Infectious Necrosis Research Articles

High-throughput virtual screening of marine algae metabolites as high-affinity inhibitors of ISKNV major capsid protein: An analysis of in-silico models and DFT calculation to find novel drug molecules for fighting infectious spleen and kidney necrosis virus (ISKNV)

Infectious Spleen and Kidney Necrosis Virus (ISKNV) is linked to severe infections that cause significant financial losses in global aquaculture. ISKNV enters the host cell through its major capsid protein (MCP), and the resulting infection can lead to mass mortality of fish. Even though several drugs and vaccines are at various stages of clinical testing, none are currently available. Thus, we sought to assess the potential of seaweed compounds to block viral entrance by inhibiting the MCP. The Seaweed Metabolite Database (1110 compounds) was assessed for potential antiviral activity against ISKNV using high throughput virtual screening. Forty compounds with docking scores of ≥8.0 kcal/mol were screened further. The inhibitory molecules BC012, BC014, BS032, and RC009 were predicted by the docking and MD techniques to bind the MCP protein significantly with binding affinities of −9.2, −9.2, −9.9, and −9.4 kcal/mol, respectively. Also, ADMET characteristics of the compounds indicated drug-likeness. According to this study, marine seaweed compounds may operate as viral entrance inhibitors. For their efficacy to be established, in-vitro and in-vivo testing is required.

Acute pancreatitis: Early Management

Abdominal pain caused by acute pancreatitis (AP) is not uncommon in day to day medical practice worldwide. AP is the sudden inflammation of the pancreas, and it may be confined to the pancreas, or may be more life-threatening, affecting all organs and systems. It progresses mildly in 80% of patients and resolves with treatment, but in cases of severe AP, with mortality of around 30% has been recorded. AP is most often established by clinical symptoms and at least threefold raised enzymes and by imaging (any two of these three).In the management AP, treatment is mainly related to the severity of the disease and approaches are constantly being updated. With early diagnosis and treatment, most of the patients can be discharged, and the development of complications and mortality can be reduced. Hemodynamic status should be assessed immediately upon presentation and resuscitative measures begun as needed. Early targeted fluid therapy within the first 48 h is critical to improve the outcome of severe AP. Patients with organ failure and or SIRS should be admitted to an ICU /HDU whenever possible. Emergency management decision are early fluid management strategy, utility and timing of antibiotics, the timing and type of nutritional support and in relevant cases endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy approachescan change the course of the disease and the length of stay in the hospital. Therefore, emergency management is important.Enteral nutrition is recommended to prevent infectious complications, whereas parenteral nutrition should be avoided.Routine use of prophylactic antibiotics in patients with severe AP and or sterile necrosis is not recommended.In patients with infected necrosis, antibiotics known to penetrate pancreatic necrosis may be useful in delaying intervention, thus decreasing morbidity and mortality. Successful clinical management requires close interdisciplinary cooperation and coordination from experienced gastroenterologists, intensive care physicians, surgeons, and radiologists. Bangladesh J Medicine 2023; Vol. 34, No. 2(1) Supplement: 188-189

Outcomes of patients treated with minimally invasive plate osteosynthesis in the management of distal tibial fractures

Background: Distal tibial fractures are a common injury, often caused by high-energy trauma, and can result in significant morbidity. Traditional surgical management with open reduction internal fixation (ORIF) is associated with complications including infection and soft tissue injury. Minimally invasive plate osteosynthesis (MIPO) has emerged as a potential alternative, with advantages including less soft tissue injury and a faster return to function. The study aimed to evaluate the outcomes of MIPO for distal tibial fractures. Method: Sample size of 38 patients between 18-80 years of age with distal tibial fractures treated with MIPO was included. Patient demographics, fracture characteristics, surgical details and postop outcomes collected. Results: A total of 38 patients with distal tibia fractures with a mean age of 44.36 years were included in the study. The mean duration of hospital stay was 12.71 days, and the time required for a union was 18.61 weeks. The AOFAS score improved significantly from 3 to 6 months after surgery. However, 15 patients (34.88%) reported complications, with deep infection and skin necrosis being the most common. Out of 43 patients, 11 underwent culture and sensitivity testing, with no growth in 5 cases, and the remaining cases showed various bacterial infections. Seven patients underwent implant removal due to complications. Conclusions: The study provides valuable information about the use of MIPO in treating distal tibia fractures, as well as the risk of complications associated with this approach.

Thermosensitive Microneedles Capable of On Demand Insulin Release for Precise Diabetes Treatment.

As a novel painless and minimally invasive transdermal drug delivery method, microneedles have solved the challenges of microbial infection and tissue necrosis associated with multiple subcutaneous injections in patients with diabetes. However, traditional soluble microneedles cannot switch drug release on and off according to the patient's needs during long-term use, which is one of the most critical elements of diabetes treatment. Herein, an insoluble thermosensitive microneedle (ITMN) that can control the release of insulin by adjusting the temperature, enabling the precise treatment of diabetes is designed. Thermosensitive microneedles are produced by in situ photopolymerization of the temperature-sensitive compound N-isopropylacrylamide with the hydrophilic monomer N-vinylpyrrolidone, which is encapsulated with insulin and bound to a mini-heating membrane. ITMN are demonstrated to have good mechanical strength and temperature sensitivity, can release significantly different insulin doses at different temperatures, and effectively regulate blood glucose in type I diabetic mice. Therefore, the ITMN provides a possibility for intelligent and convenient on-demand drug delivery for patients with diabetes, and when combined with blood glucose testing devices, it has the potential to form an integrated and precise closed-loop treatment for diabetes, which is of great importance in diabetes management.

The bactericidal effects of 632.8 nm He-Ne laser on Staphylococcus aureus colonies

The bactericidal effect of 632.8 nm low level laser has been studied in order to point out both the effective power and laser exposure time on Staphylococcus aureus, which is reported to be involved in several dermatology problems. Low level laser has been reported to be useful for infected wounds, tissue necrosis, nerve injury, osteoarthritis or other chronic pain syndromes. Numerous studies have been conducted to quantify the effective laser parameters, i.e. dose, power, and exposure time, which ultimately leads toward clinical implementation. Staphylococcus aureus bacteria colonies were exposed to laser doses with powers of both 1 and 3 mW at different exposure times varies between 3 to 30 minutes. The bacterial colonies were isolated from a patient with inflamed wounds. Two sets of bacterial colonies were prepared to be exposed to laser beam. Next, the bacterial colonies were compared before and after exposing them to laser doses. The results showed that laser sessions have reduced the number of the bacterial colonies for both doses; 1 and 3 mw at the different exposure times and concentrations. The results revealed significant dose dependent bactericidal effects of He-Ne laser on Staphylococcus aureus at 3 mW for 30 minutes, which was found to be more effective in reducing the amount of bacteria to the less than 2% of its initial count. The results exhibited the reduction of the number of colonies as a function of exposure time. Appropriate doses of 632.8 nm can kill Staphylococcus aureus, suggesting that a similar effect may be used in clinical cases of bacterial infection.

A Protocolized Management of Walled-Off Necrosis (WON) Reduces Time to WON Resolution and Improves Outcomes

Patients with infected or symptomatic walled-off necrosis (WON) have high morbidity and health care utilization. Despite the recent adoption of nonsurgical treatment approaches, WON management remains nonalgorithmic. We investigated the impact of a protocolized early necrosectomy approach compared with a nonprotocolized, clinician-driven approach on important clinical outcomes. Records were reviewed for consecutive patients with WON who underwent a protocolized endoscopic drainage with a lumen-apposing metal stent (cases), and for patients with WON treated with a lumen-apposing metal stent at the same tertiary referral center who were not managed according to the protocol (control subjects). The protocol required repeat cross-sectional imaging within 14 days after lumen-apposing metal stent placement, with regularly scheduled endoscopic necrosectomy if WON diameter reduction was <50%. Control patients were treated according to their clinician's preference without an a priori strategy. Inverse probability of treatment weighting-adjusted analysis was used to evaluate the influence of being in the protocolized group on time to resolution. A total of 24 cases and 47 control subjects were included. There were no significant differences in baseline characteristics. Although numbers of endoscopies and necrosectomies were similar, cases had lower adverse event rates, shorter intensive care unit stay, and required nutritional support for fewer days. On matched multivariate Cox regression, cases had earlier WON resolution (hazard ratio, 5.73; 95% confidence interval, 2.62-12.5). This was confirmed in the inverse probability of treatment weighting-adjusted analysis (hazard ratio, 3.4; 95% confidence interval, 1.92-6.01). A protocolized strategy resulted in faster WON resolution compared with a discretionary approach without the need for additional therapeutic interventions, and with a better safety profile and decreased health care utilization.

A stomaplasty for total laryngectomy with a previous tracheostomy

ObjectiveStomaplasties were widely used to prevent or revise stomal stenosis, however, a previous tracheostomy can limit the choice of some techniques. This study aims to deal with this condition through a novel and simple technique called “Collar stomaplasty”. MethodsThis study involved 43 patients submitted for laryngectomy between 2017 and 2020. A tracheostomy 6–31 days prior to laryngectomy was performed in all cases. The collar stomaplasty, shaping the previous tracheostomy and surrounding skin, included 17 cases and the traditional X-shaped stomaplasty included 26 cases. Fisher's exact test was applied in an intergroup comparison of complications. ResultsOne out of the collar stomaplasty group demonstrated perioperative stomal infection and avascular necrosis (5.9%). Another developed stomal stenosis (5.9%). In the X-shaped stomaplasty group, necrosis at the tip of the tracheal flap occurred in 14 cases (53.8%), and stomal stenosis occurred in 5 cases (19.2%). A statistically significance occurred in stomal necrosis (p<0.05) while no statistically difference is observed in stomal stenosis (p>0.05) between these two groups. ConclusionsThe collar stomaplasty technique creates a laryngectomy tracheostoma by remodeling a previous tracheostomy. A wide and stable stoma, which facilitates stomal care, can be accomplished by this simple technique.

A Multiplexed, Tiled PCR Method for Rapid Whole-Genome Sequencing of Infectious Spleen and Kidney Necrosis Virus (ISKNV) in Tilapia.

Tilapia farming is one of the most important sectors in aquaculture worldwide and of major importance to global food security. Infectious spleen and kidney necrosis virus (ISKNV) has been identified as an agent of high morbidity and mortality, threatening tilapia aquaculture. ISKNV was detected in Lake Volta, Ghana, in September 2018 and spread rapidly, with mortality rates between 60 and 90% and losses of more than 10 tonnes of fish per day. Understanding the spread and evolution of viral pathogens is important for control strategies. Here, we developed a tiled-PCR sequencing approach for the whole-genome sequencing of ISKNV, using long read sequencing to enable field-based, real-time genomic surveillance. This work represents the first use of tiled-PCR for whole genome recovery of viruses in aquaculture, with the longest genome target (>110 kb dsDNA) to date. Our protocol was applied to field samples collected from the ISKNV outbreaks from four intensive tilapia cage culture systems across Lake Volta, between October 2018 and May 2022. Despite the low mutation rate of dsDNA viruses, 20 single nucleotide polymorphisms accumulated during the sampling period. Droplet digital PCR identified a minimum requirement of template in a sample to recover 50% of an ISKNV genome at 275 femtograms (2410 viral templates per 5 µL sequencing reaction). Overall, tiled-PCR sequencing of ISKNV provides an informative tool to assist in disease control in aquaculture.

Genetic characterization of infectious spleen and kidney necrosis virus in Banggai cardinalfish Pterapogon kauderni identified from eight separate cases between 2000 and 2017

The authors declare that there are no conflicts of interest associated with this publication. The data that support the findings of this study are openly available in National Center for Biotechnology Information at https://www.ncbi.nlm.nih.gov/, reference number MN432490, MT926123. Figure S1 Histologic appearance of a typical infected Banggai cardinalfish from the BCIV-2010 case. (a) and (b) Spleen: Basophilic inclusion bodies in megalocytic cells whose morphology is often obscured. Foci of necrosis within intervening pulp areas. (c) and (d) Kidney: Basophilic inclusion bodies in megalocytic cells within foci of interstitial haematopoietic necrosis. (e) and (f) Intestine: Basophilic inclusion bodies in megalocytic perivascular cells but minimal mucosal reaction. Pigmentation within normal limits. Original magnifications: (a, c) 100×, (d, e) 200×, (b, f) 400×; H&E stain. Figure S2 Conventional PCR results of the Banggai cardinalfish case from 2000 (BCIV-2000) using the MCV-F/R primers (Koda et al., 2018) and a 100 bp ladder. (a) a single positive band for BCIV-2000 at the 173 bp position. Samples (b) and (c) are negative and correspond to the extraction control and negative template control, respectively. (d) a single bright band at the 173 bp position, representing the positive control for the MCV assay. Table S1 Genome annotation of the Banggai cardinalfish iridovirus from 2012 (BCIV-2012). Table S2 Genome annotation of the Banggai cardinalfish iridovirus from 2017 (BCIV-2017). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Preparation and Antibiosis Investigation of Kaolinite Nanotubes and Silver Nanowires Co-Doped Electrospinning-Silk Fibroin/Gelatin Porous Fiber Films

Skin wounds are one of the most common injuries for the human body; they can lead to an infection and cause tissue necrosis and even life-threatening injuries. Therefore, it is an urgent task to develop skin scaffold materials to meet the various needs of restoring skin’s structural integrity. In this research, kaolinite nanotubes and silver nanowires co-doped silk fibroin and gelatin composite porous fiber films were fabricated by an electrospinning method. The composition, micrograph, chemical states of elements included, biocompatibility, and antimicrobial properties of the samples produced were analyzed. After co-doping kaolinite nanotubes and silver nanowires, the fiber diameter of the porous fiber films became uniform, and the beads in the film were reduced significantly. The silk fibroin/gelatin/kaolinite nanotubes/silver nanowire (SF/GEL/KA-N/AgNWs) film shows antibacterial activity against S. aureus and E. coli, and the antibacterial rings were 7.42 mm and 5.76 mm, respectively. All the films were free of cytotoxicity and provided good biocompatibility, which is a great clinical application potential in skin.

A randomized prospective study comparing ultrasonic shears with electrocautery for post-operative morbidity in modified radical mastectomy

Background: Modified radical mastectomy is commonly performed surgery for breast carcinoma. The present study was conducted to compare intra-operative and post-operative surgical outcomes by using monopolar electrocautery and ultrasonic shears in MRM. Methods: A randomized prospective study was conducted with a sample size of 60 patients who were randomized into two groups. One group underwent MRM using ultrasonic shears (Group A) and the other one using monopolar electrocautery (Group B). Intra-and post-operative outcomes were compared. Results: Group A had less intra-operative blood loss and it was statistically significant. Group A had less pain score on post op day 1 and it was statistically significant. However, Group A had less intra-operative time and less drain output but it was statistically insignificant. Group A had less post-operative complication (seroma formation, wound infection, hematoma formation and flap necrosis) compare to Group B and it was statistically significant. Group A, patient had early drain removal compare to Group B, and was statistically significantly. Conclusions: Ultrasonic shears group had significantly lesser intra-operative bleeding, lesser post operative complications, post-operative early drain removal, less post operative pain score, when compared to electrocautery group. However, the two groups had no significant difference in post-operative drain output and operative time.

Comparison of curative effect between Tianji robot assisted screw placement and traditional cannulated screw internal fixation for femoral neck fracture

To investigate the clinical efficacy and advantages of Tianji orthopedic robot assisted cannulated screw internal fixation for femoral neck fracture. The clinical data of 41 patients with femoral neck fracture who underwent internal fixation with cannulated screws from January 2019 to January 2022 were retrospectively analyzed. According to different surgical methods, they were divided into Tianji robot group and traditional cannulated screw fixation group (traditional operation group). Among them, there were 18 patients in Tianji robot group including 8 males and 10 females with age of (56.00±4.22) years old, Garden typeⅠ (4 cases), type Ⅱ (11 cases), type Ⅲ (2 cases), and type Ⅳ (1 case). There were 23 patients in the traditional operation group, including 10 males and 13 females, aged (54.87±4.81) years old;there were 5 cases of Garden typeⅠ, 14 cases of type Ⅱ, 3 cases of type Ⅲ and 1 case of type Ⅳ. The operation time, intraoperative blood loss, fluoroscopy times, guide needle placement times, operation costs and other indicators were observed and compared between two groups. Harris score was used to evaluate hip joint function 12 months after operation. The wounds of all patients healed in Grade A without complications. There were significant differences between two groups in terms of operation time, times of intraoperative fluoroscopy, times of guide needle placement, amount of intraoperative bleeding, and operation cost (P<0.05). All 41 patients were followed up for at least 12 months. The fractures of both groups were healed. There was no infection, screw loosening, fracture displacement and femoral head necrosis in Tianji robot group during follow-up;Screw loosening occurred in 2 patients in the traditional operation group during follow-up. At 12 months after operation, Harris hip joint function score of Tianji robot group was higher than that of traditional operation group in daily activity, lameness, joint activity score and total score (P<0.05). Tianji robot assisted nail placement is a better method for the treatment of femoral neck fracture, which improves the surgical efficiency, is more accurate, has higher success rate of one-time nail placement, shorter operation time, less radiation, and has better hip joint function recovery after surgery.

Genotypic Characterization of Infectious Spleen and Kidney Necrosis Virus (ISKNV) in Southeast Asian Aquaculture

Infectious spleen and kidney necrosis virus (ISKNV) is a species within the genus Megalocytivirus (family Iridoviridae), which causes high mortality disease in many freshwater and marine fish species. ISKNV was first reported in Asia and is an emerging threat to aquaculture with increasing global distribution, in part due to its presence in ornamental fish with clinical and subclinical infections. The species ISKNV includes three genotypes: red seabream iridovirus (RSIV), turbot reddish body iridovirus (TRBIV), and ISKNV. There is an increasing overlap in the recognized range of susceptible fish hosts and the geographic distribution of these distinct genotypes. To better understand the disease caused by ISKNV, a nucleic acid hybridization capture enrichment was used prior to sequencing to characterize whole genomes from archived clinical specimens of aquaculture and ornamental fish from Southeast Asia (n = 16). The method was suitable for tissue samples containing 2.50 × 104–4.58 × 109 ISKNV genome copies mg−1. Genome sequences determined using the hybridization capture method were identical to those obtained directly from tissues when there was sufficient viral DNA to sequence without enrichment (n = 2). ISKNV genomes from diverse locations, environments, and hosts had very high similarity and matched established genotype classifications (14 ISKNV genotype Clade 1 genomes with &gt;98.81% nucleotide similarity). Conversely, two different genotypes were obtained at the same time and location (RSIV and ISKNV from grouper, Indonesia with 92.44% nucleotide similarity). Gene-by-gene analysis with representative ISKNV genomes identified 59 core genes within the species (&gt;95% amino acid identity). The 14 Clade 1 ISKNV genomes in this study had 100% aa identity for 92–105 of 122 predicted genes. Despite high overall sequence similarity, phylogenetic analyses using single nucleotide polymorphisms differentiated isolates from different host species, country of origin, and time of collection. Whole genome studies of ISKNV and other megalocytiviruses enable genomic epidemiology and will provide information to enhance disease control in aquaculture.

A novel mini-invasive step-up approach for the treatment of severe acute pancreatitis with extensive infected necrosis: A single center case series study.

Complete removal of necrosis is critical for treating patients with severe acute pancreatitis (SAP) presenting infection of pancreatic necrosis (IPN). Frequently used mini-invasive methods include the surgical step-up approach suitable for necrosis extending laterally, whereas the endoscopic step-up approach is suitable for medial necrosis. However, in patients with extensive IPN, either approach alone usually has limited treatment effects. We describe a case series of combined mini-invasive step-up approach for treating extensive IPN. Patients were diagnosed with SAP and had extensive IPN. Seven patients with SAP and extensive IPN were enrolled. All patients underwent a combined step-up approach comprising 4 steps: percutaneous catheter drainage, continuous negative pressure irrigation (CNPI), percutaneous endoscopic necrosectomy (PEN), and transgastric necrosectomy (TN). The median interval from symptom onset to percutaneous catheter drainage and CNPI was 11 days (range, 6-14) and 18 days (range, 14-26), and the median CNPI duration was 84 days (range, 54-116). The median interval from the onset of symptoms to PEN and TN was 36 days (range, 23-42) and 41 days (range, 34-48), respectively, and the median number of procedures was 2 (range, 1-2) for PEN and 3 (range, 2-4) for TN. Only a minor case of abdominal bleeding and a pancreatic-cutaneous fistula were reported, both resolved after conservative treatment. The median length of stay in the intensive care unit was 111 days (range, 73-133); all patients survived. This mini-invasive step-up approach shows promising clinical effects and is relatively safe in critically ill patients with extensive IPN and high-risk surgical intervention.

Predictive value of hyperglycemia on infection in critically ill patients with acute pancreatitis

To analyze the predictive value of hyperglycemia on the extrapancreatic infection (EPI) and infected pancreatic necrosis (IPN) of severe patients with acute pancreatitis (AP). We enrolled 234 patients with acute pancreatitis admitted to the intensive care unit (ICU) of the Second Affiliated Hospital of Nanchang University from July 2017 to July 2022 for a retrospective cohort study. We collected maximum blood glucose values three times after admission to the ICU within 120 h (Glu1: 0–24 h, Glu2: 24–48 h, Glu3: 48–120 h), the levels of leucocyte, blood urea nitrogen (BUN), C-reactive protein (CRP), procalcitonin (PCT), and albumin within 24 h after admission to the ICU, and the BISAP and SIRS scores of all patients within 24 h. EPI was taken as the primary outcome indicator and IPN as the secondary outcome indicator. The accuracy of blood glucose values in predicting acute pancreatitis infection was measured by the area under the curve (AUC). A total of 56 patients appeared EPI. Univariate analysis showed that Glu3 was associated with IPN in critically ill patients with AP. Multivariate logistic regression analysis showed that Glu2, Glu3, and SIRS > 48 h were associated with EPI in critically ill patients with AP. The AUCs of Glu2 and Glu3 to predict EPI were 0.805(95%CI: 0.717–0.892) and 0.782(95%CI: 0.685–0.878), respectively, and the cutoff values were 12.60 mmol/L and 14.75 mmol/L, respectively. The AUC of Glu2 combined with Glu3 to predict EPI was 0.812(0.725–0.899). The maximum blood glucose on Day2-5 after admission to the ICU can predict infection in critically ill patients with AP. There are differences in etiology while glucose predicting infection. Patients with hypertriglyceridemia AP need to intervene blood glucose levels more actively and earlier, and control it more strictly.

Serum Zonulin Levels as an Early Biomarker in Predicting the Severity and Complications of Acute Pancreatitis.

Acute pancreatitis can cause local or systemic complications and has high morbidity and mortality rates. In the early stages of pancreatitis, a decrease in the barrier function of the intestines and an increase in bacterial translocation are observed. Zonulin is a marker used to evaluate the integrity of the intestinal mucosal barrier. We aimed to investigate whether measuring serum zonulin levels would contribute to the early prediction of complications and severity in acute pancreatitis. Our study was an observational, prospective study and included 58 patients with acute pancreatitis and 21 healthy controls. Causes of pancreatitis and serum zonulin levels of the patients at the time they were diagnosed with pancreatitis were recorded. The patients were evaluated in terms of pancreatitis severity, organ dysfunction, complications, sepsis, morbidity, length of hospital stay, and mortality Results: Zonulin levels were higher in the control group and lowest in the severe pancreatitis group. No significant difference was observed in zonulin levels according to disease severity. There was no significant difference between zonulin levels in patients who developed organ dysfunction or sepsis. In patients with acute pancreatitis complications, zonulin levels were found to be significantly lower with a mean of 8.6 ng/mL (P < .02). Zonulin levels are not a guide in the diagnosis of acute pancreatitis, in determining its severity, and in the development of sepsis and organ dysfunction. The zonulin level at the time of diagnosis may be helpful in predicting complicated acute pancreatitis. Zonulin levels are not effective in demonstrating necrosis or infected necrosis.

Salvage Case of Corpus Cavernosum Necrosis and Urethral Perforation associated with Infection after Penile Prosthesis Insertion

Penile prosthesis implantation can be considered in patients with unsuccessful treatment with phosphodiesterase type 5 inhibitors for erectile dysfunction. Its associated postoperative complications include infection and urethral injury. Nevertheless, only a few studies have reported the successful management of severe cases. Herein, we report a case of corpus cavernosum necrosis and distal urethral perforation caused by infection after penile prosthesis insertion, which had favorable outcomes. A 60-year-old man with multiple atherosclerotic risks underwent penile prosthesis implantation for erectile dysfunction at another hospital. Postoperatively, he developed infectious necrosis and underwent prosthesis removal. However, he presented at our department because of technical difficulties in the treatment at other hospitals. The initial examination revealed extensive necrosis of the corpus cavernosum and perforation of the peripheral urethra. A thin urethral catheter was inserted, and the necrotic corpus cavernosum was debrided to preserve the artery and urethra. Then, the perforated urethra was sutured. Subsequent negative pressure wound therapy resulted in sufficient granulation and closure of the perforated urethra. One month after the surgery, the scar was resected and sutured following the circumcision line. Despite experiencing this severe postoperative complication, good functional and cosmetic outcomes were achieved after minimal surgery with a blood-flow-conserving method.

National trends and clinical outcomes of interventional approaches following admission for infected necrotizing pancreatitis in the United States.

With recent studies demonstrating the efficacy of minimally invasive approaches following infected necrotizing pancreatitis, latest guideline recommendations support their use. However, large-scale studies are lacking, and the national landscape following these guidelines remains poorly characterized. The present study examined trends in intervention strategies and the association of approach on clinical outcomes and resource use in a nationally representative cohort. The 2016-2019 National Inpatient Sample was queried for adult hospitalizations for pancreatitis with infected necrosis. Patients were classified as drain only (DO) if they received only percutaneous or endoscopic drainage, minimally invasive (MIS) if they underwent endoscopic or laparoscopic debridement, and Open if they underwent open debridement. The primary outcome was in-hospital mortality, while secondary outcomes included perioperative complications, home discharge, and resource use. Multivariable regression models were developed to evaluate the association of intervention with clinical and financial endpoints. Of 4,605 patients who received interventions, 1,735 (37.6%) were DO, 1,490 (32.4%) were MIS, and 1,380 (30.0%) were considered Open. The proportion of DO and MIS increased, while Open declined (2016, 47.0%; 2019, 24.6%; p < 0.001). Compared with Open, MIS had lower rates of abdominal compartment syndrome while having greater rates of preoperative closed drainage (31.9% vs. 13.8%, p < 0.001). After adjustment, odds of in-hospital mortality, respiratory failure, prolonged ventilation, and acute kidney injury were significantly higher in the Open cohort compared with MIS. Hospitalization duration was longer ( β , +12.1 days; 95% confidence interval, 6.8-17.5), and costs were higher ( β , +$58.7K; 95% confidence interval, 33.5-83.9) in Open compared with MIS. Minimally invasive approaches for infected pancreatic necrosis have increased over time, while open necrosectomy has declined. Open approaches compared with drainage only or minimally invasive debridement were associated with greater odds of numerous in-hospital complications and resource burden. Prognostic and Epidemiological; Level IV.

Design and clinical application of X-shaped cross-dressing method in rhytidectomy

ObjectiveTo investigate the effect of “X"-shaped cross-compression dressing of nasal root in rhytidectomy surgery. MethodsFrom 2019.01 to 2022.02, 60 patients with high SMAS facelift in our department were selected to undergo “X"-shaped cross compression bandaging of the nasal root, and the incidence of postoperative hematoma and skin necrosis were counted. ResultsThere were two small-scale hematomas, and no flap infection and skin necrosis were observed postoperatively. ConclusionNasal “X"-shaped cross-compression bandaging method is reliable. It can effectively prevent the occurrence of postoperative hematoma and other complications and significantly improve patients' comfort. Evidence based medicine(ebm) levelIV.

Genetic differentiation of Megalocytivirus by real time PCR and sequencing.

Megalocytiviruses (MCV) are double-stranded DNA viruses that infect fish. Two species within the genus are epidemiologically important for fish farming: red sea bream iridovirus (RSIV) and infectious spleen and kidney necrosis virus (ISKNV). The objective of this work was to study regions that allow the differentiation and correct diagnosis of RSIV and ISKNV. The regions ORF450L, ORF342L, ORF077, and the intergenic region between ORF37 and ORF42R were sequenced and compared with samples from the database. The tree constructed using the sequencing of the PCR product Megalocytivirus. ORF077 separated the three major clades of MCV. RISV genotypes were well divided, but not ISKNV. All qPCRs tests showed acceptable repeatability values, that is, less than 5%. Two qPCRs for ISKNV detection and two for RSIV were considered suitable for use in the diagnosis and typing of MCV. The results of this study demonstrate the importance of an accurate evaluation of methodologies for the differentiation of MCV.