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OBJECTIVE: Sox2 plays crucial roles in tissues homeostasis and regeneration. However, there are lack of a comprehensive examination of Sox2 expression and its functional role in submandibular gland regeneration. Therefore, we aimed to elucidate the impact of Sox2 on submandibular gland regeneration. MATERIALS AND METHODS: A Sprague-Dawley rat submandibular gland duct ligation/de-ligation regeneration model was conducted in this study. Sox2-shRNA vectors were retro-ductally administered into the submandibular gland to establish a stable Sox2 knockdown model. Conventional histopathological and molecular biological methods were used to investigate phenotypic changes. RESULTS: The submandibular gland normalized completely 28 days after ligature removal (following 7 days of duct ligation). AQP5 expression gradually increased after ligation removal until returning to normal levels. In submandibular gland regeneration, Sox2 re-expressed and co-expressed with AQP5+ acinar cells, and Sox2 expression peaked on day 14, recovered to normal on day 28, reproducing the developmental pattern. Sox2 knockdown hindered gland regeneration and induced irreversible fibrosis. The AQP5 expression was significantly lower than the contemporaneous solely ligated group, while the blue collagen deposition and the Vimentin expression increased prominently. The expression of CD68, IL-1ß, TNF-α and IL-17A increased significantly, and epithelial cells in the Sox2 knockdown group expressed higher levels of IL-17A. CONCLUSIONS: These findings highlight Sox2 as a crucial regulator of the acinar cell lineage. Sox2+ progenitor cells are pivotal for acinar cell maintenance, which is indispensable for submandibular gland regeneration. Collectively, our findings may help develop targeted interventions for enhancing tissue repair and preventing irreversible fibrosis in salivary gland disorders.
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Acuaporina 5 , Ratas Sprague-Dawley , Regeneración , Factores de Transcripción SOXB1 , Células Madre , Glándula Submandibular , Animales , Glándula Submandibular/metabolismo , Ratas , Regeneración/fisiología , Acuaporina 5/metabolismo , Factores de Transcripción SOXB1/metabolismo , Células Madre/metabolismo , Masculino , Ligadura , Células Acinares/metabolismo , Vimentina/metabolismo , ARN Interferente Pequeño , Molécula CD68RESUMEN
Objectives: To identify early treatment outcomes among patients having undergone ligation of intersphincteric fistula tract for complex fistula-in-ano in a tertiary care setting. METHODS: The single-centre retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from January 2016 to January 2021 of adult complex fistula-in-ano patients who underwent ligation of intersphincteric fistula tract procedure. All surgeries were done by a single surgeon. Pre- and post-operative Wexner continence scores were measured, and various factors, including change in continence, complete wound healing, postoperative infection and recurrence, were assessed. Data was analysed using SPSS 23. RESULTS: Of the 20 patients, 15(75%) were females and 5(25.0%) were males. The overall mean age was 38.4±13.8 years. The median duration of surgery was 65 minutes (interquartile range: 57-99 minutes). There were 2(10%) patients who showed a change in continence after surgery to flatus alone. Complete healing was noted in 11(55%) patients. Recurrence was noted in 8(40%) patients; trans-sphincteric fistula-in-ano in 2(10%) patients, and inter-sphincteric fistula in 6(30%). Body mass index had a significant association with the change in continence (p=0.028). CONCLUSIONS: There was a comparable risk of recurrence after ligation of intersphincteric fistula tract surgery, but among those without recurrence, the post-operative outcomes were optimal and no faecal incontinence was noted.
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Fístula Rectal , Humanos , Masculino , Femenino , Ligadura/métodos , Adulto , Fístula Rectal/cirugía , Estudios Retrospectivos , Persona de Mediana Edad , Recurrencia , Incontinencia Fecal/etiología , Incontinencia Fecal/epidemiología , Pakistán , Resultado del Tratamiento , Canal Anal/cirugía , Cicatrización de Heridas , Tempo OperativoRESUMEN
BACKGROUND: Endoscopic variceal ligation (EVL) is the primary treatment for esophageal variceal bleeding in patients with liver cirrhosis (LC). Postoperative rebleeding is a complication of EVL, contributing to over 20% of bleeding-related deaths. This study aims to examine the association between platelet-to-lymphocyte ratio (PLR) and rebleeding within 6 weeks after EVL in patients with LC. METHODS: The study included 145 eligible patients who underwent their first EVL procedure at Yijishan Hospital of Wannan Medical College between January 2016 and August 2022 (YJS cohort). An external validation cohort comprising 338 eligible patients from NO.2 People's Hospital of Fuyang City (FY cohort) between July 2018 and August 2022 was also utilized. RESULTS: In the YJS cohort, Multivariate logistic analysis indicated that high PLR is independently associated with early rebleeding after EVL. The restricted cubic spline analysis demonstrated that the risk of rebleeding increases with rising PLR, stabilizing at PLR values greater than 150. Similar findings were validated in the FY cohort. CONCLUSIONS: Our results have the potential to aid in the identification of high-risk patients for early rebleeding after EVL, thereby enabling improved clinical management and outcomes for these individuals.
This study is the first to report on the independent association between the platelet-to-lymphocyte ratio (PLR) and early rebleeding after endoscopic variceal ligation (EVL).The restricted cubic spline analysis showed a linear correlation between PLR and the risk of early rebleeding after EVL.An increase in PLR level is independently associated with a higher risk of early rebleeding after EVL.
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Várices Esofágicas y Gástricas , Hemorragia Gastrointestinal , Cirrosis Hepática , Humanos , Várices Esofágicas y Gástricas/etiología , Várices Esofágicas y Gástricas/cirugía , Várices Esofágicas y Gástricas/sangre , Masculino , Femenino , Persona de Mediana Edad , Ligadura/efectos adversos , Estudios Retrospectivos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Hemorragia Gastrointestinal/sangre , Cirrosis Hepática/sangre , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Recuento de Plaquetas , Recurrencia , Anciano , Linfocitos , Recuento de Linfocitos , Plaquetas , AdultoRESUMEN
Microsurgical varicocelectomy is the most commonly used method for the treatment of varicocele (VC) in recent years. However, it is technically demanding with the risk of damaging the normal anatomical structure of the spermatic cord, such as the cremaster muscle, testicular artery, and vas deferens during the pampiniform plexus ligation. Also, traditional varicocelectomy hinders the drainage of the stagnant venous blood of the affected testicle, resulting in a persistent scrotal appearance of varicose veins and slower remission of swelling sensation in postoperative patients with grade III VC. Therefore, we developed a retroperitoneal varicocelectomy with a microscopical spermatic venous-superficial vein of the abdominal wall bypass procedure. The spermatic vein was transected and ligated proximally through the retroperitoneal space. Then, the distal spermatic vein was freed and passed through the internal ring; under the skin of the groin, a microscopic vascular anastomosis was performed to build the bypass of the distal spermatic vein and proximal inferior epigastric vein. The high ligation facilitates the protection of the normal anatomy of the spermatic cord, and the venous bypass allows rapid testicular blood drainage, which can effectively improve the degree of varicocele, testicular pain, and even spermatogenic function. In conclusion, the present protocol describes a promising way to reconstruct the spermatic return through high retroperitoneal ligation of the spermatic vein and anastomosis of the spermatic vein-inferior epigastric vein, which resulted in faster and more obvious improvement in symptoms and better prognosis of grade III VC.
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Cordón Espermático , Varicocele , Venas , Masculino , Humanos , Varicocele/cirugía , Cordón Espermático/cirugía , Cordón Espermático/irrigación sanguínea , Venas/cirugía , Anastomosis Quirúrgica/métodos , Microcirugia/métodos , Ligadura/métodosRESUMEN
BACKGROUND: The majority of esophageal subepithelial lesions originating from the muscularis propria (SEL-MPs) are benign in nature, although a subset may exhibit malignant characteristics. Conventional endoscopic resection techniques are time-consuming and lack efficacy for small SEL-MPs. AIM: To evaluate the efficacy and safety of ligation-assisted endoscopic submucosal resection (ESMR-L) following unroofing technique for small esophageal SEL-MPs. METHODS: From January 2021 to September 2023, 17 patients diagnosed with esophageal SEL-MPs underwent ESMR-L following unroofing technique at the endoscopy center of Shenzhen People's Hospital. Details of clinicopathological characteristics and clinical outcomes were collected and analyzed. RESULTS: The mean age of the patients was 50.12 ± 12.65 years. The mean size of the tumors was 7.47 ± 2.83 mm and all cases achieved en bloc resection successfully. The average operation time was 12.2 minutes without any complications. Histopathology identified 2 Lesions (11.8%) as gastrointestinal stromal tumors at very low risk, 12 Lesions (70.6%) as leiomyoma and 3 Lesions (17.6%) as smooth muscle proliferation. No recurrence was found during the mean follow-up duration of 14.18 ± 9.62 months. CONCLUSION: ESMR-L following roofing technique is an effective and safe technique for management of esophageal SEL-MPs smaller than 20 mm, but it cannot ensure en bloc resection and may require further treatment.
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Resección Endoscópica de la Mucosa , Neoplasias Esofágicas , Leiomioma , Humanos , Resección Endoscópica de la Mucosa/métodos , Resección Endoscópica de la Mucosa/efectos adversos , Persona de Mediana Edad , Femenino , Masculino , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Adulto , Ligadura/métodos , Resultado del Tratamiento , Leiomioma/cirugía , Leiomioma/patología , Tempo Operativo , Estudios Retrospectivos , Tumores del Estroma Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/patología , Mucosa Esofágica/cirugía , Mucosa Esofágica/patología , Mucosa Esofágica/diagnóstico por imagen , Anciano , Esófago/cirugía , Esófago/patología , Esofagoscopía/métodos , Esofagoscopía/efectos adversosAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Cierre del Apéndice Auricular Izquierdo , Venas Pulmonares , Humanos , Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Ligadura/efectos adversos , Ligadura/métodos , Venas Pulmonares/cirugía , Cierre del Apéndice Auricular Izquierdo/efectos adversos , Cierre del Apéndice Auricular Izquierdo/métodosRESUMEN
BACKGROUND: Type 1 Spinal dural arteriovenous fistula (dAVF) is a rare but curable vascular cause of myelopathy. Microneurosurgery is a very efficacious modality in treating them. METHOD: A 26 year old gentleman with progressive flaccid paraparesis (LMN type) and urinary incontinence underwent surgery using exoscope for a right side T9-10 dAVF. A dilated vein was seen accompanying the exiting nerve root intraoperatively, consistent with the preoperative angiographic findings. The vein was ligated and divided leading to restitution of spinal cord vasculature on table and excellent postoperative outcome. CONCLUSION: Surgical resection is a straightforward and highly effective treatment in spinal dAVF.
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Malformaciones Vasculares del Sistema Nervioso Central , Microcirugia , Humanos , Malformaciones Vasculares del Sistema Nervioso Central/cirugía , Malformaciones Vasculares del Sistema Nervioso Central/diagnóstico por imagen , Masculino , Adulto , Microcirugia/métodos , Ligadura/métodos , Médula Espinal/cirugía , Médula Espinal/irrigación sanguínea , Médula Espinal/diagnóstico por imagen , Resultado del Tratamiento , Procedimientos Neuroquirúrgicos/métodosRESUMEN
BACKGROUND: The placement of ligatures in the cervical area of rat molars is considered as a predictable model to induce periodontitis. OBJECTIVES: The present explorative study aimed to compare the efficacy of metal wires (MWs), without or with sandblasting, versus silk ligatures (SLs) in inducing periodontal bone loss in rats. MATERIALS AND METHODS: Twenty-four Wistar rats were randomly divided into three groups of eight rats that received three different types of ligatures (MW, sandblasted wire [SMW], and SL) around their first right mandibular molar, while the contralateral tooth was left without the ligature and served as a control. Bone loss was assessed by measuring the distance from the cementoenamel junction (CEJ) to the bone crest at the distal aspect of the first molar on central mesiodistal sections generated from micro-CT scans taken 24 and 35 days after ligature placement. RESULTS: In the SL group, only in two rats the ligatures were retained until the end of the 24-day period; in all other animals, the ligatures were lost at some time point. In the SMW, the ligatures were retained only for the 24-day period. In the MW group, no ligatures were lost. Irrespective of the group or experimental period, the difference in the crestal bone level between ligated and control teeth was in most cases z < 0.20 mm, that is, in 19 out of 25 pairs of teeth. In a few cases, the bone crest was more apically located at the control teeth compared to the ligated ones (four cases each, during both 24- and 35-day experimental periods). CONCLUSIONS: Bone loss was minimal during the experimental period, with no significant differences between the test and control teeth, or among the three types of ligatures. MWs, not even roughened, do not seem to be a better alternative to SLs for inducing bone loss in the experimental periodontitis model in the rat. This assumption, however, has to be confirmed in a larger, well-powered study.
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Pérdida de Hueso Alveolar , Modelos Animales de Enfermedad , Periodontitis , Ratas Wistar , Animales , Periodontitis/patología , Ratas , Pérdida de Hueso Alveolar/etiología , Pérdida de Hueso Alveolar/patología , Ligadura , Masculino , Diente Molar , Microtomografía por Rayos X , Alambres para OrtodonciaAsunto(s)
Apéndice Atrial , Fibrilación Atrial , Ablación por Catéter , Venas Pulmonares , Humanos , Apéndice Atrial/cirugía , Fibrilación Atrial/cirugía , Fibrilación Atrial/complicaciones , Ligadura/efectos adversos , Ligadura/métodos , Venas Pulmonares/cirugía , Cateterismo/efectos adversos , Cateterismo/instrumentaciónRESUMEN
Sepsis is a pathological and biochemical disorder induced by numerous infections, leading to critical illness and a high mortality rate worldwide. Vincamine is an indole alkaloid compound obtained from the leaves of Vinca minor. The present study aims to investigate the hepato-protective activity of vincamine during colon ligation puncture (CLP)-induced sepsis at the molecular level. Sepsis was induced using the CLP model. Liver function enzymes such as ALT and AST were analyzed. The hepatic antioxidant status (SOD and GSH), lipid peroxidation (MDA), the pro-inflammatory cytokines (TNFα, IL-6, and IL-1ß), bax, bcl2, and cleaved caspase 3 proteins were estimated. Nrf-2 and Keap-1 protein expression was evaluated using western blotting. Histopathological investigation of liver tissues was also performed. CLP-induced sepsis led to liver injury through the elevation of ALT and AST liver enzymes. Oxidative stress was initiated during CLP via the suppression of hepatic GSH content and SOD activity and the elevation of MDA. The inflammatory condition was activated by the upregulation of TNFα, IL-6, IL-1ß, and Keap-1 and the downregulation of Nrf-2 proteins. The apoptosis was initiated through the activation of bax and cleaved caspase 3 protein expression and inhibition of bcl2 protein expression. However, vincamine significantly improved the hepatic histological abnormalities and decreased liver enzymes (ALT and AST). It ameliorated oxidative stress, as evidenced by reducing the hepatic MDA content and increasing the SOD activity and GSH content. Moreover, vincamine reduced the hepatic content of TNFα, IL-6, IL-1ß, and Keap-1 and increased Nrf-2 protein expression. Additionally, it upregulated bcl2 protein expression and downregulated bax and cleaved caspase 3 protein expression. Vincamine exhibited hepato-protective potential during CLP-induced sepsis via the cross-connection of antioxidant, anti-inflammatory, and anti-apoptotic activities by modulating TNFα/IL-6/IL-1ß/Nrf-2/Keap-1 and regulating bax/bcl2/cleaved caspase 3 signaling pathways.
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Apoptosis , Proteína 1 Asociada A ECH Tipo Kelch , Hígado , Factor 2 Relacionado con NF-E2 , Estrés Oxidativo , Sepsis , Transducción de Señal , Factor de Necrosis Tumoral alfa , Sepsis/metabolismo , Sepsis/tratamiento farmacológico , Sepsis/complicaciones , Estrés Oxidativo/efectos de los fármacos , Animales , Factor 2 Relacionado con NF-E2/metabolismo , Proteína 1 Asociada A ECH Tipo Kelch/metabolismo , Transducción de Señal/efectos de los fármacos , Apoptosis/efectos de los fármacos , Factor de Necrosis Tumoral alfa/metabolismo , Masculino , Hígado/metabolismo , Hígado/efectos de los fármacos , Hígado/patología , Colon/metabolismo , Colon/patología , Colon/efectos de los fármacos , Ratas , Ligadura , Modelos Animales de EnfermedadRESUMEN
Despite the high mortality rate, sepsis lacks specific and effective treatment options. Conventional antibiotics, such as TIENAM (TIE; imipenem and cilastatin sodium for injection), face challenges owing to the emergence of bacterial resistance, which reduces their effectiveness and causes adverse effects. Addressing resistance and judicious drug use is crucial. Our research revealed that aloin (Alo) significantly boosts survival rates and reduces inflammation and bacterial load in mice with sepsis, demonstrating strong antimicrobial activity. Using a synergistic Alo + TIE regimen in a cecal ligation and puncture (CLP)-induced sepsis model, we observed a remarkable increase in survival rates from 10 % to 75 % within 72 h compared with the CLP group alone. This combination therapy also modulated inflammatory markers interleukin (IL)-6, IL-1ß, and tumor necrosis factor (TNF)-α, mitigated tissue damage, regulated immune cells by lowering NK, activated CD8+ and CD4+ T cells while increasing peritoneal macrophages, and decreased the bacterial load in the peritoneal cavity. We noted a significant shift in the abdominal cavity microbiota composition post-treatment, with a decrease in harmful bacteria, such as Lachnospiraceae_NK4A136_group, Klebsiella, Bacillus, and Escherichia, and an increase in beneficial bacteria, such as Lactobacillus and Mucispirillum. Our study emphasizes the efficacy of combining Alo with TIE to combat sepsis, and paves the way for further investigations and potential clinical applications aiming to overcome the limitations of TIE and enhance the therapeutic prospects of Alo.
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Ciego , Emodina , Ratones Endogámicos C57BL , Sepsis , Animales , Sepsis/tratamiento farmacológico , Sepsis/inmunología , Sepsis/microbiología , Emodina/farmacología , Emodina/uso terapéutico , Emodina/análogos & derivados , Ciego/cirugía , Ciego/microbiología , Ratones , Masculino , Ligadura , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Punciones , Modelos Animales de Enfermedad , Imipenem/uso terapéutico , Imipenem/farmacología , Citocinas/metabolismo , Quimioterapia Combinada , Microbioma Gastrointestinal/efectos de los fármacos , Antiinflamatorios/uso terapéutico , Antiinflamatorios/farmacología , Inflamación/tratamiento farmacológico , Microbiota/efectos de los fármacos , Carga Bacteriana/efectos de los fármacosRESUMEN
Despite the high mortality associated with sepsis, effective and targeted treatments remain scarce. The use of conventional antibiotics such as TIENAM (imipenem and cilastatin sodium for injection, TIE) is challenging because of the increasing bacterial resistance, which diminishes their efficacy and leads to adverse effects. Our previous studies demonstrated that ulinastatin (UTI) exerts a therapeutic impact on sepsis by reducing systemic inflammation and modulating immune responses. In this study, we examined the possibility of administering UTI and TIE after inducing sepsis in a mouse model using cecal ligation and puncture (CLP). We assessed the rates of survival, levels of inflammatory cytokines, the extent of tissue damage, populations of immune cells, microbiota in ascites, and important signaling pathways. The combination of UTI and TIE significantly improved survival rates and reduced inflammation and bacterial load in septic mice, indicating potent antimicrobial properties. Notably, the survival rates of UTI+TIE-treated mice increased from 10 % to 75 % within 168 h compared to those of mice that were subjected to CLP. The dual treatment successfully regulated the levels of inflammatory indicators (interleukin [IL]-6, IL-1ß, and tumor necrosis factor [TNF]-α) and immune cell numbers by reducing B cells, natural killer cells, and TNFR2+ Treg cells and increasing CD8+ T cells. Additionally, the combination of UTI and TIE alleviated tissue damage, reduced bacterial load in the peritoneal cavity, and suppressed the NF-κB signaling pathway. Our findings indicate that UTI and TIE combination therapy can significantly enhance sepsis outcomes by reducing inflammation and boosting the immune system. The results offer a promising therapeutic approach for future sepsis treatment.
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Ciego , Citocinas , Glicoproteínas , Sepsis , Animales , Sepsis/tratamiento farmacológico , Sepsis/inmunología , Sepsis/mortalidad , Glicoproteínas/uso terapéutico , Glicoproteínas/farmacología , Ligadura , Ciego/cirugía , Citocinas/metabolismo , Ratones , Masculino , Combinación Cilastatina e Imipenem/uso terapéutico , Modelos Animales de Enfermedad , Ratones Endogámicos C57BL , Globulinas , Punciones , Quimioterapia Combinada , Inflamación/tratamiento farmacológico , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Cilastatina/uso terapéutico , Cilastatina/farmacología , Humanos , Antiinflamatorios/uso terapéutico , Antiinflamatorios/farmacologíaRESUMEN
An investigation was conducted to examine the impact of restrictive blood transfusion on the safety of early rebleeding following endoscopic variceal ligation (EVL) in patients with liver cirrhosis. Data were collected from patients with cirrhosis and esophageal varices who underwent EVL at the Affiliated Hospital of North Sichuan Medical College between September 2021 and March 2023. Clinical information, including serum albumin levels, hemoglobin (Hb) levels, liver function classification, and the occurrence of early rebleeding, was recorded. Patients were divided into 2 groups based on their Hb levels: 60 g/L to 90 g/L (restrictive blood transfusion) or Hbâ ≥â 90 g/L after EVL. The impact of restrictive transfusion on the post-ligation safety of EVL was observed. A total of 246 cirrhotic patients were included in the analysis. Significant differences were found in Hb levels, liver function classification, early rebleeding rates, length of hospital stay, and hospitalization expenses between the restrictive transfusion and Hbâ ≥â 90 g/L groups. The early rebleeding rate was significantly varied between the groups with different Hb levels after EVL. Multivariate logistic analysis revealed that restrictive blood transfusion (ORâ =â 4.61, 95% CI: 1.06-19.99; Pâ =â .041), Hb (ORâ =â 0.96, 95% CI: 0.95-0.97; Pâ <â .001), and Child-Pugh class C (ORâ =â 6.37, 95% CI: 1.28-31.67; Pâ =â .024) were identified as independent factors influencing early rebleeding. Our findings suggest that the risk of early rebleeding in cirrhotic patients after EVL may be increased by restrictive blood transfusion, and this should be further investigated in future research.
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Transfusión Sanguínea , Várices Esofágicas y Gástricas , Hemorragia Gastrointestinal , Cirrosis Hepática , Humanos , Várices Esofágicas y Gástricas/cirugía , Várices Esofágicas y Gástricas/etiología , Masculino , Femenino , Persona de Mediana Edad , Estudios Retrospectivos , Ligadura/métodos , Ligadura/efectos adversos , Transfusión Sanguínea/estadística & datos numéricos , Transfusión Sanguínea/métodos , Hemorragia Gastrointestinal/etiología , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Adulto , Anciano , Hemoglobinas/análisis , Hemoglobinas/metabolismo , Recurrencia , Tiempo de Internación/estadística & datos numéricosRESUMEN
Purpose: Anxiety and depression can affect the physiology of the gastrointestinal tract through the brain-gut axis, causing gastrointestinal dysfunction, which is mainly manifested as indigestion, diarrhoea, constipation, or abdominal pain. Preoperative anxiety arises in children due to separation from parents, fear of unfamiliar surroundings and anaesthesia and surgical procedures.To discuss the effect of alleviating preoperative anxiety on postoperative recovery of gastrointestinal function in children with indirect inguinal hernia after laparoscopic high ligation of the hernia sac. Patients and Methods: 90 children with laparoscopic high ligation of the herniated sac in oblique inguinal hernia were randomly divided into control group (Group C) and experimental group (Group M). The Group M was given midazolam oral solution 0.5mg/kg (maximum dose 20mg), and The Group C was given 5% glucose solution with the same dose.Primary outcome was the time to first postoperative defecation and I-FEED scores.The secondary outcomes included mYPAS-SF scores; child sedation scores; child-parent separation scores; parental STAI scores;PHBQ scores;FLACC scores, operative time, and fluid input and surgeon job satisfaction. Results: Compared with Group C, there was a shorter time to first postoperative defecation (P < 0.05), and lower I-FEED scores on postoperative day 1 (P < 0.05). The mYPAS-SF scores, which were significantly different in Group M at T1, T2, and T3 (P < 0.05), parental STAI scores at S1, child sedation scores and child-parent separation scores in T1, and surgeon job satisfaction between the two groups were significantly different (P < 0.05). There were no statistically significant differences in I-FEED scores on days 2 and 3, PHBQ scores, FLACC scores, operative time, and fluid input between the two groups of children (P > 0.05). Conclusion: Preoperative application of midazolam oral solution to relieve preoperative anxiety helps to promote the recovery of postoperative gastrointestinal function in children with indirect inguinal hernia and increases the surgeon job satisfaction.
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Ansiedad , Hernia Inguinal , Laparoscopía , Humanos , Hernia Inguinal/cirugía , Masculino , Femenino , Preescolar , Niño , Ligadura , Midazolam/farmacología , Midazolam/administración & dosificación , Recuperación de la Función , Tracto Gastrointestinal/cirugíaRESUMEN
Laparoscopic total mesorectal excision is the main surgical approach for treating rectal cancer, but there is still no clear consensus on the issue of low ligation of the inferior mesenteric artery during the procedure. Robotic surgery has been shown to have certain advantages over laparoscopic surgery in multiple studies, but further research is needed to better understand the outcomes of robotic surgery in the context of low ligation procedures. In this study, we included 1590 patients with mid-low rectal cancer. Among them, 942 patients underwent low ligation surgery (LL), divided into 138 in the robotic group and 804 in the laparoscopic group. The high ligation surgery (HL) group consisted of 648 patients. The results of LL vs HL showed that the LL group had faster bowel movement recovery (P = 0.003), lower anastomotic leak rate (P = 0.032), and lower International Prostate Symptom Score (IPSS) at 6 months postoperatively (P < 0.001). The results of Rob-LL vs Lap-LL showed that the Rob-LL group had longer operative time (P < 0.001), less blood loss (P = 0.001), more lymph nodes retrieved (P = 0.045), and lower Wexner score at 2 weeks postoperatively (P = 0.029). The concept of low ligation of the inferior mesenteric artery is a promising surgical approach that can accelerate the patient's functional recovery. When combined with robotic technology, it may offer more benefits than laparoscopic techniques.
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Laparoscopía , Arteria Mesentérica Inferior , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Humanos , Arteria Mesentérica Inferior/cirugía , Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Ligadura/métodos , Masculino , Femenino , Laparoscopía/métodos , Persona de Mediana Edad , Tempo Operativo , Anciano , Resultado del Tratamiento , Fuga Anastomótica/prevención & control , Fuga Anastomótica/etiología , Pérdida de Sangre Quirúrgica/estadística & datos numéricosRESUMEN
In this study, we evaluated the hepatoprotective effects of astaxanthin, a natural carotenoid, against the cholestatic liver fibrosis induced by bile duct ligation (BDL). Toward this end, male rats were subjected to BDL and treated with astaxanthin for 35 days. Afterwards, their serum and liver biochemical factors were assessed. Also, histopathological and immunohistochemical analyses were performed to determine the fibrosis and the expression levels of alpha-smooth muscle actin (α-SMA) and transforming growth factor beta (TGF-ß1) in the liver tissue. Based on the results, BDL caused a significant increase in liver enzyme levels, blood lipids, and bilirubin, while decreasing the activity of superoxide dismutase(SOD), catalase (CAT), and glutathione (GSH) enzymes. Also, in the BDL rats, hepatocyte necrosis, infiltration of inflammatory lymphocytes, and hyperplasia of bile ducts were detected, along with a significant increase in α-SMA and TGF-ß1 expression. Astaxanthin, however, significantly prevented the BDL's detrimental effects. In all, 10 mg/kg of this drug maintained the bilirubin and cholesterol serum levels of BDL rats at normal levels. It also reduced the liver enzymes' activity and serum lipids, while increasing the SOD, CAT, and GSH activity in BDL rats. The expression of α-SMA and TGF-ß1 in the BDL rats treated with 10 mg/kg of astaxanthin was moderate (in 34%-66% of cells) and no considerable cholestatic fibrosis was observed in this group. However, administrating the 20 mg/kg of astaxanthin was not effective in this regard. These findings showed that astaxanthin could considerably protect the liver from cholestatic damage by improving the biochemical features and regulating the expression of related proteins.
Asunto(s)
Conductos Biliares , Colestasis , Cirrosis Hepática , Ratas Wistar , Xantófilas , Animales , Xantófilas/farmacología , Xantófilas/uso terapéutico , Masculino , Ratas , Colestasis/patología , Colestasis/metabolismo , Colestasis/tratamiento farmacológico , Cirrosis Hepática/metabolismo , Cirrosis Hepática/patología , Cirrosis Hepática/tratamiento farmacológico , Cirrosis Hepática/prevención & control , Ligadura , Conductos Biliares/cirugía , Hígado/efectos de los fármacos , Hígado/patología , Hígado/metabolismo , Factor de Crecimiento Transformador beta1/metabolismoRESUMEN
BACKGROUND: Endoscopic rubber band ligation (ERBL) is a nonsurgical technique for the treatment of symptomatic internal hemorrhoids but is limited by recurrence and post-procedural pain. AIM: To evaluate satisfaction, long-term recurrence, and post-procedural pain in managing internal hemorrhoids using a combination of polidocanol foam sclerotherapy and ERBL. METHODS: This was a prospective, multicenter, randomized study. A total of 195 consecutive patients diagnosed with grade II-III internal hemorrhoids were enrolled from four tertiary hospitals and randomly divided into a cap-assisted endoscopic polidocanol foam sclerobanding (EFSB) or an ERBL group. All patients were followed-up for 12 months. Symptom-based severity and post-procedural pain were assessed using a hemorrhoid severity score (HSS) and a visual analog scale (VAS). Continuous variables were reported as medians and interquartile range. RESULTS: One hundred and ninety-five patients were enrolled, with 98 in the EFSB group. HSS was lower in the EFSB group than in the ERBL group at 8 weeks [4.0 (3.0-5.0) vs 5.0 (4.0-6.0), P = 0.003] and 12-month [2.0 (1.0-3.0) vs 3.0 (2.0-3.0), P < 0.001] of follow-up. The prolapse recurrence rate was lower in the EFSB group at 12 months (11.2% vs 21.6%, P = 0.038). Multiple linear regression analysis demonstrated that EFSB treatment [B = -0.915, 95% confidence interval (CI): -1.301 to -0.530, P = 0.001] and rubber band number (B = 0.843, 95%CI: 0.595-1.092, P < 0.001) were negatively and independently associated with the VAS score 24 hours post-procedure. The median VAS was lower in the EFSB group than in the ERBL [2.0 (1.0-3.0) vs 3.0 (2.0-4.0), P < 0.001]. CONCLUSION: Cap-assisted EFSB provided long-term satisfaction and effective relief from the recurrence of prolapse and pain 24 hours post-procedure.
Asunto(s)
Hemorroides , Polidocanol , Recurrencia , Soluciones Esclerosantes , Escleroterapia , Humanos , Polidocanol/administración & dosificación , Polidocanol/uso terapéutico , Hemorroides/terapia , Hemorroides/diagnóstico , Hemorroides/cirugía , Persona de Mediana Edad , Femenino , Masculino , Estudios Prospectivos , Escleroterapia/métodos , Resultado del Tratamiento , Ligadura/métodos , Soluciones Esclerosantes/administración & dosificación , Adulto , Anciano , Índice de Severidad de la Enfermedad , Dolor Postoperatorio/etiología , Dolor Postoperatorio/diagnóstico , Satisfacción del Paciente , Dimensión del Dolor , Polietilenglicoles/administración & dosificación , Polietilenglicoles/uso terapéuticoRESUMEN
A woman in her 20s presented with haematemesis, post-prandial abdominal pain, weight loss and anaemia. Imaging revealed a non-enhancing mass in the retroperitoneal space along the mesenteric plane, encasing the porto-mesenteric vasculature. Endoscopy showed oesophageal varices. She was diagnosed with sclerosing mesenteritis, causing extrinsic compression of the portal vein and superior mesenteric artery. She underwent endoscopic variceal ligation and received prednisolone and tamoxifen. After 3 months, her post-prandial pain improved, and she did not have further bleeding episodes.
Asunto(s)
Paniculitis Peritoneal , Vena Porta , Humanos , Femenino , Paniculitis Peritoneal/complicaciones , Paniculitis Peritoneal/diagnóstico por imagen , Paniculitis Peritoneal/diagnóstico , Vena Porta/diagnóstico por imagen , Várices Esofágicas y Gástricas/etiología , Dolor Abdominal/etiología , Arteria Mesentérica Superior/diagnóstico por imagen , Prednisolona/uso terapéutico , Prednisolona/administración & dosificación , Ligadura , Hematemesis/etiología , Oclusión Vascular Mesentérica/etiología , Oclusión Vascular Mesentérica/diagnóstico por imagen , Adulto , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Traumatic injuries affecting the veins in the lower extremities have been correlated with both mortality and severe complications. Venous injuries are recognized as a contributing factor to the development of venous thromboembolism, commonly treated through procedures involving either vein ligation or repair. Despite previous efforts, substantial uncertainty remains when it comes to choosing between the execution of ligation versus various reparative techniques. The aim of this study was to evaluate the short-term results of surgically treating traumatic venous injuries through repair compared to ligation, specifically examining the resulting impacts on trauma patients in relation to DVT and PE occurrences. METHOD: A comprehensive search strategy was employed until August 10, 2023, to systematically explore Scopus and PubMed databases. Following the removal of duplicates, two researchers independently assessed the titles and abstracts of the identified studies. Only studies meeting the project's requirements and inclusion criteria, as evaluated through their full texts, were included in our investigation. Our study exclusively focused on original articles, specifically those involving human trauma patients with isolated popliteal vein injuries. Excluded from consideration were review articles, meta-analyses, cellular and molecular research, animal studies, case reports, case series, letters to the editor, posters, duplicates, and publications in languages other than English. The implementation of this systematic review and meta-analysis conformed to the standards delineated in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULT: Conducting a thorough search, the inquiry identified 248 records. The assessment of titles and abstracts led to 51 studies that had the potential for eligibility. After reviewing the full texts of the chosen studies, 4 studies involving 1521 patients constituted the ultimate findings. CONCLUSION: We concluded that the ligation procedure had a higher incidence of pulmonary embolism compared to the repair of vein injuries, while the repair procedure had a higher incidence of deep vein thrombosis than ligation. Additional large-scale randomized controlled trials are still necessary to further support the findings of this meta-analysis.
Asunto(s)
Vena Poplítea , Embolia Pulmonar , Trombosis de la Vena , Humanos , Ligadura , Trombosis de la Vena/etiología , Embolia Pulmonar/etiología , Incidencia , Vena Poplítea/lesiones , Vena Poplítea/cirugía , Procedimientos Quirúrgicos Vasculares/métodos , Lesiones del Sistema Vascular/cirugíaRESUMEN
In rats with unilateral nephrectomy and cardiac dysfunction, renal function deteriorates at an accelerated rate, as evidenced by increased proteinuria. Whether myocardial infarct-induced heart failure (HF) exacerbates renal injury in hypertensive rats with mild renal injury has not been reported. Rats underwent either coronary ligation or sham surgery. Thirty spontaneously hypertensive rats (SHRs) aged 8 weeks were randomly divided into two groups. Group 1 was the sham group, in which the rats underwent thoracotomy without ligation of the coronary artery. Group 2 underwent coronary artery ligation. The rats in group 2 underwent coronary artery ligation on week 0. The experiment lasted 12 weeks. Urine was collected in metabolic cages over a 24-h period. Urine was collected from the rats 2 days before the end of the experiment, and the ratio of urinary protein to urinary creatinine was measured in the clinical laboratory. All rats were examined by echocardiogram one day before the end of the experiment. On the last day of the experiment, blood was collected and sent to the laboratory for analysis. Hematoxylin-eosin (HE) and periodic acid-Schiff (PAS) staining were performed on heart and kidney sections. The ejection fraction in group 2 was lower than that in group 1 (P < 0.001). The urinary albumin to creatinine ratio in group 2 was greater than that in group 1 (P < 0.001). The urea and creatinine levels in group 1 were significantly lower than those in group 2 (P < 0.01). The levels of brain natriuretic peptide (BNP), neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C were greater in the second group than in the first group (P < 0.05). The interleukin-1ß (IL-1ß) and interleukin-6 (IL-6) levels in group 2 were significantly greater than those in group 1 (P < 0.001). The malondialdehyde (MDA) levels in Group 2 were greater than those in Group 1 (P < 0.01). The glutathione peroxidase (GSH-Px) levels in Group 2 were lower than those in Group 1 (P < 0.05). The level of angiotensin II (AT-II) in group 1 was lower than that in group 2 (P < 0.001). Cardiac dysfunction secondary to myocardial infarction could induce cardiorenal interactions in SHRs. It could be interpreted by the activation of oxidative stress, changes in inflammation and alteration of renin-angiotensin-aldosterone system.