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Four patients (2 recurrent/refractory, 2 newly diagnosed) experienced disease progression on subsequent adjunct therapies, 2 of which (the 2 newly diagnosed patients) are currently being rechallenged. At a mean follow-up of 7 months, all patients are clinically stable without disease progression. Single-agent bevacizumab may be effective in the management of symptomatic newly diagnosed and recurrent/refractory cmLGG and warrants further evaluation in a clinical trial setting.

Severely burned patients are at high risk for cardiopulmonary failure. Promising studies have stimulated interest in using extracorporeal membrane oxygenation as a potential therapy for burn patients with refractory cardiac and/or respiratory failure. However, the findings from previous studies vary.

In this study, the authors conducted a systematic review and meta-analysis using standardized mortality ratios to elucidate the benefits associated with the use of extracorporeal membrane oxygenation in patients with burn and/or inhalation injuries. A literature search was performed, and clinical outcomes in the selected studies were compared.

The meta-analysis found that the observed mortality was significantly higher than the predicted mortality in patients receiving extracorporeal membrane oxygenation (standardized mortality ratio, 2.07; 95 percent CI, 1.04 to 4.14). However, the subgroup of burn patients with inhalation injuries had lower mortality rates compared to their predicted mortality rates (stan receiving extracorporeal membrane oxygenation treatment were at a higher risk of death. However, select patients, including those with inhalation injuries and those with revised Baux scores over 90, would benefit from the treatment. The authors suggest that burn patients with inhalation injuries or with revised Baux scores exceeding 90 should be considered for the treatment and early transfer to an extracorporeal membrane oxygenation center.

This retrospective case series compares the outcomes and postoperative oxygen levels in patients who underwent free flap versus primary closure/local flap reconstruction for ischemic diabetic foot wounds to determine the influence of free flap on the surrounding ischemic tissues. The authors hypothesized that the free flap would benefit the surrounding ischemic tissue as a nutrient flap by increasing the tissue oxygen content.

The patients were divided into two groups group 1 underwent free flap reconstruction, and group 2 underwent partial foot amputation with primary closure/local flap. Patient demographics, endovascular intervention, surgical outcome, postreconstruction intervention, and prereconstruction and postreconstruction transcutaneous oximetry were analyzed.

Among 54 patients, 36 were in group 1 and 18 were in group 2. There were no differences in patient demographics between the two groups. All patients had successful angioplasty. Statistical significance was noted in postreconstruction intervention in which group 2 required 2.8 ± 2.9 débridements (versus 1.2 ± 2.5 for group 1) and seven of 18 below-knee amputations (versus three of 36 for group 1) (p < 0.05). Transcutaneous partial pressure of oxygen levels were significantly higher in group 1 at 6 months after reconstruction (61.6 ± 7.5 versus 32.6 ± 5.8 mmHg) (p < 0.01).

This study shows that the role of the free flap in ischemic diabetic limb may expand beyond that of providing coverage over the vital structures, and it supports the use of the free flap as a nutrient to increase oxygen content in the ischemic diabetic foot.

Therapeutic, III.

Therapeutic, III.

With 400,000 hernias repaired annually, there is a need for development of efficient and effective repair techniques. selleckchem Previously, the authors' group compared perioperative outcomes and hospital costs of patients undergoing ventral hernia repair with retromuscular mesh using suture fixation versus fibrin glue. This article reports on 3-year postoperative outcomes, including hernia recurrence, long-term clinical outcomes, and patient-reported quality of life.

Patients who underwent ventral hernia repair performed by a single surgeon between 2015 to 2017 were identified. Patients with retromuscular resorbable mesh placed were included and matched by propensity score. Primary outcomes included hernia recurrence, surgical-site infection, surgical-site occurrence, and surgical-site occurrence/surgical-site infection requiring procedural interventions. Secondary outcomes included quality of life as assessed by the Hernia-Related Quality of Life Survey.

Sixty-three patients were eligible, and 46 patients were matched (23 suture fixation and 23 fibrin glue), with a median age of 62 years, a median body mass index of 29 kg/m2, and a median defect size of 300 cm2 (interquartile range, 180 to 378 cm2). Median follow-up was 36 months (interquartile range, 31 to 36 months). There was no difference in the incidence of hernia recurrence (13.0 percent for suture fixation and 8.7 percent for fibrin glue; p = 0.636) or other postoperative outcomes between techniques (all p > 0.05). Five patients required reoperation because of a complication (10.9 percent). Overall quality of life improved preoperatively to postoperatively at all time points (all p < 0.05), and no differences in quality-of-life improvement were seen between techniques (p > 0.05).

Ventral hernia repair with atraumatic resorbable retromuscular mesh fixation using fibrin glue demonstrates equivalent postoperative clinical and quality-of-life outcomes when compared to mechanical suture fixation.

Therapeutic, III.

Therapeutic, III.

Somatosensory or somatic tinnitus (ST) is a type of tinnitus where changes in somatosensory afference from the cervical spine or temporomandibular area alter the tinnitus perception. Very recently, the diagnostic value of a set of 16 diagnostic criteria for ST was determined. The next step in the development of easily applicable diagnostic criteria is to provide an uncomplicated model, based on the existing criteria, which can easily be used in clinical practice.

This study aims to construct an accurate decision tree, combining several diagnostic criteria, to optimize both sensitivity and specificity of ST diagnosis.

An online survey was launched on the online forum Tinnitus Talk, managed by Tinnitus Hub in a convenience sample of participants with tinnitus. The survey included 42 questions, both on the presence of diagnostic criteria for ST and on other potentially influencing factors. A decision tree was constructed to classify participants with and without ST using the rpart package in R. Tree depth le in clinical practice.

The management of critical-sized bone and soft-tissue defects of the lower extremity poses unique challenge to reconstructive surgeons. The aim of this article is to present the authors' current orthoplastic approach for the management of extended (more than 6 cm) osteocutaneous defects of the lower extremity, based on a sequential combination of two stages free flap for soft-tissue coverage and the Masquelet technique (first step) followed by reamer-irrigator-aspirator cancellous bone graft and definitive osteosynthesis (second step). This study was a single-center observational retrospective review of prospectively collected data. Adult patients (>18 years of age) with segmental bone loss of the lower extremity caused by acute trauma (Gustilo type IIIB fracture) or nonunion (septic/aseptic) who were treated with the free flap for soft-tissue coverage-Masquelet technique-reamer-irrigator-aspirator approach between January of 2017 and December of 2020 were included. Time of consolidation and early and late complications were recorded. A total of 11 patients (nine male patients and two female patients) with a mean age of 45.8 years were identified. The average bone gap length (standard deviation) was 87.3 (24.9) mm. An anterolateral thigh flap was harvested in all cases. The average duration of the first stage (i.e., time from antibiotic cement spacer placement and free flap to time of bone grafting) was 50.4 days (range, 40 to 62 days). Bone consolidation was achieved in all cases after an average period (standard deviation) of 20.4 (3.3) weeks, with acceptable functional outcomes. The free flap for soft-tissue coverage-Masquelet technique-reamer-irrigator-aspirator approach could be considered a viable option in patients with segmental critical-sized bone defects associated with a large soft-tissue deficit of the lower extremity.

Therapeutic, IV.

Therapeutic, IV.

In critically ill children, severely altered pharmacokinetics may result in subtherapeutic β-lactam antibiotic concentrations when standard pediatric dosing regimens are applied. However, it remains unclear how to recognize patients most at risk for suboptimal exposure and their outcome. This study aimed to 1) describe target attainment for β-lactam antibiotics in critically ill children, 2) identify risk factors for suboptimal exposure, and 3) study the association between target nonattainment and clinical outcome.

Post hoc analysis of the "Antibiotic Dosing in Pediatric Intensive Care" study (NCT02456974, 2012-2019). Steady-state trough plasma concentrations were classified as therapeutic if greater than or equal to the minimum inhibitory concentration of the (suspected) pathogen. Factors associated with subtherapeutic concentrations and clinical outcome were identified by logistic regression analysis.

The pediatric and cardiac surgery ICU of a Belgian tertiary-care hospital.

One hundred fifty-sevenho may require higher dosing. Future studies should focus on the impact of subtherapeutic concentrations on clinical outcome.

Subtherapeutic β-lactam concentrations are common in critically ill children and correlate with renal function. eGFR equations may be helpful in identifying patients who may require higher dosing. Future studies should focus on the impact of subtherapeutic concentrations on clinical outcome.

Despite the effects of prosthetic foot mechanical properties on gait of people with lower limb amputation, scant forefoot and heel stiffness data exist to help guide prosthetic foot prescription.

To measure forefoot and heel linear stiffness properties across commonly prescribed commercial prosthetic foot models and to describe variations in stiffness across feet targeted for users with different body weights and foot sizes.

Mechanical testing of five types of commercial prosthetic feet across nine user body weight and foot size combinations.

Linear forefoot and heel stiffness (force vs. displacement) data were collected for 41 prosthetic feet. Quasistatic testing was conducted at -15 and +20 degrees to isolate loading of the heel and forefoot, respectively.

Overall, there was a significant relationship between user body weight and both forefoot and heel stiffness, when adjusted for foot size and type ( P < 0.001). However, there were a substantial number of inconsistencies across foot type within example user body weight and foot sizes combination. Furthermore, the relative order of forefoot stiffness across foot type differed from the relative order of heel stiffness across foot type.

The inconsistencies and differences in relative order of forefoot and heel stiffness across commercial foot type suggest the importance of publishing objective stiffness and other mechanical properties of prosthetic feet. These data can aid clinicians in better matching mechanical properties of prosthetic feet with the functional goals and abilities of prosthesis users.

The inconsistencies and differences in relative order of forefoot and heel stiffness across commercial foot type suggest the importance of publishing objective stiffness and other mechanical properties of prosthetic feet. These data can aid clinicians in better matching mechanical properties of prosthetic feet with the functional goals and abilities of prosthesis users.