Sirolimus Use in Refractory Crohn's Disease.

Treatment options for patients with inflammatory bowel disease are constantly evolving; however, medication-refractory disease remains an issue. Pediatric case series show the potential benefit of sirolimus therapy in refractory Crohn's disease (CD); however, limited data exist in adult patients. As such, we retrospectively identified and report clinical outcomes for 4 patients prescribed sirolimus for treatment of refractory CD. Despite a median sirolimus therapy duration of 524 days and some therapeutic benefits, all patients discontinued therapy due to adverse effects. Our findings suggest that while sirolimus may have clinical utility, its role may be limited by treatment-derived adverse effects.

Epidemiological characteristics and factors affecting healing in unintentional pediatric wounds.

Objective: To analyze the epidemiological characteristics and wound healing conditions of common unintentional skin lacerations in children. Methods: A retrospective analysis was conducted on data from 1,107 children, aged 0-12 years, with skin lacerations who received emergency treatment at Qilu Hospital of Shandong University from January 1, 2019, to December 30, 2022. Data on age, injury site, time from injury to suturing, and wound healing conditions were statistically analyzed. Results: Among the 1,107 cases, 714 (64.5%) were male and 393 (35.5%) were female, with a male-to-female ratio of 1.8:1; median age was 5 years (IQR, 3-7). Infants and toddlers (0-3 years old) constituted the highest proportion, accounting for 36.3% (402 cases). The number of children aged over 3 years gradually decreased with increasing age. In younger children, the most common injuries were to the forehead, scalp, and lower jaw; in school-aged children, the proportion of limb and trunk injuries significantly increased. Age (OR, 1.34; 95% CI, 1.23-1.46), outdoor injuries (OR, 2.21; 95% CI, 1.18-4.16), lower limb injuries (OR, 5.35; 95% CI, 2.86-10.00), and wound length greater than 3 cm (OR, 10.65; 95% CI, 5.02-22.60) were significant risk factors for poor wound healing. The risk of poor wound healing increased by 34% for each additional year of age. Conclusion: In children, the common sites of unintentional skin lacerations show distinct age and gender distribution characteristics. Older age, outdoor injuries, longer wound lengths, and lower limb injuries are independent risk factors for poor wound healing.

Correlation between blood glucose level and poor wound healing after posterior lumbar interbody fusion in patients with type 2 diabetes.

To investigate the correlation of blood glucose level with poor wound healing (PWH) after posterior lumbar interbody fusion (PLIF) in patients with type 2 diabetes (T2D). From January 2016 to January 2023, a case-control study was conducted to analyse the clinical data of 400 patients with T2D who were treated by PLIF and internal fixation at our hospital. The following data were recorded: gender; age; body mass index (BMI); surgical stage; average perioperative blood glucose level; perioperative blood glucose variance; perioperative blood glucose coefficient of variation; glycated haemoglobin level; preoperative levels of total protein, albumin and haemoglobin; postoperative levels of total protein, albumin and haemoglobin; surgical time; intraoperative bleeding volume; operator; postoperative drainage volume; and postoperative drainage tube removal time of each group. The indicators for monitoring blood glucose variability (GV) included the SD of blood glucose level (SDBG), coefficient of variation (CV) and maximum amplitude of variation (LAGE) before and after surgery. According to the diagnostic criteria for PWH, patients with postoperative PWH were determined and assigned to two groups: Group A (good wound healing group; n = 330 patients) and Group B (poor wound healing group; n = 70 patients). The preoperative and postoperative blood GV indicators, namely SDBG, CV and LAGE, were compared between these two groups. We also determined the relationship between perioperative blood GV parameters and PWH after PLIF surgery and its predictive value through correlation analysis and receiver-operating characteristic curve. Of the 400 enrolled patients, 70 patients had PWH. Univariate analysis revealed significant differences between the two groups in the course of diabetes, mean fasting blood glucose (MFBG), SDBG, CV, LAGE, preoperative hypoglycaemic program, surgical segment, postoperative drainage time, incision length and other factors (p < 0.05). However, no significant differences were noted in factors such as gender, age, body mass index, hypertension, coronary heart disease, admission fasting blood glucose, preoperative haemoglobin A1c, surgical time, intraoperative bleeding volume, intraoperative blood transfusion volume and postoperative drainage volume (p > 0.05). The area under the curve (AUC) values of preoperative SDBG, CV and LAGE were 0.6657, 0.6432 and 0.6584, respectively. The cut-off values were 1.13 mmol/L, 6.97% and 0.75 mmol/L, respectively. The AUC values for postoperative SDBG, CV and LAGE were 0.5885, 0.6255 and 0.6261, respectively. The cut-off values were 1.94 mmol/L, 24.32% and 2.75 mmol/L, respectively. The multivariate ridge regression analysis showed that preoperative MFBG, SDBG, CV and LAGE; postoperative SDBG, CV and LAGE; postoperative long drainage time; and multiple surgical segments were independent risk factors for T2D patients to develop surgical site infection after PLIF (p < 0.05). The perioperative blood GV in patients with T2D is closely related to the occurrence of PWH after PLIF. Reducing blood GV may help to reduce the occurrence of PWH after PLIF.

Risk prediction of poor wound healing in patients with thoracoscopic lung cancer resection with drainage tube.

This work established a risk prediction (RP) model for poor wound healing (PWH) in patients with thoracoscopic lung cancer (LC) resection (TLCR) after drainage tube placement to explore its application effect. 359 patients with TLCR were categorized into a good wound healing group (GWH group, 275 cases) and a poor wound healing group (PWH group, 84 cases) based on incision healing condition. The independent prediction risk factors (IPRFs) of PWH were analyzed and a RP model was constructed. 70% of the patients were classified as the model group (Mod group) and 30% were in the validation group (Val group). Resolution of the RP model was evaluated by the area under receiver operating characteristic (ROC) curve (AUC). The Hosmer-Lemeshow goodness of fit (HLGF) test was employed to evaluate the calibration of RP model. Results from the multivariate logistic regression analysis (MLRA) showed that age, preoperative albumin levels, diabetes history, dressing change frequency, and type of wound cleaning fluid were independent risk factors (IRFs) for postoperative PWH (P<0.05). In the Mod group, AUC=0.758 (P<0.05, 95% CI=0.712-0.806), and HLGF test showed P=0.493. In the Val group, AUC=0.783 (P<0.05, 95% CI=0.675-0.834), and HLGF test showed P=0.189. In conclusion, the constructed model was convenient, feasible, and demonstrates good predictive performance for postoperative incision healing issue, holding practical value and applicability.

Analysis of risk factors affecting poor wound healing after primary cleft palate surgery.

OBJECTIVES: To study the risk factors of poor wound healing after primary cleft palate surgery. METHODS: In this study, 980 cases of congenital cleft palate treated by Sommerlad-Furlow in the Department of Cleft Lip and Palate Surgery of Sichuan University from 2017 to 2021 were continuously analyzed. Indicators included patient's age, gender, body weight, cleft palate type, width of the widest fistula, cleft palate index (width of the widest fistula/width at the posterior edge of the maxillary tubercle plane), preoperative white blood cell count, preoperative hemoglobin level, preoperative antibiotic use, doctor's seniority, use of relaxation incision, operation time, postoperative upper respiratory tract infection, and postoperative wound healing. The postoperative wound healing was divided into normal healing, delayed healing, and palatal fistula. Both delayed healing and palatal fistula were classified as poor healing. The factors that may affect the healing outcome of the palatal wound after primary cleft palate repair were analyzed using SPSS 26.0 software. RESULTS: A total of 825 patients (84.2%) had normal healing, 112 patients (11.4%) had delayed hea-ling, and 43 patients (4.4%) had palatal fistula. Doctor's seniority, width of the widest fissure, cleft palate index, and operation time influenced the wound healing effect after cleft palate surgery (P<0.05). Doctors with low seniority, wide width of the widest fistula, large cleft palate index, and long operation time were the risk factors of poor wound healing. CONCLUSIONS: Doctor's seniority, width of the widest fissure, cleft palate index, and operation time are related to the effect of healing effect after cleft palate surgery.

The risk factors of the postoperative poor wound healing in spinal tuberculosis patients: A single centre retrospective cohort study.

The purpose of this study is to find out the risk factors of poor wound healing (PWH) in spinal tuberculosis (STB) patients. A total of 232 STB patients who underwent debridement surgery between January 2012 to June 2020 were included in this retrospective study. The study cohort was divided into two groups according to the presence or absence of PWH. The clinical characteristics of STB patients who developed PWH were evaluated, and risk factors were found using logistic regression analysis. Of the 232 patients, 30 developed PWH. Multivariate binary logistic regression analysis showed that pulmonary tuberculosis, long operation time and low postoperative albumin level were independent risk factors for PWH in STB patients. Receiver operating characteristic curve analysis showed that the optimal cutoff value of PWH in operation time and postoperative albumin are 200 minutes and 30 g/L, respectively. Pulmonary tuberculosis, long operation time and low postoperative albumin level are independent risk factors for PWH following surgery for STB. Curing pulmonary tuberculosis, controlling operation time and supervising postoperative serum albumin may decrease the risk of PWH among STB patients.

Efficacy of autologous platelet-rich plasma in the treatment of refractory wounds after breast cancer surgery / 中国输血杂志

【Objective】 To explore the effect of autologous platelet-rich plasma (PRP) in the treatment of refractory wounds after radical breast cancer resection. 【Methods】 The clinical data of 8 patients with refractory wound healing after radical resection of breast cancer, who received autologous PRP treatment at the South District Wound Treatment Center from November 2020 to May 2021, were collected, including age, sex, wound location, wound area/depth, TNM staging, surgical method, postoperative pathology, chemotherapy conditions, PRP treatment, etc. Wound healing time and scar hyperplasia (vascular distribution, color, softness, thickness, itching, pain, etc.) were observed after PRP treatment. The efficacy of autologous PRP was analyzed and evaluated retrospectively based on the above data. 【Results】 The wounds of 8 patients healed smoothly, and the granulation tissue of the wound was relatively matured and completely covered by the crawling epidermis. The wound healing time was 14 to 26 (20.6±3.6) days, and all patients had not developed scar hyperplasia. 【Conclusion】 The efficacy of autologous PRP treatment of refractory wounds after radical breast cancer resection is fast and effective, and can eliminate scar hyperplasia, which is worthy of clinical promotion.

Pancytopenia, Recurrent Infection, Poor Wound Healing, Heterotopia of the Brain Probably Associated with A Candidate Novel de Novo CDC42 Gene Defect: Expanding the Molecular and Phenotypic Spectrum.

CDC42 (cell division cycle protein 42) belongs to the Rho GTPase family that is known to control the signaling axis that regulates several cellular functions, including cell cycle progression, migration, and proliferation. However, the functional characterization of the CDC42 gene in mammalian physiology remains largely unclear. Here, we report the genetic and functional characterization of a non-consanguineous Saudi family with a single affected individual. Clinical examinations revealed poor wound healing, heterotopia of the brain, pancytopenia, and recurrent infections. Whole exome sequencing revealed a de novo missense variant (c.101C > A, p.Pro34Gln) in the CDC42 gene. The functional assays revealed a substantial reduction in the growth and motility of the patient cells as compared to the normal cells control. Homology three-dimensional (3-D) modeling of CDC42 revealed that the Pro34 is important for the proper protein secondary structure. In conclusion, we report a candidate disease-causing variant, which requires further confirmation for the etiology of CDC42 pathogenesis. This represents the first case from the Saudi population. The current study adds to the spectrum of mutations in the CDC42 gene that might help in genetic counseling and contributes to the CDC42-related genetic and functional characterization. However, further studies into the molecular mechanisms that are involved are needed in order to determine the role of the CDC42 gene associated with aberrant cell migration and immune response.

Dysregulation of wound healing mechanisms in diabetes and the importance of negative pressure wound therapy (NPWT).

Diabetes is a serious disease with severe side effects and comorbidities. Diabetic foot with its chronic nonhealing ulcers, or diabetic foot ulcers, as they are commonly called, can be devastating, even leading to amputation. Many therapies exist to assist and improve wound healing. One exciting discovery is the use of negative pressure wound therapy (NPWT) as an adjunct to standard treatment. Few studies have substantively explored the molecular mechanisms of NPWT and why we see improved wound healing, a concept that demands more research. The following commentary summarizes the current literature regarding NPWT as well as some of the vast body of work that focuses on the physiologic mechanisms of wound healing in diabetics in general.

Comparison Between Convergent Sliding of Myocutaneous Flap Method and Conventional Method for Treating the Patients at Early Stage Median Sternotomy Wound Dehiscence After Cardiac Surgery / 中国循环杂志

Objective: To compare the convergent sliding of bilateral pectoral myocutaneous lfap method and conventional method for treating the early stage median sternotomy wound dehiscence in patients after cardiac surgery. Method: A total of 36 relevant patients treated in our hospital from 2010-04 to 2014-04 were studied and they were divided into 2 groups: Conventional group, the patients received sufficient draining and dressing changes followed by interrupted simple suture,n=16 and Convergent sliding group, the patients received convergent sliding of bilateral pectoral myocutaneous lfap,n=20. The clinical conditions after treatment were compared between 2 groups. Results: There were 6 patients received re-suture after the ifrst debridement because of poor healing in Conventional group, no such event happened in Convergent sliding group, P0.05; the median hospital stay time from discovering wound problem to wound healing and discharge were 13.0 (10.75, 19.5) days and 12.0 (10.0, 13.0) days, P>0.05. Conclusion: Compared to conventional method, convergent sliding of bilateral pectoral myocutaneous lfap method may obtain the better success rate of wound debridement and suture by shorter time for treating the early stage median sternotomy wound dehiscence in patients after cardiac surgery.