Elbow Release and Tricepsplasty in Arthrogrypotic Patients: A Long-Term Follow-Up Study.

PURPOSE: Obtaining elbow flexion to improve hand-to-mouth reach capability is an essential component of achieving functional independence in pediatric patients with arthrogryposis. This study analyzed the long-term outcomes of elbow release and tricepsplasty in a series of children with arthrogryposis at a tertiary institution. METHODS: Medical records of patients with arthrogryposis who underwent elbow release and tricepsplasty from 1993 to 2015, with at least 2 years of follow-up, were reviewed. Collected measures included preoperative elbow passive range of motion (ROM), postoperative elbow passive and active ROM, shoulder passive and active ROM, and Pediatric Outcomes Data Collection Instrument (PODCI) scores. Our analysis compared pre- and postoperative follow-up of elbow passive ROM and reviewed PODCI scores with age-adjusted normative values. RESULTS: Seventeen patients (4 female and 13 male) with 24 affected upper extremities (10 left elbow and 14 right elbow) were included in final analysis. Age at final follow-up averaged 11 years (range, 4-20 years), mean age at surgery was 2.7 years (range, 9.6 months-9.3 years) with mean follow-up by extremity at 8.3 years (range, 2-18 years). Differences in pre- and post-operative passive elbow ROM were significant for extension, flexion, and total arc of motion. Most parent and self-reported PODCI scores were less than the age-adjusted normal population, except in the domains of Comfort and Pain and Happiness. CONCLUSION: Long-term follow-up of elbow release and tricepsplasty in patients with arthrogryposis indicates both increased and sustained elbow flexion and arc of motion. Although PODCI scores were lower compared with the age-adjusted norm, pediatric patients with arthrogryposis were just as happy and had no more discomfort than their unaffected age-adjusted norms. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Testing of Direct Neurorrhaphy Strain.

PURPOSE: To investigate the ideal suture material to test strain at nerve repair sites. Based on nerve strain tolerance, we aimed to determine which suture reliably failed by an average of 5% and a maximum of 8% strain when loaded to failure. METHODS: The median nerve of 19 cadavers was exposed in the distal forearm, transected proximally, and attached to a spring gauge. It was marked 5 cm on either side of its midpoint to measure strain. A laceration was created at its midpoint. We performed a tension-free end-to-end repair with a single epineural suture. Load to failure of the repair site was recorded. We recorded strain at failure and mode of failure (pullout vs breakage). Eight different sutures were tested: 6-0, 8-0, 9-0, and 10-0 nylon; and 6-0, 7-0, 8-0, and 10-0 polypropylene. RESULTS: Average strain at failure of 9-0 nylon most closely approximated 5% (4.9%). Moreover, 8-0 polypropylene and 10-0 nylon and polypropylene failed with average strains less than 5% and a maximum strain of failure less than 8%. Regardless of type, 6-0 to 8-0 caliber suture failed primarily by pullout of the suture from the epineurium whereas 9-0 and 10-0 nylon and polypropylene failed by suture breakage. Decreased precision through increased variability was seen when testing sutures failing via pullout. CONCLUSIONS: Nylon suture size 8-0 has been advocated as the suggested intraoperative aid to test strain at nerve repair sites. Our study suggests that 9-0 nylon may be a more appropriate testing suture because of its more predictable failure via breakage and its failure by a threshold of 5% to 8% strain. Although 8-0 nylon and polypropylene may also represent reasonable testing sutures, 8-0 nylon failed on average above 5% strain, with strains exceeding 8%, and both failed via the mechanism of pullout. CLINICAL RELEVANCE: This study's findings provide information for surgeons attempting to decide during surgery whether to perform direct nerve repair.

A Pediatric Medial Epicondyle Fracture Cadaveric Study Comparing Standard AP Radiographic View With the Distal Humerus Axial View.

BACKGROUND: Controversy exists with regard to the amount of fracture displacement that warrants surgical fixation of medial epicondyle fractures. Inaccurate determination of degree of displacement on plain radiographs may account for the disputed management. Recently, a novel distal humerus axial radiograph technique has been developed to improve the accuracy of radiographs. The purposes of the study are 2-fold; to identify the anatomic orientation of the medial elbow epicondyle physis in children and to compare the accuracy of determining fracture displacement between axial radiographs and standard anterior-posterior (AP) radiographs in a cadaveric medial epicondyle fracture model. METHODS: Twelve pediatric elbow computed tomographic scans and 19 pediatric elbow magnetic resonance imaging scans were analyzed for the orientation of the medial elbow physis. After determining the correct orientation, 15 adult cadaveric medial epicondyle fracture models were created at displacements of 2, 5, 10 mm, and maximum displacement with elbow at 90 degrees of flexion. A linear mixed model regression analysis was used to compare displacement based on the axial versus the AP radiographic methods. RESULTS: The medial epicondyle physis was found to be a posterior structure angled distally at ~36 degrees (range, 10.7 to 49.6) and angled posteriorly at 45 degrees (range, 32.2 to 59). The AP radiograph significantly underestimated displacement relative to the axial radiograph at 5 mm [mean difference, -1.6; 95% confidence interval (CI), -2.9 to -0.3], at 10 mm (mean difference, -4.5; 95% CI, -5.8 to -3.2 mm), and at maximal displacement (mean, 15 mm; range, 13 to 20 mm) (mean difference, -7.1; 95% CI, -8.3 to -5.8). CONCLUSIONS: The medial epicondyle physis of the distal humerus is a posterior structure angled distally and posteriorly. When displacement was >5 mm, the distal humerus axial radiograph technique was significantly more accurate than the AP radiograph technique at determining actual fracture displacement in our adult cadaveric fracture models. Therefore, we recommend clinicians to include the axial radiograph view during the evaluation of patients with medial epicondyle fractures. CLINICAL RELEVANCE: This study provides further insight into the location and orientation of the medial humeral epicondyle physis, and further supports the improved accuracy of the distal humerus axial radiograph at detecting displacement in medial epicondyle fractures.

[Pharmacological mechanism analysis of oligopeptide from Pinctada fucata based on in silico proteolysis and protein interaction network].

Thoracic obstruction is mainly attributed to the scope of coronary heart disease in modern medicine, and traditional Chinese medicine(TCM) shows a significant effect in the treatment of thoracic obstruction. In this research, a network pharmacology method was carried out to systemically study the underlying mechanism of the core herbal compatibility in TCM on the thoracic obstruction. First, we collected the literature about TCM prescriptions for treating thoracic obstruction from CNKI. Then, a prescription database was establish by TCM inheritance support platform system(V2.5) to determine the medication rules and core herbal compatibility in TCM. Finally, to obtain the potential signaling pathways, KEGG pathway analysis was performed by BATMAN-TCM online analysis tool. Results showed that the potential signal pathway of core herbal compatibility in TCM for the clinical treatment of thoracic obstruction was calcium ion and cGMP-PKG signaling pathway. This study provided a new research strategy for the study of the medication rules and mechanism of traditional Chinese medicine in the treatment of thoracic obstruction.

Synthesis and in vitro antibacterial activity of quinolone/naphthyridone derivatives containing 3-alkoxyimino-4-(methyl)aminopiperidine scaffolds.

We report herein the synthesis of a series of 7-[3-alkoxyimino-4-(methyl)aminopiperidin-1-yl]quinolone/naphthyridone derivatives. In vitro antibacterial activity of these derivatives was evaluated against representative strains, and compared with ciprofloxacin (CPFX), levofloxacin (LVFX) and gemifloxacin (GMFX). The results reveal that all of the target compounds 19a-c and 20 have considerable Gram-positive activity, although they are generally less active than the reference drugs against the Gram-negative strains with some exceptions. Especially, novel compounds 19a2, 19a4 and 19a5 were found to show strong antibacterial activity (MICs: <0.008-0.5µg/mL) against all of the tested 15 Gram-positive strains including MRSA, LVFX- and GMFX-resistant MRSE, and CPFX-, LVFX- and GMFX-resistant MSSA.

[CT manifestations of liver involvement in children with Langerhans cell histiocytosis].

OBJECTIVE: To investigate the computed tomography (CT) manifestations of liver involvement in children with Langerhans cell histiocytosis (LCH). METHODS: Retrospective analysis was performed on 9 LCH children with liver involvement confirmed by clinical, laboratory and pathological examinations to investigate the CT manifestations of this condition. These children, including 6 males and 3 females, had undergone both plain CT scan and dual-phase (the arterial and portal venous phases) contrast-enhanced CT scan. RESULTS: The main CT manifestations included hepatomegaly (8 cases); periportal dendritic hypodense lesions or "periportal halo sign" (7 cases) which were mildly or moderately enhanced in the arterial phase; intrahepatic bile duct dilatation (5 cases); lymphadenopathy in the hepatic hilar or retroperitoneal region (4 cases); and diffuse small hypodense nodules (3 cases), which showed annular enhancement on the contrast-enhanced CT scan. CONCLUSIONS: CT findings may be helpful in the early diagnosis and treatment of LCH in children.

Preparation, characterization and immunomodulatory effects of unsaturated sulfated oligoguluronic acid.

Polyguluronic acid (PG) is a type of polysaccharide found in edible brown seaweeds. This study synthesized a new sulfated saccharide (SOGA) by sulfating PG-derived unsaturated oligoguluronic acid (OGA). The molecular weight and degree of sulfate-group substitution of SOGA were 1.6 kDa and 1.03, respectively. The structures of PG, OGA, and SOGA were elucidated using FT-IR and NMR spectroscopy. Furthermore, the immunomodulatory effects of PG, OGA, and SOGA on LPS-triggered RAW264.7 and BV2 cells were evaluated. SOGA, but not PG or OGA, significantly reduced the LPS-stimulated overproduction of proinflammatory mediators and suppressed the activation of corresponding signalling pathways. Also, SOGA could actively regulate immune balance by inhibiting apoptosis and pyroapoptosis. These results suggested that SOGA is a potential therapeutic agent for the prevention of diseases associated with immune disorders owing to its remarkable immunomodulatory effects, and that sulfate groups in the carbohydrate chain play a crucial role for its bioactivities.

Soy protein isolate-polyguluronate nanoparticles loaded with resveratrol for effective treatment of colitis.

Polyguluronate (PG) is an acidic homopolymer of α-(1,4)-l-guluronate separated from alginate. In this study, PG was first grafted with soy protein isolate (SPI) through the Maillard reaction to obtain a new glycoprotein (SPI-PG). Then, this novel glycoprotein was used to prepare nanoparticles to encapsulate the resveratrol (RES). Our results showed that SPI-PG-RES had better pH stability, storage stability and ionic stability than SPI-RES. In vitro digestion experiments showed that the RES bioavailability of SPI-PG-RES was much higher than that of free RES and SPI-RES. Furthermore, the in vitro antioxidant capacity of SPI-PG-RES was much stronger than that of free RES and SPI-RES. In addition, SPI-PG-RES was more effective in preventing the symptoms of DSS-induced colitis than RES and SPI-RES. These results suggested that the protein nanoparticles prepared using SPI-PG were a stable and effective hydrophobic polyphenol carrier and could be applied to food-grade components in functional foods and nutritional supplements.

Synthesis and in vitro antibacterial activity of 7-(3-alkoxyimino-5-amino/methylaminopiperidin-1-yl)fluoroquinolone derivatives.

We report herein the design and synthesis of novel 7-(3-alkoxyimino-5-amino/methylaminopiperidin-1-yl)fluoroquinolone derivatives based on the structures of new fluoroquinolones IMB and DZH. The antibacterial activity of these newly synthesized compounds was also evaluated and compared with gemifloxacin, ciprofloxacin, and levofloxacin. Results revealed that all of the target compounds 10-27 have good potency in inhibiting the growth of Staphylococcus aureus including MSSA (MIC: 0.125-8 µg/mL), Staphylococcus epidermidis including MRSE (MIC: 0.25-16 µg/mL), Streptococcus pneumoniae (MIC: 0.125-4 µg/mL), and Escherichia coli (MIC: 0.25-0.5 µg/mL). In particular, some compounds showed useful activity against several fluoroquinolone-resistant strains, and the most active compound 15 was found to be 16-128, 2-32, and 4-8-fold more potent than the three reference drugs against fluoroquinolone-resistant MSSA, MRSA, and MRSE.

Study on Knowledge, Attitudes and Behaviours About AIDS Among Undergraduates of China.

BACKGROUND: The prevention of AIDS among undergraduates in Wuhan is a public health priority. An important strategy for students to prevent AIDS is to establish correct moral concepts and cultivate a healthy lifestyle. INTRODUCTION: Through the investigation of MSM and non-MSM population in college students, this study seeks for possible influencing factors and solutions for AIDS prevention in colleges and universities. METHODS: This study was carried out in 15 universities in Wuhan. We recruited 127 MSM students through peer promotion, and 510 non-MSM students were selected by random cluster sampling. The two groups were investigated by anonymous questionnaire, and the questionnaire information was statistically analyzed. RESULTS: The awareness rate of AIDS-related knowledge among MSM students was 90.8%, while that among non-MSM students, it was 64.6%; neither meets the national requirements. The self- -recognition of MSM undergraduates was 95.0%. Among the 497 non-MSM undergraduates, 65.4% were willing to make friends with the MSM undergraduates. There were statistical differences in the social discrimination attitudes of those who knew AIDS-related knowledge (P<0.01), and the attitudes of those with knowledge of AIDS were more positive. CONCLUSION: The MSM students reported a high incidence of high-risk sexual behaviors and a gap between knowledge and behaviors. This study focuses on the comparison of the characteristics of knowledge, attitude, and behavior on AIDS between the two groups of people. AIDS prevention in colleges and universities requires a new way of thinking.

Synthesis and in vitro antibacterial activity of novel fluoroquinolone derivatives containing substituted piperidines.

We report herein the synthesis of novel 7-(4-alkoxyimino-3-aminomethyl-3-methylpiperidin-1-yl) fluoroquinolone derivatives. The antibacterial activity of the newly synthesized compounds was evaluated and correlated with their physicochemical properties. Results reveal that all of the target compounds have good potency in inhibiting the growth of Staphylococcus aureus and Staphylococcus epidermidis including MRSE (MIC: 0.125-4 microg/mL). Compounds 12, 13 are more potent than or comparable to levofloxacin against MRSA, Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, and Shigella sonnei. Compound 17 is more active than or comparable to levofloxacin against S. aureus including MRSA, S. epidermidis and S. pyogenes.

A pediatric medial epicondyle fracture study using fresh frozen adult cadavers comparing fracture displacement and loss of terminal elbow extension.

Medial epicondyle fractures are the 3rd most common pediatric elbow fractures. Regardless of treatment method, some degree of elbow motion loss has been reported. The purpose of our study was to determine the relationship between the amount of anterior fracture displacement and loss of elbow passive extension in an adult cadaveric medial epicondyle fracture model. Fifteen fresh frozen adult cadavers were procured to create fracture models at scenarios of 2, 5, 10 mm, and maximum displacement. Terminal elbow extension was recorded for each cadaveric model at each fracture scenario. A linear mixed model regression analysis was used to test the association between fracture displacement and loss of terminal elbow passive extension. At 2 mm of displacement, the average loss of terminal extension was 3.89°; at 5 mm, it was 7°; at 10 mm, it was 10.7°; at maximum displacement (~15 mm), it was 17°. A statistically significant positive linear association between fracture displacement and loss of terminal elbow extension was observed (5 mm of displacement = loss of ~4.7°). In our fracture model, when the medial epicondyle displaced anteriorly, we noticed a change in the tension of the medial collateral ligaments which lead to a decrease in terminal elbow extension. However, this only contributed partially to the loss of motion observed clinically in the literature. Even though our findings did not support the recommendation of surgical intervention to prevent loss of elbow motion in medial epicondyle fractures, we still encourage physicians to consider the consequence of displacement and its potential influence of elbow range of motion.

[MSCT perfusion imaging and its correlation with perfusion parameters, survivin expression, MVD, and pathologic grade in hepatocellular carcinomas].

OBJECTIVE: (1)To obtain the perfusion parameters of hepatocellular carcinomas(HCCs), peritumour livers and normal livers by multi-slice CT(MSCT)and to investigate their characteristics and clinical significances;(2)To investigate the correlation among perfusion parameters, survivin expression, microvessel density(MVD)and pathologic grade of HCCs. METHODS: A total of 31 patients with HCC (5 well-differentiated HCCs, 17 moderately differentiated HCCs, and 9 poorly differentiated HCCs) and 10 normal liver were studied. All underwent CT plain scan, perfusion scan, and conventional enhancement scan of the whole liver using 16-slice spiral CT (Philips Brilliance 16). Perfusion parameters were obtained by time-density curves (TDC) of region of interest (ROI) through the perfusion scans. Tissue sections of HCCs and their corresponding peritumour liver tissues of the 31 patients were detected by immunohistochemistry (SABC methods) for protein expression of survivin and MVD, and 10 normal liver tissue sections were as used as negative controls. The correlation among the perfusion parameters, survivin expression, MVD and pathology grade were analysed. RESULTS: (1)The mean values of HAP, HPP, TLP, and HAI of HCCs were 27.50 mL/(min.100 mL), 19.37 mL/(min.100 mL), 46.87 mL/(min.100 mL), and 60.38%, respectively. The mean values of those of the peritumour livers were 14.93 mL/(min.100 mL), 55.70 mL/(min.100 mL), 69.63 mL/(min.100 mL), and 21.51%, respectively. The mean value of those of the normal livers were 12.22 mL/(min.100mL), 74.56 mL/(min.100 mL), 86.78 mL/(min.100 mL), and 14.00%, respectively. The values of HAP and HAI of HCCs were significantly higher than those of the peritumor livers and the normal livers(P<0.01), and the HPP and TLP of HCCs were significant lower than those of the normal livers(P<0.01).The increase of HAP and decrease of HPP of peritumor livers were both significant compared with that of the normal livers(P<0.05). The HAP, HPP, and HAI of HCCs were significantly different from those of peritumor livers (P<0.01)except TLP. (2) Survivin expression in HCCs was detected in 23/31(74.1%), which was significantly higher than that in corresponding non-cancerous adjacent liver tissues and normal liver tissues (P<0.01). Survivin expression was positively correlated with MVD in HCCs. (3) HAP values were significantly and positively correlated with survivin expression (r=0.932,P<0.01)in HCCs.(4)The values of HAP and HAI were correlated with the pathologic grade in HCCs, and those values were increased gradually(P<0.05) among well differentiated HCCs, moderately differentiated, and poorly differentiated HCCs. CONCLUSION: CTPI can quantitatively reflect abnormal blood supply of HCCs, which will be helpful for the detection and differentiation of lesions. CT perfusion parameters well correlate with survivin expression, MVD, and the pathologic grade in HCCs, which illustrate that CTPI could hopefully be used to evaluate the angiogenesis and biological behaviors of HCCs prospectively, noninvasively, and dynamically.

[Retrospective analysis of preoperative localization of insulinomas on CT].

OBJECTIVE: To compare the value of CT using different equipment and scanning methods in preoperative localization of insulinoma and to investigate the possible causes that might influence the detection ratio on CT. METHODS: A total of 47 patients with insulinomas confirmed by operation and pathologic examination from 1990 were collected, and the related clinical information and imaging data of CT were retrospectively analyzed. RESULTS: The diagnostic accuracy for conventional CT with conventional enhancement scanning, spiral CT with pancreatic phase scanning, and multislice spiral CT with dual phasic enhancement scanning were 35.3%, 57.1%, and 81.3%, respectively, and the overall diagnostic accuracy of CT was 57.4%. The diagnostic accuracy of multislice spiral CT was greater than that of conventional CT (P<0.01). For the 2 phases of dual phasic imaging, arterial phase and portal phase had a detective rate of 75.0%and 62.5%, respectively. None of the main clinical information was related to the detection ratio on CT. The detection rate of lesions with diameter of > or =1.5 cm was significantly higher than that of <1.5 cm (76.2%vs. 42.3%). Typical appearance of the lesions on CT was isoattenuation on plain scanning, and enhanced considerably after contrast enhancement. CONCLUSION: The size of lesion is the major factor that influences the detection of insulinoma on CT. Multislice spiral CT with dual phasic enhancement scanning has a relatively high detection rate and is recommended for preoperative localization of insulinoma.

tert-Butyl 4-carbamoyl-3-methoxy-imino-4-methyl-piperidine-1-carboxyl-ate.

The title compound, C(13)H(23)N(3)O(4), was prepared starting from ethyl N-benzyl-3-oxopiperidine-4-carboxyl-ate through a nine-step reaction, including hydrogenation, Boc (tert-butoxy-carbon-yl) protection, methyl-ation, oximation, hydrolysis, esterification and ammonolysis. In the crystal structure, mol-ecules are linked by inter-molecular N-H⋯O hydrogen bonds to form a porous three-dimensional network with solvent-free hydro-phobic channels extending along the c axis.

[Synthesis and neuroprotective activity in cell culture of aminoadamantane analogues].

Seven novel derivatives of aminoadamantane with 1-aminosubstituted group were synthesized from amantadine or memantine individually in order to find new neuroprotective agent. Six of them are amides of two precursors, one is a 1-amino derivative of memantine substituted with 2-hydroxy propyl. Their chemical structures were confirmed by 1H NMR and HRMS. The neuroprotective activity in vitro was evaluated primarily with 500 micromol x L(-1) glutamate damaged SY5Y cell by measurement of MTT metabolic rate and LDH leakage rate. Glutamate reduced MTT metabolic rate, but increased LDH leakage rate significantly. The addition of new derivatives elevated the MTT value with their certain concentration, reduced cell death rate. Especially as for 3d and 4c, they fully normalized LDH leakage rate with concentration of 20 micromol x L(-1) during LDH measurement. These data indicated that 3d and 4c have significant protective effect on nerve cell against glutamate injury, deserved to be further tested and maybe helpful for treatment of neurodegenerative disease.

[Population characteristics and individual variations of enhancement of pancreas and aorta: a contrastive analysis of 2 injection rates].

OBJECTIVE: To contrastive analyze the population characteristics and individual variations of enhancement modes of normal pancreas and aorta at intravenous injection rates of 3 mL/s and 2 mL/s. METHODS: Sixty-seven patients with normal pancreas were selected, and were divided randomly into 2 groups with different intravenous injection rates (3 mL/s for 35 patients in Group A and 2 mL/s for 32 patients in Group B). Single-level serial dynamic CT scan was performed at the level where the pancreas was best demonstrated. The enhancement values of pancreas and aorta for each time point of each patient were calculated, and the time-density curves of enhancement of pancreas and aorta of each patient were obtained. The peak enhancement and the time to reach the peak enhancement of pancreas and aorta of each individual patient were evaluated, and the 2 groups were compared. The individual variations of the enhancement modes of pancreas and aorta in each group were analyzed. RESULTS: The peak enhancement of pancreas was (75.7+/-17.0) Hu at (43.9+/-6.6) s for Group A, and (66.5+/-16.0) Hu at (55.2+/-5.0) s for Group B; the peak enhancement of aorta was (226.2+/-35.2) Hu at (35.4+/-4.5) s for Group A, (182.8+/-32.8) Hu at (48.0+/-3.7) s for Group B. There were significant differences in both the peak enhancement and the time to reach the peak enhancement of pancreas and aorta between the 2 groups. The coefficients of variation of time to reach the peak enhancement for pancreas and aorta were 15.0% and 12.7% in Group A, and 9.2% and 7.7% in Group B, respectively. The temporal windows of the optimal enhancement of pancreas were (9.7+/-4.5)s and (13.7+/-3.6)s in Group A and B, respectively. CONCLUSION: Better enhancement of pancreas and aorta is obtained at 3 mL/s than 2 mL/s, the time to reach the peak enhancement of pancreas and aorta is comparatively earlier at 3 mL/s than 2 mL/s, and the temporal windows of optimal enhancement of pancreas and aorta are comparatively shorter at 3 mL/s than 2 mL/s.

[CT hepatic volume measurement combined with CT perfusion imaging in evaluating the hepatic functional reserve].

OBJECTIVE: To investigate the application of CT hepatic volume measurement combined with CT perfusion imaging (CTPI) by Spiral CT in evaluating the hepatic functional reserve in cirrhosis. METHODS: CT volume measurement of livers was performed in 32 patients with cirrhosis and 20 patients with normal livers. CTPI had been taken in 25 patients with cirrhosis and 20 patients with normal livers. The hepatic volume, parameter of blood flow perfusion, and liver volume-perfusion index were observed and analyzed. Correlations between graded fractions of hepatic function and liver volume, parameter of perfusion, and liver volume-perfusion index were also analyzed. RESULTS: The values of liver volumes (LV, LVs) reduced gradually (P<0.01) among the groups of hepatic function Grade A, B, and C. The values of the hepatic portal perfusion (HPP), total liver perfusion (TLP), hepatic arterial perfusion index (HAI), and portal perfusion index (PPI) of the cirrhosis group were significantly lower than those of the normal ones (P<0.01). The values of the HPP reduced gradually among Grade A, B, and C (P<0.05 or P<0.01). The values of PPI reduced significantly between Grade C and Grade A, B (P<0.05 or P<0.01). The liver volume-perfusion indexes (VPI, VPIs, VPPI, VPPIs) reduced gradually among Grade A, B, and C (P<0.05 or P<0.01). The correlation between liver volume-perfusion indexes and graded fractions of hepatic function was higher than other indexes, among which the correlation of VPPIs was the highest. CONCLUSION: Changes of volume and blood flow perfusion of the liver are related to the clinical grade of hepatic function. The CT volume measurement combined with CTPI will be a more comprehensive way in evaluating hepatic functional reserve.

Smartphone-Based Thermal Imaging: A New Modality for Tissue Temperature Measurement in Hand and Upper Extremity Surgeries.

BACKGROUND: Smartphone-based thermal imaging (SBTI) allows noninvasive temperature measurements. Its validity compared with a conventional infrared probe temperature scanner (IPTS) has not been studied. This study compares temperature measurements between the 2 technologies on human participants. METHODS: Bilateral index finger temperature measurements were obtained on 30 healthy participants using IPTS and SBTI devices. Dominant versus nondominant sides (side-to-side difference) and individual side measurements between the 2 methods were compared for repeatability (precision) and agreement. RESULTS: A total of 23 female and 7 male participants were tested. Based on nonoverlapping confidence intervals (CIs), intraclass correlation coefficient of repeatability was higher for SBTI than for IPTS measurements in side-to-side differences: 0.97 (95% CI, 0.96-0.99) versus 0.89 (95% CI, 0.82-0.95). The SBTI method recorded higher side-to-side difference and individual side measurements: 0.56°C (limits of agreement [LOA], -1.09°C to 2.20°C) and 2.64°C (LOA, 0.96°C-4.32°C), respectively. CONCLUSIONS: In addition to higher precision, SBTI offers added benefits of instantaneous acquisition of the temperature map of the entire hand, allowing quick comparisons of the uninjured and injured fingers. SBTI measurements consistently yielded higher temperature readings in the side-to-side difference as well as individual measurements. This suggested that both devices are not interchangeable for absolute temperature comparisons but are interchangeable in monitoring the changes in temperatures. This study suggests the potential for SBTI devices to be used in the clinical settings and may be of special benefit in telemedicine.

Standardized Note Templates Improve Electronic Medical Record Documentation of Neurovascular Examinations for Pediatric Supracondylar Humeral Fractures.

BACKGROUND: Optimization of the electronic medical record (EMR) is essential to support the clinician and to improve the quality and efficiency of patient care. The present report describes the development and implementation of a standardized template that is embedded in the EMR and is focused on a comprehensive physical examination during the evaluation of pediatric supracondylar humeral fractures. We compared the completeness of physical examinations as well as the timing of detection and documentation of neurovascular injuries before and after implementation of the template. We hypothesized that the use of a template would increase the completeness of examinations and would lead to earlier documentation of neurovascular injuries. METHODS: A multidisciplinary quality-improvement task force was created to address neurovascular documentation practices for patients who underwent operative treatment of supracondylar humeral fractures. Following a series of formative and process evaluations, a standardized EMR template was implemented. Neurovascular examination documentation practices that were in use before (pre-template group, n = 224) and after (template group, n = 300) the implementation of the template were compared. Logistic regression analyses of the 2 groups were used to compare the likelihood of a complete neurovascular examination and the timing of neurovascular injury identification. RESULTS: There was significant improvement in the documentation of the vascular (odds ratio [OR], 70.7; 95% confidence interval [CI], 39.5 to 126.6; p < 0.0001), motor (OR, 17.6; 95% CI, 9.5 to 32.7; p < 0.0001), and sensory (OR, 23.9; 95% CI, 12.9 to 44.4; p < 0.0001) examinations in the template group. Neurological injuries were more likely to be identified preoperatively in the template group compared with the pre-template group (OR, 6.8; 95% CI, 1.7 to 27.1; p = 0.0067). CONCLUSIONS: The incorporation of a standardized template in the EMR improved the completeness and timing of documentation of neurological injury. Standardized EMR templates developed by a clinically driven multidisciplinary task force have the potential to improve the quality of clinical documentation and to ease communication among providers. LEVEL OF EVIDENCE: Level III. See Instructions for Authors for a complete description of levels of evidence.