OBJECTIVE: We analysed closure techniques in the treatment of giant omphalocele. A challenging pathology where there lacks consensus.
METHODS: Cochrane, MEDLINE and EMBASE were searched between 1 January 1992 and 31 December 2022 using terms and variations: omphalocele, exomphalos, giant, closure and outcome. Papers were selected using Preferred Reporting Items for Systematic review and Meta-Analyses 2020 criteria. Data collected included demographics, timing and technique of surgical repair, morbidity and mortality.
RESULTS: We identified 342 papers; 34 met inclusion criteria with a total 356 neonates. Initial non-operative management was described in 26 papers (14 dressings, eight silo, four serial sac-ligation). Operative techniques by paper were as follows: Early closure: nine primary suture closure without patch, two primary closure with patch and four mixed methods. Delayed closure: five simple, four-component separation technique, four tissue expanders, one Botox/pneumoperitoneum and two with patch. Median number of procedures was two (1-6) in the early group versus three (1-4) in the delayed. The most favourable was early primary closure with biological patch. The most unfavourable was delayed closure with patch. Cumulative reported mortality remained high, mostly due to non-surgical causes.
CONCLUSIONS: Definitions of giant omphalocele in the literature were heterogeneous with a variety of management approaches described.

Purse-seine tropical tuna fishing in the eastern tropical Pacific Ocean (EPO) results in the bycatch of several sensitive species groups, including elasmobranchs. Effective ecosystem management balances conservation and resource use and requires considering trade-offs and synergies. Seasonal and adaptive spatial measures can reduce fisheries impacts on nontarget species while maintaining or increasing target catches. Identifying persistently high-risk areas in the open ocean, where dynamic environmental conditions drive changes in species\' distributions, is essential for exploring the impact of fisheries closures. We used fisheries observer data collected from 1995 to 2021 to explore the spatiotemporal persistence of areas of high bycatch risk for 2 species of oceanic sharks, silky shark (Carcharhinus falciformis) and oceanic whitetip shark (Carcharhinus longimanus), and of low tuna catch rates. We analyzed data collected by fisheries scientific observers onboard approximately 200 large purse-seine vessels operating in the EPO under 10 different flags. Fishing effort, catch, and bycatch data were aggregated spatially and temporally at 1° × 1° cells and monthly, respectively. When areas of high fishing inefficiency were closed the entire study period and effort was reallocated proportionally to reflect historical effort patterns, yearly tuna catch appeared to increase by 1-11%, whereas bycatch of silky and oceanic whitetip sharks decreased by 10-19% and 9%, respectively. Prior to fishing effort redistribution, bycatch reductions accrued to 21-41% and 14% for silky and oceanic whitetip sharks, respectively. Our results are consistent with previous findings and demonstrate the high potential for reducing elasmobranch bycatch in the EPO without compromising catch rates of target tuna species. They also highlight the need to consider new dynamic and adaptive management measures to more efficiently fulfill conservation and sustainability objectives for exploited resources in the EPO.
Gestión espaciotemporal adaptativa para reducir la captura incidental de tiburones en la pesca del atún Resumen La pesca con cerco del atún tropical en el Pacífico Tropical Oriental (PTO) resulta en la captura incidental de varios grupos de especies sensibles, incluidos los elasmobranquios. La gestión eficiente del ecosistema equilibra la conservación y el uso de recursos y requiere que se consideren las compensaciones y las sinergias. Las medidas espaciales adaptativas y estacionales pueden reducir el impacto de las pesquerías sobre las especies accesorias mientras mantienen o incrementan la captura intencional. La identificación de las áreas con alto riesgo persistente en mar abierto, en donde las condiciones ambientales dinámicas causan cambios en la distribución de las especies, es esencial para explorar el impacto del cierre de las pesquerías. Usamos datos de observadores de las pesquerías recolectados entre 1995 y 2021 para explorar la persistencia espaciotemporal de las áreas con alto riesgo de captura incidental para dos especies de tiburón (Carcharhinus falciformi y C. longimanus) y con tasas bajas de captura de atún. Analizamos los datos recolectados por los observadores científicos de las pesquerías a bordo de aproximadamente 200 embarcaciones grandes de pesca con cerco que operaban en el PTO bajo diez banderas diferentes. Agregamos los datos sobre el esfuerzo de pesca, captura y la captura incidental de forma espacial y temporal en celdas de 1° x 1° y mensual, respectivamente. Cuando las áreas con gran ineficiencia pesquera se encontraban cerradas durante toda la investigación y el esfuerzo se reasignaba proporcionalmente para reflejar los patrones históricos de esfuerzo, el esfuerzo anual de captura de atún parecía incrementar en un 1‐11%, mientras que la captura incidental de las dos especies de tiburones disminuía en un 10‐19% (C. falciformi) y 9% (C. longimanus). Antes de que de redistribuyera el esfuerzo de pesca, la reducción de la captura incidental se acumuló hasta el 21‐41% (C. falciformi) y 14% (C. longimanus). Nuestros resultados son congruentes con resultados previos y demuestran el gran potencial de reducción de la captura incidental de elasmobranquios en el PTO sin poner en peligro las tasas de captura de las especies de atún. Los resultados también enfatizan la necesidad de considerar medidas adaptativas nuevas y dinámicas para cumplir de forma más eficiente los objetivos de conservación y sustentabilidad para la explotación de recursos en el PTO.
【摘要】: 在东热带太平洋围网捕捞热带金枪鱼时会兼捕一些敏感物种群, 如板鳃亚纲物种。有效的生态系统管理需要平衡保护和资源利用, 并考虑利弊权衡和协同作用。季节性和适应性空间措施可减少渔业对非目标物种的影响, 同时保持或增加目标物种的渔获量。在开阔的海洋中, 动态环境条件驱动着物种分布的变化, 识别这些区域中持续存在的高风险区域对于探究渔场禁渔的影响至关重要。本研究利用1995年至2021年收集的渔业观测数据, 探讨了两种海洋中的鲨鱼(镰形真鲨[Carcharhinus falciformis]和长鳍真鲨[Carcharhinus longimanus])的高兼捕风险区域与金枪鱼的低渔获区域的时空持续性。我们分析了在东热带太平洋区域作业的约200艘悬挂10种不同船旗的大型围网渔船上渔业科学观察员收集的数据, 并将捕捞作业量、渔获量和兼捕数据分别按1° x 1°的单元格和月份进行空间和时间整合。如果在整个研究期间关闭捕捞效率低的渔场, 并根据历史上的捕捞作业格局按比例重新分配捕捞作业量, 则每年的金枪鱼渔获量可以增加1‐11%, 而镰形真鲨和长鳍真鲨的兼捕量可分别减少10‐19%和9%。在重新分配捕捞作业量之前, 镰形真鲨和长鳍真鲨的兼捕量分别逐步减少了21‐41%和14%。我们的结果与之前的研究结果一致, 证明了有望在不影响目标金枪鱼物种渔获量的情况下, 大大减少东热带太平洋中板鳃亚纲物种的兼捕量。这些结果还强调了考虑新的动态和适应性管理措施的必要性, 以更有效地实现东热带太平洋保护和可持续利用资源的目标。【翻译:胡怡思;审校:聂永刚】.

UNASSIGNED: To investigate the feasibility of leg wound closure and reconstruction of maxillofacial soft defect by a fusiform-designed skin paddle in fibula free flap (FFF).
UNASSIGNED: Fifty patients who underwent FFF for reconstruction of maxillofacial soft defect were divided into two groups. The fusiform group (20 patients) was treated using a fusiform-designed skin paddle in FFF (skin paddle width less than 2 cm), and leg wound was closed using primary suturing. Reconstruction of the maxillofacial soft defect or filling of dead space was achieved by folding the fusiform skin paddle. The conventional group (30 patients) was treated using the conventional-designed skin paddle (skin paddle width no less than 2.5 cm). The leg wound was closed using mattress suturing or skin graft, while reconstruction of the maxillofacial soft defect or filling of dead space by conventional way. The average postoperative length of hospital stay, healing time of leg wound, and post-surgical complications were recorded at least 6 months after the surgery.
UNASSIGNED: Compared with traditional method, the fusiform-designed skin paddle reduced the average healing time of the leg wound (fusiform group: 11.05 days, conventional group: 14.77 days, P < 0.05). The average length-to-width ratio in fusiform group was significantly greater than that of in conventional group (fusiform group: 5.85, conventional group: 2.93, P < 0.05), and no difference was observed on the graft size of skin paddle between two groups (fusiform group: 23.13, conventional group: 27.13, P > 0.05). The post-surgical early complications of the leg wound in the conventional group were higher than that of in the fusiform group (fusiform group: 0%, conventional group: 6.67%), while the post-surgical late complication of the donor site between the two groups showed no case. Healing disorders of maxillofacial soft reconstruction in the conventional group were higher than that of in the fusiform group (fusiform group: 5.26%, conventional group: 20.69%).
UNASSIGNED: Fusiform-designed skin paddle for closure of the leg wound and maxillofacial soft defect is a feasible alternative to the conventional- designed skin paddle. The fusiform- designed skin paddle resulted in the less postoperative length of hospital stay, shorter healing time of leg wound and less complication.

Objectives: To evaluate the effectiveness of ofloxacin ear drops versus no intervention in the repair of traumatic tympanic membrane (TM) perforations from randomized controlled trials (RCTs). Data Sources: Medline/PubMed, CENTRAL, Clinical Trials.Gov, and Google Scholar. Study Selection: Inclusion criteria: (1) English language; (2) RCT studies; (3) reported the outcomes on the application of ofloxacin and outcomes of spontaneous healing. Exclusion criteria: (1) studies without a control group; (2) patient with severe otologic disease such as chronic suppurative otitis media or ossicular disruption or patients with craniocerebral injury; (3) studies with no pretreatment values or single-arm clinical studies. Data Extraction: Country, year of publication, number of participants in each arm, patient characteristics such as age, sex, intervention details, laterality, cause of TM perforation, position of perforation, follow-up time, hearing gain, rate of TM closure, and closure time. Results: A total of 6 RCTs studies were analyzed. A total of 502 participants were included; the relative risk for closure rate of ofloxacin treatment was 1.18 [95% confidence interval (CI), 1.08 to 1.28, P < .001] and the mean difference (MD) for healing time was -18.4 (95% CI, -19.96 to -16.82, P < .001), suggesting ofloxacin has a significant effect on closure of TM perforations. However, no clinically significant effect in hearing (SMD: 0.21, 95% CI, 0.02 to 0.40, P = .03) was seen in ofloxacin group. Also, patients in the ofloxacin group were associated with a 13% reduction in the risk of infections compared to their observation-assigned counterparts, but this estimate was not statistically significant. Conclusion: Ofloxacin use in patients with traumatic TM perforation is effective in reducing healing time and increasing rate of TM perforation closure. No evidence of increased risk of hearing loss or infection rates are encountered when ofloxacin is prescribed to patients with traumatic TM perforation.

BACKGROUND: Patent foramen ovale (PFO) affects 20%-34% of adults and is associated with strokes and other disorders. The conventional treatment of PFO-related strokes is a closure procedure. The metal device is associated with some adverse events.
OBJECTIVE: Our aim was to investigate the efficacy and safety of PFO closure using cryoablation without implantation in patients with atrial fibrillation (AF) who underwent pulmonary vein isolation (PVI).
METHODS: We divided the 22 patients with both PFO and AF who underwent PVI via cryoablation into 2 groups: standard PVI + atrial septal (AS) cryoablation group (group 1, n = 11) and standard PVI group (group 2, n = 11). The guidewire accesses the left atrium through the PFO without AS puncture during the procedure. Standard PVI via cryoablation was performed. The cryoballoon was retracted to the right atrium and inflated against the AS post-PVI. Patients in group 1 had cryoablation for 120-150 seconds, whereas patients in group 2 received sham ablation. The co-primary end points were the PFO closure rate and a composite of AF recurrence and stroke/transient ischemic attack (TIA) events.
RESULTS: There were no differences in procedure-related adverse events between the 2 groups. Neither group had an ischemic stroke report at 1-year follow-up. The PFO closure rate at 6 months in group 1 was significantly higher than that in group 2 (7 [63.6%] vs 1 [9.1%]; P = .002). AF recurrence post ablation was comparable in both groups at 3 months (3 [27.3%] vs 1 [9.1%]; P = .269), 6 months (0 vs 0), and 12 months (2 [18.2%%] vs 1 [9.1%]; P = .534) of follow-up.
CONCLUSIONS: Cryoablation is a safe and effective approach to close PFO in patients with AF undergoing PVI in a single procedure.

BACKGROUND: During pituitary surgery, CSF leaks are often treated by intrasellar packing, using muscle or fat grafts. However, this strategy may interfere with the interpretation of postoperative MRI and may impact the quality of resection in cases of second surgery, due to the existence of additional fibrous tissue. We present an alternative technique, using a diaphragm reconstruction with a heterologous sponge combining fibrinogen and thrombin (TachoSil), applied in selected patients with low-flow CSF leaks. This study investigates the surgical outcome of patients treated with this strategy.
METHODS: From a cohort of 2231 patients treated from June 2011 to June 2023 by endoscopic endonasal approach for pituitary surgery, the surgical technique of diaphragm repair with TachoSil patch performed in 55 patients (2.6%) was detailed, and the rate of closure failure was analyzed at 6 months postoperatively. No intrasellar packing was used and sellar floor reconstruction was performed whenever possible. The rate of postoperative CSF leak was compared with that reported in three previous publications that also used the TachoSil patch technique.
RESULTS: Patients were mostly women (F/M ratio: 1.2) with a median age of 53.6 years. Surgery was indicated for non-functioning adenomas, Cushing\'s disease, acromegaly, and Rathke\'s cleft cysts in 38/55 (69.1%), 6/55 (10.9%), 5/55 (9.1%) and 6/55 (10.9%) patients respectively. The rate of postoperative CSF leak was 1.8% (n = 1/55), which was not significantly different from that reported in the three cohorts from the literature (2.8%, p > 0.05). No postoperative meningitis was recorded.
CONCLUSIONS: In highly selected patients with low-flow CSF leaks related to small focal diaphragm defects, diaphragm reconstruction using a TachoSil patch can be a safe and valuable alternative to intrasellar packing.

UNASSIGNED: To compare the effectiveness of transthoracic echocardiography (TTE) and X-ray guided closure of patent foramen ovale (PFO).
UNASSIGNED: In this retrospective study, clinical data from 90 patients who underwent PFO occlusion surgery in the First People\'s Hospital of Yongkang from January 2020 to December 2022 were retrospectively reviewed. Among them, 43 patients underwent X-ray guided PFO occlusion surgery (X-ray group) while 47 patients underwent TTE guided PFO occlusion surgery (TTE group). Perioperative, cardiac function related indicators were measured before and after treatment, along with right-to-left shunting status, and incidence of complications in both groups.
UNASSIGNED: There was no significant difference in the duration of surgery or hospitalization between the TTE group and the X-ray group (p>0.05). After treatment, the cardiac function indicators of both groups increased compared to before treatment (p<0.05), and there was no significant difference between the groups (p>0.05). After treatment, right-to-left shunting in the two groups improved compared to before treatment (p<0.05), with no significant difference between the groups (p>0.05). There was no significant difference in complications between the two groups (p>0.05).
UNASSIGNED: TTE guided PFO occlusion is as effective as X-ray guided PFO occlusion in the treatment of PFO. TTE surgery is clinically beneficial for reducing radiation damage with a good safety profile.

BACKGROUND: Tracheoesophageal fistula (TEF) especially malignant TEF (mTEF) is an uncommon yet critical medical condition necessitating immediate intervention. This life-threatening condition frequently manifests in critically ill patients who are dependent on prolonged mechanical ventilation and are unsuitable candidates for thoracotomy due to their compromised health status. The Management of these mTEF patients remain a significant challenge.This study aimed to evaluate the safety and efficacy of using a cardiac septal occluder for the closure of mTEF.
METHODS: 8 patients with mTEF underwent closure surgery using atrial/ventricular septal defect (ASD/VSD) septal occluders at the Respiratory Department of HuBei Yichang Central People\'s Hospital from 2021 to 2023. The procedure involved percutaneous placement of the occluder through the fistula to achieve closure.
RESULTS: The placement of the cardiac septal occluder was successfully achieved with ease and efficiency in all patients. The study demonstrated that the use of cardiac septal occluder therapy in patients with mTEF can alleviate symptoms, improve quality of life, and enhance survival rates, with no significant complications observed. Furthermore, the study provided comprehensive details on surgical indications, preoperative evaluation and diagnosis, selection of occluder, methods of occlusion, and postoperative care.
CONCLUSIONS: The application of cardiac septal occluder in the treatment of mTEF is a safe and effective palliative treatment. This approach may be particularly beneficial for patients with a high risk of complications and mortality associated with traditional surgical interventions.

暂无摘要。

OBJECTIVE: Endoscopic hand suturing (EHS) is a novel technique for closing a mucosal defect after endoscopic submucosal dissection (ESD). We investigated the technical feasibility of colorectal EHS using a modified flexible through-the-scope needle holder.
METHODS: This was a prospective multicenter study conducted at two referral centers between June 2022 and April 2023. This study included colorectal neoplasms 20-50 mm in size located in the sigmoid colon or rectum. A modified flexible through-the-scope needle holder, with an increased jaw width to facilitate needle grasping, was used for colorectal EHS. The primary end-points were sustained closure rate on second-look endoscopy (SLE) performed on postoperative days 3-4 and suturing time for colorectal EHS. Secondary end-points included complete closure rate and delayed adverse events.
RESULTS: We enrolled 20 colorectal neoplasms in 20 patients, including four patients receiving antithrombotic agents. The tumor location was as follows: lower rectum (n = 8), upper rectum (n = 2), rectosigmoid colon (n = 4), and sigmoid colon (n = 6), and the median mucosal defect size was 37 mm (range, 21-65 mm). The complete closure rate was 90% (18/20 [95% confidence interval (CI) 68.3-98.8%]), and the median suturing time was 49 min (range, 23-92 min [95% CI 35-68 min]). Sustained closure rate on SLE was 85% (17/20 [95% CI 62.1-96.8%]). No delayed adverse events were observed.
CONCLUSIONS: EHS demonstrated a high sustained closure rate. Given the long suturing time and technical difficulty, EHS should be reserved for cases with a high risk of delayed adverse events.