Crocetin and related oxygen diffusion-enhancing compounds: Review of chemical synthesis, pharmacology, clinical development, and novel therapeutic applications.

The current pandemic forced us to introspect and revisit our armamentarium of medicinal agents which could be life-saving in emergency situations. Oxygen diffusion-enhancing compounds represent one such class of potential therapeutic agents, particularly in ischemic conditions. As rewarding as the name suggests, these agents, represented by the most advanced and first-in-class molecule, trans-sodium crocetinate (TSC), are the subject of intense clinical investigation, including Phase 1b/2b clinical trials for COVID-19. Being a successor of a natural product, crocetin, TSC is being investigated for various cancers as a radiosensitizer owing to its oxygen diffusion enhancement capability. The unique properties of TSC make it a promising therapeutic agent for various ailments such as hemorrhagic shock, stroke, heart attack, among others. The present review outlines various (bio)synthetic strategies, pharmacological aspects, clinical overview and potential therapeutic benefits of crocetin and related compounds including TSC. The recent literature focusing on the delivery aspects of these compounds is covered as well to paint the complete picture to the curious reader. Given the potential TSC holds as a first-in-class agent, small- and/or macromolecular therapeutics based on the core concept of improved oxygen diffusion from blood to the surrounding tissues where it is needed the most, will be developed in future and satisfy the unmet medical need for many diseases and disorders.

Percutaneous Aspiration for Septic Thrombi in Burn Patients.

Therapeutic interventions are limited for high-risk burn patients with caval and intracardiac septic thrombi. Percutaneous thrombectomy represents a less invasive alternative to median sternotomy. However, there is limited literature on application of this approach and outcomes in these patients. We report two cases of patients with large total body surface area burns with similar caval and right intracardiac septic thrombi. Both patients were successfully treated using a percutaneous aspiration device.

The effect of ulnar styloid fractures on patient-rated outcomes after volar locking plating of distal radius fractures.

PURPOSE: Ulnar styloid fractures commonly occur with distal radius fractures (DRFs). Ulnar styloid fractures that involve the insertion of the radioulnar ligaments can cause distal radioulnar joint (DRUJ) instability, and the literature suggests that these fractures should be treated with open reduction internal fixation (ORIF). However, in the absence of DRUJ instability, the effects of ulnar styloid fractures are unknown. The purpose of this study is to evaluate the outcome of ulnar styloid fractures without DRUJ instability on patient-rated outcomes after DRF ORIF. METHODS: Between 2003 and 2008, a cohort of DRF patients treated with volar plating was enrolled. Patients with DRUJ instability treated at the time of distal radius ORIF were excluded. Radiographs were evaluated to identify and characterize ulnar styloid fractures. Patient-rated outcomes were measured at 6 weeks, 3 months, 6 months, and 12 months postoperatively using the Michigan Hand Outcomes Questionnaire (MHQ). Regression analysis was performed to determine whether the presence of an ulnar styloid fracture, the size or displacement of the fracture, or the healing status of the fracture was predictive of MHQ scores. RESULTS: One-hundred and forty-four patients were enrolled; 88 patients had ulnar styloid fractures. During the collection period, DRUJ instability was found intraoperatively in 3 patients; these patients had ulnar styloid ORIF and were not enrolled. The 144 patients with a stable DRUJ after DRF ORIF maintained DRUJ stability after surgery. In these patients, the presence of an ulnar styloid fracture did not affect MHQ scores. Furthermore, the size of the ulnar styloid fracture, the degree of displacement, and the healing status of the ulnar styloid did not affect MHQ scores. CONCLUSIONS: In patients with a stable DRUJ after DRF ORIF ulnar styloid fractures did not affect subjective outcomes as measured by the MHQ. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic III.

Robert William Smith: his life and his contributions to medicine.

Robert William Smith is best known for the eponymous Smith's fracture. He also made other important contributions to medicine and medical education, publishing on topics ranging from arthritis to neuroma. He had a great interest in pathology and helped found the Pathological Society of Dublin. At the time of his death, he was the vice president of the Royal College of Surgeons in Ireland. His contributions to the understanding of various pathologic conditions make him an important figure in medicine and in hand surgery.

Preliminary experience with the percutaneous embolization of paragangliomas at the carotid bifurcation using only ethylene vinyl alcohol copolymer (EVOH) Onyx.

BACKGROUND/PURPOSE: Carotid body paragangliomas are rare hypervascular lesions which may benefit from preoperative devascularization to reduce intraoperative blood loss. The optimal method for devascularization of these tumors is not known. Our purpose was to evaluate the extent of angiographic devascularization and intraoperative blood loss using only ethylene vinyl alcohol copolymer (EVOH) for percutaneous glomus tumor embolization. METHODS: A consecutive series of seven paragangliomas located at the carotid bifurcation were treated with percutaneous embolization with EVOH as the sole embolic agent. RESULTS: Complete devascularization of seven paragangliomas was achieved in all cases percutaneously with only EVOH. There were no complications. The average intraoperative blood loss was 55 ml (range 15-80 ml). CONCLUSIONS: Our preliminary experience suggests that EVOH may offer a higher degree of devascularization when compared with other embolic agents. This may facilitate easier surgical resection with lower blood loss. EVOH seems to be safe when percutaneously injected as the sole embolic agent.

Archie Cochrane and his vision for evidence-based medicine.

Archibald (Archie) Cochrane's most influential mark on health care was his 1971 publication, Effectiveness and Efficiency. This book strongly criticized the lack of reliable evidence behind many of the commonly accepted health care interventions at the time. His criticisms spurred rigorous evaluations of health care interventions and highlighted the need for evidence in medicine. His call for a collection of systematic reviews led to the creation of The Cochrane Collaboration. Archie Cochrane was a visionary person who helped lay down much of the foundation for evidence-based medicine. This article introduces evidence-based medicine to plastic surgery by tracing its history to the seminal efforts by Archie Cochrane.