Case Of Fistula Research Articles

Exploration of the method and efficacy of treatments for intractable pelvic pain caused by rectal or bladder fistula

Objective: To explore the causes and therapeutic effects of pelvic pain caused by rectal fistula or bladder fistula after comprehensive treatment of cervical cancer and rectal cancer (radiotherapy, surgery, chemotherapy, and other treatments). Methods: A retrospective analysis was conducted on the clinical and pathological data of patients with pelvic tumors admitted to the First People's Hospital of Yinchuan City, Ningxia and the Affiliated Cancer Hospital of Zhengzhou University from June 2016 to June 2022. The causes of persistent pelvic pain in patients after comprehensive treatment was investigated, and the corresponding therapeutic effects after clinical treatment was observed. Results: Thirty-two tumor patients experienced persistent pain after comprehensive treatment, including 22 cases of cervical cancer and 10 cases of rectal cancer. The preoperative pain of the entire group of patients was evaluated using the digital grading method, with a pain score of (7.88±1.31) points. Among the 32 patients, there were 16 cases of rectovaginal fistula or ileovaginal fistula, 9 cases of vesicovaginal fistula, 5 cases of rectoperineal fistula, and 2 cases of vesicovaginorectal fistula. Thirty-two patients were initially treated with medication to relieve pain, and according to the ruptured organs, a fistula was made to the corresponding proximal intestinal canal and renal pelvis to intercept the intestinal contents and urine. However, the pain did not significantly be improved. The pain score of treatment with the above methods for one week was (8.13±1.13) points, and there was no statistically significant difference compared to preoperative treatment (P=0.417). In the later stage, based on a comprehensive evaluation of whether the tumor had recurred, the value of organ preservation, the benefits of surgery, the balance between survival time and improving quality of life, pathological organ resection or repair was performed. The surgical methods included repair of leaks, local debridement combined with irrigation of proximal intestinal fluid, distal closure of the sigmoid colon combined with proximal ostomy, posterior pelvic organ resection, anterior pelvic organ resection, and total pelvic organ resection. One week after surgery, the patients' pain completely relieved or disappeared, with the pain score of (1.72±1.37) points, which was significantly divergent from the preoperative and initial surgical treatments (P＜0.001). Conclusions: Palliative pyelostomy and proximal enterostomy cannot effectively alleviate persistent pelvic floor pain. The fundamental way to alleviate pain is complete blocking of the inflammatory erosion of the intestinal fluid and urine.

Slow violence to disasters: Exploring racialized topographies and contextualizing social vulnerability to flood and other environmental risks

In traditional disaster scholarship, social vulnerability is a framework that leverages individual variables to explore stratification in the instance of disaster. As this body of literature has grown, we have lost more context as to why these variables are used within various applications. However, slow violence is another framework that does not necessarily focus on disasters traditionally but provides the social and political context to understand why certain individuals may be of greater risk. In this article, we combine social vulnerability and slow violence in a framework to demonstrate how individuals and groups are not inherently vulnerable to hazards. We leverage documentation from public media and related literature to contextualize the history of slow violence in two US case studies, Bonton - Texas and North Brentwood - Maryland. Despite the spatial differences between the two African-American communities, they share many similarities in how planning policy, practice, and implementation, over time, perpetrate slow violence through urban form and create social vulnerabilities and ultimately, disasters. We hope future literature can utilize the combined framework included in this manuscript to investigate and explain how a community's vulnerable predisposition to disaster is created by social and political forces at the community-level.

Identifying standard and simple designs of Power-to-Methanol processes: The costs of complexity reduction

First industrial-scale Power-to-Methanol plants are starting to be deployed in various geographic locations to tackle the problem of high greenhouse gas emissions of the predominantly fossil-based production of methanol. With the aim to speed up the deployment by streamlining their engineering and construction, we explore the potential of reducing the complexity of designs to be distributed across locations with different renewable energy conditions. A multi-objective optimization-based method incorporating a broad process network for early-stage process synthesis is proposed, which by determining the installed capacities of technologies from the chemical production, utility and storage subsystems, identifies alternative designs with different levels of complexity along two dimensions: 1) the number of different technologies used, 2) standardization of designs across different locations. The method was applied to case studies, which paired together design locations with either wind- or solar-dominant renewable resource conditions in the US and Chile for standardization. As per the method, the increases of methanol production costs due to reduced design flexibility, inherently bound to complexity reduction, were quantified and Pareto fronts were constructed. These uncovered the possibility to significantly reduce the complexity of the designs with only small increases of the production costs. By comparing the results of the case studies under different cost and operation scenarios, we characterized general aspects, which need to be considered for such design simplification. One of the main outcomes were the quantified cost-increases due to standardization, which were around 7 and 15 % relative to the specifically designed plants for each location in the US and Chile case studies respectively. A subsequent analysis of the economies of numbers through learning rates reported in academic literature suggested that the proposed standardization, even across extremely different locations, could compensate these cost-increases and be economically beneficial. Yet, more specific data on achievable cost-reductions are needed, requiring more interaction with the industry and further research, for which we highlighted promising directions.

Transcatheter renal arterial embolization for intractable urinary fistula occurring after robot-assisted partial nephrectomy: a case report.

Partial nephrectomy is the standard surgical procedure for small renal tumors. Since the advent of robot-assisted partial nephrectomy (RAPN), the number of cases of renal tumors undergoing the procedure has increased exponentially. Urinary fistula is a complication of partial nephrectomy. Conservative management using ureteral stents is useful in most cases of urinary fistulas. However, some patients develop intractable urinary fistulas. Herein, we report a case in which vascular embolization was useful for treating an infected and intractable urinary fistula that developed after RAPN. A 59-year-old man was accidentally found to have a right renal tumor (approximately 3cm in diameter) during a physical examination. Pathology was clear cell carcinoma. RAPN was performed owing to the small size of the renal tumor; however, postoperatively, an intractable urinary fistula with an isolated calyx developed, which was successfully treated with transcatheter renal arterial embolization (TAE). We encountered a rare case of infected refractory urinary fistula with an isolated calyx in which TAE was successful. TAE seems useful in treating intractable urinary fistulas with an isolated calyx occurring after RAPN.

Democrats abroad: What motivates core activists to engage in political transnationalism?

AbstractResearch into transnational political engagement of non‐resident citizens has largely focused on the Global South and less on the Global North. This article focuses on non‐resident United States citizens, or overseas Americans, asking what motivates them to become politically engaged. This article contributes insights to an insufficiently explored case. Drawing from 14 semi‐structured interviews with strongly politically engaged US citizens living abroad, this article shows that they engage in political activism for many of the same reasons as individuals from other countries, as well as ones which may be unique to the US case. Key factors include mobilising to change things at home, the role of the United States in the world, civic duty, fulfilling work and reactive transnationalism. The article concludes with policy recommendations and sets the scene for future comparative research, both within the Global North and between Global North and Global South non‐resident citizen groups.

Cost-efficiency and budget-neutral expanded access modeling of the novel PD-1 inhibitor toripalimab versus pembrolizumab in recurrent or metastatic nasopharyngeal carcinoma

Aims To estimate, in the setting of recurrent or metastatic nasopharyngeal carcinoma (R/M NPC) for an assumed 1,207 incident US cases in 2024, (1) the cost-efficiency of a toripalimab-gemcitabine-cisplatin regimen compared to a similar pembrolizumab regimen; and (2) the budget-neutral expanded access to additional toripalimab cycles and regimens afforded by the accrued savings. Methods Simulation modeling utilized two cost inputs (wholesale acquisition cost (WAC) at market entry and an ex ante toripalimab price point of 80% of pembrolizumab average sales price (ASP)) and drug administration costs over 1 and 2 years of treatment with treatment rates ranging from 45% to 90%. In the absence of trial data for pembrolizumab-gemcitabine-cisplatin in R/M NPC, it is assumed that such a regimen would be comparable to toripalimab-gemcitabine-cisplatin in efficacy and safety. Results In the models utilizing the WAC, toripalimab saves $2,223 per patient per cycle and $40,014 over 1 year of treatment ($77,805 over 2 years). Extrapolated to the 1,207-patient panel, estimated 1-year savings range from $21,733,702 (45% treatment rate) to $43,467,404 (90% rate). Reallocating these savings permits budget-neutral expanded access to an additional 2,359 (45% rate) to 4,717 (90% rate) toripalimab maintenance cycles or to an additional 126 (45% rate) to 252 (90%) full 1-year toripalimab regimens with all agents. Two-year savings range from $42,259,976 (45% rate) to $84,519,952 (90% rate). Reallocating these efficiencies provides expanded access, ranging from an additional 4,586 (45% rate) to 9,172 (90% rate) toripalimab cycles or to an additional 128–257 full 2-year toripalimab regimens. The ex ante ASP model showed similar results. Conclusion This simulation demonstrates that treatment with toripalimab generates savings that enable budget-neutral funding for up to an additional 252 regimens with toripalimab-gemcitabine-cisplatin for one full year, the equivalent of approximately 21% of the 2024 incident cases of R/M NPC in the US.

Seroprevalence of SARS-CoV-2 IgG in people with cystic fibrosis

BackgroundWhen the first known US case of COVID-19 (Coronavirus Disease 2019) was reported in early 2020, little was known about the impact of this novel virus on the cystic fibrosis community. As the majority of individuals with CF have chronic lung disease, this population was initially considered to be at high risk for severe disease as infection with a multitude of viruses has proven to cause pulmonary exacerbation. SARS-CoV-2 virus has proven challenging to study given the multiple disease manifestations, range of severity, and wave-like phenomenon that varies geographically. People with CF who become infected with COVID-19 can be asymptomatic or have symptoms ranging from mild cough and congestion to full respiratory failure, similar to the manifestations seen in non-CF individuals. By studying the seroprevalence, clinical course, and antibody durability due to COVID-19 and vaccinations, we will be better equipped to provide appropriate and informed care to people with CF. MethodsBetween July 2020 and April 2021 we enrolled 123 people with CF (pwCF) who receive care at the MN CF Center. We monitored their serology every 6 months for SARS-CoV-2 immunoglobulins (nucleocapsid and spike IgG) for evidence of natural and induced immunity. Medication use, pulmonary function, exacerbation history, and hospitalizations were extracted via electronic medical record (EMR). Results84% (101/120) of enrolled participants were vaccinated against SARS-CoV-2 during the study. Eighty three percent of the cohort showed evidence of either natural or induced “immunity.” The average duration of antibody from induced immunity in participants was 6.1 months and from natural immunity was 7.4 months with an overall average duration of antibody of 6.8 months. Earliest antibody detected was 12 days after a single dose of the BNT162b2 vaccine and antibody was detectable across a span of 13 months. Eleven percent of vaccinated individuals did not have measurable IgG. 36% of non-responders (NRs) were solid organ transplant patients on chronic immunosuppressive therapy. Only 3 people within this cohort were hospitalized due to COVID pneumonia and all three survived. ConclusionTo our knowledge, this is the first report on the seroprevalence and longevity of SARS-CoV-2 IgG to 1 year in adults with CF after the widespread availability of SARS-CoV-2 vaccinations. These data show that pwCF respond to the COVID vaccination and produce long-lasting antibodies similar to the general population.

Successful Management of Uterocutaneous Fistula After Cesarean Delivery: A Case Report

Background: We have, herein, presented a case of an uterocutaneous fistula after cesarian delivery. Case Presentation: A 24-years old female, gravida 3 para 3 with 2 living children, who underwent an emergency cesarean section about one month before the term due to preterm labor at Hamedan, was diagnosed with uterocutaneous fistula. Her medical history included 2 previous term cesarean section deliveries. She reported having fever and chills three weeks after the cesarian delivery. She also developed nausea, vomiting, and epigastric pain. Abdominal examination revealed a 30×40mm, firm, and tender mass on the right side of the cesarian section suture without any discharge. She was admitted with metritis as a primary diagnosis at N.H.F hospital. The performed transvaginal ultrasonography reported a hetero-echo mass with a diameter of 38×30×37mm with several echogenic foci and cystic components in the right ovary. After that, an abdominopelvic CT scan was done, and a 30×40mm mass in the right ovary with non-homogeneous due to collection and abnormal density with local hematoma at the site of the previous cesarian section was reported. Due to suspicion of lesion, the surgery was performed with the diagnosis of fascia opening and right Tubo-ovarian abscess and the infectious discharge of the right ovary. Right salpingo-oophorectomy surgery was performed. She was admitted again with the complaint of infectious discharge from the right side of the suture and erythema for one month. She also developed generalized abdominal pain. The patient was, thus, diagnosed with a uterocutaneous fistula and was admitted to the center. She became a trans-abdominal hysterectomy candidate and underwent surgery. Conclusion: One of the important risk factors for the fistula to be formed is an abscess. A few cases have been reported of post-cesarean uterocutaneous fistula in the literature. Surgical treatment associated with medical therapy can be effective in women with multiple cesarian sections. Any infected dehiscence must be radically operated.

Recurrence of cerebrospinal fluid-venous fistulas at different spinal levels following transvenous embolisation or blood/fibrin glue patching.

This study presents cases of recurrent cerebrospinal fluid-venous fistulas (CVFs) de novo at a different spinal level following successful treatment of initial CVFs. The aim was to highlight this rarely described phenomenon and report the clinical and imaging features after initial treatment, providing insights into the dynamics of recurrent CVFs. Understanding the course of CVFs post-treatment is crucial for optimising patient management, especially when symptoms persist or recur. We performed a retrospective chart review of all patients with recurrent CVFs at a different level after treatment of their initial CVF at our institution. Clinical and imaging records were reviewed and summarised, including Bern score features on brain magnetic resonance imaging (MRI) before and after treatment. Four patients with five recurrent CVFs were identified. Recurrent or persistent symptoms encouraged subsequent brain MRI scans, which revealed different outcomes: i.e. persistence, or improvement, or complete resolution of abnormal findings. Initial positive responses included improvement of the pachymeningeal enhancement and venous sinus distension. These improvements were reversed when recurrent symptoms arose, which was also correlated with changes in the Bern score. Recognising the factors of CVF recurrence is crucial for comprehensive management. This study underlines the significance of repeated evaluation of persistent or recurring symptoms of CSF leak after treatment for CVFs.

Partial Fistulotomy followed by Kshara application and Ksharasutra Ligation in Fistula-in-ano - Multiple approaches in a Single Case

Bhagandhara is one of the common ailments pertaining to Guda and it is mentioned under the heading of Ashtomahagada (eight major diseases). According to Acharya Susahruta, ‘Bhagandhara’ starts as deep-seated pidika (boil) surrounding Guda (anus) within two Angulas, producing fever and pain. In contemporary science it is compared to fistula-in-ano. Fistula-in-ano is a track lined by granulation tissue and communicating two epithelial lined surfaces which opens deeply in the anal canal or rectum and superficially on the skin around the anus. In modern medical science various treatment modalities has been explained but they are having its own merits and demerits. Ksharasutra is a medicated thread, indicated in ano-rectal disorders particularly in the management of Bhagandhara. In plane Kshrasutra the required time for cut through and healing of wound is more, so patients are mentally disturbed with this disease. Hence to minimize the required time, multiple interventions along with Ksharasutra is opted. In this case report, a patient of fistula- in-ano having 9cm at posterior aspect of anal canal was treated with multiple approaches which are partial fistulotomy, Kshara application and Ksharasutra ligation for remaining part of tract. Regular dressing was done with Jatyadi Ghrita for the partial fistulotomy wound and old Ksharasutra was changed with a new one by rail-road method on every week for the remaining part of fistulous tract. The unit cutting time (UCT) was measured and noted at every week. This case was cured completely within 7 weeks. Hence study concluded that the long fistula cases can be treated with multiple interventions along with Ksharasutra.

Successful management of an atrio-esophageal fistula after atrial fibrillation ablation: a case report

Abstract Background Atrio-esophageal fistula is a rare but still a catastrophic complication of radiofrequency ablation of atrial fibrillation. We report a successful case of atrio-esophageal fistula with right posterolateral thoracotomy and right femoral cannulation of cardiopulmonary bypass. Case presentation A 67-year-old man underwent radiofrequency ablation for atrial fibrillation. Nineteen days later, he developed cerebral infarction, and computed tomography showed air in the left atrium. He was transferred to our hospital for surgery. The upper body was placed in the left lateral decubitus position, and the lower body was placed in the left hemilateral decubitus position. The surgical approach was a right posterolateral thoracotomy in the 5th intercostal space. At first, the esophagus was transected at the diaphragm and tracheal carina levels. Then, an arterial line was inserted into the right common femoral artery and venous line into the right common femoral vein. Three U-shaped sutures of 3-0 polypropylene were placed to stop bleeding from the atrium. The esophagus was removed while snaring the 3-0 polypropylene sutures. There were two holes in the esophagus. Four drains were placed to clean the repaired site. After chest closure, the patient was placed supine. Cervical esophagostomy and enterostomy were performed. Gastric tube reconstruction via the retrosternal route was performed on postoperative day 28, and the patient was transferred to another hospital for rehabilitation on postoperative day 99. Conclusions It is important to thoroughly discuss with esophageal surgeon how to reach the heart and esophagus, and how to reconstruct the esophagus later.

A201 AORTO-ESOPHAGEAL FISTULA AS A COMPLICATION OF ESOPHAGEAL VARICEAL BANDING

Abstract Aims This is the first reported case of bleeding from an aorto-esophageal fistula as a consequence of ischemic esophageal ulceration post esophageal variceal banding. Methods A 46-year-old male presented with epigastric pain for one-week, which was not associated with fever, jaundice, or symptoms of GI bleed. He was hemodynamically stable with an unremarkable exam and basic labs. He underwent a CT scan which showed chronic portal vein thrombosis extending from the main portal vein into the superior mesenteric vein and evidence of portal hypertension, along with massive esophageal varices. Anticoagulation was not started due to risk of GI bleed. Upper endoscopy confirmed the presence of three columns of large esophageal varices in the distal and mid esophagus, the largest was 3 cm in size. There was no stigmata of recent bleeding and no gastric varices. Seven bands were applied. CT abdomen was repeated on the seventh day of admission, showing extension of portal vein thrombosis. As such, the thrombosis team started a low dose of anticoagulation. (dalteparin 7500 IU). He tolerated it well and showed no signs of bleeding prior to discharge. The day after discharge, the patient presented again with an episode of melena. Examination was remarkable for tachycardia, hypotension and melena. Hemoglobin was stable. Patient was admitted with impression of upper GI bleed most likely secondary to post banding ulcer. He was started on medical therapy. Anticoagulation was held. Next day, the patient had an episode of hematemesis with large amount of blood and clots. Emergent upper endoscopy showed active bleeding in the distal esophagus. Further examination showed a full-thickness, 7 mm defect in the lower esophagus with fresh red blood emptying from it into the esophagus (Figure 1). Thoracic surgery was consulted and suspected a perforated esophageal ulceration at the site of previous banding, with an aorto-esophageal fistula. Patient deteriorated immediately and passed away. The cause of death was cardiac arrest secondary to acute blood loss anemia. Results AEF is a recognized cause of upper GI bleeding with a high mortality rate. While rare, it can occur secondary to ischemic esophageal ulcer post EV banding. Conclusions This is the first reported case of an aorto-esophageal fistula as a consequence esophageal variceal band ligation. While extremely rare, this complication should be considered as a potentially fatal complication of variceal banding, especially in the setting of a diseased or previously repaired aorta.

A Comparative Study in the Management of Fistula in ANO

Abstract: Background- Fistula in ano is an abnormally communication between rectum or anal canal to skin around the anus. Fistula in ano is mostly seen after an anorectal abscess. According to Ayurveda “bhagandra” is formed after “guda pidika”. The principle of management of fistula are eradication of infected anal crypt and fistulous track and preserved function of sphincter. Methods- this is a randomized comparative study 30 case of fistula in ano presenting at opd of national resource center of kshar sutra in sir suderlal hospital institute of medical science Banaras Hindu university. from 15 patients were treated with IFTAK and 15 patients were treated with modified LIFT.

Multifaceted surgical approach of combined thoracoretroperitoneal incision and midline abdominal incision for a secondary aortoenteric fistula

BackgroundWe report a one-stage surgery to the case of secondary aortoenteric fistula (sAEF) after prosthetic reconstruction of abdominal aortic aneurysm, by multifaceted approach.Case presentationA 63-year-old male was admitted to our unit under diagnosed of sAEF after prosthetic reconstruction of abdominal aortic aneurysm, and a pseudoaneurysm of thoracoabdominal aorta due to infection. The patient underwent emergency operation. Firstly, we placed the patient in a modified right lateral decubitus position and performed thoracoabdominal aortic replacement with retroperitoneal approach by thoracoretroperitoneal incision which combined thoracotomy and pararectal incision, and secondly, we changed to a supine position and performed closure of the duodenal fistula and omental flap transposition by midline abdominal incision. The patient was doing well without complications.ConclusionsA one-stage, multifaceted surgical approach covering both prosthetic reconstruction of thoracoabdominal aorta and closure of sAEF with omentopexy is reasonable and useful strategy.

Management of a recurrent third branchial arch fistula using combined endoscopic and open approach

Branchial cleft anomalies are rare, congenital lesions, that occur due to the maldevelopment of the branchial apparatus, during fetal maturation. Anomalies of the third and fourth arch contribute to a very small proportion of these. Most cases are detected in childhood, either as a cyst, sinus or fistula in the neck. Some of the common treatment approaches to third branchial cleft fistulas include endoscopic cauterization, open cervical fistulectomy and, in cases of recurrence, selective neck dissection. Here, we present a case of recurrent branchial fistula of the third arch, wherein we used a combined cervical and intraoral approach, conserving the thyroid cartilage, to achieve a complete excision of the fistula tract.

P866 Management of fistulizing Crohn's Disease in a moroccan population: about 125 cases

Abstract Background Crohn's disease is an inflammatory enterocolitis, which may be complicated by enteroenteric, enterovesical, rectovaginal, enterocutaneous and anoperineal fistulas. This is a retrospective study of fistulizing Crohn's disease cases followed in our gastroenterology department. Methods We report a retrospective and descriptive study, covering all cases of fistulizing Crohn's disease, collected in the hepato-gastroenterology department at our university hospital center during a 9-year study period, from 2015 to 2023. All patients with digestive and/or anal crohn's fistula were included. Comparison of categorical variables was performed with Fisher's exact test using SPSS 10.0 software. The significance level was p < 0.05. Results 125 patients had a fistulizing form of Crohn's disease. The location of fistulas was represented by anoperineal fistulas (32.6%), followed by enteroenteral (22.9%) and enterocutaneous (23%) fistulas, then enterovesical (9%) and rectovaginal (3.8%) fistulas. Surgical treatment was immediately indicated in all cases of enterocutaneous and enterovesical fistulas, and 66.7% of rectovaginal fistulas. Proctological drainage was performed in 57.1% of cases of anoperineal fistulas. 33 cases of anoperineal fistulas and one case of recto-vaginal fistulas were treated with infliximab. Clinical remission was also significantly associated with medical treatment with biologics versus immunosuppressants (P=0.0018). Surgical treatment remains indicated in the majority of cases of fistulizing Crohn's disease. Conclusion Fistulizing Crohn's disease poses a problem for medical and surgical management. Surgical treatment remains indicated in the majority of Crohn's fistula cases. This study also showed that endoscopic recurrence and clinical remission were significantly associated with the type of postoperative medical treatment.

P097 Spatially resolved insights into fistulating Crohn's disease pathogenesis: Unveiling molecular heterogeneity

Abstract Background Crohn's disease (CD) frequently results in fistula development in approximately 40% of patients due to sustained, transmural inflammation within the bowel wall. Despite advanced treatments, recurrence of fistulae affects one third of patients. Understanding its pathogenesis is crucial for targeted treatments, yet remains poorly defined. This study employs spatial transcriptomic and single-cell RNA-sequencing (scRNA-seq) technologies to characterise human fistulating CD tissue pathology. Methods Unbiased FFPE spatial transcriptomics (10x Visium) were applied to surgically resected, full-thickness (FT) tissue from 20 CD-associated fistulae cases and 15 controls. Subsequently, selected cases underwent further analysis using custom 500-plex MERFISH subcellular resolution spatial transcriptomics (Vizgen MERSCOPE). Additionally, a reference single-cell cohort encompassing patients with fistulating, stricturing, and inflammatory CD phenotypes, along with healthy controls, was generated. Optimisation of scRNA-seq for resected FT ileal tissue enabled the isolation and profiling of epithelial, immune, and stromal populations (10x Chromium). Computational analysis facilitated the spatial localisation of single-cell clusters enriched in fistula CD tissue, identifying key parameters linked to fistula development. Results The scRNA-seq data revealed diverse CD-specific cellular states adopted by intestinal fibroblasts, with IL11+ fibroblasts prominently expressing CD82, COL7A1, MMP1, CHI3L1, suggestive of pro-fibrotic signalling and regenerative morphogen pathways. This coincided with the expansion of a CD-specific subpopulation of pericytes (CCL19/CCL21) involved in leucocyte migration. Spatial profiling of CD fistula tracts by Visium and MERSCOPE unveiled an enrichment of key epithelial developmental transcription factors (e.g., GRHL3) and localised the pro-fibrotic signature displaying increased IL11 and MMP expression, along with perturbed WNT signalling within the fistula stroma. Active proliferation (HOPX, MKI67) was observed at the base of fistula tracts and within the stroma. Transcriptomic characterisation depicted a gradual loss in stem cell signature (LGR5, ASCL2, SMOC2) and supporting telocytes (POSTN) toward the leading edge of the fistula, signifying abnormal epithelium loss. Conclusion This pioneering study integrates multi-modal spatial transcriptomics and single-cell profiling to unveil the intricate cellular and molecular landscape in FT, fistulating CD pathology. Spatial analyses elucidate specific mechanisms involved in epithelial loss, stromal remodelling, and perturbed WNT signalling pathways within fistulating tissue, outlining a course of disrupted regenerative processes in fistulating CD.

Efficacy and safety of negative wound pressure in the treatment of surgical complications after radical cystectomy: a retrospective cohort study

Background: Negative pressure wound treatment (NPWT) is a relatively new, but promising method for management of surgical site infection (SSI). The literature data on the use of NPWT for complications in oncology surgery, and after radical cystectomy (RC) in particular, is scarce.
 Aim: To evaluate the short-term results of NPWT dressings in the management of SSI after RC.
 Materials and methods: We retrospectively analyzed data from 446 patients who had RC with various uroderivation types in the Department of Oncourology of the N. N. Petrov National Medical Research Center of Oncology from January 2012 to December 2021. A total of 62 cases of SSI emerging up to day 30 after RC were identified with complete data. Thirty six (36) cases of SSI were managed according to standard procedures, and 26 patients with SSI were treated with NPWT (VivanoTec® S 042) at constant negative pressure mode. The physical condition of the patients before RC was assessed according to the American Society of Anesthesiology (ASA) classification, and the severity of the patient's condition at SSI diagnosis within APACHE II scale. The following parameters were also analyzed: body mass index, median number of days in the hospital, number of program wound sanitations (surgical debridement) or frequency of changing NPWT dressings, changes over time in C-reactive protein and leukocyte index of intoxication, and events of clinical interest (intestinal fistulas and lateralization of the median wound margins, hernias).
 Results: Most cases of post-RC SSIs were identified in men (57/62, 91.93%). The standard management and NPWT study groups were well balanced for age, body mass index, and ASA physical status. The median time from the first surgical debridement of the wound to its closure was significantly shorter in the standard surgical management group: 4 days (0; 8.75) versus 8.5 days (3.25; 12.0) in the NPWT group (p = 0.026). However, this did not negatively affect the length of hospitalization (28.08 ± 12.80 and 30.03 ± 16.27 days, respectively, p = 0.599). The 30-day mortality rates were not significantly different between the groups (p = 0.137). In our series with NPWT dressings, there were no cases of intestinal fistulas in the early and late postoperative periods.
 Conclusion: Negative pressure wound treatment is a safe and effective method of SSI management. It is not inferior to the generally accepted treatment standard with surgical wound debridement, staged sanitations or dressings. NPWT dressings allow for early primary muscular-fascial closure of the abdominal cavity and does not increase the duration of hospital stay, postoperative death rates and the risk of intestinal fistulas.

A Scanner Darkly: Copyright Liability and Exceptions in Artificial Intelligence Inputs and Outputs

Abstract This article delves into the legal issues surrounding the use of copyrighted works in training artificial intelligence (AI). It examines two critical questions: firstly, whether accessing and analysing copyrighted works for AI training constitutes copyright infringement; and secondly, whether outputs generated by AI from these inputs infringe on copyright. The primary focus is on the United Kingdom’s jurisdiction, with comparative analyses from EU law and a few US cases. The article aims to bring clarity to these multifaceted legal issues by thoroughly exploring the technicalities of machine learning and its implications for ongoing and future litigation. The hypothesis suggests that most inputs may fall under existing exceptions and limitations, but the outputs’ legality may depend on individual case specifics. The conclusion reflects on the inevitable legal challenges that accompany technological advances, as happened in the past with file sharing and the early World Wide Web. The article highlights the current stage of AI technology and law, suggesting that legal precedents or legislative actions might eventually settle disputes. It also emphasizes the importance of finding technological solutions – like metadata standards or proactive initiatives – to balance copyright holders’ rights with AI innovation. The article concludes by acknowledging the irreversible emergence of AI in our lives and the legal system’s need to adapt, offering equitable solutions to copyright holders while fostering technological advancement.

A Systematic Review of Mortality Associations in Patients who Develop Tracheoinnominate Artery Fistula Following Tracheostomy.

Tracheoinnominate artery fistulas (TIFs) are a rare but deadly complication of tracheostomy. Tracheoinnominate artery fistula cases in the literature were summarized in order to understand mortality associations. MEDLINE was searched for studies reporting individual characteristics of patients with TIFs after tracheostomy, excluding cases without tracheostomy or with additional procedures at the tracheostomy site. This study followed PRISMA guidelines. 121 TIF patients from 18 case series and 46 case reports were included. The median age was 40years, and 52.9% were male. The overall mortality rate was 64.5%. There were differences in mortality between cases that presented initially with vs without sentinel bleeding (odds ratio [OR] .34; CI [confidence interval] .16-.73; P = .006). The mortality rate also differed in whether or not the tracheostomy cuff was over-inflated for temporary hemostasis during resuscitation (OR 3.57 (CI 1.57-8.09); P = .002). Treatment compared to no treatment had lower mortality rates (OR .11 (CI 0.04-.32); P < .001); no differences were found if treatment was endovascular vs open surgical. Mortality is a major concern after detection of a TIF and resuscitation paired with endovascular or open surgical intervention is imperative. Rapidly investigating sentinel bleeds and intervening upon hemorrhage with temporary cuff over inflation may lead to improved outcomes.