Efficacy and safety of 13 surgical techniques for the treatment of complex anal fistula, non-Crohn CAF: a systematic review and network meta-analysis.

BACKGROUND: Considering the difficulty of treating complex anal fistula (CAF), various surgical techniques exist in clinical work. However, none are ideal. Evidence on the efficacy and safety of different surgical treatments is scarce. The authors aimed to compare the outcomes of the 13 surgical techniques and tried to find the best surgical method for treating CAF. MATERIALS AND METHODS: The authors searched worldwide databases, including Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed, from inception to March 2023. All randomized controlled trials comparing the outcomes of 13 surgical techniques were included according to the PICO principles. The indicators of the cure rate, the recurrence rate, the complication rate, the operating time, the postoperative pain on day 1 (VAS), and the postoperative incontinence in month 1 (Wexner) were extracted and analyzed using STATA software 15.1, Review Manager 5.4, and GeMTC14.3. RESULTS: Twenty-eight randomized controlled trials with a total of 2274 patients were included in the network meta-analysis. There was no statistically significant difference in the comparison among any surgical interventions in terms of the cure rate ( P >0.05 Table 2) and recurrence rate ( P >0.05 Table 3). However, in terms of complication rate, fistulectomy was lower than FPS (Median: 0.14; 95% CI: 0.02-0.70) or fistulotomy (Median: 0.09; 95% CI: 0.01-0.55), and fistulotomy was lower than EAFR (Median: 0.24; 95% CI: 0.05-0.84), LIFT (Median: 0.17; 95% CI: 0.02-0.66) or LIFT-EAFR (Median: 0.11; 95% CI: 0.01-0.69) ( P >0.05 Table 4). The surface estimated the advantages and disadvantages under the cumulative ranking (SUCRA). The ranking results indicated that fistulectomy might have the lowest complication rate (SUCRA=7.9%). Because the network results of the operating time, the postoperative pain, and the postoperative incontinence contained no closed loops, the results of their probability ranking could only be referenced, demonstrating that fistulectomy might have the shortest operating time (SUCRA=23.4%), video-assisted modified ligation of the intersphincteric fistula tract (VAMLIFT) might have the lowest postoperative pain on day 1 (VAS) (SUCRA=0.4%) and LIFT might have the lowest postoperative incontinence in month 1(Wexner) (SUCRA=16.2%). CONCLUSION: Fistulectomy might have the lowest complication rate, which might be the relatively superior surgical technique for treating CAF.

Comparison of clinical outcomes of anal fistula plug and endoanal advancement flap repair treating the complex anal fistula: a systematic review and meta-analysis.

Anal fistula (AF) is a common disease with high prevalence and surgical operations are effective treatments in clinical work. There exist many well-known surgical techniques treating complex anal fistula (CAF), however, none is ideal. To compare the superiority of Anal fistula plug (AFP) and Endoanal advancement flap repair (EAFR) for complex anal fistula. We searched worldwide databases including Pubmed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and SinoMed from their inception to March 2023. Studies comparing the outcomes of AFP and EAFR were included according to the PICO principles. The indicators of the healing rate, recurrence rate, wound infection rate, and complication rate, et al. were extracted and compared between different surgical methods. 5 RCTS and 7 non-RCTs were included in the meta-analysis with a total of 847 patients (341 patients conducted with AFP and 506 patients with EAFR). By combining the total effect of the 12 articles, we found that there was a statistical difference reporting the healing rate of AFP 48.3% and EAFR 64.4% treating the CAF (OR 0.68, 95% CI 0.30,1.55, P = 0.03), and EAFR has a better healing rate. However, there was no significant difference in terms of the recurrence rate (OR 1.68, 95% CI 0.80,3.54, P = 0.17), the wound infection rate (OR 1.82, 95% CI 0.95,3.52, P = 0.07), and the complication rate (OR 1.06, 95% CI 0.70,1.61, P = 0.77) either in the 12 articles or in the subgroup. The meta-analysis indicated that the EAFR was superior to AFP in terms of the healing rate treating the CAF, however, there were no significant differences between the two groups when it came to the recurrence rate, the wound infection rate, and the complication rate. EAFR might be one initial treatment for the complex cryptoglandular anal fistulas compared with AFP.

Carbon quantum dots (CQDs) mediated Z-scheme g-C3N4-CQDs/BiVO4 heterojunction with enhanced visible light photocatalytic degradation of Paraben.

The construction of a novel Z-scheme system which possesses superior charge separation and high redox ability is highly desirable for efficient photocatalytic degradation of organic pollutants. Herein, a carbon quantum dots (CQDs) modified g-C3N4 (GCN) and BiVO4 (BVO) composite (GCN-CQDs/BVO) was fabricated via an initial loading of CQDs on GCN, and a subsequent combination with BVO during its hydrothermal synthesis. Physical characterization (e.g. TEM, XRD, XPS) verified the intimate heterojunction structure of the composite, while CQDs improved its light absorption. The band structures of GCN and BVO were evaluated, displaying the feasibility for Z-scheme formation. In comparison with GCN, BVO, and GCN/BVO, GCN-CQDs/BVO generated the highest photocurrent and lowest charge transfer resistance, inferring the prominently improved charge separation. Under visible light irradiation, GCN-CQDs/BVO exhibited the significantly enhanced activity in degrading the typical Paraben pollutant--benzyl paraben (BzP), achieving the removal of 85.7% in 150 min. The effects of various parameters were explored, demonstrating that neutral pH was optimal, while coexisting ions (CO32-, SO42-, NO3-, K+, Ca2+, Mg2+) and humic acid impacted the degradation negatively. Meanwhile, trapping experiments and electron paramagnetic resonance (EPR) technique revealed that superoxide radicals (•O2-) and hydroxyl radical (•OH) were primarily responsible for BzP degradation by GCN-CQDs/BVO. In particular, with the assistance of CQDs, the generation of •O2- and •OH was notably augmented. Based on these results, a Z-scheme photocatalytic mechanism was proposed for GCN-CQDs/BVO, where CQDs acted as electron mediators to combine the holes from GCN and electrons from BVO, resulting in significantly improved charge separation and maximized redox ability. Moreover, the toxicity of BzP was remarkably reduced during the photocatalytic process, emphasizing its great potential in abating the risk of Paraben pollutants.

Enhanced photocatalytic degradation of paraben preservative over designed g-C3N4/BiVO4 S-scheme system and toxicity assessment.

Paraben preservatives have been listed as emerging pollutants due to their ubiquity in various environmental matrices, especially the water bodies. How to efficiently and practically eliminate these paraben pollutants is therefore of great importance. Herein, a designed S-scheme heterojunction photocatalyst, consisting of graphitic carbon nitride (g-C3N4) and monoclinic bismuth vanadate (BiVO4), was fabricated by a facile hydrothermal synthesis and employed to treat benzyl-paraben (BzP). TEM and XPS analysis testified the intimate interaction between g-C3N4 and BiVO4, and the consequently smoothed interfacial charge transfer rendered the feasible recombination of the photoexcited electrons (from BiVO4) and holes (from g-C3N4). The as-established S-scheme system enabled the left g-C3N4 electrons and BiVO4 holes to maintain the high redox abilities and accelerated the charge separation concurrently. In particular, the g-C3N4/BiVO4 composite generated much higher photocurrent response as compared with pure g-C3N4 and BiVO4, highlighting the improved separation of photoinduced charges. Therefore, under visible light and natural solar light irradiation, the g-C3N4/BiVO4 composite showed the significantly enhanced photocatalytic degradation of BzP, which was further optimized with 5 wt% g-C3N4 in the composite. According to the Mott-Schottky plots and identified active species, the mechanism of the g-C3N4/BiVO4 S-scheme heterojunction system was illustrated. In addition, during the photocatalytic degradation process, the acute toxicity of the reaction solutions on zebrafish embryos was notably reduced. In conclusion, the demonstrated strategy to enhance the photocatalytic performance by designing S-scheme heterostructure may provide more insights into the development of high-efficiency photocatalyst towards the solar energy utilization and environmental treatment. Furthermore, photocatalytic degradation had been proved to be an efficient method for eliminating the ecological risk of paraben pollutants, warranting more attention in future work.

Perineal burn injury with hidradenitis suppurativa: A case report.

RATIONALE: Hidradenitis suppurativa (HS) is a chronic, inflammatory skin disease which usually presents with painful, deep-seated, inflamed lesions in the apocrine gland-bearing areas. Severe HS has interconnecting sinus tracts and when it occurs in the perianal region, perianal fistulas can form. Obesity and smoking are 2 risk factors for the development of HS. PATIENT CONCERNS: We report a case of a 33-year-old male diagnosed with perianal HS and perianal fistula following a burn injury to the area that occurred during childhood. DIAGNOSIS: Through integration of the clinical signs and imaging results, the patient was diagnosed with HS, Hurley stage III with perianal fistulas. INTERVENTIONS: The patient accepted surgical therapy. Performed under the general anesthesia, the procedure comprised sinus tracts excision and drainage. OUTCOMES: The patient was discharged from the hospital 6 weeks after surgery. LESSONS: The pathogenesis of the HS in this case was the burn injury interfering with sweat gland formation around the anus. Moreover, the scar from the burn made surgical treatment difficult.

SFRP2 and slug contribute to cellular resistance to apoptosis in hypertrophic scars.

Hypertrophic scars (HS) are skin disorders which occur after wounding and thermal injury. Our previous studies have suggested that secreted frizzled-related protein 2 (SFRP2) is involved in HS formation and that the suppression of SFRP2 promotes apoptosis of hypertrophic scar fibroblasts (HSFBs). However, the mechanisms have not been clarified. Previous studies revealed that Slug expression inhibits cell apoptosis, in vitro and in vivo, and SFRP2 regulates the expression of Slug in cervical cancer cells. In the present study, we quantified differential expression levels of expression of SFRP2 and Slug in HS and normal skin tissues by immunohistochemistry, both of which have important anti-apoptosis roles. Furthermore, a short hairpin RNA approach was adopted to investigate the potential function of SFRP2 and Slug in HSFB apoptosis. Cell apoptosis was detected using fluorescence-activated cell sorting and Caspase-3 activity was assayed by spectrophotometry. This study demonstrates that SFRP2 expression, as well as Slug, is dramatically up-regulated in HS relative to normal skin tissues, and the Slug expression is positively correlated with SFRP2. Slug expression was down-regulated in SFRP2-deficient cells, and the down-regulation of Slug expression increased sensitivity to apoptosis which was induced through a caspase-3-dependent pathway. The infected cells with reduced levels of Slug were tested for the expression of apoptosis-related genes (Bcl-2, Bax and PUMA) which were previously identified as Slug targets. Bcl-2 expression was down-regulated in Slug-deficient cells. In conclusion, SFRP2 appears to interact with Slug to affect the apoptosis of hypertrophic scar fibroblasts.

[Effect of staphylococcal enterotoxin C injection on post liposuction seroma].

OBJECTIVE: To study the mechanism of treatment of post liposuction seroma with Staphylococcal enterotoxin C injection. METHODS: 64 cases with post liposuction seroma were treated with Staphylococcal enterotoxin C injection or routine procedures. The exudate of those patients was collected to analyze the ratio, pH value, cell species and numbers, and the value of TP, ALP, LDH, AST, ALT, gamma-GT, ADA, ApoB, TC. RESULTS: The ratio, numbers of lymphocyte and mesothelial cells and TP, LDH, ADA, TC value in exudate in Staphylococcal enterotoxin C group were significantly higher than those in control group. CONCLUSIONS: The effect of Staphylococcal enterotoxin C injection on the exudate of seroma may be related to the non-inflammation reaction.