Tube pedicle flap in the management of a Grade III C lower limb injury.

Salvage of a Grade III C lower limb injury is a challenging problem. Apart from microsurgical revascularisation, they frequently need soft tissue coverage procedures. Due to the magnitude of the injury, local flaps from adjacent tissues may not be available and microsurgical free flaps are the flaps of choice. We present an instance where the defect in the middle third of a revascularised leg was covered by a tube pedicle flap raised from the groin and transferred, with the wrist as the carrier. This was chosen because of the below knee amputation on the opposite side combined with long segment circumferential loss of skin in the affected extremity and paucity of vein graft sources. Thus the reconstruction of a limb which was saved by microsurgery was completed by tube pedicle flap. In exceptional circumstances 'old' techniques are still useful.     

Trabecular bone density of male human cervical and lumbar vertebrae

The objective of this study was to determine the bone mineral density (BMD) of cervical vertebrae and correlate with the lumbar spine. Fifty-seven young adult healthy male volunteers, ranging from 18 to 41 years of age, underwent quantitative computed tomography (QCT) scanning of C2-T1 and L2-L4 vertebrae. To account for correlations, repeated measures techniques were used to compare data as a function of spinal level and region. Linear regression methods were used (+/-95% CI) to compare data as a function of spinal level and region. The mean age and body height were 25.0 +/- 5.8 years and 181.0 +/- 7.6 cm. BMD decreased from the rostral to caudal direction along the spinal column. Grouped data indicated that the neck is the densest followed by the first thoracic vertebra and low back with mean BMD of 256.0 +/- 48.1, 194.3 +/- 44.2, and 172.2 +/- 28.4 mg/cm(3), respectively; differences were statistically significant. While BMD did not vary significantly between the three lumbar bodies, neck vertebrae demonstrated significant trends. The matrix of correlation coefficients between BMD and spinal level indicated that the relationship is strong in the lumbar (r = 0.92-0.96) and cervical (r = 0.73-0.92) spines. Data from the present study show that the trabecular bony architecture of the neck is significantly different from the low back. These quantitative BMD data from a controlled young adult healthy human male volunteer population may be valuable in establishing normative data specifically for the neck. From a trabecular bone density perspective, these results indicate that lumbar vertebrae cannot act as the best surrogates for neck vertebrae. Significant variations in densities among neck vertebrae, unlike the low back counterpart, may underscore the need to treat these bones as different structures.     

Modeling changes in intervertebral disc mechanics with degeneration

Mechanical response of the spine to various dynamic loading conditions can be analyzed by way of in vitro and in vivo studies. Ethical concerns, interpretation of conclusions reached in animal studies, and lack of detailed stress distributions in the disc components are the major disadvantages of relying solely on in vivo studies. Intraspecimen variability, difficulty in including muscle activity, and inability to mimic fluid exchange into the disc during unloading are some of the disadvantages of in vitro models. The poroelastic finite element models can provide a method of understanding the relationship between biomechanical performance of the disc due to cyclic loading and disc degeneration. A poroelastic finite element model, including regional variation of strain-dependent permeability and osmotic pressure, was used to study the effect of disc degeneration on biomechanical properties as well as propagation of failure in the disc components when cyclic loading was applied to the lumbar disc. The results predicted that healthy discs were much more flexible than degenerated discs, and the disc stiffness decreased with increasing the number of load cycles independent of degenerative condition. Failure was found to progress as the drained elastic properties of the disc components decreased due to the presence of failure. Poroelastic finite element modeling, including strain-dependent permeability and osmotic pressure, is the most advanced analytical tool currently available that can be used to understand how cyclic loading affects the biomechanical characteristics of a degenerated lumbar disc. However, a complete understanding of behavior of the intervertebral disc will ultimately be achieved only with use of a combination of computational models together with in vitro and in vivo experimental methods. Finite element models of discs with varying degrees of disc degeneration will help clinicians understand the initiation and progression of disc failure and degeneration and will assist in the development of approaches to stimulate the regeneration of disc tissues.     

Trauma Symptoms in Bone Marrow Transplant Survivors: The Role of Nonmedical Life Events

This cross-sectional study investigated the association of trauma-related symptomatology and recent life events in cancer survivors following bone marrow transplantation (BMT). One hundred adults averaging 4.4 years post-BMT were interviewed. Participants reported their trauma-related symptomatology regarding cancer and its treatment as well as the number and valence of recent life events. Results indicated that the more negative life events a person experienced, the greater his/her trauma-related symptomatology. The association of trauma-related symptomatology with positive events varied by the individuals' level of physical functioning. For individuals with poorer physical functioning, higher levels of trauma-related symptomatology were associated with a greater number of positive events, suggesting the greater vulnerability of these individuals to any type of change in their life.     

Giant lipoma causing a colo-colonic intussusception

Intussusception is much more common in children than in adults. Unlike in children, intussusception in adults is associated with an identifiable etiology in 90 per cent of cases. Lipomas are the second most common benign tumors of the colon. Small lipomas are usually asymptomatic and are found incidentally during colonoscopy. Giant lipomas are uncommon causes for colonic intussusception. This usually presents as abdominal pain and vomiting and less commonly as diarrhea. Computed tomography is an excellent method to diagnose giant colonic lipomas, by showing a well demarcated, round, low-attenuated lesion in the lumen of the colon. The definitive treatment for symptomatic lipomas is surgical resection. Both laparoscopic and open resections have been described. Endoscopic resection of colonic lipomas is associated with a high complication rate. In this report, we present a patient with a giant colonic lipoma causing colocolonic intussusception.     

Posttraumatic Stress Symptoms and Associated Comorbidity During the COVID-19 Pandemic in Ireland: A Population-Based Study

The prevalence of posttraumatic stress disorder (PTSD) as it relates to individuals’ experiences of the COVID-19 pandemic has yet to be determined. This study was conducted to determine rates of COVID-19–related PTSD in the Irish general population, the level of comorbidity with depression and anxiety, and the sociodemographic risk factors associated with COVID-19–related PTSD. A nationally representative sample of adults from the general population of the Republic of Ireland (N = 1,041) completed self-report measures of all study variables. The rate of COVID-19–related PTSD was 17.7% (n = 184), 95% CI [15.35%, 19.99%], and there was a high level of comorbidity with generalized anxiety (49.5%) and depression (53.8%). Meeting the diagnostic requirement for COVID-19–related PTSD was associated with younger age, male sex, living in a city, living with children, moderate and high perceived risk of COVID-19 infection, and screening positive for anxiety or depression. Posttraumatic stress symptoms related to the COVID-19 pandemic are common in the general population. Our results show that health professionals responsible for responding to the COVID-19 pandemic should expect to routinely encounter symptoms and concerns related to posttraumatic stress.     

Natural micropolymorphism in human leukocyte antigens provides a basis for genetic control of antigen recognition

Human leukocyte antigen (HLA) gene polymorphism plays a critical role in protective immunity, disease susceptibility, autoimmunity, and drug hypersensitivity, yet the basis of how HLA polymorphism influences T cell receptor (TCR) recognition is unclear. We examined how a natural micropolymorphism in HLA-B44, an important and large HLA allelic family, affected antigen recognition. T cell–mediated immunity to an Epstein-Barr virus determinant (EENLLDFVRF) is enhanced when HLA-B*4405 was the presenting allotype compared with HLA-B*4402 or HLA-B*4403, each of which differ by just one amino acid. The micropolymorphism in these HLA-B44 allotypes altered the mode of binding and dynamics of the bound viral epitope. The structure of the TCR–HLA-B*4405^EENLLDFVRF complex revealed that peptide flexibility was a critical parameter in enabling preferential engagement with HLA-B*4405 in comparison to HLA-B*4402/03. Accordingly, major histocompatibility complex (MHC) polymorphism can alter the dynamics of the peptide-MHC landscape, resulting in fine-tuning of T cell responses between closely related allotypes.     

Recent Developments in the Role of Coenzyme Q10 for Coronary Heart Disease: a Systematic Review

Purpose of Review

This review examines recent randomized clinical trials evaluating the role of coenzyme Q10 (CoQ10) in the management of coronary heart disease.

Recent Findings

CoQ10 is one of the most commonly used dietary supplements in the USA. Due to its antioxidant and anti-inflammatory effects, CoQ10 has been studied extensively for possible use in managing coronary heart disease. One of the most common applications of CoQ10 is to mitigate statin-associated muscle symptoms (SAMS) based on the theory that SAMS are caused by statin depletion of CoQ10 in the muscle. Although previous studies of CoQ10 for SAMS have produced mixed results, CoQ10 appears to be safe. Because CoQ10 is a cofactor in the generation of adenosine triphosphate, supplementation has also recently been studied in patients with heart failure, which is inherently an energy deprived state. The Q-SYMBIO trial found that CoQ10 supplementation in patients with heart failure not only improved functional capacity, but also significantly reduced cardiovascular events and mortality. Despite these positive findings, a larger prospective trial is warranted to support routine use of CoQ10. Less impressive are the effects of CoQ10 on specific cardiovascular risk factors such as blood pressure, dyslipidemia, and glycemic control.

Summary

Current evidence does not support routine use of CoQ10 in patients with coronary heart disease. Additional studies are warranted to fully determine the benefit of CoQ10 in patients with heart failure before including it in guideline-directed medical therapy.