. A literature search of PubMed, Web of Science, Embase, and the Cochrane Library covered records up to April 20, 2024. Only systematic reviews and meta-analyses on stem cell therapy for Crohn's disease were considered. Data were extracted and analyzed for clinical efficacy indicators like remission induction and safety metrics, including adverse events and mortality rates.</p><p><strong>Results: </strong>Sixteen systematic reviews were included, spanning studies conducted between 2009 and 2023. Stem cell therapy showed a pooled risk ratio (RR) of 1.299 (95% CI: 1.192 to 1.420) for clinical remission, indicating a 29.9% increased likelihood of remission compared to controls. The pooled RR for healing perianal Crohn's disease was 1.358 (95% CI: 1.13 to 1.631), suggesting a 35.8% increased likelihood of healing. A pooled RR of 1.481 (95% CI: 1.036 to 2.116) shows a 48.1% higher immediate fistula closure rate with stem cell therapy. For long-term outcomes, a RR of 1.422 (95% CI: 1.091 to 1.854) indicates a 42.2% increased likelihood of maintaining closure. However, stem cell therapy did not significantly impact Crohn's Disease Activity Index (CDAI) (RR: 1.154, 95% CI: 0.193 to 6.883) and Perianal Disease Activity Index (PDAI) scores (mean difference at 12 weeks: -0.505, 95% CI: -2.481 to 1.471; mean difference at 24 weeks: -0.338, 95% CI: -1.638 to 0.963). The safety profile was comparable to conventional therapies, with a pooled RR of 0.972 (95% CI: 0.739 to 1.278) for adverse events and 1.136 (95% CI: 0.821 to 1.572) for serious adverse events.</p><p><strong>Conclusion: </strong>Stem cell therapy offers significant progress in treating Crohn's disease, particularly in complex cases, by improving fistula closure rates and suggesting potential as a supplementary therapy. Its safety profile aligns with conventional treatments, yet ongoing clinical trials are crucial to optimize its use. Continual research will enable healthcare providers to tailor more effective treatment strategies for this challenging condition.</p>","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":null,"pages":null},"PeriodicalIF":12.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three-dimensional adipose-derived stem cell spheroids enhance adipogenesis and angiogenesis in fat grafts: Experimental research. 三维脂肪源性干细胞球增强脂肪移植中的脂肪生成和血管生成:实验研究。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/JS9.0000000000002100
Sang-Oh Lee, Bo-Yoon Park, Tiep Tien Nguyen, Kyoo-Ri Kwon, Mi-Jin Kim, Hae Young Yang, Jay Kim, Jee-Heon Jeong, Il-Kug Kim
{"title":"Three-dimensional adipose-derived stem cell spheroids enhance adipogenesis and angiogenesis in fat grafts: Experimental research.","authors":"Sang-Oh Lee, Bo-Yoon Park, Tiep Tien Nguyen, Kyoo-Ri Kwon, Mi-Jin Kim, Hae Young Yang, Jay Kim, Jee-Heon Jeong, Il-Kug Kim","doi":"10.1097/JS9.0000000000002100","DOIUrl":"https://doi.org/10.1097/JS9.0000000000002100","url":null,"abstract":"","PeriodicalId":14401,"journal":{"name":"International journal of surgery","volume":null,"pages":null},"PeriodicalIF":12.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
In-depth cerebrovascular lipidomics profiling for discovering novel biomarkers and mechanisms in moyamoya and intracranial atherosclerotic disease. 深入脑血管脂质组学分析,发现莫亚莫亚和颅内动脉粥样硬化疾病的新型生物标记物和机制。
IF 12.5 2区 医学 Q1 SURGERY Pub Date : 2024-10-01 DOI: 10.1097/JS9.0000000000002092
Kangmin He, Xinmei Wang, Yu Gu, Xiao Tong, Xuanfeng Qin, Yujun Liao, Li-Hao Huang, Jiaxi Wang, Bin Xu

Background: Despite considerable research efforts, the precise etiology and underlying pathways contributing to Moyamoya Disease (MMD) remain poorly understood. Moreover, the overlapping vascular pathologies shared between MMD and Intracranial Atherosclerotic Disease (ICAD) pose challenges in clinical differentiation, even with gold-standard cerebral angiography. An in-depth exploration of lipidomic alterations in cerebral intracranial MMD vessels could offer valuable insights into the pathogenesis of MMD-related mechanisms, encompassing MMD and ICAD, and unveil novel biomarkers and potential therapeutic targets. However, to date, comprehensive lipidomic profiling has been lacking.

Materials and methods: To discover novel biomarkers and unravel the pathophysiological mechanisms underlying MMD, we conducted a lipidomics analysis to characterize various lipid species in matched human extracranial and intracranial artery tissues from patients diagnosed with MMD (n=99) and ICAD (n=12).

Results: Our analysis identified 569 lipid species and delineated a robust panel of lipidomic biomarkers capable of effectively distinguishing MMD from ICAD (area under curve=0.98), as determined by receiver operating characteristic curve analysis. Notably, we observed a significantly more pronounced positive correlation of diacylglycerols and a negative association of triglycerides in intracranial artery tissues of MMD patients compared to those with ICAD, suggesting a potential role of dysregulated diacylglycerol-induced signaling in MMD pathogenesis. Furthermore, our investigation into the correlations of critical differential intracranial artery vessel lipid species between MMD and ICAD and clinical parameters revealed negative associations with plasma iron levels, implying a potential link between plasma iron metabolism and artery lipid homeostasis during MMD pathogenesis.

Conclusion: These findings offer promising prospects for advancing clinical diagnosis for enhanced differentiation between the two disease conditions. Additionally, they shed light on the fundamental mechanisms implicated in MMD pathogenesis and suggest potential therapeutic avenues through targeting artery vessel lipids or plasma iron levels.

背景:尽管开展了大量研究工作,但人们对导致莫亚莫亚病(MMD)的确切病因和潜在途径仍然知之甚少。此外,MMD 和颅内动脉粥样硬化性疾病(ICAD)的血管病理相互重叠,这给临床鉴别带来了挑战,即使是采用金标准脑血管造影术也是如此。对颅内多发性硬化症(MMD)脑血管脂质体改变的深入研究可为了解多发性硬化症相关机制(包括多发性硬化症和颅内动脉粥样硬化症)的发病机制提供有价值的见解,并揭示新的生物标志物和潜在的治疗靶点。然而,迄今为止还缺乏全面的脂质组学分析:为了发现新的生物标志物并揭示MMD的病理生理机制,我们进行了脂质组学分析,以确定来自确诊为MMD(99人)和ICAD(12人)患者的匹配人体颅外和颅内动脉组织中各种脂质的特征:结果:我们的分析鉴定出了569种脂质,并根据接收者操作特征曲线分析,确定了一组能够有效区分MMD和ICAD的脂质体生物标志物(曲线下面积=0.98)。值得注意的是,与 ICAD 患者相比,我们观察到 MMD 患者颅内动脉组织中的二酰甘油呈明显的正相关,而甘油三酯呈负相关,这表明二酰甘油诱导的信号传导失调在 MMD 发病机制中可能起了作用。此外,我们对MMD和ICAD患者颅内动脉血管脂质种类的临界差异与临床参数的相关性进行了调查,结果显示与血浆铁水平呈负相关,这意味着在MMD发病过程中,血浆铁代谢与动脉脂质平衡之间存在潜在联系:这些研究结果为临床诊断提供了广阔的前景,有助于更好地区分这两种疾病。结论:这些发现为临床诊断提供了广阔的前景,有助于加强对这两种疾病的鉴别。此外,它们还揭示了MMD发病的基本机制,并提出了针对动脉血管脂质或血浆铁水平的潜在治疗途径。
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International journal of surgery
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