Journal of Surgical Research最新文献_第3页

Lycopene Inhibits Postoperative Abdominal Adhesion Formation in a Mice Model 番茄红素抑制小鼠模型术后腹部粘连的形成

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-13 DOI: 10.1016/j.jss.2024.10.007

HaoChongyang Tong MD , ChangChun Ye MD , Lei Fu MD , Chao Qu MD , WenHao Lin MD , Ni Yang MD , QingGuo Du MD

Introduction

The prevention of postoperative abdominal adhesions is one of the top concerns of surgeons after abdominal surgery. Therefore, identifying effective interventions to reduce postoperative abdominal adhesions are essential.

Methods

Fifty male Bagg’s albino/c mice were randomly divided into five groups, and all groups underwent postoperative adhesion model surgery, except for the sham group. The sham and control groups were gavaged with saline solution. Based on the control group, the sodium hyaluronate group was treated with 1 mL sodium hyaluronate (smeared on the modeling site and the abdominal cavity was closed). The other two groups were gavaged with different doses of lycopene (10 μg/kg and 20 μg/kg). Seven d after surgery, the mice were sacrificed and adhesion conditions were assessed using Nair's scoring system. Subsequently, adherent tissues were harvested and the inflammation was assessed by using haematoxylin and eosin staining and enzyme linked immunosorbent assay for interleukin-6 and transforming growth factor-β1. Oxidative stress and collagen deposition condition were also detected in each mouse. Furthermore, a lycopene-induced HMrSV5 cell model was used to explore the possible functional mechanisms.

Results

20 μg/kg of lycopene-treated group had a lower Nair's and inflammation score, both with an average score of 1.75. Also, the level of transforming growth factor -β1 and interleukin-6 in the 20 μg/kg of lycopene-treated group was lower than others. Furthermore, 20 μg/kg of lycopene had reduced the reactive oxygen species and malondialdehyde levels in adhesion tissues compared to other groups. Fiber thickness and α-smooth muscle actin expression in adherent tissues were significantly reduced after lycopene treatment. Besides, 20 μg/kg of lycopene treatment can promote the expression of nuclear factor erythroid 2-related factor 2 and silent information regulator 1. In in-vitro studies, lycopene protected mesothelial cells from H₂O₂ -induced oxidative stress injury.

Conclusions

Lycopene can attenuate abdominal adhesion in the mice model by reducing inflammation and oxidative stress, and the possible mechanism may rely on promoting the expression of nuclear factor erythroid 2-related factor 2 and silent information regulator 1.

导言：预防术后腹腔粘连是腹部手术后外科医生最关心的问题之一。因此，确定减少术后腹腔粘连的有效干预措施至关重要：方法：将 50 只雄性 Bagg's albino/c 小鼠随机分为 5 组，除假组外，其余各组均接受术后粘连模型手术。假组和对照组灌胃生理盐水。在对照组的基础上，透明质酸钠组使用 1 mL 透明质酸钠（涂抹在造模部位并关闭腹腔）。另外两组分别灌胃不同剂量的番茄红素（10 μg/kg和20 μg/kg）。手术七天后，小鼠被处死，并使用奈尔评分系统评估粘附情况。随后，收获粘连组织，使用血红素和伊红染色法以及白细胞介素-6和转化生长因子-β1的酶联免疫吸附试验评估炎症情况。还检测了每只小鼠的氧化应激和胶原蛋白沉积情况。结果：20 μg/kg番茄红素处理组的奈氏评分和炎症评分较低，平均分均为1.75。此外，番茄红素 20 μg/kg 治疗组的转化生长因子-β1 和白细胞介素-6 水平也低于其他组。此外，与其他组相比，20 μg/kg 番茄红素可降低粘附组织中的活性氧和丙二醛水平。番茄红素处理后，粘附组织中的纤维厚度和α-平滑肌肌动蛋白表达明显减少。此外，20 μg/kg 番茄红素还能促进核因子红细胞 2 相关因子 2 和沉默信息调节因子 1 的表达。在体外研究中，番茄红素能保护间皮细胞免受 H2O2 诱导的氧化应激损伤：番茄红素可通过减少炎症和氧化应激减轻小鼠模型的腹腔粘连，其可能的机制可能是促进核因子红细胞 2 相关因子 2 和沉默信息调节因子 1 的表达。

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引用次数: 0

Plasmas From Patients With Burn Injury Induce Endotheliopathy Through Different Pathways 烧伤患者的血浆通过不同途径诱导内皮细胞病变

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-12 DOI: 10.1016/j.jss.2024.10.011

John W. Keyloun MD , Edward J. Kelly MD , Bonnie C. Carney PhD , Saira Nisar MBBS, MS , Sindhura Kolachana BS , Lauren T. Moffatt PhD , Thomas Orfeo PhD , Jeffrey W. Shupp MD

Introduction

The contribution of endothelial injury to the pathogenesis of burn shock is not well characterized. This work investigates potential mechanisms underlying dysregulation of endothelial barrier function by burn patient plasmas.

Methods

Plasma was collected from burn-injured patients (n = 8) within 4 h of admission. Demographic and injury characteristics were collected and markers of injury severity including international normalized ratio, activated partial thromboplastin time, and levels of syndecan-1 and interleukin (IL)-6, IL-1B, IL-10, Il-12p70, and tumor necrosis factor-α measured. Human umbilical vein endothelial cell monolayers (HUVEC-m) exposed to either burn patient plasma or multidonor plasma (HHP) were assessed for permeability (40 kDa fluorescein isothiocyanate (FITC)-Dextran diffusion), intercellular gap area (F-actin staining) and incidence of apoptosis (TUNEL assay). Post plasma exposure, RNA was isolated and used in polymerase chain reaction (PCR) arrays targeting genes relevant to cytoskeletal structure or apoptosis. Differences between HHP and burn plasma-treated HUVEC-m were analyzed.

Results

Five plasmas promoted significant increases in HUVEC-m permeability. When plasmas were grouped based on their capacity to increase permeability, no differences in age, %total body surface area, gender, hospital mortality, international normalized ratio, activated partial thromboplastin time, or cytokine concentration were observed; however, significantly higher syndecan-1 levels were seen in the plasmas inducing increased permeability. Increases in intercellular gap area and apoptosis and relevant gene expression were observed after exposure to patient plasmas but none of these metrics correlated completely with the pattern or magnitude of the changes in permeability.

Conclusions

Burn patient plasmas variably disrupt HUVEC-m homeostasis, differentially inducing changes in permeability, intercellular gap area, and apoptosis. Neither increases in intercellular gap size nor apoptosis appear sufficient to explain the pattern of changes in permeability.

导言：内皮损伤对烧伤休克发病机制的影响尚不十分明确。本研究探讨了烧伤患者血浆导致内皮屏障功能失调的潜在机制：方法：从烧伤患者（n = 8）入院 4 小时内采集血浆。方法：收集烧伤患者（8 人）入院 4 小时内的血浆，收集其人口统计学特征和损伤特征，并测量损伤严重程度的标志物，包括国际标准化比率、活化部分凝血活酶时间、辛迪加-1 和白细胞介素 (IL)-6 、IL-1B、IL-10、Il-12p70 以及肿瘤坏死因子-α 的水平。对暴露于烧伤患者血浆或多捐献者血浆（HHP）的人脐静脉内皮细胞单层（HUVEC-m）的通透性（40 kDa 异硫氰酸荧光素（FITC）-葡聚糖扩散）、细胞间隙面积（F-肌动蛋白染色）和细胞凋亡发生率（TUNEL 检测）进行了评估。血浆暴露后，分离 RNA 并将其用于聚合酶链式反应 (PCR) 阵列，靶向与细胞骨架结构或细胞凋亡相关的基因。分析了经 HHP 和烧伤血浆处理的 HUVEC-m 之间的差异：结果：有五种血浆能显著增加 HUVEC-m 的通透性。根据血浆增加通透性的能力对血浆进行分组时，没有观察到年龄、体表总面积百分比、性别、住院死亡率、国际标准化比率、活化部分凝血活酶时间或细胞因子浓度方面的差异；但是，在诱导通透性增加的血浆中，辛迪加-1的水平明显较高。在接触患者血浆后，观察到细胞间隙面积和细胞凋亡以及相关基因表达的增加，但这些指标都与通透性变化的模式或程度不完全相关：烧伤患者血浆会不同程度地破坏 HUVEC-m 的稳态，不同程度地诱导通透性、细胞间隙面积和细胞凋亡的变化。细胞间隙大小和细胞凋亡的增加似乎都不足以解释通透性的变化模式。

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引用次数: 0

Low Rates of Short-Term Anastomotic Complications After Kono-S versus Side-to-Side Stapled Anastomosis Kono-S 与侧对侧缝合吻合术后短期吻合并发症发生率较低。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-12 DOI: 10.1016/j.jss.2024.10.015

Olivia Ziegler MD , Amber M. Moyer MD , Ji Ho Park MD , Mckell Quattrone MD , Audrey S. Kulaylat MD, MSc , Michael J. Deutsch MD , N. Arjun Jeganathan MD , Walter A. Koltun MD , Jeffrey S. Scow MD

Introduction

The Kono-S (KS) anastomosis for Crohn's disease (CD) is associated with improved endoscopic and clinical long-term outcomes. Ileocolonic anastomoses in CD are associated with an unacceptable anastomotic complication rate - up to 40%. Investigation of short-term benefits of KS is thus warranted. Here, we evaluate 90-d postoperative complications following KS versus side-to-side stapled anastomosis in patients with CD.

Methods

This is a retrospective case-control conducted at our tertiary medical center; data retrieved are from cases between January 2019 and May 2023. Thirty-eight consecutive patients with CD who underwent KS were matched with 38 patients who underwent side-to-side stapled anastomosis. Patients were initially age and sex matched; then, characteristics including body mass index, American Society of Anesthesiologists class, and disease severity indicated by inpatient status, preoperative laboratory values, steroid and disease modifying drug use were compared between cases and controls, using chi square, t-test, or Mann–Whitney U test.

Results

Cohorts did not differ in the aforementioned characteristics with the exception of higher preoperative erythrocyte sedimentation rate in the KS group. There was no difference in operative approach, or complications between groups; one patient undergoing KS required return to operating room for fascial dehiscence, while two in the side-to-side stapled group required return to operating room for anastomotic complications. KS operative times were significantly longer.

Conclusions

KS is associated with an acceptable rate of short-term complications. In our matched series of 38 patients, we had no anastomotic leaks or bleeds in our KS group. Adoption of this technique may provide immediate postoperative benefits in addition to long-term disease reduction.

导言：Kono-S（KS）吻合术治疗克罗恩病（CD）可改善内镜和临床长期疗效。克罗恩病的回结肠吻合术与难以接受的吻合并发症率有关，高达 40%。因此，有必要对 KS 的短期益处进行研究。在此，我们评估了 CD 患者 KS 与侧对侧订书机吻合术后 90 天的并发症：这是一项在我们的三级医疗中心进行的回顾性病例对照；数据取自 2019 年 1 月至 2023 年 5 月期间的病例。38例连续接受KS手术的CD患者与38例接受侧对侧订书机吻合术的患者进行了配对。患者的年龄和性别初步匹配；然后，使用chi square、t检验或Mann-Whitney U检验比较病例和对照组之间的特征，包括体重指数、美国麻醉医师协会等级、住院状态显示的疾病严重程度、术前实验室值、类固醇和疾病调节药物的使用情况：除 KS 组术前红细胞沉降率较高外，其他组别在上述特征方面均无差异。KS组有一名患者因筋膜开裂需要返回手术室，而侧对侧缝合组有两名患者因吻合口并发症需要返回手术室。KS手术时间明显更长：结论：KS与可接受的短期并发症发生率相关。结论：KS术的短期并发症发生率尚可接受。在我们的38例患者配对系列中，KS组没有发生吻合口漏或出血。采用这种技术除了能长期减少疾病外，还能在术后立即获益。

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引用次数: 0

Plasma Inclusive Resuscitation is Not Associated With Transfusion-Related Acute Lung Injury Under Updated Guidelines 根据最新指南，血浆包容性复苏与输血相关急性肺损伤无关。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-12 DOI: 10.1016/j.jss.2024.08.011

Desiree N. Pinto MD, MPH , Caitlin Mehta BS , Edward J. Kelly MD , Shane K. Mathew MD , Bonnie C. Carney PhD , Melissa M. McLawhorn RN, BSN , Lauren T. Moffatt PhD , Taryn E. Travis MD , Jeffrey W. Shupp MD , Shawn Tejiram MD

Introduction

Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.

Methods

Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.

Results

Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (n = 39) compared to late PIR (n = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, P = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, P = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, P = 0.62).

Conclusions

In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.

简介：血浆包容性复苏（PIR）使用新鲜冰冻血浆作为晶体液的辅助手段来治疗烧伤休克，与其他胶体相比具有潜在的优势。然而，输血相关急性肺损伤（TRALI）的安全性问题依然存在。本研究的目的是根据最新的加拿大血液服务共识定义，评估严重烧伤患者队列中 TRALI 与 PIR 之间的关联：对2018年至2022年期间在烧伤中心需要PIR的烧伤患者进行了回顾性研究。为了评估 TRALI，记录了与急性低氧血症、双侧肺水肿、左心房高压以及 PIR 后 6 小时内呼吸状态变化相关的数据。为了确定与 PIR 时间相关的其他风险和益处，对早期（0-8 h）和晚期（8-24 h）启动 PIR 的复苏量和结果进行了比较：结果：在纳入研究的 88 名患者中，根据最新定义，没有患者出现 TRALI I 型或 II 型。早期 PIR（39 人）与晚期 PIR（49 人）相比，总体表面积百分比（TBSA，36.3%，26.0%，P = 0.01）更高。早期 PIR 的预测 24 小时血容量更高（10.1 升，6.3 升，P = 0.049），但观察到的 24 小时血容量（cc/kg/%TBSA）并无显著差异（5.2，5.3，P = 0.62）：结论：在一组接受 PIR 的严重烧伤患者中，根据最新的加拿大血液服务共识定义，没有患者出现 TRALI I 型或 II 型。尽管总烧伤面积（TBSA）较高，但较早使用 PIR 与较高的复苏量无关。为了更好地确定与 PIR 相关的潜在风险和益处，有必要开展进一步的研究。

{"title":"Plasma Inclusive Resuscitation is Not Associated With Transfusion-Related Acute Lung Injury Under Updated Guidelines","authors":"Desiree N. Pinto MD, MPH , Caitlin Mehta BS , Edward J. Kelly MD , Shane K. Mathew MD , Bonnie C. Carney PhD , Melissa M. McLawhorn RN, BSN , Lauren T. Moffatt PhD , Taryn E. Travis MD , Jeffrey W. Shupp MD , Shawn Tejiram MD","doi":"10.1016/j.jss.2024.08.011","DOIUrl":"10.1016/j.jss.2024.08.011","url":null,"abstract":"<div><h3>Introduction</h3><div>Plasma inclusive resuscitation (PIR) uses fresh frozen plasma as an adjunct to crystalloid in the management of burn shock and has potential benefits over other colloids. Yet, safety concerns for transfusion-related acute lung injury (TRALI) exist. The aim of this study evaluated the association between TRALI and PIR in a cohort of severely burn-injured patients using the updated Canadian Blood Services Consensus definitions.</div></div><div><h3>Methods</h3><div>Burn-injured patients requiring PIR at a burn center from 2018 to 2022 were retrospectively reviewed. To assess for TRALI, data related to acute hypoxemia, bilateral pulmonary edema, left atrial hypertension, and changes to respiratory status up to 6 h after PIR were recorded. To identify other risks and benefits associated with PIR timing, resuscitative volumes and outcomes were compared between early (0-8 h) and late PIR (8-24 h) initiation.</div></div><div><h3>Results</h3><div>Of the 88 patients included for study, no patient developed TRALI type I or II under the updated definitions. Early (<em>n</em> = 39) compared to late PIR (<em>n</em> = 49) was associated with a higher percent total body surface area (TBSA, 36.3%, 26.0%, <em>P</em> = 0.01). The predicted 24-h volume was higher for early PIR (10.1 L, 6.3 L, <em>P</em> = 0.049), but the observed 24-h volume (cc/kg/%TBSA) was not significantly different (5.2, 5.3, <em>P</em> = 0.62).</div></div><div><h3>Conclusions</h3><div>In a cohort of severely burn-injured patients undergoing PIR, no patient developed TRALI type I or type II under the updated Canadian Blood Services Consensus definitions. Earlier use of PIR was not associated with higher resuscitative volumes despite higher TBSA. Further studies are necessary to better ascertain the potential risks and benefits associated with PIR.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 81-89"},"PeriodicalIF":1.8,"publicationDate":"2024-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Early Postoperative Serum Sirtuin 1 Predicts Postoperative Cognitive Dysfunction in Elderly Patients 术后早期血清 Sirtuin 1 预测老年患者的术后认知功能障碍

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-12 DOI: 10.1016/j.jss.2024.10.006

Jinshan Shi MD , Haibo Chen MD , Yujie Zhang MD , Ke Jiang MD

Introduction

Postoperative cognitive dysfunction (POCD) is a common complication following cardiac surgery, particularly in elderly patients undergoing cardiopulmonary bypass (CPB). While Sirtuin 1 (SIRT1) has been implicated in the mitigation of POCD, its potential as a predictive biomarker for POCD remains unclear.

Methods

Patients undergoing CPB cardiac surgery were evaluated for POCD using the Montreal Cognitive Assessment. Based on the assessment results, patients were divided into two groups, with further stratification by key factors. The correlation between these risk factors and POCD incidence was analyzed. Odds ratios were calculated for six risk factors, and the receiver operating characteristic curve analysis was used to evaluate the predictive power of early postoperative serum SIRT1 levels for POCD.

Results

Six risk factors—including age, education level, CPB duration, aortic occlusion duration, anesthesia duration, and early postoperative serum SIRT1—were strongly associated with POCD incidence. Patients with POCD had decreased early postoperative serum SIRT1 levels. SIRT1 was found to be a significant predictor of POCD, with high sensitivity and specificity. Additionally, neuron-specific enolase and S100β levels were elevated in POCD patients and negatively correlated with early postoperative serum SIRT1 levels.

Conclusions

Early postoperative serum SIRT1 serves as an effective biomarker for predicting POCD, offering both high sensitivity and specificity, and could be used to anticipate the onset of clinical POCD.

简介术后认知功能障碍（POCD）是心脏手术后常见的并发症，尤其是在接受心肺旁路术（CPB）的老年患者中。虽然 Sirtuin 1（SIRT1）与减轻 POCD 有关联，但其作为 POCD 预测生物标志物的潜力仍不清楚：使用蒙特利尔认知评估对接受 CPB 心脏手术的患者进行 POCD 评估。根据评估结果，患者被分为两组，并按关键因素进一步分层。分析了这些风险因素与 POCD 发生率之间的相关性。计算了六个风险因素的风险比，并使用接收者操作特征曲线分析评估了术后早期血清 SIRT1 水平对 POCD 的预测能力：结果：包括年龄、教育程度、CPB持续时间、主动脉闭塞持续时间、麻醉持续时间和术后早期血清SIRT1在内的六个风险因素与POCD的发生率密切相关。POCD 患者术后早期血清 SIRT1 水平降低。研究发现，SIRT1 是预测 POCD 的重要指标，具有很高的灵敏度和特异性。此外，POCD 患者的神经元特异性烯醇化酶和 S100β 水平升高，并与术后早期血清 SIRT1 水平呈负相关：结论：术后早期血清 SIRT1 是预测 POCD 的有效生物标志物，具有高敏感性和特异性，可用于预测临床 POCD 的发生。

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引用次数: 0

TAVI in Patients With Severe Aortic Stenosis and Coexisting Mitral Valve Regurgitation 严重主动脉瓣狭窄并发二尖瓣反流患者的 TAVI。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-12 DOI: 10.1016/j.jss.2024.10.012

Mohammed Salem MD , Tomasz Stankowski MD , Sleiman Sebastian Aboul-Hassan MD , Anja Muehle MD , Axel Harnath MD , Kristin Rochor MD , Claude Tshibangu Lukusa MD , Volker Herwig MD , Temirlan Erkenov MD , Barłomiej Perek MD , Dirk Fritzsche MD

Introduction

Severe aortic stenosis with coexisting mitral regurgitation (MR) of various severity is a common finding. The goal of our study was to evaluate the relation between transcatheter transfemoral aortic valve implantation (TAVI) on coexisting MR and compare the outcome in MR improvement and nonimprovement groups.

Methods

We retrospectively analyzed 252 patients who underwent TAVI with associated at least moderate MR between January 2018 and December 2020. Effect of changes in MR grade at discharge and 6-12 mo follow-up were compared.

Results

Echocardiography was performed at discharge in 245 patients and at follow-up in 154 patients. MR improvement was seen in 60.8% patients and nonimprovement in 39.2%. Overall survival was significantly higher in the MR improvement group (P = 0.020). There was a statistically significant effect on MR grade with a significant increase in the proportion of patients with mild MR at follow-up compared to discharge (58.4% versus 38.3%, P < 0.001). A similar positive effect was seen on left ventricular ejection fraction (LVEF) at follow-up compared to discharge (P < 0.001). LVEF in the MR improvement group was significantly higher at follow-up versus discharge (P < 0.001), but there was no statistically significant change in LVEF in the nonimprovement group at follow-up versus discharge (P < 0.722).

Conclusions

TAVI in severe aortic stenosis with coexisting significant mitral valve regurgitation decreases MR severity in more than 60% of patients and improved LVEF as well as mortality.

导言：严重主动脉瓣狭窄并发不同程度的二尖瓣反流（MR）是一种常见病。我们的研究旨在评估经导管经股动脉主动脉瓣植入术（TAVI）与并存二尖瓣反流之间的关系，并比较二尖瓣反流改善组和未改善组的疗效：我们回顾性分析了2018年1月至2020年12月期间接受TAVI并伴有至少中度MR的252例患者。比较了出院时和随访 6-12 个月时 MR 分级变化的影响：245名患者在出院时进行了超声心动图检查，154名患者在随访时进行了超声心动图检查。60.8%的患者MR改善，39.2%的患者未改善。MR改善组的总生存率明显更高（P = 0.020）。MR分级对随访的影响具有统计学意义，与出院时相比，轻度MR患者的比例明显增加（58.4%对38.3%，P 结论：MR分级对随访的影响具有统计学意义，与出院时相比，轻度MR患者的比例明显增加（58.4%对38.3%，P）：严重主动脉瓣狭窄合并二尖瓣返流的 TAVI 可降低 60% 以上患者的 MR 严重程度，并改善 LVEF 和死亡率。

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引用次数: 0

Novel Asymmetrical Linear Stapler: Safety Test and Pathological Assessment in a Porcine Model 新型不对称线性缝合器：猪模型的安全性测试和病理评估

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-09 DOI: 10.1016/j.jss.2024.10.003

Yong Chae Jung MD , Wen Xue Piao MD , Ji-yeon Kim MD, PhD , Sang-il Lee MD, PhD , Ying Jie Cui MD , Yooyoung Chong MD , Hyun Jin Cho MD, PhD , Min-Woong Kang MD, PhD

Introduction

Prognosis in patients undergoing resection for lung and gastrointestinal cancers may differ, depending on the microscopic involvement of surgical margins. Linear staplers, widely used for pulmonary or bowel resection, consist of three rows of fasteners on both sides of a resection line. Although multiple rows of fasteners ensure stump and specimen closure, specimen could compromise accurate pathological evaluation of the true surgical margin. We aimed to compare the novel asymmetrical linear stapler (NALS) with the symmetrical linear stapler (SLS) in a porcine model for stump security and accurate pathological evaluation.

Materials and Methods

We used the NALS with three and two rows of staples on the stump and specimen sides, respectively. We performed small bowel resection in a porcine model using the NALS and examined hemostasis of resection margin, tightness of stumps under a specific burst pressure, distances between the true resection margin and staple line, and pathology of the resection margin. An SLS was used as the control.

Results

No bleeding was observed at the tissue site after initial blotting of the stapler line with either stapler type. The staplers endured a burst pressure of 3.6 kPa for 15 s without leakage. The distance between the cutting edge and staple line for two rows was significantly greater than the distance between the cutting edge and the nearest staple line for three rows.

Conclusions

The NALS is safe and may be more accurate than is SLS for the pathological evaluation of true surgical margins.

导言：接受肺癌和胃肠癌切除术的患者的预后可能有所不同，这取决于手术边缘的显微受累情况。广泛用于肺部或肠道切除术的线性订书机由切除线两侧的三排紧固器组成。虽然多排紧固器可确保残端和标本的闭合，但标本可能会影响对真实手术边缘的准确病理评估。我们的目的是在猪模型中比较新型非对称线性订书机（NALS）和对称线性订书机（SLS），以确保残端安全和准确的病理评估：我们使用的 NALS 在残端和标本侧分别装有三排和两排订书钉。我们使用 NALS 在猪模型中进行了小肠切除术，并检查了切除边缘的止血情况、特定爆破压力下残端松紧度、真正切除边缘与订书线之间的距离以及切除边缘的病理情况。结果：结果：使用任何一种订书机，在订书机线初步印迹后，组织部位均未观察到出血。两种订书机都能承受 3.6 千帕的爆破压力 15 秒，且无泄漏。两行缝合线的切缘与缝合线之间的距离明显大于三行缝合线的切缘与最近缝合线之间的距离：结论：NALS 是安全的，在对真实手术边缘进行病理评估时可能比 SLS 更准确。

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引用次数: 0

Psoas Muscle Volume as an Indicator of Sarcopenia and Disposition in Traumatic Hip Fracture Patients 腰肌体积是创伤性髋部骨折患者肌肉疏松症和体质的指标。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-09 DOI: 10.1016/j.jss.2024.10.005

Sahak E. Hovsepian MS , Catherine H. Zwemer BS , Alex I. Halpern MD , Sophia H. Wu BS , Christian M. Farag BA , Aalap Herur-Raman MS , Ahmed Ismail BS , Aneil P. Srivastava BS , Oleksiy Melnyk BS , Mary Baginsky MS, RD , Susan Kartiko MD, PhD

Introduction

Sarcopenia, or the loss of lean muscle mass, is associated with increased morbidity and mortality as well as poor surgical outcomes. The aim of our study was to utilize computed tomography imaging to obtain the total psoas volume (TPV) as a potential marker of sarcopenia. We then investigated the relationship between TPV and outcomes in surgically managed hip fracture patients, particularly their discharge disposition.

Methods

A retrospective review of surgically managed hip fracture patients at a single institution level one American College of Surgeons verified trauma center between 2017 and 2022 was performed. The primary endpoint was patient disposition after hospitalization. TPV was collected via three dimension reconstruction of computed tomography images. Student's t-test was used to assess for association between TPV and demographic variables. Binary logistic regressions were performed to examine variables that could predict patient disposition among the patients.

Results

We identified 64 surgically managed hip fracture patients, 57.8% of whom were males, with a median age of 74 (IQR: 62, 88). Black race (244.4 vs. 190.3, P = 0.032) and younger age (252.2 vs. 181.8, P = 0.004) were associated with higher TPV. Male patients with higher TPV had a higher likelihood of being discharged home as opposed to a skilled nursing or rehabilitation facility (251.3 vs. 191.1, P = 0.02). In multivariable analysis adjusting for sex, race, body mass index, and age, males with a higher TPV were more likely to be discharged home (odds ratio: 1.012; 95% confidence interval: 1.004 1.020; P = 0.028).

Conclusions

Psoas muscle volume can be used to predict which male patients are likely to be discharged home postoperatively after surgically managed traumatic hip fracture.

导言：肌肉疏松症或瘦肌肉量减少与发病率和死亡率增加以及手术效果不佳有关。我们的研究旨在利用计算机断层扫描成像获得腰肌总体积（TPV），作为肌少症的潜在标志。然后，我们调查了 TPV 与接受手术治疗的髋部骨折患者的预后之间的关系，尤其是他们的出院处置：我们对 2017 年至 2022 年期间在一家美国外科学院认证的一级创伤中心接受手术治疗的髋部骨折患者进行了回顾性研究。主要终点是患者住院后的处置。TPV通过计算机断层扫描图像的三维重建收集。采用学生 t 检验评估 TPV 与人口统计学变量之间的关联。我们还进行了二元逻辑回归，以研究可预测患者处置的变量：我们确定了 64 名接受手术治疗的髋部骨折患者，其中 57.8% 为男性，中位年龄为 74 岁（IQR：62，88）。黑人（244.4 对 190.3，P=0.032）和年轻（252.2 对 181.8，P=0.004）与 TPV 较高有关。TPV较高的男性患者出院回家的可能性比出院到专业护理或康复机构的可能性更高（251.3 对 191.1，P = 0.02）。在调整性别、种族、体重指数和年龄的多变量分析中，TPV较高的男性更有可能出院回家（几率比：1.012；95% 置信区间：1.004 1.020；P = 0.028）：结论：腰肌体积可用于预测哪些男性患者在手术治疗创伤性髋部骨折后有可能在术后出院回家。

{"title":"Psoas Muscle Volume as an Indicator of Sarcopenia and Disposition in Traumatic Hip Fracture Patients","authors":"Sahak E. Hovsepian MS , Catherine H. Zwemer BS , Alex I. Halpern MD , Sophia H. Wu BS , Christian M. Farag BA , Aalap Herur-Raman MS , Ahmed Ismail BS , Aneil P. Srivastava BS , Oleksiy Melnyk BS , Mary Baginsky MS, RD , Susan Kartiko MD, PhD","doi":"10.1016/j.jss.2024.10.005","DOIUrl":"10.1016/j.jss.2024.10.005","url":null,"abstract":"<div><h3>Introduction</h3><div>Sarcopenia, or the loss of lean muscle mass, is associated with increased morbidity and mortality as well as poor surgical outcomes. The aim of our study was to utilize computed tomography imaging to obtain the total psoas volume (TPV) as a potential marker of sarcopenia. We then investigated the relationship between TPV and outcomes in surgically managed hip fracture patients, particularly their discharge disposition.</div></div><div><h3>Methods</h3><div>A retrospective review of surgically managed hip fracture patients at a single institution level one American College of Surgeons verified trauma center between 2017 and 2022 was performed. The primary endpoint was patient disposition after hospitalization. TPV was collected via three dimension reconstruction of computed tomography images. Student's <em>t</em>-test was used to assess for association between TPV and demographic variables. Binary logistic regressions were performed to examine variables that could predict patient disposition among the patients.</div></div><div><h3>Results</h3><div>We identified 64 surgically managed hip fracture patients, 57.8% of whom were males, with a median age of 74 (IQR: 62, 88). Black race (244.4 vs. 190.3, <em>P</em> = 0.032) and younger age (252.2 vs. 181.8, <em>P</em> = 0.004) were associated with higher TPV. Male patients with higher TPV had a higher likelihood of being discharged home as opposed to a skilled nursing or rehabilitation facility (251.3 vs. 191.1, <em>P</em> = 0.02). In multivariable analysis adjusting for sex, race, body mass index, and age, males with a higher TPV were more likely to be discharged home (odds ratio: 1.012; 95% confidence interval: 1.004 1.020; <em>P</em> = 0.028).</div></div><div><h3>Conclusions</h3><div>Psoas muscle volume can be used to predict which male patients are likely to be discharged home postoperatively after surgically managed traumatic hip fracture.</div></div>","PeriodicalId":17030,"journal":{"name":"Journal of Surgical Research","volume":"304 ","pages":"Pages 67-73"},"PeriodicalIF":1.8,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"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

Prophylactic Sartorius Flap Reconstruction is Associated With Reduced Vascular Graft Infection 预防性萨尔托里肌瓣重建可减少血管移植物感染。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-08 DOI: 10.1016/j.jss.2024.10.004

Young Kim MD, MS, Roberto S. Loanzon MD, Christina L. Cui MD, MAS, Kevin W. Southerland MD, Zachary F. Williams MD

Introduction

Complications in the femoral area following vascular surgery are frequent and linked to considerable morbidity, including the risk of underlying graft infection. Sartorius muscle flaps are an important adjunct for the treatment of wound complications. In this study, we examined our experience with prophylactic sartorius muscle flap coverage and its association with prosthetic vascular graft infection.

Methods

In this single-center analysis, electronic medical records were retrospectively reviewed for all sartorius muscle flap procedures performed from 2012 to 2021. Prophylactic indication was defined as flap reconstruction during index revascularization in the absence of active inguinal infection.

Results

Over the 9-y period, a total of 54 prophylactic sartorius flaps were performed in 47 patients. The median patient age was 66 y (interquartile range [IQR] 61-77 y). Wound complications requiring reintervention occurred in 16 (29.6%) patients, including 6 (11.1%) surgical site infections, 5 (9.3%) wound dehiscence, and 5 (9.3%) infected seromata. Among patients suffering wound complications, 30-d readmission (75.0% versus 26.3%, P = 0.004) and reoperative flap creation rates (25.0% versus 2.6%, P = 0.010) were higher, whereas 30-d mortality rates (0.0% versus 5.3%, P = 0.51) were similar. Only one patient (1.9%) developed vascular graft infection over a median follow-up period of 2.4 y (IQR 0.9-4.0 y). On multivariate analysis, body mass index (adjusted odds ratio 1.23, 95% confidence interval, 1.12-1.35, P = 0.023) was associated with reoperative wound complications.

Conclusions

Wound complications were common after prophylactic sartorius flap creation in this high-risk population; however, infection of the underlying vascular graft was rare. These data suggest that sartorius flap may be effective in a prophylactic role.

导言：血管手术后股骨部位经常出现并发症，发病率相当高，包括潜在的移植物感染风险。萨尔图里斯肌瓣是治疗伤口并发症的重要辅助手段。在这项研究中，我们考察了预防性萨尔图里斯肌皮瓣覆盖的经验及其与人工血管移植感染的关系：在这项单中心分析中，我们对 2012 年至 2021 年期间进行的所有artorius肌皮瓣手术的电子病历进行了回顾性审查。预防性适应症的定义是：在没有活动性腹股沟感染的情况下，在指数血管重建过程中进行皮瓣重建：在9年期间，共有47名患者接受了54例预防性腓肠肌肌皮瓣手术。患者年龄中位数为 66 岁（四分位数间距 [IQR] 61-77 岁）。16例（29.6%）患者出现了需要再次手术的伤口并发症，包括6例（11.1%）手术部位感染、5例（9.3%）伤口开裂和5例（9.3%）血清块感染。在出现伤口并发症的患者中，30 天后再入院率（75.0% 对 26.3%，P = 0.004）和再次手术制作皮瓣率（25.0% 对 2.6%，P = 0.010）较高，而 30 天后死亡率（0.0% 对 5.3%，P = 0.51）则相似。中位随访期为2.4年（IQR 0.9-4.0年），仅有一名患者（1.9%）发生血管移植感染。多变量分析显示，体重指数（调整后的几率比1.23，95%置信区间为1.12-1.35，P = 0.023）与再手术伤口并发症有关：结论：在这一高风险人群中，预防性腓肠肌瓣制作术后伤口并发症很常见，但下层血管移植物感染却很少见。这些数据表明，腓肠肌瓣在预防性治疗中可能是有效的。

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引用次数: 0

Neurologic Complications Associated With Burn Injury and Resuscitation 与烧伤和复苏相关的神经系统并发症。

IF 1.8 3区医学 Q2 SURGERY

Journal of Surgical Research

Pub Date : 2024-11-07 DOI: 10.1016/j.jss.2024.09.086

Connor L. Kenney MD , Brian D. Stephens MD , Kelsey A. Cacic MD , Alicia M. Williams MD , Steven G. Schauer DO , Jan-Michael Van Gent DO , Geoffrey W. Peitz MD , Michael D. April MD , Julie A. Rizzo MD

Background

Treatment for large burn injuries relies on adequate fluid resuscitation secondary to the severe systemic inflammatory response. With improved critical care and better understanding of the complications of over and under resuscitation, morbidity and mortality rates are decreasing. Neurologic complications are not often considered as an over-resuscitation complication after burn injury but may be considered an additional form of compartment syndrome–intracranial compartment syndrome; however, it has not been evaluated for a possible threshold similar to the Ivy Index for abdominal compartment syndrome.

Methodology

This study was conducted as a single center, retrospective review of patients admitted to the Burn Intensive Care Unit within 24 h of injury and who received neuroimaging within 96 h. Patients were grouped based on the resuscitation volumes at ≤200 and >200 mL/kg for evaluation of the development of worsening neurologic findings.

Results

Forty-one patients were available for review with 30 patients ≤200 mL/kg and 11 patients >200 mL/kg. Twenty-one patients (70.0%) and 7 patients (63.6%), < 200 and > 200 mL/kg respectively, has repeat imaging. Follow-up imaging was found to be worse in patients receiving greater than 200 mL/kg (85.7% versus 47.6%, P value 0.064).

Conclusions

Providers should be aware of the potential for neurologic sequelae of resuscitation that is often only found on imaging in patients receiving high-volume resuscitation for their burn injury.

背景：由于严重的全身炎症反应，大面积烧伤的治疗依赖于充分的液体复苏。随着重症监护水平的提高以及对过度复苏和复苏不足并发症的进一步了解，发病率和死亡率正在下降。神经系统并发症通常不被认为是烧伤后过度复苏的并发症，但可被认为是颅内隔室综合征的另一种形式；然而，尚未对其进行评估，以确定是否存在类似于腹腔隔室综合征艾维指数的阈值：本研究以单中心为单位，对烧伤重症监护室在受伤后 24 小时内收治的、在 96 小时内接受神经影像学检查的患者进行回顾性复查。根据复苏量≤200 毫升/千克和>200 毫升/千克对患者进行分组，以评估神经系统检查结果的恶化情况：41名患者接受了复查，其中30名患者的复苏量≤200毫升/千克，11名患者的复苏量>200毫升/千克。21 名患者（70.0%）和 7 名患者（63.6%）（< 200 毫升/千克和> 200 毫升/千克）进行了重复成像。接受大于 200 毫升/千克治疗的患者的随访成像效果更差（85.7% 对 47.6%，P 值 0.064）：医疗服务提供者应该意识到复苏可能会导致神经系统后遗症，而这种后遗症往往只有在烧伤患者接受大容量复苏时才会在影像学检查中发现。

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引用次数: 0