Aims: Scoliosis is a lateral curvature of the spine with associated rotation, often causing distress due to appearance. For some curves, there is good evidence to support the use of a spinal brace, worn for 20 to 24 hours a day to minimize the curve, making it as straight as possible during growth, preventing progression. Compliance can be poor due to appearance and comfort. A night-time brace, worn for eight to 12 hours, can achieve higher levels of curve correction while patients are supine, and could be preferable for patients, but evidence of efficacy is limited. This is the protocol for a randomized controlled trial of 'full-time bracing' versus 'night-time bracing' in adolescent idiopathic scoliosis (AIS). Methods: UK paediatric spine clinics will recruit 780 participants aged ten to 15 years-old with AIS, Risser stage 0, 1, or 2, and curve size (Cobb angle) 20° to 40° with apex at or below T7. Patients are randomly allocated 1:1, to either full-time or night-time bracing. A qualitative sub-study will explore communication and experiences of families in terms of bracing and research. Patient and Public Involvement & Engagement informed study design and will assist with aspects of trial delivery and dissemination. Discussion: The primary outcome is 'treatment failure' (Cobb angle progression to 50° or more before skeletal maturity); skeletal maturity is at Risser stage 4 in females and 5 in males, or 'treatment success' (Cobb angle less than 50° at skeletal maturity). The comparison is on a non-inferiority basis (non-inferiority margin 11%). Participants are followed up every six months while in brace, and at one and two years after skeletal maturity. Secondary outcomes include the Scoliosis Research Society 22 questionnaire and measures of quality of life, psychological effects of bracing, adherence, anxiety and depression, sleep, satisfaction, and educational attainment. All data will be collected through the British Spine Registry.
The mechanisms of water and chloride oxidation by a WO3 photoanode are probed by photoinduced absorption spectroscopy (PIAS) coupled with transient photocurrent (TC) measurements. Linear sweep voltammograms (LSVs) and incident photon to current efficiencies (IPCEs) are obtained, in the water oxidation electrolyte (1 M HClO4) and chloride oxidation electrolyte (3.5 M NaCl in 1 M HClO4). Other work shows that the faradaic efficiency of water oxidation to O2 in 1 M HClO4 is ca. 1.0, and that for chloride oxidation to Cl2 in 3.5 M NaCl plus 1 M HClO4 is ca. 0.62. The PIAS/TC data reveals a 0.4 order dependency of the rate of water oxidation on the steady state concentration of photogenerated surface holes, [hs+]ss, and an approximately first order dependency of the rate of chloride oxidation on [hs+]ss. Associated mechanisms and rate determining steps for water and chloride oxidation at the photoanode surface that account for these reaction orders are proposed.
INTRODUCTION: The use of nitinol continuous compression staples has shown clinical utility in the management of various orthopaedic injuries. While literature is most robust in the realm of foot/ankle and spine surgery, the use of nitinol staples has been documented in fixation of wrist, olecranon, patella, and pelvis fractures. METHODOLOGY: A narrative review was conducted by searching three online databases - PubMed, Web of Science, and Cochrane using the terms "Nitinol" and "Staple" published between 2003 and 2023. A total of 42 articles met inclusion/exclusion criteria and were included in this review. REVIEW: Literature outside of foot/ankle and spine surgery is largely limited to biomechanical studies, case reports, and finite element analyses. The literature is summarized within this review by anatomic location including foot/ankle, lower extremity, hand, upper extremity, spine, and pelvis. CONCLUSION: Existing literature demonstrates a diverse array of applications for nitinol continuous compression staples in both axial and appendicular orthopaedic care. Advantages of these implants include ease of application, ability to capture small bony fragments, continuous compression across a fracture or arthrodesis, and full coaptation which maximizes the surface area for healing and/or fusion.
Fractures, Bone , Orthopedics , Humans , Alloys , Fractures, Bone/surgery , Arthrodesis
Carbon dioxide, CO2, is an essential part of life, in that through green plant photosynthesis it is used to generate food and fuel and is generated in both aerobic and anaerobic respiration. Industrially, it is used in fire extinguishers, supercritical fluid extractions, and food packaging. Environmentally, it is in the atmosphere, hydrosphere, and biosphere and is responsible for global warming and the acidification of the oceans. The monitoring of CO2 in the gas phase is usually carried out using FTIR spectroscopy, whereas the measurement of dissolved CO2 usually involves an electrochemical device. Excitingly, the most recent forms of CO2 indicators appear to offer significant advantages over current methods, such as simplicity, low cost, and portability. This Account highlights the work of the Mills group on transforming CO2 colorimetric indicator technology from the usual water-based (i.e., "wet") indicator form to dry CO2-sensitive inks, pigments, plastics, and adhesives. Initially, the basic theory associated with colorimetric CO2 indicators is described, and the simple relationship between indicator absorbance and the partial pressure of CO2, PCO2, established. The early work on CO2-sensitive inks is then described, where such inks comprise a hydrophilic pH-sensitive dye anion, coupled with a lipophilic quaternary ammonium cation, dissolved in a nonaqueous solution of a polymer which, when cast, forms a dry ink film that gives a reversible color response when exposed to CO2 both in the gas phase and dissolved in solution. The ability to tune the sensitivity of a CO2 ink film to the desired application through the judicious choice of the pH indicator dye and base concentration is described. The dependence of the sensitivity of a CO2 ink film on temperature is used to create a temperature indicator, and the ability to tune the ink, to respond to high levels of CO2, is used to create a fizziness indicator for carbonated drinks. Very sensitive CO2 inks are used to make a vacuum and a general air-pressure indicator. The more recent development in CO2 indicator technology is described in which CO2 inks are used to coat silica particles to make a range of different CO2-sensitive pigments, which, when incorporated into a plastic, through extrusion, produce a range of novel CO2-sensitive plastic films that have many notable advantages over their ink film counterparts. Examples are then given of such plastic films being used for dissolved CO2 measurements in salt water, for food packaging, and as an early wound-infection indicator. Finally, the recent incorporation of a CO2-sensitive pigment into a pressure sensitive adhesive to make an after opening freshness tape is described briefly. Although most commercial CO2 indicators are assessed by eye and so are limited to qualitative analysis, this work shows that colorimetric CO2 indicators can be used for quantitative analysis through absorbance measurements. Nowadays, such measurements can be readily made using just a digital camera and color analysis software via digital camera colorimetry, DCC, which is likely to have a significant impact on the widespread use of the CO2 indicators described herein, their commercial viability, and their potential areas of application.
SUMMARY: As volume and understanding of genital gender affirming surgery (gGAS) has grown, so has the spectrum of surgical techniques to better serve a wider range of transgender and non-binary individuals. Given the diverse spectrum of individuals seeking phalloplasty, we emphasize the importance of patient driven decision-making, beginning with the initial consultation. Phalloplasty surgery is not a one-size-fits-all surgery, but instead should be viewed from an individually-customized approach. This article discusses the technical details for vaginal preservation without scrotoplasty or clitoral tissue burial in a shaft-only phalloplasty (SOP). The technique involves degloving the clitoral shaft, with inset at the ventral base of the phallus, addressing the redundant clitoral hood, and accompanying reduction labiaplasty with a Y-to-V adjacent tissue transfer. The phallus may be neurotized with clitoral nerves from one side of the clitoris, and/or the ilioinguinal nerve. This technique obliterates the degloved clitoral hood and re-suspends the labia minora anteriorly, improving final aesthetics and striving to meet patient genital goals.
The kinetics of the removal of stearic acid (SA) islands by photocatalytic coatings is controversial, with some reporting that the islands fade as their thickness, h, decreases with the irradiation time, t, but maintain a constant area, a, -da/dt = 0, and others reporting that -dh/dt = 0 and -da/dt = -constant, i.e., the islands shrink, rather than fade. This study attempts to understand the possible cause for these two very different observations through a study of the destruction of a cylindrical SA island and an array of such islands, on two different photocatalytic films, namely, Activ self-cleaning glass, and a P25 TiO2 coating on glass, which have established uniform and heterogeneous surface activities, respectively. In both cases, using optical microscopy and profilometry, it is shown that, irrespective of whether there is as a single cylindrical island or an array of islands, h decreases uniformly with t, -dh/dt = constant, and -da/dt = 0, so that the SA islands just fade. However, in a study of the photocatalyzed removal of SA islands with a volcano-shaped profile, rather than that of a cylinder, it is found that the islands shrink and fade. A simple 2D kinetic model is used to rationalize the results reported in this work. Possible reasons for the two very different kinetic behaviors are discussed. The relevance of this work to self-cleaning photocatalytic films is discussed briefly.
Purpose: Diabetic retinopathy (DR) is the most common microvascular complication associated with diabetes mellitus (DM), affecting approximately 40% of this patient population. Early detection of DR is vital to ensure monitoring of disease progression and prompt sight saving treatments as required. This article describes the data contained within the INSIGHT Birmingham, Solihull, and Black Country Diabetic Retinopathy Dataset. Design: Dataset descriptor for routinely collected eye screening data. Participants: All diabetic patients aged 12 years and older, attending annual digital retinal photography-based screening within the Birmingham, Solihull, and Black Country Eye Screening Programme. Methods: The INSIGHT Health Data Research Hub for Eye Health is a National Health Service (NHS)-led ophthalmic bioresource that provides researchers with safe access to anonymized, routinely collected data from contributing NHS hospitals to advance research for patient benefit. This report describes the INSIGHT Birmingham, Solihull, and Black Country DR Screening Dataset, a dataset of anonymized images and linked screening data derived from the United Kingdom's largest regional DR screening program. Main Outcome Measures: This dataset consists of routinely collected data from the eye screening program. The data primarily include retinal photographs with the associated DR grading data. Additional data such as corresponding demographic details, information regarding patients' diabetic status, and visual acuity data are also available. Further details regarding available data points are available in the supplementary information, in addition to the INSIGHT webpage included below. Results: At the time point of this analysis (December 31, 2019), the dataset comprised 6 202 161 images from 246 180 patients, with a dataset inception date of January 1, 2007. The dataset includes 1 360 547 grading episodes between R0M0 and R3M1. Conclusions: This dataset descriptor article summarizes the content of the dataset, how it has been curated, and what its potential uses are. Data are available through a structured application process for research studies that support discovery, clinical evidence analyses, and innovation in artificial intelligence technologies for patient benefit. Further information regarding the data repository and contact details can be found at https://www.insight.hdrhub.org/. Financial Disclosures: Proprietary or commercial disclosure may be found after the references.
Trauma-informed care has become a pillar of competent psychological services. A foundation in understanding trauma and its treatment should be viewed as essential for clinical psychologists entering the field, as working with individuals that have experienced trauma is inevitable. OBJECTIVE: The objective of this study was to evaluate the number of accredited doctoral programs in clinical psychology that require a course in trauma-informed theory and intervention in their curriculum. METHOD: Clinical psychology programs accredited by the American Psychological Association were surveyed to determine their requirement for a course related to trauma-informed care. Program information was initially reviewed online and in the absence of clear indication within their program websites, survey questions were sent to the program Chair and/or Directors of Clinical Training. RESULTS: Data were obtained from 193 of the 254 APA-accredited programs included in this survey process. Only nine (5%) require a course related to trauma-informed care. Of these, five were PhD programs and four were PsyD programs. This equates to 202 (8%) of graduating doctoral students having been required to take a course related to trauma-informed care. CONCLUSIONS: Trauma exposure is common and a major factor to be considered in the development of psychological disorders and overall physical and emotional wellbeing. As a result, clinical psychologists should enter the field with a foundation in understanding the impact and treatment of trauma exposure. However, only a minority of graduating doctoral students have been required to take a course related to this topic in their graduate curriculum. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
OBJECTIVES: High-energy pelvic ring injuries are associated with significant morbidity and mortality, elevating the importance of injury pattern identification. The purpose of this study was to use a novel 3D computed tomography (CT) unfolding process to both evaluate high-energy pelvic ring injures and to produce injury frequency maps based on injury patterns. METHODS: Patients 18-65 years of age presenting to a level 1 trauma center with pelvic ring injuries between 2016 and 2020 were identified. Of the 482 patients reviewed, 355 were excluded primarily due to having a low energy mechanism, inadequate radiographs, or an isolated fracture. Unfolded pelvic CT images were created using syngo.via CT Bone Reading software. Pelvic ring injury frequency maps were created using the unfolded pelvic CT images and a previously described mapping technique. RESULTS: One hundred twenty-seven patients analyzed had a mean age of 32.7 years. The most common mechanisms of injury (MOI) were motor vehicle collision (30.7%) and fall from height (23.6%). The breakdown of pelvic ring injuries included LC1 = 44.1%, LC2 = 7.1%, LC3 = 14.2%, APC1 = 2.4%, APC2 = 15.0%, APC3 = 5.5%, and VS = 11.8%, with OTA/AO-61B = 74.0% and OTA/AO-61C = 26.0%. Pelvic ring mapping revealed that articular and bony injuries varied markedly between the different types of pelvic ring disruptions, both in type and location. CONCLUSIONS: Pelvic ring injury frequency maps created from unfolded CT images reflect consistent injury patterns providing distinctive information based on force vector mechanisms. Unfolded CT images allow for a novel way to visualize pelvic ring injuries which yield greater comprehension of failure patterns with implications for treatment.
Fractures, Bone , Pelvic Bones , Humans , Adult , Pelvic Bones/diagnostic imaging , Pelvic Bones/injuries , Retrospective Studies , Fractures, Bone/diagnostic imaging , Tomography, X-Ray Computed/methods , Radiography , Trauma Centers
Rationale: High circulating galectin-3 is associated with poor outcomes in patients with coronavirus disease (COVID-19). We hypothesized that GB0139, a potent inhaled thiodigalactoside galectin-3 inhibitor with antiinflammatory and antifibrotic actions, would be safely and effectively delivered in COVID-19 pneumonitis. Objectives: Primary outcomes were safety and tolerability of inhaled GB0139 as an add-on therapy for patients hospitalized with COVID-19 pneumonitis. Methods: We present the findings of two arms of a phase Ib/IIa randomized controlled platform trial in hospitalized patients with confirmed COVID-19 pneumonitis. Patients received standard of care (SoC) or SoC plus 10 mg inhaled GB0139 twice daily for 48 hours, then once daily for up to 14 days or discharge. Measurements and Main Results: Data are reported from 41 patients, 20 of which were assigned randomly to receive GB0139. Primary outcomes: the GB0139 group experienced no treatment-related serious adverse events. Incidences of adverse events were similar between treatment arms (40 with GB0139 + SoC vs. 35 with SoC). Secondary outcomes: plasma GB0139 was measurable in all patients after inhaled exposure and demonstrated target engagement with decreased circulating galectin (overall treatment effect post-hoc analysis of covariance [ANCOVA] over days 2-7; P = 0.0099 vs. SoC). Plasma biomarkers associated with inflammation, fibrosis, coagulopathy, and major organ function were evaluated. Conclusions: In COVID-19 pneumonitis, inhaled GB0139 was well-tolerated and achieved clinically relevant plasma concentrations with target engagement. The data support larger clinical trials to determine clinical efficacy. Clinical trial registered with ClinicalTrials.gov (NCT04473053) and EudraCT (2020-002230-32).
COVID-19 , Humans , SARS-CoV-2 , Galectin 3 , Inflammation , Treatment Outcome
A thin, 30 µm, flexible, robust low-density polyethylene, LDPE, film, loaded with 30 wt% P25 TiO2, is extruded and subsequently rendered highly active photocatalytically by exposing it to UVA (352 nm, 1.5 mW cm-2) for 144 h. The film was tested for anti-viral activity using four different viruses, namely, two strains of Influenza A Virus (IAV), WSN, and a recombinant PR8, encephalomyocarditis virus (EMCV), and SARS-CoV-2 (SARS2). The film was irradiated with either UVA radiation (352 nm, 1.5 mW cm-2; although only 0.25 mW cm-2 for SARS2) or with light from a cool white fluorescent lamp (UVA irradiance: 365 nm, 0.047 mW cm-2). In all cases the films exhibited an average virus inactivation rate of >1.5log/h. In the case of SARS2, the rates were > 2log/h, with the rate determined using a dedicated, low intensity UVA source (0.25 mW cm-2) only 1.3 x's faster than that for a cool white lamp (UVA irradiance = 0.047 mW cm-2), which suggests that SARS2 is particularly prone to photocatalytic inactivation even under low UV irradiation conditions, such as found in a room lit with just white fluorescent tubes. This is the first example of a flexible, very thin, photocatalytic plastic film, produced by a scalable process (extrusion), for virus inactivation. The potential of such a film for use as a disposable, self-sterilising thin plastic material alternative to the common, non-photocatalytic, inert equivalent used currently for curtains, aprons and table coverings in healthcare is discussed briefly.
COVID-19 , Titanium , Catalysis , Humans , Plastics , Polyethylene , SARS-CoV-2 , Ultraviolet Rays
The photocatalytic oxidation of stearic acid, SA, by O2 is a common test method used to assess the activity of new materials and underpins a standard test for self-cleaning activity. The kinetics of this process have been well-studied and are often interpreted using one of two simple models, which are revisited here in this overview. The first model is based on the common scenario of a SA layer on top of an all-photocatalyst layer which yields zero order kinetics, for which it is suggested that all the reaction sites are occupied by SA during the bulk of the photocatalytic process. An important, but rarely noted feature of this system is that the rate of SA removal depends directly upon the fraction of absorbed ultra-bandgap radiation, which suggests that the photocatalyst particles are extensively networked, thereby allowing the photogenerated electrons and holes to move rapidly and efficiently to the surface to effect the destruction of SA. The second kinetic model has been used to describe the first order kinetics of SA removal observed for mesoporous photocatalytic films comprised of isolated photocatalyst particles, in which the SA is inside (rather than on top) of the photocatalytic film, and is developed further here. It is shown that, contrary to previous reports, this model is not appropriate for porous photocatalytic films in which the particles are extensively networked, such as ones based on powders or sol-gel films, even though they too may exhibit decay kinetics where the order is > 0. The reason for the latter kinetics appears to be a distribution of reactivities through such films, i.e. high and low activity sites.
3D printing is known as a fast, inexpensive, reproducible method for producing prototypes but is also fast becoming recognised as a scalable, advanced manufacture process. Two types of lab-scale, 3D printed plastic, fixed-film, flow-through photocatalytic reactors are described, both of which are sinusoidal in shape, and only differ in that one has no baffles, reactor A, whereas the other has, reactor B. Both reactors are lined with a P25 TiO2/polylactic acid (PLA) coating, which, after UVA pre-conditioning, is used to photocatalyse the bleaching of circulating aqueous solutions of either methylene blue, MB, or phenol, PhOH, repeatably, without any obvious loss of activity. The rate of the photocatalysed bleaching of MB exhibited by reactor B shows a much lower dependence upon flow rate than reactor A, due to the greater lateral mixing of the laminar flow streams produced by the baffles. The photonic efficiencies of reactor A for the photocatalysed bleaching of MB and PhOH were determined to be 0.025% and 0.052%, respectively, and the photocatalytic space-time yields (PSTY) to be 0.98 × 10-4 and 1.49 × 10-4 m3 of reaction solution.m-3 reactor volume.day-1.kW-1, respectively. This is the first example of an all plastic, 3D printed photocatalytic reactor and demonstrates the advantages of 3D printing for prototyping. Given the 3D printing is a scalable process, possible potential areas of application are discussed briefly.
Plastics , Water Purification , Catalysis , Phenol , Printing, Three-Dimensional , Titanium , Water Purification/methods
BACKGROUND: In 2019, 14.0% of infants in Thailand were exclusively breastfed up to 6 months of age. To increase exclusive breastfeeding, an objective assessment measure would be useful to maternity care providers for appraising the problems encountered by new mothers' experiences with breastfeeding. RESEARCH AIMS: To translate the Bristol Breastfeeding Assessment Tool from English into Thai; to assess the reliability and validity of the Thai Bristol Breastfeeding Assessment Tool; and to explore the relationship of a mother's self-efficacy to successful breastfeeding. METHODS: Using a methodological design, we purposively sampled 302 new mothers from two tertiary hospitals in Thailand who had given birth to a single baby with an uncomplicated vaginal birth. The Thai Bristol Breastfeeding Assessment Tool's structure was examined using confirmatory factor analysis. Concurrent and convergent validity were assessed using the Thai LATCH instrument and Thai Breastfeeding Self-Efficacy Scale, respectively. RESULTS: The inter-item Thai Bristol Breastfeeding Assessment Tool correlation coefficients were positive and strong. The correlation between scores of the Thai Bristol Breastfeeding Assessment Tool and Thai LATCH instrument were positive and strong and had acceptable concurrent validity. The confirmatory factor analysis model fit the Thai Bristol Breastfeeding Assessment Tool data perfectly and the Cronbach's alpha coefficient had acceptable internal reliability. CONCLUSIONS: The Thai Bristol Breastfeeding Assessment Tool is a cross-culturally translated instrument equivalent to its English version and demonstrated acceptable validity and reliability. The instrument provides a mechanism for an objective assessment and monitoring system of optimal breastfeeding practices in Thai mothers with newborns.
Breast Feeding , Maternal Health Services , Female , Humans , Infant, Newborn , Pregnancy , Psychometrics , Reproducibility of Results , Surveys and Questionnaires , Thailand
In this review, we highlight the role played by metal nanoparticles (NPs) in photocatalytic oxidation with titania as a support. This is presented in two parts, namely, partial photo-oxidation in which an organic sacrificial agent is oxidised in anaerobic conditions to produce hydrogen (photo-reforming), and photo-oxidative mineralisation of organics in aerobic conditions. We present some rules for such reactions that dictate which organic molecules can react readily, and which metals are likely to be useful for such reactions. Generally, the presence of metal NPs enhances enormously the ability of titania to yield hydrogen from photo-reforming, and a wide range of molecules can be used, including biomass. The metal NPs most used are those that are easily reduced, that is, the precious metals. The large enhancement in rate seen with metal for hydrogen production is not so extreme for the oxidation reactions, but is still significant. An important factor in all of this catalysis is the nature of the interaction between the metal NPs, which can play a multiplicity of chemical and electronic roles, and the photoactive support. A sharp dependency of rate on loading of metal is found, with maximum rates at ~0.5-2 wt% loading, depending on the metal used. The source of this dependency is the bifunctional nature of the system, in which the intimacy of both materials is crucial to performance. This rate variation is linked to the interface between the two, which is then linked to the size of the metal NPs. In fact, the rate is proportional to an area adjacent to the metal particles that we call the expanding photocatalytic area and overlap (EPAO) kinetic model. This model describes the dependence well. Rising rates with increasing coverage of particles is associated with increase in this total area but, at the maximum, these areas overlap and at higher loadings the available active area diminishes, reproducing the observed behaviour well.
Metal Nanoparticles , Titanium , Catalysis , Hydrogen/chemistry , Metal Nanoparticles/chemistry , Titanium/chemistry
BACKGROUND: The vertical rectus abdominis myocutaneous (VRAM) flap is one of the options for soft-tissue reconstruction in the groin and thigh. The aim of this study is to evaluate the clinical outcomes, risk factors for complications, and the utility of using mesh to prevent abdominal hernia. METHODS: A retrospective review of patients who underwent VRAM flap reconstruction to reconstruct proximal thigh and groin defects from 1997 to 2018 was performed. Data regarding patient demographics, surgical characteristics, and postoperative outcomes were collected. Proportional hazard regression analysis was performed to assess the association of the risk of recipient site complications. A systematic review was performed to assess the outcomes and summarize the evidence from published studies. RESULTS: Fifty-three patients were identified and included in this study. In most of the cases, the procedures were performed after tumor resection (77%) and in the rest of the cases, they were performed for chronic complicated wounds (23%). Twenty-five (47.2%) patients developed complications. Intraoperative and postoperative radiotherapy, chronic kidney disease, history of prior tumor resection, and reconstructions of chronic complicated wounds were associated with an increased risk of recipient site complications. A systematic review identified 9 articles, for a total of 189 reconstructions. The pooled complications and failure rates were 31.2% and 2.1%, respectively. Stratified analysis showed that the rate of abdominal hernia was similar in patients with mesh (16.7%) and in patients with primary closure only (15.1%; p = 0.761). CONCLUSION: Defects in the groin or proximal thigh can be treated successfully with the VRAM flap. Although wound complications and hernia rates are high, the reconstruction failure rate is low.
Hernia, Abdominal , Myocutaneous Flap , Neoplasms , Plastic Surgery Procedures , Groin/surgery , Hernia, Abdominal/surgery , Humans , Myocutaneous Flap/transplantation , Neoplasms/surgery , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgery , Plastic Surgery Procedures/adverse effects , Plastic Surgery Procedures/methods , Rectus Abdominis/transplantation , Retrospective Studies , Thigh/surgery
PURPOSE: Studies have shown that bracing is an effective treatment for patients with idiopathic scoliosis. According to the current classification, almost all braces fall in the thoracolumbosacral orthosis (TLSO) category. Consequently, the generalization of scientific results is either impossible or misleading. This study aims to produce a classification of the brace types. METHODS: Four scientific societies (SOSORT, SRS, ISPO, and POSNA) invited all their members to be part of the study. Six level 1 experts developed the initial classifications. At a consensus meeting with 26 other experts and societies' officials, thematic analysis and general discussion allowed to define the classification (minimum 80% agreement). The classification was applied to the braces published in the literature and officially approved by the 4 scientific societies and by ESPRM. RESULTS: The classification is based on the following classificatory items: anatomy (CTLSO, TLSO, LSO), rigidity (very rigid, rigid, elastic), primary corrective plane (frontal, sagittal, transverse, frontal & sagittal, frontal & transverse, sagittal & transverse, three-dimensional), construction-valves (monocot, bivalve, multisegmented), construction-closure (dorsal, lateral, ventral), and primary action (bending, detorsion, elongation, movement, push-up, three points). The experts developed a definition for each item and were able to classify the 15 published braces into nine groups. CONCLUSION: The classification is based on the best current expertise (the lowest level of evidence). Experts recognize that this is the first edition and will change with future understanding and research. The broad application of this classification could have value for brace research, education, clinical practice, and growth in this field.
Braces , Scoliosis , Consensus , Humans , Orthotic Devices , Scoliosis/therapy , Treatment Outcome
A simple, non-invasive, colour-based carbon dioxide (CO2) indicator is described. The indicator provides an indirect response to the rapid, aerobic microbial colonisation of an underlying wound when used in conjunction with an occlusive (i.e. sealed) dressing. The indicator has potential as an early warning indicator of infection in chronic wounds.
BACKGROUND: Small recalcitrant defects of the mandible and maxilla may be secondary to tumor, trauma, infection, and congenital origin. Vascularized bone grafting has been shown to effectively manage these defects; however, donor sites are limited. The vascularized medial femoral condyle (MFC) provides adequate cortical cancellous bone with the option of a skin island, consistent anatomy, and minimal donor site morbidity. This article outlines the use of the MFC flap for maxillomandibular reconstruction. METHODS: A retrospective chart review of patients who required segmental maxillomandibular reconstruction with the MFC flap was conducted. A total of 9 patients (5 men and 5 women) with an average age of 45.3 years were identified. The etiology of the defects, flap sizes, and postoperative outcomes were recorded. RESULTS: Three patients had osteoradionecrosis of the neomandible after irradiation of the free fibula reconstruction, 3 patients had defects after cancer extirpation (1 mandible, 2 maxillary), 1 patient had a maxillary defect from trauma, and 2 patients had a residual cleft palate defect. All defects failed initial treatment with nonvascularized bone grafts. The average dimensions of the MFC flaps were 1.2 × 2.5 × 4 cm. Two of 9 flaps included a skin island. Eight flaps survived completely, but 1 patient suffered from flap failure requiring debridement and resulted in an oroantral fistula. Four patients received endosseous dental implants. Average time to union was 6.7 months, and average time to implant was 6.75 months. The average follow-up time was 24.9 months. CONCLUSIONS: The MFC flap is useful in the reconstruction of small segmental maxillomandibular defects and for the salvage of a neomandible after osteoradionecrosis. The MFC flap provides a reliable platform for endosseous dental implants and serves as an alternative source of vascularized bone reconstruction in the head and neck.
Free Tissue Flaps , Plastic Surgery Procedures , Bone Transplantation , Female , Femur , Humans , Male , Mandible/surgery , Middle Aged , Retrospective Studies
