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Donor site morbidity following radial forearm flap (RFF) harvest remains a controversial issue. The aim of this meta-analysis was to answer the question “Are the range of wrist movements (range of motion, ROM) and hand strength affected after RFF harvesting?” The PubMed, Embase, Scopus, and Cochrane Library electronic databases were systematically searched (to December 2019). Self-controlled studies evaluating hand biomechanics after RFF harvest were included. Weighted mean differences with 95% confidence intervals were calculated using the random-effects model. The outcome variables were ROM, forearm movements, grip, and pinch strengths. Thirteen studies involving a total of 335 patients were included. With the exception of grip strength and supination, which showed statistically significant reductions of about 2.40 kg and 2.86° (P < 0.05), all other ROM, forearm movements, and pinch strengths showed an insignificant difference when the operated hand was compared to the non-operated hand (P > 0.05). Regression analysis showed that the method of donor site closure and size of the donor site defect had an insignificant impact on hand biomechanics. This study confirms the lack of discernible biomechanical morbidity after RFF transfer. The minimal reduction in hand biomechanics after RFF is considered to be clinically negligible.  相似文献   
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Antiphospholipid syndrome (APS) is an autoimmune disease and one of the most common causes of acquired thrombophilia. It is characterised by the occurrence of thrombotic or obstetric events associated with the presence of persistent antiphospholipid antibodies. The diagnosis can be challenging, particularly because some biological tests can be disturbed by anticoagulant treatment or inflammation.In the recent years, new antiphospholipid antibodies, including anti-phosphatidylserine/prothrombin antibodies (anti-PS/PT), have emerged but their clinical significance and causality remain uncertain.Biologically, several studies have found a strong correlation between the presence of lupus anticoagulant (LA) and anti-PS/PT antibodies. Clinically, the presence of anti-PS/PT antibodies is associated with an increased risk of thrombosis and obstetric complications. There is also an association with thrombocytopenia, suggesting that the presence of anti-PS/PT antibodies may be associated with more severe clinical APS. Among seronegative APS patients, 6–17% of patients are positive for anti-PS/PT antibodies. This might influence the therapeutic management of patients.This article aims to provide an update on contribution of anti-PS/PT antibodies detection for the diagnosis and management of APS.  相似文献   
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BackgroundThe choice of surgical approach during total hip arthroplasty (THA) remains highly controversial. The aim of the present study was to compare 30-day major and minor complications, following primary THA between the direct anterior, lateral, and posterior approaches.MethodsOur hospital performs primary THAs using all 3 aforementioned approaches based on surgeon preference. Patients who underwent primary THA from August 2010 to August 2017 were identified using our institution’s total joint registry, and their data were combined with prospectively collected data from the National Surgical Quality Improvement Program database (which evaluates a random sample of approximately 20% of all surgical patients in our hospital). Baseline characteristics, operative variables, and postoperative complications were then compared between the three groups.ResultsThe analysis comprised 1967 primary THAs (1913 patients), whereby 56%, 29%, and 15% were performed through a posterior, lateral, and direct anterior approach, respectively. Thirty-day major and minor complications occurred in 3.9% and 9.4% of surgeries, respectively. After adjusting for baseline patient characteristics, there was no significant difference in major or minor perioperative complications between the 3 approaches.ConclusionsThis study compared perioperative complications between the 3 most commonly used approaches for THA utilizing a synthesis of our institutional total joint registry and high-quality National Surgical Quality Improvement Program data. Thirty-day major and minor complications were similar regardless of the surgical approach employed, which may help surgeons and patients simplify the multiple considerations taken into account when deciding on surgical approach for primary THA.Level of EvidenceTherapeutic, Level III.  相似文献   
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The Ostheimer lecture is given each year at the annual meeting of the Society for Obstetric Anesthesia and Perinatology. It summarizes “What’s New in Obstetric Anesthesia” based on a systematic evaluation of the relevant literature published in the previous calendar year. In this review I consider studies published in 2016 focused on the prevalence of, and risk factors for, maternal morbidity and mortality. I also discuss novel therapeutic approaches to the prevention and treatment of major sources of maternal morbidity and mortality.  相似文献   
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《Injury》2019,50(4):931-938
BackgroundWe aimed to describe and quantify postoperative complications in the older hip fracture population, develop and validate a hip fracture postoperative morbidity survey tool (HF–POMS).MethodsA prospective clinical observation study of patients (≥ 70 years) admitted for emergency hip fracture surgery, was conducted across three English National Health Service hospitals. Outcome data items were developed from the Postoperative Morbidity Survey (POMS), Cardiac-POMS, hip fracture postoperative literature and orthogeriatric clinical team input. Postoperative outcome data were collected on days 1, 3, 5, 8 and 15; 341 patients participated.ResultsA 12-domain HF-POMS tool was developed with acceptable construct validity on all HF–POMS days. Patients with high perioperative risk scores as measured by the NHFS and ASA grade were more prone to develop HF–POMS defined morbidities. High morbidity rates occurred in the following domains; renal, ambulation assistance, pain and infectious. Presence of any morbidity on postoperative days 8 and 15 was associated with subsequent length of stay of 3.08 days (95% CI 0.90–5.26, p = 0.005) and 15.81 days (95% CI 13.35–18.27, p = 0.001) respectively. Observed average length of stay was 16.9 days. HF–POMS is a reliable and valid tool for measuring early postoperative complications in hip fracture patients. Additional domains are necessary to account for all morbidity aspects in this patient population compared to the original POMS.ConclusionMany patients remained in hospital for non-medical reasons. HF-POMS may be a useful tool to assist in discharge planning and randomised control trial outcome definitions.  相似文献   
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