Determinants of poor outcome after laceration and surgical incision repair

The most important outcomes after repair of traumatic lacerations and surgical incisions are their long-term cosmetic appearance and development of infection. However, few studies have attempted to identify patient and wound characteristics associated with increased infection rates and suboptimal scar appearance. The authors determined patient and wound characteristics associated with wound infection or suboptimal appearance after laceration or incision repair. A secondary analysis of data collected from a multicenter randomized clinical trial comparing the outcome of lacerations and incisions closed with tissue adhesive or standard closure methods conducted at 10 clinical inpatient and outpatient sites was performed. The presence of infection and scar appearance were prospectively determined using validated outcomes. Univariate and multivariate analyses were performed to identify patient and wound characteristics associated with poor wound outcome (wound infection at 5 to 10 days or suboptimal appearance at 3 months). Eight hundred fourteen patients with 924 wounds (383 lacerations, 541 incisions) were enrolled. Mean age was 32 years and 47 percent were female. Characteristics associated with suboptimal cosmetic appearance on multivariate analysis were presence of associated tissue trauma [odds ratio (OR), 3.9; 95 percent confidence interval (CI), 1.4 to 10.7], use of electrocautery (OR, 3.4; 95 percent CI, 1.8 to 6.5), incomplete wound edge apposition (OR, 2.9; 95 percent CI, 1.7 to 5.0); extremity location (OR, 2.1; 95 percent CI, 1.2 to 3.7), and wound width (OR, 1.08; 95 percent CI, 1.01 to 1.14). Characteristics associated with wound infection on univariate analysis included associated tissue trauma (8.7 percent versus 1.2 percent, p = 0.04) and incomplete wound apposition (6.6 percent versus 0.5 percent). Suboptimal appearance was more common in infected wounds (relative risk, 3.2; 95 percent CI, 1.8 to 5.6). Suboptimal wound appearance is increased with extremity wounds, wide wounds, incompletely apposed wounds, associated tissue trauma, use of electrocautery, and infection. Type of closure device and use of deep sutures had no effect on infection rates or cosmetic appearance.     

Malnutrition is Common and Increases the Risk of Adverse Medical Events in Older Adults With Femoral Fragility Fractures

BackgroundFemoral fragility fractures are one of the most common injuries managed by orthopedic surgeons. Malnutrition influences the poor outcomes observed in this population. Our purpose was to assess the annual trends of malnutrition diagnosis and determine risk factors for malnutrition and complications in patients 65 years and older presenting with femoral fragility fractures. We hypothesized that malnutrition would increase the risk of postoperative wound infection, wound dehiscence, non-union, and mortality.MethodsThe PearlDiver database was reviewed from 2010 to 2020. Patients ≥ 65-years-old with femur fractures treated with operative fixation were identified by CPT code. A preoperative diagnosis of malnourished state was defined by ICD-9 and ICD-10 codes and patients were divided into malnourished and non-malnourished cohorts. Patients were tracked for one year following operative fixation of a femoral fragility fracture for the occurrence of infection, wound dehiscence, nonunion and mortality. The rates of these complications were compared between malnourished and nonmalnourished cohorts.ResultsThere were 178,283 total femoral fragility fractures identified in patients aged 65-years or older. The overall prevalence of malnutrition diagnosis in this geriatric population was 12.8%. Documented malnutrition in femoral fragility fractures increased from 1.6% to 32.9% from 2010-2020 (P<0.0001). Compared to patients without malnutrition, patients with malnutrition are at increased risk of mortality (OR 1.31, 95% CI 1.2558 – 1.3752, p < 0.0001), are more likely to develop a wound infection (OR 1.49; 95% CI 1.252 – 1.7626; p < 0.0001), more likely to have a wound dehiscence (OR 1.55; 95% CI 1.3416 – 1.7949; p < 0.0001), and more likely to develop non-union (1.89; 95% CI 1.6946 – 2.1095; p < 0.0001). Multiple demographic variables were associated with malnutrition diagnosis including higher age, higher Charlson Comorbidity Index, female sex, dementia, and institutionalization. Parkinson’s disease, feeding difficulty and institutionalization demographic variables had the highest risk of malnutrition.ConclusionThe current study found that malnutrition diagnosis significantly increases the risk of adverse medical events in elderly adults with femoral fragility fractures. The rates of malnutrition increased steadily from 2010-2020. This trend is likely a result of increased awareness and testing for malnutrition, not reflecting an actual increased prevalence of malnutrition. Multiple expected demographic variables are associated with diagnosis of malnutrition. Level of Evidence: III     

Endoscopic Vascular Harvest in Coronary Artery Bypass Grafting Surgery: A Meta-Analysis of Randomized Trials and Controlled Trials

OBJECTIVE:: This meta-analysis sought to determine whether endoscopic vascular graft harvesting (EVH) improves clinical and resource outcomes compared with conventional open graft harvesting (OVH) in adults undergoing coronary artery bypass surgery. METHODS:: A comprehensive search was undertaken to identify all randomized and nonrandomized trials of EVH versus OVH up to April 2005. The primary outcome was wound complications. Secondary outcomes included any other clinical morbidity and resource utilization. Odds ratios (OR), weighted mean differences (WMD), or standardized mean differences (SMD) and their 95% confidence intervals (95% CI) were analyzed. RESULTS:: Thirty-six trials of 9,632 patients undergoing saphenous vein harvest met the inclusion criteria (13 randomized; 23 nonrandomized). Risk of wound complications was significantly reduced by EVH compared with OVH (OR 0.31, 95% CI 0.23-0.41). Similarly, the risk of wound infections was significantly reduced (OR 0.23, 95% CI 0.20-0.53; P < 0.0001). Need for surgical wound intervention was also significantly reduced (OR 0.16, 95% CI 0.08-0.29). The incidence of pain, neuralgia, and patient satisfaction was improved with EVH compared with OVH. Postoperative myocardial infarction, stroke, reintervention for ischemia or angina recurrence, and mortality were not significantly different. Operative time was significantly increased (WMD 15.26 minutes; 95% CI 0.01, 30.51), hospital length of stay was reduced (WMD -0.85 days; 95% CI -1.55, -0.15), and readmissions were reduced (OR 0.53, 95% CI 0.29-0.98). Costs were insufficiently reported to allow for aggregate analysis. CONCLUSIONS:: Endoscopic vascular graft harvesting of the saphenous vein reduces wound complications and improves patient satisfaction and resource utilization. Further research is required to determine the incremental cost-effectiveness of EVH versus OVH.     

Complications of abdominoplasty in 86 patients

A total of 101 consecutive abdominoplasty patients were reviewed retrospectively. Of these, 14 male (mean age at time of operation, 34.3 years; range, 23 to 53 years) and 72 female (mean age at time of operation, 38.9 years; range, 19 to 64 years) patients had adequate documentation for inclusion in this study.Complications were recorded as either wound complications (wound infection, partial wound dehiscence, seroma, hematoma, and skin edge necrosis) or complications after surgery (deep vein thrombosis, pulmonary emboli, ileus, sensibility disorder of the skin of the thighs, and death). The complications were subsequently correlated for sex, race, the patient's age at surgery, body mass index before surgery, and the seniority of the surgeon.Nine male patients (64.3 percent) and 11 female patients (15.3 percent) had wound complications. Almost 10 percent of our patients sustained an injury to the lateral cutaneous nerve of the thigh.Male patients should be informed about their possible higher risk of complications, and special attention must be given by the surgeon to the prevention of such complications.Moreover, specific attention must be given to the preservation of the lateral cutaneous nerves of the thigh in both male and female patients undergoing abdominoplasties.     

A longitudinal study of pre- and post-weaning tail damage in non-docked pigs

Tail-biting occurs pre-weaning, but literature on tail damage during lactation and on the development of damage over time is sparse, especially for non-docked piglets. We assessed the prevalence of tail damage in non-docked piglets in a commercial Danish piggery during the lactation and weaning period, and investigated the within-animal association of tail lesions pre- and post-weaning. Non-docked piglets (n = 741) from 51 loose-housed sows were individually marked and tracked from birth to 9 weeks (w9) of age. Tail damage was scored during lactation at w1 and w4, and once a week post-weaning (average weaning age 30 days) at w6 to w9. The within-animal association of tail damage before and after weaning was investigated at pig level using generalized mixed models. Tail damage was prevalent already pre-weaning. During the lactation period, the prevalence of tail lesions was 5% at w1 and 42% at w4, with the most prevalent score being ‘superficial damages’ (66.7%, score 1; pre-weaning scheme: 0 = no damage, 3 = tail wound). Post-weaning, 45% of pigs had a tail lesion at least once over the four assessments, with 16.7% of pigs having a tail lesion at least at two assessments. The majority of lesions were ‘minor scratches’ (34.2%, score 1; post-weaning scheme: 0 = no damage, 4 = wound – necrotic tail end) and a ‘scabbed wound’ (19.9%, score 3). The number of pigs with lesions as well as wound severity increased over time. More pigs had a tail wound at w8 (15%, P < 0.001 and < 0.01) and w9 (19%, P < 0.001 and < 0.001) compared to w6 (2.7%) and w7 (5.6%). Pigs with tail lesions pre-weaning (w1: OR 3.0, 95% CI 0.9 to 10.2; w4: OR 3.4, 95% CI 2.0 to 5.8) had a significantly higher risk of having a wound post-weaning, and pigs with lesions at w4 additionally were at a higher risk (OR 3.0, 95% CI 1.8 to 5.1) of having a lesion over several assessments. Females compared to castrated males had a significantly lower risk of having tail lesions at w1 (OR 0.3, 95% CI 0.1 to 0.8). Similarly, females were at a significantly lower risk (OR 0.5, 95% CI 0.4 to 0.9) of having a wound post-weaning, and tended to have a lower risk of having lesions over several assessments (OR 0.7, 95% CI 0.5 to 1.2). Our study confirmed that tail damage is prevalent already during the lactation period, and that pre-weaning tail damage is predictive of tail wounds post-weaning.     

Efficacy of antimicrobial triclosan-coated polyglactin 910 (Vicryl* Plus) suture for closure of the abdominal wall after colorectal surgery

This study compared Triclosan coated polyglactin 910 (Vicryl* Plus) with polyglactin 910 (Vicryl*) on abdominal wall healing in colorectal surgery patients. 184 patients with colorectal cancer were included in the study. In 91, the abdominal wall was closed with the Vicryl* Plus, and in 93 patients with Vicryl*. Demographic characteristics, biochemical inflammatory parameters, wound appearance, length of hospital stay, postoperative wound complications and post-incisional hernia were recorded. In the Vicryl* Plus group there was a shorter hospital stay (13.2 +/- 1.3 days; 21.4 +/- 2.8 respectively). In the Vicryl* Plus group inflammatory parameters decreased to normal within the first week whereas in the Vicryl* group remained increased. In the Vicryl* Plus group four patients had a wound discharge, seven had inflammatory reactions to the skin sutures. One dehiscence was noticed. In the Vicryl* group 12 patients had an SSI, 14 patients had inflammatory reactions to the skin sutures and 7 patients had a wound dehiscence. Closure of the abdominal wall using Vicryl* Plus decreases postoperative wound complications, length of hospital stay and is associated with a more rapid return of inflammatory markers to normal.     

Factors associated with immediate abortion complications.

OBJECTIVE: To identify factors associated with increased risk of immediate complications from induced abortion. DESIGN: Retrospective analysis of a provincial database. SETTING: All Ontario general hospitals in which abortions are performed and all free-standing abortion clinics in Ontario. POPULATION: Women in Ontario aged 15 to 44 years who underwent an induced abortion in the province (without concurrent sterilization) between Jan. 1, 1992, and Dec. 31, 1993. OUTCOME MEASURES: Recording of complications at the time of the procedure, gestational age, type of procedure, place of abortion (hospital or clinic), and patient''s age, parity and history of previous abortion (spontaneous or induced). RESULTS: During the study period 83 469 abortions were performed that met our inclusion criteria. Immediate complications were reported in 571 cases (0.7%). Multivariate logistic regression analysis revealed that, after other variables were controlled for, the patient''s age, parity and history of previous abortions (spontaneous or induced) were not significant risk factors for immediate complications; however, gestational age, method of abortion and place of abortion were significant risk factors (p < 0.001). The odds ratio (OR) for having a complication from abortion was 1.3 (95% confidence interval [CI] 1.02 to 1.63) between 9 and 12 weeks, compared with having one after abortion at 9 weeks or earlier, and increased to 3.3 (95% CI 2.23 to 5.00) after abortion between 17 and 20 weeks. Compared with surgical dilatation and curettage (D&C), instillation of saline and instillation of prostaglandins were more likely to be associated with immediate complications (OR 24.0, 95% CI 13.22 to 43.70, and OR 11.7, 95% CI 6.43 to 21.18, respectively), whereas both suction D&C and insertion of a laminaria tent were less likely to be associated with immediate complications (OR 0.4, 95% CI 0.26 to 0.67, and OR 0.3, 95% CI 0.19 to 0.52, respectively). Compared with women who had an abortion in a free-standing clinic, the risk for immediate complications was greater among those who had an abortion in a hospital, especially a teaching hospital (OR 1.9, 95% CI 1.38 to 2.58), a nonteaching hospital with 200 to 399 acute care beds (OR 3.1, 95% CI 2.27 to 4.21) and a nonteaching hospital with fewer than 200 acute care beds (OR 5.9, 95% CI 4.04 to 8.64). CONCLUSION: The risk of immediate complications from induced abortion is very low. Unlike in previous studies, the woman''s age, parity and history of previous spontaneous or induced abortions were not found to be risk factors. However, advancing gestational age and procedures involving instillation of saline or prostaglandins were predictive factors of immediate complications.     

Risk for gastroschisis in primigravidity, length of sexual cohabitation, and change in paternity

BACKGROUND: Maternal epidemiologic similarities between gastroschisis and preeclampsia have led to the objective of evaluating the risk for gastroschisis related to primigravidity, change in paternity, and length of cohabitation, considered as risk factors for preeclampsia. METHODS: The subjects were 288 newborns with isolated gastroschisis and 576 normal controls, matched by maternal age. They were ascertained in the Estudio Colaborativo Latino Americano de Malformaciones Congenitas hospital network of 10 South American countries between 1982 and 2005. Epidemiologic variables were compared among controls, between primigravidas and multigravidas, between multigravidas who had and had not changed partners, and between mothers with short and long cohabitation times with their partners. Risks associated with primigravidity, short cohabitation time, and changing paternity, as well as their combinations, were calculated. An eventual interaction between maternal age and the three risk factors was assessed. RESULTS: Only a short cohabitation time showed a significant OR for gastroschisis (OR = 2.36, 95% CI: 1.52-3.66, p < .001), whereas ORs were not significant for primigravidity (OR = 1.40, 95% CI: 0.84-2.35, p = .192) nor for changing paternity (OR = 1.20, 95% CI: 0.49-3.10, p = .752). The risk was highest for multigravidas who had changed partners (OR = 8.71, 95% CI: 2.93-21.12, p < .001), followed by multigravidas who had not changed partners (OR = 3.99, 95% CI: 1.07-15.43, p = .049), and by primigravidas (OR = 3.02, 95% CI: 1.58-5.76, p = .001), all having cohabitated for a short time. Maternal age did not modify these risks. CONCLUSIONS: Three groups at risk for a child with gastroschisis were identified, all having in common a short cohabitation time. Antigenic or "modern" lifestyle-related factors might be involved in the origin of gastroschisis.     

USE OF A NEW POLYBUTILATE-COATED POLYESTER SUTURE IN CARDIOVASCULAR SURGERY

Polybutilate coated polyester (Dacron) sutures were evaluated in a variety of cardiovascular procedures performed on 117 patients. The age range was from 6 months to 88 years, and long-term follow-up was available in 100 patients. The most frequently sutured tissues were those of the aorta, atrium, fascia and pericardium. Suture sizes ranged from 1-0 through 5-0, the most common being 3-0. There were no suture related complications, and the performance was found to be superior to non-coated polyester sutures and other forms of coated sutures. Favorable characteristics were: 1) ease of passage through tissue, especially through prosthetic materials; 2) ease of tying, 3) increased knot security; and 4) better handling characteristics in general. Because of the firm bonding of polybutilate with the polyester suture, flaking (minute amounts of the coating which become dislodged) and suture drag characteristics of other coated polyester sutures were not experienced.     

Microvascular reconstruction of the hypopharynx: defect classification,treatment algorithm,and functional outcome based on 165 consecutive cases

The objectives of this study were three-fold: to develop a scheme for classification of hypopharyngeal defects, to establish a reconstructive algorithm based on this system, and to assess the functional outcome of such reconstruction. This study is a retrospective review of a 14-year experience with 165 consecutive microvascular reconstructions of the hypopharynx in 160 patients. The average patient age was 59 years (95 percent CI, 37 to 81). Thirty-four patients were operated on for recurrent disease; 71 had preoperative radiotherapy. Partial defects were reconstructed with radial forearm flaps (n = 52); circumferential defects were reconstructed with jejunum (n = 90); and extensive, noncircumferential longitudinal defects were reconstructed with rectus abdominis flaps (n = 23). The overall free flap success rate was 98 percent. Six flaps required reexploration, two of which were salvaged. The incidence of fistula was 7 percent and stricture, 4 percent. Preoperative radiotherapy was significantly associated with risk of recipient site complications (OR, 2.3; 95 percent CI, 1.0 to 5.0). Follow-up data were available on 95 percent of patients: 53 percent were able to tolerate an unrestricted diet, 23 percent a soft diet, 12 percent liquids only, and 12 percent were limited to tube feedings. The treatment algorithm for microvascular hypopharyngeal reconstruction is based on the type of defect with partial defects with radial forearm flaps, circumferential defects reconstructed with free jejunal flaps, and extensive, multilevel defects reconstructed with rectus abdominis myocutaneous flaps. Microvascular reconstruction of pharyngeal defects is highly successful with few postoperative complications. With appropriate flap selection, functional outcome can be optimized.     

Complications after breast reconstruction with alloplastic material in breast cancer patients submitted or not to post mastectomy radiotherapy

Background and purposeBreast reconstruction following mastectomy is a relevant element of breast cancer treatment. The purpose of this study was to evaluate the influence of radiotherapy (RT) on local complications in patients with breast cancer that had undergone breast reconstruction with alloplastic material.Materials and methodsRetrospective study of breast cancer patients submitted to mastectomy and breast reconstruction from 2009 to 2013. Clinical and treatment variables were correlated with early and late complications.Results251 patients were included; mean age was 49.7 (25 to 78) years. Reconstruction was immediate in 94% of the patients, with 88% performed with a temporary tissue expander. Postoperative radiotherapy (RT) was delivered to 167 patients (66.5%). Early complications were present in 26.3% of the patients. Irradiated patients presented 5.4% incidence of late complications versus 2.4% for non-irradiated patients (p = 0.327). Diabetes (OR = 3.41 95% CI: 1.23–9.45, p = 0.018) and high body mass index (BMI) (OR = 2.65; 95% CI: 1.60–4.37, p < 0.0001) were the main risk factors. The overall incidence of late complications was 4.4%, with predominance of severe capsular contracture (8/11). Arterial hypertension (OR = 4.78; 95% CI: 1.97–11.63, p = 0.001), BMI (OR = 0.170; 95% CI: 0.048–0.607, p = 0.006) and implant placement (OR = 3.55; 95% CI: 1.26–9.99, p = 0.016) were related to late complications.ConclusionsThe overall rate of complications was low in this population. Radiotherapy delivery translated into a higher but not statistically significant risk of late complications when compared with the non-irradiated patients. Already well-known clinical risk factors for complications after breast reconstruction were identified.     

Prevalence,Awareness, Treatment and Control of Diabetes Mellitus in a Chinese Population

ObjectiveThe purpose of this study is to evaluate the prevalence, awareness, treatment and glycemic control of diabetes mellitus (DM) in a Chinese population. The findings from this study are expected to offer scientific evidence to better prevent and control the growing number of reported and untreated cases.MethodsA cross-sectional survey was conducted in Jiangsu, China. We recruited permanent residents over 18 years of age from eight towns in Jintan (JT) and six towns in Yangzhong (YZ) using a three-stage stratified cluster sampling method. The rates of DM prevalence, awareness, treatment and control as well as their related factors were analyzed.ResultsA total number of 15404 people were entered into the analysis. The DM prevalence, awareness, treatment and control rates were 7.31%, 58.35%, 51.87% and 14.12%, respectively. Multivariable logistic regression analysis showed that being female was positively related to prevalence (OR = 1.21, 95% CI: 1.07–1.37), awareness (OR = 1.52, 95% CI: 1.19–1.93), treatment (OR = 1.48, 95% CI: 1.17–1.88) and control (OR = 1.87, 95% CI: 1.30–2.67) of DM. Having a family history of diabetes was significantly correlated with DM risk (OR = 1.86, 95% CI: 1.37–2.54) and increased awareness (OR = 3.12, 95% CI: 2.19–4.47), treatment (OR = 3.47, 95% CI: 2.45–4.90) and control (OR = 1.81, 95% CI: 1.22–2.68) of DM. Former smoking status (OR = 1.82, 95% CI: 1.23–2.71), overweight (OR = 2.11, 95% CI: 1.72–2.60) and obesity (OR = 3.46, 95% CI: 2.67–4.50) were related to the risk of DM. Additionally, we found current drinking status to be positively correlated with DM risk (OR = 1.30, 95% CI: 1.01–1.66) and negatively correlated with DM awareness (OR = 0.41, 95% CI: 0.29–0.59) and treatment (OR = 0.41, 95% CI: 0.29–0.59). Our study highlights the high prevalence and inadequate awareness, treatment and control of DM in the Chinese population.ConclusionsManagement and prevention of DM-related complications should be considered an essential strategy by governments and society. This study assessed the reasons why DM has been increasing and established the first step in determining where to start regarding preventative methods.     

An association between NQO1 genetic polymorphism and risk of bladder cancer

NAD(P)H:quinone oxidoreductase (NQO1) is a detoxification enzyme that plays a critical role in protecting cells against chemically induced oxidative stress, cytotoxicity, mutagenicity, and carcinogenicity. NQO1 protects cells from oxidative damage by preventing the generation of reactive oxygen species and reducing certain environmental carcinogens, such as nitroaromatic compounds, heterocyclic amines, and possible cigarette smoke condensate. A C-->T single nucleotide polymorphism in exon 6 was shown to reduce NQO1 enzyme activity, which may diminish the protection provided by NQO1. Therefore, we hypothesized that people with the variant allele genotypes of NQO1 are at higher risk for bladder cancer. In an ongoing case-control study, the NQO1 genotypes were successfully identified by polymerase chain reaction restriction fragment length polymorphism in 265 bladder cancer patients and 261 control subjects matched for age, sex, and ethnicity. The frequency of the variant NQO1 allele was 18% for controls and 21% for cases. The variant allele genotypes of NQO1 were associated with a higher risk of bladder cancer in Caucasians (odds ratio (OR)=1.51; 95% confidence interval (CI)=1.01-2.25). Further analysis in Caucasians showed an elevated bladder cancer risk in men (OR=1.75; 95% CI=1.08-2.85) but not in women (OR=1.16; 95% CI=0.57-2.37). In addition, the variant allele genotypes were associated with higher bladder cancer risk in ever smokers (OR=1.78; 95% CI=1.06-3.00), but not in never smokers (OR=1.19; 95% CI=0.65-2.20). These results suggest that the NQO1 genetic polymorphism modulates bladder cancer risk, especially in men and ever smokers.     

Risks associated with "components separation" for closure of complex abdominal wall defects

The reconstruction of complex abdominal wall defects can often pose a significant challenge to surgeons and their patients. Complex ventral hernias may result from large tumor resections, trauma from gunshot wounds, or infections following routine abdominal surgery. "Components separation" of the abdominal musculature uses advancement of local autologous tissue, when available, to close large ventral wall defects. The authors report on a retrospective chart review of 30 patients who underwent components separation for the closure of complex abdominal defects. The study group was 50 percent female, with a mean age of 45 years, body mass index of 33.2 kg/m2, and abdominal defect size of 240 cm2. On average, 20 percent of patients had preoperative wound infections, 30 percent had intraoperative bowel enterotomies, and 33 percent required prosthetic mesh for closure. Total surgery time averaged 4.8 hours, with a mean postoperative stay of 12.5 days and follow-up of 9.5 months. The recurrence rate was 10 percent; postoperative complications included midline ischemia, infection, and dehiscence occurring at rates of 20, 40, and 43 percent, respectively. This study provides a comprehensive review of the risks and complications associated with the treatment of complex ventral hernias and those associated with abdominal "components separation."     

Cardiometabolic Risk Profiles Associated with Chronic Complications in Overweight and Obese Type 2 Diabetes Patients in South China

Background

Type 2 diabetes is often accompanied by altered cardiometabolic risk profiles, including abdominal obesity, hypertension, and dyslipidaemia. The association of altered cardiometabolic risk profiles with chronic complications of diabetes is not well investigated.

Methods

We recruited 2954 type 2 diabetes patients with a body mass index ≥25 kg/m² who visited the diabetes clinics of 62 hospitals in 21 cities in Guangdong province of China from August 2011 to March 2012. Demographic characteristics, personal and family medical histories, and data on chronic complications of diabetes were collected. Clinical examinations and laboratory assessment were conducted.

Results

Abdominal obesity was found in 91.6% of the study population, elevated blood pressure in 78.3%; elevated serum triacylglycerols in 57.8%, and reduced serum HDL-C in 55.9%. Among the cardiometabolic risk factors, elevated blood pressure was significantly associated with almost all the chronic complications of diabetes. After adjusting for age, gender, duration of diabetes, and HbA1c, elevated blood pressure was significantly associated with diabetic retinopathy (OR 1.63, 95% CI: 1.22–2.19), diabetic nephropathy (OR 3.16, 95% CI: 2.25–4.46), cardiovascular disease (OR 2.71, 95% CI: 1.70–4.32), and stroke (OR 1.90, 95% CI: 1.15–3.12). Abdominal adiposity was significantly associated with diabetic nephropathy (OR 1.39, 95% CI: 1.11–1.74). Elevated triacylglycerols was significantly associated with diabetic retinopathy (OR 1.29, 95% CI: 1.05–1.58) and diabetic nephropathy (OR 1.30, 95% CI: 1.05–1.58). Reduced HDL-C was significantly associated with stroke (OR 1.41, 95% CI: 1.05–1.88).

Conclusions

Altered cardiometabolic risk profiles, and elevated blood pressure in particular, were significantly associated with chronic complications in overweight and obese patients with type 2 diabetes. Future studies on the prevention of chronic complications of diabetes might make lowering blood pressure a primary target.     

Internal use of n-butyl 2-cyanoacrylate (Indermil) for wound closure: an experimental study.

n-Butyl 2-cyanoacrylate glue (Indermil) was used for the closure of dorsal wounds on rabbits. A 4-cm-long and 1-cm-wide laceration was created bilaterally on the back of 15 rabbits. One side was closed with absorbable 2-0 subcutaneous sutures and fast absorbable 3-0 skin sutures, whereas the other side was closed with cyanoacrylate glue applied on both deep and superficial tissues. A partial wound dehiscence occurred on the glue side in one animal at 2 weeks. The animal was killed at this time and considered a bad result in the glue group. In all other animals, no seroma, partial dehiscence, or wound infection occurred. Histopathologic analysis revealed that Indermil induced edema and a mild acute inflammatory reaction and resorbed almost completely within 2 months when applied to well-vascularized tissues. The application of glue on the cutaneous wound edges is a fast and easy procedure that does not seem to delay or inhibit the healing process or its quality.     

Rigid fixation of the calvaria in craniosynostosis without using "rigid" fixation

Early observations of intracranial translocation of metal wires, plates, and screws used for infant skull surgery have led some surgeons to investigate alternative forms of fixation. The purpose of this study was to review a series of infants and children in whom absorbable suture fixation was used as the sole method of fixation in cranial vault remodeling. Standard osteotomies were successfully modified to permit the use of this less rigid form of fixation. Over a 6-year period, 142 cranial vault procedures were performed, primarily for craniosynostosis, using absorbable sutures (2-0 polydioxanone). Patients who did not have absorbable suture fixation, or who had a combination of absorbable sutures with another form of fixation, were excluded from this review. Records were reviewed for results (assessed by both the treating surgeon and an independent anthropologist) and for complications. The average age of patients was 2 years, 7 months (range, 1 month to 16 years). The clinical results were judged as follows: grade I (excellent), 49 percent; grade II (minor imperfections), 48 percent; grade III (small surgical procedure needed), 2 percent; and grade IV (complete reoperation required), 1 percent. Anthropologic results were similarly distributed: excellent, 36 percent; good, 56 percent; fair, 8 percent; and poor, 0 percent. Those 3 to 8 percent of patients who were found to have the poorest results were all noted to have syndromes, and it appeared that an inherent lack of growth was the primary basis for the low score. There were no deaths or major complications in this series of patients. The smaller complications identified were infections [four cases (2.8 percent)] and transient cerebrospinal fluid leak [two cases (1.4 percent)]. The most important factor in determining whether absorbable suture fixation was sufficient was the size of a preexisting calvarial defect. Although concerns have been raised about a possible link between absorbable suture fixation and subsequent poor reossification, no such association was noted in this review. The primary disadvantage of using absorbable sutures was the lack of rigidity provided. Advantages included lower costs, speed of application, and the absence of observed intracranial translocation. In conclusion, the use of absorbable suture fixation (with modifications in osteotomy design) was associated with both acceptable aesthetic outcomes and low complication rates. Craniofacial surgeons may wish to consider the use of absorbable sutures as another option for bone fixation in treatment of craniosynostosis.     

Risk factors for physical disability in patients with leprosy disease in Yunnan,China: Evidence from a retrospective observational study

BackgroundLeprosy is potentially debilitating. The risk factors related to physical disabilities associated with leprosy disease in Yunnan, China was not clear.Methodology/Principal findingsWe studied 10644 newly detected leprosy patients from Yunnan, China, from 1990 to 2019. Factors associated with Grade 1 (G1D) and Grade 2 (G2D) physical disabilities or overall physical disabilities (combined G1D and G2D) associated with leprosy were analyzed using multinomial and ordinal logistic regression analyses. The following factors were associated with the development of physical disability in these patients with leprosy: delayed diagnosis [odds ratio (OR): 5.652, 4.399, and 2.275; 95% confidence intervals (CIs): 4.516–7.073, 3.714–5.212, and 2.063–2.509; for ≥ 10, 5–10 y, and 2–5 years, respectively], nerve damage (OR: 3.474 and 2.428; 95% CI: 2.843–4.244, and 1.959–3.008; for 2 and 1 damaged nerves, respectively), WHO classification of PB (OR: 1.759; 95% CI: 1.341–2.307), Ridley-Jopling classification (OR: 1.479, 1.438, 1.522 and 1.239; 95% CI: 1.052–2.079, 1.075–1.923, 1.261–1.838, and 1.072–1.431; for TT, BT, BB, and BL when compared with LL, respectively), advanced age (OR: 1.472 and 2.053; 95% CI: 1.106–1.960 and 1.498–2.814; for 15–59 and over 60 years old, respectively), zero skin lesions (OR: 1.916; 95% CI: 1.522–2.413), leprosy reaction (OR: 1.528; 95% CI: 1.195–1.952), rural occupation (OR: 1.364; 95% CI: 1.128–1.650), Han ethnicity (OR: 1.268; 95% CI: 1.159–1.386), and male sex (OR: 1.128; 95% CI: 1.024–1.243).ConclusionsDelayed diagnosis, nerve damage, no skin lesions, WHO and Ridley-Jopling classifications, leprosy reactions, advanced age, rural occupation, Han ethnicity, and male sex were associated with disability in leprosy patients. Identifying risk factors could help to prevent physical disability.     

Selected gene polymorphisms and their interaction with maternal smoking, as risk factors for gastroschisis

BACKGROUND: Gastroschisis is a severe birth defect in which the infant is born with a portion of the intestines extruding through a small tear in the abdominal wall, usually to the right of the umbilical cord. Its etiology is unknown, but the prevailing hypothesis is that it results from a vascular accident at the time of involution of the right umbilical vein or of the development of the superior mesenteric artery. METHODS: In a case-control study of 57 cases of gastroschisis and 506 controls, we tested DNA for polymorphisms of 32 genes representing enzymes involved in angiogenesis, blood vessel integrity, inflammation, wound repair, and dermal or epidermal strength. RESULTS: In logistic regression, controlling for maternal ethnicity, and using the homozygote wild-type as referent, the following gene polymorphisms were associated with an increased risk for a gastroschisis for heterozygotes: ICAM1 gly241arg (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1 -3.4); NOS3 glu298asp (OR, 1.9; 95% CI, 1.1-3.4); NPPA 2238T > C (OR, 1.9; 95% CI, 1.0-3.4); and ADD1 gly460trp (OR, 1.5; 95% CI, 0.8-2.8). Additionally, for the NPPA and ADD1 single-nucleotide polymorphisms (SNPs), the homozygote variants had a significantly higher risk than the heterozygotes (OR, 7.5; 95% CI, 1.7-33.5 and OR, 4.9; 95% CI, 1.9-12.9, respectively). Three SNPs showed a strong interaction with maternal smoking. The risk for smokers with 1 or 2 variant alleles compared to nonsmokers with the wild-type allele were: NOS3 (OR, 5.2; 95% CI, 2.4-11.4); ICAM1 (OR, 5.2; 95% CI, 2.1-12.7); and NPPA (OR, 6.4; 95% CI, 2.8-14.6). CONCLUSIONS: These results support the hypothesis of a vascular compromise as part of a multifactorial etiology of gastroschisis involving both genes and environmental factors.     

新型可控降解外科缝合线的研制

目的：研制一种新型的可控降解手术缝合线,以满足不同伤口缝合的需要。方法：缝合线的最里层为壳聚糖纤维芯,中间为胶原层,最外层为羧甲基壳聚糖层;从里到外,各层厚度比例为2：x：（3-x）,其中1〈x〈3。结果：不同型号的缝合线降解速度可控,适用于不同愈台期的伤口缝合,并具有很好的生物相容性和抗感杂性。结论：研制的新型缝合线操作方便,性价比高,植入体内后降解速度可控,伤口愈合快,不留明显疤痕,尤其适于野战环境条件下应用。