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Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

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World Journal of Gastrointestinal Surgery 2019年第12期11卷 422-432页

作者： Jin Joo Kim Young Jun Park Ki Yoon Moon Jin Hyeong Park Yong Ki Jeong Eun Young Kim Division of trauma and surgical Critical Care Department of Surgery Seoul St. Mary’s Hospital College of Medicine The Catholic University of Korea

BACKGROUND Polymyxin B hemoperfusion(PMX-HP)has been used as a treatment for intraabdominal septic shock by absorbing and removing endotoxins of gram-negative *** To investigate the clinical efficacy of PMX-HP in patients with gram-negative septic shock who underwent abdominal *** From January 2012 to December 2018,patients who had septic shock secondary to peritonitis were *** were classified into PMX-HP treated and control groups based on postopreative intervention using *** clinical outcomes were compared using 1:1 propensity score matching methods to balance the overall distribution between the two *** After propensity score matching,40 patients were analyzed(20 patients in the PMX group and 20 patients in the control group).The scores of total Sequential Organ Failure Assessment(SOFA)score,renal SOFA and coagulation SOFA were significantly improved in the PMX group but not in the control group.(from 11.2±5.8 to 4.7±3.5 in PMX group vs 10.0±4.0 to 8.7±7.3 in control group,P=0.047 from 2.6±1.0 to 0.7±1.0 in PMX group vs 2.6±1.5 to 2.8±1.6 in control group,P=0.000,from 1.6±1.5 to 1.3±1.3 in PMX group vs 1.2±1.2 to 2.8±1.8 in control group,P=0.014,respectively).Further,the length of intensive care unit(ICU)stay was significantly shorter in PMX ***,no statistically significant difference was found in ICU mortality(50%in PMX group vs 50%in control group).CONCLUSION PMX-HP is a feasible adjunct treatment for peritonitis in ICU patients with peritonitis for improved organ impairment and to stabilize *** would be helpful to enhance clinical outcomes especially in patients with complete elimination of the source of gram-negative bacilli infection by surgical procedure accompanied with conventional treatment of sepsis.

关键词： Intraabdominal septic shock Panperitonitis Polymyxin B hemoperfusion Sepsis Toraymyxin

Outcomes of early versus late irrigation and debridement of pediatric open long bone fractures

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World Journal of Orthopedics 2024年第6期15卷 539-546页

作者： Riya Savla Yen-Hong Kuo Nasim Ahmed Department of Surgery and trauma Hackensack Meridian School of MedicineNutleyNJ 07110United States Department of Medical Sciences Hackensack Meridian School of medicineNutleyNJ 08753United States Office of Research Administration Hackensack Meridian Health Research InstituteNutleyNJ 077110United States Department of Surgery Department of Trauma and Surgical Critical CareJersey Shore University Medical CenterNeptuneNJ 07754United States Department of Surgery Department of Trauma and Surgical Critical CareHackensack Meridian School of MedicineNutleyNJ 07110United States

BACKGROUND Open long bone fractures are a major concern for pediatric patients due to the risk of surgical site infection(SSI).Early studies have recommended irrigation and debridement of open fractures within 6 hours-8 hours for the prevention of *** to the American College of Surgeons(ACS)Best Practice Guidelines,in 2015,irrigation and debridement should be done within 24 *** To identify whether early irrigation and debridement,within 8 hours,vs late,between 8 hours and 24 hours,for pediatric open long bone fractures impacts rate of *** Using retrospective data review from the National trauma Data Bank,trauma Quality Improvement Project(TQIP)of *** database is own by the ACS and it is the largest database for trauma quality program in the *** matching analysis was performed for the *** There were 390 pediatric patients with open long bone fractures who were incl-uded in the *** completing propensity score matching,we had 176 patients in each category,irrigation and debridement within 8 hours and irrigation and debridement between 8 hours and 24 *** found no significant differences between each group for the rate of deep SSI which was 0.6%for patients who received surgical irrigation and debridement within 8 hours and 1.1%for those who received it after 8 hours[adjusted odd ratio(AOR):0.5,95%CI:0.268-30.909,P>0.99].For the secondary outcomes studied,in terms of length of hospital stay,patients who received irrigation and debridement within 8 hours stayed for an average of 3.5 days,and those who received it after 8 hours stayed for an average of 3 days,with no significant difference found,and there were also no sig-nificant differences found between the discharge dispositions of the *** Our findings support the recommendation for managing open long bone fractures from the ACS:Complete surgical irrigation and debridement within 24 hours.

关键词： Pediatric trauma Open tibia fracture Irrigation and debridement Timing of intervention surgical site infection

The emerging role of tranexamic acid and its principal target,plasminogen,in skeletal health

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Acta Pharmaceutica Sinica B 2024年第7期14卷 2869-2884页

作者： Weixin Xie Antonia Donat Shan Jiang Anke Baranowsky Johannes Keller Department of trauma and Orthopedic Surgery University Medical Center Hamburg-EppendorfHamburg 20246Germany

The worldwide burden of skeletal diseases such as osteoporosis,degenerative joint disease and impaired fracture healing is steadily *** acid(TXA),a plasminogen inhibitor and anti-fibrinolytic agent,is used to reduce bleeding with high effectiveness and safety in major surgical *** its widespread clinical application,the effects of TXA beyond anti-fibrinolysis have been noticed and prompted renewed interest in its *** clinical trials have characterized the effects of TXA on reducing postoperative infection rates and regulating immune responses in patients undergoing ***,several animal studies suggest potential therapeutic effects of TXA on skeletal diseases such as osteoporosis and fracture *** a direct effect of TXA on the differentiation and function of bone cells in vitro was shown,few mechanisms of action have been ***,we summarize recent findings of the effects of TXA on skeletal diseases and discuss the underlying plasminogen-dependent and-independent mechanisms related to bone metabolism and the immune *** furthermore discuss potential novel indications for TXA application as a treatment strategy for skeletal diseases.

关键词： Tranexamic acid Osteoporosis Osteoarthritis Fracture healing Bone metabolism Inflammation Plasminogen Fibrinolysis

RANK-ligand and osteoprotegerin as biomarkers in the differentiation between periprosthetic joint infection and aseptic prosthesis loosening

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World Journal of Orthopedics 2017年第4期8卷 342-349页

作者： Max J Friedrich Matthias D Wimmer Jan Schmolders Andreas C Strauss Milena M Ploeger Hendrik Kohlhof Dieter C Wirtz Sascha Gravius Thomas M Randau Department of Orthopedics and trauma Surgery University Clinic of Bonn

AIM To assess serum levels of RANK-ligand(RANKL) and osteoprotegerin(OPG) as biomarkers for periprosthetic joint infection(PJI) and compare their accuracy with standard *** One hundred and twenty patients presenting with a painful total knee or hip arthroplasty with indication for surgical revision were included in this prospective clinical trial. Based on standard diagnostics(joint aspirate, microbiological, and histological samples) and Musculoskeletal infection Society consensus classification,patients were categorized into PJI, aseptic loosening,and control groups. Implant loosening was assessed radiographically and intraoperatively. Preoperative serum samples were collected and analyzed for RANKL, OPG, calcium, phosphate, alkaline phosphatase(AP), and the bone-specific subform of AP(b AP). Statistical analysis was carried out, testing for significant differences between the three groups and between stable and loose implants. RESULTS All three groups were identical in regards to age, gender, and joint distribution. No statistically significant differences in the serum concentration of RANKL(P = 0.16) and OPG(P = 0.45) were found between aseptic loosening and PJI, with a trend towards lower RANKL concentrations and higher OPG concentrations in the PJI group. The RANKL/OPG ratio was significant for the comparison between PJI and non-PJI(P = 0.005). A ratio > 60 ruled out PJI in all cases(specificity: 100%, 95%CI: 89, 11% to 100.0%) but only 30% of non-PJI patients crossed this threshold. The positive predictive value remained poor at any cut-off. In the differentiation between stable and loose implants, none of the parameters measured(calcium, phosphate, AP, and b AP) showed a significant difference, and only AP and b AP measurements showed a tendency towards higher values in the loosened group(with P = 0.09 for AP and P = 0.19 for b AP). CONCLUSION Lower RANKL and higher OPG concentrations could be detected in PJI, without statistical significance.

关键词： Aseptic loosening Diagnostic RANK-ligand Periprosthetic joint infection Biomarker Osteoprotegerin

Direct anterior approach hip arthroplasty:How to reduce complications-A 10-years single center experience and literature review

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World Journal of Orthopedics 2022年第4期13卷 388-399页

作者： Fabrizio Rivera Luca C Comba Alessandro Bardelli Department of Orthopedic trauma SS Annunziata HospitalSavigliano 12038Italy Department of Orthopedic trauma Universitàdegli Studi di TorinoTorino 10124Italy

BACKGROUND The direct anterior approach for total hip arthroplasty(DAA-THA)is increasing in popularity due to some advantages such as less surgical trauma,minimal dissection of soft tissues,shorter rehabilitation times,faster return to daily activities,lower incidence of *** the other hand,the literature reports a high rate of intraoperative complications,with many different rates and complication types in the published *** To analyze our complications comparing results with the literature;to report measures that we have taken to reduce complications *** All DAA-THA patients with one year minimum follow up who were operated at a single high-volume centre,between January 2010 and December 2019 were included in this retrospective *** surgeries were performed using cementless short anatomical or straight stems and press fit ***’followup was performed,at 6 wk,3 mo,then annually post-surgery with clinical and radiological *** outcomes were stem revision for aseptic loosening and all-cause stem *** outcome was intra-operative and post-operative complications *** A total of 394 patients underwent DDA-THA from January 2010 and December 2019,for a total of 412 hips;twelve patients lost to follow-up and one patient who died from causes not related to surgery were excluded from the *** average age at the time of surgery was 61 years(range from 28 to 78 years).Mean follow-up time was 64.8 mo(range 12-120 mo).Seven stems were *** cortical perforation,one trochanteric and lateral cortical wall intraoperative fracture,one diaphyseal fracture,three clinically symptomatic early subsidence and one late aseptic *** also observed 3 periprosthetic fractures B1 according to the Vancouver *** minor complications not requiring stem revision were 5 un-displaced fractures of the calcar region treated with preventive cerclage,one early infection,one case of late pos

关键词： Hip arthroplasty Direct anterior approach Short hip stem Minimally invasive surgery Complications

SARS-CoV-2 and the pancreas: What do we know about acute pancreatitis in COVID-19 positive patients?

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World Journal of Gastroenterology 2022年第36期28卷 5240-5249页

作者： Giuseppe Brisinda Maria Michela Chiarello Giuseppe Tropeano Gaia Altieri Caterina Puccioni Pietro Fransvea Valentina Bianchi Department of Medical and surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Medicine and Surgery UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)can cause pancreatic damage,both directly to the pancreas via angiotensin-converting enzyme 2 receptors(the transmembrane proteins required for SARS-CoV-2 entry,which are highly expressed by pancreatic cells)and indirectly through locoregional vasculitis and *** that,there is no clear evidence that SARS-CoV-2 is an etiological agent of acute *** pancreatitis in coronavirus disease 2019(COVID-19)positive patients often recognizes biliary or alcoholic *** prevalence of acute pancreatitis in COVID-19 positive patients is not exactly ***,COVID-19 positive patients with acute pancreatitis have a higher mortality and an increased risk of intensive care unit admission and necrosis compared to COVID-19 negative *** respiratory distress syndrome is the most frequent cause of death in COVID-19 positive patients and concomitant acute *** this article,we reported recent evidence on the correlation between COVID-19 infection and acute pancreatitis.

关键词： Acute pancreatitis SARS-CoV-2 Severe acute pancreatitis Multiparametric scores Infected necrosis Step-up approach

Treatment of infected soft tissue loss

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Plastic and Aesthetic Research 2023年第1期10卷 113-123页

作者： Stefano Artiaco Beatrice Limone Daniele Vezza Francesco Bosco Fortunato Giustra Giulia Colzani Department of Orthopaedics and traumatology Orthopaedic and Trauma CenterTorino 10126Italy

Hand coverage in infected soft tissue loss(STL)is a challenging clinical *** and well-timed antibiotic therapy and careful debridement are crucial for the success of the subsequent reconstructive *** must be radical,and all nonviable or infected tissue should be *** medical control and multiple procedures can be required when infection recurrence is observed after primary *** healing of STL is usually necessary in these complex *** pressure wound therapy(NPWT)is often used as a temporary instrument to reduce oedema and drainage,facilitating the attainment of a clean wound for subsequent *** to the type and size of the defect,multiple options ranging from skin grafts and substitutes to local and free flaps can be selected for the treatment of infected STL.A reconstructive ladder approach and case-by-case decision making should always be *** to the unique function and role of the hand,the surgical strategy must also take into account aesthetic and functional *** and Plastic surgeons should manage this wide variety of treatment options in a multidisciplinary and high-specialized context including radiologists,microbiologists,infectious disease specialists and physiotherapists,customizing the treatment path to the specific patient's situation.

关键词： Reconstruction flap skin substitute soft tissue loss infection hand coverage

Clinical outcome of open ankle fractures in patients above 70 years of age

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World Journal of Orthopedics 2023年第7期14卷 554-561页

作者： Wajiha Zahra Mina Seifo Paul Cool David Ford Tosan Okoro Department of trauma and Orthopedics Royal Shrewsbury HospitalShrewsbury SY38XQUnited Kingdom Department of trauma and Orthopedics Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation TrustOswestry SY107AGUnited Kingdom Department of trauma and Orthopedics Keele UniversityStafford ST55BGUnited Kingdom

BACKGROUND Open fractures of the ankle are complex injuries requiring multidisciplinary input and are associated with significant morbidity and ***,data on the clinical outcomes of open ankle fracture management in patients older than 70 is *** To evaluate the clinical outcomes following open ankle fracture management in patients older than *** secondary aim is to look at predictors of poor *** Following local research and audit department registration,22 years of prospectively collated data from an electronic database in a district general hospital were *** patients older than 70 years of age with an open ankle fracture requiring surgical intervention were *** information,the nature,and the number of surgical interventions were ***,including surgical site infection(SSI),venous thromboembolic events(VTEs)during hospital stay,and mortality rate,were *** A total of 37 patients were identified(median age:84 years,range:70-98);n=30 females median age:84 years,range:70-97);n=7 males median age:74 years,range:71-98))who underwent surgical intervention after an open ankle *** patients developed SSIs(43%).Superficial SSIs(n=8)were managed without surgical intervention and treated with antibiotics and regular dressing *** SSIs(n=8;20%)required a median of 3(range:2-9)surgical interventions,with four patients requiring multiple washouts and one patient having metalwork *** incidence was 5%during the hospital *** patients died within 30 d,and mortality at one year was 19%.The 10-year mortality rate was 57%.The presence of a history of stroke,cancer,or prolonged inpatient stay was found to be predictive of lower survivorship in this population(log-rank test:cancer P=0.008,stroke P=0.001,length of stay>33 d P=0.015).The presence of a cardiac history was predictive of wound complications(logistic regression,P=0.045).Age,number of operations,and di

关键词： Fragility fracture Open fracture Clinical outcome Mortality infection Survival

surgical management of the diabetic foot:The current evidence

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World Journal of Orthopedics 2024年第5期15卷 404-417页

作者： Richard Henry Randall Roberts Gareth Rhys Davies-Jones James Brock Vaishnav Satheesh Greg AJ Robertson Department of trauma and Orthopaedics Wrexham Maelor HospitalWrexham LL137TDUnited Kingdom Department of trauma and Orthopaedics The Robert Jones and Agnes Hunt Orthopaedic HospitalOswestry SY107AGUnited Kingdom

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens *** review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,*** escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality *** review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse *** addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot *** integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

关键词： Diabetes Diabetic foot Charcot Osteomyelitis Amputation Diabetic foot attack Conservative surgery