Annals of translational medicine最新文献

[This corrects the article DOI: 10.21037/atm-22-222.].

Background: Since dermal matrices (DMs) were first described in surgery, they have become an integral part of the reconstructive ladder, providing plastic surgeons with new approaches to wound reconstruction. While they have been used in reconstruction of a wide range of wounds, there has been limited or no literature on their effects when used in conjunction with fully absorbable antibiotic beads. Therefore, the aim of this study was to analyze the effects of using Matriderm^® dermal matrix concurrently with Stimulan^® absorbable antibiotic beads on wound healing and readiness for skin grafting.

Case description: In this manuscript, we report the case of an adult ethnic Chinese male patient with recalcitrant infected right lower limb fasciotomy wounds managed using Matriderm^® dermal matrix in conjunction with Stimulan^® absorbable antibiotic beads prior to split-thickness skin graft reconstruction. The patient was a non-smoker with no known comorbid medical conditions and had initially presented with right lower limb compartment syndrome and rhabdomyolysis following a fall with long lie. He subsequently underwent an emergency fasciotomy with resulting medial and lateral right lower limb fasciotomy wounds. In this case report, wound revascularization, granulation formation and readiness for skin grafting were observed after one week of concurrent application of Matriderm^® and Stimulan^®. The patient's post-operative recovery was uneventful and he was discharged eleven days post skin grafting. There was at least 97% graft uptake and the graft donor site had healed well and was left exposed.

Conclusions: The application of DMs in conjunction with absorbable antibiotic beads may shorten time to readiness for definitive wound coverage. Further randomized controlled trials are required to evaluate this potentially synergistic relationship.

Background: The practice of intravenous fluid and vasopressor therapy in intensive care unit (ICU) patients, particularly in those who receive invasive ventilation, has been subject to change. Traditional approaches of 'early and liberal fluid administration' and 'late and restrictive vasopressor use' have been challenged, leading to recommendations for giving less fluids and earlier administration of vasopressors. Recommendations for fluid deresuscitation-active fluid removal-are absent. The global approach to fluid and vasopressor therapy in invasively ventilated patients is currently unclear. Our aim is to explore the practice of intravenous fluid and vasopressor therapy in invasively ventilated ICU patients in a study named 'Practice of Fluid and Vasopressor Therapy in Critically Ill Invasively Ventilated Patients' (PRoFLUID).

Methods: PRoFLUID is an international, multicenter, observational cohort study in critically ill adult patients that are invasively ventilated for more than 24 hours. The outcomes include various aspects of fluid and vasopressor therapy, urine output and cumulative fluid balances. We will also collect duration of ventilation, lengths of stay and mortality in ICU and hospital. We expect to collect granular data on fluid and vasopressor therapy in a sample of at least 2,500 patients.

Discussion: PRoFLUID will provide useful insights into the practice of fluid and vasopressor therapy in invasively ventilated critically ill patients. PRoFLUID also allows us to determine whether geo-economic differences in management of intravenous fluid and vasopressor therapy exist, and allows for analyses of associations of aspects of fluid and vasopressor therapy with outcomes. Last but not least, its findings could feed sample size calculations of future randomized clinical trials of fluid and vasopressor therapy. In conclusion, PRoFLUID will collect data on fluid and vasopressor therapy in invasively ventilated ICU patients worldwide, providing insights that will guide future clinical decisions and randomized trial designs.

Trial registration: ClinicalTrials.gov NCT05968066. Registered on August 1, 2023.

Keywords: Intensive care; invasive ventilation; fluid therapy; fluid management; vasopressor.

Background: Metastatic dedifferentiated liposarcoma (DDLPS) is primarily managed with chemotherapy, yet with poor response rate. Locoregional therapies, such as radiotherapy and percutaneous cryoablation, can provide palliation for inoperable metastatic sarcomas. In rare instances, those ablative therapies can elicit an immune-mediated regression of untreated metastases in a process named the abscopal effect. With the growing use of immunotherapy, reports on the abscopal effect have become more frequent during the last decade.

Case description: A 55-year-old patient with no prior medical history was diagnosed with a stage IV DDLPS. The patient was first treated with induction chemotherapy followed by en bloc resection and adjuvant radiotherapy. After two local relapses treated with chemotherapy, the patient developed a systemic disease progression. While progressing on immunochemotherapy, the patient underwent palliative percutaneous cryoablation. Three months after the procedure, the ¹⁸fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸FDG PET/CT) showed regression of the distant metastasis alongside the regression of the cryoablated tumor, suggesting an abscopal effect.

Conclusions: The occurrence of the abscopal effect after progressive disease suggests that cryoablation triggered a systemic immune response, highlighting the potential of this treatment combination. However, it remains a rare phenomenon, and further research and clinical trials are required to determine optimal treatment sequencing.

Background: Sore throat is a prevalent symptom of coronavirus disease 2019 (COVID-19), particularly when caused by the Omicron variants. However, the association between sore throat and immune responses to different severe acute respiratory syndrome coronavirus 2 variants remains unclear. This study aimed to elucidate the characteristics of immune responses associated with sore throat in patients with COVID-19 before and after the emergence of Omicron.

Methods: In this prospective observational study, we enrolled patients with COVID-19 hospitalized between December 2020 and April 2022, which covered the pre-Omicron and Omicron (BA.1 variant) endemic periods. Sore throat was assessed using a daily questionnaire, including an analog scale for sore throat grade (0 to 3) from admission until discharge. Serum levels of immune indicators were assessed using enzyme-linked immunosorbent assay.

Results: A total of 47 patients infected with Omicron and 136 patients infected with preceding variants were included in the analyses. The frequency of sore throat was significantly higher in participants infected with Omicron than that in those infected with preceding variants (66% vs. 42%, P<0.005). Sore throat was associated with nasopharyngeal viral load, interleukin-6 (IL-6)/interferon-α (IFN-α) levels in participants infected with preceding variants, whereas, it was associated with age, the body mass index, and interferon-λ1 (IFN-λ1) in participants infected with Omicron.

Conclusions: Infection with the Omicron variant is characterized by increased sore throat frequency and altered associations between sore throat and several immune indicators, including IFN-α, IL-6, and IFN-λ1.

[This corrects the article DOI: 10.21037/atm-20-7005.].