Comparative Efficacy of Drug Interventions for Keloids: A Network Meta-analysis.

BACKGROUND: Keloids are common benign skin lesions originating from a disorganized fibroproliferative collagen response; these lesions often lead to both physical and psychological problems. The optimal treatment for keloids is yet to be standardized. Intralesional injection, which is simple and nontraumatic, is one of the most commonly used treatment modalities for these lesions. In this study, we compared 5 different drugs (intralesional injections) for the treatment of keloids in terms of efficacy. METHODS: We systemically searched relevant studies on PubMed, EMBASE, and Cochrane Library. Randomized clinical trials on the safety and efficacy of triamcinolone acetonide (TAC), 5-fluorouracil (5-FU), botulinum toxin A (BTA), verapamil, and bleomycin were included in this study. RESULTS: This network meta-analysis included a total of 1114 patients from 20 randomized controlled trials. Botulinum toxin A alone and TAC plus 5-FU exhibited significantly better efficacy than did 5-FU, TAC, and verapamil. No significant difference in efficacy between BTA alone and TAC combined with 5-FU was observed. No significant differences were noted in the adverse event rate between BTA, TAC plus 5-FU, 5-FU, and TAC. Furthermore, we performed surface under the cumulative ranking curve analyses to predict the rank of each intervention (by efficacy and adverse event rate). The predicted ranking by efficacy was as follows: TAC plus 5-FU, BTA, bleomycin, TAC, 5-FU, and verapamil; the predicted ranking by adverse events was as follows: TAC, 5-FU, TAC plus 5-FU, and BTA. Funnel plot analysis revealed no publication bias. CONCLUSIONS: Botulinum toxin A and TAC plus 5-FU appear to have outstanding therapeutic efficacy for keloids. The rate of adverse events was similar among BTA, TAC, 5-FU, and TAC plus 5-FU. Nonetheless, additional reviews of rigorous, large-scale randomized controlled trials are warranted for further validation of our findings.

Retromolar intubation with video intubating stylet in difficult airway: A randomized crossover manikin study.

OBJECTIVE: Difficult airway situations, such as trismus and neck rigidity, may prohibit standard midline orotracheal intubation. An alternative route of intubation from the retromolar space using a fiberoptic scope or rigid intubation stylet has been reported. There is no study investigating the applicability of retromolar intubation using a video intubating stylet. This study comparatively analyzed difficult airway management using a video intubating stylet in the retromolar and standard midline approaches. METHODS: A randomized crossover manikin study was conducted between January 2021 and June 2021 at a tertiary teaching hospital. Thirty-six emergency medicine residents and attending physicians were enrolled, and all participated in an educational course regarding video intubating stylet in standard midline and retromolar approaches. Then, they performed both intubation approaches in a randomized order on a manikin seven times with different airway settings each time. The duration of successful intubation, first attempt success rate, overall success rate, number of attempts, and self-reported difficulty were recorded and compared. RESULTS: Thirty-six emergency physicians were included in the study. Compared with the standard midline approach, the use of the retromolar approach significantly reduced the duration of successful intubation in difficult airway scenarios such as limited mouth opening and neck rigidity with (44.77 [28.58-63.65] vs. 120 [93.86-120] s, p < 0.001) and without tongue edema (31.5 [22.57-57.74] vs. 44.72 [36.23-65.34] s, p = 0.012). Furthermore, the retromolar approach increased the first attempt success rate in scenarios of limited mouth opening and neck rigidity with (91.67% vs. 16.67%, p < 0.001) and without (97.22% vs. 72.22%, p = 0.012) tongue edema. The self-reported difficulty was also significantly lower with the retromolar approach than with the standard approach in the above two scenarios. CONCLUSIONS: The retromolar approach for intubation using a video intubating stylet may be a promising choice for selected patients with a combination of difficult airway features such as limited mouth opening, neck rigidity, and edematous tongue.

Dynamic microfluidic bioreactor-Hip simulator (DMBH) system for implant toxicity monitoring.

The generation of degradation products (DPs) like ions and organo-metallic particles from corroding metallic implants is an important healthcare concern. These DPs generate local and systemic toxicity. The impact on local toxicity is well documented, however, little is known about systemic toxicity. This is mainly due to the limited scope of the current microtiter plate-based (static) toxicity assay techniques. These methods do not mimic the systemic (dynamic) conditions. In this study, it is hypothesized that DPs incubated with cells in static conditions might provide improper systemic toxicity results, as there is no movement mimicking the blood circulation around cells. This study reports the development of a three-chambered prototype microfluidic system connected to the operational hip implant simulator to test the cellular response induced by the DPs. This setup is called a dynamic microfluidic bioreactor-hip simulator system. We hypothesize that a dynamic microfluidic system will provide a realistic toxicology response induced by DPs than a static cell culture plate. To prove the hypothesis, Neuro2a (N2a) cells were used as representative cells to study systemic neurotoxicity by the implant DPs. The microfluidic bioreactor system was validated by comparing the cell toxicity against the traditional static system and using COMSOL modeling for media flow with DPs. The hip implant simulator used in this study was a state-of-the-art sliding hip simulator developed in our lab. The results suggested that static toxicity was significantly more compared to dynamic microfluidic-based toxicity. The newly developed DMBH system tested for in situ systemic toxicity on N2a cells and demonstrated very minimum toxicity level (5.23%) compared to static systems (31.16%). Thus, the new DMBH system is an efficient tool for in situ implant metal systemic toxicity testing.

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial.

BACKGROUND: As an essential component of multimodal analgesia approaches after total knee arthroplasty (TKA), local infiltration analgesia (LIA) can be classified into peri-articular injection (PAI) and intra-articular injection (IAI) according to administration techniques. Currently, there is no definite answer to the optimal choice between the two techniques. Our study aims to investigate analgesic efficacy and safety of PAI versus IAI in patients receiving simultaneous bilateral TKA. METHODS: This randomized controlled trial was conducted from February 2017 and finished in July 2018. Sixty patients eligible for simultaneous bilateral total knee arthroplasty were randomly assigned to receive PAI on one side and IAI on another. Primary outcomes included numerical rating scale (NRS) pain score at rest or during activity at 3 h, 6 h, 12 h, 24 h, 48 h, and 72 h following surgery. Secondary outcomes contained active or passive range of motion (ROM) at 1, 2, and 3 days after surgery, time to perform straight leg raise, wound drainage, operation time, and wound complications. RESULTS: Patients experienced lower NRS pain scores of the knee receiving PAI compared with that with PAI during the first 48 h after surgery. The largest difference of NRS pain score at rest occurred at 48 h (PAI: 0.68, 95%CI[0.37, 0.98]; IAI: 2.63, 95%CI [2.16, 3.09]; P < 0.001); and the largest difference of NRS pain score during activity also took place at 48 h (PAI: 2.46, 95%CI [2.07, 2.85]; IAI: 3.90, 95%CI [3.27, 4.52]; P = 0.001). PAI group had better results of range of motion and time to perform straight leg raise when compared with IAI group. There were no differences in operation time, wound drainage, and wound complication. CONCLUSION: PAI had the superior performance of pain relief and improvement of range of motion to IAI. Therefore, the administration technique of peri-articular injection is recommended when performing local infiltration analgesia after total knee arthroplasty. TRIAL REGISTRATION: The trial was retrospectively registered in the Chinese Clinical Trial Registry as ChiCTR1800020420 on 29th December, 2018. LEVEL OF EVIDENCE: Therapeutic Level I.

Autoantibody against aldehyde dehydrogenase 2 could be a biomarker to monitor progression of Graves' orbitopathy.

PURPOSE: This study surveyed the novel autoantigens expressed in the orbital fat tissue of patients with Graves' orbitopathy (GO) and explored the possibility of the autoantibodies against novel autoantigens as biomarkers for GO. METHODS: We used immuno-proteomic methods to survey novel autoantigens expressed in the orbit fat tissue of GO patients and confirmed by enzyme-linked immunosorbent assay (ELISA). RESULTS: One protein spot (aldehyde dehydrogenase 2 (ALDH2)) revealed high reactivity with the GO serum than did the healthy control serum and was further verified by ELISA. We found that the plasma anti-ALDH2 antibody level was increased in GO patients compared to healthy control donors. In addition, anti-ALDH2 antibody level was correlated with GO activity classified by clinical activity score(r = 0.588, p < 0.001, using Pearson's correlation). CONCLUSIONS: These increased levels of anti-ALDH2 antibody in GO serum suggested that ALDH2 could attribute target autoantigen in GO, and anti-ALDH2 autoantibody might serve as a biomarker for GO and help to predict disease activity.

[Saying goodbye to the newborn: the unease and actions of nursing professionals in handling stillbirth care].

BACKGROUND: Facing the death of newborns is an inescapable part of the professional responsibilities of delivery room nurses. The meaning of the inner conflict of these nurses and their nursing experience in handling newborn death is poorly addressed in nursing practice. PURPOSE: This research explores the stillbirth care experiences of delivery room nurses. METHODS: A qualitative approach was used to investigate the stillbirth-care experiences of nurse participants. RESULTS: The results elicited the experiences of participants with inner conflict and their resulting action caring. Main themes extracted from data include: feeling unease about being unable to provide effective treatment and the need to say goodbye to the deceased newborn. The former includes the subthemes of: guilt about doing nothing and feeling conflicted about ending a life. The latter includes: caring about and empathizing with the mother and accompanying the mother as she says goodbye to her baby. Additionally, the theme of saying a personal goodbye to the newborn baby includes praying for the baby and respecting baby's body. CONCLUSIONS / IMPLICATIONS FOR PRACTICE: The findings of this study enhance the nursing practice knowledge of stillbirth nursing in the delivery room.

Evaluating three internal fixation techniques for Pauwels III femoral neck fractures via finite element analysis.

The selection of implants for fixing unstable femoral neck fractures (FNF) remains contentious. This study employs finite element analysis to examine the biomechanics of treating Pauwels type III femoral neck fractures using cannulated compression screws (3CS), biplane double-supported screw fixation (BDSF), and the femoral neck system (FNS). A three-dimensional model of the proximal femur was developed using computed tomography scans. Fracture models of the femoral neck were created with 3CS, BDSF, and FNS fixations. Von Mises stress on the proximal femur, fracture ends, internal fixators, and model displacements were assessed and compared across the three fixation methods (3CS, BDSF, and FNS) during the heel strike of normal walking. The maximum Von Mises stress in the proximal fragment was significantly higher with 3CS fixation compared to BDSF and FNS fixations (120.45 MPa vs. 82.44 MPa and 84.54 MPa, respectively). Regarding Von Mises stress distribution at the fracture ends, the highest stress in the 3CS group was 57.32 MPa, while BDSF and FNS groups showed 51.39 MPa and 49.23 MPa, respectively. Concerning implant stress, the FNS model exhibited greater Von Mises stress compared to the 3CS and BDSF models (236.67 MPa vs. 134.86 MPa and 140.69 MPa, respectively). Moreover, BDSF displayed slightly lower total displacement than 3CS fixation (7.19 mm vs. 7.66 mm), but slightly higher displacement than FNS (7.19 mm vs. 7.03 mm). This study concludes that BDSF outperforms 3CS fixation in terms of biomechanical efficacy and demonstrates similar performance to the FNS approach. As a result, BDSF stands as a dependable alternative for treating Pauwels type III femoral neck fractures.

Impact of traumatic brain injury on risk for schizophrenia and bipolar disorder.

The impact of traumatic brain injury (TBI) on subsequent risk of schizophrenia (SCZ) or bipolar disorder (BD) remains contested. Possible genetic and environmental confounding effects have also been understudied. Therefore, we aim to investigate the impact of TBI on the risk of SCZ and BD and whether the effect varies by injury severity, age at injury, and sex. We identified 4,184 SCZ and 18,681 BD cases born between 1973 and 1998 in the Swedish National Registers. Case-control samples matched (1:5) on birth year, sex, and birthplace were created along with a family design study, with cases matched to non-case full siblings. TBI was associated with higher risk of SCZ and BD (IRR=1.33 for SCZ, IRR=1.78 for BD). The association remained significant in the sibling comparison study. Moderate or severe TBI was associated with higher risk for both SCZ and BD compared to mild TBI. Older age at injury was associated with higher risk of SCZ and BD, and the effect of TBI was stronger in women than men. Findings indicate that TBI is a risk factor for both SCZ and BD with differential impact by age, severity and sex and that this association cannot be explained by familial confounding alone.

Tracheal Replacement Techniques and Associated Mortality: A Systematic Review.

OBJECTIVE: Tracheal replacement is a crucial operation to enhance the quality of life for patients with extensive tracheal lesions. The most suitable surgical techniques for different clinical conditions remain a topic of debate. Through a reviewing of the relevant literature, this study investigated the association between surgical techniques and mortality rate. DATA SOURCES: Studies were collected from PubMed, Embase, the Web of Science, the Cochrane Center Register of Controlled Trials, and ClinicalTrials.gov. METHODS: This systematic review encompassed literature from the inception of each database to May 10, 2023, focusing on tracheal replacement for patients who underwent circumferential resection of the trachea or partial resection with preservation of the posterior membranous wall. Non-human and non-clinical studies were excluded. RESULTS: About 31 studies were included in the assessment comprising a combination of case reports and case series, and 118 patients underwent tracheal replacement through four underlying methodologies, including tracheal allotransplantation, autologous tissue reconstruction, bioprosthetic reconstruction, or tissue engineering surgery. Each modality exhibits unique advantages and disadvantages, leading to variable outcomes in clinical application. CONCLUSION: Tracheal replacement is challenging due to the absence of an ideal substitution or graft material. Despite limited clinical successes observed across various modalities, we believe autologous tissue reconstruction for tracheal replacement has the advantage of broadest indications, low rejection rate, and avoidance of immunosuppressive agents. Future research should focus on achieving tracheal replacement that preserves mucociliary clearance, lateral rigidity, and longitudinal flexibility. LEVEL OF EVIDENCE: NA Laryngoscope, 134:1517-1522, 2024.

Investigation of cell-accelerated corrosion (CAC) on the CoCrMo alloy with segregation banding: Hip implant applications.

Metal alloy microstructure plays a crucial role in corrosion associated with total hip replacement (THR). THR is a prominent strategy that uses metal implants such as cobalt-chromium-molybdenum (CoCrMo) alloys due to their advantageous biological and mechanical properties. Despite all benefits, these implants undergo corrosion and wear processes in-vivo in a synergistic manner called tribocorrosion. Also, the implant retrieval findings reported that fretting corrosion occurred in-vivo, evidenced by the damage patterns that appeared on the THR junction interfaces. There is no scientific data on the studies reporting the fretting corrosion patterns of CoCrMo microstructures in the presence of specific biological treatments to date. In the current study, Flat-on-flat fretting corrosion set-up was customized and used to study the tribocorrosion patterns of fretting corrosion to understand the role of alloy microstructure. Alloy microstructural differences were created with the implant stock metal's longitudinal and transverse cutting orientations. As a result, the transverse created the non-banded, homogenous microstructure, whereas the longitudinal cut resulted in the banded, non-homogenous microstructure on the surface of the alloy (in this manuscript, the terms homogenous and banded were used). The induced currents were monitored using a three-electrode system. Three different types of electrolytes were utilized to study the fretting corrosion patterns with both homogeneous and banded microstructures: 1. Control media 2. Spent media (the macrophage cell cultured media) 3. Challenged media (media collected after the macrophage was treated with CoCrMo particles). From the electrochemical results, in the potentiostat conditions, the banded group exhibited a higher induced current in both challenged and spent electrolyte environments than in control due to the synergistic activity of CoCrMo particles and macrophage demonstrating more corrosion loss. Additionally, both Bode and Nyquist plots reported a clear difference between the banded and homogeneous microstructure, especially with challenged electrolytes becoming more corrosion-resistant post-fretting than pre-fretting results. The banded microstructure showed a unique shape of the fretting loop, which may be due to tribochemical reactions. Therefore, from the electrochemical, mechanical, and surface analysis data results, the transverse/homogenous/non-banded alloy microstructure groups show a higher resistance to fretting-corrosion damage.

Climate sensitivity and relative humidity changes in global storm-resolving model simulations of climate change.

The climate simulation frontier of a global storm-resolving model (GSRM; or k-scale model because of its kilometer-scale horizontal resolution) is deployed for climate change simulations. The climate sensitivity, effective radiative forcing, and relative humidity changes are assessed in multiyear atmospheric GSRM simulations with perturbed sea-surface temperatures and/or carbon dioxide concentrations. Our comparisons to conventional climate model results can build confidence in the existing climate models or highlight important areas for additional research. This GSRM's climate sensitivity is within the range of conventional climate models, although on the lower end as the result of neutral, rather than amplifying, shortwave feedbacks. Its radiative forcing from carbon dioxide is higher than conventional climate models, and this arises from a bias in climatological clouds and an explicitly simulated high-cloud adjustment. Last, the pattern and magnitude of relative humidity changes, simulated with greater fidelity via explicitly resolving convection, are notably similar to conventional climate models.