Determination of the appropriate catheter length and place for needle thoracostomy by using computed tomography scans of pneumothorax patients

Introduction

The primary goal of this study was to compare the chest wall thicknesses (CWT) at the 2nd intercostal space (ICS) at the mid-clavicular line (MCL) and 5th ICS at the mid-axillary line (MAL) in a population of patients with a CT confirmed pneumothorax (PTX). This result will help physicians to determine the optimum needle thoracostomy (NT) puncture site in patients with a PTX.

Materials and methods

All trauma patients who presented consecutively to A&E over a 12-month period were included. Among all the trauma patients with a chest CT (4204 patients), 160 were included in the final analysis. CWTs were measured at both sides and were compared in all subgroup of patients.

Results

The average CWT for men on the 2nd ICS-MCL was 38 mm and for women was 52 mm; on the other hand, on the 5th ICS-MAL was 33 mm for men and 38 mm for women. On the 2nd ICS-MCL 17% of men and 48% of women; on the 5th ICS-MAL 13% of men and 33% of women would be inaccessible with a routine 5-cm catheter. Patients with trauma, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 2nd ICS-MCL. Patients with trauma, lung contusion, sternum fracture, subcutaneous emphysema and multiple rib fractures would have thicker CWT on the 5th ICS-MAL.

Conclusions

This study confirms that a 5.0-cm catheter would be unlikely to access the pleural space in at least 1/3 of female and 1/10 of male Turkish trauma patients, regardless of the puncture site. If NT is needed, the 5th ICS-MAL is a better option for a puncture site with thinner CWT.     

Limitations of IL-2 and Rapamycin in Immunotherapy of Type 1 Diabetes

Administration of low-dose interleukin-2 (IL-2) alone or combined with rapamycin (RAPA) prevents hyperglycemia in NOD mice. Also, low-dose IL-2 cures recent-onset type 1 diabetes (T1D) in NOD mice, partially by boosting pancreatic regulatory T cells (T_reg cells). These approaches are currently being evaluated in humans. Our objective was to study the effect of higher IL-2 doses (250,000–500,000 IU daily) as well as low-dose IL-2 (25,000 IU daily) and RAPA (1 mg/kg daily) (RAPA/IL-2) combination. We show that, despite further boosting of T_reg cells, high doses of IL-2 rapidly precipitated T1D in prediabetic female and male mice and increased myeloid cells in the pancreas. Also, we observed that RAPA counteracted IL-2 effects on T_reg cells, failed to control IL-2–boosted NK cells, and broke IL-2–induced tolerance in a reversible way. Notably, the RAPA/IL-2 combination failure to cure T1D was associated with an unexpected deleterious effect on glucose homeostasis at multiple levels, including β-cell division, glucose tolerance, and liver glucose metabolism. Our data help to understand the therapeutic limitations of IL-2 alone or RAPA/IL-2 combination and could lead to the design of improved therapies for T1D.In type 1 diabetes (T1D), the immune system destroys the pancreatic β-cells (1). At clinical onset, ∼30% of β-cells are still able to produce insulin (2), thus stopping autoimmune destruction, which at this stage is a promising approach (3). Along the same lines, there is a growing list of phase I/II clinical trials based on immunomodulation that are currently being conducted in T1D patients (4).NOD mice, which develop spontaneous T1D, represent an accepted model for testing new therapies (5), the gold standard being that treatments that cure overt hyperglycemia in these mice may be most appropriate for translation into the clinic, as was the case for anti-CD3 antibodies (Abs) (6), which have been tested in patients with promising results (7). In addition, results from our own group showing that low-dose interleukin-2 (IL-2) can prevent (8) and revert disease in NOD mice (9) have led to the translation of this strategy into clinical trials in T1D patients (clinical trial reg. no. {"type":"clinical-trial","attrs":{"text":"NCT01353833","term_id":"NCT01353833"}}NCT01353833, clinicaltrials.gov).We have shown that in NOD mice, administration of low-dose IL-2 for 5 days induced the remission of new-onset T1D by specifically boosting regulatory T cells (T_reg cells) in the pancreas without activating pathogenic effector T cells (T_eff cells). However, remission was obtained in only 60% of treated mice, and half of them became diabetic again during the following months (9). Consequently, improving IL-2 therapy by optimizing dosing or combining IL-2 with other immunomodulatory drugs, such as rapamycin (RAPA), could be of great importance for the goal of translating this therapy to humans.RAPA has been used in clinical transplantation for many years (10), and it has been safely administered to T1D patients during islet transplantation (11,12). In mice, RAPA monotherapy can prevent T1D development (13); however, it is unable to induce disease reversal (14). Moreover, RAPA and IL-2 were found to be synergistic for the prevention of diabetes in NOD mice (13). Consequently, we decided to test whether RAPA could synergize with short-term IL-2 therapy to reverse T1D and reinforce the development of long-term tolerance.In this work, we have further studied the mechanisms of action of IL-2 and RAPA alone or in combination in the NOD model of T1D.     

Visual rehabilitation by using corneal wavefront-guided transepithelial photorefractive keratectomy for corneal opacities after epidemic keratoconjunctivitis

International Ophthalmology - To evaluate long-term visual and refractive outcomes of corneal wavefront-guided transepithelial photorefractive keratectomy (t-PRK) with mitomycin C for the treatment...     

Anatomical variations of donor portal vein in right lobe living donor liver transplantation: the safe use of variant portal veins

In right lobe (RL) living donor liver transplantation (LDLT), portal vein (PV) variations are of immense clinical significance. In this study, we describe in detail our PV reconstruction techniques in RL grafts with variant PV anatomy and evaluate the impact of accompanying biliary variations on the recipient outcomes. In a total of 386 RL LDLTs performed between July 2004 and July 2012, the clinical data on 52 (13%) transplants using RL grafts with variant PV anatomy were retrospectively analyzed. Portal vein anatomy was classified as type 2 in 20 patients, type 3 in 24 patients, and type 4 in eight patients. The PV reconstruction techniques utilized included back‐wall plasty (n = 21), back‐wall plasty with saphenous vein graft interposition (n = 6), saphenous vein graft interposition (n = 5), cryopreserved iliac vein Y‐graft interposition (n = 6), and quiltplasty (n = 3). There was no donor mortality. In a median follow‐up of 29 months, none of the recipients had vascular complications. Anomalous PV anatomy was associated with a high (54%) incidence of biliary variations; however, these variations did not result in increased biliary complication rate. Overall, the 1‐ and 3‐year patient survival rates of recipients were 91% and 81%, respectively. Vascular and biliary variations in RL grafts render LDLT technically more challenging. By employing appropriate reconstruction techniques, it is possible to successfully use RL grafts with PV variations without endangering recipient and donor safety.     

Is there a relationship between attention deficit/hyperactivity disorder and Osgood–Schlatter disease?

Purpose

The purpose of this prospective study is to investigate the relationship between Osgood–Schlatter disease (OSD) and attention deficit/hyperactivity disorder (ADHD).

Methods

Seventy-four children with a diagnosis of OSD were referred to child and adolescent psychiatry department for the evaluation of ADHD. Diagnostic and Statistical Manual of Mental Disorders was used for diagnostic criteria.

Results

Diagnosis of ADHD was made in 56 (75.6 %) out of 74 children.

Conclusions

Results of this study suggest that ADHD is a significant risk factor for OSD. During the evaluation of a patient with OSD, a thorough history should be obtained about the behavioral symptoms that indicate underlying ADHD. In case of suspicion, these patients should be referred for an additional evaluation by a child psychiatrist.

Level of evidence

II.     

Strength of Different Krackow Stitch Configurations Using High-strength Suture

The purpose of the present study concerning high-strength sutures was to determine whether increasing the number of locking loops with different size sutures or decreasing the suture size with increased suture strands would have any influence on the strength of Achilles tendon repair. A total of 32 fresh bovine Achilles tendon specimens were randomly assigned to 4 groups. For 3 of the groups, 1 suture was used (no. 2 or no. 5 FiberWire? with 2 or 4 Krackow locking loops). For the fourth group, 2 sutures (2-0 FiberWire?) with 2 locking loops were used. After repair, the study groups underwent cyclic loading (0 to 200 N, 200 cycles) and then underwent tension to failure in a testing machine. Cyclic elongation, peak to peak displacement, ultimate load, stiffness, and failure mode were recorded for each specimen. The tendon width and thickness were measured in all specimens. The mean width, thickness, cyclic displacement, load to failure, and pull-out stiffness showed no differences among the 4 groups. The cyclic peak to peak displacements (0.01 ± 0.01 mm) were smallest with the no. 5 suture with 4 locking loops (p < .05), with no failure during cyclic loading, unlike in the other groups. In the group with 2-0 suture with 4 strands and 2 locking loops, 6 failed during cyclic loading. The number of locking loops used might have had an influence on the strength of the Krackow suture configuration using the larger diameter, high-strength sutures. However, decreasing the suture diameter, with a simultaneous increase in the number of strands, failed to improve the initial strength of the repair.     

Obstruction of mechanical mitral valves by preserved posterior leaflet remnants

We report two cases of mechanical prosthetic mitral valve obstruction caused by remnants of the mitral valve posterior leaflet tissue preserved from the previous surgery. Both patients had rheumatic mitral stenosis causing New York Heart Association class III symptoms prior to mitral valve replacement.     

Alexithymia and Emotional Intelligence in Patients with Panic Disorder, Generalized Anxiety Disorder and Major Depressive Disorder

Emotional Intelligence (EI) is a broad personality construct signifying the ability to perceive and to regulate affects within oneself. Alexithymia is another personality construct denoting difficulty in identifying and expressing emotions, with an externally oriented thinking style. Although previously considered to be independent, some studies have shown that these constructs overlap. The aim of this study was to evaluate and compare the levels of EI and alexithymia in patients with panic disorder, major depressive disorder (MDD), and generalized anxiety disorder (GAD). The subjects included 171 psychiatric patients and 56 non-clinical controls. Psychiatric diagnoses were based on DSM-IV criteria. The Emotional Intelligence Scale-34 (EIS-34) and the Toronto Alexithymia Scale (TAS-20) were used to assess EI and alexithymia. All three patient groups scored statistically significantly higher than the non-clinical controls on TAS-20 total score and the TAS-20 subfactors of difficulty identifying feelings and difficulty describing feelings. EIS-34 scores were lower in patient groups than in the non-clinical controls, but only the EIS-34 intrapersonal subscale was significant difference. Total TAS-20 and EIS-34 scores in the patient cohort were inversely and significantly correlated These results reaffirm an overlap between EI and alexithymia with the intrapersonal factor of EI to be more dependent on the difficulty identifying feelings dimension of alexithymia in subjects with MDD and GAD.