Combination of sodium butyrate and probiotics ameliorates severe burn-induced intestinal injury by inhibiting oxidative stress and inflammatory response

Burns are a common traumatic injuries with considerable morbidity and mortality rates. Post-burn intestinal injuries are closely related to oxidative stress and inflammatory response. The aim of the current study was to investigate the combined effect of sodium butyrate (NaB) and probiotics (PROB) on severe burn-induced oxidative stress and inflammatory response and the underlying mechanism of action. Sprague-Dawley rats with severe burns were treated with NaB with or without PROB. Pathomorphology of skin and small intestine tissue was observed using hematoxylin and eosin staining and severe burn-induced apoptosis in small intestine tissue was examined via terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling assay. The release of factors related to inflammation was quantified using ELISA kits and qRT-PCR and levels of oxidative stress markers were evaluated using biochemical assays. Furthermore, mitochondrial morphological changes in small intestinal epithelial cells were observed using transmission electron microscopy. In addition, the underlying mechanism associated with the combined effect of NaB and PROB on severe burn-induced oxidative stress and inflammatory response was investigated using western blotting. The combination of NaB and PROB exerted protective effects against severe burn-induced intestinal barrier injury by reducing the levels of diamine oxidase and intestinal fatty acid binding protein. Combined NaB and PROB treatment inhibited severe burn-induced oxidative stress by increasing superoxide dismutase levels and decreasing those of malondialdehyde and myeloperoxidase levels. Severe burn-induced inflammation was suppressed by combined NaB and PROB administration, as demonstrated by the decreased mRNA expression of tumor necrosis factor-α, interleukin-6, interleukin-1β, and high mobility group box-1 in the small intestine. In addition, this study showed that combined NaB and PROB administration increased nuclear factor-erythroid 2-related factor 2 (Nrf2) protein expression and decreased the phosphorylation of nuclear factor (NF)-κB and extracellular signal-regulated kinase 1/2 (ERK 1/2). In conclusion, our findings indicate that combined NaB and PROB treatment may inhibit severe burn-induced inflammation and oxidative stress in the small intestine by regulating HMGB1/NF-κB and ERK1/2/Nrf2 signaling, thereby providing a new therapeutic strategy for intestinal injury induced by severe burn.     

Enlisting healthcare professionals in the campaign against incendiary weapons

AThe exceptionally severe burns caused by incendiary weapons make strengthening international law a humanitarian imperative. Given healthcare professionals’ deep understanding of the human cost of burn injuries, they are in a unique position to urge governments to initiate a process to assess the law’s shortcomings at a major UN disarmament meeting in December. One way to advocate for such policy change is by signing an open letter from healthcare professionals and burn survivor organizations.     

Gray matter atrophy and corresponding impairments in connectivity in patients with anti-N-methyl-D-aspartate receptor encephalitis

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a severe autoimmune disease that is commonly accompanied by cognitive impairment and various neurological and psychiatric symptoms, advanced image analyses help explore the pathogenesis of this disease. Therefore, this study aimed to explore specific structural and functional alterations and their relationship with the clinical symptoms of anti-NMDAR encephalitis. In this study, twenty-two patients with anti-NMDAR encephalitis after the acute stage and 29 controls received cognitive assessments and magnetic resonance imaging. Grey matter atrophy was measured using voxel-based morphometry, and functional alterations in abnormal regions were subsequently investigated using resting state functional connectivity (RSFC). Finally, correlation analyses were performed to explore the associations between imaging alterations and cognitive assessments. The patients demonstrated significant gray matter atrophy in the bilateral triangle part of the inferior frontal gyrus (triIFG.L and triIFG.R) and right precuneus, decreased RSFC between triIFG.L and bilateral Heschl gyrus (HES), decreased RSFC between triIFG.R and HES.R, decreased RSFC between right precuneus and left cerebellum, and increased RSFC between triIFG.R and left superior frontal gyrus. Further correlation analyses showed that the gray matter volume in triIFG.R and decreased RSFC between triIFG.L and HES.R were associated with decreased memory scores, whereas decreased RSFC between triIFG.R and HES.R was marginally correlated with the disease course in patients. In conclusion, this study suggests that cognitive impairments in patients with anti-NMDAR encephalitis may be mainly associated with gray matter atrophy and abnormal RSFC in the triIFG. These findings provide new insights into anti-NMDAR encephalitis pathogenesis and help explore potential treatments.

     

Biomechanical evaluation of different internal fixation methods based on finite element analysis for Pauwels type III femoral neck fracture

Background and objectiveThe best internal fixation method for the treatment of Pauwels type III femoral neck fractures (FNFs) remains to be demonstrated. Through finite element analysis, this study explored whether dynamic hip screw (DHS) combined with anti rotation screw or medial buttress plate can improve the stability of internal fixation, and the femoral neck system (FNS) with similar structure to DHS and the traditional cannulated screw (CSs) were added for comparison. To evaluate their respective biomechanical advantages and disadvantages in the treatment of Pauwels type III FNFs.MethodsSix groups of internal fixation models for the treatment of FNFs were established, including CSs, DHS, DHS combined with single anti-rotation screw (DHS + SS), and DHS combined with both anti-rotation screw (DHS + BS), DHS combined with medial buttress plate (DHS + MBP), new femoral neck internal fixation system (Femoral Neck System, FNS). Four finite element analysis models were established for each group, evaluation of femoral displacement and internal fixation stress during stair climbing and walking conditions, and the contact force of the hip joint was used in two cases, dynamic and static.ResultsThe fracture plane motion and peak stress of internal fixators were the lowest with DHS + BS and CSs fixation, and the two results are very close, The peak value of DHS combined with anti rotation screw or medial buttress plate is much lower than that of DHS, indicating that the fixation effect of the combined model is enhanced, and there is no significant difference between FNS and DHS + SS.ConclusionBoth the anti rotation screw and medial buttress plate can effectively reduce the movement of fracture section and share the shear force of DHS, FNS has the similar fixation stability to DHS + SS, DHS + BS has the biomechanical advantages of significantly reducing the risk of internal fixation failure and femoral yield. Therefore, the use of DHS + BS may be a more favorable choice in the case of Pauwels type III FNFs with higher fixation requirements.     

Orthotopic Heart Transplant with Concurrent Supracoronary Ascending Aortic Replacement

BackgroundWe report a case of successful orthotopic heart transplant with concurrent supracoronary ascending aortic replacement (SCAAR) using a vascular conduit.Case PresentationAn orthotopic heart transplant was performed on a 29-year-old White man with idiopathic dilated cardiomyopathy and reduced ejection fraction (20%).During the revision of the donor heart, a wall defect was detected in the ascending part of the donor aorta that could not be corrected.It was decided to perform a SCAAR using a 22-mm polytetrafluoroethylene vascular conduit and double-patch sandwich technique with Teflon patches.Two months later postoperative computed topography scan demonstrated sufficient patency of the vascular conduit and aorta with an improvement in the general somatic and functional state of the patient, and normal systolic and diastolic function of the transplanted heart.ConclusionsOur clinical case is unique in the complexity of the procedure with potential high intraoperative and early postoperative risks as well as the fact that SCAAR was performed immediately after heart transplant.In this clinical case, reconstruction of the ascending aorta with a vascular conduit is a strategically correct solution in the event of aortic defects that cannot be corrected with a suture technique.     

A New Strategy of Liver Transplantation for Locally Advanced Unresectable Perihilar Cholangiocarcinoma Using Living Grafts With Simultaneous Resection of Recipients’ Hepatic Artery and Portal Vein Without Neoadjuvant Radiation: A Case Report

BackgroundPerihilar cholangiocarcinoma (pCCA) is often unresectable, because it includes crucial blood vessels in portal area. The prognosis of locally advanced unresectable cholangiocarcinomas is extremely poor. Recently, there have been several reports of the prognosis improving drastically with transplantation and combined chemoradiation therapy. However, liver transplantation for pCCA has 2 big problems. The first is that pCCA is located at a lethal position and its progress is sometimes rapid; therefore, the optimal timing of transplantation is sometimes lost. The second is vascular complications associated with neoadjuvant radiation, especially in living donor liver transplantation (LDLT).To overcome these problems, we performed conversion surgery using LDLT with simultaneous resection of the hepatic artery and portal vein, instead of neoadjuvant radiation. Herein, we report our experience of interposition reconstruction.MethodsA 31-year-old man with primary sclerosing cholangitis (PSC) was diagnosed with locally advanced unresectable pCCA. The patient underwent radical chemotherapy (gemcitabine/cisplatin/S-1) and avoided radiation because of PSC. After 6 months, positron emission tomography–computed tomography revealed no lymph node metastasis. There was no time to wait. We immediately performed LDLT with simultaneous resection of hepatic artery and portal vein, and microsurgical reconstruction using auto-vessel grafts.ResultsThe recipient recovered and was discharged 31 days posttransplant. His liver function improved, and he has had no recurrence after LDLT.ConclusionLDLT with neoadjuvant radiation is associated with high risk of vascular complications. In some cases, conversion surgery after radical chemotherapy using good timing LDLT without radiation may increase chances of transplantation for locally advanced pCCA.     

Long-term morbidities following unintentional dural puncture in obstetric patients: A systematic review and meta-analysis

Study objectiveTo investigate the association of unintentional dural puncture (UDP) and postdural puncture headache (PDPH) with the risk of chronic headache, backache, neckache and depression. We also investigated if epidural blood patch (EBP) is associated with reduced risk of these morbidities.DesignSystematic review and meta-analysis.PatientsPregnant women who experienced UDP and/or PDPH versus those who had uneventful neuraxial procedures, and women who received EBP versus those who did not.InterventionsNone.MeasurementsPrimary outcomes were headache, backache, and neckache lasting ≥12 months, and depression ≥1 month. Secondary outcomes included chronic headache, backache, and neckache persisting ≥1 and ≥ 6 months, and the effects of EBP on those outcomes at ≥1 and ≥ 12 months. Subgroup analyses of prospective studies and sensitivity analyses of primary outcomes excluding poor quality studies were performed.Main resultsTwelve studies compared 6541 women with UDP and/or PDPH versus 1,004,510 with uncomplicated neuraxial procedures. Eight studies compared EBP (n = 3610) with no EBP (n = 3154). UDP and/or PDPH were associated with increased risk of headache (RR 3.95; 95%CI 2.13 to 7.34; I² 42%), backache (RR 2.72; 95%CI 2.04 to 3.62; I² 1%), and neckache (RR 8.09; 95%CI 1.03 to 63.35) persisting ≥12 months, and depression (RR 3.12; 95%CI 1.44 to 6.77; I² 90%) lasting ≥1 month. Results were consistent in analyses at ≥1 and ≥ 6 months, subgroup analyses of prospective studies, and after exclusion of one poor-quality study from our primary outcome. EBP was not associated with significant reduction in the risk of long-term morbidities.ConclusionsUDP and/or PDPH were associated with increased risk of chronic headache, backache, neckache, and depression. EBP was not associated with a significant reduction in those risks, but this conclusion is limited by the heterogeneity of current data and lack of information on the success of EBP in relieving acute PDPH symptoms.