Free anterolateral thigh flap with vascularized lateral femoral cutaneous nerve for the treatment of neuroma‐in‐continuity and recurrent carpal tunnel syndrome after carpal tunnel release

Treatment of recurrent carpal tunnel syndrome (CTS) is challenging, especially in a case with recurrent CTS and a neuroma formation. Resection of the neuroma causing the syndrome, reconstruction of the nerve gap of the median nerve, and covering up the reconstructed median nerve with well‐vascularized soft tissue for prevention of CTS re‐recurrence are the essential procedures. We report a case of recurrent CTS with severe pain due to a neuroma‐in‐continuity successfully treated using a free anterolateral thigh (ALT) flap with a vascularized lateral femoral cutaneous nerve (LFCN). A 2 cm neuroma existed in the median nerve and was resected. The nerve gap was repaired using a vascularized LFCN included in the ALT flap. The ALT flap was transferred to the wrist to cover the median nerve. The severe pain disappeared completely and the sensory and motor impairment of the median nerve improved 5 months after the free flap surgery, as the Tinel's sign moved distally away from the wrist and disappeared. The result of the Semmes‐Weinstein test improved from 5.08 to 4.31 and she was able to flex and extend the right wrist and fingers without pain. CTS did not recur 15 months after the surgery. A free ALT flap with vascularized LFCN allows nerve reconstruction for the median nerve gap created after neuroma resection and coverage of the median nerve with well‐vascularized soft tissue to prevent adhesion and CTS recurrence. © 2013 Wiley Periodicals, Inc. Microsurgery 34:145–148, 2014.     

Trends in Length of Stay and 30-Day Complications After Total Knee Arthroplasty: An Analysis From 2006 to 2016

BackgroundHospital length of stay (LOS) is a quality metric and target of recent efforts in the last decade to decrease healthcare costs and postoperative nosocomial complications after total knee arthroplasty (TKA). However, decreasing LOS has raised concerns of possible increased complication and readmission rates. We present a decade-long analysis in trends of LOS and 30-day complication and unplanned readmissions following TKA.MethodsThe National Surgical Quality Improvement Program registry was utilized to identify patients undergoing elective primary TKA between 2006 and 2016. Three cohorts of patients were created based on year of surgery (2006-2009 [N = 7111], 2010-2013 [N = 71,943], and 2014-2016 [N = 142,710]). Patient demographics, perioperative variables, LOS, 30-day postoperative complications, and readmission rates were analyzed between the 3 cohorts using bivariate and multivariate analyses.ResultsLOS decreased significantly over time when the 2006-2009 cohort (3.7 days) was compared to the 2010-2013 cohort (3.3 days, P < .001) and 2014-2016 cohort (3.0 days, P < .001). Similarly, there was a decrease in the rate of total 30-day complications in the 2006-2009 cohort (5.37%) compared to 2010-2013 (3.86%) and 2014-2016 (3.13%, P < .001), with significantly lower rates of deep vein thrombosis, sepsis, and urinary tract infection in the latter cohorts. Decreasing rates of 30-day readmission were also observed in the 2010-2013 cohort (3.63%) compared to 2013-2016 cohort (3.23%, P < .001).ConclusionIn the last decade, there has been a trend toward decreasing LOS after TKA. Despite concerns about early discharge, data from a national registry demonstrated a simultaneous decrease in total 30-day complication and readmission rates.Level of EvidenceIII, Retrospective cohort study.     

失效模式与效应分析在低能X线术中放疗的应用

目的:探讨失效模式与效应分析(FMEA)在低能X线术中放疗(IORT)中的应用,分析其在IORT中的潜在风险,初步探讨FMEA优化IORT管理、减少潜在风险发生的可行性。方法:由IORT团队(1名放疗科医生、1名放疗科物理师、2名外科医生、2名护士)成立FMEA工作小组,应用FMEA方法开展系统风险评估。确立流程模块,...     

姜黄素对阿尔茨海默病细胞模型miRNA106a的影响

目的探讨阿尔茨海默病(Alzheimer’s disease,AD)中姜黄素与miR-106a的关系。方法将PC12细胞随机分为5组:正常对照组(PC12细胞组),模型组(PC12细胞与浓度为4μg/mL的Aβ1-42共培养24h),anti-miR-106a组(造模成功后转染anti-miR-106a),姜黄素组(造模成功后加姜黄素,终浓度为20μmol/L)、共同作用组(anti-miR-106a加入姜黄素)。RT-PCR检测miR-106a的含量;Western blotting检测APP的含量。结果 RT-PCR结果显示,与正常对照组相比,模型组和anti-miR-106a组miR-106a含量均明显降低(P<0.05),而姜黄素组明显升高(P<0.05)。Western blotting结果显示,与正常对照组相比,模型组(P<0.05)和anti-miR-106a组(P<0.01)APP明显增加,姜黄素组APP比模型组明显降低(P<0.05)。结论姜黄素可通过正性调节miR-106a而参与AD的治疗。     

Congenital Cytomegalovirus Infection in Children with Autism Spectrum Disorder: Systematic Review and Meta-Analysis

Association of congenital cytomegalovirus (CMV) infection with autism spectral disorder (ASD) has been suggested since 1980s. Despite the observed association, its role as a risk factor for ASD remains to be defined. In the present review, we systematically evaluated the available evidence associating congenital CMV infection with ASD using PubMed, Web of Science, Cochrane Library, and Embase databases. Any studies on children with CMV infection and ASD were evaluated for eligibility and three observational studies were included in meta-analysis. Although a high prevalence of congenital CMV infection in ASD cases (OR 11.31, 95% CI 3.07–41.66) was indicated, too few events (0–2 events) in all included studies imposed serious limitations. There is urgent need for further studies to clarify this issue.     

Correction to: Spindle‑related brain activation in patients with insomnia disorder: An EEG‑fMRI study

Brain Imaging and Behavior -     

护士发生差错事故后压力源与焦虑状况及应对方式的研究

目的 探讨护理人员发生差错事故后压力源、焦虑状况、应对方式及其关系.方法 对四川省4所综合医院发生差错事故后的203名护士采用自设护士发生差错事故后压力源调查表及焦虑自评量表、简易应对方式量表进行问卷调查.结果 护士发生差错事故后前3位压力源为:患者或家属发现及发现后投诉致纠纷赔偿,相关部门对当事人、科室的处罚(经济、行政),对当事人及科室通报批评;护士发生差错事故后SAs总分为(37.76±8.38)分,显著高于常模(P<0.01),焦虑发生率为83.25%;护士发生差错事故后,积极应对评分显著高于常模,消极应对评分显著低于常模(均P<0.01);护士发生差错事故后压力源评分与积极应对评分呈负相关关系(P<0.01).结论 护理管理部门应高度重视发生差错事故后护士的工作压力源和心理健康状况;改进管理策略,营造安全文化,引导护士采取积极应对方式减轻心理压力,提高心理健康水平.     

Overexpression of protease inhibitor-dead secretory leukocyte protease inhibitor causes more aggressive ovarian cancer in vitro and in vivo

The alarm anti-protease secretory leukocyte protease inhibitor (SLPI) is frequently overexpressed in ovarian cancer cells and has been proposed for inclusion in biomarker panels but function remains unclear. We hypothesized that SLPI overexpression promotes ovarian cancer growth and survival. Low SLPI-expressing Hey-A8 ovarian cancer cells were engineered to produce functional (WT) or protease inhibitor-null (PI-) mutant SLPI; lack of PI activity was confirmed by enzymatic assay. WT/SLPI and PI- mutants stimulated significant proliferation and survival of Hey-A8 ovarian cancer cells under basal culture conditions ( P ≤ 0.02), in soft agar colony number and size ( P ≤ 0.05), and in anoikis resistance ( P ≤ 0.005). SLPI protected the ovarian cancer survival factor, progranulin (PRGN), and HEY-A8 cells from degradation and apoptosis due to neutrophil elastase. PI-/SLPI cells had greater protective activity than WT/SLPI cells. HEY-A8 murine xenografts revealed enhanced solid tumor formation, dissemination, and invasion in WT/SLPI and PI-/SLPI mutants. Increased proliferation was demonstrated by Ki-67 staining ( P ≤ 0.02). Increased secreted PRGN was seen in culture and was also observed by immunohistochemistry in the SLPI transfectant xenografts. This study describes a PI-independent function for SLPI in ovarian cancer growth and dissemination. ( Cancer Sci 2009; 100: 434–440).     

High-Dose Inhaled Budesonide May Substitute for Oral Therapy After an Acute Asthma Attack

Patients attending the emergency room with acute asthma, participating in a study comparing salbutamol (albuterol in the United States) via a dry powder inhaler (Turbuhaler®) with pressurized metered-dose inhaler (pMDI), were included in this 1-week follow-up study with the aim of assessing whether inhaled budesonide via Turbuhaler may be an alternative to prednisolone tablets after an acute asthma attack. Eighty-one patients with a mean age of 38 years and forced expiratory volume in 1 sec (FEV₁) of 64% predicted normal value after treatment with salbutamol were randomized in this double-blind, double-dummy, parallel-group study. The doses given were budesonide 1600 μg b.i.d. or prednisolone in daily doses from 40 mg (day 1) decreased to 5 mg (day 7). FEV₁ was recorded before and after the 7-day treatments and peak expiratory flow (PEF) morning and evening, clinical symptoms (visual analogue scale 0-100), and doses of rescue medication (terbutalineTurbuhaler 0.25 mg/dose) were recorded daily. The mean increase in FEV, from baseline to day 7 was 1 7.3% in the budesonide Turbuhaler group and 1 7.6% in the prednisolone group. Mean values of morning PEF increased from day 1 to day 7 by 67 L/min in the budesonide Turbuhaler group and by 57 L/min in the prednisolone group (not significant). There were no statistically significant differences between the groups in clinical symptoms and in the number of doses of rescue medication. Because of disease deterioration, five patients in the Turbuhaler group and three in the prednisolone group needed additional symptomatic as well as corticosteroid treatment. Inhaled budesonide in high doses may be a substitute for oral therapy as follow-up treatment after an acute asthma attack.     

The effects of gastric surgery on systemic ghrelin levels in the morbidly obese

HYPOTHESIS: Circulating ghrelin, produced primarily in the stomach, is a powerful orexigen. Ghrelin levels are elevated in states of hunger, but rapidly decline postprandially. Early alterations in ghrelin levels in morbidly obese patients undergoing weight reduction surgery may be attributed to gastric partitioning. DESIGN AND PATIENTS: Thirty-four patients underwent Roux-en-Y gastric bypass with a completely divided gastroplasty to create a 15-mL vertically oriented gastric pouch. Eight other patients underwent other gastric procedures that did not involve complete division of the stomach, including 4 vertical banded gastroplasties and 4 antireflux surgical procedures. Six additional patients undergoing antireflux surgery served as lean control subjects. Plasma samples were obtained before surgery and immediately after surgery. In a substudy, plasma was collected after Roux-en-Y limb formation and after dividing the stomach to identify any changes in plasma ghrelin levels. SETTING: Tertiary university medical center. MAIN OUTCOME MEASURES: Ghrelin levels at different stages of surgical intervention. RESULTS: Mean +/- SEM preoperative and postoperative ghrelin levels in the gastric bypass group were 355 +/- 20 and 246 +/- 13 pg/mL, respectively (P<.001). In the vertical banded gastroplasty group and in all patients undergoing antireflux surgery, ghrelin levels were not significantly changed. CONCLUSIONS: Compared with morbidly obese humans, lean controls had significantly higher plasma ghrelin levels at baseline. A divided gastroplasty creating a small proximal gastric pouch results in significant early declines in circulating ghrelin levels that are not observed with other gastric procedures. This may explain, in part, the loss of hunger sensation and rapid weight loss observed following gastric bypass surgery.