Notes

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581; 95% CI 1.454-8.820;
= .006).

This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.
This study revealed that age, sleep disorder/obstructive sleep apnea, and longer hospital stay after tonsillectomy are significant risk factors for post-tonsillectomy bleeding. This study provides an important baseline for further local studies in the future.Melanoma a common skin tumor induced by excessive hyperplasia of abnormal melanocyte. Circular RNAs (circRNAs) play critical roles in various diseases and presented as the prognostic markers of melanoma. The present study was designed to confirm the effect of circ 0001591 on human melanoma cell growth and to elucidate its mechanism. Patient with melanoma was obtained from Shaanxi Provincial People's Hospital. Cell viability of A2058 cell was detected by MTT assay. The expression of circ 0001591 in serum of patients with melanoma was increased. Up-regulation of circ 0001591 promoted cell growth and cell invasion, and reduced apoptotic rate of melanoma. Down-regulation of circ 0001591 reduced cell growth and cell invasion, and promoted apoptotic rate of melanoma.Up-regulation of circ 0001591 induced PI3 K and p-Akt protein expressions in melanoma through induction of ROCK1 by suppression of miR-431-5p. Over-expression of circ 0001591 suppressed PI3 K and p-Akt protein expressions via suppression of ROCK1 in melanoma by induction of miR-431-5p. MiR-431-5p reduced the effects of circ 0001591 down-regulation on cell growth of melanoma through PI3K/AKT signal pathway. ROCK1 reduced the effects of circ 0001591 on cell growth of melanoma through PI3K/AKT signal pathway. Our findings demonstrated that circ 0001591 inhibits the progression of human melanoma through ROCK1/PI3K/AKT signal pathway by targeting ROCK1 by miR-431-5p.Coronavirus pandemics causes systemic and mainly pulmonary changes. We assessed the prevalence of generalized anxiety disorder (GAD) in pandemic survivors and the general population. Papers indexed by MEDLINE/PubMed, The Cochrane, Embase, Lilacs, Scielo, Psycoinfo, and Pepsic databases were searched to April 2020, using GAD and Coronavirus (CoV) infection as keywords. Sixteen studies with 25,779 participants in eight countries were included. A 46% pooled prevalence of anxiety symptoms (95% CI 33.9-58.2%) was found with significant evidence of between-study heterogeneity (Q = 154953, I2 = 99.99%, p  less then  0.001). Age and sex were not found to be significant moderators for anxiety symptoms. Intervention programs for anxiety symptoms are highly recommended.
Our aims were (a) to determine whether subtalar arthroereisis (STA) as adjunct procedure improved radiographic correction of stage IIb adult-acquired flexible flatfoot deformity (AAFD); (b) to assess the STA-related complication rate.

A retrospective analysis of 22 feet (21 patients) diagnosed with stage IIb AAFD treated by medializing calcaneal osteotomy (MCO), flexor digitorum longus (FDL) transfer, spring ligament (SL) repair with or without Cotton osteotomy and with or without STA in a single institution was carried out. Seven measurements were recorded on pre- and postoperative (minimum 24 weeks) radiographs by 2 observers and repeated twice by 1 observer. Inter- and intraobserver reliabilities were assessed. The association of demographic (gender, side, age, body mass index) and surgical variables (Cotton, STA) with radiographic change was tested with univariate analysis followed by a multivariable regression model.

Excellent inter- and intraobserver reliabilities were demonstrated for all measurements (intraclass correlation coefficient range, 0.75-0.99). Gender, side, Cotton osteotomy, and STA were included in the multivariable analysis. Regression showed that STA was the only predictor of change in talonavicular coverage angle (TNCA) (

= 0.31;
= .03) and in calcaneo-fifth metatarsal angle (CFMA) (

= 0.40;
= .02) on dorsoplantar view. STA was associated to a greater change in TNCA by 10.1° and in CFMA by 5°. Four patients out of 12 STA complained of sinus tarsi pain after STA, and removal of the implant resolved symptoms in 3 of them.

In this series, STA as an adjunct procedure to MCO, FDL transfer, SL repair in the treatment of stage IIb AAFD led to improvement in correction of forefoot abduction. STA-related complication and removal rates were 33%.

Level IV Retrospective cohort study.
Level IV Retrospective cohort study.
To evaluate the outcomes of implanting intrastromal corneal ring segment (ICRS) using two different strategies in a specific paracentral keratoconus phenotype.

Eighty-nine eyes with paracentral keratoconus with perpendicular topographic astigmatism and comatic axes were evaluated before and after implanting a 150° arc-length ICRS. Patients were divided into two groups according to the axis where the ICRS was implanted Group I comatic axis and Group II flat topographic axis. Uncorrected (UDVA) and corrected (CDVA) distance visual acuities, refractive errors, and root mean square (RMS) for coma-like aberration were recorded. The postoperative follow-up was 1 year.

Mean UDVA (logMAR) changed from 0.49 ± 0.37 preoperatively to 0.30 ± 0.32 6 months afterwards (
 < 0.001) in the group I and from 0.53 ± 0.34 to 0.37 ± 0.35 (
 < 0.001), in the group II. Mean CDVA in group I changed from 0.11 ± 0.18 preoperatively to 0.06 ± 0.14 6 months after surgery (
 < 0.001). In group II the improvement did not reach statistical significance (from 0.09 ± 0.10 to 0.07 ± 0.09;
 = 0.06). No eyes lost lines of CDVA in group I. Eight eyes (15.7%) lost lines of CDVA in group II. The spherical equivalent decreased after surgery in both groups (
 < 0.001). The RMS for corneal coma-like aberration only decreased in the group I (
 < 0.001).

Both strategies provided safe and effective visual and refractive outcomes in the specific keratoconus phenotype analyzed. The orthopedic strategy provided better visual outcomes than the refractive one.
Both strategies provided safe and effective visual and refractive outcomes in the specific keratoconus phenotype analyzed. The orthopedic strategy provided better visual outcomes than the refractive one.
Tibiotalocalcaneal (TTC) arthrodesis is a salvage reconstructive procedure for ankle and subtalar arthritis and deformity. This study aims to identify fusion rates and complications of TTC arthrodesis procedures performed at our institution using a specific retrograde intramedullary nail. Additionally, we analyzed the subpopulation that sustained an intramedullary nail break.

A retrospective review was conducted of 45 patients who underwent 47 TTC arthrodesis procedures with intramedullary fixation using the Phoenix nail at our institution from October 2010 to September 2017. learn more Patient age, body mass index, sex, smoking status, diabetes diagnosis, peripheral vascular disease, thyroid disease, inflammatory arthritis, steroid use, prior ankle fractures and procedures, fusion rates, nail diameter, time to hardware failure, preoperative coronal plane deformity, and return to work were obtained.

Successful fusion was confirmed in 79% of tibiotalar, 70% of subtalar, and 66% of combined tibiotalar and subtalar joints. Eight of 47 (17%) TTC nails suffered nail breakage postoperatively. Although statistical analysis was not performed due to the small population size, patients with nail failure had lower rates of tibiotalar (38% vs 87% of patients without nail failure) and combined tibiotalar/subtalar fusion (25% vs 74%). Ten percent of patients without nail breakage required revision surgery, compared to 75% of patient with nail breakage.

This study describes TTC arthrodesis outcomes at our institution. It demonstrates a high complication rate using a specific retrograde intramedullary nail, including nail breakage and non-union. Further analysis and improvement in technique and implant design may decrease revision rates and improve outcomes.

Therapeutic, Level IV.
Therapeutic, Level IV.
Cable closure has been introduced as a potential alternative to traditional wire cerclage (WC) for closure of median sternotomy. To evaluate whether cable closure improves patient outcomes, we conducted a systematic review and meta-analysis of the literature.

Ovid versions of Medline and Embase, and Google Scholar were used for the literature search. This yielded 7 studies (
= 2,758), which compared traditional WC to cable closure systems. Outcomes included deep sternal wound infection, sternal dehiscence, postoperative pain score, and sternal wound infection.

We found significantly lower incidence of sternal dehiscence for cable closure compared to WC (risk ratio [RR] 0.14, 95% confidence interval [CI] 0.03 to 0.59
< 0.01

= 0%) but no difference in DSWI (RR 0.97, 95% CI 0.39 to 2.42,
= 0.95,

= 33%). Cable closure was also associated with lower pain when compared with the WC group (mean difference -1.04 points, 95% CI -1.89 to -0.19
= 0.02,

= 87%).

This study suggests that cable closure results in less incidence of sternal dehiscence and pain compared to WC. Nonetheless, there remains a limited number of studies on this topic and further high-quality studies are required to confirm the results of this meta-analysis.
This study suggests that cable closure results in less incidence of sternal dehiscence and pain compared to WC. Nonetheless, there remains a limited number of studies on this topic and further high-quality studies are required to confirm the results of this meta-analysis.
Durability of mitral valve (MV) repair for functional mitral regurgitation (FMR) remains suboptimal. We sought to create a highly reproducible, quantitative ex vivo model of FMR that functions as a platform to test novel repair techniques.

Fresh swine hearts (
= 10) were pressurized with air to a left ventricular pressure of 120 mmHg. The left atrium was excised and the altered geometry of FMR was created by radially dilating the annulus and displacing the papillary muscle tips apically and radially in a calibrated fashion. This was continued in a graduated fashion until coaptation was exhausted. Imaging of the MV was performed with a 3-dimensional (3D) structured-light scanner, which records 3D structure, texture, and color. The model was validated using transesophageal echocardiography in patients with normal MVs and severe FMR.

Compared to controls, the anteroposterior diameter in the FMR state increased 32% and the annular area increased 35% (
< 0.001). While the anterior annular circumference remained fixed, the posterior circumference increased by 20% (
= 0.026). The annulus became more planar and the tenting height increased 56% (9 to 14 mm,
< 0.001). The median coaptation depth significantly decreased (anterior leaflet 5 vs 2 mm; posterior leaflet 7 vs 3 mm,
< 0.001). The ex vivo normal and FMR models had similar characteristics as clinical controls and patients with severe FMR.

This novel quantitative ex vivo model provides a simple, reproducible, and inexpensive benchtop representation of FMR that mimics the systolic valvular changes of patients with FMR.
This novel quantitative ex vivo model provides a simple, reproducible, and inexpensive benchtop representation of FMR that mimics the systolic valvular changes of patients with FMR.
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