Accuracy of ICD-10 Coding for Femoral Head Bearing Surfaces in Hip Arthroplasty.

BACKGROUND: The International Classification of Diseases-10 Procedure Code System (ICD-10-PCS) introduced oxidized zirconium (OxZi) and niobium procedural codes to the types of femoral head bearing surfaces in 2017. These codes aimed to increase procedural specificity in coding and improve data collection through administrative claims databases. This study aimed to assess the accuracy of ICD-10-PCS coding for femoral head bearing surfaces (cobalt chrome/metal, ceramic, and OxZi) in hip procedures. METHODS: A retrospective analysis of 6,204 procedures utilizing femoral heads performed between October 1, 2017 and August 26, 2021 at a large, urban academic hospital was conducted. Operative reports and implant logs were queried to determine the femoral head bearing surface, which was used during the total hip arthroplasty. These results were then compared to the ICD-10-PCS codes in the billing records. Coding accuracy was subsequently determined and statistical differences between the three groups were evaluated. RESULTS: The ICD-10-PCS coding was accurate for 90.8% (5,634/6,204) of cases. Coding accuracy for ceramic femoral heads (95.4%, 4,171/4,371) was significantly greater than that of both cobalt chrome/metal (73.7%, 606/822; P < .001) and OxZi (84.8%, 857/1,011; P < .001) femoral heads. CONCLUSION: While coding for ceramic femoral heads was very accurate, OxZi and cobalt chrome/metal femoral heads were miscoded at a rate of approximately 20%. These inaccuracies call for further evaluation of the ICD-10-PCS coding process to ensure that conclusions drawn from clinical research performed through administrative claims databases are not subject to error.

The effect of reduced bone mineral density on elective total hip arthroplasty outcomes.

INTRODUCTION: Reduced bone mineral density (BMD) and disruption of normal bony architecture are the characteristics of osteopenia and osteoporosis and in patients undergoing total hip arthroplasty (THA) may cause failure of trabecular ingrowth. The purpose of this study is to evaluate the impact of reduced BMD on outcomes following primary elective THA. METHODS: A retrospective chart review of 650 elective THAs with a DEXA scan in their electronic health record (EHR) from 2011 to 2020 was conducted at an urban, academic center and a regional, health center. Patients were separated into three cohorts based on their t-score and the World Health Organizations definitions: normal (t-score ≥ - 1), osteopenia (t-score < - 1.0 and > - 2.5), and osteoporosis (t-score ≤ - 2.5). Demographic and outcome data were assessed. Subsidence was assessed for patients with non-cemented THAs. Regression models were used to account for demographic differences. RESULTS: 650 elective THAs, of which only 11 were cemented, were included in the study. Patients with osteopenia and osteoporosis were significantly older than those without (p = 0.002 and p < 0.0001, respectively) and had a lower BMI (p < 0.0001 and p < 0.0001, respectively). PFx was significantly greater in patients with osteoporosis when compared to those with normal BMD (6.5% vs. 1.0%; p = 0.04). No such difference was found between osteoporotic and osteopenic patients. The revision rate was significantly higher for osteoporotic patients than osteopenic patients (7.5% vs. 1.5%; p = 0.04). No such difference was found between the other comparison groups. CONCLUSION: Patients with osteoporosis were older with reduced BMI and had increased PFx after non-cemented elective THA. Understanding this can help surgeons formulate an appropriate preoperative plan for the treatment of patients with osteoporotic bone undergoing elective THA.

Bacillus subtilis PgcA moonlights as a phosphoglucosamine mutase in support of peptidoglycan synthesis.

Phosphohexomutase superfamily enzymes catalyze the reversible intramolecular transfer of a phosphoryl moiety on hexose sugars. Bacillus subtilis phosphoglucomutase PgcA catalyzes the reversible interconversion of glucose 6-phosphate (Glc-6-P) and glucose 1-phosphate (Glc-1-P), a precursor of UDP-glucose (UDP-Glc). B. subtilis phosphoglucosamine mutase (GlmM) is a member of the same enzyme superfamily that converts glucosamine 6-phosphate (GlcN-6-P) to glucosamine 1-phosphate (GlcN-1-P), a precursor of the amino sugar moiety of peptidoglycan. Here, we present evidence that B. subtilis PgcA possesses activity as a phosphoglucosamine mutase that contributes to peptidoglycan biosynthesis. This activity was made genetically apparent by the synthetic lethality of pgcA with glmR, a positive regulator of amino sugar biosynthesis, which can be specifically suppressed by overproduction of GlmM. A gain-of-function mutation in a substrate binding loop (PgcA G47S) increases this secondary activity and suppresses a glmR mutant. Our results demonstrate that bacterial phosphoglucomutases may possess secondary phosphoglucosamine mutase activity, and that this dual activity may provide some level of functional redundancy for the essential peptidoglycan biosynthesis pathway.

Chronicling Research and Practice Evolution in Pediatric Physical Therapy.

PURPOSE: To observe research and practice trends in the journal, Pediatric Physical Therapy, as a proxy for the field. METHODS: All issues of Pediatric Physical Therapy published from 1989 to 2019 were chronicled and summarized. Data were extracted regarding variables related to the issues and individual articles. RESULTS: The most common diagnosis studied was cerebral palsy. The proportion of studies involving middle childhood and adolescent-aged participants increased over time. Cohort studies and exercise were the most common study type and intervention studied, respectively. The proportion of scientific content in the journal increased. CONCLUSION: It is evident that pediatric physical therapy research has evolved over the past 30 years, both in rigor of articles published and in breadth of populations studied. WHAT THIS ADDS TO THE EVIDENCE: This review adds an in-depth evaluation of trends in the literature, facilitating the profession's continued growth.

A metabolic checkpoint protein GlmR is important for diverting carbon into peptidoglycan biosynthesis in Bacillus subtilis.

The Bacillus subtilis GlmR (formerly YvcK) protein is essential for growth on gluconeogenic carbon sources. Mutants lacking GlmR display a variety of phenotypes suggestive of impaired cell wall synthesis including antibiotic sensitivity, aberrant cell morphology and lysis. To define the role of GlmR, we selected suppressor mutations that ameliorate the sensitivity of a glmR null mutant to the beta-lactam antibiotic cefuroxime or restore growth on gluconeogenic carbon sources. Several of the resulting suppressors increase the expression of the GlmS and GlmM proteins that catalyze the first two committed steps in the diversion of carbon from central carbon metabolism into peptidoglycan biosynthesis. Chemical complementation studies indicate that the absence of GlmR can be overcome by provision of cells with N-acetylglucosamine (GlcNAc), even under conditions where GlcNAc cannot re-enter central metabolism and serve as a carbon source for growth. Our results indicate that GlmR facilitates the diversion of carbon from the central metabolite fructose-6-phosphate, which is limiting in cells growing on gluconeogenic carbon sources, into peptidoglycan biosynthesis. Our data suggest that GlmR stimulates GlmS activity, and we propose that this activation is antagonized by the known GlmR ligand and peptidoglycan intermediate UDP-GlcNAc. Thus, GlmR presides over a new mechanism for the regulation of carbon partitioning between central metabolism and peptidoglycan biosynthesis.

The Obligate Intracellular Bacterium Orientia tsutsugamushi Targets NLRC5 To Modulate the Major Histocompatibility Complex Class I Pathway.

Orientia tsutsugamushi is an obligate intracellular bacterium that infects mononuclear and endothelial cells to cause the emerging global health threat scrub typhus. The ability of O. tsutsugamushi to survive in monocytes facilitates bacterial dissemination to endothelial cells, which can subsequently lead to several potentially fatal sequelae. As a strict intracellular pathogen that lives in the cytoplasm of host cells, O. tsutsugamushi has evolved to counter adaptive immunity. How the pathogen does so and the outcome of this strategy in monocytes versus endothelial cells are poorly understood. This report demonstrates that O. tsutsugamushi reduces cellular levels of NOD-, LRR-, and CARD-containing 5 (NLRC5), a recently identified specific transactivator of major histocompatibility complex class I (MHC-I) component gene expression, to inhibit MHC-I biosynthesis. Importantly, the efficacy of this approach varies with the host cell type infected. In nonprofessional antigen-presenting HeLa and primary human aortic endothelial cells, the O. tsutsugamushi-mediated reduction of NLRC5 results in lowered MHC-I component transcription and, consequently, lower total and/or surface MHC-I levels throughout 72 h of infection. However, in infected THP-1 monocytes, which are professional antigen-presenting cells, the reductions in NLRC5 and MHC-I observed during the first 24 h reverse thereafter. O. tsutsugamushi is the first example of a microbe that targets NLRC5 to modulate the MHC-I pathway. The differential ability of O. tsutsugamushi to modulate this pathway in nonprofessional versus professional antigen-presenting cells could influence morbidity and mortality from scrub typhus.

Don't let sleeping dogmas lie: new views of peptidoglycan synthesis and its regulation.

Bacterial cell wall synthesis is the target for some of our most powerful antibiotics and has thus been the subject of intense research focus for more than 50 years. Surprisingly, we still lack a fundamental understanding of how bacteria build, maintain and expand their cell wall. Due to technical limitations, directly testing hypotheses about the coordination and biochemistry of cell wall synthesis enzymes or architecture has been challenging, and interpretation of data has therefore often relied on circumstantial evidence and implicit assumptions. A number of recent papers have exploited new technologies, like single molecule tracking and real-time, high resolution temporal mapping of cell wall synthesis processes, to address fundamental questions of bacterial cell wall biogenesis. The results have challenged established dogmas and it is therefore timely to integrate new data and old observations into a new model of cell wall biogenesis in rod-shaped bacteria.

Delayed Pneumoperitoneum After Percutaneous Endoscopic Gastrostomy (PEG) Tube Placement: A Case Report.

When used for a selected patient population, percutaneous endoscopic gastrostomy (PEG) can provide enteral nutrition percutaneous endoscopic gastrostomy (PEG) safely. PEG tubes generally possess a very low chance of life-threatening complications but due to the patient population that requires PEG tubes, a delayed diagnosis of minor complications could be fatal. In this study, we present a case of delayed pneumoperitoneum, discovered weeks after our patient underwent PEG placement for enteral nutritional needs. The patient recovered without the need for operative intervention. The development of a pneumoperitoneum in the setting of recent PEG needs a thorough clinical evaluation, and caution must be taken before immediately proceeding to operative exploration.

Secretion of Sphinganine by Drug-Induced Cancer Cells and Modified Mimetic Sphinganine (MMS) as c-Src Kinase Inhibitor.

BACKGROUND: Cancer cells exhibit selective metabolic reprogramming to promote proliferation, invasiveness, and metastasis. Sphingolipids such as sphingosine and sphinganine have been reported to modulate cell death processes in cancer cells. However, the potential of extracellular sphinganine and its mimetic compounds as inducers of cancer cell death has not been thoroughly investigated. METHODS: We obtained extracellular conditioned medium from HCT-116 cells treated with the previously reported anticancer composition, goat urine DMSO fraction (GUDF). The extracellular metabolites were purified using a novel and in-house developed vertical tube gel electrophoresis (VTGE) technique and identified through LC-HRMS. Extracellular metabolites such as sphinganine, sphingosine, C16 sphinganine, and phytosphingosine were screened for their inhibitory role against intracellular kinases using molecular docking. Molecular dynamics (MD) simulations were performed to study the inhibitory potential of a novel designed modified mimetic sphinganine (MMS) (Pubchem CID: 162625115) upon c-Src kinase. Furthermore, inhibitory potential and ADME profile of MMS was compared with luteolin, a known c-Src kinase inhibitor. RESULTS: Data showed accumulation of sphinganine and other sphingolipids such as C16 sphinganine, phytosphingosine, and ceramide (d18:1/14:0) in the extracellular compartment of GUDF-treated HCT-116 cells. Molecular docking projected c-Src kinase as an inhibitory target of sphinganine. MD simulations projected MMS with strong (-7.1 kcal/mol) and specific (MET341, ASP404) binding to the inhibitory pocket of c-Src kinase. The projected MMS showed comparable inhibitory role and acceptable ADME profile over known inhibitors. CONCLUSION: In summary, our findings highlight the significance of extracellular sphinganine and other sphingolipids, including C16 sphinganine, phytosphingosine, and ceramide (d18:1/14:0), in the context of drug-induced cell death in HCT-116 cancer cells. Furthermore, we demonstrated the importance of extracellular sphinganine and its modified mimetic sphinganine (MMS) as a potential inhibitor of c-Src kinase. These findings suggest that MMS holds promise for future applications in targeted and combinatorial anticancer therapy.

RNA-sequencing predicts a role of androgen receptor and aldehyde dehydrogenase 1A1 in osteosarcoma lung metastases.

One-third of pediatric patients with osteosarcoma (OS) develop lung metastases (LM), which is the primary predictor of mortality. While current treatments of patients with localized bone disease have been successful in producing 5-year survival rates of 65-70%, patients with LM experience poor survival rates of only 19-30%. Unacceptably, this situation that has remained unchanged for 30 years. Thus, there is an urgent need to elucidate the mechanisms of metastatic spread in OS and to identify targetable molecular pathways that enable more effective treatments for patients with LM. We aimed to identify OS-specific gene alterations using RNA-sequencing of extremity and LM human tissues. Samples of extremity and LM tumors, including 4 matched sets, were obtained from patients with OS. Our data demonstrate aberrant regulation of the androgen receptor (AR) pathway in LM and predicts aldehyde dehydrogenase 1A1 (ALDH1A1) as a downstream target. Identification of AR pathway upregulation in human LM tissue samples may provide a target for novel therapeutics for patients with LM resistant to conventional chemotherapy.

Essentials of Computed Tomography Imaging of Hematuria.

Hematuria is defined usually as the presence of blood in the urine, either on voiding or in a catheterized specimen. Hematuria is broadly divided into microscopic and gross hematuria and may be symptomatic or asymptomatic. The causes of hematuria include a very wide spectrum of conditions. However, here, we have filtered the causes causing gross hematuria, including calculus, trauma, tumors, vascular, and miscellaneous causes. Plain X-rays of the kidney, ureter, and bladder; ultrasound; intravenous urography; computed tomography (CT); magnetic resonance imaging; retrograde ureterography and pyelography (RGP); cystoscopy; and ureteroscopy are techniques that are useful for diagnosis. In the past, one or a combination of several techniques was used to evaluate hematuria but recently, advances in CT urography mean that it can be used alone for this task. This article briefly reviews the common causes of gross hematuria in adults and their evaluation by CT-based urography. Gross hematuria is evaluated well with CT scan urography which includes an unenhanced scan, the nephrographic phase, and the excretory phase. Unenhanced scans are routinely performed to evaluate the basic parameters such as the size, shape, position, and outline of the kidneys and calculus disease, which is the most common cause of hematuria. Renal parenchymal diseases including masses are best visualized in the nephrographic phase along with other abdominal organs. Delayed excretory phases including the kidneys, ureters, and bladder are useful for detecting urothelial diseases. CT urography's protocol permits evaluations of hematuria through a single examination.

Role of viral pathogen(s) detection in hospital-based management of 29-90-day-old infants with unexplained fever.

BACKGROUND: The risk for invasive bacterial infection (IBI) in young infants with fever increases the use of invasive and therapeutic interventions, such as lumbar puncture (LP) and antimicrobials which may be unnecessary. In the present study, we analyzed whether viral pathogen(s) detection using a respiratory pathogen panel (RPP) alters the use of LP and antibiotics in 29-90-day-old infants presenting with fever to a regional pediatric hospital. METHODS: We collected medical history, clinical presentation, diagnostic tests and results, treatment, disposition, and length of stay (LOS) for selected patients. Data were compared between RPP positive (+) and RPP negative (-) infants. Use of LP and antibiotics were controlled for using regression analysis. P values <0.05 were considered significant. RESULTS: Among 172 RPP-tested infants, 45.4% had a virus(es). LP and antibiotics were used in 14.2% and 19.5% of infants in RPP(+) and in 17.0% and 28.7% in RPP(-) groups (P=0.60, 0.16), respectively. Nearly half of the infants in both groups were admitted and had comparable LOS. Hospitalization and at least one abnormal laboratory result were associated with a 2-3 times higher chance of LP and antibiotic utilization, irrespective to age and temperature level. No studied infant had been diagnosed with IBI, and 14.5% of infants in the RPP(-) group had bacteriuria. CONCLUSIONS: Detection of viral pathogen(s) did not significantly reduce the use of LP or antimicrobials in young infants with unexplained fever.

Primary total hip arthroplasty in patients older than 90 years of age: a retrospective matched cohort study.

INTRODUCTION: Advanced age is considered a major risk factor for postoperative complications in total hip arthroplasty (THA). Consequently, older patients undergoing THA may require more detailed pre-procedural examinations and more healthcare resources postoperatively than younger patients. The purpose of this study was to compare discharge parameters and complication rates of THA in patients ⩾90 years old to those <90 years old. METHODS: A retrospective review of 14,824 THA patients from 2011 to 2021 at a high-volume, urban academic centre was conducted. Patients ⩾90 years old were propensity-matched to a control group of patients aged <90 years old. Patient demographics, surgical time, hospital length of stay (LOS), discharge disposition, and 90-day revision, readmission, and mortality rates were collected. Demographic differences and outcomes were assessed using chi-square and independent sample t-tests. RESULTS: After propensity matching, the average age in the younger cohort (YC, n = 54) was 75.81 ± 7.89, and 91.61 ± 1.73 for the older cohort (OC, n = 54). The OC had a longer LOS than the YC (mean 3.90 vs. 3.06 days; p = 0.031). Discharge disposition significantly differed (p = 0.007); older patients were more likely to be discharged to skilled nursing facilities (33.3% vs. 14.8%) or acute rehabilitation centres (14.8% vs. 3.7%) and less likely to be discharged to prior place of residence (home self-managed/home with services, 51.9% vs. 79.6%). There was no significant difference in surgical time (93.87 ± 29.75 vs. 96.09 ± 26.31 min; p = 0.682), 90-day revision rate (3.7% vs. 0%; p = 0.153), 90-day readmission rate (9.4% vs. 3.7%; p = 0.543), and 90-day mortality rate (1.9% vs. 1.9%; p = 1.000). CONCLUSIONS: Although THA patients over 90 years of age had a longer LOS and differing discharge disposition, these patients had similar complications compared to their younger counterparts. Thus, our study supports similar efficacy of THA in patients 90 years and older relative to younger THA candidates.

Preoperative Risk Stratification in Arthroscopic Rotator Cuff Repair: Aspartate Aminotransferase-to-Platelet Ratio Index as an Estimate of Liver Dysfunction.

BACKGROUND: Aspartate Aminotransferase-to-Platelet Ratio Index (APRI) is a cost-effective and noninvasive measure of liver function, an alternative to the gold standard liver biopsy which is resource-intensive and invasive. This study investigates the association between various degrees of liver dysfunction based on APRI and 30-day postoperative complications following arthroscopic rotator cuff repair (aRCR). METHODS: The American College of Surgeons National Surgical Quality Improvement Program database was queried for all patients who underwent aRCR between 2015 and 2021. The study population was divided into four groups based on preoperative APRI: normal/reference (APRI ≤ 0.5), mild fibrosis (0.5 < APRI ≤ 0.7), significant fibrosis (0.7 < APRI ≤ 1), and cirrhosis (APRI > 1). Multivariate logistic regression analysis was conducted to investigate the connection between preoperative APRI and postoperative complications. RESULTS: Compared to normal liver function, mild fibrosis was significantly associated with male gender, lower BMI, American Society of Anesthesiologists (ASA) classification ≥ 3, and comorbid diabetes, hypertension, chronic obstructive pulmonary disease, and bleeding disorders. Significant fibrosis was significantly associated with male gender, greater BMI, ASA classification ≥ 3, and comorbid diabetes, hypertension, and bleeding disorders. Cirrhosis was significantly associated with younger age, ASA classification ≥ 3, smokers, and comorbid diabetes and bleeding disorders. Compared to normal liver function, fibrosis was not associated with complications, significant fibrosis was associated with myocardial infarction, and cirrhosis was associated with major complications, sepsis, non-home discharge, and mortality. However, mild fibrosis, significant fibrosis, and cirrhosis were independently associated with any adverse 30-day postoperative complications following aRCR. CONCLUSION: Among those with predicted liver damage based on preoperative APRI, 30-day postoperative complications following aRCR were not found to be independently associated with preoperative mild fibrosis, significant fibrosis, or cirrhosis. Our results suggest that APRI predictive of liver dysfunction may be a weaker deterrent to undergoing aRCR compared to other orthopedic surgeries.

Percutaneous ablation of renal tumors versus surgical ablation and partial nephrectomy: Medicare trends and reimbursement cost comparison from 2010 to 2018.

PURPOSE: The purpose of this study is to analyze trends in Medicare volume and reimbursement for percutaneous and surgical ablation as well as laparoscopic and open partial nephrectomy for treatment of small renal tumors from 2010 to 2018. METHODS: Claims from the Medicare Part B Physician/Supplier Procedure Summary from 2010 to 2018 were extracted using CPT codes for percutaneous and surgical renal ablation and surgical and laparoscopic partial nephrectomy. Facility reimbursement and relative value units (RVUs) were obtained using the Centers for Medicare & Medicaid Services physician fee schedule look-up tool. RESULTS: Volume of percutaneous ablation increased from 2539 to 4571 procedures (80.0%). Specifically, percutaneous cryoablation became the dominant technique, increasing from 1434 to 2981 procedures (107.9%). Overall, volume of partial nephrectomy also increased by 40.4%, driven by an increase in laparoscopic partial nephrectomy from 3227 to 7770 procedures (140.8%) with a decrease in open partial nephrectomy from 3489 to 1661 (- 52.4%). Volume of surgical ablations also decreased 72.7% from 1260 to 344 procedures. In 2018, reimbursement was $358.56 for percutaneous radiofrequency ablation, $481.32 for percutaneous cryoablation, $1216.43 for surgical radiofrequency ablation, $1269.35 for surgical cryoablation, $1381.67 for open partial nephrectomy, and $1552.66 for laparoscopic partial nephrectomy. CONCLUSION: There has been a trend toward minimally invasive techniques for treatment of small renal tumors among Medicare patients. Laparoscopic partial nephrectomy has become the dominant treatment. In the setting of evidence showing comparable outcomes with surgery as well as lower costs to insurers, the volume of percutaneous ablation has also markedly increased.

Nipple-Sparing Mastectomy and Immediate Reconstruction: A Propensity Score-Matched Analysis of Satisfaction and Quality of Life.

BACKGROUND: Although it is intuitive that nipple-sparing mastectomy in selected patients would result in excellent cosmetic outcomes and high patient satisfaction, studies of clinical outcomes and health-related quality of life are limited and show mixed results. This study aimed to use a propensity score-matching analysis to compare satisfaction and health-related quality-of-life outcomes in patients who underwent implant-based reconstruction following bilateral nipple-sparing mastectomy or skin-sparing mastectomy. METHODS: A propensity score-matching analysis (1:1 matching, no replacement) was performed comparing patients undergoing nipple-sparing or skin-sparing mastectomy with immediate bilateral implant-based breast reconstruction. Patients with a history of any radiation therapy were excluded. Matched covariates included age, body mass index, race, smoking history, neoadjuvant chemotherapy, bra size, and history of psychiatric diagnosis. Outcomes of interest included BREAST-Q scores and complications. RESULTS: The authors examined 1371 patients for matching and included 460 patients (nipple-sparing mastectomy, n = 230; skin-sparing mastectomy, n = 230) in the final analyses. The authors found no significant differences in baseline, cancer, and surgical characteristics between matched nipple-sparing and skin-sparing mastectomy patients, who also had similar profiles for surgical complications. Interestingly, the authors found that postoperative Satisfaction with Breasts scores and all other health-related quality-of-life domains were stable over a 3-year period and did not differ significantly between the two groups. CONCLUSIONS: Compared with skin-sparing mastectomy, bilateral nipple-sparing mastectomy did not improve patient-reported or clinical outcomes when combined with immediate implant-based reconstruction. The impact that nipple-sparing mastectomy may have on breast aesthetics and the ability of the BREAST-Q to gauge an aesthetic result following nipple-sparing mastectomy warrant further investigation. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Intratarsal keratinous cysts of the meibomian gland (a sebaceous duct cyst): report of 2 cases.

Intratarsal keratinous cyst of the meibomian gland is a recently described entity that recurs if not completely excised. Herein, we report 2 cases and discuss their diagnosis and management: (1) A 57-year-old man with a recurrent mass of the upper eyelid treated with incision and drainage as a chalazion for more than 5 years and (2) An 85-year-old man presented with a slow growing nodule of the upper eyelid. Exploration via the eyelid crease approach revealed cysts fixed to the tarsus that were completely excised with a portion of the anterior tarsus. Histologically, these cysts exhibited a keratinizing squamous epithelium without a granular layer (trichilemmal keratinization), were lined by an eosinophilic undulating cuticle, contain string-like keratin debris, and had a fibrous wall without sebaceous lobules. All epithelial components strongly expressed high-molecular weight keratins, whereas the lining, cuticle, and keratin contents strongly expressed carcinoembryonic antigen. No recurrence has occurred 7 and 12 months postoperatively. The location and clinicopathologic findings of intratarsal keratinous cysts distinguish it from sebaceous tumors, steatocystoma simplex, epidermoid cyst, and dermoid cyst. However, like steatocystomas, intratarsal keratinous cysts exhibit a sebaceous duct phenotype. The anterior lid crease approach with partial tarsectomy seems to be an effective treatment.

The effect of sterilization and disinfection on the physical-mechanical properties of preformed crowns.

INTRODUCTION: Different sizes of crowns may be tried on children since there is no universal crown size because of distinctions in tooth morphology from one child to other. During the process of trial and error, the crown gets contaminated which needs to be sterilized for reuse of crown. This study was carried out to evaluate the physical-mechanical outcome after the sterilization and disinfection of pediatric preformed crowns. MATERIALS AND METHODS: In total, sixty crowns consisted of 20 each, stainless steel crowns (SSCs) (3M ESPE), preveneered stainless steel (Kinder Krowns), and Zirconia crowns (Kinder Krowns) which were divided into four groups. G1 in which crowns did not undergo any sterilization, G2 consisted of fast sterilization, similarly G3 was slow sterilization, and G4 underwent chemical disinfection using Korsolex Plus for 15 min. Following sterilization, all the crown samples were observed under a stereomicroscope at ×200 magnification and assessed for color change, crazing, dimensional stability, and fracturing. Post hoc Tukey test and two-way ANOVA were performed for comparison between types of crowns and sterilization methods, with a significance level was set at P < 0.05. RESULTS: There was no color change or fracturing following sterilization among crowns in any of the groups. Highest crazing was noted in stainless steel and the least in Zirconia crowns. Preveneered stainless steel was the most dimensionally stable and SSCs was the least. CONCLUSION: No color changes and fracture were noted in any type of crowns. Preveneered stainless steel was most dimensionally stable followed by Zirconia and SSCs. Maximum crazing was seen in SSCs and nil in Zirconia.

Effects of health beliefs, social support, and self-efficacy on sun protection behaviors among medical students: testing of an extended health belief model.

Sun protection behaviors (SPB) are important modifiable risk factors for skin cancer. As the most common malignancies in the world, skin cancers account for significant morbidity, mortality, and economic burden. Physicians play a key role in educating patients about proper SPB. Medical education provides the foundation for physician understanding of SPB and future patient education. The Health Belief Model (HBM) is a theoretical model that offers constructs to help explain health behaviors. This cross-sectional study examined a convenience sample of 186 medical student to assess their engagement in SPB through the lens of the 6 HBM constructs and social support. Overall, we found engagement in SPB among our cohort to be low. About 70.4% report never using wide-brimmed hats and only 44.6% often or always use sunscreen. Hierarchical multiple regressions were performed in three blocks to analyze the relationship between the independent variables (HBM constructs and social support) and dependent variable (SPB) after controlling for the influence of demographic covariates. In our health constructs model, beliefs about susceptibility, benefits minus barriers, and self-efficacy were found to be significant predictors of engaging in SPB. Addition of social support in the final model did not significantly improve prediction of SPB engagement. These findings support use of educational programs based on HBM for the improvement of SPB among medical students.

Association Between Revascularization and Quality of Life in Patients With Coronary Chronic Total Occlusions: A Systematic Review.

BACKGROUND: Percutaneous revascularization of coronary chronic total occlusions (CTO) has increased due to advances in technology and operator expertise. Quality of life (QoL) remains an important but understudied outcome following CTO revascularization. Our aim is to conduct a systematic review of the impact of CTO revascularization on QoL. METHODS: We searched three databases (Ovid MEDLINE, EMBASE, EBM reviews) from January 1st, 1990 to May 17th, 2020. Studies reporting on the following QoL metrics post CTO revascularization were included: QoL subscale of the Seattle Angina Questionnaire (SAQ-QoL). The ROBINS-I tool and Cochrane risk of bias tool were used to critically assess for risk of bias. RESULTS: We identified 1476 articles, of which 21 articles met inclusion criteria. Three categories of studies were identified with distinct patient populations. In the first category (1 study), CTO patients treated with either PCI or CABG compared to medical therapy had a significant improvement in SAQ-QoL compared to baseline (PCI 54.2 to 74.3; CABG 56.1 to 78.0; p < 0.05). In the second category (1 study), CTO patients compared to non-CTO patients had similar improvements in SAQ-QoL post PCI (CTO baseline 53.2 to 80.3; non-CTO baseline 56.5 to 80.6; p < 0.05). Finally, a third category with only CTO patients treated with PCI to the CTO vessel included 19 studies, all of which on average showed a significant improvement in SAQ-QoL post successful PCI, compared to non-successful PCI. CONCLUSION: Despite the limited literature, revascularization of CTO vessel was generally associated with improvement in QoL. BRIEF SUMMARY: Quality of life (QoL) is an important but understudied outcome following CTO revascularization. We conducted a systematic review of the impact of CTO revascularization on QoL. Despite the limitations of a lack of enough randomized control trials and the small number of studies, our systematic review highlights a trend of improvement in QoL indices after revascularization of CTO.