Amputation vs Reconstruction in Type IV Tibial Hemimelia: Functional Outcomes and Description of a Novel Surgical Technique.

Introduction: The management of tibial hemimelia can be complex and involve either amputation or reconstruction. The decision made carries significant implications on patients and their families. This is a case series in the management of Type IV tibial hemimelia with a description of a novel surgical technique in the reconstructive arm of the pathway. Materials and methods: The study included four patients with bilateral tibial hemimelia have an amputation in one limb and reconstructive surgery on the other. The reconstruction involved a supratalar double osteotomy of the tibia and fibula, followed by a staged hindfoot osteotomy using a circular ring fixator. Functional outcomes are reported using the Special Interest Group in Amputee Medicine (SIGAM) and the short form 12 (SF-12) methods. Results: The mean age of patients in our cohort is 14 years (3-27 years) with mean age of surgery at 3 years. One case had an amputation following initial reconstructive surgery due to psychological distress and regressive behaviour. SIGAM functional outcome scores of F were recorded in three of four cases, with one patient performing at level B. On the reconstructive side, two of three patients reported a mean physical short form 12 (SF-12) score of 56.7 and a mental SF-12 score of 55.7. One patient reported a physical SF-12 score of 28.5 and a mental SF-12 score of 30.3. Discussion and conclusion: A reconstructive option provides a satisfactory functional outcome, comparable to the population mean, in the majority of patients in our cohort. Clinical significance: A staged supratalar double osteotomy followed later by a hindfoot osteotomy is effective in centralising the ankle and creates a plantigrade weight-bearing platform for ambulation in patients with Type IV tibial hemimelia. How to cite this article: Tang CH, Addar A, Fernandes JA. Amputation vs Reconstruction in Type IV Tibial Hemimelia: Functional Outcomes and Description of a Novel Surgical Technique. Strategies Trauma Limb Reconstr 2023;18(1):32-36.

US Contrast Agent Arrival Time Difference Ratio for Benign versus Malignant Subpleural Pulmonary Lesions.

Background US has proven valuable in the diagnosis of subpleural pulmonary lesions (SPLs); however, existing US indicators have limitations. Purpose To propose and validate a revised contrast-enhanced (CE) US indicator for differential diagnosis of benign and malignant SPLs and to compare its performance with existing CE US diagnostic criteria. Materials and Methods This prospective study (Chinese clinical trial registry, ChiCTR1800019828) enrolled patients with SPLs between May 2019 and August 2020. They were divided into a developmental cohort (DC) and a validation cohort (VC). In the DC, the optimal indicator was selected from five CE US indicators. In the VC, the selected indicator was compared with existing CE US diagnostic criteria using the area under the receiver operating characteristic curve (AUC). Pathologic analysis, microbial evidence, and clinical follow-up were used as reference standards for all SPLs. Results A total of 902 participants (DC, 424 participants; VC, 478 participants) with SPLs (mean age, 56 years ± 17; 593 men) were evaluated. The arrival time (AT) difference ratio proved to be the optimal indicator to distinguish benign from malignant SPLs. In the overall (regardless of lesion size), large (vertical diameter >3 cm), and small (vertical diameter ≤3 cm) lesion groups, the cutoff values of the AT difference ratio were 43%, 42%, and 50% and the AUCs obtained from the VC were 0.91 (95% CI: 0.88, 0.93), 0.97 (95% CI: 0.94, 0.98), and 0.77 (95% CI: 0.71, 0.83) respectively, which were higher than those of lesion-lung AT difference greater than 2.5 seconds (0.81 [P < .001], 0.85 [P < .001], and 0.7 [P = .005], respectively), lesion AT greater than 7.5 seconds (0.65 [P < .001], 0.64 [P < .001], and 0.63 [P < .001], respectively), and lesion AT greater than 10 seconds (0.67 [P < .001], 0.68 [P < .001], and 0.64 [P < .001] respectively). Conclusion The US contrast agent arrival time difference ratio enables better differentiation of benign and malignant subpleural lesions when compared with existing diagnostic criteria. Online supplemental material is available for this article. Published under a CC BY 4.0 license.

Development and Prospective Validation of an Ultrasound Prediction Model for the Differential Diagnosis of Benign and Malignant Subpleural Pulmonary Lesions: A Large Ambispective Cohort Study.

OBJECTIVE: To develop and prospective validate an ultrasound (US) prediction model to differentiate between benign and malignant subpleural pulmonary lesions (SPLs). METHODS: This study was conducted retrospectively from July 2017 to December 2018 (development cohort [DC], n = 592) and prospectively from January to April 2019 (validation cohort [VC], n = 220). A total of 18 parameters of B-mode US and contrast-enhanced US (CEUS) were acquired. Based on the DC, a model was developed using binary logistic regression. Then its discrimination and calibration were verified internally in the DC and externally in the VC, and its diagnostic performance was compared with those of the existing US diagnostic criteria in the two cohorts. The reference criteria were from the comprehensive diagnosis of clinical-radiological-pathological made by two senior respiratory physicians. RESULTS: The model was eventually constructed with 6 parameters: the angle between lesion border and thoracic wall, basic intensity, lung-lesion arrival time difference, ratio of arrival time difference, vascular sign, and non-enhancing region type. In both internal and external validation, the model provided excellent discrimination of benign and malignant SPLs (C-statistic: 0.974 and 0.980 respectively), which is higher than that of "lesion-lung AT difference ≥ 2.5 s" (C-statistic: 0.842 and 0.777 respectively, P <0.001) and "AT ≥ 10 s" (C-statistic: 0.688 and 0.641 respectively, P <0.001) and the calibration curves of the model showed good agreement between actual and predictive malignancy probabilities. As for the diagnosis performance, the sensitivity and specificity of the model [sensitivity: 94.82% (DC) and 92.86% (VC); specificity: 92.42% (DC) and 92.59% (VC)] were higher than those of "lesion-lung AT difference ≥ 2.5 s" [sensitivity: 88.11% (DC) and 80.36% (VC); specificity: 80.30% (DC) and 75.00% (VC)] and "AT ≥ 10 s" [sensitivity: 64.94% (DC) and 61.61% (VC); specificity: 72.73% (DC) and 66.67% (VC)]. CONCLUSION: The prediction model integrating multiple parameters of B-mode US and CEUS can accurately predict the malignancy probability, so as to effectively differentiate between benign and malignant SPLs, and has better diagnostic performance than the existing US diagnostic criteria. CLINICAL TRIAL REGISTRATION: www.chictr.org.cn, identifier ChiCTR1800019828.

Contrast-Enhanced Ultrasound of the Pleural Cavity: A Method to Locate Pleural Catheters and Identify Fibrous Septa.

We aimed to explore the value of contrast-enhanced ultrasound (CEUS) of the pleural cavity in locating catheters and identifying fibrous septa and to compare CEUS with multiple existing methods. We included 304 participants whose pleural effusion could not continue to be drained and compared the catheter-localization capabilities of empirical diagnosis, B-mode ultrasound with normal saline and CEUS, with computed tomography as the reference standard. CEUS performed the best (accuracy, 100%; sensitivity, 100%; specificity, 100%), followed by B-mode ultrasound with normal saline (accuracy, 77.78%; sensitivity, 62.5%; specificity, 100%), and finally empirical diagnosis (accuracy, 54.17%; sensitivity, 66.67%; specificity, 33.33%). The capabilities of CEUS and computed tomography to identify fibrous septa were evaluated, with B-mode ultrasound as the reference, and CEUS (accuracy, 100%; sensitivity, 100%; specificity, 100%) was superior to computed tomography (accuracy, 82.41%; sensitivity, 26.09%; specificity, 97.65%). Overall, CEUS can accurately locate catheters and identify fibrous septa, with performance superior to existing methods.

Effect of dietary phosphorus levels on meat quality and lipid metabolism in broiler chickens.

To analyze the influence of dietary phosphorus (P) levels on meat quality and lipid metabolism, a 42-day feeding experiment (P deficient group; normal group; high P level groups of H1 and H2, respectively) using 100 one-day-old broilers was conducted. Results demonstrated that the quality of broiler chicken meat in deficient or high P groups decreased relative to the normal group. High P diets resulted in increased lightness, redness values, shear forces and decreased fatty acid contents and intramuscular fat content in breast meat (p<0.01). Compared with normal group, lower malic enzyme activity, higher fatty acid synthase and AMP-activated protein kinase activities were observed in the treatment groups (p<0.05). Chickens fed with normal diets had the lowest serum total cholesterol and triglyceride levels which differed from that of other treatments (p<0.05). High-P diets significantly decreased the lipid accumulation in the liver (p<0.01), whereas phosphorus levels in breast meat increased significantly (p<0.01). It can be concluded that deficient or higher P levels could affect meat quality and expression of indicators on lipid metabolism of broiler chickens.

Flavor compounds and sensory profiles of a novel Chinese marinated chicken.

BACKGROUND: Marinating is a Chinese traditional meat-processing method using aged brine that brings popular flavor together with food safety issues. In this study a novel method named quantitative marinating (QM) was developed to improve Chinese traditional marinating (TM). Flavor compounds and sensory profiles of two marinated products were determined to verify if the improved marinating method could maintain the characteristic flavors of TM. RESULTS: Fifty-four, 60, 60, 60 and 44 volatile flavor compounds were identified from four processing stages of QM and TM respectively. Contents of taste compounds first increased and then decreased in the processing stages of QM. The total free amino acid contents of QM and TM products were 789 and 536 mg per 100 g respectively. The total nucleotide content of QM product (22.21 mg per 100 g) was higher than that of TM (20.75 mg per 100 g), while the fatty acid content of QM product (26.66 mg g(-1)) was lower than that of TM (44.43 mg g(-1)). Finally, QM received higher sensory scores than TM. CONCLUSION: Volatile flavor compounds, taste compounds and sensory properties of QM were richer than those of TM, indicating that QM can not only maintain the original aroma of TM but also have advantages in taste compounds.

A hitherto unrecognised case of progressive multifocal leukoencephalopathy.

A 65-year-old man presented with a 6-week history of increasing confusion with associated cognitive decline. Empirical antibiotic cover for a urinary tract infection was prescribed with no response. After exhaustive radiological and pathological investigations were carried out, a diagnosis of John Cunningham virus encephalopathy was made. This case report describes the varied clinical presentation of symptoms and their management options, along with the latest clinical opinions behind them.

Major haemorrhage in pubic rami fractures.

A 62-year-old man presented to the emergency department, having fallen 6 ft from a ladder, with pain over his left hip and shoulder. He was managed according to the Advanced Trauma Life Support (ATLS) protocol, and his primary survey showed no haemodynamic compromise. Initial radiographs showed a unilateral left superior and inferior pubic rami fracture, which was treated conservatively. Forty-eight hours post-admission, the patient became tachycardic and hypotensive and was found to have dropped his haemoglobin from 125 to 89 g/L. After resuscitation, a repeat contrast CT scan revealed an enlarging haematoma in his pelvis. This was treated with urgent angioembolisation and the patient was further stabilised in the intensive care unit. This report shows the need for a low threshold in suspecting intrapelvic bleeds in patients with pubic rami fractures, and the need for prompt treatment of such patients, either surgically or radiologically.

Development of a novel method for hot-pressure extraction of protein from chicken bone and the effect of enzymatic hydrolysis on the extracts.

To investigate the hot-pressure extraction of protein from chicken bone (CB), chicken bone extracts (CBE) was prepared from CB by heating at 130±0.5 °C for 120 min, followed by filtration, standing, defatting, and concentration. Effects of enzymatic hydrolysis on the properties of hydrolysates were examined. Results showed CBE contained 25.59% of protein, and showed a desirable value of protein digestibility-corrected amino acid score for adult. The total amino acid (AA) content of CBE is 21.99%, among which 40.62% and 54.66% are essential and fresh AA, respectively. Forty kinds of volatile compounds were identified after 24 h of hydrolysis, with 2,3,5-trimethylpyrazine as the key flavor compound. After 8 h of hydrolysis of CBE, the content of small MW of peptides (400-1000 Da) increased by 74 times compared with that of 1 h. CBE and its hydrolysates demonstrate a new kind of potential suitable nutritional supplement in various foods.