Eliaseneliasen1896
Hepatitis C infections are highest in African Americans, and the rates of chronic hepatitis C are highest in those born outside the United States. Patients with hepatitis C have an increased risk for surgical complications after total joint arthroplasty, and studies have demonstrated that these risks normalize when patients are preoperatively screened and treated. Optimization in these vulnerable groups includes working closely with psychosocial resources, the primary care team, and infectious disease specialists to ensure treatment access and compliance.
Patients with hemifacial microsomia (HFM) may undergo unilateral mandibular distraction osteogenesis (MDO) before skeletal maturity in an effort to improve facial symmetry. Mandibular distraction osteogenesis's effect on airway volumes have been studied in the past, though to our knowledge, none have accounted for the effect of head and neck posture on airway morphology. This study aimed to tackle this shortcoming, using imaging to analyze the upper airway of patients with HFM before and after surgical intervention with MDO.
The authors retrospectively reviewed patients with a diagnosis of unilateral HFM whom underwent unilateral MDO with an oblique vector at age 4 to 14 years at a single institution from 2004 to 2019. Patients with pre- and post-MDO three-dimensional computed tomography scans of the upper airway within 12 months of distractor placement and removal, respectively, were included. Head and neck postures were determined by craniocervical, pitch, roll, and yaw angles. Pre- and post-operative p RG CSA (F[12.6] = -1.64, P = 0.13), RP anteroposterior distance (F[14.0] = 0.30, P = 0.77), or RG anteroposterior distance (F[20.0] = -0.04, P = 0.97).
Oblique vector MDO in patients with HFM is associated only with statistically significant changes in the surface area of the upper airway, and is not associated with statistically significant changes in dimensions like volume, CSA, or anteroposterior dimension. This is an important finding, as it may guide discussions surrounding risk/benefit ratio for MDO in childhood.
Oblique vector MDO in patients with HFM is associated only with statistically significant changes in the surface area of the upper airway, and is not associated with statistically significant changes in dimensions like volume, CSA, or anteroposterior dimension. This is an important finding, as it may guide discussions surrounding risk/benefit ratio for MDO in childhood.
Secondary cranioplasty is often required following trauma, infection, radiation, or oncologic care, but is complicated by soft-tissue deficits with limited regional options. Scalp tissue expanders can provide hair-bearing, vascularized tissue for tension-free closure yielding optimal aesthetic results. However, the upper limit of safe scalp expansion has not been explored. This study sought to evaluate the efficacy of extended scalp tissue expansion for challenging cranioplasties in a consecutive series.
Patients who underwent scalp tissue expansion before cranioplasty were retrospectively identified from a single institution between the years 2017 and 2020. Patient demographics, tissue expansion characteristics, and complications during expansion and after cranioplasty were collected.
Six patients were identified who underwent staged scalp expansion for cranioplasty; 5 were male (83.3%) with a mean age of 43.8 ± 12.5 years. Indications for cranioplasty included 2 epilepsy-related procedures, 1 oligodendroglioma, 2 infectious processes, and 1 traumatic incident. A single expander was used in 5 cases, whereas 2 were used in the remaining case. The average expander fill volume was 434.3 ± 115 ccs with a mean expansion time of 3.3 ± 1.4 months. Expander infection occurred in 1 case and expander exposure in another, but adequate scalp expansion was still achieved in both. check details Successful closure over cranioplasty was obtained in 5 cases (83.3%); 1 patient ultimately required free flap reconstruction for soft-tissue coverage.
In cases of extended scalp defects, scalp tissue expansion remains the preferred method for recruiting large quantities of like tissue before implant cranioplasty.
In cases of extended scalp defects, scalp tissue expansion remains the preferred method for recruiting large quantities of like tissue before implant cranioplasty.Malignant peritoneal mesothelioma is a rare cancer associated with minimal durable disease control with chemotherapy and poor overall survival. The efficacy of combined cytotoxic chemotherapy and immune checkpoint inhibitors (ICIs) in malignant peritoneal mesothelioma has not previously been studied. We describe the clinical course of 2 patients with metastatic peritoneal mesothelioma who both relapsed with platinum nonresponsive disease after initial cytoreductive surgery and chemotherapy. In both cases, addition of pembrolizumab to platinum and pemetrexed treatment resulted in a substantial partial and a near complete disease response. Notably, both patients possessed tumors without validated biomarkers of ICI response, including low tumor mutational burden and negative programmed death ligand-1. The unique genomic landscape of each patient may have enabled increased tumor immunorecognition and ICI efficacy. In addition, chemotherapy priming of the tumor microenvironment may have improved ICI response. This report supports future research to characterize the benefit of combination chemotherapy and ICI in peritoneal mesothelioma.The aim of this study was to evaluate the characteristics of paediatric hand fractures (PHF) at a tertiary hospital in South China based on sex, age, mechanism of injury and anatomical region. A retrospective observational study was performed on children aged 15 years and younger who were referred for actual or suspected hand fractures between January 2016 and December 2020. Medical records and radiographs were reviewed for age at the time of injury, sex, site and fracture pattern and mechanism of injury. A total of 436 consecutive children with 478 hand fractures were reviewed. Hand fractures was more common in boys (281/436; 64.4%) than in girls (155/436; 35.6%), although most fractures occurred in children aged 0-3 years (198/436; 45.4%). Distal phalanges were the most commonly injured bones (184/478; 38.5%), and the base fractures were most common (151/476; 31.7%); the fifth digit was most commonly injured (150/478; 31.3%). Crush injuries were the leading cause of fracture in children younger than 6 years of age (207/325; 63.7%), whereas punch injuries were the major cause of injury in older age groups (55/153; 35.9%); 60.1% of the fractures were managed nonsurgically. This study showed patterns of PHF in a tertiary hospital in South China. It illustrates the local variability across sex, age group, injury type and injury mechanism. Such demographic data will be valuable for optimally resourcing healthcare systems locally and help guide prevention policies.Children with cerebral palsy (CP) often have changes in proximal femoral geometry. Neck-shaft angle (NSA), Hilgenreiner epiphyseal angle (HEA) and head-shaft angle (HSA) are used to measure these changes. The impact of femoral rotation on HEA/HSA and of ab/adduction on HEA/HSA/NSA is not well known. This study aimed to determine and compare the effect of rotation, ab/adduction and flexion/extension on HEA/HSA/NSA. Radiographic measurements from 384 patients with Gross Motor Function Classification System (GMFCS) levels I-V were utilized. NSA/HSA for affected hips were used with femoral anteversion averages to create three-dimensional models of 694 hips in children with CP. Each hip was rotated, ab/adducted and flexed/extended to simulate malpositioning. HEA/HSA/NSA of each model were measured in each joint position, and differences from correct positioning were determined. Mean HEA error at 20° of internal/external rotations were -0.60°/3.17°, respectively, with the NSA error of -6.56°/9.94° and the HSA error of -3.69°/1.21°. Each degree of ab/adduction added 1° of the HEA error, with no NSA/HSA error. NSA was most sensitive to flexion. Error for all measures increased with increasing GMFCS level. HEA/HSA were minimally impacted by rotation. NSA error was much higher than HEA/HSA in internal rotation and flexion whereas HEA was sensitive to changes in ab/adduction. Given abduction is more easily detectable on imaging than rotation, HEA may be less affected by positioning errors that are common with children with CP than NSA. HSA was least affected by position changes. HEA/HSA could be robust, complementary measures of hip deformities in children with CP.
Despite the large number of workers in surface sand and gravel mines, there are no previous studies on a cohort of these workers.
A cross-sectional study of Michigan surface mine workers included a questionnaire and for those who worked ≥15 years spirometry and chest x-ray.
Questionnaires were completed by 1207 miners, 111 had an X-ray and 70 had spirometry. There were no silicosis cases. There were 117 with asthma, 22 COPD, 129 saw a doctor for shortness of breath (SOB), 125 with possible work-related asthma, and 26 abnormal spirometry results.
Although, no cases of silicosis were identified, there was more current asthma; and an association of current asthma, COPD and seeing a doctor for SOB with time since first worked, and obstructive changes in some nonsmokers that suggested the potential for adverse respiratory effects.
Although, no cases of silicosis were identified, there was more current asthma; and an association of current asthma, COPD and seeing a doctor for SOB with time since first worked, and obstructive changes in some nonsmokers that suggested the potential for adverse respiratory effects.
This study examines the relationship between opioid use prevalence and subsequent filing of workers' compensation claims.
A retrospective cohort study design was utilized to examine data from drivers' initial commercial driver medical exam, employment data, and workers' compensation claims data.
Data from 57,733 over 7 years were analyzed. Drivers who reported opioid use at their initial medical exam visit filed subsequent workers' compensation claims 1.81 times sooner (p = 0.0001; 95% CI 1.34, 2.44) than drivers who did not report opioid use at their CDME when controlling for age, gender, BMI, and diastolic blood pressure.
These findings provide information that may aid in improving regulations to control for incidents, training programs to inform professional drivers of factors that increase accident risk and educating prescribers about increased risks of injury among opioid-using drivers.
These findings provide information that may aid in improving regulations to control for incidents, training programs to inform professional drivers of factors that increase accident risk and educating prescribers about increased risks of injury among opioid-using drivers.
We examined associations between working conditions and sickness absence due to mental disorders (LTSA-MD) among younger female public sector employees from different employment sectors.
Survey data collected in 2017 (n = 3,048) among 19-39-year-old female employees of the City of Helsinki, Finland, were used to examine job demands, job control, physical workload, computer work, and covariates. Register data on LTSA-MD were used over 1-year follow-up. Negative binomial regression models were applied.
Adverse psychosocial and physical working conditions were associated with higher LTSA-MD during the follow-up. Health and social care workers had the highest number of days of LTSA-MD.
Working conditions are important factors when aiming to prevent LTSA-MD among younger employees, in the health and social care sector in particular.
Working conditions are important factors when aiming to prevent LTSA-MD among younger employees, in the health and social care sector in particular.
