全层缝合在预防阑尾炎术后切口感染中的应用

目的：探讨全层缝合在预防阑尾炎术后切口感染的治疗效果。方法：将皮肤、皮下组织、腹外斜肌腱膜全层褥式缝合(腹膜不予缝合)。结果：56例患者无一例感染，也未发现近期并发症。结论：此方法对预防切口感染有较好疗效，且能缩短手术时间，操作简单，建议值得临床应用。     

The Use of Oral Amino-Bisphosphonates and Coronavirus Disease 2019 (COVID-19) Outcomes

The determinants of the susceptibility to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection and severe coronavirus disease 2019 (COVID-19) manifestations are yet not fully understood. Amino-bisphosphonates (N-BPs) have anti-inflammatory properties and have been shown to reduce the incidence of lower respiratory infections, cardiovascular events, and cancer. We conducted a population-based retrospective observational cohort study with the primary objective of determining if oral N-BPs treatment can play a role in the susceptibility to development of severe COVID-19. Administrative International Classification of Diseases, Ninth Revision, Clinical ModificationI (ICD-9-CM) and anatomical-therapeutic chemical (ATC) code data, representative of Italian population (9% sample of the overall population), were analyzed. Oral N-BPs (mainly alendronate and risedronate) were included in the analysis, zoledronic acid was excluded because of the low number of patients at risk. Incidence of COVID-19 hospitalization was 12.32 (95% confidence interval [CI], 9.61–15.04) and 11.55 (95% CI, 8.91–14.20), of intensive care unit (ICU) utilization because of COVID-19 was 1.25 (95% CI, 0.38–2.11) and 1.42 (95% CI, 0.49–2.36), and of all-cause death was 4.06 (95% CI, 2.50–5.61) and 3.96 (95% CI, 2.41–5.51) for oral N-BPs users and nonusers, respectively. Sensitivity analyses that excluded patients with prevalent vertebral or hip fragility fractures and without concomitant glucocorticoid treatment yielded similar results. In conclusion, we found that the incidence of COVID-19 hospitalization, intensive care unit (ICU) utilization, and COVID-19 potentially related mortality were similar in N-BPs–treated and nontreated subjects. Similar results were found in N-BPs versus other anti-osteoporotic drugs. We provide real-life data on the safety of oral N-BPs in terms of severe COVID-19 risk on a population-based cohort. Our results do not support the hypothesis that oral N-BPs can prevent COVID-19 infection and/or severe COVID-19; however, they do not seem to increase the risk. © 2021 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).     

Inhibition of bacterial and leukocyte adhesion under shear stress conditions by material surface chemistry

Biomaterial-centered infections, initiated by bacterial adhesion, persist due to a compromised host immune response. Altering implant materials with surface modifying endgroups (SMEs) may enhance their biocompatibility by reducing bacterial and inflammatory cell adhesion. A rotating disc model, which generates shear stress within physiological ranges, was used to characterize adhesion of leukocytes and Staphylococcus epidermidis on polycarbonate-urethanes and polyetherurethanes modified with SMEs (polyethylene oxide, fluorocarbon and dimethylsiloxane) under dynamic flow conditions. Bacterial adhesion in the absence of serum was found to be mediated by shear stress and surface chemistry, with reduced adhesion exhibited on materials modified with polydimethylsiloxane and polyethylene oxide SMEs. In contrast, bacterial adhesion was enhanced on materials modified with fluorocarbon SMEs. In the presence of serum, bacterial adhesion was primarily neither material nor shear dependent. However, bacterial adhesion in serum was significantly reduced to 10% compared to adhesion in serum-free media. Leukocyte adhesion in serum exhibited a shear dependency with increased adhesion occurring in regions exposed to lower shear-stress levels of 7 dyne/cm². Additionally, polydimethylsiloxane and polyethylene oxide SMEs reduced leukocyte adhesion on polyether-urethanes. In conclusion, these results suggest that surface chemistry and shear stress can mediate bacterial and cellular adhesion. Furthermore, materials modified with polyethylene oxide SMEs are capable of inhibiting bacterial adhesion, consequently minimizing the probability of biomaterial-centered infections.     

Pneumatic compression in the treatment of chronic ulcers

Abstract

Objective: To review existing literature that examines physiological mechanisms and clinical effects of different types of pneumatic compression (PC) therapy in the treatment of chronic wounds.

Methods: Electronic databases were searched using intermittent, sequential, cardiosynchronous, pneumatic, compression, ulcer, wound, healing, and treatment as key words. All clinical studies were included provided the study subjects had chronic wounds, the treatment included PC, and wound healing was a measured outcome. Original clinical reports investigating the physiological effects of PC were also retrieved and reviewed.

Results: There is a strong physiological basis behind the use of PC for improving venous and arterial circulation. Six randomised controlled trials (RCTs) have compared the effect of PC to compression therapy or standard wound care on the healing of venous ulcers. However, these RCTs have produced conflicting results. One recent controlled clinical trial reported significantly improved healing and reduced amputation rate of people with chronic arterial ulcers. A well designed RCT also demonstrated greater oedema reduction and faster healing of diabetic foot ulcers compared to sham controls. Research is emerging to delineate optimal treatment protocols.

Conclusion: PC may be a valuable adjunct to aid in the treatment of individuals with venous, arterial, and diabetic ulcers. It should be considered for those people who are not compliant with compression bandaging or those at risk of limb amputation.     

A novel controlled drug-delivery system for growth hormone applied to healing skin wounds in diabetic rats

Controlled release systems for drugs, hormones and growth factors can be particularly useful in tissue repair processes. These systems act as a biodegradable support containing the substance to be delivered, allowing their gradual release. In the past years, the local application of growth factors has acquired special relevance as a therapeutic option for use in subjects who show deficient tissue scarring, the hormone dose being the limiting factor for its success. In this study, the in vitro biocompatibility of a copolymer formed by vinylpyrrolidone and 2-hydroxyethyl methacrylate, used as an administration vehicle for hGH, was evaluated. The system was then tested in vivo in terms of its capacity for healing incisional wounds in healthy and diabetic rats. For the in vitro studies, polymer and hormone degradation rates were determined, and polymer biocompatibility was evaluated in fibroblast cultures. In the in vivo experiments, an incision was made in the back of the animals, and polymers discs with/without hGH, were introduced in the aperture. Morphological, immunohistochemical and morphometric evaluations were performed on wound tissue specimens 3-10 days after surgery. In vitro, the polymer was found to be biodegradable and showed no toxic effects on fibroblasts, the hormone being slowly released to the culture medium. In untreated diabetic rats, a delayed skin scarring and cell response were observed, compared to that noted in healthy animals. Skin closure, keratinisation and fibrosis occurred earlier in the presence of the polymer-hGH system. The use of this co-polymer as an administration vehicle for hGH improves the wound scarring process in the pathological setting of diabetes.     

Antibacterial and antimycotic activity of a cross-linked electrospun poly(vinyl pyrrolidone)–iodine complex and a poly(ethylene oxide)/poly(vinyl pyrrolidone)–iodine complex

Photo-cross-linked poly(vinyl pyrrolidone) (PVP) and poly(ethylene oxide)(PEO)/PVP electrospun nanofibrous mats containing complex-bound iodine have been studied. FT-IR spectroscopy analyses have proved that coordination of molecular iodine with carbonyl group and nitrogen atom of pyrrolidone rings of the PVP chains has taken place. The distribution of iodine along the fibers is uniform as revealed by X-ray mapping. The microbiological tests have demonstrated that the iodine complex-containing electrospun mats are highly effective against the Gram-positive bacterium Staphylococcus aureus, the Gram-negative bacterium Escherichia coli and the fungus Candida albicans. Comparison with iodine complex-containing films has shown that the iodine complex-containing nanofibers exhibit a higher killing rate than the films against bacteria E. coli. SEM observations showed that PVP–iodine nanofibrous mats inhibit the adhesion of bacteria S. aureus. These characteristic features make the electrospun iodine-containing nanofibers good candidates for wound-dressing materials.     

健脾饮对学龄前儿童反复呼吸道感染的治疗作用

【目的】探讨健脾饮(由白术、黄芪、鸡内金、黄精、橘红组成)对学龄前儿童反复呼吸道感染(RRTI)的治疗作用及其对T细胞亚群的影响。【方法】采用简单随机法将100例RRTI患儿随机分为两组,在感染间歇期治疗组50例用健脾饮治疗,对照组50例用卡介苗多糖、核酸注射液治疗。两组均治疗6个月,并随访1年,观察两组总疗效,统计两组患儿年平均发病次数和每次患病天数,分别检测两组治疗前后T细胞亚群指标,并与50例正常组进行对照分析。【结果】治疗组近期控制23例,显效18例,有效7例,无效2例,总有效率为96.0%;对照组近期控制22例,显效15例,有效10例,无效3例,总有效率为94.0%。统计结果显示,两组疗效相仿(P>0.05);但治疗组在减少年平均发病次数和每次患病天数方面优于对照组(P<0.05或P<0.01)。临床观察发现,RRTI患儿血清CD3、CD4水平及CD4与CD8比值低于正常儿,CD8水平高于正常儿(P<0.05或P<0.01)。治疗组经健脾饮治疗后血清CD4水平提高,CD8水平下降,CD4与CD8比值增高(与治疗前比较,P<0.05),与对照组比较也均有显著性差异(P<0.05),并基本达到正常组水平(P>0.05)。【结论】健脾饮能有效减少RRTI患儿年平均发病次数和每次发病天数,这可能与其改善RRTI患儿的T细胞亚群指标,提高RRTI患儿的细胞免疫功能有关。     

Comparison of ventricular drainage in poor grade patients after intracranial hemorrhage

Abstract

Objectives: The selection of patients and treatment criteria for acute hydrocephalus and intracranial pressure (ICP) after intracranial hemorrhage remains unclear. In general neurosurgical practice, there is a tendency to use external ventricular drainage (EVD) for the patients. This study was undertaken to analyse the complications and efficiency of the different treatment modalities.

Methods: The effects, complications and outcome of ventricular drainage on high ICP and hydrocephalus were analysed retrospectively in 109 patients with intracranial hemorrhage. All the patients were assessed using the Glasgow Coma Scale, computed tomography and ICP monitoring. We excluded patients over the GCS of 8. All patients underwent a procedure for ICP monitoring plus ventricular cerebrospinal fluid (CSF) drainage. Sixty-one patients were managed with one (single) EVD system; 12 patients needed two EVD systems consecutively, while 23 patients underwent an EVD procedure followed by permanent ventriculoperitoneal (VP) shunt insertion. Thirteen patients were treated only by VP shunt for ventricular drainage. The infection rate and outcome 9 months after hemorrhage were analysed.

Results: The infection rates were 8.1% in the one-EVD group, 33.3% in the two-EVD group (one EVD versus two EVD, p<0.05), 8.6% in the EVD-VP group and 7.7% in the VP shunt group. The mortality rates were 73.7% in the one-EVD group, 83.8% in the two-EVD group, 47.8% (p<0.05) in the EVD-VP group and 53.8% (p<0.01) in the VP shunt group.

Discussion: This study indicates that single and short-term use of EVD and/or early VP shunting are associated with a low risk of infection. Furthermore, early VP shunting may protect the brain from the irregular control of intracranial hypertension and may allow more time for resolution of CSF circulation and significantly lowers the mortality rates.     

Enterocutaneous Fistula: a Rare Complication of Laparoscopic Adjustable Gastric Banding

Morbid obesity is a refractory disease with serious co-morbidities. Laparoscopic adjustable gastric banding (LAGB) has generally been a safe and effective method for achieving sustained weight loss. We report a man who presented after LAGB with persistent wound infection at the access port-site, which failed conservative management. Diagnostic laparoscopy found an enterocutaneous fistula from herniated bowel (in a Richter's hernia) into which the catheter had eroded. The small bowel and fascial defect were repaired. The catheter was then clipped and divided, and the port was removed.