Enhancing the Sustainability of Eco-friendly Potentiometric Ion Selective Electrodes for Stability-Indicating Measurement of Ethamsylate: Application in Bulk and Pharmaceutical Formulations.

BACKGROUND: Through the use of sustainable and green chemistry concepts, scientists need to decrease waste, conserve energy, and develop safe substitutes for hazardous compounds, all for protecting and benefiting society and the environment. OBJECTIVE: Four novel eco-friendly ion selective electrodes (ISE) were created to determine Ethamsylate (ETM) in bulk powder and different pharmaceutical formulations. The present electrodes were fabricated and evaluated to clearly distinguish ETM from a variety of inorganic, organic ions, sugars, some common drug excipients and the degradation product, hydroquinone (HQ) of ETM, and thus could be used for stability-indicating methods. METHODS: The electrodes fabrication was based on 2-nitrophenyl octyl ether (NPOE) that was employed as a plasticizer in electrodes 1, 2, and 3 within a polymeric matrix of polyvinyl chloride (PVC) except for electrode 4, in which dibutyl sebacate was used as a plasticizer. Electrodes 1 & 2 were fabricated using tetra dodecyl ammonium bromide as an anionic exchanger and adding 4-sulfocalix-8-arene as an ionophore only to electrode 2, but electrode 1 prepared without incorporation of an ionophore. The fabrication of electrodes 3 & 4 was based on ethamsylate-tetraphenylborate (ETM-TPB) as an ion-association complex in a PVC matrix. The environmental sustainability was assessed using Green Analytical Procedure Index (GAPI), and Analytical Greenness Metric for Sample Preparation (AGREEprep). RESULTS: Electrodes 1 & 2 had linear dynamic ranges of (10-1-10 -5) and (10-1-10 -4) respectively, with a Nernstian slope of 49.6 and 53.2 mV/decade, respectively. Electrodes 3 & 4 had linear dynamic ranges of (10-1-10 -4), with a Nernstian slope of 43.9 and 40.2 mV/decade, respectively. CONCLUSION: The generated electrodes' selectivity coefficients showed good selectivity for ETM. The utility 4-sulfocalix-8-arene as ionophore had a significant influence on increasing the membrane sensitivity and selectivity of electrode 2 compared to other electrodes.

Analysis of the sonographic predictors of difficult laparoscopic cholecystectomy in symptomatic cholelithiasis.

BACKGROUND: Laparoscopic cholecystectomy (LC) is one of the most common laparoscopic procedures performed by young surgeons nowadays. Sometimes, LC could be challenging, especially for junior surgeons leading to serious complications. Therefore, this study aims to investigate the preoperative ultrasonographic features that could predict difficult LC. METHODS: In this prospective study, patients (n = 204) who underwent LC for symptomatic cholelithiasis from January 2020 to August 2022 were included. Preoperative parameters, including the ultrasonographic findings, were evaluated for their ability to predict difficult LC. RESULTS: The difficulty of LC was evaluated using two intraoperative scores. Among the ultrasonic parameters that were assessed preoperatively, thickened gallbladder (GB) wall, contracted GB, and impacted stone in the GB neck were associated with difficult LC. However, an impacted stone in the GB neck was the only independent predictor of difficult LC according to both difficulty scores in the multivariate analysis (odds ratio [OR] = 7.56, p = .001; OR = 8.42, p = .001). CONCLUSIONS: The impacted stone in the GB neck is an ultrasonographic sign of difficult LC. It should alert the surgeon for a more appropriate preoperative preparation, and the patient should be informed about the increased risk of complications, including conversion to open cholecystectomy.

Utilizing industrial byproducts for the manufacture of clay-cellulose nanocomposite cements with enhanced sustainability.

This study investigates the influence of different nano clay contents (0, 1, 3, and 5 wt% of cement) on the microstructure and the mechanical properties of cement composites reinforced with varying Nano cellulose fiber contents (0, 0.5, 0.75, and 1 wt% of cement). Unlike previous research that employed sonication to improve dispersion in the cement matrix, this study explores the effects of unsonicated nano-cellulose addition and the combined incorporation of nano-cellulose and nano-clay. The results demonstrate that these additions significantly enhance the compressive strength, abrasion resistance, and water absorption ratios of the cement composites. Furthermore, the inclusion of nano-clay improves the microstructure of the cement matrix, strengthening the interfacial transition zone and reinforcing the bond between nano-cellulose and the cement matrix. The microstructural analysis using scanning electron microscopy (SEM) reveals the presence of a dense interconnected structure characterized by rod-like crystals. This research contributes to the development of sustainable construction materials by examining the effects of nano-cellulose and nano-clay on the properties and microstructure of cement composites. The utilization of industrial byproducts, such as wood sawdust, for the extraction of nano-cellulose offers an eco-friendly approach to enhance the performance of cement-based materials. The maximum compressive strength obtained, after 28 days, was at mix with 0.75% NCL + 5%NC with a gain of 53.5% than that of the control mix. In mixes containing only nano-clay (NCL), the increase in NCL content led to a higher rate of water absorption in the cement matrix, which reaches 4%. Confirming the results obtained from compressive strength and water absorption, mix with 0.75% NCL and 5% NC had obtained the optimum values with an improvement of 20% than that of the control mix.

D-line Approach for Safe Laparoscopic Cholecystectomy: Initial Experience.

Introduction The critical view of safety is an important concept for safe laparoscopic cholecystectomy. However, no standard step-by-step approach for achieving the critical view of safety has been established until now. Therefore, this study aims to evaluate a new approach for achieving the critical view of safety using the diagonal line of liver segment IV as an anatomical landmark. Patients and methods In this prospective non-randomized study, patients (n= 112) who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis were included. The first 47 patients underwent laparoscopic cholecystectomy using the diagonal line approach (DLC group) whereas, the next 65 patients underwent laparoscopic cholecystectomy using the conventional method (CLC group).  Results No significant difference between both groups regarding the preoperative characteristics, operative time, and intraoperative blood loss. Laparoscopic subtotal cholecystectomy was performed more in the DLC group (6% vs 0%, p= 0.07). Whereas, in the CLC group, there was a tendency towards conversion to open cholecystectomy in difficult cases (6% vs 2%, p= 0.40). No intra- or postoperative complications occurred in either group.  Conclusion The diagonal line approach is a feasible and useful step-by-step technique to achieve the critical view of safety in laparoscopic cholecystectomy and enables surgeons to perform safe laparoscopic subtotal cholecystectomy in difficult cases.

Wood sawdust waste-derived nano-cellulose as a versatile reinforcing agent for nano silica cement composites: a systematic study on its characterization and performance.

The development of sustainable construction materials is a pressing concern for researchers worldwide, as the cement industry is a major contributor to environmental degradation. The incorporation of nano-materials with cement composites has emerged as a promising solution to sustainable materials production. In this study, the effect of the addition of nano cellulose produced from wood sawdust waste on the performance of cement-based nano-silica composite was investigated. The nano-materials were incorporated at low concentrations and in gel form to eliminate the need for any advanced dispersion techniques. The results indicated that the addition of even low concentrations of nano cellulose significantly enhanced the compactness and mechanical properties of the cement matrix. The crack propagation was observed to be arrested with better adherence to the cement hydration product, which resulted from the presence of nano-silica. The nano cellulose fibers were found to bridge the calcium silicate hydrate products, arresting the propagation of cracks at their initial condition. The high pozzolanic reactivity of nano-silica ensured a minimal amount of calcium hydroxide, which is a significant contributor to the carbon footprint of cement production. Overall, the findings of this study suggest that the incorporation of nano cellulose from wood sawdust waste with cement-based nano-silica composite can lead to the development of sustainable and high-performance building materials with improved mechanical properties and reduced environmental impact.

Predictors of portal vein complications after pediatric liver transplantation: A German center experience.

BACKGROUND: Portal vein complications (PVCs) after pediatric liver transplantation (LT) are sometimes asymptomatic, especially in the early phase, and can threaten both the graft and patient's survival. Therefore, the purpose of this study is to analyze the risk factors for portal vein thrombosis (PVT) and portal vein stenosis (PVS) after pediatric LT. METHODS: All pediatric patients (n = 115) who underwent primary LT at Regensburg University Hospital between January 2010 and April 2017 were included in this study. The pre-, intra-, and postoperative parameters of all patients were retrospectively reviewed and risk factors for both PVT and PVS were analyzed. RESULTS: Of the 115 patients, living donor LT was performed on 57 (49.5%) patients, and biliary atresia was the primary diagnosis in 65 patients (56%). After pediatric LT, 9% of patients developed PVT, and 16.5% developed PVS. Patient weight ≤7 kg [odds ratio (OR) 9.35, 95% confidence interval (CI) 1.03-84.9, p = .04] and GRWR >3% (OR 15.4, 95% CI 1.98-129.5, p = .01) were the independent risk factors for the development of PVT and PVS, respectively upon multivariate analysis. The overall patient survival rates at 1, 3, and 5 years were 91%, 90%, and 89%, respectively, and there was no difference in patient survival among those with and without PVCs. CONCLUSIONS: Pediatric patients with body weight <7 kg and/or receiving a graft with GRWR >3% may develop PVCs and so require certain surgical modifications, close follow-up, and prophylactic anticoagulant therapy following transplant.

Image-guided laparoscopic cholecystectomy using indocyanine green fluorescence cholangiography: what is the optimal time of administration?

INTRODUCTION: Near-infrared (NIR) fluorescent cholangiography (FC) using indocyanine green (ICG) in laparoscopic cholecystectomy (LC) has been used as a technique for real-time visualization of bile ducts for approximately ten years; however, no standard protocol has been determined. This study aimed to determine the optimal time of administration of ICG. MATERIAL AND METHODS: In this prospective study, patients (n = 30) indicated for LC were divided into two groups. The first group received ICG 1 h before anesthesia at a dose of 0.1 mg/kg (1 h group), whereas the other group received ICG immediately after anesthesia with the same dose (0 h group). RESULTS: The rates of identification of the cystic duct (CD) and common bile duct (CBD) using NIR FC before and after dissection of Calot's triangle were comparable between the two groups. The fluorescence intensity ratios of CD/Liver and CBD/Liver were significantly higher in the 1 h group (2.2 vs. 0.49 and 2.1 vs. 0.38, respectively, p < .001) with minimal background liver fluorescence interference in the 1 h group. CONCLUSIONS: The study illustrates that administration of ICG 1 h before surgery with a dose of 0.1 mg/kg allows superior visualization of the extrahepatic bile ducts with minimal fluorescence interference from the background liver.

Splenic auto-transplantation after splenectomy for trauma: evaluation of a new technique.

BACKGROUND: Splenic autotransplantation is a promising method to recover splenic functions after traumatic splenectomy. However, it is associated with several postoperative complications, such as subphrenic abscess, intestinal obstruction and torsion of the omentum with necrosis of the implanted splenic tissues. Therefore, the aim of this study is to evaluate a new splenic autotransplantation technique that could overcome those complications. MATERIALS AND METHODS: A single segment of the spleen was implanted inside a pedunculated omental pouch and fixed in the native site of the spleen in 15 patients who underwent splenectomy for abdominal trauma. This group of patients was compared with the next 17 patients who underwent splenectomy alone. Additionally, splenic functions of the patient and control groups were evaluated 3 months using peripheral blood smear [the presence of Howell-Jolly (HJ) bodies] and abdominal contrast-enhanced computed tomography (CECT). RESULTS: All patients who underwent splenic autotransplantation showed evidence of a well-vascularised splenic tissue on CECT and normal peripheral blood smear without HJ bodies 3 months postoperatively. No postoperative complications related to splenic autotransplantation were observed, and platelet count after 3 months was significantly higher in patients who underwent splenectomy only (p = 0.04). CONCLUSIONS: Splenic autotransplantation using the aforementioned technique could restore splenic functions with minimum postoperative complications related to the procedure.

Evans Syndrome After Successful Immunosuppressant-Free Living-Donor Liver Transplant.

Evans syndrome is an uncommon disease characterized by a combination of autoimmune hemolytic anemia and autoimmune thrombocytopenia concomitantly or sequentially with a positive direct Coombs test in the absence of any underlying known cause. Here, we present a case of an adult patient who underwent living-donor liver transplant that was preceded by bone marrow transplant 20 years earlier from the same HLA identical donor and who received a single-agent immunosuppressive therapy for only 2 months as prophylaxis against graft-versus-host disease. Two months after transplant, he developed Evans syndrome with severe anemia and thrombocytopenia. After administration of steroids and intravenous immunoglobulin, the patient's anemia and thrombocytopenia improved dramatically. Through the 7 years of follow-up, the patient has not developed graft-versus-host disease or acute or chronic rejection. This case demonstrates a rare complication posttransplant and the possibility of functional tolerance of liver grafts after a combined liver and bone marrow transplant from the same donor.

Current Status of Liver Transplantation Using Marginal Grafts.

The use of marginal liver grafts has become an inevitable option because of the continuous increase in the number of patients awaiting liver transplantation and the severe shortage of suitable donors. Recently, several approaches have been adapted to expand the donor pool and improve the outcome of marginal grafts in both deceased and living donor liver transplantation. Accordingly, this review discusses the various types of marginal grafts in both deceased and living donor liver transplantation, their outcome and the up-to-date innovations or strategies to extend the donor pool and improve the patient and graft survival post-transplant.

Different clinical risk scores for prediction of early mortality after liver resection for hepatocellular carcinoma: which is the best?

BACKGROUND: Prediction of early mortality after hepatectomies for hepatocellular carcinoma is essential to identify high-risk patients and to decrease the operative mortality rate. Several post-operative clinical risk scores were developed recently to predict mortality post-hepatectomy; however, which one is the best remains undefined. Therefore, the aim of this study was to evaluate the performance of the different post-operative clinical risk scores in predicting early mortality after hepatectomies. METHODS: A total of 240 patients who underwent liver resection for hepatocellular carcinoma at our hospital between June 2011 and July 2016 were retrospectively reviewed. Post-operative clinical risk scores including 50-50 criteria, peak bilirubin >7 mg/dL, model for end-stage liver disease (MELD), risk assessment for early mortality and Hyder scores were evaluated for their performance in predicting early mortality after hepatic resection using the receiver operating characteristic (ROC) curve. RESULTS: The 90-day mortality rate after hepatic resection was around 2.5%. The 50-50 criteria and peak bilirubin >7 mg/dL were weak predictors of early mortality with low sensitivity (area under the ROC curve: 0.65, 0.66, respectively), whereas, Hyder, risk assessment for early mortality, and post-operative MELD were good predictors of early mortality (area under the ROC curve: 0.89, 0.91 and 0.88, respectively). Moreover, MELD score on post-operative day 3 was an independent risk factor for 90-day mortality with an odds ratio of 1.4 (95% confidence interval 1.06-1.81, P = 0.02). CONCLUSIONS: Post-operative clinical risk scores, especially MELD, were capable of predicting early mortality after liver resection and should be used to identify high-risk patients and provide them with more intensive medical care.

A Propensity Score-Based Analysis of Laparoscopic Liver Resection for Liver Malignancies in Elderly Patients.

PURPOSE: Laparoscopic liver resection is safe, feasible and associated with less blood loss, shorter hospital stays and fewer postoperative complications in the working age patients with malignant liver tumors. However, it is still unclear if the elderly patients with malignant liver tumors would also benefit from that approach as the younger patients. So, the aim of the study was to compare the clinical outcomes of laparoscopic versus open liver resection for malignant liver tumors in elderly patients. MATERIALS AND METHODS: Between March 2009 and July 2016, all elderly patients (≥70 years old) who underwent laparoscopic (n = 40) and open (n = 202) liver resection for malignant liver tumors were included. A one to one propensity score matching analysis was performed, based on 6 covariates, to decrease the selection bias. RESULTS: There was no significant difference between the laparoscopic and open liver resection groups regarding the patient characteristics and tumor features. The operative time was comparable between both groups (Laparoscopic group 259 min vs Open group 308 min, p = .86), while patients who underwent laparoscopic liver resection had lower intraoperative blood loss (30 ml vs 517 ml, p < .0001), shorter hospital stays (10 days vs 23 days, p < .0001), and less overall morbidity (15% vs 38%, p = .04). The one-, three-, and five-year survival for patients with hepatocellular carcinoma was comparable between both groups (Laparoscopic group 96%, 74%, 47%, vs Open group 94%, 71%, 48%, p = .82), whereas The one-, three-, and five-year recurrence-free survival for patients with hepatocellular carcinoma was significantly higher in the laparoscopic group (88%, 60%, 60% vs 54%, 25%, 19%, p = .019). CONCLUSIONS: Laparoscopic approach for minor liver resection in elderly patients is safe and feasible with less blood loss, a shorter hospital stay, less postoperative complications and a better oncological outcome.

Sclerosing encapsulating peritonitis after living-donor liver transplantation: A case series, Kyoto experience.

Sclerosing encapsulating peritonitis (SEP), or abdominal cocoon is a rare cause of intestinal obstruction, and still etiology remains unknown. We report a series of 4 patients with abdominal cocoon, and all the 4 patients had previously undergone living-donor liver transplantation (LDLT). There was no evidence of SEP before and during LDLT. At the time of diagnosis of SEP, 3 out of 4 patients had ascites. First and fourth patients had multiple episodes or attacks of cholangitis, which were managed by percutaneous transhepatic biliary drainage and hepaticojejunostomy, respectively. All 4 patients presented with intestinal obstruction and 3 of them underwent a successful operation. The fourth patient died due to liver failure and complications of the SEP. The first 3 patients are doing well without SEP recurrence. Our experience suggest that the prognosis of SEP is poor in patients with poor graft liver functions after LDLT.

Is Muscle MELD a More Promising Predictor for Mortality After Living Donor Liver Transplantation?

BACKGROUND: To improve the outcome of living donor liver transplantation (LDLT), a scoring system that could predict accurately the patient and graft survival posttransplant is necessary. The aim of this study is to evaluate our previously proposed Muscle-model for end-stage liver disease (M-MELD) score and to compare it with the other available scores to find the best system that correlates with postoperative outcome after liver transplant. METHODS: We retrospectively reviewed the data of 199 patients who underwent LDLT from January 2010 to July 2016 and calculated the preoperative MELD, MELD Na, the product of donor age and MELD (D-MELD), M-MELD, integrated MELD, and the balance of risk (BAR) score in all patients. The area under the receiver operating characteristics curves (AUCs) of each score was computed and compared at 3-, 6-months, and 1-year after LDLT. RESULTS: The M-MELD, D-MELD, and integrated MELD had a good discriminative performance in predicting 3-month mortality after LDLT with AUCs > 0.7, while the M-MELD was the only score that showed a good discriminative performance in predicting 6-month and 1-year mortality after LDLT with AUCs > 0.7. CONCLUSION: Muscle-MELD score is a simple and useful predictor of patient survival after LDLT which showed a better predictive performance than other available scores.

The Impact of Preoperative Hemoglobin Level on the Short-Term Outcomes After Living Donor Liver Transplantation.

BACKGROUND: Preoperative anemia was reportedly associated with increased morbidity and mortality after various types of surgeries. However, its impact on the outcomes after liver transplantation has not been thoroughly investigated. METHODS: We retrospectively investigated the clinical outcome of 216 consecutive adult patients who underwent living donor liver transplantation at our institute between January 2010 and June 2017 and stratified them according to the hemoglobin level before transplant. Risk factors for 90-day patient mortality, especially infection-related mortality and early graft loss, were evaluated. RESULTS: We found that patients with preoperative hemoglobin below 10 g/dl required more intraoperative packed red blood cell transfusions (p = 0.002) and had significantly higher early 90-day postoperative mortality rate (p = 0.007), particularly infection-related mortality (p = 0.002), lower overall graft, and patient survival rates (p = 0.007, p = 0.013, respectively). Preoperative hemoglobin below 10 g/dl was an independent risk factor for increased post-transplant 90-day patient mortality (OR 2.92, p = 0.02), infection-related mortality (OR 6.81, p = 0.02), and early graft loss (OR 3.26, p = 0.01). CONCLUSION: Preoperative hemoglobin level below 10 g/dl is associated with poorer short-term outcomes after liver transplantation and should be corrected preoperatively if possible through safe and effective treatment modalities.

Human leukocyte antigen compatibility and lymphocyte cross-matching play no significant role in the current adult-to-adult living donor liver transplantation.

BACKGROUND: The impact of human leukocyte antigen (HLA) compatibility and positive lymphocyte cross-match (LCM) on organ transplantation is well-recognized particularly in kidney and heart transplantation; however, it is still debatable in liver transplantation (LT). So, the aim of this study was to evaluate the impact of HLA mismatch and positive LCM on the outcome of LT. METHODS: We retrospectively analyzed the data of all adult recipients who underwent living donor LT at our institute between January 2010 and July 2016. We excluded all ABO blood group incompatible LDLT patients and patients with incomplete data regarding HLA genotyping (n = 134). The type and degree of HLA-A, HLA-B, HLA-C, HLA-DR, HLA-DQ mismatch and LCM were assessed in each donor-recipient pair and their relationship to the occurrence of rejection, CMV infection and graft survival was evaluated. RESULTS: A higher percentage (>50%) of donor-recipient pairs had 1 HLA mismatch at each locus in the host-vs-graft direction and seventeen recipients (13%) had positive LCM. Human leukocyte antigen mismatch and positive LCM were not correlated with increased incidence of acute rejection (P = .37, P = .6, respectively), CMV infection post-transplant (P = .52, P = .76, respectively), or graft failure (HR 1.22, P = .68 and HR 1.73, P = .34, respectively). CONCLUSION: Positive LCM and HLA mismatches did not affect the overall graft survival after adult-to-adult LDLT and should not be considered as contraindications for liver transplantation.

Evaluation of a new energy device for parenchymal transection in laparoscopic liver resection.

INTRODUCTION: THUNDERBEAT (TB) is a novel device that uses both ultrasonic and advanced bipolar energies for hemostasis. Several recent human studies have proved the safety and efficacy of TB in different surgical procedures, but there have been no similar studies about its efficacy in hepatic parenchymal transection. Therefore, the aim of the study was to assess the safety and efficacy of the TB device in laparoscopic liver resection. METHODS: This retrospective study compared TB and ultrasonic Harmonic devices in 80 patients who underwent laparoscopic liver resection from 2010 to 2016 in our institution. To reduce the selection bias, the two groups were matched in a 1-to-2 ratio on the basis of propensity scores. RESULTS: There were no differences in the preoperative patient characteristics between the two groups. The extent of liver resection was comparable between the groups. Although the Harmonic group's intraoperative blood loss and operative time were less than that of the TB group, the differences were not statistically significant (P = 0.08, P = 0.32, respectively). Postoperative complications, mortality within 90 days, and hospital stay were comparable between the two groups. CONCLUSION: TB is as safe and effective for parenchymal transection in laparoscopic hepatectomy as ultrasonic devices, but it is not a superior alternative.

Evaluation of safety of concomitant splenectomy in living donor liver transplantation: a retrospective study.

In Asian countries, concomitant splenectomy in living donor liver transplantation (LDLT) is indicated to modulate the portal vein pressure in the small-sized graft to protect against small for size syndrome. While concomitant splenectomy in deceased donor liver transplantation is almost contraindicated based on Western Reports of increased mortality and morbidity rate due to septic complications, there are few studies about that in LDLT. So, we retrospectively investigated the clinical outcome of adult LDLT at Kyoto University Hospital from July 2010 to July 2016. We divided the patients (n = 164) into those with concomitant splenectomy (n = 88) and those without (n = 76). The splenectomy group showed significantly increased operative time and intraoperative blood loss (P = 0.008, P = 0.0007, respectively), and significantly higher rate of postoperative splenic vein thrombosis and cytomegalovirus infection (P = 0.03, P = 0.016, respectively). However, there were no significant differences between the two groups regarding the incidence of postoperative hemorrhage (P = 0.06), post-transplant bacteremia (P = 0.38), infection-related mortality rates (P = 0.8), acute rejection (P = 0.87), and patient and graft survival (P = 0.66, P = 0.67 respectively); finally, model for end-stage liver disease score above 30 was an independent predictor for infection-related mortality post-transplant (HR = 5.99, 95% CI = 2.15-16.67, P = 0.001). In conclusion, concomitant splenectomy in LDLT can be safely performed when indicated.

The impact of wound age on the infection rate of simple lacerations repaired in the emergency department.

BACKGROUND: The influence of wound age on the risk of infection in simple lacerations repaired in the emergency department (ED) has not been well studied. It has traditionally been taught that there is a "golden period" beyond which lacerations are at higher risk of infection and therefore should not be closed primarily. The proposed cutoff for this golden period has been highly variable (3-24h in surgical textbooks). Our objective is to answer the following research question: are wounds closed via primary repair after the golden period at increased risk for infection? METHODS: We searched MEDLINE, EMBASE, and other databases as well as bibliographies of relevant articles. We included studies that enrolled ED patients with lacerations repaired by primary closure. Exclusion: (1) delayed primary repair or secondary closure, (2) wounds requiring intra-operative repair, skin graft, drains, or extensive debridement, and (3) grossly contaminated or infected at presentation. We compared the outcome of wound infection in two groups of early versus delayed presentations (based on the cut-offs selected by the original articles). We used "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) criteria to assess the quality of the included trials. RESULTS: 418 studies were identified. Four trials enrolling 3724 patients in aggregate met our inclusion/exclusion criteria. The overall quality of evidence was low. The infection rate in the wounds that presented with delay ranged from 1.4% to 32%. One study with the smallest sample size (only 19 delayed wounds), which only enrolled lacerations to hand and forearm, showed higher rate of infection in patients with delayed (older than 12h) wounds (relative risk of infection: 4.8, 95% confidence interval, 1.9-12.0). The infection rate in delayed wound groups in the remaining three studies was not significantly different. CONCLUSION: The existing evidence does not support the existence of a golden period nor does it support the role of wound age on infection rate in simple lacerations.