Gibbonsvillarreal2489
029). There were no differences in disruptive behavior (FLACC p = 0.573), anxiety (VPTm p = 0.474), blood pressure (SBP p = 0.954; DBP p = 0.899), heart rate (p = 0.726), oxygen saturation (p = 0.477), and respiratory rate (p = 0.930) between anesthetic techniques.
Conventional technique resulted in less pain perception for dental local anesthesia.
Conventional technique reduces the self-reported pain in children 9-12 years old, and therefore, the use of additional devices or different anesthetic techniques is not justified.
Conventional technique reduces the self-reported pain in children 9-12 years old, and therefore, the use of additional devices or different anesthetic techniques is not justified.
Intra-articular fractures are associated with posttraumatic arthritis if inappropriately treated. Exact reduction of the joint congruency is the main factor to avoid the development of arthrosis. Aim of this study was to evaluate feasibility of computer-assisted surgical planning and 3D-printed patient-specific instrumentation (PSI) for treatment of distal intraarticular radius fractures.
7 Patients who suffered a distal intraarticular radius fracture were enrolled in this prospective case series. Preoperative CT-scan was recorded, whereupon a 3D model was computed for surgical planning and design of PSI for surgical navigation. Postoperative accuracy and joint congruency were assessed. Patients were followed-up 3, 6 and 12months postoperatively.
Mean follow-up was 16months. Over all range of motion was restored and flexion, extension and pronation showed significant recovery, p < 0.05. Biggest intraarticular joint step-off and gap reduced from average 2.49 (± 1.04) to 0.8mm (± 0.44), p < 0.05 and 6.12mm (± 1.04) to 2.21mm (± 1.16), p < 0.05. Average grip strength restored (3-16months) from 20.33kg (± 7.12) to 39.3kg (± 19.55) p < 0.05, 100% of the healthy contralateral side. 3D-accuracy for guided fragments was 2.07mm (± 0.64) and 8.59° (± 2.9) and 2.33mm (± 0.69) and 12.86°(± 7.13), p > 0.05 for fragments reduced with ligamentotaxis.
Computer-assisted and PSI navigated intraarticular radius fracture treatment is feasible, safe and accurate. The benefits of this method, however, do not outstand the additional effort.
IV.
IV.
Tibial intercondylar eminence fracture is a rare fracture and is commonly treated with suture, screw or bio-absorbable nail. Current literature includes little information regarding outcome of surgically treatment with bio-absorbable nails. The purpose of this study was to report the clinical and functional outcomes in patients with tibial intercondylar eminence fractures arthroscopically treated with bio-absorbable nails.
The study design was retrospective follow-up. Sixteen patients, age 11-16years, were surgically treated with bio-absorbable nail following an intercondylar eminence fracture. Thirteen patients participate in the present follow-up study. The median follow-up time was 6.5years. The main outcome measurement was the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcome measurements consisted of Eq5d-5L questionnaire, knee pain, knee laxity, range of motion (ROM), muscle strength, gait analyses, radiological outcomes, activity and level.
The median KOOS scores for the five subscales were pain 98.5 (19-100), symptoms 90.5 (54-100), ADL 100 (22-100), sport 87.5, (0-100) and QOL 88.0 (13-100), indication satisfactory outcome. https://www.selleckchem.com/products/as2863619.html Low level of gait asymmetry was observed. Almost balanced muscle strength between the injured and non-injured leg for knee extension and knee flexion strength was observed. Measurement of anterior knee laxity showed 12 patients with a knee laxity between -1 and 2mm. The examination of intercondylar eminence displacement at the time of follow-up showed that 12 patients had a displacement of 2mm or less.
This case series demonstrates satisfactory patient-reported and functional outcomes in the treatment of intercondylar eminence fractures in children and adolescents with bio-absorbable nails.
This case series demonstrates satisfactory patient-reported and functional outcomes in the treatment of intercondylar eminence fractures in children and adolescents with bio-absorbable nails.
Acute kidney injury represents a major adverse effect of vancomycin administration. The aim of the present study is to accumulate all biopsy-proven cases of vancomycin nephrotoxicity and assess the association of histopathological features with renal prognosis.
Medline, Scopus, CENTRAL, Web of Science, and Clinicaltrials.gov were systematically searched from inception to 29 September 2020. All case reports/series providing individual data of patients with biopsy-proven vancomycin nephrotoxicity were held eligible. A time-to-event analysis was performed evaluating the effects of histological diagnosis on renal recovery.
Overall, 18 studies were included, comprising 21 patients. Acute tubulointerstitial nephritis was the predominant pattern in 9 patients and was associated with a significantly higher risk of permanent renal dysfunction (HR 5.08, 95% CI [1.05-24.50)] compared to acute tubular necrosis. Tubulitis and eosinophilic infiltration were the most common histopathological findings, while interstitibe linked to lower recovery rates and worse long-term renal outcomes. A novel cast nephropathy obstructive mechanism has been suggested, necessitating further confirmation. Large-scale studies should define the exact indications of kidney biopsy in cases with suspected vancomycin nephrotoxicity.Pacific oyster (Crassostrea gigas) is one of the most widely cultivated shellfish species in the world. Because of its economic value and complex life cycle involving drastic changes from a free-swimming larva to a sessile juvenile, C. gigas has been used as a model for developmental, environmental, and aquaculture research. However, due to the lack of genetic tools for functional analysis, gene functions associated with biological or economic traits cannot be easily determined. Here, we reported a successful application of CRISPR/Cas9 technology for knockout of myosin essential light chain gene (CgMELC) in C. gigas. C. gigas embryos injected with sgRNAs/Cas9 contained extensive indel mutations at the target sites. The mutant larvae showed defective musculature and reduced motility. In addition, knockout of CgMELC disrupted the expression and patterning of myosin heavy chain positive myofibers in larvae. Together, these data indicate that CgMELC is involved in larval muscle contraction and myogenesis in oyster larvae.
Immune-checkpoint inhibitors (ICIs) are standard treatments for metastatic non-small cell lung cancer (NSCLC). Patients with poor performance status (PS) are underrepresented in clinical trials. We evaluate the efficacy and safety of ICIs in a real-world setting.
We conducted a multi-institutional retrospective study to assess clinical outcomes of NSCLC treated with ICIs. We categorized pts within two groups (PS 0-1 vs 2) and assessed clinical outcomes and safety.
Two hundred and sixty nine patients were included, 44 patients (16.4%) had baseline PS 2 and 223 patients (82.9%) PS 0-1. The overall response rate (ORR) was 30.4%, median PFS was 7.26months (95% CI 5.1-9.4), and median OS was 15.18months (95% CI 9.5-20.9). Patients with a PS 2 were most likely to received ICIs in the second or later line (84.1% vs 64.6%; p = 0.01), had baseline steroids (21.4% vs 8.2%; p 0.010), lower response rate (16.7% vs 34.5%; p 0.02) and clinical benefit (35.7% vs 71%; p 0.000) compared to PS 0-1 pts. Moreover, PS ≥ 2 patients had shorter PFS, median 2.2months (95% CI 1.3-3.1) compared to 9.9months (95% CI 6.7-13.1] and shorter OS, 3.3months (95% CI 2.6-4.2) versus 24.1months (95% CI 16.1-32.1), respectively. PS was significantly associated with PFS and OS in multivariate analysis. As it was expected, immunotherapy was well tolerated with a safety profile comparable to the previous published data.
Based on these retrospective results, patients with poor baseline performance status seem to have poor clinical outcomes with ICIs in the real-world setting.
Based on these retrospective results, patients with poor baseline performance status seem to have poor clinical outcomes with ICIs in the real-world setting.
Anticoagulation management of patients with antiphospholipid syndrome (APS) undergoing cardiac surgery is challenging due to the prolongation of activated clotting time (ACT). Currently, no study has compared the utility of ACT monitoring using the Hemochron Jr. Signature+ and that of heparin concentration management using the Hemostasis Management System (HMS) Plus in patients with APS.
A 71-year-old woman with APS was scheduled to undergo an aortic valve replacement for aortic regurgitation. The ACT was measured using the Hemochron Jr. Signature+, and the heparin concentration was measured concurrently using the HMS Plus. ACT over 480 s corresponded to an adequate heparin concentration during cardiopulmonary bypass. The clinical course was uneventful, and no thrombotic or hemorrhagic complications were observed.
In the present patient with APS, the Hemochron Jr. Signature+ was useful as an anticoagulation management during cardiac valve surgery.
In the present patient with APS, the Hemochron Jr. Signature+ was useful as an anticoagulation management during cardiac valve surgery.
The aim of the study was to compare the distance of intrusion of the cement into the bone in different areas both in the femur and the tibia in vivo, measured in the radiograph after implanting a total knee arthroplasty (TKA) with three different cement techniques.
A prospective randomized study of 90 consecutive patients operated on at our institution with a cemented U2 Knee System TKA and medium viscosity Simplex P
bone cement. After pulse lavage, the cement was applied on the bone surfaces (group 1), on the implant surfaces (group 2) or both on the bone and the implant surfaces (group 3). The cement intrusion was measured in the postoperative radiographs in eight different regions in the tibial component and in six regions in the femoral component. The cement employed was calculated by weighting the cement after mixing and weighting the discarded cement.
The average intrusion of the cement was similar in all three groups of cementing techniques in the femoral components (1.6mm; p = 0.386), and in tdistance of the cement into the bone, and the intrusion depth of the cement into the trabecular tibial bone is greater than the minimum suggested for fixation.Precision medicine aims to tailor medical treatment to match individual characteristics and to stratify individuals to concentrate benefits and avoid harm. It has recently been joined by precision public health-the application of precision medicine at population scale to decrease morbidity and optimise population health. Newborn preventive genomic sequencing (NPGS) provides a helpful case study to consider how we should approach ethical questions in precision public health. In this paper, I use NPGS as a case in point to argue that both precision medicine and precision public health need public health ethics. I make this argument in two parts. First, I claim that discussions of ethics in precision medicine and NPGS tend to focus on predominantly individualistic concepts from medical ethics such as autonomy and empowerment. This highlights some deficiencies, including overlooking that choice is subject to constraints and that an individual's place in the world might impact their capacity to 'be responsible'. Second, I make the case for using a public health ethics approach when considering ethics and NPGS, and thus precision public health more broadly.
