Background:. The prevention of peritendinous adhesions after tendon repair is a significant challenge in hand surgery. To our best knowledge, this is the very first study using MatriDerm and a wraparound technique. Our study was a prospective, double-blinded, randomized case-control study using MatriDerm as an adhesion barrier after primary repair of the flexor digitorum profundus tendon of the human hand in zone II. Methods:. We evaluated 38 patients with flexor digitorum profundus injuries. All tendons were repaired using core and circumferential sutures. Randomization was double-blinded, with participants being divided into 2 groups of 19 patients. In the first group, the repaired site was wrapped in MatriDerm, whereas in the second, the site was repaired without MatriDerm. Clinical and functional results were evaluated using the total active movement (TAM) assessment, ultrasound, and visual analog pain scale. Results:. The MatriDerm group showed a mean TAM of 82.1%, whereas that of the control group was 66.11%. According to the statistical Mann-Whitney U test, results with MatriDerm were significantly higher compared with the control group, with a medium effect size (exact P = 0.014, P < 0.05, Pearson r = 0.36). Adhesion formation according to ultrasound and pain scores was similar between the control and MatriDerm groups. Conclusions:. Our prospective, double-blinded, randomized clinical study showed significantly better TAM outcomes in repaired tendons wrapped in MatriDerm. The promising results of this novel MatriDerm application in zone II flexor tendon repair should undergo wider, adequately powered clinical trials in the future.
Introduction: Metabolic dysfunction-associated steatotic liver disease (MASLD) is associated with insulin resistance and metabolic disturbances. Sex hormone-binding globulin (SHBG) is closely linked to metabolic regulation and has been shown to differ between individuals with and without MASLD. Objective: This study aimed to investigate the associations between SHBG and MASLD and their relationships with insulin resistance, body mass index (BMI), age, and sex in a combined male-female cohort. Patients and Methods: We studied 98 men and 54 women with MASLD and 74 men and 55 women without MASLD (aged 25-64 years). Participants underwent abdominal ultrasonography and fasting blood sampling, including measurements of glucose, liver enzymes, lipids, insulin, SHBG, estradiol, and testosterone. Results: SHBG levels were lower in individuals with MASLD than in controls, with a more pronounced reduction in women. MASLD status was associated with an approximately 10 nmol/L lower SHBG concentration (p < 0.0001; gender × MASLD interaction p = 0.0462). Higher estradiol levels were associated with higher SHBG concentrations (p = 0.0009), although this association differed by sex (gender × log-estradiol interaction p = 0.0147). Older age and higher total cholesterol levels were associated with higher SHBG levels, whereas higher triglyceride levels were associated with lower SHBG levels. Conclusions: SHBG showed significant associations with MASLD and with key metabolic and hormonal factors, including BMI, age, and sex. Inclusion of both men and women extends prior male-only research and provides a broader characterisation of sex-specific associations in MASLD.
Purpose Midface reconstruction poses a complex set of challenges for reconstructive surgeons. The optimal midface reconstruction must possess a durable underlying bone construct capable of integrating dental implants. Facial contour is restored by the overlying microvascular soft tissue reconstruction with reestablishment of the oral cavity. A plethora of microvascular flaps used in clinical practice have been described including those harvested from the iliac crest, scapula, fibula, forearm and back (latissimus dorsi). The objective was to share our experiences with each of these treatment options that have continued to evolve over time for the benefit of patients. Methods Our institution has over three decades of experience in reconstructing complex midface defects and this article summarizes midface reconstruction from an evolutionary perspective (for type II, III and IV defect; Browns classification, Supplementary Table I). We broadly divide this into (i) flaps supplied by the subscapular system (ii) autologous reconstruction with titanium mesh and (iii) fibula microvascular flaps using 3D planning. Results The advantages and disadvantages for each approach are discussed (Supplementary Table II). Conclusion In the future, it is expected that 3D planning coupled with rapid prototyping, intraoperative navigation and CT imaging will become standard procedural practice.
BACKGROUND:Intravenous amino acids (AA) reduce acute kidney injury (AKI) in adult patients undergoing cardiac surgery. Because the optimal duration of AA infusion is unknown, we investigated the effect of AA infusion duration on AKI and survival. METHODS:In a secondary post hoc analysis of the PROTECTION randomised double-blind placebo-controlled trial, we divided patients into brief (≤48 h) or prolonged (>48 h but ≤72 h) AA infusion. The primary objective was to assess whether the direction of the effects on AKI and ICU mortality was consistent across subgroups. RESULTS:A total of 3481/3511 patients had available data. Brief and prolonged AA infusion had similar magnitude and direction of effect on AKI (interaction P=0.89), with a risk reduction of 3.8% (25% to 21%) and 5.7% (44% to 38%), respectively. Brief AA infusion showed a reduction in the use of renal replacement therapy, whereas prolonged infusion showed no effect. The effects of AA on intensive care unit mortality were discordant (a reduction from 1.9% to 1.0% in the brief infusion group, and an increase from 2.5% to 3.5% in the prolonged infusion group; interaction P=0.04). CONCLUSIONS:The effect of AA on AKI was consistent across subgroups, whereas they had opposing effects on survival in patients receiving brief or prolonged study drug infusion and in favour of the brief infusion group. Although these results are hypothesis generating, centres that are following European guidelines and PROTECTION trial results and are implementing AA in clinical practice should consider AA infusion lasting ≤48 h. CLINICAL TRIAL REGISTRATION:NCT03709264.
Acute kidney injury (AKI) is a common complication after cardiac surgery and is associated with increased morbidity and mortality. Intravenous amino acids (AA) infusion reduces postoperative AKI. Given the high prevalence of patients with diabetes and their increased susceptibility to renal injury, this study aimed to assess whether the renal-protective effect of AA infusion is maintained in this population. This post-hoc subgroup analysis examined patients with diabetes included in the multinational, double-blind, randomized, placebo-controlled PROTECTION trial. Participants were randomized to receive a continuous intravenous infusion of AA (2 g/kg of the ideal body weight per day; up to 72 h) or placebo during the perioperative period of cardiac surgery. Among 644 patients with diabetes (AA n = 309; placebo n = 335), the incidence of any-stage AKI was 43.3
