Explore the vast range of titles available.

Achieving rapid definitive hemostasis is essential to ensure survival of patients with massive bleeding in pre-hospital care. It is however challenging to develop hemostatic agents or dressings that simultaneously deliver a fast, long-lasting and safe treatment of hemorrhage. Here, we integrate meso-/micro-porosity, blood coagulation and stability into a flexible zeolite-cotton hybrid hemostat. We employ an on-site template-free growth route that tightly binds mesoporous single-crystal chabazite zeolite onto the surface of cotton fibers. This hemostatic material maintains high procoagulant activity after water flow treatment. Chabazite particles are firmly anchored onto the cotton surface with < 1% leaching after 10 min of sonication. The as-synthesized hemostatic device has superior hemostatic performance over most other clay or zeolite-based inorganic hemostats, in terms of higher procoagulant activity, minimized loss of active components and better scalability for practical applications (a hemostatic T-shirt is hereby demonstrated as an example). Zeolites have attracted attention and have been applied as haemostatic agents; however, there are issues associated with released zeolite powder. Here, the authors report on the growth of zeolites on cotton fibres with high stability and haemostatic ability.

The aim of this study was to verify the efficacy of wound protection with a plastic ring wound protector (ring drape) and using new sterile instruments when closing the abdominal wall (wound closure set), both of which were used to prevent incisional surgical site infection (SSI) after hepatectomy. The incidence of incisional SSIs and the clinical courses of 572 patients who underwent hepatectomy between January 2010 and December 2015 were studied retrospectively. The patients were divided into three period groups according to the period when each infection countermeasure was started. Incisional SSI incidence decreased significantly with additional countermeasures: 1 period 10.1%; 2 period 2.08% (p=0.0114); 3 period, 1.63% (1st vs. 3 period, p=0.0016). A multivariate analysis showed that postoperative bile leakage [odds ratio (OR)=4.12, p=0.012] and not using a ring drape (OR=0.176, p=0.003) were independent factors for incisional SSI. Incisional SSI incidence was significantly reduced by using ring drape after hepatectomy.

The objective of this study was to investigate if delivering multiple doses of N-acetylcysteine (NAC) post-surgery in addition to pre-incisional administration significantly impacts the wound healing process in a rat model. Full-thickness skin incisions were carried out on the dorsum of 24 Sprague-Dawley rats in six locations. Fifteen minutes prior to the incision, half of the sites were treated with a control solution, with the wounds on the contralateral side treated with solutions containing 0.015%, 0.03% and 0.045% of NAC. In the case of the NAC treated group, further injections were given every 8 h for three days. On days 3, 7, 14 and 60 post-op, rats were sacrificed to gather material for the histological analysis, which included histomorphometry, collagen fiber organization analysis, immunohistochemistry and Abramov scale scoring. It was determined that scars treated with 0.015% NAC had significantly lower reepithelization than the control at day 60 post-op (p = 0.0018). Scars treated with 0.045% NAC had a significantly lower collagen fiber variance compared to 0.015% NAC at day 14 post-op (p = 0.02 and p = 0.04) and a lower mean scar width than the control at day 60 post-op (p = 0.0354 and p = 0.0224). No significant differences in the recruitment of immune cells and histological parameters were found. The results point to a limited efficacy of multiple NAC injections post-surgery in wound healing.

Scar formation following large-area vaginal defects post-vaginoplasty is a major clinical challenge. Compared to skin scars, vaginal scars can lead to pain during intercourse and urinary difficulties, severely impacting quality of life. Small extracellular vesicles (sEVs) encapsulate diverse bioactive components, making them potential therapeutic agents. Designing functional scaffolds that incorporate sEVs is a promising approach for scarless vaginal defect repair. sEVs-loaded scaffolds were developed through electrostatic interactions between negatively charged sEVs secreted by urine-derived stem cells (USC-sEVs) and positively charged human acellular amniotic membranes. The efficacy of sEVs-loaded scaffolds in the treatment of vaginal defects in rabbits was assessed by histological analysis. Immunofluorescence staining, Western blot, qRT-PCR and collagen gel contraction analyses were conducted to evaluate the antifibrotic effects of USC-sEVs. RNA sequencing was employed to elucidate the underlying mechanisms involved. LC‒MS/MS analysis was used to identify candidate upstream proteins in USC-sEVs. In vivo experiments demonstrated that the sEVs-loaded scaffolds promoted scarless healing of vaginal defects in rabbits by modulating collagen deposition, reducing fibrosis, and diminishing inflammation. In vitro experiments revealed that USC-sEVs significantly inhibited the proliferation, collagen production, and activation of fibroblasts with a fibrotic phenotype, indicating the antifibrotic properties of USC-sEVs. Transcriptome and Western blot analyses revealed that USC-sEVs treatment inhibited fibrosis by downregulating the TGF-β and p38 MAPK signaling pathways. LC‒MS/MS analysis identified 2653 proteins encapsulated in USC-sEVs. Western blot analysis revealed that decorin, an inhibitor of the TGF-β signaling pathway, and DUSP3, a negative regulator of p38 phosphorylation, were enriched in USC-sEVs and could be transferred to fibroblasts. USC-sEVs inhibited fibrosis and promoted scarless healing by delivering decorin and DUSP3 proteins, which regulate the TGF-β and p38 MAPK signaling pathways, respectively. This study highlights the potential of sEVs-loaded scaffolds as a promising strategy for scarless vaginal repair following vaginoplasty, offering a novel approach for regenerative medicine with significant translational potential for clinical application.

Scarless wound healing is ideal for patients suffering from soft tissue defects. In this study, we prepared a novel wet dressing (β-CD-ic-CUR/GC) based on the visible light-cured glycol chitosan (GC) hydrogel and inclusion complex between beta-cyclodextrin (β-CD) and curcumin (CUR). We also evaluated its efficacy in the acceleration of wound healing as compared to that of CUR-loaded GC (CUR/GC). The conjugation of glycidyl methacrylate (GM) to GC for photo-curing was confirmed by 1H-NMR measurement, and the photo-cured GC hydrogel was characterized by the analyses of rheology, swelling ratio, SEM and degradation rate. After visible light irradiation, the surface/cross-sectional morphologies and storage (G′)/loss (G′′) moduli revealed the formation of hydrogel with interconnected porosity. The dressing β-CD-ic-CUR/GC exhibited a controlled release of 90% CUR in a sustained manner for 30 days. On the other hand, CUR/GC showed CUR release of 16%. β-CD acted as an excipient in improving the water-solubility of CUR and affected the release behavior of CUR. The in vivo animal tests including measurement of the remaining unhealed wound area and histological analyses showed that β-CD-ic-CUR/GC may have potential as a wet dressing agent to enhance soft tissue recovery in open fractures.

Background This study was designed to evaluate the prevalence, morbidity, and prognostic impact of port-site metastasis (PSM) in patients with epithelial ovarian cancer (EOC) undergoing laparoscopy before subsequent primary debulking surgery (PDS). Methods All consecutive patients treated between 2000 and 2014, who had a laparoscopy followed by PDS, were extracted from our prospectively maintained database. All patients with histological examination of port-sites were included in this unicentric exploratory analysis. Results A total of 250 (25.5 %) of 982 patients with EOC underwent laparoscopy before PDS. Port-site resection was performed in those 214 (85.6 %) patients in whom a complete or almost complete resection with residuals ≤1 cm was achieved. Median interval between laparoscopy and PDS was 25 days. PSM was detected in 100 of 214 patients (46.7 %). Risk factors for PSM were higher tumor stage (odds ratio [OR] 13.5, 95 % confidence interval [CI] 2.9–62.0, p  = 0.04), positive lymph node status (OR 3.0, 95 % CI 1.3–6.7, p  = 0.009), and ascites >500 mL (OR 3.9, 95 % CI 1.5–10.0, p  = 0.005). Wound healing disorders and postoperative morbidity were significantly higher in patients with PSM (Clavien–Dindo Classification grade 3–5: 41.0 vs. 14.9 %, p  < 0.001). However, multivariate Cox-regression models did not identify PSM as independent prognostic factor. Conclusions The prevalence of PSM after laparoscopy in EOC patients is considerably high. PSM had no impact on survival; however, PSM were associated with more postoperative complications and a higher surgical treatment burden. This should be balanced with the expected benefit when laparoscopy is considered for the management of EOC.

Post-operative surgical site infections (SSI) present a serious threat and may lead to complications. Currently available dressings for SSI lack mucoadhesion, safety, efficacy and most importantly patient compliance. We aimed to address these concerns by developing a bioactive thiolated chitosan-alginate bandage embedded with zinc oxide nanoparticles (ZnO-NPs) for localized topical treatment of SSI. The FTIR, XRD, DSC and TGA of bandage confirmed the compatibility of ingredients and modifications made. The porosity, swelling index and lysozyme degradation showed good properties for wound healing and biodegradation. Moreover, in-vitro antibacterial activity showed higher bactericidal effect as compared to ZnO-NPs free bandage. In-vivo wound healing in murine model showed significant improved tissue generation and speedy wound healing as compared to positive and negative controls. Over all, thiolated bandage showed potential as an advanced therapeutic agent for treating surgical site infections, meeting the required features of an ideal surgical dressing.

Background The effects of preoperative malnutrition and preoperative correction of hypoalbuminemia (PCH) on the short- and long-term outcomes in patients with gastric cancer are unclear. Objective This study aimed to examine the effect of preoperative nutritional status on short- and long-term outcomes in patients who underwent radical gastrectomy, and also explored the role of PCH in malnourished patients with gastric cancer. Methods We prospectively reviewed data from patients with gastric cancer who were treated in our department between January 2009 and December 2014. The effect of preoperative nutritional status on short- and long-term outcomes in patients who underwent radical gastrectomy was investigated, and we explored whether PCH could improve the short- and long-term outcomes of these patients. Results A total of 1976 patients were analyzed, including 412 patients in the malnourished group and 1564 in the well-nourished group. The overall incidence of complications in the malnourished group was significantly higher than the well-nourished group (21.4 vs. 15.5%, p  = 0.005). Except for incision infection (3.2 vs. 1.6%, p  = 0.041), there were no significant differences for other complications. In the malnourished group, 98 cases of preoperative hypoproteinemia were corrected (PCH group), whereas 314 cases were not (NPCH group). The incidence of incision infection in the PCH group was significantly lower than in the NPCH group (0 vs. 4.1%, p  = 0.041). The median follow-up time was 39 months (1.0–88.0 months), and the 3-year overall survival (OS; 59.1 vs. 75%, p  < 0.001) and disease-free survival (DFS; 54.8 vs. 72.5%, p  < 0.001) rates were significantly lower in the malnourished group than in the well-nourished group. A multivariate Cox regression analysis showed that malnutrition was an independent prognostic factor for 3-year OS (hazard ratio [HR] 1.211, 95% confidence interval [CI] 1.01–1.452, p  = 0.039) and DFS (HR 1.168, 95% CI 1.013–1.398, p  = 0.043). For the malnourished group with stage I gastric cancer, the PCH and NPCH groups showed no significant differences in 3-year OS (90.0 vs. 89.0%, p  = 0.227) or DFS (90.0 vs. 87.3%, p  = 0.363); however, for the malnourished group with stages II–III gastric cancer, the 3-year OS (69.9 vs. 47.6%, p  = 0.013) and DFS (55.4 vs. 43.6%, p  = 0.046) rates were significantly higher in the PCH group than in the NPCH group. Conclusions The incidence of incision infection was significantly higher in patients with malnutrition than in well-nourished patients. The 3-year OS and DFS rates were significantly lower in malnourished patients than in well-nourished patients. PCH may both reduce the incidence of incisional infection in patients with malnutrition and improve 3-year OS and DFS rates for malnourished patients with stages II–III gastric cancer; however, to confirm our findings, further studies are warranted.

BackgroundTemporal artery biopsy (TAB) is often performed by ophthalmology trainees without direct supervision. The traditional model of ‘see one, do one, teach one’ still prevails in most units. Whilst it is generally a safe procedure, damage to the temporal branch of the facial nerve has been reported when harvesting the frontal branch of the superficial temporal artery.MethodsA survey of trainees from Wessex, Wales, London and Severn deaneries was performed to look at current training techniques, anatomical knowledge and practice.Results38 trainees responded to the survey, with complete responses from 28 participants. Formal teaching of the anatomical considerations in TAB was not reported by any trainee, with informal teaching being standard practice. Whilst 61% of respondents reported having learnt about the anatomical ‘danger zone’ for facial nerve damage, 97% of trainees chose an incision that fell within this zone when given a choice between potential incision sites.ConclusionTAB remains a largely trainee-taught, trainee-performed procedure. Most trainees are not aware of how to avoid the risk of damage to the temporal branch of the facial nerve. We suggest harvesting the parietal branch of the temporal artery via an incision outside the anatomical ‘danger zone’. In our experience, this is an easily taught technique that minimises the potential risk of damage to the frontal branch of the facial nerve.

Non-healing wounds continue to be a clinical challenge for patients and medical staff. These wounds have a heterogeneous etiology, including diabetes and surgical trauma wounds. It is therefore important to decipher molecular signatures that reflect the macroscopic process of wound healing. To this end, we collected wound sponge dressings routinely used in vacuum assisted therapy after surgical trauma to generate wound-derived protein profiles via global mass spectrometry. We confidently identified 311 proteins in exudates. Among them were expected targets belonging to the immunoglobulin superfamily, complement, and skin-derived proteins, such as keratins. Next to several S100 proteins, chaperones, heat shock proteins, and immune modulators, the exudates presented a number of redox proteins as well as a discrete neutrophil proteomic signature, including for example cathepsin G, elastase, myeloperoxidase, CD66c, and lipocalin 2. We mapped over 200 post-translational modifications (PTMs; cysteine/methionine oxidation, tyrosine nitration, cysteine trioxidation) to the proteomic profile, for example, in peroxiredoxin 1. Investigating manually collected exudates, we confirmed presence of neutrophils and their products, such as microparticles and fragments containing myeloperoxidase and DNA. These data confirmed known and identified less known wound proteins and their PTMs, which may serve as resource for future studies on human wound healing.