Self-retaining barbed suture reduces warm ischemia time during laparoscopic partial nephrectomy

Objective: To evaluate the efficacy and safety of self-retaining barbed suture in renorrhaphy during laparoscopic partial nephrectomy by comparing surgical outcomes in a prospective randomized manner.

Material and methods: From July 2014 to July 2015, a total of 60 patients with T1 renal tumor were randomized into two equal groups: self-retaining barbed suture (SRBS) and conventional absorbable polyglactin suture (non-SRBS group). All patients were treated by retroperitoneal laparoscopic partial nephrectomy. One surgeon with high volume experience performed all procedures. The patient demographics and perioperative outcomes were compared.

Results: The patient demographics and tumor characteristics were comparable. The mean tumor size and R.E.N.A.L. scores were comparable between the two groups. LPN was successfully accomplished in all patients without open conversion. The warm ischemia and renorrhaphy times were significantly shorter in the SRBS group (18.8?±?8.2 vs. 22.9?±?7.3?min, P?=?.04; 10.4?±?3.7 vs. 13.8?±?5.6?min, P?=?.01). The minor complication rate was 13.3% vs. 10.0%, which was comparable. No major complication occurred.

Conclusions: The randomized controlled trial demonstrates that SRBS for renorrhaphy during retroperitoneal laparoscopic partial nephrectomy is safe and efficient. Application of barbed suture simplifies the parenchymal repair procedure and reduces warm ischemia time in comparison with conventional suture.     

Penetrating injury of the cornea by a barbed fish hook and its surgical management by “Cut-it out technique”

Fishing is a worldwide pastime enjoyed by millions of people. Ocular fishing injuries though uncommon may cause potentially devastating ocular trauma. We report a rare case of penetrating injury of the cornea by a barbed fish hook and its successful surgical management by “cut-it out technique”. We are discussing the various techniques available for removal of fish hooks. The hook can be successfully removed with minimal trauma to ocular structures by understanding the structure of the fish hook and by employing the appropriate method of extraction.     

Barbed Versus Traditional Sutures: Closure Time,Cost, and Wound Related Outcomes in Total Joint Arthroplasty

The purpose of this study was to compare barbed sutures to traditional sutures in three domains: time, cost, and wound related outcomes in total knee arthroplasty (TKA) and total hip arthroplasty (THA). A total of 34 patients were enrolled in a prospective randomized controlled trial to assess time to wound closure and cost. In addition, a retrospective chart review of an additional 100 patients was conducted to further assess wound-related outcomes. On average, barbed sutures decreased time to wound closure by 9.72 min (P < 0.05) after controlling for length of incision, patient's BMI and number of physicians closing. Further, using barbed sutures saved an average of $549.59 per case. However, increased frequency and severity of wound complications were associated with barbed sutures.     

新型倒刺缝线在腹腔镜下肾部分切除术中的疗效及安全性的荟萃分析

目的:系统评价新型倒刺缝线与普通缝线在腹腔镜下肾部分切除术(LPN)中应用的疗效及安全性,为临床选择提供循证依据。方法:制定检索策略计算机分别检索PubMed、Medline、Cochrane Central Register of Controlled Trials、维普、万方、中国生物医学文献数据库、中国科学引文数据库(CSCD)及中国期刊全文数据库(CNKI)。手工检索:中华泌尿外科杂志、临床泌尿外科杂志、现代泌尿外科杂志、微创泌尿外科杂志4种杂志。检索时间均从建库至2017年4月。检索国内外有关新型倒刺缝线与普通缝线在LPN中应用疗效的临床对照研究,按Cochrane系统评价方法提取资料,由2名评价员对纳入文献的质量进行评价,采用RevMan 5.3统计软件进行统计分析。结果:共纳入13篇临床对照研究,中文11篇,外文2篇,共包括1 100例患者,其中新型倒刺缝线566例,普通缝线534例。Meta分析结果显示:2种缝线在肿瘤直径(MD=0.01,95%CI:0.08~0.09,P=0.81)方面差异无统计学意义,但在肾脏热缺血时间(MD=-4.99,95%CI:-6.11^-3.86,P<0.00001)、手术时间(MD=-6.61,95%CI:-10.30^-2.93,P=0.0004)、R.E.N.A.L.评分(MD=0.32,95%CI:0.08~0.55,P=0.008)、术后并发症发生率(MD=0.49,95%CI:0.26~0.92,P=0.03)、术中出血量(MD=-9.54,95%CI:-18.08^-1.00,P=0.03)及术后住院时间(MD=-0.35,95%CI:-0.69^-0.01,P=0.04)等方面比较差异有统计学意义。结论:LPN中,与普通缝线相比,新型倒刺缝线在肾脏热缺血时间、手术时间、术中出血量、术后并发症及术后住院时间等方面具有明显优势。但鉴于纳入文献有限,关于新型倒刺缝线与普通缝线在LPN中应用的疗效及安全性有待于多中心、高质量的随机对照试验进一步验证。     

Comparison of Standard Suture vs Barbed Suture for Closing the Porcine Knee Joint: Evaluation of Biomechanical Integrity and Permeability

Background

This study aimed to compare the biomechanical strength and permeability of barbed vs traditional suture for closure of the porcine knee joint.

Identifying the Relative Contributions of Rac1 and Rac2 to Osteoclastogenesis

Rac small GTPases may play an important regulatory role in osteoclastogenesis. Our in vitro and in vivo results show that both Rac1 and Rac2 are required for optimal osteoclast differentiation, but Rac1 is more critical. Rac1 is the key Rac isoform responsible for regulating ROS generation and the actin cytoskeleton during the multiple stages of osteoclast differentiation. Introduction: Recent evidence suggests that the Rac small GTPases may play an important regulatory role in osteoclastogenesis. This finding is important because bisphosphonates may regulate their antiresorptive/antiosteoclast effects through the modification of Rho family of small GTPases. Materials and Methods: To elucidate the specific roles of the Rac1 and Rac2 isoforms during osteoclastogenesis, we used mice deficient in Rac1, Rac2, or both Rac1 and Rac2 in monocyte/osteoclast precursors. Macrophage‐colony stimulating factor (M‐CSF)– and RANKL‐mediated osteoclastogenesis in vitro was studied by using bone marrow‐derived mononucleated preosteoclast precursors (MOPs). The expression of osteoclast‐specific markers was examined using quantitative real‐time PCR and Western blot analysis. Free actin barbed ends in bone marrow MOPs after M‐CSF stimulation was determined. The ability of MOPs to migrate toward M‐CSF was assayed using Boyden chambers. Margin spreading on heparin sulfate‐coated glass and RANKL‐induced reactive oxygen species generation were also performed. Functional assays of in vitro‐generated osteoclasts were ascertained using dentine sections from narwal tusks. Osteoclast levels in vivo were counted in TRACP and immunohistochemically stained distal tibial sections. In vivo microarchitexture of lumbar vertebrate was examined using μCT 3D imaging and analysis. Results: We show here that, although both Rac isoforms are required for normal osteoclast differentiation, Rac1 deletion results in a more profound reduction in osteoclast formation in vitro because of its regulatory role in pre‐osteoclast M‐CSF‐mediated chemotaxis and actin assembly and RANKL‐mediated reactive oxygen species generation. This Rac1 cellular defect also manifests at the tissue level with increased trabecular bone volume and trabeculae number compared with wildtype and Rac2‐null mice. This unique mouse model has shown for the first time that Rac1 and Rac2 play different and nonoverlapping roles during osteoclastogenesis and will be useful for identifying the key roles played by these two proteins during the multiple stages of osteoclast differentiation. Conclusions: Rac1 and Rac2 play different and nonoverlapping roles during osteoclastogenesis. This model showed that Rac1 is the key Rac isoform responsible for regulating ROS generation and the actin cytoskeleton during the multiple stages of osteoclast differentiation.     

Knee Arthrotomy Repair With a Continuous Barbed Suture : A Biomechanical Study

We compared knee arthrotomy closures using interrupted biodegradable sutures and running bidirectionally barbed sutures in cadaveric specimens subjected to cyclic loading. During the initial 2000 flexion cycles, both groups maintained closure and no suture ruptured. Suture throws were then sequentially cut to weaken the repairs, and the knees were cyclically flexed after each cut. Both types of suture repairs survived the cutting of the first throw or stitch and subsequent cyclical testing. However, there was a significant difference in the repairs after multiple cuts (log-rank test, P < .003). None of the knees in the interrupted suture group survived more than 3 cuts, whereas in the barbed repair group, it took the severing of as many as 7 throws for failure to occur.     

Comparison of two different renorrhaphy techniques in retroperitoneal laparoscopic partial nephrectomy for complex tumor

Background Partial nephrectomy is currently the standard treatment for clinical T1 renal neoplasms, as it can provide oncologic outcomes equivalent to radical nephrectomy. The aim was to evaluate the efficacy of self-retaining suture （SRS） in renorrhaphy technique in retroperitoneal laparoscopic partial nephrectomy （LPN） for a single renal mass of moderate or high complexity by assessing peri-operative outcomes. Methods A retrospective analysis was done of 64 patients between 2010 and 2012 for complex renal mass （RENAL score 〉7） in whom retroperitoneal LPN was performed with two layers using continuous knotless barbed suture （Quill PDO SRS group; n=34） and absorbable vicryl （non-SRS group; n=30）, respectively. Cases were matched for RENAL score. All the surgical procedures were performed by the same surgeon with experience of more than 500 cases of LPN. Comparisons were made in patients and preoperative outcomes and peri-operative complications between SRS group and non-SRS group. Results Mean warm ischemia time （WIT） in SRS group was less than non-SRS group （18.0 vs. 24.8 minutes, P=-0.021）. Renorrhaphy suture cost in SRS group was lower than non-SRS group （$269.6 vs. $335.8, P=0,001）. There were no significant differences between the two groups for postoperative changes in creatinine and estimated glomerular filtration rate and the rate of peri-operative complications. Conclusion SRS was safe for complex renal tumor with two layers, continuous and unknot suture, during LPN and would reduce the WIT and renorrhaphy suture cost significantly.     

Bacterial adhesion to suture material in a contaminated wound model: Comparison of monofilament,braided, and barbed sutures

Contaminated suture material plays an important role in the physiopathology of surgical site infections. Recently, suture material has been developed characterized by barbs projecting from a monofilament base. Claimed advantages for barbed sutures are a shortened wound closure time and reduced maximum wound tension. It has also been suggested that these sutures would be advantageous microbiologically. The aim of this study was to test the microbiological characteristics of the barbed Quill in comparison to the monofilament Ethilon II and the braided sutures Vicryl and triclosan‐coated Vicryl Plus. In our study, sutures were cultivated on color‐change agar with Staphylococcus aureus , Staphylococcus epidermidis , Enterococcus faecium , Escherichia coli , and Pseudomonas aeruginosa and the halo size was measured. In a second study arm with longer cultivation bacterial growth was followed by antibiotic treatment. Ethilon II and Quill showed good comparable results, whereas large halos were found around Vicryl. Vicryl Plus results depended on triclosan sensitivity. After longer bacterial cultivation and antibiotic treatment, halos were up to 3.6 times smaller on Quill than on Vicryl (p < 0.001), but 1.4 times larger than on Ethilon II (p < 0.001) regarding S. aureus . Confocal microscopy analysis showed bacterial colonization between the braided filaments on Vicryl and beneath the barbs on Quill. From a microbiological perspective, barbed sutures can be recommended in aseptic surgery, but should only be used carefully in septic surgery. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:925–933, 2017.

     

节段性膀胱经排刺法为主治疗神经根型颈椎病

目的:观察节段性膀胱经排刺法和常规针刺法治疗神经根型颈椎病的临床疗效,为优化临床治疗方案提供依据。方法:通过门诊收集神经根型颈椎病60例,按就诊时间先后为序随机分为两组,常规针刺加膀胱经排刺法治疗组(简称治疗组)和常规针刺治疗组(简称对照组)各30例,观察治疗前后临床症状、体征变化,对两组疗效进行比较。结果:①两组临床疗效:治疗组总有效率100%,对照组总有效率90%,两组比较差异显著(P0.05),治疗组临床疗效优于对照组。②治疗前后临床症状积分:治疗组和对照组治疗后症状积分差值差异有显著性(P0.05),说明治疗组在改善症状上优于对照组。结论:常规针刺加膀胱经排刺法治疗神经根型颈椎病的临床效果显著,可行性好,可作为临床治疗方案的优选手法。