The level of bifurcation of peroneal artery and its implications for posterolateral approach to the ankle: a CT angiography study

xlomafota13 shared this article with you from Inoreader The level of bifurcation of peroneal artery and its implications for posterolateral approach to the ankle: a CT angiography study Via radiol anat Surg Radiol Anat. 2021 Jul 17. doi: 10.1007/s00276-021-02800-y. Online ahead of print. ABSTRACT PURPOSE: This study aims to provide data, with the use of computed tomography angiography, regarding the level of bifurcation of the peroneal artery to the anterior perforating branch and the lateral calcaneal branch, in relation to the osseous anatomic structures of the tibial plafond, the medial malleolus and the lateral malleolus. METHODS: The study included patients who underwent diagnostic computed tomography angiography of the lower extremities. Measurements were performed in two-dimensional reconstructions and included the perpendicular distance from peroneal artery bifurcation into anterior perforating branch and lateral calcaneal branch to the lowest level of tibial plafond (D1), medial malleolus (D2) and lateral malleolus (D3). The distances were also normalized to the length of the tibia. RESULTS: Sixty patients and a total of 115 limbs were enrolled in this study. The mean distance ± standard deviation from peroneal artery bifurcation to tibial plafond (D1) was 4.33 ± 1.12 cm (normalized 0.12 ± 0.03) (range 2.54-8.26 cm), to medial malleolus (D2) was 5.53 ± 1.18 cm (normalized 0.16 ± 0.03) (range 3.27-9.5 cm) and to lateral malleolus (D3) was 6.53 ± 1.17 cm (normalized 0.18 ± 0.03) (range 4.71-10.2 cm), respectively. There was no significant difference between right and left limb measurements (p > 0.05). Females presented lo wer, but not statistically significant (p > 0.05), D1, D2 and D3 measurements compared to males. CONCLUSION: The bifurcation of the peroneal artery takes place at lower level compared to previously published studies and consequently extreme caution should be exercised when performing the posterolateral approach to the ankle. This study adds to the understanding of the relevant vascular anatomy of the region and assists in performing the posterolateral approach to the ankle with safety. PMID:34275009 | DOI:10.1007/s00276-021-02800-y View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Circular RNA EGLN3 silencing represses renal cell carcinoma progression through the miR-1224-3p/HMGXB3 axis

xlomafota13 shared this article with you from Inoreader Circular RNA EGLN3 silencing represses renal cell carcinoma progression through the miR-1224-3p/HMGXB3 axis Via histochem Acta Histochem. 2021 Jul 15;123(6):151752. doi: 10.1016/j.acthis.2021.151752. Online ahead of print. ABSTRACT BACKGROUND: Renal cell carcinoma (RCC) is a common tumor of the urinary system, and its global incidence is increasing annually. Circular RNAs (circRNAs) are involved in RCC tumorigenesis; however, the role of circ-EGLN3 (hsa_circ_0031594) derived from the Egl nine homolog 3 (EGLN3) gene in RCC remains undetermined. METHODS: Circ-EGNL3 expression was examined b efore and after RNase R and actinomycin treatments in RCC cells and tissues. Cell proliferation, migration, and invasion were assessed using the CCK-8 assay, EdU staining, and wound-healing and Transwell assays. The interactions between microRNA (miR)-1224-3p and circ-EGLN3, and between miR-1224-3p and HMG box domain containing 3 (HMGXB3) were predicted by bioinformatics analysis and validated by dual-luciferase reporter assay. RESULTS: Circ-EGLN3 was identified using RNase R and actinomycin treatments. Circ-EGLN3 was upregulated in RCC cells and tissues and correlated with poor overall survival. Silencing of circ-EGNL3 decreased RCC cell proliferation, migration, and invasion. Mechanistic studies indicated that circ-EGNL3 acts as a sponge for miR-1224-3p, which targeted HMGXB3. Circ-EGNL3 indirectly upregulated HMGXB3 by targeting miR-1224-3p, and overexpression of circ-EGLN3 reversed the repressive effects of miR-1224-3p on RCC. CONCLUSION: Circ-EGLN3 regulated RCC pro gression through the miR-1224-3p/HMGXB3 axis, suggesting its potential as a therapeutic target. PMID:34274607 | DOI:10.1016/j.acthis.2021.151752 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Clinical value of contrast-enhanced ultrasonography in focal hypoechogenic lesions of thyroid

xlomafota13 shared this article with you from Inoreader Clinical value of contrast-enhanced ultrasonography in focal hypoechogenic lesions of thyroid Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 18. doi: 10.1007/s00405-021-06982-4. Online ahead of print. ABSTRACT OBJECTIVE: The objectives of this study were to analyze the accuracy of contrast-enhanced ultrasonography (CE-US) in diagnosing focal hypoechogenic lesions of the thyroid (FHLT), and to explore the clinical value of CE-US in the diagnosis of FHLT. METHODS: Patients undergoing CE-US and ultrasound-guided fine needle aspiration (US-FNA) of FHLT at First Hospital of China Medical University between January 2017 and December 2018 were selected for the study; this included patients with papillary thyroid carcinoma (PTC), subacute thyroiditis (SAT) and focal Hashimoto thyroiditis (FHT). All patients underwent color Doppler ultrasonography (CD-US) after which thyroid image reporting and data system (TI-RADS) grading were done. Then, each patient underwent CE-US and US-FNA. The results of the CE-US were analyzed using descriptive stat istics. The cytopathological results from the US-FNAs were the gold standard used to confirm the diagnoses. RESULTS: A total of 56 patients were selected for the study. In the PTC group (n = 16), grading was as follows: TI-RADS4a, n = 3; TI-RADS4b, n = 12; and TI-RADS4c, n = 1. More patients with PTC showed heterogeneous hypoenhancement (n = 15) than heterogeneous isoenhancement (n = 1) on CE-US. In the SAT group (n = 24), grading was as follows: TI-RADS3, n = 1; TI-RADS4a, n = 18; TI-RADS4b, n = 5. Fewer patients with SAT showed heterogeneous hypoenhancement (n = 2) than heterogeneous isoenhancement (n = 22) on CE-US. In the FHT group (n = 16), grading was as follows: TI-RADS3, n = 1; TI-RADS4a, n = 11; TI-RADS4b, n = 4. Of those in the FHT group, one patient showed heterogeneous isoenhancement, one patient showed heterogeneous hypoenhancement, and 14 showed uniform isoenhancement on CE-US. The diagnostic accuracy of CD-US alone differed significantly from that of CD-US + CE- US (p < 0.05). CONCLUSION: CE-US has a high diagnostic accuracy for FHLT and can be used to identify PTC, SAT, and FHT. PMID:34274997 | DOI:10.1007/s00405-021-06982-4 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Quality of life after transoral CO2 laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis

xlomafota13 shared this article with you from Inoreader Quality of life after transoral CO<sub>2</sub> laser posterior cordotomy with or without partial arytenoidectomy for bilateral adductor vocal cord paralysis Via http://link.springer.com/journal/405,European archives of oto-rhino-laryngology,The European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino Eur Arch Otorhinolaryngol. 2021 Jul 18. doi: 10.1007/s00405-021-06971-7. Online ahead of print. ABSTRACT OBJECTIVES: Bilateral adductor vocal cord paralysis (BAVCP) is a rare and challenging condition whose main consequence is reduction of airway patency at the glottic level, often causing respiratory distress, while vocal function tends to remain almost normal. We investigated the effect of transoral glottal widening on quality of life and decannulation rates in patients affected by BAVCP. METHODS: We retrospectively evaluated patients affected by BAVCP and treated by transoral CO2 posterior cordotomy with or without medial partial arytenoidectomy (PC ± MPA) at two referral centers. The primary outcome was change in quality of life, evaluated pre- and post-operatively by the ADVS, VHI-30, and EAT-10 questionnaires. Secondary outcomes were the need for retreatments and, for patients with tracheotomy, the time to decan nulation. RESULTS: Thirty-three patients met selection criteria. The etiology was post-surgical in 27 cases (81.8%), idiopathic in 4 (12.1%), a trauma-related in 1 (6.0%), and to other causes in 1 (3.0%). In 22 cases (66.7%), PC was combined with MPA. A significant improvement in responses for the ADVS (p < .0001) and EAT-10 (p < .0001) was observed, whereas the VHI-30 score did not change significantly post-operatively. All nine patients with a tracheostomy were successfully decannulated within 18 months after the surgical procedure. CONCLUSIONS: For patients affected by BAVCP, PC ± MPA by transoral CO2 laser microsurgery is a safe, customizable and minimally invasive treatment that can guarantee an affordable balance between quality of life in terms of phonation and swallowing and acceptable airway patency. PMID:34274996 | DOI:10.1007/s00405-021-06971-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report

xlomafota13 shared this article with you from Inoreader Conservative Management of Traumatic Brown-Séquard Syndrome: A Case Report Via leak of cerebrospinal fluid Am J Case Rep. 2021 Jul 18;22:e930036. doi: 10.12659/AJCR.930036. ABSTRACT BACKGROUND Traumatic spinal cord injuries are quite common; however, a rare form of incomplete spinal cord injury is Brown-Sequard syndrome. Brown-Sequard syndrome is defined by the National Institute of Neurological Disorders and Strokes as "a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side." CASE REPORT A 33-year-old man was brought to the Emergency Department by Saudi Red Crescent with multiple stab wounds on the left upper thoracic and lower cervical regions. He was tachycardic, but otherwise vitally stable. His Glasgow Coma Scale score was 15. The patient presented with bilateral lower limb weakness, more on the ipsilateral (left) side, and contralateral (right) hypoesthesia from the level of the nip ple below. Cervical and thoracic magnetic resonance imaging revealed ligamentous injury defect at the posterior dura and indicating a dural tear with minor cerebrospinal fluid leak. Focal hyperintense signal intensity was noted on the left side of the spinal cord, representing contusion. The patient was managed conservatively with daily physical therapy. Strength had improved substantially by the time of discharge and sensation was improving. CONCLUSIONS Brown-Sequard syndrome is associated with good prognosis. These patients require a multidisciplinary approach because it provides the best chance of recovery to pre-injury status. These injuries may cause disastrous neurological deficits; therefore, preventive strategies should be designated to decrease the incidence of such injuries. PMID:34274937 | DOI:10.12659/AJCR.930036 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time

xlomafota13 shared this article with you from Inoreader Outcome after surgical treatment of cerebrospinal fluid leaks in spontaneous intracranial hypotension-a matter of time Via leak of cerebrospinal fluid J Neurol. 2021 Jul 18. doi: 10.1007/s00415-021-10710-7. Online ahead of print. ABSTRACT OBJECTIVE: Spinal cerebrospinal fluid (CSF) leaks cause spontaneous intracranial hypotension (SIH). Microsurgery can sufficiently seal spinal CSF leaks. Yet, some patients suffer from residual symptoms. Aim of the study was to assess predictors for favorable outcome after surgical treatment of SIH. METHODS: We included consecutive patients with SIH treated surgically from January 2013 to May 2020. Subjects were surveyed by a questionnaire. Primary outcome was resolution of symptoms as rated by the patient. Secondary outcome was postoperative headache intensity on the numeric rating scale (NRS). Association between variables and outcome was assessed using univariate and multivariate regression. A cut-off value for continuous variables was calculated by a ROC analysis. RESULTS: Sixty-nine out of 86 patients (80.2%) returned the questionnaire and were analyzed. Mean age was 46.7 years and 68.1% were female. A significant association with the primary and secondary outcome was found only for preoperative symptom duration (p = 0.001 and p < 0.001), whereby a shorter symptom duration was associated with a better outcome. Symptom duration remained a significant predictor in a multivariate model (p = 0.013). Neither sex, age, type of pathology, lumbar opening pressure, nor initial presentation were associated with the primary outcome. ROC analysis yielded treatment within 12 weeks as a cut-off for better outcome. CONCLUSION: Shorter duration of preoperative symptoms is the most powerful predictor of favorable outcome after surgical treatment of SIH. While an initial attempt of conservative treatment is justified, we advocate early definitive treatment within 12 weeks in case of persisting symptoms. PMID:34274993 | DOI:10.1007/s00415-021-10710-7 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

FACE-Q Craniofacial Module: Part 1 validation of CLEFT-Q scales for use in children and young adults with facial conditions

xlomafota13 shared this article with you from Inoreader FACE-Q Craniofacial Module: Part 1 validation of CLEFT-Q scales for use in children and young adults with facial conditions Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 10:S1748-6815(21)00292-8. doi: 10.1016/j.bjps.2021.05.040. Online ahead of print. ABSTRACT BACKGROUND: The CLEFT-Q includes 12 independently functioning scales that measure appearance (face, nose, nostrils, teeth, lips, jaws), health-related quality of life (psychological, social, school, speech distress), and speech function, and an eating/drinking checklist. Previous qualitative research revealed that the CLEFT-Q has content validity in noncleft craniofacial conditions. This study aimed to examine the psychometric performance of the CLEFT-Q in an international sample of patients with a broad range of facial conditions. METHODS: Data were collected between October 2016 and December 2019 from 2132 patients aged 8 to 29 years with noncleft facial conditions. Rasch measurement theory (RMT) analysis was used to examine Differential Item Function (DIF) by comparing the original CLEFT-Q sample a nd the new FACE-Q craniofacial sample. Reliability and validity of the scales in a combined cleft and craniofacial sample (n=4743) were examined. RESULTS: DIF was found for 23 CLEFT-Q items when the datasets for the two samples were compared. When items with DIF were split by sample, correlations between the original and split person locations showed that DIF had negligible impact on scale scoring (correlations ≥0.995). In the combined sample, RMT analysis led to the retention of original content for ten CLEFT-Q scales, modification of the Teeth scale, and the addition of an Eating/Drinking scale. Data obtained fit with the Rasch model for 11 scales (exception School, p=0.04). Person Separation Index and Cronbach alpha values met the criteria. CONCLUSION: The scales described in this study can be used to measure outcomes in children and young adults with cleft and noncleft craniofacial conditions. PMID:34274246 | DOI:10.1016/j.bjps.2021.05.040 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

The impact of closed incisional negative pressure therapy on anterior lateral thigh flap donor site healing and scarring: A retrospective case-control study

xlomafota13 shared this article with you from Inoreader The impact of closed incisional negative pressure therapy on anterior lateral thigh flap donor site healing and scarring: A retrospective case-control study Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Jun 13:S1748-6815(21)00300-4. doi: 10.1016/j.bjps.2021.05.049. Online ahead of print. ABSTRACT BACKGROUND: The objective of this study was to investigate whether closed incisional negative pressure therapy (cINPT) is suitable to improve anterior lateral thigh (ALT) flap donor site healing and scarring. METHODS: We identified 271 ALT free flaps of widths between 7 and 9 cm and primary donor site closure performed between January 2012 to December 2019. Patients were divided into cases of cINPT versus controls without cINPT as part of this retrospective case-control review. We compared the incidences of postoperative donor site complications (wound dehiscence, infection, seroma, hematoma) and the degree of scarring severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS). RESULTS: A total of 106 ALT donor sites received cINPT (39%), whereas th e remaining 165 donor sites received conventional dressings (61%). The distribution of gender, age, body mass index, comorbidities, and mean flap sizes were comparable between both groups. The occurrence of surgical wound dehiscence was significantly lower in the cINPT group (2.8%), when compared to controls (9.0%) (p = 0.04). Furthermore, the mean length of postoperative hospital stay was significantly shorter in the cINPT group (19 ± 8 days versus 21 ± 11 days; p = 0.03). CINPT was associated with a more favorable donor site scar quality when assessed by VSS (p = 0.03) and POSAS (p = 0.002). CONCLUSION: The use of cINPT was associated with significantly less ALT donor site complications and superior scar quality accelerating patients' postoperative recovery. PMID:34274247 | DOI:10.1016/j.bjps.2021.05.049 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Normothermic ex vivo perfusion of the limb allograft depletes donor leukocytes prior to transplantation

xlomafota13 shared this article with you from Inoreader Normothermic ex vivo perfusion of the limb allograft depletes donor leukocytes prior to transplantation Via Journal of plastic, reconstructive & aesthetic surgery : JPRAS J Plast Reconstr Aesthet Surg. 2021 Apr 11:S1748-6815(21)00172-8. doi: 10.1016/j.bjps.2021.03.071. Online ahead of print. ABSTRACT INTRODUCTION: The donor immune compartment plays a central role in graft rejection of the vascularised composite allograft (VCA) by contributing to 'direct presentation'. Using our limb ex vivo normothermic machine perfusion (EVNP) protocol designed for prolonged allograft preservation, this study aimed to assess whether donor leukocytes responsible for allograft rejection are mobilised from the donor compartment. METHODS: Five genetically different pig forelimbs underwent perfusion via the brachial and radial collateral artery for 6 h after 2 h of cold storage. Oxygenated haemodilute leucocyte-deplete blood was recirculated at normothermia using an extracorporeal perfusion system. Tissue perfusion was evaluated clinically and biochemically via blood perfusate. The temporal kinetics of donor leucocyte extravasation, cytokine secretion and cell-free DNA was characterised in the circulating perfusate. RESULTS: Flow cytometry revealed increasing populations of viable leukocytes over time, reaching 49 billion leukocytes by 6 h. T (3.0 × 109 cells) and B cells (3.1 × 108 cells) lymphocytes, monocytes (2.7 × 109 cells), granulocytes (8.1 × 109 cells), NK (6.3 × 108) and γδ (8.1 × 108) cells were all identified. Regulatory T cells comprised a minor population (1.6 × 107 cells). There was a cumulative increase in pro-inflammatory cytokines suggesting that the donor limb has the capacity to elicit significant inflammatory responses that could contribute to leucocyte activation and diapedesis. CONCLUSION: EVNP not only acts as a preservation tool, but could also be utilized to immunodeplete the VCA allograft prior to transplantation. This has clinical implications to mitigate acute rejection and prevent graft dysfunction and supports the future application of machine perfusion in graft preservation and immune modulation. PMID:34274245 | DOI:10.1016/j.bjps.2021.03.071 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

A case of spontaneous middle cranial fossa cerebrospinal fluid leak presenting as recurrent bacterial meningitis

xlomafota13 shared this article with you from Inoreader A case of spontaneous middle cranial fossa cerebrospinal fluid leak presenting as recurrent bacterial meningitis Via leak of cerebrospinal fluid Rinsho Shinkeigaku. 2021 Jul 17. doi: 10.5692/clinicalneurol.cn-001606. Online ahead of print. ABSTRACT A 19-year-old man with a history of Chiari type I malformation was admitted to our hospital two times within a 2-month period because of bacterial meningitis. Cerebrospinal fluid (CSF) analysis showed neutrophilic pleocytosis and hypoglycorrhachia. During the second admission, we became aware of hearing loss on the right since age 15 years. High-resolution temporal bone CT showed soft tissue opacification of the right epitympanum and external auditory canal. Tissue biopsy resulted in CSF otorrhea and pneumocephalus. CT cisternography revealed a temporal bone CSF leak. Brain MRI showed a dural defect localized to the anterior petrous apex. Using a combined middle cranial fossa-transmastoid approach, the dural defect and associated arachnoid granulations were located along the superior side of the greater petrosal nerve and repaired. A CSF le ak without underlying pathology, such as trauma, surgery, or congenital abnormality, is defined as spontaneous. Spontaneous CSF leak should be considered as a cause of recurrent bacterial meningitis even when CSF otorrhea and fluid behind the tympanic membrane are clinically absent. PMID:34275956 | DOI:10.5692/clinicalneurol.cn-001606 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.