大湾区慢性创面医护康标准化体系建设联盟,《中国科技论文》体表外科卷编辑委员会,黄广涛1,吴 军1,郇京宁1,2
(1.深圳大学第一附属医院(深圳市第二人民医院)烧伤整形科,广东深圳518000;2.上海交通大学医学院附属瑞金医院烧伤整形与创面修复科,上海200011)
摘要:负压封闭引流技术(negative pressure wound therapy, NPWT)自2017年国内首部烧伤外科应用专家共识发布以来,其技术类型与临床应用范围均取得了显著拓展。特别是在促进各类急慢性创面愈合及预防外科手术部位感染方面,已累积了大量高质量循证证据。为整合国内外最新研究成果与临床实践经验,规范操作标准,提升治疗水平,国内创面修复相关多学科领域的专家共同撰写了本更新版共识。本共识汇聚了国内多位在创面相关的多学科领域的专家,结合国内外最新研究成果,遵循严谨的循证医学原则,采用系统综述方法,聚焦于NPWT的技术分类、适应症、参数优化及并发症处理等核心议题。工作小组系统检索了PubMed、Web of Science、IEEE Xplore及中国知网等数据库中2015—2025年相关文献,共获得791篇。经去重、筛选,并根据纳入标准(临床研究、随机对照试验、meta分析及相关共识等)最终纳入210篇文献进行证据综合与评价。本共识旨在为创面修复相关学科的临床医生提供基于最新证据、统一且可操作的治疗方案与技术规范。共识内容充分结合了我国临床实践的现状与需求,以期推动NPWT在国内的合理、规范及高效应用,最终惠及广大患者。
关键词:负压封闭引流技术;手术部位感染;创面修复;手术切口并发症
Yesica Y. Quiroz 1 , Enver Moncada 2 , Erika Llorens 3 , Ivan Schwartzmann 4 , Jorge Caffarati 5 , Anna Bujons *
Summary
Introduction
Paratesticular sarcoma is an aggressive malignant tumor of mesenchymal origin. The rhabdo-myosarcoma is the most common among children. Rhabdomyosarcoma treatment consists of surgery, chemotherapy and radiotherapy. Prognosic depends on local recurrence and distant metastasis.
Material and methods
We present the case of a 16-year-old male, who in April 2016 underwent right radical orchiectomy surgery by testicular mass rapidly evolving, with pathological results indicating a paratesticular rhabdomyosarcoma. The extension study showed a precaval adenopathy suggestive of lymph node metastasis, therefore it was a high-grade rhabdomyosarcoma. There was an appropriate response after chemotherapy (Protocol EpSSG RMS2005) and we decided to perform a robotic.
Results
We performed a transperitoneal approach with 8 mm trocar and 12 mm optica trocar. We accessed the retroperitoneal space through a latero-colic incision. Then we performed a craniocaudal lymph node dissection until the aortic bifurcation. The surgical time was 240 min with a blood loss of 200 ml. There were no complications. The patient was discharged on the fourth day after surgery. Pathology showed metastasis of rhabdomyosarcoma without capsular rupture. After two months, we placed the left testicle into inguinal canal prior to radiotherapy.
Conclusions
Robotic lymph node metastasis lymphadenectomy from paratesticular sarcomas is a feasible treatment with the advantage of minimally invasive surgery and acceptable morbidity.
Issue: Volume 64 - Issue 12 - December 2018 ISSN 1943-2720
Index: Ostomy Wound Manage. 2018;64(12).
Please provide a short description of your background, training, and experience.I have 30 years in the pharmaceutical industry, with 15 years in big pharma within senior management positions in research and development (R&D) as well as 15 years in a number of successful biotechs in C-level management positions. Throughout my professional career, I developed expertise in all phases of R&D across multiple therapeutic areas, including raising significant funds and serving as the architect of several clinical stage licensing deals.
In addition to serving as the CEO and Executive Director of the Supervisory Board at Neem Biotech (concurrently serve as a member of several scientific advisory boards and supervisory boards as a non-executive director and am a strategic advisor to several venture capital firms and their portfolio companies.
Prior to starting my career, I obtained a BSc in Applied Biology from University of Bradford (United Kingdom) and my PhD in Biochemistry from University of Swansea (Wales, United Kingdom).
What would Neem like readers to know about the company?Neem Biotech is a pharmaceutical biotechnology company that is based in the Welsh Valleys of the United Kingdom. Neem is a small company that has a big heart and big goals. Arising from humble beginnings, it has grown in 5 years from single staff numbers to a team of nearly 25 at the moment. Neem aspires to play a leading role in bringing about better quality of life for people with chronic wounds through the development of non-traditional antibiotics.
Neem’s staff have a diverse mix of chemical and biological expertise; they apply this expertise and their cumulative problem-solving skills in the company’s drug development program. Our flagship drug development program targets better management of acute, localized, or spreading infections that occur in chronic wounds.
The company has generated deep expertise in quorum sensing, the chemical signaling processes that bacteria such as Staphylococcus aureus and Pseudomonas aeruginosa use to proliferate and evade the effects of both the hosts’ immune system and any antibiotics that may be taken ultimately harming the hosts. Neem’s lead product’s quorum sensing capabilities create a unique opportunity to minimize bacterial invasion of surrounding tissue, decrease damage to this tissue, reduce attachment by bacteria to surrounding surfaces, and disrupt the formation of biofilms. As a potential nontraditional antibiotic, successful development of this candidate could bring a novel approach that targets the harmful effects of bacteria in wounds.
What are your day-to-day and extraordinary responsibilities as the CEO of Neem?I see my most important responsibility as leading a team of committed and talented scientists through the process of taking a compound that shows promise to treat and prevent the spread of infection in wounds through the necessary discovery and development processes so that this compound can be tested for use as a first-in-class therapy in the treatment of wound infection. This is not only my day-to-day focus but also an extraordinary privilege.
As the face of the company, I have the honor of presenting Neem Biotech’s work at conferences, meetings, round table discussions and panels such as the ASM Biofilms conference recently held in Washington, DC. This can mean a fair amount of traveling on occasion. This provides the opportunity for Neem to become an internationally-recognized biotech company.
As Neem’s activities are expanding, at least some time every day is spent in making sure that the company has the necessary resources and direction to allow this growth to take place.
As a hands-on CEO, my day-to-day office schedule involves keeping track of my team’s progress and wellbeing. This translates to spending a large part of my time in face-to-face discussions with my staff. The back-office functions of my role are no less important: corporate and board functions mean that the company remains on-course strategically and financially.
What is the biggest challenge you face working in the realm of wound care?Wounds are a multifaceted and complex phenomenon, with many different outcome permutations possible. One of the factors that impacts outcomes is the presence of infection in wounds and the individual’s specific responses to treatments received for such wounds. Bacteria such as S aureus and P aeruginosa are frequently found in wounds and can be particularly difficult to treat effectively. A legacy technical challenge is that wound interventions have historically often not received positive opinions from regulatory authorities in view of this complexity. This and bringing an intervention with a novel mechanism of action are the challenges we will need to overcome. Challenges can, however, also be viewed as opportunities, and this is how Neem has chosen to view our work in the management of wound infections.
What do you find to be the most rewarding parts of your job?It is a very privileged position to be part of a process that moves an idea from being a concept into a tangible, biologically-active compound that shows a positive effect on human disease conditions. I have had the privilege of being involved in about 10 such programs where small molecule compounds were translated from ideas in chemists’ and biologists’ heads to compounds that showed good effect in human trials. This is a very powerful motivating factor and one of the most rewarding aspects of my work.
In day-to-day practice, rewarding moments have included achievements such as successful identification of a drug candidate after months of intensive experimentation and testing, receiving word of a successful submission to regulatory authorities or being awarded grant funding to take the program further. These milestones make all the hard work on the team’s part worthwhile.
What about Neem attracted you to the company?The innovative approach to an area of high unmet need, the energizing culture that fosters invention and achievement, and the team of expert and highly motivated individuals.
How do you maintain a work-life balance?I live by the motto “work hard, play hard.” In addition, I have a delightful young family that ensures I get away from thinking about work all the time. Lastly, I am a musician and enjoy live music of all types which helps me relax.
What book/reading material is sitting on your nightstand/coffee table?I currently have 50 Years of Rolling Stone: The Music, Politics and People that Changed Our Culture on my coffee table.
伤口世界平台生态圈,以“关爱人间所有伤口患者”为愿景,连接、整合和拓展线上和线下的管理慢性伤口的资源,倡导远程、就近和居家管理慢性伤口,解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
扫一扫了解详情:
任何关于疾病的建议都不能替代执业医师的面对面诊断。所有门诊时间仅供参考,最终以医院当日公布为准。
网友、医生言论仅代表其个人观点,不代表本站同意其说法,请谨慎参阅,本站不承担由此引起的法律责任。