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Scientific Reports May 2024Inguinal hernia repair is performed more than 20 million times per annum, representing a significant health and economic burden. Over the last three decades, significant...
Inguinal hernia repair is performed more than 20 million times per annum, representing a significant health and economic burden. Over the last three decades, significant technical advances have started to reduce the invasiveness of these surgeries, which translated to better recovery and reduced costs. Here we bring forward an innovative surgical technique using a biodegradable cyanoacrylate glue instead of a traumatic suture to close the peritoneum, which is a highly innervated tissue layer, at the end of endoscopy hernia surgery. To test how this affects the invasiveness of hernia surgery, we conducted a cohort study. A total of 183 patients that underwent minimally invasive hernia repair, and the peritoneum was closed with either a conventional traumatic suture (n = 126, 68.9%) or our innovative approach using glue (n = 57, 31.1%). The proportion of patients experiencing acute pain after surgery was significantly reduced (36.8 vs. 54.0%, p = 0.032) by using glue instead of a suture. In accordance, the mean pain level was higher in the suture group (VAS = 1.5 vs. 1.3, p = 0.029) and more patients were still using painkillers (77.9 vs. 52.4%, p = 0.023). Furthermore, the rate of complications was not increased in the glue group. Using multivariate regressions, we identified that using a traumatic suture was an independent predictor of acute postoperative pain (OR 2.0, 95% CI 1.1-3.9, p = 0.042). In conclusion, suture-less glue closure of the peritoneum is innovative, safe, less painful, and possibly leads to enhanced recovery and decreased health costs.
Topics: Humans; Hernia, Inguinal; Pain, Postoperative; Male; Female; Laparoscopy; Middle Aged; Peritoneum; Herniorrhaphy; Aged; Sutures; Adult; Tissue Adhesives; Suture Techniques; Cyanoacrylates
PubMed: 38782992
DOI: 10.1038/s41598-024-62364-w -
Journal of Cellular and Molecular... May 2024Peritoneal fibrosis is a common pathological response to long-term peritoneal dialysis (PD) and a major cause for PD discontinuation. Understanding the cellular and...
Peritoneal fibrosis is a common pathological response to long-term peritoneal dialysis (PD) and a major cause for PD discontinuation. Understanding the cellular and molecular mechanisms underlying the induction and progression of peritoneal fibrosis is of great interest. In our study, in vitro study revealed that signal transducer and activator of transcription 3 (STAT3) is a key factor in fibroblast activation and extracellular matrix (ECM) synthesis. Furthermore, STAT3 induced by IL-6 trans-signalling pathway mediate the fibroblasts of the peritoneal stroma contributed to peritoneal fibrosis. Inhibition of STAT3 exerts an antifibrotic effect by attenuating fibroblast activation and ECM production with an in vitro co-culture model. Moreover, STAT3 plays an important role in the peritoneal fibrosis in an animal model of peritoneal fibrosis developed in mice. Blocking STAT3 can reduce the peritoneal morphological changes induced by chlorhexidine gluconate. In conclusion, our findings suggested STAT3 signalling played an important role in peritoneal fibrosis. Therefore, blocking STAT3 might become a potential treatment strategy in peritoneal fibrosis.
Topics: Peritoneal Fibrosis; STAT3 Transcription Factor; Animals; Fibroblasts; Mice; Aminosalicylic Acids; Phenotype; Signal Transduction; Disease Models, Animal; Peritoneum; Interleukin-6; Extracellular Matrix; Male; Mice, Inbred C57BL; Humans; Chlorhexidine; Peritoneal Dialysis; Benzenesulfonates
PubMed: 38780509
DOI: 10.1111/jcmm.18381 -
Frontiers in Immunology 2024Peritoneal dialysis is a widely used method for treating kidney failure. However, over time, the peritoneal structure and function can deteriorate, leading to the... (Review)
Review
Peritoneal dialysis is a widely used method for treating kidney failure. However, over time, the peritoneal structure and function can deteriorate, leading to the failure of this therapy. This deterioration is primarily caused by infectious and sterile inflammation. Sterile inflammation, which is inflammation without infection, is particularly concerning as it can be subtle and often goes unnoticed. The onset of sterile inflammation involves various pathological processes. Peritoneal cells detect signals that promote inflammation and release substances that attract immune cells from the bloodstream. These immune cells contribute to the initiation and escalation of the inflammatory response. The existing literature extensively covers the involvement of different cell types in the sterile inflammation, including mesothelial cells, fibroblasts, endothelial cells, and adipocytes, as well as immune cells such as macrophages, lymphocytes, and mast cells. These cells work together to promote the occurrence and progression of sterile inflammation, although the exact mechanisms are not fully understood. This review aims to provide a comprehensive overview of the signals from both stromal cells and components of immune system, as well as the reciprocal interactions between cellular components, during the initiation of sterile inflammation. By understanding the cellular and molecular mechanisms underlying sterile inflammation, we may potentially develop therapeutic interventions to counteract peritoneal membrane damage and restore normal function.
Topics: Humans; Peritoneal Dialysis; Peritoneum; Animals; Stromal Cells; Cell Communication; Inflammation; Peritonitis
PubMed: 38779674
DOI: 10.3389/fimmu.2024.1387292 -
International Journal of Medical... 2024Peritoneal dialysis (PD), hemodialysis and kidney transplantation are the three therapies to treat uremia. However, PD is discontinued for peritoneal membrane fibrosis...
Peritoneal dialysis (PD), hemodialysis and kidney transplantation are the three therapies to treat uremia. However, PD is discontinued for peritoneal membrane fibrosis (PMF) and loss of peritoneal transport function (PTF) due to damage from high concentrations of glucose in PD fluids (PDFs). The mechanism behind PMF is unclear, and there are no available biomarkers for the evaluation of PMF and PTF. Using microarray screening, we found that a new long noncoding RNA (lncRNA), RPL29P2, was upregulated in the PM (peritoneal membrane) of long-term PD patients, and its expression level was correlated with PMF severity and the PTF loss. and rat model assays suggested that lncRNA RPL29P2 targets miR-1184 and induces the expression of collagen type I alpha 1 chain (COL1A1). Silencing RPL29P2 in the PD rat model might suppress the HG-induced phenotypic transition of Human peritoneal mesothelial cells (HPMCs), alleviate HG-induced fibrosis and prevent the loss of PTF. Overall, our findings revealed that lncRNA RPL29P2, which targets miR-1184 and collagen, may represent a useful marker and therapeutic target of PMF in PD patients.
Topics: Animals; Female; Humans; Middle Aged; Rats; Collagen Type I, alpha 1 Chain; Disease Models, Animal; Glucose; MicroRNAs; Peritoneal Dialysis; Peritoneal Fibrosis; Peritoneum; Rats, Sprague-Dawley; RNA, Long Noncoding
PubMed: 38774747
DOI: 10.7150/ijms.93547 -
Pathology, Research and Practice Jun 2024Microscopic heterotopic extraovarian sex cord-stromal proliferations were first reported in the literature in 2015 by McCluggege. Afterwards, few similar cases have been... (Review)
Review
Microscopic heterotopic extraovarian sex cord-stromal proliferations were first reported in the literature in 2015 by McCluggege. Afterwards, few similar cases have been described. Herein, we report the fourteenth case of microscopic heterotopic sex cord-stromal proliferation and the third case sited in the pelvic peritoneum. The clinical history of these rare cases suggests their benign nature. Knowledge of this histological pattern is important for differential diagnoses such as malignant pathologies and metastatic diseases.
Topics: Female; Humans; Middle Aged; Cell Proliferation; Choristoma; Sex Cord-Gonadal Stromal Tumors
PubMed: 38772117
DOI: 10.1016/j.prp.2024.155351 -
Cancer Reports (Hoboken, N.J.) May 2024Malignant extrarenal rhabdoid tumor (MERT) is a rare and highly metastatic tumor, which is more than 75% of patients dying within 6 months of initial diagnosis, and it... (Review)
Review
BACKGROUND
Malignant extrarenal rhabdoid tumor (MERT) is a rare and highly metastatic tumor, which is more than 75% of patients dying within 6 months of initial diagnosis, and it often leads to misdiagnosis and delayed treatment.
CASE
This paper reports a 16-year-old girl who presented with the chief complaint of acute abdominal pain. She underwent laparoscopic exploration and excisional biopsy, then pathological examination and immunohistochemistry revealed "extrarenal malignant rhabdomyoma." One month after operation, she died of intra-abdominal hemorrhage and multiple organ dysfunction.
CONCLUSION
MERT were often misdiagnosed and had a poor prognosis. The surgery and chemotherapy are usually beneficial to prolong the survival time of patients with MERT.
Topics: Humans; Female; Rhabdoid Tumor; Adolescent; Omentum; Peritoneal Neoplasms; Fatal Outcome
PubMed: 38767517
DOI: 10.1002/cnr2.2086 -
Frontiers in Immunology 2024Dimethyl fumarate (DMF, Tecfidera) is an oral drug utilized to treat relapsing-remitting multiple sclerosis (MS). DMF treatment reduces disease activity in MS....
Dimethyl fumarate (DMF, Tecfidera) is an oral drug utilized to treat relapsing-remitting multiple sclerosis (MS). DMF treatment reduces disease activity in MS. Gastrointestinal discomfort is a common adverse effect of the treatment with DMF. This study aimed to investigate the effect of DMF administration in the gut draining lymph nodes cells of C57BL6/J female mice with experimental autoimmune encephalomyelitis (EAE), an animal model of MS. We have demonstrated that the treatment with DMF (7.5 mg/kg) significantly reduces the severity of EAE. This reduction of the severity is accompanied by the increase of both proinflammatory and anti-inflammatory mechanisms at the beginning of the treatment. As the treatment progressed, we observed an increasing number of regulatory Foxp3 negative CD4 T cells (Tr1), and anti-inflammatory cytokines such as IL-27, as well as the reduction of PGE2 level in the mesenteric lymph nodes of mice with EAE. We provide evidence that DMF induces a gradual anti-inflammatory response in the gut draining lymph nodes, which might contribute to the reduction of both intestinal discomfort and the inflammatory response of EAE. These findings indicate that the gut is the first microenvironment of action of DMF, which may contribute to its effects of reducing disease severity in MS patients.
Topics: Animals; Dimethyl Fumarate; Encephalomyelitis, Autoimmune, Experimental; Lymph Nodes; Mice; Female; T-Lymphocytes, Regulatory; Mice, Inbred C57BL; Mesentery; Cytokines; Immunosuppressive Agents; Disease Models, Animal
PubMed: 38765015
DOI: 10.3389/fimmu.2024.1391949 -
Journal of Surgical Case Reports May 2024Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. Herein, we report a case of persistent pneumothorax after...
Persistent pneumothorax after laparoscopic appendectomy in a patient who had undergone radical esophagectomy 5 years before: possible relationship with vulnerability of the hiatus after esophagectomy: a case report.
Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. Herein, we report a case of persistent pneumothorax after laparoscopic appendectomy. A 57-year-old male, with a history of minimally invasive esophagectomy and intrathoracic gastric tube reconstruction 5 years before, underwent a laparoscopic appendectomy. A chest X-ray taken on postoperative Day 1 revealed the development of the right pneumothorax, which took more than 3 days to resolve spontaneously. Although the mechanism of postoperative pneumothorax was unclear, it seemed likely that the air that had replaced carbon dioxide in the peritoneal cavity migrated into the thoracic cavity through the esophageal hiatus, which was not covered by the peritoneum or pleura after surgical resection. The present case, together with our previous similar case, suggests that a history of esophageal cancer surgery increases the risk of pneumothorax after laparoscopic surgery, probably regardless of when this was performed.
PubMed: 38764740
DOI: 10.1093/jscr/rjae308 -
Journal of Abdominal Wall Surgery : JAWS 2024To describe and compare a peritoneal closure technique using cyanoacrylate glue (Glubran 2, GEM, Cardiolink SL) with a microdroplet device (Glutack, GEM, Cardiolink SL)...
Closure of the Peritoneum in Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair (TAPP) With Cyanoacrylate Glue in a Microdroplet Device: A Single Surgeon Prospective Comparison vs. Barbed Suture.
PURPOSE
To describe and compare a peritoneal closure technique using cyanoacrylate glue (Glubran 2, GEM, Cardiolink SL) with a microdroplet device (Glutack, GEM, Cardiolink SL) in laparoscopic transabdominal preperitoneal repair (TAPP) of inguinal hernia with the routinely used barbed suture peritoneal closure (V-Lock 3.0, Covidien France).
MATERIALS AND METHODS
From January to August 2022, 60 patients undergoing TAPP repair for uni- or bilateral inguinal hernia were randomized into one of two groups. One using as mesh fixation and peritoneal closure the Glutack device with Glubran 2 cyanoacrylate glue (Glu-close group) and the other using mesh fixation with cyanoacrylate and peritoneal closure with V-lock 3.0 (Sut-close group), with a follow-up of 12 months. Demographic variables, operative time, peritoneal closure time, main surgical findings and main intra- and postoperative complications were analyzed prospectively.
RESULTS
63 patients were included with no losses to follow-up. The mean operative time was 34 min (range 58.25) for the glu-close group and 40 (range 64.25) for the sut-close group, with no conversion (0%) for either group. The mean flap closure time was 1.18 min (SD 24 0.19) for the glu-close group and 3.24 min (SD 0.78) for the sut-close group, with statistically significant differences ( < 0.001). The intraoperative complication rate was 0 for the glu-close group and 0 for the sut-close group, with no significant difference. The median hospital stay was 0.8 days (range, 0-1) for both groups. The median duration of follow-up was 12 months and none had hernia recurrence. The postoperative VAS score at the first and second check-up at 1 month and 3 months was 2.83 (SD 1.341) and 0.60 (SD 0.621) in the sut-close group and 1.03 (0.984) and 0.24 (SD 0.435) in the glue-close group, with significant differences ( < 0.001 and < 0.012).
CONCLUSION
The data demonstrated by the study are that the glue can be used safely to close the peritoneum and that the method provides a small, statistically significant but not clinically relevant reduction in the time to close the peritoneal flap, as well as in postoperative pain after surgery in short and medium term.
PubMed: 38764701
DOI: 10.3389/jaws.2024.12562 -
Porcine Health Management May 2024Umbilical outpouchings (UOs) in pigs are of welfare and production concern in Danish pig herds. One of the challenges is the transportation of these animals due to the...
BACKGROUND
Umbilical outpouchings (UOs) in pigs are of welfare and production concern in Danish pig herds. One of the challenges is the transportation of these animals due to the size of the UOs and ulcerations on them. With certain precautions and an approval from a veterinarian, pigs with UOs may be transported, however, UOs are associated with several intra-abdominal lesions, e.g. peritonitis and incarceration, which may worsen during the process of transportation. The prevalence and characterization of intra-abdominal lesions associated with UOs following transportation has not been investigated. Therefore, the objective of the present study was to evaluate lesions associated with the intestines and peritoneum in slaughter pigs with wounded UOs following transportation to an abattoir.
RESULTS
A cross-sectional study involving three conventional Danish pig herds was conducted comprising 96 slaughter pigs with wounded UOs transported to an abattoir. Following slaughter the UOs with accompanying intestines were examined pathologically. Three distinct morphological categories were present: hernia, enterocystoma and herniating enterocystoma. Intra-abdominal lesions were present in 72% of the animals, representing 65% (44/68) of the hernias, 77% (10/13) of the enterocystomas, and 100% (15/15) of the herniating enterocystomas. Several different lesions were found like bleedings, acute/chronic peritonitis and hypertrophy of the intestinal muscular layers.
CONCLUSIONS
The prevalence of intra-abdominal lesions in pigs transported with a wounded UO was found to be high independent of the underlying condition, and it is clear that these pigs possess a vulnerable group of animals, especially during physical stressful situations like transportation. More information is needed regarding the prevalence of intra-abdominal lesions in UO pigs without wounds on the UO. The results provide valuable knowledge, that can be used when examining and evaluating UO pigs before transportation.
PubMed: 38760866
DOI: 10.1186/s40813-024-00371-z