An Analysis of the Timing for Closure of a Diverting Loop Ileostomy.

A diverting loop ileostomy (DLI) is used to protect a distal gastrointestinal anastomosis at risk of leakage. While patients typically prefer early DLI closure, surgeons vary in opinion regarding optimal timing. This study evaluated whether the timing of DLI closure impacts outcomes.A retrospective review was performed on patients who underwent DLI creation within one health care system between 2012 and 2020. Patient characteristics and postoperative outcomes were compared across ileostomies closed in ≤2 months, 2-4 months, and >4 months. Outcomes examined included anastomotic leak, other complications, reintervention, and death within 30 days.A total of 500 DLIs were analyzed for the study, 455 of which were closed. The three closure groups were similar in patient characteristics and comorbidities. None of the outcome variables analyzed in this study demonstrated a statistically significant difference between groups, suggesting that in patients otherwise fit for surgery, DLI closure can be safely performed within 2 months of creation.

Comparison of homografts and bovine jugular vein conduits in the pulmonary position in patients <20 years of age.

OBJECTIVE: To compare the performance of homografts and bovine jugular vein (BJV) conduits in the pulmonary position. METHODS: All patients with congenital heart disease up to age 20 years who underwent pulmonary valve replacement with homografts or BJV at 3 centers in Australia were evaluated. There were 674 conduits, with 305 (45%) pulmonary homografts (PHs), 303 (45%) BJV conduits, and 66 (10%) aortic homografts (AHs). Endpoints were freedom from reintervention, structural valve degeneration (SVD), and infective endocarditis (IE). Propensity score matching was used to balance the comparison of PH and BJV conduits. RESULTS: The median follow-up was 6.4 years (interquartile range, IQR, 3.1-10.7 years). Freedom from reintervention at 5 and 10 years was 92% and 80%, respectively, for PH, 74% and 37% for BJV, and 75% and 47% for AH. BJV conduits had a higher risk of reintervention (P < .001) and SVD (P < .001) compared with PHs. These findings were confirmed with propensity score matching valid for conduit size >15 mm. AHs >15 mm had a higher risk of reintervention (P < .001) and SVD (P < .001) compared with PHs >15 mm. The performance of AHs and BJV conduits was similar across all sizes (reintervention, P = .94; SVD, P = .72). The incidence of IE was 1% for PH, 10% for BJV, and 1.5% for AH. CONCLUSIONS: In patients age <20 years with a conduit >15 mm, PHs outperformed BJV conduits and AHs in the pulmonary position. The performance of AH and BJV was comparable. Small conduits (≤15 mm) had similar performance across all conduit types.

Surface chemistry and spectroscopy studies on 1,4-naphthoquinone in cell membrane models using Langmuir monolayers.

Investigating the role of drugs whose pharmaceutical activity is associated with cell membranes is fundamental to comprehending the biochemical processes that occur on membrane surfaces. In this work, we examined the action of 1,4-naphthoquinone in lipid Langmuir monolayers at the air-water interface, which served as a model for half of a membrane, and investigated the molecular interactions involved with tensiometry and vibrational spectroscopy. The surface pressure-area isotherms exhibited a noticeable shift to a lower area in relation to 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) and 1,2-dihexadecanoyl-sn-glycero-3-phospho-l-serine (DPPS) lipid monolayers, which indicated a disruption of the monolayer structure and solubilisation of the lipids towards the aqueous subphase. To better correlate to the action of this drug in biological membrane events, cell cultures that represented tumorigenic and non-tumorigenic cells were spread onto the air-water interface, and 1,4-naphthoquinone was then incorporated. While only slight changes were observed in the non-tumorigenic cells upon drug incorporation, significant changes were observed in the tumorigenic cells, on which the organisation of the Langmuir monolayers was disrupted as evidenced by tensiometry and vibrational spectroscopy. This work then shows that this drug interacts preferentially for specific surfaces. In simplified models, it has a higher effect for the negative charged DPPS rather than the zwitterionic DPPC; and for complex cell cultures, 1,4-naphthoquinone presents a more significant effect for that representing tumorigenic cells.

Effect of general and epidural anesthesia on hemostasis and fibrinolysis in hepatic patients.

This study was designed to compare the effect of general anesthesia using isoflurane and epidural anesthesia using ropivacaine on hemostasis in hepatic patients. Sixty patients were randomly allocated into two groups to receive either general or epidural anesthesia which further subdivided into control and hepatic subgroups. Blood samples were collected preoperatively, immediate post-operatively and on third post-operative day to measure hemoglobin (Hb), platelet count (PLT),), prothrombin time (PT), partial thromboplastin time (PTT), and thrombin time (TT). Specific hemostatic and fibrinolytic parameters were also included; von Willebrand factor (vWF), soluble platelet selectin (sP-selectin), prothrombin fragment (PF(1+2)), tissue plasminogen activator (tPA), plasminogen activator inhibitor-1 (PAI-1) and D-dimer. Hemoglobin showed a significant post-operative decrease in all subgroups. Post-operative changes of PLT, PT, PTT and TT were comparable between general and epidural anesthesia. General anesthesia showed a marked significant increase in specific parameters compared to epidural anesthesia. This study concluded that epidural ropivacaine anesthesia provided better hemostatic stability especially in hepatic patients.

Assessment of platelet activation in coupled schistosomiasis and viral hepatitis infection: contribution to complexity of course and development of complications.

This study assessed platelet activation and its possible contribution to the pathogenesis of liver cirrhosis (LC), hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT). Forty-five patients with LC caused by dual schistosomiasis and viral hepatitis infections were enrolled in the study, 15 had LC only, 15 were complicated with HCC, and 15 were complicated with PVT, in addition to 15 healthy controls. Platelet morphological parameters including platelet count, platelet crit, mean platelet volume (MPV) and platelet distribution width (PDW), as well as platelet activation as evidenced by measuring soluble platelet selectin (sP-selectin) level and the release of beta-thromboglobulin (beta-TG), transforming growth factor beta-1 (TGF-beta1) and platelet derived growth factor-AA (PDGF-AA) were evaluated. The results obtained revealed significant reduction in platelet count, platelet crit and MPV while PDW was significantly increased in all LC patients in comparison to controls. sP-selectin, beta-TG, TGF-beta1 & PDGF-AA revealed significant increase in all diseased groups when compared to control group. Patients complicated with HCC or PVT demonstrated significant increase in the aforementioned parameters in comparison to patients with LC only. Patients with PVT showed significant increase versus HCC patients. These findings indicate that platelet activation is a prominent feature in LC and its serious complications HCC & PVT. This activation can play an important role in the pathogenesis of LC, HCC & PVT in patients with mixed schistosomiasis and viral hepatitis infections. Such patients need careful medical attention and effective treatment. Stabilization of the activated platelets and the dual suppression of PDGF & TGF-beta1 could be new therapeutic strategies against LC and its sequels.