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.
Authors
Lia van Rijswijk
Issue: Volume 64 - Issue 9 - September 2018 ISSN 1943-2720
Index: Ostomy Wound Manage. 2018;64(9):6-7.
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Almost every health care professional who has submitted manuscripts for publication in an indexed and peer-reviewed journal has a story to tell about manuscript rejection(s). This puts them in good company and their manuscript(s) squarely in the majority. From what can be gleaned from the literature, the manuscript acceptance rate for medical and nursing journals is <50% (ranging from about 10% to 75%).1-3The acceptance rate for manuscripts submitted to Ostomy Wound Management can be categorized as average; currently, approximately 35% of manuscripts submitted to our journal are accepted for publication.
These numbers represent frequent disappointment and a loss of time for authors, editors, and reviewers. Such data also have the potential to increase the appeal of submitting the rejected manuscript for publication in a predatory journal where it will be more likely to be published; however, doing so can negatively impact the authors’ pocketbooks and reputations while ensuring the work will be lost because it is not indexed in reputable databases (eg, Medline and the Cumulative Index to Nursing and Allied Health Literature; it also may not be archived by the “publisher”.4
Because communications from clinicians and researchers through scholarly publications in peer-reviewed and indexed journals remain the gold standard for advancing science, knowing how to prevent your work from gathering dust is crucial. Let’s look at some of the most common reasons manuscripts are rejected for publication.
The topic is not relevant for the readers of the journal or the information does not provide new knowledge or a new or updated perspective on a particular issue, concern, or methodology.1,2,5Manuscripts that simply rehash information are not a publishing priority. It is crucial to carefully consider the target audience of the journal before submitting your manuscript. For example, most of our readers are clinicians. As a result, the number of preclinical studies we publish is limited. Check the mission of the journal before submitting your manuscript (eg, author instructions and the focus of publications in OWMcan be found at www.o-wm.com/authorinfo ).
The manuscript contains flaws in study design, methodology, analysis, the results reporting and interpretation. Missing information is a common shortcoming among manuscripts submitted to this and other journals.1,2,5 This includes inconsistencies among the purpose of the work, the methods used, and the results reported. It also includes omitting a clear description regarding Institutional Review Board approval, informed consent, participant identity protection procedures used, numbers that do not add up, and other missing information. Whether a randomized controlled clinical study, case study, case series, survey, literature review, or meta-analysis, all publications containing original data must adhere to established scientific criteria for the work and follow the same manuscript format. The bottom line for all reporting of original data is that the reader should be able to duplicate the work reported.
The manuscript is poorly written. In one survey, editors of nursing journals reported that poor writing was the second most common reason for rejecting manuscripts.2 In another report, 24% of rejected manuscripts were categorized as being “difficult to follow”.1 At OWM, we also see a considerable number of manuscripts that are poorly organized, difficult to follow, and/or poorly written. No matter how much work went into a project, a poorly written manuscript means reviewers will have a difficult time understanding what was done and how. This significantly decreases the likelihood acceptance. There are few excuses for submitting work that is poorly organized and poorly written. Authors should get a second, third, or even fourth opinion before submitting. Ask colleagues (preferably persons who are not familiar with your work) to tell you honestly if they understand what you did/did not do.
The author(s) did not follow the guidelines for authors. This, too, is a common but very preventable reason for manuscript rejection. All journals provide detailed instructions about the required manuscript format and general adherence to the American Medical Association or American Psychological Association manuals of style guidelines. Simply follow the instructions. If you have written a paper for another purpose that was not published (eg, a class assignment; FYI, we welcome student authors), you typically cannot simply submit it for publication without considering this requirement (as well as the above-mentioned considerations). In one study, one third of rejected manuscripts did not adhere to the journal’s author guidelines.2 Clearly, reviewers will not reject a manuscript if someone missed a few periods in a reference list. But, as with reason 3 above, there are few excuses for not reading and following the guidelines.
The conclusions are overstated, the results overinterpreted, or the Discussion or Conclusion is weak.These common reasons cited for manuscript rejection1,5,6 could technically be considered under the elements mentioned under reason 2 but warrant a separate review here because they are common concerns cited by OWM reviewers. After reviewing and reading the reviews of approximately 1000 manuscripts (that is what happens after being in this position for >20 years), I see 2 themes related to problems with the discussion and conclusion. The first centers on a disconnect between the method of the work and its implications for practice and research. This often involves an incorrect interpretation of terms such as effectiveness, efficacy, and cost effectiveness — in other words, the basics of science. The second theme involves the overinterpretation of some or all of the results and is frequently supported by carefully selected references. For example, important references pertaining to the topic typically are ignored in favor of those that support the authors’ belief and represents failure to consider alternative explanations, uncritical acceptance of results, unexplained inconsistencies, inflation of the importance of the findings, or a conclusion disproportionate to the results.5
Hopefully, the explanations of common reasons for manuscript nonacceptance will help aspiring authors and prevent receipt of the dreaded “your manuscript was rejected” letter (we try to word our decision letters a bit more delicately). These considerations also may help authors develop a strategy on how to address the cited reasons for rejection — that is, if at first you don’t succeed…. Clearly, if the study design or methodology exhibits major flaws, there may be little you can do aside from taking it as a lesson learned for future studies and projects. However, if the main concerns about your manuscript appear to center on analysis, interpretation, clarity, or organization, these issues can be fixed. However, not unlike medicine itself and the entire process of scientific publishing, there are no magic bullets. For authors, even the adage that writing is 5% inspiration and 95% perspiration does not apply to developing manuscripts for publication— it’s more like 1% inspiration and 99% perspiration! For the editors and reviewers at OWM, the same equation applies.We, too, must adhere to established guidelines. The process is not perfect, but we (editors, staff, and reviewers) do what we can to make it expedient, sound, and fair, including the use of a double-blind review process to reduce the risk of bias.7
Please don’t be discouraged if we cannot accept your manuscript; it is not a comment on your intelligence or your skills as a clinician. Our files are thick with manuscripts we could not accept. We want (no, make that we need) to have lots of submissions to review. Before you submit a manuscript, consider what your most demanding English, Research, or Statistics professor would write across the top of the paper. If you think your manuscript would earn you a high passing grade, please send it our way.
Disclosure
The opinions and statements expressed herein are specific to the respective authors and not necessarily those of OWM or HMP. This article was not subject to the Ostomy Wound Management peer-review process.
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
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