RESUMO
Apoptosis, inflammation, and wound healing are critical pathophysiological events associated with various liver diseases. Currently, there is a lack of in vivo approaches to study hepatocyte apoptosis-induced liver injury and repair. To address this critical knowledge gap, we developed a unique genetically modified mouse model, namely, 3-Transgene (Tg) with inducible Hepatocyte-Specific Apoptosis Phenotype (3xTg-iHAP) in this study. The 3xTg-iHAP mice possess three transgenes including Alb-Cre, Rosa26-rtTA, and tetO-Fasl on a B6 background. These mice are phenotypically normal, viable, and fertile. After subcutaneous administration of a single dose of doxycycline (5 mg/kg, Dox) to 3xTg-iHAP mice, we observed a complete histological spectrum of sterile liver wound-healing responses: asymptomatic hepatocyte apoptosis at 8 h, necrotic liver injury and sterile inflammation at 48 h, followed by hepatocyte mitosis and regeneration within 7 days. During the injury phase, the mice exhibited an increase in the biomarkers of alanine aminotransferase (ALT), chemokine (C-X-C motif) ligand 1 (CXCL1), and IL-6 in peripheral blood, as well as α-smooth muscle actin (α-SMA) protein in liver tissues. Conversely, the mice displayed a decrease in these markers in the recovery phase. Remarkably, this model shows that the sterile liver injury following elevated hepatocyte apoptosis is associated with an increase in myeloid cells in the liver. Within 7 days post-Dox administration, the liver of Dox-treated 3xTg-iHAP mice displays a normal histological structure, indicating the completion of wound healing. Together, we established a novel mouse model of injury and regeneration induced by hepatocyte apoptosis. This tool provides a robust in vivo platform for studying the pathophysiology of sterile liver inflammation, regeneration, and new therapeutic interventions for liver diseases.NEW & NOTEWORTHY Bu et al. present a triple-transgenic mouse model, namely, 3xTg-iHAP mice that are engineered to explore hepatocyte apoptosis-triggered sterile liver injury and regeneration. This model demonstrates a full spectrum of liver wound-healing responses from asymptomatic apoptosis to injury, myeloid cell-dominant sterile inflammation, and repair after induction of hepatocyte-specific apoptosis. The robust nature of this model makes it an invaluable in vivo tool for studying sterile liver inflammation, regeneration, and new therapeutic strategies.
Assuntos
Apoptose , Modelos Animais de Doenças , Hepatócitos , Regeneração Hepática , Camundongos Transgênicos , Células Mieloides , Animais , Hepatócitos/metabolismo , Hepatócitos/patologia , Camundongos , Células Mieloides/metabolismo , Fígado/metabolismo , Fígado/patologia , Cicatrização , Camundongos Endogâmicos C57BL , Quimiocina CXCL1/metabolismo , Quimiocina CXCL1/genéticaRESUMO
BACKGROUND: To help prevent complications after incisional ventral hernia repair, traditional teaching has recommended using closed suction drains. However, some studies suggest that there is an increased infection risk with use of surgical drains, and it is uncertain whether use of extended postoperative prophylactic antibiotics while drains remain in place helps prevent surgical-site infections. Evidence guiding surgeons' clinical practice regarding antibiotic use following hernia repair is lacking. METHODS: The authors sought to determine whether the use of extended postoperative antibiotic prophylaxis beyond standard Surgical Care Improvement Project guidelines with closed-suction surgical drain placement in incisional ventral hernia repair reduces the incidence of postoperative surgical-site infections. A retrospective review of 234 patients who underwent an incisional ventral hernia repair from 2003 to 2013 at a single institution was performed. Demographic, preoperative, operative, and postoperative data were collected and analyzed. RESULTS: Extended postoperative prophylactic antibiotics significantly reduce the incidence of postoperative surgical-site infections (OR, 0.31; p < 0.01). The odds ratio, when stratified by Ventral Hernia Working Group Scale, was 0.63, 0.25, 0.30, and 0.13 (p < 0.001 by the Mantel-Haenszel combined test) for grades 1, 2, 3, and 4, respectively, but was not statistically significant for differences between hernia grades. However, as the hernia grade increased, the odds ratio tended to decrease, suggesting that extended prophylactic antibiotics may be more effective at decreasing the incidence of surgical-site infections at higher grades. CONCLUSION: Extended antibiotic prophylaxis reduces surgical site infection risk following complex ventral hernia repairs, and should be considered in all cases. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Assuntos
Antibioticoprofilaxia/métodos , Drenagem/métodos , Hérnia Ventral/cirurgia , Herniorrafia/métodos , Infecção da Ferida Cirúrgica/prevenção & controle , Adulto , Idoso , Estudos de Coortes , Esquema de Medicação , Feminino , Seguimentos , Hérnia Ventral/diagnóstico , Herniorrafia/efeitos adversos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Cuidados Pós-Operatórios/métodos , Estudos Retrospectivos , Medição de Risco , Telas Cirúrgicas , Fatores de Tempo , Cicatrização/fisiologiaRESUMO
This article presents an overview of the cleft lip nasal deformity and its treatment. The complex pathologic changes to normal nasal anatomy are described, and treatment strategies for both unilateral and bilateral cleft lip patients are presented. The surgical technique for management of the cleft lip nasal deformity is discussed as it pertains to both primary and secondary correction.
Assuntos
Fenda Labial/complicações , Fenda Labial/cirurgia , Nariz/anormalidades , Rinoplastia/métodos , HumanosRESUMO
In general, university-based global health initiatives have tended to focus on expanding access to primary care. In the past, surgical programs may have been characterized by sporadic participation with little educational focus. However, there have been some notable exceptions with plastic surgery volunteer missions. We offer another model of regularly scheduled surgical trips to rural Haiti in plastic and general surgery. The goal of these trips is to reduce the burden of surgical disease and ultimately repair every cleft lip/palate in Haiti. Another principal objective is to accelerate the training of American residents through increased case load and personal interaction with attending surgeons in a concentrated period. Diversity of the case load and the overall number of surgeries performed by residents in a typical surgical trip outpaces the experiences available during a typical week in an American hospital setting. More importantly, we continue to provide ongoing training to Haitian nurses and surgeons in surgical techniques and postoperative care. Our postoperative complication rate has been relatively low. Our follow-up rates have been lower than 70% despite intensive attempts to maintain continued communication with our patients. Through our experiences in surgical care in rural Haiti, we were able to quickly ramp up our trauma and orthopedic surgical care immediately after the earthquake. Project Medishare and the University of Miami continue to operate a trauma and acute care hospital in Port au Prince. The hospital provides ongoing orthopedic, trauma, and neurosurgical expertise from the rotating teams of American surgeons and training of Haitian surgeons in modern surgical techniques. We believe that surgical residencies in the United States can improve their training programs and reduce global surgical burden of disease through consistent trips and working closely with country partners.
Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Desastres , Terremotos , Cirurgia Bucal/educação , Cirurgia Plástica/educação , Comunicação , Educação em Enfermagem , Seguimentos , Haiti , Hospitais Urbanos/organização & administração , Humanos , Internato e Residência , Missões Médicas , Unidades Móveis de Saúde/organização & administração , Procedimentos Neurocirúrgicos , Procedimentos Ortopédicos , Relações Médico-Paciente , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Socorro em Desastres , Saúde da População Rural , Centros de Traumatologia/organização & administração , Resultado do Tratamento , Estados Unidos , Voluntários , Ferimentos e Lesões/cirurgiaRESUMO
The etiology of congenital diaphragmatic hernia (CDH) is unknown. Phenotypic patterns of CDH defects provide clues about normal diaphragm development and the pathophysiology of CDH. We report a case of a patient who was diagnosed with CDH postnatally and was found on imaging to have simultaneous Bochdalek and Morgagni hernias on the right side. During the operative repair of these defects, an additional left-sided Morgagni-type defect was also found. To the best of our knowledge, this form of CDH has not been previously reported.
Assuntos
Hérnias Diafragmáticas Congênitas , Doenças do Prematuro/cirurgia , Glândulas Suprarrenais/cirurgia , Antibacterianos/uso terapêutico , Diafragma/embriologia , Feminino , Hérnia Diafragmática/classificação , Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/embriologia , Hérnia Diafragmática/patologia , Hérnia Diafragmática/cirurgia , Herniorrafia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Doenças do Prematuro/embriologia , Doenças do Prematuro/patologia , Recém-Nascido Pequeno para a Idade Gestacional , Rim/cirurgia , Fígado/cirurgia , Linfangioma Cístico/diagnóstico por imagem , Linfangioma Cístico/embriologia , Morfogênese , Pneumonia/tratamento farmacológico , Pneumonia/etiologia , Pneumonia/terapia , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/terapia , Transtornos Respiratórios/etiologia , Respiração Artificial , Telas Cirúrgicas , Ultrassonografia Pré-NatalRESUMO
BACKGROUND: Lipoplasty remains the most common cosmetic surgical procedure performed in the United States. In spite of its well documented clinical advantages, ultrasound-assisted lipoplasty (UAL) accounts for less than 20% of all lipoplasty procedures currently performed. OBJECTIVE: The purpose of this study is to determine the blood content of third-generation internal UAL aspirate and compare it to traditional lipoplasty aspirate. METHODS: The lipoplasty aspirate of 27 consecutive patients who underwent traditional suction-assisted lipoplasty (SAL) of their back and posterior flanks was compared to the aspirate of 30 consecutive patients who underwent third-generation internal UAL of their backs and posterior flanks using the VASER Internal Ultrasound Device (Sound Surgical Technologies; Louisville, CO). The volume and composition of the wetting solution used was the same for both groups. The aspirate analysis was performed by an independent laboratory on a Beckman Coulter LH 750 blood analyzer (Fullerton, CA) and consisted of complete blood counts after separation of the fat. RESULTS: The hemoglobin content of SAL aspirate was 7.5 times greater than in the aspirate. The hematocrit value of SAL aspirate was 6.5 times greater than in the VASER-assisted lipoplasty aspirate. Statistical analysis using an independent t test confirmed that the data was statistically significant with P values of < .0001 for both hemoglobin content and hematocrit values. CONCLUSIONS: We conclude that third-generation internal UAL should be considered for patients undergoing large-volume lipoplasty procedures or lipoplasty of tight, fibrous areas, such as the back and posterior flanks, where increased blood loss is expected.
Assuntos
Perda Sanguínea Cirúrgica , Hemoglobinas/análise , Lipectomia/métodos , Terapia por Ultrassom , Adolescente , Adulto , Dorso/diagnóstico por imagem , Dorso/cirurgia , Feminino , Hematócrito , Humanos , Lipectomia/instrumentação , Pessoa de Meia-Idade , Gordura Subcutânea/química , Resultado do Tratamento , Ultrassonografia , Adulto JovemRESUMO
Comprehensive anthropometric measures in children with cleft lip (CL) and cleft palate (CP) have suggested that similar qualitative growth disturbances may be present in the auricle. We propose a study to evaluate and better understand auricular development in nonsyndromic children born with CL/CP. Our institution is a tertiary referral center for children with craniofacial anomalies. During a 4-year period, we randomly selected 50 nonsyndromic children, aged 5 to 18 years, with CL or CP. Fifty age-matched control children without craniofacial anomalies were selected as a control group. Anthropometric measurement analysis was conducted to compare auricular length (sa-sba), width (pra-pa), attachment to the cranium (obs-obi), and degree protrusion. Auricular index was also calculated for each group. Using a multivariate analysis of variance, statistical analysis with a P < 0.001 demonstrates group differences when comparing ear length and ear protrusion in nonsyndromic children with CL/CP to age-matched controls. Ear length was greater in the control group, whereas ear protrusion (distance from the mastoid process to helical rim) was found to be decreased in the experimental group. Age and sex did not demonstrate significant differences in ear protrusion or length between the control and experimental groups. In nonsyndromic children with CL/CP, greater sensitivity should be given to the timing of auricular surgery. Comparisons of age-matched auricular measurements suggest that ear development may be altered in children with CL or CP. Further research is needed to investigate anthropological differences between nonsyndromic children with cleft and the normal population.
Assuntos
Fenda Labial/complicações , Fissura Palatina/complicações , Orelha Externa/anormalidades , Adolescente , Estudos de Casos e Controles , Cefalometria , Criança , Pré-Escolar , Anormalidades Craniofaciais/etiologia , Feminino , Humanos , Masculino , Análise Multivariada , Estatísticas não ParamétricasRESUMO
The following case reports on the successful use of Integra® (Integra LifeSciences, Plainsboro, NJ) as an alternative for coverage of exposed tibia in a patient with necrotizing fasciitis and significant comorbidities. Necrotizing fasciitis is a generalized term that is used to describe soft tissue infections in which necrosis of the fascia and subcutaneous tissue occurs. Necrotizing fasciitis will often begin with disproportionate pain, localized erythema, and skin discoloration with vesicle formation. As the disease progresses along fascial planes, an area of deep necrosis develops with eventual signs of systemic toxicity and sepsis. Diagnosis of this condition can be quite challenging, and the diagnostic value of laboratory tests is limited. Aggressive treatment of necrotizing fasciitis is extremely important; the infection develops rapidly and can quickly lead to systemic toxicity and death. Traditionally, management of necrotizing fasciitis consists of resuscitation and stabilization of the patient, aggressive surgical debridement of all nonviable tissue, and the administration of broad-spectrum antibiotics. Reconstructive surgery is indicated for many patients who have recovered from necrotizing fasciitis. Integra, an artificial dermal regeneration template (DRT), has emerged as an adjunct to split-thickness grafts or tissue transfers. This case exemplifies the potential for DRT to provide another, more direct alternative for coverage of a complex, exposed wound. .
RESUMO
Sturge-Weber syndrome (SWS), Klippel-Trenaunay syndrome (KTS), and Parkes-Weber syndrome (PWS) represent a wide range of congenital vascular abnormality syndromes. Although many of the diagnostic criteria overlap for these syndromes, there are important differences among these diseases that carry important prognostic and therapeutic implications. This review attempts to clearly distinguish among SWS, KTS, and PWS, although loosely categorizing them as a family of congenital vascular disorders. A review of literature reveals that a variety of diagnostic tools exist that can help differentiate between the syndromes and assess risk for certain complications, which may help tailor various treatment modalities for a particular patient.
Assuntos
Síndrome de Sturge-Weber/diagnóstico , Doenças Vasculares/congênito , Malformações Arteriovenosas/diagnóstico , Vasos Sanguíneos/anormalidades , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Trombocitopenia/diagnósticoRESUMO
BACKGROUND: Although it is becoming more common for abdominoplasty to be performed in combination with other procedures, it has been suggested that such combined procedures may raise the risk of postoperative complications. OBJECTIVE: The purpose of this study was to determine whether abdominoplasty performed in conjunction with adjunct procedures would result in an increased morbidity. METHODS: A total of 102 patients who underwent abdominoplasty, either alone or combined with additional surgery, between March 2003 and March 2005 were included. A retrospective chart review following institutional review board guidelines was conducted. Combined surgeries included breast reduction, mastopexy, hysterectomy, colostomy revisions, and ventral hernia repairs. Complication rates were also correlated with body mass index (BMI). Twenty-seven patients underwent abdominoplasty alone, and 47 patients were in the abdominoplasty combined group. Complication rates of 18.5% vs. 17%, respectively, were analyzed with a t test (P = .44) and were further stratified in relation to BMI. RESULTS: We found a direct correlation between elevated BMI and increased complication rate. Comparison of BMI < 25 (normal) with BMI > 30 (obese) revealed complication rates of 9% vs. 36%, respectively (P < .02). Obesity in our study was a significant predictor of postoperative complications. CONCLUSIONS: It would appear that combining abdominoplasty with additional surgical procedures does not lead to increased complication rates and is safe with carefully selected patients and appropriate deep vein thrombosis prophylaxis.
RESUMO
BACKGROUND: Flow cytometry is a rapid and reliable method for measuring nuclear DNA content and genome size. Fluorochrome binding characteristics, sample preparation and differences in DNA condensation, and availability of binding sites can cause variations in results obtained. METHODS: Blood samples from 82 vertebrate species were collected in 10% dimethyl sulfoxide and stained with propidium iodide/hypotonic citrate or 4,6-diamidino-2-phenylindole dihydrochloride for analysis of DNA content and electronic nuclear volume (ENV). Trout red blood cells (TRBCs), human peripheral blood lymphocytes, and human buccal cavity cells were used as internal standards. RESULTS: Mean fluorescence channel (MFC) values of TRBC and buccal cavity cells used as internal standards were stable at 15 to 120 min of propidium iodide staining. TRBCs mixed with other cells especially human peripheral blood cells showed an increase in MFC. ENV and MCF values were less variable in different species of birds than in reptiles or mammals. Genome size based on use of buccal cavity cells as the internal standard showed a high degree of correlation with previous reports. CONCLUSIONS: Proper selection and use of internal standards and sample preparation are essential for reliable determination of DNA content and genome size in vertebrates by flow cytometry.