Notes

Key proximal fibular perspective: A possible indicator from the tibial mechanised axis within opening-wedge substantial tibial osteotomy.
Competency-based medical education (CBME) is an outcomes-based approach that has taken root in residency training nationally and internationally. CBME explicitly places the patient, family, and community at the center of training with the primary goals of concomitantly improving both educational and clinical outcomes. Family medicine, as the foundational primary care discipline, has always embraced the importance of linking training with health system needs and performance since its inception. While CBME is no longer a new concept, full implementation of this outcomes-based approach has been daunting and challenging. selleck inhibitor Gaps in the effectiveness, safety, equity, efficiency, timeliness, and patient/family centeredness of health and health care in the United States continue to be persistent and pernicious. These gaps summon family medicine and the entire graduate medical education system to take stock of its current state and to examine how more fully embracing an outcomes-based educational approach can help to close these gaps. This article provides a brief history of the CBME movement, and more importantly, its key underlying educational principles and science. I will explore the key inflection points of progress, including identifying core CBME components, introduction of competency Milestones, experimental pilots of time variable training, advancements in mastery-based learning, and advances in work-based assessment, within the context of family medicine. I will conclude with suggestions for accelerating the adoption and implementation of CBME within family medicine residency training.
Early-life antibiotic use can alter the intestinal flora and modify the risk of developing Crohn disease (CD), but rigorous epidemiological evidence is limited, with inconsistent results.

We identified all children born in Denmark from 1995 to 2009 and followed them from birth until death, emigration, a diagnosis of CD, or January 1, 2013. Using Cox regression, we assessed the association between antibiotic exposure in the first year of life and subsequent risk for CD, adjusting for sex, degree of urbanization, birth order, birth year, route of delivery, gestational age, smoking during pregnancy, intake of nonsteroidal anti-inflammatory drugs in the first year of life, and family history of CD.

During a median 9.5 years (9.3 million total person-years), CD was diagnosed in 208 of 979,039 children. Antibiotic use in the first year of life was associated with a higher risk of CD (adjusted hazard ratio, 1.4; 95% confidence interval [CI], 1.1-1.8), with the highest risk with ≥6 courses of antibiotics (adjusted hazard ratio, 4.1; 95% CI, 2.0-8.5). A family history of CD did not modify these risk associations. The cumulative risk of CD at the 11th birthday for children exposed to antibiotics in their first year of life was 0.16‰ (95% CI, 0.11‰-0.22‰) compared to 0.11‰ (95% CI, 0.08‰-0.15‰) for children unexposed to antibiotics in their first year of life.

Antibiotic use in the first year of life is associated with a modestly increased risk for CD, although the absolute risk is very low.
Antibiotic use in the first year of life is associated with a modestly increased risk for CD, although the absolute risk is very low.
Polycystic ovary syndrome (PCOS), a highly prevalent endocrine disorder characterized by hyperandrogenism, is the leading cause of anovulatory infertility.

This proof-of-concept study evaluated clinical efficacy and safety of the neurokinin 3 (NK3) receptor antagonist fezolinetant in PCOS.

This was a phase 2a, randomized, double-blind, placebo-controlled, multicenter study (EudraCT 2014-004409-34).

The study was conducted at 5 European clinical centers.

Women with PCOS participated in the study.

Interventions included fezolinetant 60 or 180mg/d or placebo for 12 weeks.

The primary efficacy endpoint was change in total testosterone. Gonadotropins, ovarian hormones, and safety/tolerability were also assessed.

Seventy-three women were randomized, and 64 participants completed the study. Adjusted mean (SE) changes in total testosterone from baseline to week 12 for fezolinetant 180 and 60mg/d were -0.80 (0.13) and -0.39 (0.12) nmol/L versus -0.05 (0.10) nmol/L with placebo (P<0.0001 and P<0.05, respectively). Adjusted mean (SE) changes from baseline in luteinizing hormone (LH) for fezolinetant 180 and 60mg/d were -10.17 (1.28) and -8.21 (1.18) versus -3.16 (1.04) IU/L with placebo (P<0.0001 and P=0.0022); corresponding changes in follicle-stimulating hormone (FSH) were -1.46 (0.32) and -0.92 (0.30) versus -0.57 (0.26) IU/L (P=0.0336 and P=0.3770), underpinning a dose-dependent decrease in the LH-to-FSH ratio versus placebo (P<0.001). Circulating levels of progesterone and estradiol did not change significantly versus placebo (P>0.1). Fezolinetant was well tolerated.

Fezolinetant had a sustained effect to suppress hyperandrogenism and reduce the LH-to-FSH ra.
Fezolinetant had a sustained effect to suppress hyperandrogenism and reduce the LH-to-FSH ra.
Burn scar and alopecia on hair bearing area can severely affect social life of the patients. Unlike healthy skin, poor biological and mechanical properties of scar tissue in the recipient area can reduce survival rate of hair graft following hair transplantation.

Combined non-ablative fractional laser (NAFL) and microfat injection could improve survival rate of hair grafts on post burn scar.

Thirteen patients with alopecia resulting from burn scar in hair bearing area of the scalp and face were treated with combined NAFL and microfat graft and subsequently follicular unit extraction (FUE) hair transplantation. Cicatricial alopecia occurred on the scalp, eyebrow, mustache, and beard areas. Patients were treated with 3-6 sessions of NAFL, and-2-5 sessions of microfat graft injections, followed by one session of hair transplantation using FUE technique.

Hair transplantation was successfully performed with good to excellent results. The survival rate of transplanted follicular units ranged from 76 to 95 percent (mean, 85.04%) and the density success rate per square centimeter ranged from 76.9 to 95.2 percent (mean, 84.54%). All patients expressed high satisfaction with the results and no complication was encountered.

Hair transplantation, after combined NAFL and microfat injection is a promising treatment for post burn alopecia.
Hair transplantation, after combined NAFL and microfat injection is a promising treatment for post burn alopecia.
In addition to body contouring, there is anecdotal and supportive clinical evidence of reduced laxity and skin tightening after cryolipolysis. 10,11.

The nature by which cryolipolysis triggers dermal changes has not been established. This study investigated fundamental mechanisms behind clinically observed dermal changes using molecular and immunohistochemistry methods.

This feasibility study involved n=7 subjects that received cryolipolysis treatment. Tissue samples were harvested from 3 days to 5 weeks after treatment. RNA-Sequencing examined differential gene expression of major collagens. RNA In Situ Hybridization (RNA-ISH) investigated the distribution of one of the gene markers for collagen Type I (COL1A1). Immunohistochemistry for Procollagen Type I, heat shock protein 47 (HSP47), transforming growth factor beta (TGF-β and Tropoelastin was performed and quantified.

Gene expression analysis highlighted a gradual upregulation of collagen mRNA genes. RNA-ISH confirmed upregulation of COL1A1 mRNA ang process driven by increased TGF-β and higher expression of HSP47 was observed. Overall, these data provide the first evidence of dermal remodeling and clarify the mechanism by which cryolipolysis may induce skin improvement.A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was how efficacious are Octreotide and Somatostatin in the management of chylothorax in congenital cardiac surgical patients. Altogether >55 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The comparative data on LOS and chylothorax duration are mixed though interpretation is difficult since Octreotide has been instituted belatedly from the onset of chylothorax in multiple instances. There is also preliminary evidence to suggest that responders to Somatostatin and Octreotide are affected by single-ventricle physiology and CVP levels. Meanwhile, non-responders tend to have higher mortality and may merit earlier surgical intervention. The included studies thus far have significant limitations such as low-level evidence study design, selection bias, variability in duration and dosage of therapy and heterogenous comparative arms. Notwithstanding these limitations, Octreotide has shown to be an useful adjunct treatment in reducing chylothorax volume especially in patients with higher output chylothorax (>40 ml/kg/h) after the failure of conservative management.
The objective of this study was to determine the variation in intrapleural pressure (IPP) with and without air leakage using a digital chest drainage system (DCS) for each pressure setting.

In this retrospective single-centre study, we analysed 49,553 h of air leakage after anatomical lung resection in 714 patients between 2018 and 2020. The transition of mean IPP and mean air leak flow was monitored using DCS, and the association between mean IPP and mean air leak flow was examined. The relationship between the transition of mean IPP and air leakage according to the varying suction pressures on DCS was also investigated.

Overall, 272 patients (38.1%) showed air leakage after surgery. The mean IPP in patients without air leakage was -12.0 ± 2.9 cmH2O and maintained at about -12 cmH2O constantly, while the mean IPP in patients with air leakage was -8.3 ± 1.9 cmH2O, which changed to -12 cmH2O instantly if air leakage disappeared (P < 0.001). Among patients with air leakage, the mean IPP changed more distinctly in patients with mild suction management than in those with conventional suction management (-5.0 ± 2.6 to -11.5 ± 4.2 and -8.8 ± 1.3 to -12.1 ± 2.5 cmH2O, respectively; P < 0.001).

The change in IPP on a DCS is useful for detecting air leakage. Furthermore, management with a mild suction setting on DCS makes it easy to recognize the disappearance of postoperative air leakage.
The change in IPP on a DCS is useful for detecting air leakage. Furthermore, management with a mild suction setting on DCS makes it easy to recognize the disappearance of postoperative air leakage.
Homografts are often in short supply. Today, European guidelines recommend that all tissues contaminated by any of 18 different bacteria and fungi be discarded before antibiotic decontamination has been conducted. The tissue bank in Lund uses more liberal protocols It accepts all microbes prior to decontamination except multiresistant microbes and Pseudomonas species. The aim of this study was to analyse the effect of contamination on the long-term outcome and occurrence of endocarditis in recipients.

Data were collected on homografts and on recipients of homografts in the right ventricular (RV) outflow tract who were operated on between 1995 and 2018 in Lund. The long-term outcome of recipients was analysed in relation to different types of contamination using Cox proportional hazard regression. The proportion of patients with endocarditis was analysed with the χ2 test.

The study included 509 implanted homografts. Follow-up was a maximum of 24 years and 99% complete. A total of 156 (31%) homografts were contaminated prior to antibiotic decontamination.
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