An eighteen-year review of intensive care requirements for paediatric burns in a regional burns service.

INTRODUCTION: Advances in burns management have reduced mortality. Consequently, efficient resource management plays an increasingly important role in improving paediatric burns care. This study aims to assess the support requirements and outcomes of paediatric burns patients admitted to a burns centre intensive care unit in comparison to established benchmarks in burns care. METHOD: A retrospective review of burns patients under the age of 16 years old, admitted to a regional burns service intensive care unit between March 1998 and March 2016 was conducted. RESULTS: Our analysis included 234 patients, with the percentage of TBSA affected by burn injury ranging from 1.5% to 95.0%. The median (IQR) %TBSA was 20.0% (11.0-30.0), and the observed mortality rate was 2.6% (6/234). The median (IQR) length of stay was 0.7 days/%TBSA burn (0.4-1.2), 17.9% (41/229) required circulatory support and 2.6% (6/234) required renal replacement. Mortality correlated with smoke inhalation injury (P < 0.001), %TBSA burn (P = 0.049) and complications (P = 0.004) including infections (P = 0.013). CONCLUSIONS: Among children with burn injuries who require intensive care, the presence of inhalational injury and the diagnosis of infection are positively correlated with mortality. Understanding the requirements for organ support can facilitate a more effective allocation of resources within a burns service.

Homodigital Pedicled Digital Artery Perforator flaps for fingertip reconstruction - a review of flap options.

Background: Digital artery perforator flaps provide a useful option for reconstruction of soft tissue defects of the digits, and many variations of these flaps have been described for fingertip defects. This review aims to summarize various pedicled digital artery perforator flap anatomical configurations described in literature for fingertip reconstruction and their results. Methods: A literature review of PubMed, Medline and Embase databases was conducted. Studies reporting homodigital digital artery perforator flaps for fingertip reconstruction without sacrificing the proper digital artery were included in the review. Data collected included flap design, perforator location, pathology, defect location, flap dimensions, flap survival, sensory recovery, range of movement, outcome measures, and complications. The flaps were analysed and categorized based on flap location, flap design, transfer method, and flap innervation. Results: Pedicled digital artery perforators have been described in various configurations by different authors including propeller, bilobed, V-Y advancement, rotation and turnover flaps. Variations to make these flaps sensate have also been described. According to the available reports, these flaps have low complications and high patient satisfaction rates. Conclusion: Pedicled digital artery perforator flaps provide a versatile option for the reconstruction of fingertip and thumb tip defects. Various flap options are available for use depending on the reconstructive need. They are quicker and easier to perform than free flaps and can provide excellent outcomes in suitable cases.

Real-world performance of blood-based proteomic profiling in first-line immunotherapy treatment in advanced stage non-small cell lung cancer.

PURPOSE: Immune checkpoint inhibition (ICI) therapy has improved patient outcomes in advanced non-small cell lung cancer (NSCLC), but better biomarkers are needed. A clinically validated, blood-based proteomic test, or host immune classifier (HIC), was assessed for its ability to predict ICI therapy outcomes in this real-world, prospectively designed, observational study. MATERIALS AND METHODS: The prospectively designed, observational registry study INSIGHT (Clinical Effectiveness Assessment of VeriStrat® Testing and Validation of Immunotherapy Tests in NSCLC Subjects) (NCT03289780) includes 35 US sites having enrolled over 3570 NSCLC patients at any stage and line of therapy. After enrolment and prior to therapy initiation, all patients are tested and designated HIC-Hot (HIC-H) or HIC-Cold (HIC-C). A prespecified interim analysis was performed after 1-year follow-up with the first 2000 enrolled patients. We report the overall survival (OS) of patients with advanced stage (IIIB and IV) NSCLC treated in the first-line (ICI-containing therapies n=284; all first-line therapies n=877), by treatment type and in HIC-defined subgroups. RESULTS: OS for HIC-H patients was longer than OS for HIC-C patients across treatment regimens, including ICI. For patients treated with all ICI regimens, median OS was not reached (95% CI 15.4 to undefined months) for HIC-H (n=196) vs 5.0 months (95% CI 2.9 to 6.4) for HIC-C patients (n=88); HR=0.38 (95% CI 0.27 to 0.53), p<0.0001. For ICI monotherapy, OS was 16.8 vs 2.8 months (HR=0.36 (95% CI 0.22 to 0.58), p<0.0001) and for ICI with chemotherapy OS was unreached vs 6.4 months (HR=0.41 (95% CI 0.26 to 0.67), p=0.0003). HIC results were independent of programmed death ligand 1 (PD-L1). In a subgroup with PD-L1 ≥50% and performance status 0-1, HIC stratified survival significantly for ICI monotherapy but not ICI with chemotherapy. CONCLUSION: Blood-based HIC proteomic testing provides clinically meaningful information for immunotherapy treatment decision in NSCLC independent of PD-L1. The data suggest that HIC-C patients should not be treated with ICI alone regardless of their PD-L1 expression.

Flexor tendon dysfunction due to a rare fracture of the proximal phalanx: A case report.

Flexor tendon entrapment in fractures of the proximal phalanx is a rare occurrence. This complication has only been reported in association with displaced epiphyseal and diaphyseal fractures. Here we describe a case of an unusual proximal phalangeal fracture pattern with functional hindrance of the flexor mechanism. A 34-year-old man presented with an absent flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) function of the ring finger 4 weeks after an injury. X-Ray Examination revealed a bony fragment on the radial volar aspect of the proximal phalanx. USS revealed an intact FDS and FDP tendons. Excision of the bony fragment with tenolysis led to restoration of function.