Guhua Hospital

The prevalence of cholelithiasis in Mexico is high, and cholecystectomy is a very frequent procedure where antimicrobials are employed, being important to sample and culture the bile fluid to identify local susceptibility to antibiotics to avoid complications and reduce antimicrobial resistance. An observational, cross-sectional, prospective study was designed to identify bile fluid flora in patients undergoing cholecystectomy in a secondary-care teaching hospital with identification, sensitivity, and antimicrobial resistance testing. There were 60 patients (47 female and 13 male), which yielded 15 cases with bactibilia. Bacterial identification was Enterococcus faecalis in 6 cases (40%), Escherichia coli in 5 cases (33.3%), Klebsiella pneumoniae in 2 cases (13.3%), and Raoutella planticola and Streptococcus infantarius, each in one patient. E. faecalis, E. coli, R. planticola, and S. infantarius were mostly sensitive to quinolones, whereas K. Pneumoniae was sensitive to carbapenems and tigecycline. Resistance occurred for ampicillin, benzylpenicillin, and trimethoprim/sulfamethoxazole. Based on our local microbial findings, it is proposed that in cases of acute biliary pathology in patients above the seventh decade of life, empirical antibiotic prophylaxis be used and a bile fluid sample be taken before starting gallbladder dissection, for later adjustment of antibiotic therapy.

A gossypiboma (GPB), also referred to as a textiloma (TXT), is a mass formed as a result of the body’s inflammatory and granulomatous response to retained surgical textile material (RSTM), most commonly gauze or mesh fibers. Its reported incidence ranges from 1 in 1,000 to 1 in 10,000 surgical procedures, although the true frequency is believed to be significantly higher due to underreporting related to medicolegal concerns. This entity is clinically important because it may mimic more common postoperative complications such as abscess (ABS), seroma (SER), or mesh infection (MI), frequently leading to diagnostic delay and unnecessary morbidity.The purpose of this report is to present an uncommon instance of mesh-associated textiloma (MAT) following ventral hernia repair with polypropylene mesh (PPM) and to highlight its radiologic, histopathologic, and clinical features that allow differentiation from other postoperative collections.A 39-year-old female patient with a history of ventral hernia underwent surgical repair with mesh implantation. Postoperatively, she developed persistent umbilical discharge and, three months later, progressive abdominal fluid leakage. Contrast-enhanced computed tomography (CECT) revealed a well-defined hypodense intraperitoneal collection measuring 80 × 64 × 40 mm with a fistulous tract (FT) extending to the abdominal wall, without evidence of systemic inflammatory dissemination. These features, particularly the encapsulated nature of the collection and the organized fistulization pattern, were highly suggestive of a chronic foreign-body reaction (FBR) rather than an acute ABS, which typically presents with diffuse inflammatory infiltration, or MI, which is associated with diffuse mesh thickening and surrounding cellulitis.A second surgical exploration was performed, and the resected specimen underwent histopathological examination (HPE), which demonstrated foreign-body granulomatous inflammation (FBGI) with multinucleated giant cells (MGC) surrounding textile fibers embedded in fibrous tissue, consistent with MAT, and without evidence of dysplasia or malignancy. Following complete excision and aponeurotic closure, the patient recovered uneventfully, with no recurrence during follow-up.This case reinforces that MAT should be included in the differential diagnosis of persistent postoperative collections after mesh-based hernia repair and demonstrates that characteristic CECT findings combined with timely surgical management are essential to reduce morbidity and prevent long-term complications.

Dear Editor, We read with interest the Publish Ahead of Print article by Liu and colleagues examining whether peri-operative serum metabolomic alterations are associated with post-operative complications and hospital stay in colorectal cancer (CRC) surgery[1]. In this observational cohort of 243 patients enrolled from January to December 2024, paired serum samples were obtained 1 day before surgery and again on the first day after surgery, quantified using an advance IVDr high-throughput nuclear magnetic resonance platform, and analyzed alongside peri-operative clinical indicators. The authors evaluated both pre-operative metabolite levels and post-/pre-operative metabolite ratios. They report that integrating metabolic variables with clinical indicators improved discrimination for in-hospital major complications: the AUC increased from 0.749 (clinical indicators alone) to 0.776 when pre-operative metabolites were added, and from 0.727 to 0.805 when metabolite ratios were added. For hospital stay, the combined model increased the explained variance to R2 0.137 (vs 0.102 for clinical indicators alone). The discussion also highlights that recovery-related physiological alterations may be detectable as early as 1 day after surgery, suggesting a potential window for early post-operative risk stratification. These results are encouraging and clinically thought-provoking. One time-related point, however, could affect how readers interpret what the post-operative metabolomic signal represents. Because the post-operative blood draw was performed on the first day after surgery, it is plausible that a subset of major complications – or the earliest clinical changes that prompt diagnostic work-up and treatment – may have emerged before the sampling time. If so, post-operative day 1 metabolite ratios could partly act as early markers of complications already evolving, rather than predictors of events that occur later in the hospital course. This distinction matters clinically: an “early warning” marker measured during immediate recovery can be valuable, but it is conceptually different from a model that is framed as predicting future complications from a baseline time point. To keep this issue answerable within the existing dataset, we would be grateful if the authors could clarify two closely linked items, consistent with guidance for reporting prediction model studies[2]. First, what was the typical interval between the end of surgery and the post-operative blood sampling (for example, median [IQR] hours), and was sampling generally standardized (e.g., morning draws) or dependent on workflow and patient stability? Second, among patients who developed major complications, on which post-operative day – or at what time from surgery – was the first complication first documented or treated? Even a brief summary of the proportion of events first recognized before versus after the post-operative blood draw, and the median time to first event, would help readers judge the effective lead time provided by the metabolomic ratios. In addition, if these timestamps are available in the routinely collected records already analyzed, a timing-restricted sensitivity analysis could strengthen interpretability without requiring any new measurements – for example, repeating the ROC analysis after excluding complications first documented before the post-operative sample, or restricting the endpoint to complications first identified after a prespecified window such as 24 hours. Reporting discrimination separately for “early” versus “later” events could also clarify whether the model’s strength lies in capturing immediate post-operative physiology or in forecasting subsequent deterioration. Such evaluation may facilitate comparison with other peri-operative metabolomics studies in CRC surgery that likewise leveraged early post-operative sampling to identify patients at risk for severe complications[3]. Notwithstanding this query, we commend Liu and colleagues for assembling one of the larger peri-operative metabolomics datasets in CRC surgery and for using metabolite ratios as a pragmatic way to capture individual metabolic responses to surgical stress. We hope that clarification of event timing – and, if feasible, a timing-restricted sensitivity analysis – will further strengthen clinical interpretability and support translation of this promising approach.

Plasma fibrinogen is essential in thrombosis and fibrinolysis, yet its dynamic changes pre- and post-intravenous thrombolysis (IVT) for predicting brain injury severity and prognosis in acute ischemic stroke (AIS) patients remain unclear. This study examined how fibrinogen trends before and after IVT correlate with brain injury severity and clinical outcomes in IVT-treated patients. This multicenter study prospectively enrolled AIS patients treated with IVT at 16 hospitals and recorded their fibrinogen trends before and after thrombolysis. Levels of brain injury markers were measured to represent the extent of brain injury, including glial fibrillary acidic protein (GFAP), ubiquitin c-terminal hydrolase L1 (UCH-L1), S100β, and neuron-specific enolase (NSE). Prognostic indicators included early neurological deterioration (END), hemorrhagic transformation, infarct volume, National Institutes of Health Stroke Scale (NIHSS) score at 7 days, 3-month poor outcome (modified Rankin Scale [mRS] score > 1), and mortality. A total of 827 patients were enrolled, with 207 exhibiting elevated fibrinogen levels 24 h after IVT. Patients with elevated fibrinogen levels exhibited significantly higher levels of brain injury markers (GFAP, UCH-L1, S100β), larger infarct volumes, higher NIHSS scores at 7 days, and a higher incidence of END and poor outcomes compared to those with non-elevated fibrinogen levels. Both univariate and multivariate analyses identified elevated fibrinogen levels after IVT as an independent predictor of severe brain injury, larger infarct volume, higher NIHSS score, occurrence of END, and poor outcomes. Elevated fibrinogen levels 24 h after IVT are independently associated with more severe brain injury and worse clinical outcomes in AIS patients.

Acute cerebral infarction, or stroke, is one of the leading causes of death and disability among adults worldwide, and the key to its treatment is achieving early recanalization of occluded blood vessels, methods for which include intravenous thrombolysis and mechanical thrombectomy. This article reports a case of a 43-year-old female who suddenly suffered acute cerebral infarction and was treated with tissue plasminogen activator intravenous thrombolysis. During the thrombolysis process, transcranial Doppler ultrasound was used to evaluate acute occlusion of the left middle cerebral artery, which was confirmed via an emergency head magnetic resonance angiography and digital subtraction angiography. Before mechanical thrombectomy, repeat angiography showed that the occluded left middle cerebral artery had regained blood flow, and after postoperative follow-up transcranial Doppler ultrasound, the blood flow of the left middle cerebral artery and anterior cerebral artery was found to have fully recovered. The patient’s symptoms were completely relieved, and they were discharged after 7 days of treatment, with follow-up at 2 weeks and 3 months showing no abnormal symptoms or intracranial blood flow. This case not only provides evidence that tissue plasminogen activator intravenous thrombolysis can salvage the ischemic penumbra, dissolve thrombi, and encourage reperfusion in occluded intracranial large arteries, but it also emphasizes the critical role of transcranial Doppler ultrasound in the rapid assessment of acute large vessel occlusions. As such, our report highlights the importance of transcranial Doppler ultrasound in clinical interventions to optimize outcomes in acute stroke management.

Bacterial infection can cause severe pneumonia which leads to high morbidity and mortality. The pathophysiology of pneumonia is characterized by epithelial damage. Our lab recently reported on miRNA-302 (miR-302) family that plays an important role in epithelial regeneration by promoting proliferation of alveolar epithelial progenitor cells to regenerate alveolar epithelial cells (AECs). The existing dilemma on miRNA therapeutics in clinical applications is characterized by effectiveness of cellular uptake and endosomal escape. Here, we describe an optimized lipid nanoparticle (LNP) strategy for the delivery of miRNA mimics to AECs for respiratory tract infection. In this study, we developed miR-302-LNP mimics delivered by nasal administration for lung therapy. Optimized treatment of Klebsiella pneumoniae (Kp)-infected mice with miR-302 mimics improved pulmonary function, host recovery, and survival. To understand the mechanisms of protection against pneumonia, we examined AECs damage and regeneration in Kp-infected mouse lungs. Our results showed that Kp-infected murine pneumonia model with lethal dosage, resulting in severe damage to AECs. We found an increase of miR-302 in AECs, which coincided with AECs regeneration in the miR-302–treated mice. These results demonstrate a promising miRNA-based therapy to enhance host recovery from bacterial pneumonia, which can be used as a novel application of regenerative medicine for the treatment of lung injury.

ABSTRACTTumor microenvironment‐responsive imaging‐guided therapy has emerged as a novel approach for malignant tumor prognosis and therapy. A multifunctional nanoscale drug delivery system is often employed to realize diagnosis, treatment, monitoring, and evaluation by combining a therapeutic unit and an imaging unit to enable. In this study, we designed and prepared a theranostic nanomedicine by conjugating a small‐molecular gadolinium chelate (Diethylenetriaminepentaacetic acid Gadolinium[III] chelate, Gd‐DOTA) and a chemotherapeutic drug paclitaxel (PTX) via a cathepsin B‐responsive linker (glycylphenylalanylleucylglycine, Gly‐Phe‐Leu‐Gly, GFLG) onto a peptide dendron‐hyaluronic acid (HA) hybrid. Upon reaching the tumor microenvironment, the GFLG linker was cleaved by overexpressed cathepsin B, leading to simultaneous release of PTX for targeted chemotherapy and Gd‐DOTA for enhanced magnetic resonance imaging (MRI). The experiments demonstrated that the theranostic nanomedicine significantly enhanced MRI contrast and exhibited superior antitumor efficacy in 4T1 breast tumor models without pronounced systemic toxicity. Importantly, under the tumor microenvironment, effective release and clearance of Gd‐DOTA from the hybrid postimaging reduced the risk of long‐term toxicity. This study presents a feasible approach for cancer theranostics by integrating precise imaging, targeted therapy, and rapid clearance of toxic drugs in a single platform. This promising nanomedicine could be explored for clinical translation.

ABSTRACTBackgroundA malignant tracheoesophageal fistula (mTEF) is a complication of primary tumor growth or the recurrence of esophageal tumors or lung carcinoma. Patients with mTEF have lower survival and quality of life than those who do not develop this complication. Esophageal cancer (EC), a common gastrointestinal malignancy, ranks among the world's leading causes of cancer‐related death. The low survival rate in patients with EC is attributed to malnutrition, repeated aspiration, and severe infection; the mean survival duration is 2–4 months after diagnosis. This study investigated the clinical characteristics of patients with EC complicated with mTEF and the efficacy of various treatment regimens.MethodsThis study was a retrospective analysis of the clinical data of 51 patients with EC complicated with mTEF hospitalized at Guangdong Provincial People's Hospital from February 2007 to May 2021. Patients were divided into three groups according to their treatment regimen: a traditional medical (TM) treatment group, an esophageal intervention (EI) treatment group, and an airway intervention (AI) treatment group.ResultsOf the 51 patients, 22 received TM treatment, 13 received AI, and 16 received EI. The overall median survival duration was 87 days (TM group, 42 days; AI group, 108 days; EI group, 104 days) and the overall mean survival duration was 130.1 days (TM group, 88.1 days; AI group, 153.5 days; EI group, 166.1 days). Cox regression analysis revealed that the treatment regimen was an independent predictive risk factor for increased survival 1 month after treatment in patients with EC complicated with mTEF, and most symptoms were relieved in the EI and AI groups.ConclusionsInterventional treatment of the esophagus and airway in patients with EC complicated with mTEF is an effective approach to improve symptoms and increase short‐term survival.