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General Physiology and Biophysics Jan 2024To investigate the potential functions and regulatory mechanism of circRSU1 on septic acute lung injury (sepsis-ALI) progression. We used lipopolysaccharide...
To investigate the potential functions and regulatory mechanism of circRSU1 on septic acute lung injury (sepsis-ALI) progression. We used lipopolysaccharide (LPS)-stimulated human pulmonary microvascular endothelial cells (HPMECs) to establish the cell model of sepsis-ALI in vitro. qRT-PCR and Western blotting were used for the detection of genes and proteins. The migration and tubulogenesis of HPMECs were assessed by transwell, wound healing, and tube formation assays. Inflammatory factors were detected by ELISA analysis. Cell permeability (PA) was determined by transendothelial resistance (TEER) and fluorescein isothiocyanate (FITC) with transwell assay. The interaction between miR-1224-5p and circRSU1 or ITGA5 (Integrin Subunit Alpha 5) was studied by dual-luciferase reporter and RNA pull-down assays. CircRSU1 expression was decreased after LPS treatment in HPMECs. Functionally, re-expression of circRSU1 in HPMECs could alleviate LPS-induced inflammatory response, the inhibition of cell migration and tube formation and enhancement of cell permeability. Mechanistically, circRSU1 acted as a sponge for miR-1224-5p. LPS treatment enhanced miR-1224-5p expression, and inhibition of miR-1224-5p reversed LPS-evoked HPMEC dysfunction mentioned above. Moreover, miR-1224-5p could abolish the protective effects of circRSU1 on HPMECs. In addition, miR-1224-5p directly targeted ITGA5, and circRSU1 was able to regulate ITGA5 expression via interacting with miR-1224-5p. CircRSU1 could alleviate LPS-induced HPMEC injury by miR-1224-5p/ITGA5 axis, indicating the potential molecular contribution of circRSU1 in sepsis-ALI.
Topics: Humans; Acute Lung Injury; Apoptosis; Endothelial Cells; Lipopolysaccharides; MicroRNAs; Sepsis; RNA, Circular
PubMed: 38312030
DOI: 10.4149/gpb_2023031 -
Anesthesia and Analgesia Jan 2024In ancient Iran, humans have been looking for ways to anesthetize, control, and reduce pain to perform surgeries to treat diseases, which is evident in ancient...
In ancient Iran, humans have been looking for ways to anesthetize, control, and reduce pain to perform surgeries to treat diseases, which is evident in ancient scientists' medical and nonmedical works. Although modern anesthesia expanded with the introduction of ether into this process, this great success was achieved after years of suffering and with the efforts of scientists throughout history who have played an essential role in advancing this knowledge. In ancient Iran, may (wine) was one of the materials of anesthesia, as in the Avesta, and Minooye Kherad, the properties of wine as an anesthetic are mentioned. Marijuana and Haoma were also used as other substances. The creation of a "hypnotic sponge" in ancient times made general anesthesia and many surgical procedures possible in subsequent centuries. In the history of medicine in Iran, various terms such as Mokhadir (anesthetic), Monavim (sedative), Mosabbit (hypnotic), and Mosakkin (pain relief) have been used to control pain. The purpose of this research was to introduce and study the materials and methods of anesthesia and analgesia in ancient Iran. The results show that anesthesia owes its early progress in part to the works of early Iranian practitioners.
PubMed: 38289872
DOI: 10.1213/ANE.0000000000006830 -
International Journal of Biological... Mar 2024Hemorrhage is a potentially life-threatening emergency that can occur at any time or place. Whether traumatic, congenital, surgical, disease-related, or drug-induced,... (Review)
Review
Hemorrhage is a potentially life-threatening emergency that can occur at any time or place. Whether traumatic, congenital, surgical, disease-related, or drug-induced, bleeding can lead to severe complications or death. Therefore, the development of efficient hemostatic materials is critical. However, the results and prognosis demonstrated by clinical means of hemostasis do not reach expectations. With the development of technology, novel hemostatic materials have been developed from polysaccharides (chitosan, hyaluronic acid, alginate, cellulose, cyclodextrins, starch, dextran, and carrageenan), peptides (self-assembling peptides), and proteins (silk fibroin, collagen, gelatin, keratin, and thrombin). These new materials exhibit high hemostatic efficacy due to the enhancement or interaction of various hemostatic mechanisms. The main forms include adhesives, sealants, bandages, hemostatic powders, and hemostatic sponges. This article introduces the clotting process and principles of hemostatic methods and reviews the research on polysaccharide-, peptide-, and protein-based hemostatic materials in the last five years. The design ideas and hemostatic principles of polysaccharide-, peptide-, and protein-based hemostatic materials are mainly introduced. Finally, we summarize material designs, advantages, disadvantages, and challenges regarding hemostatic materials.
Topics: Humans; Hemostatics; Hemostasis; Blood Coagulation; Polysaccharides; Hemorrhage; Chitosan; Peptides
PubMed: 38280705
DOI: 10.1016/j.ijbiomac.2024.129752 -
Journal of the American College of... May 2024We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training...
BACKGROUND
We previously reported the successful development of a computer-aided diagnosis (CAD) system for preventing retained surgical sponges with deep learning using training data, including composite and simulated radiographs. In this study, we evaluated the efficacy of the CAD system in a clinical setting.
STUDY DESIGN
A total of 1,053 postoperative radiographs obtained from patients 20 years of age or older who underwent surgery were evaluated. We implemented a foreign object detection application software on the portable radiographic device used in the operating room to detect retained surgical sponges. The results of the CAD system diagnosis were prospectively collected.
RESULTS
Among the 1,053 images, the CAD system detected possible retained surgical items in 150 images. Specificity was 85.8%, which is similar to the data obtained during the development of the software.
CONCLUSIONS
The validation of a CAD system using deep learning in a clinical setting showed similar efficacy as during the development of the system. These results suggest that the CAD system can contribute to the establishment of a more effective protocol than the current standard practice for preventing the retention of surgical items.
Topics: Humans; Software; Diagnosis, Computer-Assisted; Radiography; Foreign Bodies; Computers; Sensitivity and Specificity
PubMed: 38258847
DOI: 10.1097/XCS.0000000000001012 -
Collagen Matrix to Restore the Tympanic Membrane: Developing a Novel Platform to Treat Perforations.Polymers Jan 2024Modern otology faces challenges in treating tympanic membrane (TM) perforations. Instead of surgical intervention, alternative treatments using biomaterials are...
Modern otology faces challenges in treating tympanic membrane (TM) perforations. Instead of surgical intervention, alternative treatments using biomaterials are emerging. Recently, we developed a robust collagen membrane using semipermeable barrier-assisted electrophoretic deposition (SBA-EPD). In this study, a collagen graft shaped like a sponge through SBA-EPD was used to treat acute and chronic TM perforations in a chinchilla model. A total of 24 ears from 12 adult male chinchillas were used in the study. They were organized into four groups. The first two groups had acute TM perforations and the last two had chronic TM perforations. We used the first and third groups as controls, meaning they did not receive the implant treatment. The second and fourth groups, however, were treated with the collagen graft implant. Otoscopic assessments were conducted on days 14 and 35, with histological evaluations and TM vibrational studies performed on day 35. The groups treated with the collagen graft showed fewer inflammatory changes, improved structural recovery, and nearly normal TM vibrational properties compared to the controls. The porous collagen scaffold successfully enhanced TM regeneration, showing high biocompatibility and biodegradation potential. These findings could pave the way for clinical trials and present a new approach for treating TM perforations.
PubMed: 38257047
DOI: 10.3390/polym16020248 -
No Shinkei Geka. Neurological Surgery Jan 2024In this feature article, we underscore the advantages of Transposition over Interposition in the management of trigeminal neuralgia and hemifacial spasm. Interposition,...
In this feature article, we underscore the advantages of Transposition over Interposition in the management of trigeminal neuralgia and hemifacial spasm. Interposition, while effective, has raised concerns owing to long-term complications associated with the use of artificial materials, such as Teflon and silicone sponges. Transposition, on the other hand, mitigates these issues, showcasing adaptability to a range of anatomical and pathological conditions and affirming its standing as a safer and more effective treatment alternative. Each technique has distinct applications that are governed by the patient's specific anatomical and pathological needs. While Transposition is emerging as a favored option, Interposition remains relevant in specific cases, underscoring the necessity for a personalized approach to neurovascular decompression. In offering a comprehensive overview, this article is not just an academic exercise, but also a practical resource. A nuanced exploration of these surgical interventions is meant to provide readers with actionable insights, blending the current findings with real-world applicability. The goal is to foster a deeper understanding and aid practitioners in making informed decisions that are finely attuned to each patient's unique needs and conditions, ensuring optimal outcomes, while prioritizing safety and effectiveness.
Topics: Humans; Microvascular Decompression Surgery; Hemifacial Spasm; Silicones; Trigeminal Neuralgia
PubMed: 38246682
DOI: 10.11477/mf.1436204891 -
NPJ Science of Learning Jan 2024The existing performance evaluation methods in robot-assisted surgery (RAS) are mainly subjective, costly, and affected by shortcomings such as the inconsistency of...
The existing performance evaluation methods in robot-assisted surgery (RAS) are mainly subjective, costly, and affected by shortcomings such as the inconsistency of results and dependency on the raters' opinions. The aim of this study was to develop models for an objective evaluation of performance and rate of learning RAS skills while practicing surgical simulator tasks. The electroencephalogram (EEG) and eye-tracking data were recorded from 26 subjects while performing Tubes, Suture Sponge, and Dots and Needles tasks. Performance scores were generated by the simulator program. The functional brain networks were extracted using EEG data and coherence analysis. Then these networks, along with community detection analysis, facilitated the extraction of average search information and average temporal flexibility features at 21 Brodmann areas (BA) and four band frequencies. Twelve eye-tracking features were extracted and used to develop linear random intercept models for performance evaluation and multivariate linear regression models for the evaluation of the learning rate. Results showed that subject-wise standardization of features improved the R of the models. Average pupil diameter and rate of saccade were associated with performance in the Tubes task (multivariate analysis; p-value = 0.01 and p-value = 0.04, respectively). Entropy of pupil diameter was associated with performance in Dots and Needles task (multivariate analysis; p-value = 0.01). Average temporal flexibility and search information in several BAs and band frequencies were associated with performance and rate of learning. The models may be used to objectify performance and learning rate evaluation in RAS once validated with a broader sample size and tasks.
PubMed: 38242909
DOI: 10.1038/s41539-024-00216-y -
ACG Case Reports Journal Jan 2024Retained surgical sponge is a relatively rare medical condition with potential serious medicolegal implications. The term "gossypiboma" is frequently used to describe...
Retained surgical sponge is a relatively rare medical condition with potential serious medicolegal implications. The term "gossypiboma" is frequently used to describe this condition. We present a case of a 40-cm-long retained surgical sponge in a 43-year-old woman who presented with unexplained chronic abdominal pain for several years. She had a history of open cholecystectomy, hepaticojejunostomy, and enteroenterostomy. Computed tomography scan revealed a large cotton sponge anchored within the large bowel. Surgical exploration is usually required for the retrieval of gossypiboma. However, it was successfully removed endoscopically using a diathermic needle knife with no immediate complications. The patient was discharged after 48 hours with marked improvement in her abdominal pain. This case emphasizes the emerging role of novel endoscopic interventions, resulting in excellent clinical outcomes, avoiding major surgical interventions, and providing cost-effective benefits.
PubMed: 38234979
DOI: 10.14309/crj.0000000000001251 -
Surgical Endoscopy Mar 2024After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes...
BACKGROUND
After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy.
MATERIAL AND METHODS
A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (- 40, - 125, and - 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22).
RESULTS
Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p < 0.01). After EndoVAC therapy with - 125 mmHg a significant increase in tissue oxygenation to 61.9 ± 5.5% was seen after 60 min and stayed stable after 120 min (62.9 ± 9.4%, p < 0.01 vs tissue ischemia). A similar improvement was seen with EndoVAC therapy at - 200 mmHg. A nonsignificant increase in oxygenation levels was also seen after therapy with - 40 mmHg, from 46.3 ± 3.4% to 52.5 ± 4.3% and 53.9 ± 8.1% after 60 and 120 min respectively (p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with - 200 mmHg but not with - 40 and - 125 mmHg.
CONCLUSIONS
EndoVAC therapy with a pressure of - 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion.
Topics: Swine; Animals; Esophagectomy; Anastomosis, Surgical; Stomach; Anastomotic Leak; Ischemia; Perfusion; Edema; Esophageal Neoplasms
PubMed: 38180542
DOI: 10.1007/s00464-023-10647-0 -
Surgical Technology International Dec 2023Anterior cervical diskectomy and fusion (ACDF) has evolved significantly in the last few years with the aim of enhancing effectiveness and safety while reducing...
Anterior cervical diskectomy and fusion (ACDF) has evolved significantly in the last few years with the aim of enhancing effectiveness and safety while reducing hospitalization and healthcare-related costs. Transitioning from iliac crest autografts to allografts minimizes donor-site complications like pain, infections, and hematoma. Allograft options, such as polyetheretherketone (PEEK) and tantalum, vary in their osteoinductive properties and elastic modulus, influencing fusion rates, time, and the rate of subsidence. Recently introduced zero-profile cages offer bone fixation through screws, resulting in reduced blood loss, improved spinal alignment, and decreased complications like dysphagia and adjacent segment disease. Intraoperative neuromonitoring (IONM) has gained widespread use. The North American Spine Society (NASS) 2023 recommendations endorse IONM in cervical deformity corrections and myelopathy cases. Insufficient studies hinder clear radiculopathy recommendations, but emerging research supports IONM for patients at greater risk of C5 nerve root injury or positional injury. Advancements in hemostatic agents, such as gelatin sponges, oxidized cellulose, and fibrin sealants, contribute to safety by reducing postoperative hematoma rates and eliminating the need for drainage. Innovations like the exoscope, endoscope, and computed-tomography (CT) navigation have transformed surgical practices. Exoscopes are emerging as an alternative to microscopes, offering benefits like a smaller footprint, adjustable positioning, lower costs, and shared intraoperative views for educational purposes. The use of endoscope offers the possibility of performing a minimally invasive technique with improved results in terms of cosmesis and patient-perceived outcome. CT navigation can be useful in high-risk procedures, such as cervical plate placement for major instability. This paper provides an overview of cutting-edge technologies in ACDF surgery, emphasizing cage materials and designs, safety measures, and operating room advancements. It also highlights areas for future research, underlining the procedure's continuous evolution.
PubMed: 38171486
DOI: 10.52198/23.STI.43.NS1732