Intraoperative Wound Irrigation for the Prevention of Surgical Site Infection After Laparotomy: A Randomized Clinical Trial by CHIR-Net.

Importance: Surgical site infections frequently occur after open abdominal surgery. Intraoperative wound irrigation as a preventive measure is a common practice worldwide, although evidence supporting this practice is lacking. Objective: To evaluate the preventive effect of intraoperative wound irrigation with polyhexanide solution. Design, Setting, and Participants: The Intraoperative Wound Irrigation to Prevent Surgical Site Infection After Laparotomy (IOWISI) trial was a multicenter, 3-armed, randomized clinical trial. Patients and outcome assessors were blinded to the intervention. The clinical trial was conducted in 12 university and general hospitals in Germany from September 2017 to December 2021 with 30-day follow-up. Adult patients undergoing laparotomy were eligible for inclusion. The main exclusion criteria were clean laparoscopic procedures and the inability to provide consent. Of 11 700 screened, 689 were included and 557 completed the trial; 689 were included in the intention-to-treat and safety analysis. Interventions: Randomization was performed online (3:3:1 allocation) to polyhexanide 0.04%, saline, or no irrigation (control) of the operative wound before closure. Main Outcome and Measures: The primary end point was surgical site infection within 30 postoperative days according to the US Centers for Disease Control and Prevention definition. Results: Among the 689 patients included, 402 were male and 287 were female. The median (range) age was 65.9 (18.5-94.9) years. Participants were randomized to either wound irrigation with polyhexanide (n = 292), saline (n = 295), or no irrigation (n = 102). The procedures were classified as clean contaminated in 92 cases (8%). The surgical site infection incidence was 11.8% overall (81 of 689), 10.6% in the polyhexanide arm (31 of 292), 12.5% in the saline arm (37 of 295), and 12.8% in the no irrigation arm (13 of 102). Irrigation with polyhexanide was not statistically superior to no irrigation or saline irrigation (hazard ratio [HR], 1.23; 95% CI, 0.64-2.36 vs HR, 1.19; 95% CI, 0.74-1.94; P = .47). The incidence of serious adverse events did not differ among the 3 groups. Conclusions and Relevance: In this study, intraoperative wound irrigation with polyhexanide solution did not reduce surgical site infection incidence in clean-contaminated open abdominal surgical procedures compared to saline or no irrigation. More clinical trials are warranted to evaluate the potential benefit in contaminated and septic procedures, including the emergency setting. Trial Registration: drks.de Identifier: DRKS00012251.

Elderly Patients with Hepatocellular Carcinoma Benefit from Liver Transplantation as Much as Younger Ones.

Introduction: The literature on liver transplantation (LT) for cirrhosis-associated hepatocellular carcinoma (cirr-HCC) in elderly patients (≥65 years of age) is scarce. The aim of this study was therefore to analyze the outcome after LT for cirr-HCC in elderly patients in our single-center experience. Methods: All consecutive patients who underwent LT for cirr-HCC at our center were identified from our prospectively collected LT database and stratified into an elderly (≥65 years) and a younger (<65 years) cohort. Perioperative mortality as well as Kaplan-Meier estimations of overall (OS) and recurrence-free survival (RFS) were compared between age strata. A subgroup analysis was performed for patients with HCC only inside Milan criteria. For further oncological comparison, outcome in the subgroup of elderly LT recipients with HCC inside Milan was also compared to a group of elderly patients undergoing liver resection for cirr-HCC inside Milan extracted from our institutional liver resection database. Results: Out of 369 consecutive patients with cirr-HCC who underwent LT between 1998 and 2022 at our center, we identified 97 elderly (with a subgroup of 14 septuagenarians) and 272 younger LT patients. 5- and 10-year OS in elderly compared to younger LT patients was 63% and 52% versus 63% and 46% (p = 0.67), respectively, while 5- and 10-year RFS was 58% and 49% versus 58% and 44% (p = 0.69). 5-/10-year OS and RFS in 50 elderly LT recipients with HCC inside Milan were 68%/55% and 62%/54%, respectively, which compared to 46%/38% (p = 0.07) and 26%/14% (p < 0.0001) in elderly patients after liver resection for cirr-HCC inside Milan. Conclusion: Our results in almost 100 elderly patients after LT for cirr-HCC show that older age per se should not be considered a contraindication to LT and that selected elderly patients older than 65 and even 70 years benefit from LT as much as younger ones.

Efficient osteogenic differentiation of the dental pulp stem cells on ß-glycerophosphate loaded polycaprolactone/polyethylene oxide blend nanofibers.

Hard tissue lesion treatment in oral and maxillofacial has been challenging because of tissue complexities. This study aimed to investigate novel biopolymeric construct effects on the osteogenic differentiation potential of the dental pulp stem cells (DPSCs) for introducing a cell copolymer bioimplant. A blended polycaprolactone (PCL)-polyethylene oxide (PEO) was fabricated using electrospinning, simultaneously filled by ß-glycerophosphate (ß-GP). After that biocompatibility and release kinetics of the PCL-PEO+ß-GP was evaluated and compared with PCL-PEO and then the osteogenic differentiation potential of the DPSCs was examined while being cultured on the scaffolds and compared with those cultured on the culture plate. The results demonstrated that scaffolds have not any cytotoxicity and ß-GP can release in a long-term manner. Alkaline phosphatase activity and calcium content were significantly increased in DPSCs while being cultured on the PCL-PEO+ß-GP compared with the other groups. Runt-related transcription factor 2, collagen type-I, osteonectin, and osteocalcin (OSC) genes expression was upregulated in DPSCs cultured on the PCL-PEO+ß-GP and was significantly higher than those cultured on the PCL-PEO. Immunocytochemistry result also confirmed the positive effects of PCL-PEO+ß-GP on the osteogenic differentiation of the DPSCs by presenting a higher OSC protein expression. According to the results, incorporation of the ß-GP in PCL-PEO makes a better construct for osteogenic induction into the stem cells and it could be also considered as a great promising candidate for bone, oral, and maxillofacial tissue engineering applications.

Cardiac involvement in rheumatoid arthritis: A cross-sectional study in Iran.

BACKGROUND: Cardiovascular disease is one of the extra-articular manifestations of rheumatoid arthritis (RA) that is the most common cause of death in these patients. So we decided to evaluate RA patients in terms of history, clinical examination, electrocardiography, and echocardiography to determine the prevalence of types of cardiac involvements in these patients. METHODS: 100 consecutive patients, diagnosed with RA, referred to rheumatology clinic in Razi referral hospital of Rasht, Iran, were enrolled. Complete physical examination of the joints was performed in all subjects to evaluate the remission of disease. Signs and symptoms of possible cardiac involvement were evaluated in patients by taking history and erythrocyte sedimentation rate test; moreover, an expert cardiologist performed complete cardiovascular examination in all participants. Then, all subjects were referred to a same center for electrocardiography and echocardiography. Finally, analysis was performed by using chi-square and t tests. RESULTS: 23 (23%) males and 77 (77%) females were included in this study. Tachycardia, dyspnea, and chest pain were the most cardiac signs and symptoms of patients. 32 subjects had abnormal findings in electrocardiogram. The most abnormal findings in patient's ECG were ST interval and T wave changes. Abnormal findings in echocardiography were observed in 74 participants. Pericardial involvement and ventricular dysfunction were the most abnormal findings in patient's echocardiography. We found a significant relation between duration of RA disease and abnormal echocardiography findings (p<0.05). CONCLUSION: This study indicates the high prevalence of cardiac involvement in RA patients.

Comparison of Antifungal Activity of 2% Chlorhexidine, Calcium Hydroxide, and Nanosilver gels against Candida Albicans.

OBJECTIVES: Residual microorganisms in the root canal system (RCS) after endodontic therapy such as Candida albicans are a major cause of endodontic failure. Calcium hydroxide (CH) and chlorhexidine (CHX) have suitable antimicrobial activity against bacteria and can be used as intracanal medicaments. Nanosilver has also shown antimicrobial activity against microorganisms. This study aimed to compare the antifungal effect of calcium hydroxide, 2% chlorhexidine and nanosilver gels on Candida albicans. MATERIALS AND METHODS: Eighty-one single-rooted teeth were selected. After root canal preparation, the teeth were contaminated. After culture, the teeth were randomly divided into 4 groups. In experimental groups, 24 teeth were selected and completely filled with CH, 2% CHX and nanosilver gels in each group. Nine teeth were selected in the control group and filled with saline solution. After 1, 3, and 7 days, samples were obtained by #30 sterile paper points, and #2 and #4 Gates Glidden drills and cultured on solid Sabouraud agar. RESULTS: The results demonstrated that CH and 2% CHX had equal antifungal effects on samples taken by paper point and #2 Gates Glidden drill at all time points. Both CH and 2% CHX were more effective than nanosilver at all time periods. There was no statistically significant difference between medicaments in samples taken by #4 Gates Glidden drill. CONCLUSION: CH and 2% CHX gels have significantly higher antifungal activity than nanosilver gel. Also, CH and 2% CHX gels are equally effective against Candida albicans.

Depressive symptoms in patients with subclinical hypothyroidism--the effect of treatment with levothyroxine: a double-blind randomized clinical trial.

Despite the increasing evidence for relationships between thyroid dysfunction and neuropsychiatric alterations, the effect of treatment of thyroid disease on various clinical psychiatric outcomes is controversial. The purpose of this study was to investigate the effect of levothyroxine treatment on depressive symptoms in subjects with subclinical hypothyroidism. A randomized double-blind placebo-controlled clinical trial was performed. Sixty subjects (51 females and 9 males) with subclinical hypothyroidism were enrolled. Beck Depression Inventory was completed for all participants at the beginning of the study and 12 weeks after enrollment. The intervention and control groups received levothyroxine and placebo, respectively, for 12 weeks. There were no statistical differences in the total depression score and its subscales between the two groups at the beginning of the study. The Beck Depression Inventory score decreased from 16.79 ± 13.25 to 12.37 ± 10.01 (p value = 0.04) in the intervention group. The change in score was not significant for the control group (13.77 ± 11.71 to 11.86 ± 10.71; p value= 0.16). The affective subscale of Beck Depression Inventory did not change after 12 weeks of treatment with levothyroxine, while somatic subscale remarkably improved in the intervention group (p value = 0.02). This study showed the efficacy of treatment of subclinical hypothyroidism in people with levothyroxine in relation to depressive symptoms.

Microfluidic space-domain time-resolved emission spectroscopy of terbium(III) and europium(III) chelates with pyridine-2,6-dicarboxylate.

This article describes the utilization of laminar microflows for time-resolved emission measurements with steady-state excitation and detection. Passing a laminar flow through a short illuminated section of a microchannel provided a means for pulsed-like photoexcitation of the moieties carried by the fluid. Imaging the microchannel flows carrying thus photoexcited chelates of lanthanide ions allowed us to extract their excited-state lifetimes from the spatial distribution of the changes in the emission intensity. The lifetime values obtained using this space-domain approach agreed well with the lifetimes from time-domain measurements. This validated space-domain microfluidic approach reveals a means for miniaturization of time-resolved emission spectroscopy.

Changes of subtests of Wechsler Memory Scale and cognitive function in subjects with subclinical hypothyroidism following treatment with levothyroxine.

INTRODUCTION: Subclinical hypothyroidism has been reported to be associated with disturbed cognitive function. In this study, changes of subtests of the Wechsler Memory Scale and memory quotient were investigated in subjects with subclinical hypothyroidism following treatment with levothyroxine. The aim of the study was a randomized double blind placebo-controlled clinical trial. MATERIAL AND METHODS: Sixty subjects (51 females and 9 males) with subclinical hypothyroidism were enrolled. Memory quotient was evaluated at the beginning of the study and three months after enrollment, using Wechsler's memory test. Subclinical hypothyroidism was defined as serum TSH level between 4.5 mU/l and 10 mU/l in the presence of normal free-T4 (0.8-2 ng/dl) and positive anti-TPO-Ab. The intervention and control groups received levothyroxine and placebo respectively for 3 months. Re-evaluation was done using the Wechsler Memory Scale at the end of the study. RESULTS: The mean age was 34 ±10 years, mean TSH level was 8.25 ±3.64 muIU/l. Memory quotient was similar in both groups at the beginning of the study: 105.70 ±2.1 in intervention group vs. 105.87 ±2.1 in control group (p = 0.89). At the end of the study, the memory quotient rose by 9.3 points in the intervention group and by 3.23 in the controls (p = 0.002). Analysis of the scores of Wechsler Memory subtests in the intervention group indicated significant improvement of mental control (p = 0.002), logical memory (p < 0.001), associate learning (p = 0.014), age corrected score (p = 0.002), and memory quotient (p < 0.001). CONCLUSIONS: This study showed the efficacy of levothyroxine for cognitive function of subjects with subclinical hypothyroidism.