Notes

Boerhaave Malady Introducing since Tension Pneumothorax: First Documented American Scenario.
Nonunion of a femoral periprosthetic fracture is a rare occurrence in orthopedic practice. Failure of a periprosthetic fracture to heal can lead to substantial disability and pain for patients as well as the potential need for component revision. Relatively little literature exists describing their management and outcome.

Eleven patients with femoral periprosthetic fracture nonunion who presented for tertiary care were enrolled in a prospective data registry. Patients were considered to have developed nonunion following failure of progression in radiographic and clinical healing for a 6-month period. All patients were seen at standard postoperative intervals, and outcomes were recorded using the Short Musculoskeletal Function Assessment (SMFA), visual analog scale (VAS) for pain, physical examination, and radiographic examination. Preoperative radiographs were reviewed for classification.

Eleven patients had periprosthetic femoral fracture nonunion associated with prior hip (five patients) or knee (six ing with bone graft and retention of primary components. In addition, successful periprosthetic nonunion repair improves function and pain in these patients.
Periprosthetic fracture nonunions can be successfully treated with operative intervention aimed at compression plating with bone graft and retention of primary components. In addition, successful periprosthetic nonunion repair improves function and pain in these patients.
Tethered cord syndrome (TCS) is an occult spinal dysraphism that includes low lying conus, tight filum terminale, lipomeningomyelocele, split cord malformations, dermal sinus tracts, and dermoids. This congenital disorder has been associated with musculoskeletal, neurological, and gastrointestinal abnormalities. This study presents a retrospective review of the prospectively collected data of TCS patients and their concurrent diagnoses or associated anomalies.

The National Inpatient Sample (NIS) database from 2003 to 2012 was used for data collection. Hospital- and year-adjusted weights allowed for accurate assessment of the incidence of TCS, as well as cardiac and gastrointestinal (GI) and genitourinary (GU) anomalies. K-means clustering analysis was run to discover patterns of concurrent cardiac, GI, GU, and other system anomalies in TCS patients.

A total of 13,470 discharges with a diagnosis of TCS were identified in the NIS database, and at least one additional anomaly was identified in 40.7% of TCSystourethral anomaly or cystic kidney disease with or without large intestinal atresia.
This study provides a nationwide prospective on congenital anomalies and concurrent conditions present in tethered cord syndrome patients in the United States and demonstrates that 40.7% of TCS patients have at least one associated anomaly. The most common congenital anomalies studied were spina bifida, urogenital with or without cardiac septal defects, and cystourethral anomaly or cystic kidney disease with or without large intestinal atresia.Objective In recent years, reticulated open-cell foam-based closed-incision negative pressure therapy (ROCF-ciNPT) has shown effectiveness in management of various postoperative incisions. These dressings consist of a skin interface layer that absorbs fluid from the skin surface and reduces the potential for microbial colonization within the dressing by means of ionic silver. This study examines the ability of silver to reduce the bioburden within the dressing as well as the localized effect due to potential silver mobility. selleck inhibitor Approach Ability of silver to reduce bioburden within the ROCF-ciNPT dressing was assessed using Staphylococcus aureus, Pseudomonas aeruginosa, and Candida spp. Furthermore, silver mobility was assessed using an in vitro skin model to study the zone of inhibition along with released silver quantification. Using a porcine model, diffusion of silver into blood and tissue was studied using emission spectrometry and histology. Results Microbial growth in the ROCF-ciNPT dressing was significantly reduced (∼2.7-4.9 log reduction) compared to a silver-free negative control. No zone of inhibition was observed for microbial colonies for up to 7 days with minimal localized silver release ( less then 5.5 ppm release). In vivo studies demonstrated no measurable concentration ( less then 0.2 μg/g) of silver in the blood, urine, feces, kidney, and liver tissue biopsy. Innovation This study provides an important insight into silver concentration and mobility within the ROCF-ciNPT dressing, given emerging concerns associated with potential silver cytotoxicity. Conclusion These results indicate the concentration of silver (0.019% silver by weight) in the ROCF-ciNPT dressings has been adequate to reduce bioburden within the skin interface layer, while severely limiting the amount of silver leaching out.Objective Application of aerogels in bone tissue engineering is an emerging field, while the reports of electrospinning nanofiber-reinforced aerogels are limited. This research aimed at fabricating the nanofiber-reinforced aerogels and evaluating their physiochemical and biological properties. Approach The chitosan (CS) aerogels incorporated with cellulose acetate (CA) and poly (ɛ-caprolactone) (PCL) nanofibers were fabricated via ball milling and freeze-drying techniques. Scanning electron microscopy (SEM), Fourier transform infrared (FT-IR) spectrum, X-ray photoelectron spectroscopy (XPS), compressive experiment, and in vitro experiment were conducted to assess their physiochemical properties and biological behavior. Results The SEM examination showed that satisfying morphology was attained in the CA/PCL/CS aerogels with incorporation of CA/PCL nanofibers and CS solution. The results of FT-IR and XPS indicated the perfect incorporation of CA, PCL, and CS. A compressive experiment confirmed that the CA/PCL/CS aerogels enhanced the compressive modulus of the pure CS aerogel. For in vitro experiment, the CA/PCL/CS composite scaffolds were proven to possess better cytocompatibility compared with the pure CS. Also, cells on the CA/PCL/CS showed well-extended morphology and could infiltrate into a porous scaffold. Furthermore, confocal experiment revealed that the CA/PCL/CS could also promote the osteogenic differentiation of MC3T3-E1 cells. Innovation This study fabricated the nanofiber-reinforced aerogels mainly to optimize the cell/material interaction of the pure CS scaffold. Conclusion The CA/PCL nanofibers not only improved the mechanical property of the CS aerogel to some extent but also facilitated cell adhesion and osteogenic differentiation. Thus, it could be considered a promising candidate for bone tissue engineering.Background Documentation and navigation through electronic health records (EHRs) is an essential, but stressful, task. We present the magnitude, determinants of such events, and solutions proposed by nurses to address EHR-related stress (EHR-S) at a tertiary eye hospital in Saudi Arabia. Methods Nurses of an eye hospital were surveyed in 2019 about EHR-S. A Likert scale was used to assess the responses of 10 components of EHR-related work. The total score was graded as follows minimum (11). The score was correlated with determinants. Solutions suggested by nurses to reduce stress were reviewed. Results This survey covered 212 nurses. Of them, 106 (50%; 95% confidence interval 43.3-56.7) reported EHR-S. The median EHR-S score was -3.0 (interquartile range -9.0; +8.0). Thirty-five (16%) nurses reported severe EHR-S. Senior nurses (M-W, p less then 0.02) and those working in emergency and recovery units (M-W, p less then 0.01) had statistically higher EHR-S. The main stressors were incomplete EHR work by other departments affecting nursing care (70.8%), difficulty in correction after entering the data (60.4%), and difficulty in data retrieval (60.4%). The main solutions to reduce EHR-S were to reduce the frequency of changes to configuration of the EHR (58%), more training (54.2%), and appreciation of good work (52.8%). Conclusions EHR-S is experienced by half of the nurses working at an eye care hospital. Implementation of solutions such as better training and fewer changes to the EHR system could reduce stress levels of nurses.Background Gas-forming pyogenic liver abscess (GFPLA) accounts for up to 30% of all pyogenic liver abscess (PLA) cases. However, little is known of the differences in clinical features and prognosis between GFPLA and non-GFPLA. Aim This retrospective study compared the clinical features and prognosis of GFPLA and non-GFPLA. Patients and Methods Data for 392 patients with PLA treated from January 1, 2007 to December 31, 2016 were reviewed. Gas-forming pyogenic liver abscess was defined as gas in the abscess. Liver abscesses were considered non-GFPLA (n = 326) or GFPLA (n = 66). The clinical features and outcomes of patients with GFPLA were compared with that of patients without GFPLA. Results The groups were similar in gender ratio, age, smoking, drinking, and comorbidities. Klebsiella pneumoniae was the most common pathogenic bacteria, but the negative rate of bacterial culture of the non-GFPLA group was higher than that of the GFPLA. In etiologies, the GFPLA group had more biliary source infection and less cclinical entity.The purpose of this study was to characterise lower-limb joint kinetics during consecutive double unders and speed step sprints performed by competitive jump rope athletes, and to compare these measurements to running. Sixteen adolescent competitive jump rope athletes performed consecutive double under, speed step, and running trials while motion capture and ground reaction force data were collected. Lower-limb joint moments, power, and work were calculated using an inverse dynamics approach and discrete measurements were compared between skills. Peak ground reaction forces were similar between movements; however, knee and hip joint kinetics were distributed differently between double unders and speed step. In general, double unders were characterised by an increased reliance on knee joint kinetics, while speed step was characterised by an increased reliance on hip joint kinetics. Peak ankle moments were 9-20% greater in speed step when compared to double unders and running (p ≤ 0.050), and peak negative ankle power was 39-114% greater in double unders and speed step when compared to running (p ≤ 0.002). These findings may have important implications for injury risk and load management in jump rope athletes or other individuals that incorporate jump rope into their training programs.Technology has played an important role in responding to the novel coronavirus (SARS-CoV-2) and subsequent COVID-19 pandemic. The virus's blend of lethality and transmissibility have challenged officials and exposed critical limitations of the traditional public health apparatus. However, throughout this pandemic, technology has answered the call for a new form of public health that illustrates opportunities for enhanced agility, scale, and responsiveness. The authors share the Microsoft perspective and illustrate how technology has helped transform the public health landscape with new and refined capabilities - the efficacy and impact of which will be determined by history. Technologies like chatbot and virtualized patient care offer a mechanism to triage and distribute care at scale. Artificial intelligence and high-performance computing have accelerated research into understanding the virus and developing targeted therapeutics to treat infection and prevent transmission. New mobile contact tracing protocols that preserve patient privacy and civil liberties were developed in response to public concerns, creating new opportunities for privacy-sensitive technologies that aid efforts to prevent and control outbreaks.
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