BACKGROUND Colorectal resection is associated with 3-5 wk long elevations in the plasma levels of at least 11 proangiogenic proteins that may stimulate tumor angiogenesis postsurgery.The increases during the first wee...BACKGROUND Colorectal resection is associated with 3-5 wk long elevations in the plasma levels of at least 11 proangiogenic proteins that may stimulate tumor angiogenesis postsurgery.The increases during the first week after surgery may be related to the acute inflammatory response;the cause(s)of the week 2-5 increases is unknown.The wounds are a possible source because of the important role that angiogenesis plays in the healing process.The main hypothesis of the study is that wound fluid levels of the proteins studied will be elevated well beyond plasma levels which,in turn,are elevated from preoperative baseline levels.AIM To determine plasma and wound fluid levels of 8 proangiogenic proteins after colorectal resection for cancer and benign pathology.METHODS Blood and wound fluid samples were taken simultaneously on postoperative(postop)day 1,3,and later time points until wound drain removal in 35 colorectal cancer patients and 31 benign disease patients undergoing colorectal resection in whom closed wound drains had been placed in either the pelvis or the subcutaneous space of the abdominal incision.Postop plasma levels were compared to preop plasma and postop wound fluid levels(separate analyses for cancer and benign groups).RESULTS Sixty-six colorectal disease patients were studied(35 cancer,31 benign pathology).Most patients underwent minimally invasive surgery(open surgery in 11%of cancer and 6%of benign patients).The majority in the cancer group had rectal resections while in the benign group sigmoid or right colectomy predominated.Plasma levels of all 8 proteins were significantly elevated from baseline (P<0.05) at all post-operative time points in the cancer group and at 90% of time points(29/32) in the benign group.Wound levels of all 8 proteins were 3-106 times higher (P<0.05) than plasma levels at 87-90 percent of postop time points;of note,wound levels were more than 10 times higher at 47-50% of time points.CONCLUSION Plasma protein levels were elevated for 3 weeks after surgery;wound fluid levels were much greater than corresponding blood levels.Healing wounds may be the source of the plasma increases.展开更多
目的通过仿真创伤全流程早期救治模拟演练分析我国县域医院创伤救治能力现状。方法2018年7月—2022年7月在全国40家县域医院举办了中国创伤救治培训基层版(China trauma training basic,CTCT?-B),培训包括仿真的创伤早期全流程救治模拟...目的通过仿真创伤全流程早期救治模拟演练分析我国县域医院创伤救治能力现状。方法2018年7月—2022年7月在全国40家县域医院举办了中国创伤救治培训基层版(China trauma training basic,CTCT?-B),培训包括仿真的创伤早期全流程救治模拟演练。本研究对演练中创伤院前急救、院前院内信息联动、院内早期评估与处置、院内救治模式和流程、影响救治结局因素等进行归纳统计分析。结果40家县域医院,其中二级医院29家,三级医院11家;院前急救模式:依托型32家,指挥型6家,独立型2家;院前急救能力方面:院前规范处置31家,不规范处置7家,不处置2家;院前院内信息联动方面:电话/微信24家,院前急救系统8家,中国创伤联盟紫云系统6家,无信息交互2家;院内交接和早期评估:能够按照创伤救治规范化培训要求进行评估和处置23家,不规范17家;创伤救治模式方面:以急诊科为主导的多学科会诊模式34家,创伤科主导的创伤救治模式4家,专科主导多学科会诊模式2家;实体创伤病房6家,急诊病房23家,无病房11家;40名模拟创伤患者16人死亡,其余存活,死亡原因为早期评估和处置不规范,输血流程不合理、创伤相关核心技术缺乏,有效运行的创伤多学科团队缺乏。结论县域创伤救治过程中存在创伤早期评估和核心技术不足、缺乏院内高效的多学科救治团队、创伤集中收治模式尚未普及等问题,亟须重视解决。展开更多
基金Supported by a generous donation from the Thompson Family Foundation to the Division of Colon and Rectal Surgery,Department of Surgery,Mount Sinai West Hospital,New York
文摘BACKGROUND Colorectal resection is associated with 3-5 wk long elevations in the plasma levels of at least 11 proangiogenic proteins that may stimulate tumor angiogenesis postsurgery.The increases during the first week after surgery may be related to the acute inflammatory response;the cause(s)of the week 2-5 increases is unknown.The wounds are a possible source because of the important role that angiogenesis plays in the healing process.The main hypothesis of the study is that wound fluid levels of the proteins studied will be elevated well beyond plasma levels which,in turn,are elevated from preoperative baseline levels.AIM To determine plasma and wound fluid levels of 8 proangiogenic proteins after colorectal resection for cancer and benign pathology.METHODS Blood and wound fluid samples were taken simultaneously on postoperative(postop)day 1,3,and later time points until wound drain removal in 35 colorectal cancer patients and 31 benign disease patients undergoing colorectal resection in whom closed wound drains had been placed in either the pelvis or the subcutaneous space of the abdominal incision.Postop plasma levels were compared to preop plasma and postop wound fluid levels(separate analyses for cancer and benign groups).RESULTS Sixty-six colorectal disease patients were studied(35 cancer,31 benign pathology).Most patients underwent minimally invasive surgery(open surgery in 11%of cancer and 6%of benign patients).The majority in the cancer group had rectal resections while in the benign group sigmoid or right colectomy predominated.Plasma levels of all 8 proteins were significantly elevated from baseline (P<0.05) at all post-operative time points in the cancer group and at 90% of time points(29/32) in the benign group.Wound levels of all 8 proteins were 3-106 times higher (P<0.05) than plasma levels at 87-90 percent of postop time points;of note,wound levels were more than 10 times higher at 47-50% of time points.CONCLUSION Plasma protein levels were elevated for 3 weeks after surgery;wound fluid levels were much greater than corresponding blood levels.Healing wounds may be the source of the plasma increases.
文摘目的通过仿真创伤全流程早期救治模拟演练分析我国县域医院创伤救治能力现状。方法2018年7月—2022年7月在全国40家县域医院举办了中国创伤救治培训基层版(China trauma training basic,CTCT?-B),培训包括仿真的创伤早期全流程救治模拟演练。本研究对演练中创伤院前急救、院前院内信息联动、院内早期评估与处置、院内救治模式和流程、影响救治结局因素等进行归纳统计分析。结果40家县域医院,其中二级医院29家,三级医院11家;院前急救模式:依托型32家,指挥型6家,独立型2家;院前急救能力方面:院前规范处置31家,不规范处置7家,不处置2家;院前院内信息联动方面:电话/微信24家,院前急救系统8家,中国创伤联盟紫云系统6家,无信息交互2家;院内交接和早期评估:能够按照创伤救治规范化培训要求进行评估和处置23家,不规范17家;创伤救治模式方面:以急诊科为主导的多学科会诊模式34家,创伤科主导的创伤救治模式4家,专科主导多学科会诊模式2家;实体创伤病房6家,急诊病房23家,无病房11家;40名模拟创伤患者16人死亡,其余存活,死亡原因为早期评估和处置不规范,输血流程不合理、创伤相关核心技术缺乏,有效运行的创伤多学科团队缺乏。结论县域创伤救治过程中存在创伤早期评估和核心技术不足、缺乏院内高效的多学科救治团队、创伤集中收治模式尚未普及等问题,亟须重视解决。
