Evaluating the impact of an anti-microbial silver-impregnated surgical dressing on wound infections and healing: A randomised clinical trial.

StopBac is an innovative silver-impregnated antimicrobial dressing specifically designed to reduce surgical site infections and enhance healing. The primary objective of this study was to compare infection healing rate at 30 days after surgery between primarily closed surgical wounds covered with StopBac and those covered with Cosmorpor, a standard surgical dressing. Between 1.3.2023 and 30.4.2023, we conducted a prospective screening of all patients undergoing surgical operations within a single surgical department. Patients were randomised into either the Cosmopor group or the StopBac group. Outcome measures were superficial and deep surgical site infections and healed wounds. Data concerning patient and surgical factors were prospectively collected and analysed. The analysis comprised 275 patients, divided into two groups: 140 patients in the StopBac group and 135 in the Cosmopor group. The StopBac dressing was associated with a reduced rate of infection, with an odds ratio of 0.288 (p < 0.001), and an increased likelihood of wound healing at 30 days after surgery. The odds ratio for healing at 30 days was 4.661 (p < 0.001). StopBac was associated with a lower incidence of surgical wound infections and a higher probability of healing at 30 days after surgery, when compared with standard dressing.

Mechanochemical synthesis of non-stoichiometric copper sulfide Cu1.8S applicable as a photocatalyst and antibacterial agent and synthesis scalability verification.

An effort to prepare different non-stoichiometric CuxSy compounds starting from elemental precursors using mechanochemistry was made in this study. However, out of the 7 stoichiometries tested, it was only possible to obtain three phases: covellite CuS, chalcocite Cu2S and digenite Cu1.8S and their mixtures. To obtain the digenite phase with the highest purity, the Cu : S stoichiometric ratio needed to be fixed at 1.6 : 1. The reaction between copper and sulfur was completed within a second range, however, milling was performed for up to 15 minutes until the equilibrium in phase composition between digenite and covellite was reached. The possibility of preparing the product in a 300 g batch by eccentric vibratory milling in 30 minutes was successfully verified at the end. The estimated crystallite sizes for the digenite Cu1.8S obtained via lab-scale and scalable experiments were around 12 and 17 nm, respectively. The obtained products were found to be efficient photocatalysts under visible light irradiation in the presence of hydrogen peroxide, being capable of the complete degradation of the Methyl Orange dye in a concentration of 10 mg L-1 in 2 hours. Finally, the antibacterial potential of both lab-scale and large-scale industrial products was proven and, regardless of the manufacturing scale, the nanoparticles retained their properties against bacterial cells.

Segmental Versus Partial Portomesenteric Resection in Pancreatectomy for Pancreatic Cancer.

INTRODUCTION: Portomesenteric vein resections are a well-established part of pancreatectomies for advanced tumors that invade the portomesenteric axis. There are two main types of portomesenteric resections: partial resections, where only part of the venous wall is removed and segmental resection, where the full circumference of the wall is removed. The aim of this study is to compare short-term and long-term outcomes between these two techniques. METHODS: This is a single-centre retrospective study of the patients with pancreatic cancer who underwent pancreatectomy with portomesenteric vein resections between November 2009 and May 2021. RESULTS: From a total of 773 pancreatic cancer procedures, 43 (6%) patients underwent pancreatectomy with portomesenteric resections: 17 partial and 26 segmental. The overall median survival was 11 mo. For the partial portomesenteric resections, the median survival was 29 mo, and for the segmental portomesenteric resections, it was 10 mo (P = 0.019). The primary patency of the reconstructed veins after partial resection was 100% and after segmental resection was 92% (P = 0.220). Negative resection margins were achieved in 13 patients (76%) who underwent partial portomesenteric vein resection and 23 patients (88%) who underwent segmental portomesenteric vein resection. CONCLUSIONS: |Although this study is associated with worse survival, segmental resection is often the only way to safely remove pancreatic tumors with negative resection margins.

The manipulation of natural mineral chalcopyrite CuFeS2via mechanochemistry: properties and thermoelectric potential.

In this study, the properties of the natural mineral chalcopyrite CuFeS2 after mechanical activation in a planetary mill were studied. The intensity of mechanical activation was controlled by changing the revolutions of the mill in the range 100-600 min-1. A series of characterization techniques, such as XRD, SEM, TEM, TA (DTA, TG, and DTG), particle size analysis, and UV-vis spectroscopy was applied and reactivity studies were also performed. Several new features were revealed for the mechanically activated chalcopyrite, e.g. the poly-modal distribution of produced nanoparticles on the micrometer scale, agglomeration effects by prolonged milling, possibility to modify the shape of the particles, X-ray amorphization and a shift from a non-cubic (tetragonal) structure to pseudo-cubic structure. The thermoelectric response was evaluated on the "softly" compacted powder via the spark plasma sintering method (very short holding time, low sintering temperature, and moderate pressure) by measuring the Seebeck coefficient and electrical and thermal conductivity above room temperature. The milling process produced samples with lower resistivity compared to the original non-activated sample. The Seebeck data close to zero confirmed the "compensated" character of natural chalcopyrite, reflecting its close-to stoichiometric composition with low concentration of both n- and p-type charge carriers. Alternatively, an evident correlation between thermal conductivity and energy supply by milling was observed with the possibility of band gap manipulation, which is associated with the energy delivered by the milling procedure.

Pancreaticoduodenal artery aneurysm associated with coeliac trunk occlusion treated with aorto-hepatic bypass and aneurysm resection.

Pancreaticoduodenal artery aneurysms are rare visceral artery aneurysms that may be associated with stenosis of the coeliac trunk. We present a case of a 48-year-old woman with a symptomatic aneurysm of the inferior pancreaticoduodenal artery caused by occlusion of the coeliac trunk due to median arcuate ligament syndrome. The patient was treated with an aorto-hepatic bypass and excision of the aneurysm. We discuss the case and the complexities and controversies in the treatment of this disease.

A systematic review and meta-analysis on the management of concomitant abdominal aortic aneurysms and renal tumours.

OBJECTIVES: The treatment of concomitant abdominal aortic aneurysms and renal tumours is controversial. The aim of this study was to ascertain which of the following three strategies, one-stage open aneurysm repair and nephrectomy, two-stage open aneurysm repair and nephrectomy or two-stage endovascular aneurysm repair and nephrectomy, is the best approach. METHODS: systematic review and meta-analysis of articles published between January 1992 and April 2021 describing the treatment of concomitant abdominal aortic aneurysms and renal tumours. RESULTS: A total of 1168 records were identified. After the selection process, 12 studies with data on 89 patients were included. Sixty-two patients underwent one-stage open procedures, 18 patients underwent two-stage open procedures and nine underwent two-stage endovascular procedures. The overall postoperative mortality was 0.82% (95% CI, 0.00-4.61). The postoperative mortality for one-stage open procedures was 3.09% (95% CI, 0.00-10.11). No deaths occurred in the postoperative period open two-stage procedures or two-stage endovascular procedures. The weighted postoperative morbidity for all procedures was 23.86% (95% CI, 12.64-35.08) and for open one-stage procedures was 37.40% (95% CI, 14.33-60.47). Data concerning postoperative complications of two-stage open procedures were extractable from only one patient in whom no complications were reported. Two postoperative complications were reported after two-stage endovascular procedures from a total of six patients with extractable postoperative data. We were unable to perform meta-analysis on long-term outcomes as the data were reported non-uniformly. CONCLUSION: There is currently no evidence to suggest that any procedure is associated with better outcomes. However, a one-stage open approach was the most commonly used option, favoured as it avoids delaying treatment of either of the conditions. Two-stage open procedures were preferred in cases where the surgical risk of a one-stage procedure was higher than the potential benefit. For such cases, two-stage endovascular repair is becoming more popular as a less invasive approach.

VariClose® vein sealing system is inferior to endovenous laser ablation for the treatment of varicose veins.

BACKGROUND: One of the three commercially available cyanoacrylate venous glues used for the treatment of saphenous vein insufficiency is the VariClose® vein sealing system. Previous studies have documented a high rate of occlusion and minimal postoperative complications. The aim of this study was to compare occlusion rates and clinical outcomes of endovenous laser treatment with the VariClose® vein sealing system in the treatment of truncal vein insufficiency. PATIENTS AND METHODS: Retrospective non-randomized single center study with prospectively collected data comparing endovenous laser treatment and VariClose® procedures between April 2018 and November 2019. RESULTS: VariClose® was used in 27 patients (30 veins) and endovenous laser treatment in 42 patients (51 veins). The occlusion rate at one, three, and six months were 96%, 85%, and 65% for VariClose® procedures and 100%, 100%, and 97% for endovenous laser treatment procedures (p = 0.01), respectively. Reduction of VCSS scores before treatment and at the last postoperative follow-up visit in the VariClose® group dropped by an average of 1.8 ± 1.6 and in the endovenous laser treatment by an average of 3.3 ± 2.9 (p = 0.01). CONCLUSION: VariClose® vein sealing system is inferior to endovenous laser treatment as a treatment option for varicose veins as it has a higher recanalization rate.

How Czech and Slovak vascular surgeons and nephrologists accept recommendations of the European Society of Vascular Surgery - survey study.

Arteriovenous access (AVA) is the cornerstone for the long-term haemodialysis treatment in the patient with end-stage kidney disease. Nowadays, European Society of Vascular Surgery (ESVS) has presented clinical guidelines regarding all aspects of AVA. The aim of the study was to identify acceptance rate of selected ESVS recommendations among Czech and Slovak vascular surgeons and nephrologists. We carried out a prospective analysis of 7 questions from an online survey collected from January to February 2020. 211 (33 %) of 646 participants responded to the survey. Questions were divided into two groups, general and surgical. General questions were for both nephrologist and vascular surgeons. Surgical questions were evaluated only for vascular surgeons. In the first group 190 (90 %) respondents accept, that extremity dominance is important for location of AVA, 186 (89 %) agree that clinically suspected venous hypertension/central vein occlusion is an indication for fistulography, 111 (53 %) agree, that indwelling central venous catheter/pacemaker is an indication for AVA creation in the opposite side. In the second group, 50 (57 %) agree that patients before AVA creation should be examined with a tourniquet prior to surgery, 45 (51 %) agree, that pre-operative ultrasonography mapping is recommended, 66 (75 %) agree, that the inner radial artery and the cephalic vein should be more than 2.0 mm, and only 9 (10 %) respondents agree that regional anaesthesia is preferred over local anaesthesia for AVA creation. In both Czech and Slovak Republic, preoperative planning is not uniform and ESVS recommendations for AVA are accepted at the level of 57 %.

Repair of Aneurysmal Arteriovenous Fistulae: A Systematic Review and Meta-analysis.

OBJECTIVE: Aneurysms arising from arteriovenous fistulae are a common finding among dialysed patients and pose a risk of acute bleeding. The aim of this study was to perform a systematic review and meta-analysis evaluating the surgical options for the treatment of aneurysmal arteriovenous fistulae. METHODS: A systematic review and meta-analysis of articles published between January 1973 and March 2019 describing the surgical treatment of arteriovenous fistulae aneurysms. RESULTS: A total of 794 records were identified. After duplicate and low quality studies were removed, 72 full text articles were reviewed and from these 13 were included in the meta-analysis. The total number of patients was 597. Aneurysms were located in the upper arm in 289 (59%) cases and the smallest diameter of a treated aneurysm was 15 mm. The most frequent indication for treatment was bleeding prevention in 513 (86%) cases. Aneurysmorrhaphy was the surgical method of choice in all 13 studies. The pooled primary patency at 12 months was 82% (95% CI 69%-90%, 12 studies, I2 = 84%, p < .01). The 12 month primary patency rates were similar for aneurysmorrhaphy with external prosthetic reinforcement (85%, 95% CI 71%-93%, two studies, I2 = 0%, p = .33) and aneurysmorrhaphy performed using a stapler (74%, 95% CI 61%-83%, four studies, I2 = 0%, p = .48) and without a stapler (82%, 95% CI 60%-94%, six studies, I2 = 92%, p < .01). CONCLUSION: Aneurysmorraphy of arteriovenous fistulae is a procedure with acceptable short and long term results, with a low complication and aneurysm recurrence rate.

The role of the vascular surgery in oncosurgery.

Surgical resection remains the cornerstone for the curative treatment of oncological disease. In a situation when a tumour encases a critical arterial or venous structure, long term oncological control may be achieved only through careful preoperative planning within a multidisciplinary team incorporating oncological and vascular specialists. The present review addresses the principles in planning oncovascular surgery, describes the oncovascular procedure in pancreatic, liver, renal and endometriosis cancer as well as vascular involvement in retroperitoneal soft sarcoma and sarcoma in lower extremity. In conclusion, the present review highlights that major vessel involvement of a tumour mass should not necessarily be considered as a barrier to en bloc resection and hence curative oncosurgery procedure.

Simultaneous valorization of polyvinyl chloride and eggshell wastes by a semi-industrial mechanochemical approach.

A semi-industrial approach for simultaneous treatment of eggshell and industrial polyvinyl chloride waste utilizing tools of ball milling is reported therein. On a hundred-gram scale, it is possible to transfer more than 55% of chlorine present in the polyvinyl chloride representing an environmental burden, into harmless soluble form. On a laboratory scale, a complete dechlorination was achieved. The ratio of eggshell-to-polyvinyl chloride plays a significant role for the effective dechlorination and the kinetics of semi-industrial process follows zero-order kinetics with the rate constant 1.23 × 10-5 s-1. Chlorine is mainly in the form of calcium chloride. This study is an example of efficient simultaneous valorization of two waste materials on a semi-industrial scale, as the products can be utilized again.

Mechanochemical Synthesis and Characterization of CuInS2/ZnS Nanocrystals.

In this study, CuInS2/ZnS nanocrystals were synthesized by a two-step mechanochemical synthesis for the first time. In the first step, tetragonal CuInS2 was prepared from copper, indium and sulphur precursors. The obtained CuInS2 was further co-milled with zinc acetate dihydrate and sodium sulphide nonahydrate as precursors for cubic ZnS. Structural characterization of the CuInS2/ZnS nanocrystals was performed by X-ray diffraction analysis, Raman spectroscopy and transmission electron microscopy. Specific surface area of the product (86 m²/g) was measured by low-temperature nitrogen adsorption method and zeta potential of the particles dispersed in water was calculated from measurements of their electrophoretic mobility. Optical properties of the nanocrystals were determined using photoluminescence emission spectroscopy.

Realgar nanoparticles versus ATO arsenic compounds induce in vitro and in vivo activity against multiple myeloma.

Multiple myeloma (MM), a B cell malignancy characterized by clonal proliferation of plasma cells in the bone marrow, remains incurable despite the use of novel and conventional therapies. In this study, we demonstrated MM cell cytotoxicity triggered by realgar (REA; As4 S4 ) nanoparticles (NREA) versus Arsenic trioxide (ATO) against MM cell lines and patient cells. Both NREA and ATO showed in vivo anti-MM activity, resulting in significantly decreased tumour burden. The anti-MM activity of NREA and ATO is associated with apoptosis, evidenced by DNA fragmentation, depletion of mitochondrial membrane potential, cleavage of caspases and anti-apoptotic proteins. NREA induced G2 /M cell cycle arrest and modulation of cyclin B1, p53 (TP53), p21 (CDKN1A), Puma (BBC3) and Wee-1 (WEE1). Moreover, NREA induced modulation of key regulatory molecules in MM pathogenesis including JNK activation, c-Myc (MYC), BRD4, and histones. Importantly, NREA, but not ATO, significantly depleted the proportion and clonogenicity of the MM stem-like side population, even in the context of the bone marrow stromal cells. Finally, our study showed that both NREA and ATO triggered synergistic anti-MM activity when combined with lenalidomide or melphalan. Taken together, the anti-MM activity of NREA was more potent compared to ATO, providing the preclinical framework for clinical trials to improve patient outcome in MM.

Hallmarks of mechanochemistry: from nanoparticles to technology.

The aim of this review article on recent developments of mechanochemistry (nowadays established as a part of chemistry) is to provide a comprehensive overview of advances achieved in the field of atomistic processes, phase transformations, simple and multicomponent nanosystems and peculiarities of mechanochemical reactions. Industrial aspects with successful penetration into fields like materials engineering, heterogeneous catalysis and extractive metallurgy are also reviewed. The hallmarks of mechanochemistry include influencing reactivity of solids by the presence of solid-state defects, interphases and relaxation phenomena, enabling processes to take place under non-equilibrium conditions, creating a well-crystallized core of nanoparticles with disordered near-surface shell regions and performing simple dry time-convenient one-step syntheses. Underlying these hallmarks are technological consequences like preparing new nanomaterials with the desired properties or producing these materials in a reproducible way with high yield and under simple and easy operating conditions. The last but not least hallmark is enabling work under environmentally friendly and essentially waste-free conditions (822 references).