Greater Success of Primary Fascial Closure of the Open Abdomen : A Retrospective Study Analyzing Applied Surgical Techniques, Success of Fascial Closure, and Variables Affecting the Results

Background and Aims: The open abdomen technique is a standard procedure in the treatment of intra-abdominal catastrophe. Achieving primary abdominal closure within the initial hospitalization is a main objective. This study aimed to analyze the success of closure rate and the effect of negative pressure wound therapy, mesh-mediated medial traction, and component separation on the results. We present the treatment algorithm used in our institution in open abdomen situations based on these findings. Material and Methods: Open abdomen patients (n=61) treated in Tampere University Hospital from May 2005 until October 2013 were included in the study. Patient characteristics, treatment prior to closure, closure technique, and results were retrospectively collected and analyzed. The first group included patients in whom direct or bridged fascial closure was achieved, and the second group included those in whom only the skin was closed or a free skin graft was used. Background variables and variables related to surgery were compared between groups. Results and Conclusion: Most of the open abdomen patients (72.1%) underwent fascial defect repair during the primary hospitalization, and 70.5% of them underwent direct fascial closure. Negative pressure wound therapy was used as a temporary closure method for 86.9% of the patients. Negative pressure wound therapy combined with mesh-mediated medial traction resulted in the shortest open abdomen time (p=0.039) and the highest fascial repair rate (p=0.000) compared to negative pressure wound therapy only or no negative pressure wound therapy. The component separation technique was used for 11 patients; direct fascial closure was achieved in 5 and fascial repair by bridging the defect with mesh was achieved in 6. A total of 8 of 37 (21.6%) patients with mesh repair had a mesh infection. The negative pressure wound therapy combined with mesh-mediated medial traction promotes definitive fascial closure with a high closure rate and a shortened open abdomen time. The component separation technique can be used to facilitate fascial repair but it does not guarantee direct fascial closure in open abdomen patients.Peer reviewe

Day surgery in reduction mammaplasty – saving money or increasing complications?

Background: The benefits of reduction mammoplasty procedures have been reported previously. However, to control the rise in public healthcare costs, we need to find ways of conducting these procedures safely and more cost-effectively. Our aim was to examine whether reduction mammaplasty performed in an outpatient setting has comparable surgical complication rates to those performed in an inpatient setting. We also investigated whether any savings gained from day surgery are still present after any possible indirect costs are considered. Methods: The study population comprised 276 patients who underwent reduction mammaplasty in a single center between January 2019 and February 2021. Data were collected from patient medical records. The costs associated with the primary procedure and any possible additional expenses were calculated. Basic statistical comparisons were performed for propensity score-matched data. Results: Complication rates, readmissions, number of contacts to the health care system, and need for additional surgical interventions were comparable between outpatients and inpatients. The basic costs for outpatients were 2990 euros per patient and 3923 euros for inpatients. Total costs after possible extra expenses were lower in day surgery as it was markedly more cost-effective than patients treated as inpatients. Conclusions: Reduction mammaplasties can be safely performed in an outpatient setting. Moreover, the emergence of complications is comparable to those performed in an inpatient setting. An outpatient setting produced significant cost savings not only in the immediate costs of primary surgery but also in the costs associated with possible complications and extra contacts to the healthcare system.publishedVersionPeer reviewe

Progress and Research Needs of Plant Biomass Degradation by Basidiomycete Fungi

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Characterization of a feruloyl esterase from Aspergillus terreus facilitates the division of fungal enzymes from Carbohydrate Esterase family 1 of the carbohydrate-active enzymes (CAZy) database

Feruloyl esterases (FAEs) are accessory enzymes for plant biomass degradation, which catalyse hydrolysis of carboxylic ester linkages between hydroxycinnamic acids and plant cell-wall carbohydrates. They are a diverse group of enzymes evolved from, e.g. acetyl xylan esterases (AXEs), lipases and tannases, thus complicating their classification and prediction of function by sequence similarity. Recently, an increasing number of fungal FAEs have been biochemically characterized, owing to their potential in various biotechnological applications and multitude of candidate FAEs in fungal genomes. However, only part of the fungal FAEs are included in Carbohydrate Esterase family 1 (CE1) of the carbohydrate-active enzymes (CAZy) database. In this work, we performed a phylogenetic analysis that divided the fungal members of CE1 into five subfamilies of which three contained characterized enzymes with conserved activities. Conservation within one of the subfamilies was confirmed by characterization of an additional CE1 enzyme from Aspergillus terreus. Recombinant A.terreus FaeD (AtFaeD) showed broad specificity towards synthetic methyl and ethyl esters, and released ferulic acid from plant biomass substrates, demonstrating its true FAE activity and interesting features as potential biocatalyst. The subfamily division of the fungal CE1 members enables more efficient selection of candidate enzymes for biotechnological processes.Peer reviewe

Respiration rate determinations suggest Heterobasidion parviporum subpopulations have potential to adapt to global warming

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