Management of paediatric fifth metacarpal neck fractures: a systematic review.

BACKGROUND: Fifth metacarpal neck fractures (FMCNFs) are common among paediatric patients. Complications include reduced metacarpophalangeal (MCP) range of motion and grip strength, which impede the hand's functional abilities. Various management options are available, but indications are not standardised. This systematic review aims to assimilate all available evidence on the management of paediatric FMCNFs to determine appropriate treatment pathways. METHODS: PubMed (Medline), EMBASE, Scopus and Google Scholar were used to identify evidence pertaining to the management of these fractures. RESULTS: Ten studies were identified, involving 237 patients with a mean age of 14.4 years (Range 9-17). Ninety percent of patients were male. Sixty-one (26%) patients, with an average fracture angulation of 27° (Range 16°-33°) and no rotational deformities, were managed with immobilisation alone. These patients returned to normal metacarpophalangeal range of motion and grip strength. Fifty-four (23%) patients, with an average fracture angulation of 42.7° (Range 33°-54°), were managed with fracture reduction and immobilisation. This technique did not yield sustained reduction of fractures with significant angulation or rotation after intervention. One hundred twenty-two (51%) patients, with an average fracture angulation of 48.3° (Range 30°-58°) and including cases of malrotation, were managed with fracture reduction and surgical fixation. These patients experienced good functional outcomes. CONCLUSIONS: This review suggests paediatric FMCNFs can be safely managed with immobilisation alone when there is an absence of rotational deformity and an angulation of < 30°. In the case of a higher fracture angulation or rotational deformity, fracture reduction and surgical fixation is an appropriate method of management.

Inoperable malignant bowel obstruction: palliative interventions outcomes - mixed-methods systematic review.

BACKGROUND: Parenteral nutrition (PN) and palliative venting gastrostomies (PVG) are two interventions used clinically to manage inoperable malignant bowel obstruction (MBO); however, little is known about their role in clinical and quality-of-life outcomes to inform clinical decision making. AIM: To examine the impact of PN and PVG on clinical and quality-of-life outcomes in inoperable MBO. DESIGN: A mixed-methods systematic review and narrative synthesis. DATA SOURCES: The following databases were searched (from inception to 29 April 2021): MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL, Bielefeld Academic Search Engine, Health Technology Assessment and CareSearch for qualitative or quantitative studies of MBO, and PN or PVG. Titles, abstracts and papers were independently screened and quality appraised. RESULTS: A total of 47 studies representing 3538 participants were included. Current evidence cannot tell us whether these interventions improve MBO survival, but this was a firm belief by patients and clinicians informing their decision. Both interventions appear to allow patients valuable time at home. PVG provides relief from nausea and vomiting. Both interventions improve quality of life but not without significant burdens. Nutritional and performance status may be maintained or improved with PN. CONCLUSION: PN and PVG seem to allow valuable time at home. We found no conclusive evidence to show either intervention prolonged survival, due to the lack of randomised controlled trials that have to date not been performed due to concerns about equipoise. Well-designed studies regarding survival for both interventions are needed. PROSPERO REGISTRATION NUMBER: CRD42020164170.

Carbon Neutral Hand Surgery: Simple Changes to Reduce Carbon Footprint.

Introduction: Rapid climate change poses a major challenge to healthcare. The operating room is especially responsible for carbon emission, with 20% to 70% of hospital waste traced back to the operating room. This literature review aims to suggest changes that can be made in hand surgery for a more sustainable practice. Methods: A literature search was conducted from PubMed, Medline, and other online search engines with the keywords "carbon footprint, environmental health, carbon neutral, plastic surgery, hand surgery, surgery." Results: "Reduce, Reuse, Recycle, Research, Rethink and Culture" was the framework used to recommend a more carbon neutral practice. In reduction, techniques such as cutting down oversupply of materials, adopting protocols to perform cases in ambulatory settings, and simple measures to reduce energy were identified as valuable methods. Modified sterilization techniques and reprocessing single-use devices were techniques identified for reuse and recycling involved single-stream recycling, staff training, and donation of basic surgical supplies. Research involved adopting data-driven programs for life cycle assessment of all equipment in the operating room, while the use of telemedicine and "green meetings' were suggested for rethinking. Finally, strategies to encourage a team approach to environmental responsibility were discussed. Conclusion: Carbon neutral practice must be implemented to safeguard sustainable and cost-effective operating rooms and healthcare systems. Hand surgery can pave the way for other specialties through the use of available resources to develop guidelines for carbon neutral practice. This requires active effort from hand surgeons to act as role models for other healthcare professionals.

Introduction : Les changements climatiques rapides constituent un défi majeur pour les soins de santé. La salle d'opération est particulièrement responsable de l'émission de carbone avec 20% à 70% des déchets hospitaliers rapportés aux salles d'opération. Cette revue de la littérature vise à suggérer les changements qui peuvent être apportés dans la chirurgie de la main pour une pratique plus durable. Méthodes : Une recherche bibliographique a été menée dans les bases de données PubMed, Medline et autres moteurs de recherche en ligne avec les mots-clés suivants : empreinte carbone, santé environnementale, carbone neutre, chirurgie plastique, chirurgie de la main et chirurgie. Résultats : « Réduire, Réutiliser, Recycler, Rechercher, Repenser et Culture ¼ a été le cadre utiliser pour recommander une pratique plus neutre en matière de carbone. Sous « réduction ¼, des techniques telles que des coupures dans l'excès d'approvisionnement en matériaux, l'adoption de protocoles permettant de traiter des cas en ambulatoire et des mesures simples pour réduire la consommation d'énergie sont des méthodes qui ont été jugées utiles. Des techniques de stérilisation modifiées et de retraitement de dispositifs à usage unique sont des techniques identifiées pour la réutilisation; le recyclage a impliqué une collecte en vrac, la formation du personnel et le don de fournitures chirurgicales de base. La recherche a nécessité d'adopter des programmes pilotés sur des données pour l'évaluation du cycle de vie de tout équipement de la salle de l'opération pendant que le recours à la télémédecine et aux réunions respectueuses de l'environnement était suggéré pour le thème « repenser ¼. Enfin, des stratégies visant à encourager une approche d'équipe envers la responsabilité environnementale ont été discutées. Conclusion : Une pratique carbone neutre doit être mise en œuvre pour protéger les salles d'opération durables et rentables ainsi que les systèmes de soins de santé. La chirurgie de la main peut ouvrir la voie à d'autres spécialités par l'utilisation des ressources disponibles afin d'élaborer des lignes directrices pour l'empreinte carbone de la pratique. Cela nécessite un effort de la part des chirurgiens de la main pour devenir des exemples pour les autres professionnels de santé.

Influence of scar age, laser type and laser treatment intervals on paediatric burn scars: a systematic review and meta-analysis.

Background: Laser therapy has emerged to play a valuable role in the treatment of paediatric burn scars; however, there is heterogeneity in the literature, particularly concerning optimal timing for initiation of laser therapy. This study aims to investigate the effect of factors such as scar age, type of laser and laser treatment interval on burn scar outcomes in children by meta-analysis of previous studies. Methods: A literature search was conducted across seven databases in May 2022 to understand the effects of laser therapy on burn scar outcomes in paediatric patients by metanalysis of standardized mean difference (SMD) between pre- and post-laser intervention. Meta-analyses were performed using the Comprehensive Meta-Analysis software version 4.0. Fixed models were selected when there was no significant heterogeneity, and the random effects model was selected for analysis when significant heterogeneity was identified. For all analyses, a p-value < 0.05 was considered significant. Results: Seven studies were included in the meta-analysis with a total of 467 patients. Laser therapy significantly improved Vancouver Scar Scale (VSS)/Total Patient and Observer Scar Assessment Scale (Total POSAS), vascularity, pliability, pigmentation and scar height of burn scars. Significant heterogeneity was found between the studies and thus subgroup analyses were performed. Early laser therapy (<12 months post-injury) significantly improved VSS/POSAS scores compared to latent therapy (>12 months post-injury) {SMD -1.97 [95% confidence interval (CI) = -3.08; -0.87], p < 0.001 vs -0.59 [95%CI = -1.10; -0.07], p = 0.03} as well as vascularity {SMD -3.95 [95%CI = -4.38; -3.53], p < 0.001 vs -0.48 [95%CI = -0.66; -0.30], p < 0.001}. Non-ablative laser was most effective, significantly reducing VSS/POSAS, vascularity, pliability and scar height outcomes compared to ablative, pulse dye laser and a combination of ablative and pulse dye laser. Shorter treatment intervals of <4 weeks significantly reduced VSS/POSAS and scar height outcomes compared to intervals of 4 to 6 weeks. Conclusions: Efficacy of laser therapy in the paediatric population is influenced by scar age, type of laser and interval between laser therapy application. The result of this study particularly challenges the currently accepted initiation time for laser treatment. Significant heterogeneity was observed within the studies, which suggests the need to explore other confounding factors influencing burn scar outcomes after laser therapy.

Management of Pediatric Volar Plate Avulsion Fractures of the Proximal Interphalangeal Joint: A Systematic Review.

BACKGROUND: Sudden, forced hyperextension injuries to the proximal interphalangeal joint leading to volar plate avulsion fractures are common hand injuries in children. Suboptimal management of these fractures can lead to the development of long-term complications such as stiffness and flexion contracture. METHODS: MEDLINE (PubMed), Scopus, Embase, Google Scholar, and Cochrane CENTRAL databases were systematically searched, and additional studies were found through reference of articles up to June 15, 2023. Identified articles were assessed using predetermined inclusion/exclusion criteria. RESULTS: Twenty-five articles were included, involving 268 patients with ages from 3 to 17 years. Fractures with less than 30% joint involvement, classified as Eaton type I or II, or designated as "Stable" in the Keifhaber-Stern classification, were treated through nonsurgical means. Surgical interventions, encompassing open reduction and internal fixation, were reserved for fractures with more than 30% joint involvement and/or meeting criteria such as Eaton type IIIa or IIIb and Keifhaber-Stern "Tenuous" or "Unstable." Positive outcomes were seen in 99.5% of patients receiving nonsurgical treatment, compared with 85.7% in the surgical cohort. CONCLUSIONS: The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically. In fractures with more than 30% joint involvement, surgical interventions yielded positive results. To further substantiate these findings, larger prospective studies with uniform measures are needed to validate the results of this study.

Efficacy of Massage Techniques for Hypertrophic Burn Scars - A Systematic Review of Literature.

Despite advancements in burn care, evidence estimates that pathological scarring occurs in 32%-75% of cutaneous burns. Scar massage therapy is an under researched method of management for hypertrophic burn scars which has scope to be a low-cost treatment alternative. The aim of this systematic review was to determine the efficacy of scar massage techniques for common hypertrophic burn scar symptoms such as contraction, pruritus, pain and visibility. The keywords and corresponding MeSH terms were inputed into PubMed, EMBASE, Cochrane database of Systematic Reviews, University Library of Hull, York and Queen Mary, University of London. Following the implementation of predetermined inclusion and exclusion criteria, ten papers were included for data extraction. Quality assessment of all papers was performed using the Cochrane Risk of Bias tool and ROBINS-I tool. Data pertaining to the nature of the participant demographics, scar massage treatment, and study outcomes was extracted. Nine of the ten studies showed a significant improvement for scar massage treatment of hypertrophic burn scar symptoms despite using different massage techniques. Friction and oscillation massage was used in partnership to improve scar function, whereas effleurage and petrissage used in longer sessions was seen to improve scar visibility and pain. Scar pruritus was improved by each massage technique. Scar massage has been shown to be effective at improving scar outcomes. This paper suggests massage techniques should be tailored to the patients' symptoms. A large, randomized control trial is required to advance this area of research.

Type of delivery and perinatal outcomes in pregnant women diagnosed with COVID-19: A systematic review and meta-analysis.

BACKGROUND: There is paucity in the literature that provides a comprehensive and evidence-based conclusion regarding this topic. OBJECTIVE: To compare perinatal outcomes of vaginal and caesarean section delivery in women diagnosed with COVID-19 by meta-analysis of literature. SEARCH STRATEGY: The search was conducted on MEDLINE, EMBASE, LILACS, CINAHL, Scopus, Web of Science and Cochrane Database of Systematic Reviews by 25th May 2022. SELECTION CRITERIA: The inclusion criteria involved pregnant women diagnosed with COVID-19 who underwent caesarean section and those who had vaginal deliveries. DATA COLLECTION AND ANALYSIS: The included studies were meta-analyzed for various outcomes including: Gestational age, maternal intensive care unit admission, maternal death, prematurity, newborn birth weight, newborn intensive care unit admission, Apgar scores, newborn death, and newborn vertical transmission of COVID-19. The meta-analysis was conducted using Comprehensive Meta-Analysis (CMA) software, version 3.3.070. MAIN RESULTS: The meta-analyses included 2,566 deliveries (866 caesarean sections and 1,700 vaginal deliveries) and identified that caesarean section was significantly associated with increased prematurity (OR 2.5 [1.7; 3.6], p < 0.001), lower birth weight (-118 g [-170; -66], p < 0.001), and a higher need for maternal (OR 9.54 [5.22; 17.43], p < 0.01) and neonatal intensive care unit intervention (OR 3.67 [2.71; 4.96], p < 0.01) compared to vaginal delivery. CONCLUSION: COVID-19 infection alone should not be an indication for caesarean section as there is insufficient evidence that caesarean section reduces mortality, improves birth conditions, or prevents vertical transmission. Additionally, caesarean section is associated with poorer perinatal outcomes compared to vaginal delivery.

Outcomes of Composite Grafts for Pediatric Fingertip Amputations: A Systematic Review.

Introduction The aim of this study was to explore the outcomes of composite grafts in fingertip amputations in children as well as the contributing factors that may affect outcomes. Methods Literature search was conducted across six databases in March 2022 to select studies on the use of composite grafts on fingertip amputations in the pediatric population. Results Twelve articles with 735 composite grafts were identified for review. Most fingertip injuries occurred in the less than 5-year age group and were due to crush type injuries. In studies that reported "complete" graft take as a separate outcome measure, 17.3% of fingertips with this result were observed. In the studies that reported "complete" and "partial" graft take together as an outcome measure, 81.6% of fingertips achieved this outcome. A lower proportion of failed graft take was observed in more distal fingertip amputations. Infection (3.8%) and nail abnormalities (3.4%) were the most common complications following composite grafting. Conclusion Composite grafting can be considered as a useful method of treatment in this population. Clinicians should be aware of the potential complications following this method of treatment such as infection and nail abnormalities. More proximal fingertip amputations may warrant other surgical interventions (beyond Level II on the modified Ishikawa/Ishikawa classification). Significant heterogeneity was observed within the studies, mainly due to lack of standardization in assessment and reporting of outcomes.

Influence of scar age, laser type and laser treatment intervals on adult burn scars: A systematic review and meta-analysis.

AIM: The study aims to identify whether factors such as time to initiation of laser therapy following scar formation, type of laser used, laser treatment interval and presence of complications influence burn scar outcomes in adults, by meta-analysis of previous studies. METHODS: A literature search was conducted in May 2022 in seven databases to select studies on the effects of laser therapy in adult hypertrophic burn scars. The study protocol was registered with PROSPERO (CRD42022347836). RESULTS: Eleven studies were included in the meta-analysis, with a total of 491 patients. Laser therapy significantly improved overall VSS/POSAS, vascularity, pliability, pigmentation and scar height of burn scars. Vascularity improvement was greater when laser therapy was performed >12 months (-1.50 [95%CI = -2.58;-0.42], p = 0.01) compared to <12 months after injury (-0.39 [95%CI = -0.68; -0.10], p = 0.01), the same was true for scar height ((-1.36 [95%CI = -2.07; -0.66], p<0.001) vs (-0.56 [95%CI = -0.70; -0.42], p<0.001)). Pulse dye laser (-4.35 [95%CI = -6.83; -1.86], p<0.001) gave a greater reduction in VSS/POSAS scores compared to non-ablative (-1.52 [95%CI = -2.24; -0.83], p<0.001) and ablative lasers (-0.95 [95%CI = -1.31; -0.59], p<0.001). CONCLUSION: Efficacy of laser therapy is influenced by the time lapse after injury, the type of laser used and the interval between laser treatments. Significant heterogeneity was observed among studies, suggesting the need to explore other factors that may affect scar outcomes.

Development and validation of a WHO ICF compliant hand and upper limb assessment tool for children: The Reach Out questionnaire.

BACKGROUND: Current tools for evaluating hand and upper limb function in children do not represent all domains of the World Health Organization International Classification of Disability, Functioning and Health (ICF) framework and may not capture an accurate progression or regression of function over time. PURPOSE: Based on this framework, we have developed an assessment tool (Reach Out) to evaluate function in children aged from 2 to 16 years following consultation with an advisory panel of specialists. STUDY DESIGN: Primary clinical study. METHODS: Construct validity along with test-retest reliability, inter-rater reliability and sensitivity to change have all been analyzed to validate the Reach Out assessment tool. RESULTS: The assessment tool has been validated in a total of 231 patients. Significant construct validity of 0.64 (P < .00001, 95% confidence interval = 0.56-0.71, n = 231) for both age groups and diagnostic groups was observed. The Reach Out questionnaire was internally consistent with a Cronbach's Alpha of > 0.8 for most domains in most age groups. Test re-retest scores showed that the questionnaire was reliable with most domains of the questionnaire achieving high scores of reliability (P ≤ .03). We also received positive feedback from participants and parents. CONCLUSIONS: The use of this new tool will help identify both progression and regression of function, allowing a more tailored and holistic approach to treatment in children with conditions affecting the hand and upper limb through the incorporation of International Classification of Disability, Functioning and Health domains. This tool is quicker to complete and can be applied to a wide range of ages and diagnostic groups compared to previous assessment tools.

Utility of a Pediatric Adaptive Sports Clinic: A Case Series Review.

BACKGROUND: Limited funding is available for athletes with disabilities in the United Kingdom. This compounds the barriers to participation and development that already exist. METHOD: To combat this growing problem, a Multi-Disciplinary Pediatric Adaptive Sports Clinic was formed. RESULT: Fifteen athletes with disabilities attended the Clinic from November 2017 to November 2019. In our cohort, there were 10 males and 5 females (age range: 13-18 years). Most athletes participated at a grassroots level (n = 9). The range of diagnoses included cerebral palsy, Ehlers Danlos syndrome and congenital hand differences. Forty-four appointments were made after the initial meeting with a 95% attendance rate. Improvements beyond the minimal clinically important differences (MCID) for the Patient Specific Functional Scale, Numerical Pain Rating Scale, and Medical Research Council Manual Muscle Testing Scale were noted in over half of cases. CONCLUSION: With a focus on injury prevention and strength and conditioning techniques, this clinic supported athletes to successfully compete from a recreational to an elite level across all types of sports and adolescent ages by providing patient-specific regimens. Our case series provides preliminary evidence to suggest the formation of similar clinics that can support athletes with disabilities across a range of sports.

A Single Stage Composite Cleft Septorhinoplasty for Correction of the Mature Unilateral Cleft Nose Deformity - The Gujrat Technique.

OBJECTIVE: To evaluate the results of a single stage composite cleft septorhinoplasty procedure ("The Gujrat Technique") to correct the exaggerated cleft nose deformity after completion of nasal growth in an adult patient cohort. METHODS: Adult patients with a residual unilateral cleft nasal deformity were deemed eligible for the proposed "Gujrat Technique". Over a 10-year period (2007-2017), 96 adult patients underwent this composite cleft septorhinoplasty as a single stage operation. Post-operative nasal symmetry evaluation was undertaken using the validated computer program 'SymNose'. Functional outcome and patient satisfaction were assessed using Nasal Obstruction Symptom Evaluation scale and Rhinoplasty Outcome Evaluation (ROE) questionnaires respectively. Various statistical analysis methods were used to validate the obtained results. RESULTS: Due to poor compliance with follow-up, post-operative assessments were undertaken in only 32 patients. The single group study design using the non-parametric matching pairs Wilcoxon Sign test (p < 0.001) showed overall good to excellent functional and aesthetic outcomes and higher scores of the digital SymNose grading system. There was a significant improvement in ROE scores (from 26.4 ± 2.9 to 85.9 ± 4.7, p < 0.001). There were no major complications or revisions needed in our series. CONCLUSION: The individual components of "The Gujrat Technique" are not novel but their combination in this adult unilateral cleft rhinoplasty cohort has demonstrated a high patient satisfaction with its aesthetic appeal and functional versatility. In the background of limited resources and unpredictable patient follow up, the simplicity, reproducibility and cost effectiveness of this technique make it a practical reconstructive option.

Engineering functional and anthropomorphic models for surgical training in interventional radiology: A state-of-the-art review.

Training medical students in surgical procedures and evaluating their performance are both necessary steps to ensure the safety and efficacy of surgeries. Traditionally, trainees practiced on live patients, cadavers or animals under the supervision of skilled physicians, but realistic anatomical phantom models have provided a low-cost alternative because of the advance of material technology that mimics multi-layer tissue structures. This setup provides safer and more efficient training. Many research prototypes of phantom models allow rapid in-house prototyping for specific geometries and tissue properties. The gel-based method and 3D printing-based method are two major methods for developing phantom prototypes. This study excluded virtual reality based technologies and focused on physical phantoms, total 189 works published between 2015 and 2020 on anatomical phantom prototypes made for interventional radiology were reviewed in terms of their functions and applications. The phantom prototypes were first categorized based on fabrication methods and then subcategorized based on the organ or body part they simulated; the paper is organized accordingly. Engineering specifications and applications were analyzed and summarized for each study. Finally, current challenges in the development of phantom models and directions for future work were discussed.

Supporting Technologies for COVID-19 Prevention: Systemized Review.

Background: During COVID-19, clinical and health care demands have been on the rapid rise. Major challenges that have arisen during the pandemic have included a lack of testing kits, shortages of ventilators to treat severe cases of COVID-19, and insufficient accessibility to personal protective equipment for both hospitals and the public. New technologies have been developed by scientists, researchers, and companies in response to these demands. Objective: The primary objective of this review is to compare different supporting technologies in the subjugation of the COVID-19 spread. Methods: In this paper, 150 news articles and scientific reports on COVID-19-related innovations during 2020-2021 were checked, screened, and shortlisted to yield a total of 23 articles for review. The keywords "COVID-19 technology," "COVID-19 invention," and "COVID-19 equipment" were used in a Google search to generate related news articles and scientific reports. The search was performed on February 1, 2021. These were then categorized into three sections, which are personal protective equipment (PPE), testing methods, and medical treatments. Each study was analyzed for its engineering characteristics and potential social impact on the COVID-19 pandemic. Results: A total of 9 articles were selected for review concerning PPE. In general, the design and fabrication of PPE were moving toward the direction of additive manufacturing and intelligent information feedback while being eco-friendly. Moreover, 8 articles were selected for reviewing testing methods within the two main categories of molecular and antigen tests. All the inventions endeavored to increase sensitivity while reducing the turnaround time. However, the inventions reported in this review paper were not sufficiently tested for their safety and efficiency. Most of the inventions are temporary solutions intended to be used only during shortages of medical resources. Finally, 6 articles were selected for the review of COVID-19 medical treatment. The major challenge identified was the uncertainty in applying novel ideas to speed up the production of ventilators. Conclusions: The technologies developed during the COVID-19 pandemic were considered for review. In order to better respond to future pandemics, national reserves of critical medical supplies should be increased to improve preparation. This pandemic has also highlighted the need for the automation and optimization of medical manufacturing.

Exploring the Perceptions Surrounding Hospital Chaplains in Patient Care and Healing.

The authors distributed a questionnaire to various hospital staff to explore perceptions surrounding the role of chaplains in patient care and healing through assessing opinions, beliefs, and knowledge. Results revealed a poor understanding of the role of the hospital chaplain in the UK. The authors therefore advocate education programs to increase awareness of the varied role of the hospital chaplain in fulfilling patient spiritual needs to increase referral practices, leading to improved patient outcomes.

Efficacy of mTOR inhibitors (sirolimus) in isolated limb overgrowth: a systematic review.

We systematically assessed the literature on the use of sirolimus for the treatment of isolated limb overgrowth conditions and its various modalities of administration in PubMed, Scopus, Ovid MEDLINE, Web of Science, Google Scholar, Cochrane Database of Systematic Reviews, references of journals and grey literature using pre-trialled Medical Subject Headings terms and articles. Eleven articles were included, and 39 patients were identified for review. Sirolimus was given orally in 38 patients and topically in one patient. Sirolimus was found to be highly effective in treatment of isolated limb overgrowth conditions with improvement of symptoms (physical, emotional, social) reported in all but one patient. Dosage and adverse effects seemed to be closely correlated. The result of our study suggests that sirolimus should be considered as an adjuvant or first-line management in isolated limb overgrowth in prospective trials.

Applications of Robotics, Artificial Intelligence, and Digital Technologies During COVID-19: A Review.

Many countries have enacted a quick response to the unexpected coronavirus disease 2019 (COVID-19) pandemic by using existing technologies. For example, robotics, artificial intelligence, and digital technology have been deployed in hospitals and public areas for maintaining social distancing, reducing person-to-person contact, enabling rapid diagnosis, tracking virus spread, and providing sanitation. In this study, 163 news articles and scientific reports on COVID-19-related technology adoption were screened, shortlisted, categorized by application scenario, and reviewed for functionality. Technologies related to robots, artificial intelligence, and digital technology were selected from the pool of candidates, yielding a total of 50 applications for review. Each case was analyzed for its engineering characteristics and potential impact on the COVID-19 pandemic. Finally, challenges and future directions regarding the response to this pandemic and future pandemics were summarized and discussed.

Systematic Review of Medpor Versus Autologous Ear Reconstruction.

ABSTRACT: Ear reconstruction is 1 of the most technically challenging sub-specialties of craniofacial and reconstructive plastic surgery. The reconstructive ear must not only fulfil the requirement of being aesthetically pleasing but must also have good vascularity with a low complication rate. Several ear reconstructive techniques have been developed such as the autologous ear reconstruction technique using costal cartilage and ear reconstruction with high-density porous polyethylene or Medpor (Porex Surgical, Inc, College Park, GA). Autologous ear reconstructive techniques have advantages of durability and low infection rates however are associated with poorer aesthetic outcomes such as poor projection of the ear. Medpor has advantages of a more consistent three-dimensional definition without the need to harvest costochondral cartilage and create a donor site. However, due to its alloplastic material properties, Medpor has historically been reported as having a higher rate of extrusion and infection. This is the first systematic review to compare the outcomes of both techniques. The 6 studies that were reviewed were analyzed against 3 evaluative criteria: aesthetic outcome, complication rate, and convenience of intervention. This is so a comprehensive, evidence-based decision can be made by the surgeon and patient when ear reconstruction is required. The results showed heterogeneity in data and a lack of detailed descriptions of the assessment for aesthetic outcomes and convenience, hence were inconclusive. The results however showed that there were more complications with Medpor framework with 15% of total cases resulting in either extrusion or infection compared to 2% of autologous ear reconstruction framework.

Femoral artery aneurysms.

True aneurysms are dilatations of blood vessels, bounded by the tunica intima, tunica media and tunica adventitia. False aneurysms are dilatations bounded by the tunica adventitia only, and are more common than true aneurysms. The femoral artery is the second most common location for true peripheral artery aneurysms, and the most common site of false aneurysms. If left untreated, devastating complications can occur, such as infection, rupture, ischaemia and limb loss. Femoral artery aneurysms should be identified early and managed by a vascular specialist. This article outlines the evidence for the epidemiology, investigation and management of femoral artery aneurysms.