Experience of small tissue bites with conventional tissue bites in emergency setting for midline abdominal wound closure

Background: Midline incision provides excellent access to the abdominal cavity. However, wound infection following a laparotomy can increase morbidity as well as burden on health care system. Wound prognosis can be influenced by the type of incisions, suture material and the method of closure. This study aimed to assess the outcome of midline abdominal wound closure using two different techniques of wound closure.Methods: This was a prospective observational study and consisted of 300 consecutive patients ≥18 years of age undergoing abdominal surgery through a midline incision in emergency setting. Patients who were included in the study were then randomised into two groups. In group I, midline laparotomy was closed with large tissue bites and in group II small tissue bites were used.Results: Out of 300 patients included in this study, 150 patients were subjected to large tissue bites and another 150 patients to small tissue bites. 29 patients out of 150 patients (19%) in large tissue bites group and 16 patients (11%) in small tissue bites developed surgical site infection (SSI). 23 patients out of 50 patients (15%) in large tissue bites group and 11 patients (7%) in small tissue bites developed wound dehiscence.Conclusions: In this study, we found that the patients in group II whose midline laprotomy was closed with small tissue bites had better wound outcome postoperatively in terms of wound site infection and wound dehiscence.

Usefulness of Fractal Analysis of Kirsch Edge Images for the Tissue Fragment Inner Structure in Breast FNAB

<b><i>Objective:</i></b> Recent advances in high-precision mammography and ultrasound screening have led to an increase in the detection of early lesions (ductal carcinoma in situ and small cancers) appearing as microcalcified lesions or microcystic images, and there needs to be an improvement in the accuracy of breast fine-needle aspiration biopsy (FNAB) assessing these lesions. The objective of this study was to investigate whether fractal analysis of Kirsch edge images for the tissue fragment inner structure (FKT) is useful in breast FNAB. FKT measures tissue fragment chromasia of hyperchromatic crowded tissue fragments (HCG), tissue fragment shape unevenness, and tissue fragment inner structure complexity. <b><i>Study Design Materials:</i></b> Nineteen epithelial tissue fragments of fibroadenoma (FA) from 7 patients and 52 tissue fragments of invasive breast carcinoma of no special type (IBC-NST) (grade 1–2) from 11 patients were assessed. First, tissue fragments were classified into small (smaller than 60 × 102 μm²), medium, and large (100 × 102 μm² or larger), and the appearance rate of each size was determined. Second, for FKT, the luminance value of tissue fragment chromasia, the unevenness and fractal value, and the tissue fragment inner structure complexity were determined. In statistical analysis, the Steel-Dwass test, nonlinear discriminant analysis, and receiver operating characteristic analysis were performed, setting the significance level at <i>p</i> &#x3c; 0.05. <b><i>Results:</i></b> “Unevenness of the tissue fragment shape,” “fractal value of the tissue fragment shape,” and “fractal value of the tissue fragment inner structure” were significantly higher in small and large tissue fragments in IBC-NST compared with those in FA. The specificity and sensitivity were the highest (100%) in small tissue fragments in multivariate analysis using 4 variables (“luminance value of tissue fragment chromasia,” “unevenness of tissue fragment shape,” “fractal value of the tissue fragment shape,” and “fractal value of the tissue fragment inner structure”). <b><i>Conclusion:</i></b> FKT, which evaluates “tissue fragment darkness,” “tissue fragment shape unevenness,” and “tissue fragment inner structure complexity” focusing on small tissue fragments of HCG in breast FNAB, is useful as a system that assists cytopathological assessment of breast FNAB.

PSVI-26 Optimized small tissue specific protein isolation trough complexed diafiltration technique

Physiologically active and pure small tissue specific proteins are in demand in various fundamental and applied areas due to its bioactive properties. It is known that proteins can aggregate, as well as form a highly concentrated layer at the border of the filtration membrane or adhere to it, which significantly interferes with filtration. To eliminate these effects, protein-peptide extracts are recommended to be diluted, as well as using special agents, among them amino acids are more suitable for food industry. The purpose of the study is to develop the isolation and purification of proteins with molecular weight lower 50kDa from porcine hearts and aortas, using different amino acids and its combination. It was previously revealed, that family of fatty acid binding proteins (FABP) is one of the most stable and physiologically active protein in such raw materials. The final technology includes extraction, centrifugation, dilution of extract, diafiltration, lyophilization, dissolving in a small volume of distilled water, dialization and final drying. Concentration of 1.0% glycine and 0.1M proline in both diluted extract and exchange solution was revealed to be most effective to prevent protein aggregation. Dialysates were dried lyophilically and O’Farrell 2DE-electrophoresis with MALDI-TOF MS and MS/MS mass spectrometry identification were used. No proteins of 50kDa and bigger were detected. Proteins of lipid metabolism, peroxiredoxin 2, transgelins etc. with molecular weight lower 50kDa were found. The developed technology allows increasing cardiac and adipocytic isoforms of FABP family content. Cardiac isoform was previously identified in raw material, while adipocytic was newly detected. Adipocytic isoform content is lower than cardiac one; therefore, it was not detected in raw material, but application of complexed diafiltration technique led to increasing its content in dialysate. The developed technology can be used for separation and purification of animal proteins in native and stable forms.

Optimization of a Method for the Simultaneous Extraction of Polar and Non-Polar Oxylipin Metabolites, DNA, RNA, Small RNA, and Protein from a Single Small Tissue Sample

A more comprehensive picture of tissue biology can be obtained through the application and integration of multiple omic technologies. However, the common challenge in working with a precious sample is having a sample too small to separately extract analytes of interest for each experiment. Considering the high heterogeneity that can be present in a single tissue sample, extracting all biomolecules from a single and undivided tissue is preferable because it allows direct comparison of results. Here, we combined a modified Folch extraction method with DNA, RNA, small RNA, and protein extraction using two commercial kits, which allowed us to extract polar metabolites and non-polar oxylipin metabolites, DNA, RNA, small RNA, and protein simultaneously from a small tissue sample. The method was validated in terms of quantity and quality of analytes for downstream analyses.

Comparison of efficacy of large tissue bites versus small tissue bites for midline abdominal wound closure

Background: Incisional hernia is common complication after median laparotomy, with reported incidence varying between 2% and 20%. For prevention of incisional hernia, many clinical trials and meta-analyses have demonstrated that mass closure technique with simple running suture is good option to close midline incision. An attempt was made in this study to compare efficacy of large tissue bites vs small tissue bites for midline abdominal wound closure.Methods: Three hundred thirty patients admitted for midline laparotomy were randomized into Group A, and Group B. Group A, and Group B patients underwent abdominal closure by small bites technique, and large bites technique respectively. Patients were followed at 7th postoperative day, 1 month, 6 months, and 12 months. Primary outcome measures were incidence of incisional hernia, incidence of postoperative complications like post-operative pain, surgical site infections, wound dehiscence whereas, secondary outcome measure was fascial closure time. Inter-group comparison of categorical, and continuous variables was done using Chi-square test/Fisher’s exact test and unpaired ‘t’ test respectively.Results: Incidence of incisional hernia was significantly higher in large bites suture technique compared to small bites suture technique at 12 months follow up. Mean time required for fascial closure time was significantly higher in small bite group compared to large bite group. There was no statistically significant difference in postoperative pain, surgical site infections, and wound dehiscence among the two groups.Conclusions: The rate of incisional hernia was lower in small bites technique compared with large bites technique in midline abdominal incisions.

The Ponticulus Ethmoidalis: A Newly Appreciated Anatomic Landmark in Endoscopic Sinus Surgery

Introduction: Ethmoid sinus anatomy is so variable it has been referred to as a “labyrinth.” Accordingly, this provides a challenge for surgeons performing ethmoidectomy. Identifying consistent anatomic features or landmarks within the ethmoid sinus can aid surgeons performing sinus surgery. The goal of this investigation was to determine if subtle anatomic features are consistently present within the retrobullar recess and could potentially serve as a reliable landmark for surgeons performing ethmoid surgery. Materials and Methods: Ethmoid sinus anatomy was studied in 60 sinonasal complexes through several methods including gross anatomic dissection, endoscopic dissection and 3-D CT stereoscopic imaging. Results: Review of gross sagittal sinonasal specimens revealed that the retrobullar recess was present in all specimens and a tissue bridge was noted emanating from the basal lamella deep within the retrobullar recess in 23/24 gross sagittal specimens; in 1/24 specimens it was quite small or difficult to appreciate. In the radiographic analysis, the tissue bridge was noted in 17/18, in 1/18 it was not appreciated. In the endoscopic dissections it was noted in 17/18, in 1/18 it was small or not appreciated. Conclusion: The small tissue bridge, or ponticulus within the retrobulbar recess was seen in nearly all ethmoid sinuses studied leading us to venture that could be used in surgery to orient surgical dissection through the basal lamella into the posterior ethmoid region.