The Outcomes of Isolated Tibiocalcaneal Arthrodesis: A Systematic Review

Background

Tibiocalcaneal arthrodesis (TCA) can be achieved by internal fixation (intramedullary nail or plate), external fixation, or a combination. Evidence for the optimal approach is limited. This systematic review examines the outcomes of these different approaches to guide surgical management.

Methods

A MEDLINE and Oxford SOLO search was performed using "tibiocalcaneal," "ankle," "fusion OR arthrodesis." The primary outcome was union. Secondary outcomes included rates of postoperative complications, weightbearing status, rates of revision surgery, and PROMs. We included any studies with follow-up greater than 6 months that contained our primary outcome and at least 1 secondary outcome.

Results

The initial search yielded 164 articles, of which 9 studies totaling 53 cases met the criteria. The majority of articles were excluded because they were nonsurgical studies, or were not about isolated TCA but were for tibiotalocalcaneal arthrodesis, more complex reconstructions (eg, Charcot), case reports, and/or did not include the predetermined outcome measures.TCA union rate was 86.2% following external fixation, 82.4% for intramedullary nail fixation, and 83.3% for plate fixation. One patient underwent a hybrid of external and internal fixation, and the outcome was nonunion. The rate of complications following TCA was 69.8%.

Conclusion

There is limited evidence on the best operative approach for isolated tibiocalcaneal arthrodesis. Both external and internal fixation methods had comparable union rates. External fixation had frequent complications and a more challenging postoperative protocol. Novel techniques such as 3D-printed cages and talus replacement may become a promising alternative but require further investigation.

Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation: a narrative review and proposed treatment algorithm

Isolated cervical spine facet fractures are often overlooked. The primary imaging modality for diagnosing these injuries is a computed tomography scan. Treatment of unilateral cervical facet fractures without evidence of dislocation or subluxation remains controversial. The available evidence regarding treatment options for these fractures is of low quality. Risk factors associated with the failure of nonoperative treatment are: comminution of the articular mass or facet joint, acute radiculopathy, high body mass index, listhesis exceeding 2 mm, fragmental diastasis, acute disc injury, and bilateral fractures or fractures that adversely affect 40% of the intact lateral mass height or have an absolute height of 1 cm.

Isolated mitral valve endocarditis: Patient, disease, and surgical factors that influence outcomes

OBJECTIVE

The objectives of this study were to investigate patient characteristics, valve pathology, bacteriology, and surgical techniques related to outcome of patients who underwent surgery for isolated native (NVE) or prosthetic (PVE) mitral valve endocarditis.

METHODS

From January 2002 to January 2020, 447 isolated mitral endocarditis operations were performed, 326 for NVE and 121 for PVE. Multivariable analysis of time-related outcomes used random forest machine learning.

RESULTS

Staphylococcus aureus was the most common causative organism. Of 326 patients with NVE, 88 (27%) underwent standard mitral valve repair, 43 (13%) extended repair, and 195 (60%) valve replacement. Compared with NVE with standard repair, patients who underwent all other operations were older, had more comorbidities, worse cardiac function, and more invasive disease. Hospital mortality was 3.8% (n = 17); 0 (0%) after standard valve repair, 3 (7.0%) after extended repair, 8 (4.1%) after NVE replacement, and 6 (5.0%) after PVE re-replacement. Survival at 1, 5, and 10 years was 91%, 75%, and 62% after any repair and 86%, 62%, and 44% after replacement, respectively. The most important risk factor for mortality was renal failure. Risk-adjusted outcomes, including survival, were similar in all groups. Unadjusted extended repair outcomes, particularly early, were similar or worse than replacement in terms of reinfection, reintervention, regurgitation, gradient, and survival.

CONCLUSIONS

A patient- and pathology-tailored approach to surgery for isolated mitral valve endocarditis has low mortality and excellent results. Apparent superiority of standard valve repair is related to patient characteristics and pathology. Renal failure is the most powerful risk factor. In case of extensive destruction, extended repair shows no benefit over replacement.

Isolated Extensor Hallucis Longus Compartment Syndrome: A Case Report

We present the case of an isolated extensor hallucis longus compartment syndrome following a diaphyseal fibular fracture. Our subject underwent syndesmotic fixation and experienced ongoing pain post-procedure. This was associated with an isolated loss of power in extension of the hallux. A diagnosis of an isolated extensor hallucis longus compartment syndrome followed. Our case highlights the vulnerability of this muscle belly to ischemia and reiterates the value of complete clinical examination in the postoperative patient.

Short-Term Outcome of Isolated Kidney Transplantation in Children with Autosomal Recessive Polycystic Kidney Disease: A Case Series and Literature Review

Autosomal recessive polycystic kidney disease (ARPKD) is often associated with hepatobiliary disease in the form of hepatic fibrosis and/or Caroli disease. Combined liver-kidney transplantation (CLKT) is a transplant modality of choice in children with both end-stage renal disease (ESRD) and severe hepatic disease. However, there is no consensus on whether children with ARPKD-associated ESRD without severe hepatic disease can be treated with isolated kidney transplantation (KT) without the need for CLKT. We retrospectively studied the efficacy of isolated KT in children with ARPKD without severe hepatic disease, and followed the course of hepatic disease post KT. This is a single-center study of three children with ARPKD and ESRD who underwent isolated KT. None of them had severe hepatic disease at the time of KT. All children were clinically diagnosed with ARPKD in the immediate postnatal period. All had hepatic fibrosis of varying degrees and two had intrahepatic biliary duct (IHBD) dilatation. None had gastrointestinal (GI) bleed, portal hypertension or cholangitis. Two children had preemptive KT. Pre-transplant unilateral or bilateral native nephrectomy were performed for two children, and one underwent unilateral native nephrectomy at the time of KT. The median creatinine clearance at a median post-KT follow-up of 24 months was 60.3 mL/min/1.73 m2. The two-year graft and patient survival were both 100%. Post KT, all three patients continued to demonstrate evidence of hepatic fibrosis and IHBD on sonogram; however, none of them were either evaluated for or required liver transplantation given normal synthetic liver function and absence of portal hypertension or other severe hepatobiliary disease. There were no adverse events observed such as cholangitis, GI bleed, or multiorgan failure. Hence, an excellent short-term graft and patient survival was demonstrated in this study of children with ARPKD and mild to moderate hepatic disease who received isolated KT. Long-term follow-up and larger studies are important to assess the efficacy of isolated KT in this subset of children with ARPKD.

Seroprevalence and Molecular Characterization of Brucella abortus from the Himalayan Marmot in Qinghai, China

Objective

Brucellosis is a serious public health issue in Qinghai (QH), China. Surveying the seroprevalence and isolation of B. abortus strains from marmots is key to understanding the role of wildlife in the maintenance and spread of brucellosis.

Methods

In this study, a set of methods, including a serology survey, bacteriology, antibiotic susceptibility, molecular genotyping (MLST and MLVA), and genome sequencing, were employed to characterize the two B. abortus strains.

Results

The seroprevalence of brucellosis in marmots was 7.0% (80/1146) by serum tube agglutination test (SAT); one Brucella strain was recovered from these positive samples, and another Brucella strain from a human. Two strains were identified as B. abortus bv. 1 and were susceptible to all eight drugs examined. The distribution patterns of the accessory genes, virulence associated genes, and resistance genes of the two strains were consistent, and there was excellent collinearity between the two strains on chromosome I, but they had significant SVs in chromosome II, including inversions and translocations. MLST genotyping identified two B. abortus strains as ST2, and MLVA-16 analysis showed that the two strains clustered with strains from northern China. WGS-SNP phylogenetic analysis showed that the strains were genetically homogeneous with strains from the northern region, implying that strains from a common lineage were spread continuously in different regions and hosts.

Conclusion

Seroprevalence and molecular clues demonstrated frequent direct or indirect contact between sheep/goats, cattle, and marmots, implying that wildlife plays a vital role in the maintenance and spread of B. abortus in the Qinghai-Tibet Plateau.

Improving Social Isolation and Loneliness Among Adolescents With Physical Disabilities Through Group-Based Virtual Reality Gaming: Feasibility Pre-Post Trial Study

BACKGROUND

Adolescents with disabilities experience alarmingly higher rates of depression and isolation than peers without disabilities. There is a need to identify interventions that can improve mental health and isolation among this underserved population. Innovations in virtual reality (VR) gaming "standalone" headsets allow greater access to immersive high-quality digital experiences, due to their relatively low cost.

OBJECTIVE

This study had three purposes, which were to (1) examine the preliminary effects of a low-cost, home-based VR multiplayer recreation and socialization on depression, socialization, and loneliness; (2) quantify the acceptability of the program as measured by participant adherence, total play time, and exercise time; and (3) identify and describe behavioral mechanisms that affected participant engagement.

METHODS

This was a single-group, pre- to postdesign trial. The intervention was conducted at home. Participants were recruited from a children's hospital. The intervention lasted 4 weeks and included 2×1-hour sessions per week of supervised peer-to-peer gaming. Participants used the Meta Quest 2 headset to meet peers and 2 coaches in a private party held digitally. Aim 1 was evaluated with the Children's Depression Inventory 2 Short Form and the University of California, Los Angeles Loneliness Scale 20 items, which are measures of social isolation and loneliness, respectively. Aim 2 was evaluated through the following metrics: participant adherence, the types of games played, friendship building and playtime, and program satisfaction and enjoyment.

RESULTS

In total, 12 people enrolled (mean age 16.6, SD 1.8 years; male: n=9 and female: n=3), and 8 people completed the program. Mean attendance for the 8 participants was 77% (49 sessions of 64 total possible sessions; mean 6, SD 2 sessions). A trend was observed for improved Children's Depression Inventory 2 Short Form scores (mean preintervention score 7.25, SD 4.2; mean postintervention score 5.38, SD 4.1; P=.06; effect size=0.45, 95% CI -0.15 to 3.9), but this was not statistically significant; no difference was observed for University of California, Los Angeles Loneliness Scale 20 items scores. Most participants (7/8, 88%) stated that they became friends with a peer in class; 50% (4/8) reported that they played with other people. Participants reported high levels of enjoyment and satisfaction with how the program was implemented. Qualitative analysis resulted in 4 qualitative themes that explained behavioral mechanisms that determined engagement in the program.

CONCLUSIONS

The study findings demonstrated that a brief VR group program could be valuable for potentially improving mental health among adolescents with physical disabilities. Participants built friendships with peers and other players on the web, using low-cost consumer equipment that provided easy access and strong scale-up potential. Study findings identified factors that can be addressed to enhance the program within a larger clinical trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/study/NCT05259462.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/42651.

Risk of adverse pregnancy outcome in isolated single umbilical artery diagnosed at the mid-trimester anomaly scan: a large Danish retrospective cohort study

OBJECTIVE

To examine the association of isolated single umbilical artery (iSUA) confirmed at the mid-trimester anomaly scan and adverse pregnancy outcome and congenital malformations with up to 10 years postnatal follow up.

METHODS

This retrospective cohort study included 116,501 singleton pregnancies consecutively enrolled in first trimester screening for aneuploidies and mid-trimester anomaly scan at three University Hospitals in the Capital Region of Copenhagen, Denmark.Data from the Danish Fetal Medicine Database (2008-2017) were verified by manually scrutinizing pre- and postnatal records. The main outcomes of interest were intrauterine fetal demise (IUFD), small for gestational age (SGA), preterm delivery, cesarean section and unrecognized pre- and postnatal congenital malformations.

RESULTS

In total, 775 pregnancies with iSUA were identified. Isolated SUA were associated with a significantly increased risk of IUFD (OR 4.16, 95% CI 2.06-8.44), SGA < 3^rd centile (aOR 2.41, 95% 1.85-3.14) and SGA < 10^th centile (aOR 1.84, 95% CI 1.53-2.21), but not with preterm delivery or cesarean section. The laterality of the missing artery was not associated with SGA. In total, 4.3% of pregnancies with iSUA had unrecognized congenital malformations. 1.5% with iSUA had congenital cardiovascular malformations, which were considered minor.

CONCLUSION

Isolated SUA is associated with IUFD and SGA, supporting surveillance during third trimester. If, during the mid-trimester scan, the sonographer achieves thorough, extended cardiac views and finds no additional malformation other than SUA, fetal echocardiography seems not to be needed.

Clinical features of isolated Fallopian tube torsion: evidence from a large series

We aimed at studying isolated Fallopian tube torsion (IFTT) in a relatively large cohort of women and to evaluate different features of IFTT in comparison to a large cohort of women with non-IFTT adnexal torsion (NIAT). This was a retrospective cohort study. We included women with surgically confirmed ovarian and/or Fallopian tube torsion between March 2011 and June 2020. Fifty-four cases of IFTT were surgically confirmed during the study period and were compared to 422 surgically confirmed NIAT. The rate of controlled ovarian hyperstimulation treatments, current pregnancy, and vomiting was lower in the IFTT group compared with the NIAT group. Cervical tenderness and vaginal discharge were more common in the IFTT group. Oedematous and enlarged ovaries were less common in the IFTT group. In multivariate regression analysis, the following factors were independently associated with IFTT: (i) vaginal discharge [adjusted odds ratio (aOR) 95% CI 8.16, 1.98-33.55]; (ii) cervical motion tenderness (aOR 95% CI 2.71, 1.01-7.29); (iii) fertility treatments (aOR 95% CI 0.26, 0.70-0.77); (iv) previous abdominal surgery (aOR 95% CI 0.46, 0.22-0.96); (v) vomiting (aOR 95% CI 0.38, 0.19-0.76); and (vi) enlarged ovary (aOR 95% CI 0.34, 0.18-0.65). In conclusion, we have identified factors positively and negatively associated with IFTT in a large cohort of women with adnexal torsion.

Low-Energy Trauma-Induced Bilateral Isolated Posteromedial Tibial Plateau Fracture in a Healthy Young Adult: A Case Report

Introduction

Tibial plateau fractures account for average 1% of all fractures in adults. They mostly related to high-energy trauma in young adult and milder traumatic injuries in elderly due to osteoporosis.

Case Report

In this case, we reported a 28-year-old male patient who admitted to the emergency room with painful and swollen bilateral knees who had fallen on his knees while playing leapfrog. When his friend jumped on his back, he fell on his knees with the forced flexion and valgus of the knee. Plain radiographs of the knees revealed bilateral posterior tibial plateau fractures. Open reduction and internal fixation were the choice of treatment. Full range of motion was allowed but not weight-bearing for 2 months. At 6 months of follow-up, the patient had full range of motion and weight-bearing with no complaint.

Conclusion

We present bilateral posteromedial tibial plateau fracture in a healthy young adult which is not mentioned in the literature before and we want to emphasize that posteromedial approach in the supine position, even for both knees in the same operation session, is appropriate to reach the fracture and reduce it easily.

Isolated fracture of the talus with asymptomatic contralateral talar fissure in two dogs

CASE HISTORY

Two adult male dogs were separately presented for acute-onset, severe hind limb lameness isolated to the tarsus. There were no prior orthopaedic concerns and there was no significant trauma associated with the onset of lameness in either case.

CLINICAL FINDINGS

Pain and effusion of the affected tarsus were found in both cases. Lameness was not responsive to oral analgesia. Radiography was insufficient to fully determine the extent of the damage in the tarsus; the fracture was visible in one case only. CT imaging demonstrated an isolated, lateral, trochlear ridge talar fracture in both cases and contralateral talar abnormalities of comparable location and direction to the fracture.

DIAGNOSIS

Isolated lateral trochlear ridge fracture of the talus without significant trauma or concurrent injury. Abnormalities of talus of the contralateral limb were demonstrated on CT imaging.

CLINICAL RELEVANCE

A previously unrecognised pathological process may affect the talus of adult dogs that could predispose them to develop fracture of the lateral talar ridge without significant trauma. Further investigations are required to determine the prevalence and risk of fracture associated with this abnormality.Abbreviations: HIF: Humeral intercondylar fissure.

Plantar Dislocation of the Middle Cuneiform Bone With Medial Cuneiform Subluxation: A Case Report

The middle cuneiform is the keystone of the transverse arch and is located between the medial cuneiform and lateral cuneiforms. Isolated middle cuneiform plantar dislocations are rare injuries due to their shape and ligamentous structural connections. A 20-year-old female patient was admitted to the emergency service of another clinic after a 70 kg iron tractor piece fell on her foot 20 days before she was referred to our clinic. Conservative treatment with a short leg circular cast was applied, considering that there was a fracture in the cuneiforms on X-ray imaging. The patient, who was re-evaluated at the second-week follow-up, was referred to our hospital considering the complex injury of the cuneiforms. There was tenderness over the cuneiform in the physical examination. X-ray and computed tomography images of the patient revealed plantar dislocation of the middle cuneiform bone. with subluxation of the medial cuneiform. Open reduction and internal fixation were performed for the middle cuneiform. During the six-month follow-up, the patient had no complaints and was able to do routine work. No lucency or arthritic changes were observed in the X-ray at the 22-month control. Plantar middle cuneiform dislocations are rare and late diagnosis can lead to poor results. This case is presented to emphasize the importance of considering this rare injury and using advanced imaging studies when necessary, considering the mechanism of injury.

A Rare Case of Isolated Spontaneous Common Carotid Artery Dissection Treated by Telescoping Stents

An isolated spontaneous common carotid artery (CCA) dissection is an extremely rare cause of stroke, and standard treatment guidelines are not yet established. This case report presents a rare case of isolated spontaneous CCA dissection but with typical and obvious radiological findings, and it could be informative and educational to clinicians. Telescoping multiple carotid stents can be a feasible treatment option for this case with recurrent ischemia due to a long segment dissection.

e-Mental Health Program to Prevent Psychological Distress Among French-Speaking International Students in a Linguistic-Cultural Minority Context (Ottawa, Alberta, and Quebec): Protocol for the Implementation and Evaluation of Psy-Web

BACKGROUND

Based on experiences with the COVID-19 pandemic, postsecondary institutions were most affected by the restrictions. Students, especially international students, have borne the brunt associated with in-person learning restrictions imposed by public health recommendations. Canada is among the top 3 countries hosting international students (ISs), including Francophone students in provinces such as Quebec and other anglophone regions. Academic restrictions were accompanied by other measures such as quarantine, self-isolation, social distancing, and travel ban, to cite some. This has had a wide-ranging impact on these ISs. The resulting psychological distress and burden may have a much greater impact on Francophone ISs in anglophone settings, many of whom had ordinarily limited access to active offers of care in French in addition to cultural barriers and low literacy of the health care system. In order to take advantage of the effectiveness of eHealth as a pertinent and promising avenue, our project intends to build a web-based application that is cost-effective, user-friendly, anonymous, and capable to prompt interactive interventions as a first-line resource for psychological distress. In fact, internet applications have been increasingly used for the management of psychological distresses, and internet-based cognitive behavioral therapy is one of the preferred methods to prevent or control them.

OBJECTIVE

The aims of this study are to (1) design, implement, and maintain Psy-Web for the psychological support of ISs and (2) analyze the results of the implementation of the Psy-Web platform, the additional resources solicited, and the results obtained.

METHODS

This interventional project will use a sequential mixed design in the exploratory phase (phase 1) including the construction of the Psy-Web platform. A quantitative prospective component (phase 2) will include the intervention content of the Psy-Web platform. In total, 105 ISs participants (study group) and 52 ISs (control group), based on a ratio of 1:2, will be considered. The control group participants include those who did not use the web platform.

RESULTS

The project is at the data collection stage (phase 1). Psy-Web will be built in accordance with the DMAIC (Define, Measure, Analyze, Improve and Control) model with the perspective of boosting its robustness. As a first-line resource to prevent psychological distress and ultimately improve their academic performance, Psy-Web is an innovative opportunity for high education managers. The project involves a multisectoral and a multidisciplinary partnership.

CONCLUSIONS

The project will develop a promising web-based solution to prevent psychological distress. Ultimately, Psy-Web will be operable in multiple languages including French.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/47059.

Isolated Palmoplantar Lentiginosis

The distribution of lentigines offers great insight into the multitude of potential-associated genetic or acquired conditions. In this report, we described a unique presentation of lentigines limited to the palms and soles in a healthy individual. Personal and familial history, clinical examination, serological testing, and whole-genome sequencing were all unremarkable. The benign clinical features and absence of associated medical conditions support the likely lentigo simplex with an isolated palmoplantar distribution. To date, no similar distribution has been reported. This case extends the breadth of view into all possible presentations of lentigines.

Isolated Asymptomatic Colonic Plasmacytoma Presenting as a Polyp at Screening Colonoscopy

Isolated extramedullary plasmacytomas (IEMPs) are rare. Extramedullary plasmacytomas (EMPs) are uncommon and mostly occur in the nasopharynx or upper respiratory tract. EMP involvement of the gastrointestinal tract occurs in approximately 10% of cases, more often in the small bowel than the colon. Less than 40 cases of colonic IEMP have been reported. Asymptomatic colonic IEMPs are extremely rare with few reported cases. We present a 57-year-old asymptomatic man with a colonic IEMP found during screening colonoscopy. A sigmoid colon polyp was removed and diagnosed as a plasmacytoma. Further investigation revealed it to be an isolated lesion.

Molecular characterization, complete genome sequencing, and pathogenicity of Novel Duck Reovirus from South Coastal Area in China

Novel Duck Reovirus (NDRV) that has been found throughout the world in waterfowl, and it has been extensively described. Here, we report the complete genome sequence of a NDRV strain isolated in China called NDRV YF10. This strain was collected from 87 samples with infected ducks in South Coastal Area. The NDRV genome consists of 23,419 bp. With the assistance of computer analysis, the promoter and terminator of each gene segment and 10 viral genes segments were identified, which encode polypeptides ranging from 98 to 1,294 amino acids. All gene fragments of this virus strain were determined and compared to previously reported strains, revealing genetic variation with similarity rates ranging from 96 to 99% for each gene segment. Each gene segment formed 2 host-associated groups, the waterfowl-derived reovirus and the avian-derived reovirus, except for the S1 gene segment, which was closely related to ARV evolution and formed a host-independent subcluster. This difference may be due to Avian Reovirus (ARV) evolving in a host-dependent manner. In order to evaluate the pathogenicity of YF10, a novel isolated strain of NDRV was tested in 2 types of ducks. It was observed that the YF10 isolated strain exhibits varying degrees of virulence, highlighting the potential risk posed to different types of ducks. In conclusion, our findings emphasize the importance of epidemiology studies, molecular characterization, and prevention of NDRV in waterfowl.

Endovascular Treatment for Isolated Infected Iliac Artery Aneurysms

PURPOSE

Isolated infected iliac artery aneurysms (IIIAAs) are extremely rare, life-threatening, and intractable. This study aimed to evaluate the outcomes of endovascular treatment in patients with IIIAAs.

METHODS

A retrospective study was conducted for all patients who underwent endovascular treatment for IIIAAs between June 2012 and June 2022 in 3 hospitals. The clinical data and follow-up outcomes were reviewed and assessed.

RESULTS

Fifteen patients were included in this study. The median age was 69 years, 12 patients (80%) were men, and 8 (53%) had hypertension. Most of the patients presented with abdominal or lumbar pain (87%) and fever (60%). The offending pathogen was identified in 11 patients (73%). Fifteen patients had a total of 16 IIIAAs, with 12 (75%) involving the common iliac artery. The immediate technical success rate was 100%, and the 30-day mortality was 7%. Infection-related complications occurred in 2 patients (13%) during hospitalization who were treated by open surgery at a later stage. The median follow-up was 23 months (range: 6-80 months, mean: 32 ± 25 months). Aneurysm recurrence was identified in one patient (7%) 5 months after endovascular repair. It was managed by endovascular stent-graft repair with percutaneous catheter drainage. No patients died during the follow-up period.

CONCLUSION

Endovascular treatment is feasible, safe, and effective for patients with IIIAAs, achieving acceptable clinical outcomes. Infection surveillance with essential reintervention should be considered for potential infection-related complications.

CLINICAL IMPACT

This study first reported that 15 patients underwent endovascular treatment for primary isolated infected iliac artery aneurysms (IIIAAs). It showed a good early and midterm outcomes. This is the first and largest multi-center study and the first literature review of IIIAAs. It provides an evidence that endovascular treatment is feasible, safe, and effective to treat IIIAAs. It suggests endovascular treatment is a promising alternative or a bridge to conventional open surgery for IIIAAs. This may promote endovascular therapy in the management of IIIAAs. It would help clinicians to make an appropriate treatment choice for IIIAAs.

Functional and physicochemical properties of protein from giant squid (Dosidicus gigas) extracted using foam-aided pH-shift processing

Jumbo squid (Dosidicus gigas) is a commercially valuable mollusk in Mexico; 80% of its body is edible. Despite the high protein content (∼18%) and low cholesterol content of this species, its high proteolytic activity (microbial and endogenous enzymes) induces protein degradation and consequent reduction in functional properties from a structural viewpoint. Gelation capacity (texture profile of the gels obtained), solubility, water holding capacity, foaming capacity, emulsification capacity, and emulsion stability were evaluated in protein concentrates obtained by foam-aided pH-shift processing: (A) myofibrillar protein extraction with distilled water and no pH-shifting; (B) alkaline solubilization and isoelectric precipitation; (C) acidic solubilization and isoelectric precipitation; and (D) process A and isoelectric precipitation. Process B showed superior gelation capacity, D had high emulsion stability across a wide range of pH values (4.0-8.0) and C lower plate counts of aerobic mesophilic. Therefore, all three alternative extraction processes showed techno-functional advantages. PRACTICAL APPLICATION: Jumbo squid is an abundant protein source in México, most of which is exported. Functional and physicochemical properties of muscle protein were improved by pH-shift processing. The recovered protein showed modifications of technological properties, using one of the methods described can lead to produce a protein extract with the most desirable attributes, such as foaming, emulsifying, or gelling capacities. The functional and physicochemical properties of protein from squid can be enhanced by selecting a certain pH-shift processing, depending on the desirable use. There is a broad perspective on the use of these protein extracts as ingredients or additives.

Isolated Versus Full Component Revision in Total Knee Arthroplasty for Aseptic Loosening

BACKGROUND

Revision of both femoral and tibial components of a total knee arthroplasty (TKA) for aseptic loosening has favorable outcomes. Revision of only one loose component with retention of others has shorter operative time and lower cost; however, implant survivorship and clinical outcomes of these different operations are unclear.

METHODS

Between January 2009 and December 2019, a consecutive cohort of revision TKA was reviewed. Univariate and multivariable analyses were used to study correlations among factors and surgical related complications, time to prosthesis failure, and functional outcomes (University of California Los Angeles, Knee Society functional, knee osteoarthritis and outcome score for joint replacement, Veterans RAND 12 (VR-12) physical, and VR-12 mental).

RESULTS

A total of 238 patients underwent revision TKA for aseptic loosening. The mean follow-up time was 61 months (range 25 to 152). Ten of the 105 patients (9.5%) who underwent full revision (both femoral and tibial components) and 18 of the 133 (13.5%) who underwent isolated revision had subsequent prosthesis failure [Hazard ratio (HR) 0.67, P = .343]. The factor analysis of type of revision (full or isolated revision) did not demonstrate a significant difference between groups in terms of complications, implant failures, and times to failure. Metallosis was related to early time to failure [Hazard ratio 10.11, P < .001] and iliotibial band release was associated with more complications (Odds ratio 9.87, P = .027). Preoperative symptoms of instability were associated with the worst improvement in University of California Los Angeles score. Higher American Society of Anesthesiologists status and higher Charlson Comorbidity Index were related with worse VR-12 physical (-30.5, P = .008) and knee osteoarthritis and outcome score for joint replacement (-4.2, P = .050) scores, respectively.

CONCLUSION

Isolated and full component revision TKA for aseptic loosening does not differ with respect to prosthesis failures, complications, and clinical results at 5 years. Poor American Society of Anesthesiologists status, increased comorbidities, instability, and a severe bone defect are related to worse functional improvement.

LEVEL OF EVIDENCE

III, cohort with control.

MRI findings of periarticular lesions with isolated greater tubercle fractures and dislocation

PURPOSE

To identify MRI findings for injuries to periarticular soft tissue structures that were related to isolated greater tubercle fracture.

MATERIALS AND METHODS

16 patients (mean age: 53.8, range 30-71 yrs) were enrolled and diagnosed with isolated greater tubercle (GT) fracture with CT and MRI and underwent shoulder arthroscopy from September 2009 to April 2019. Two musculoskeletal radiologists were blinded to the patient history and arthroscopic surgical findings and reviewed patient's CT and MRI. Fracture displacement, fracture center, and presence of bony Bankart lesion with Hill sachs lesion were checked on shoulder CT. Soft tissue injuries, including rotator cuff injury, deltoid muscle injury, long head of biceps tendon injury, capsular injury, glenoid injury, and injury location of the subscapularis and infraspinatus were checked on shoulder MRI.

RESULTS

MRI showed supraspinatus injury (56.3%), subscapularis injury (56.3%), deltoid muscle injury (25%), infraspinatus injury (25%), teres minor muscle injury (37.5%), injury of the long head of the biceps tendon (43.8%), inferior glenohumeral ligament tear (87.5%), superior labral anterior-toposterior lesion (25%), Bankart lesion (18.8%), and Hill-Sachs lesion (6.3%). 88.9% of subscapularis injuries and 75% of infraspinatus injuries showed caudal predominance. All of the patients with infraspinatus injuries showed concomitant teres minor muscle injuries. In order of frequency, the fracture centers were anterior (25%), posterior (31.3%), and all (43.8%). For patients with Bankart and HillSachs lesions, the fracture center included the posterior portion in all cases.

CONCLUSION

MRI and active arthroscopic examinations may be valuable when an isolated GT avulsion fracture is identified on X-ray examination.

Dispositional resilience predicts psychological adaptation of seafarers during and after maritime operations

BACKGROUND

Seafarers, whether on cargo, fishery, or naval ships, may be exposed to unique and unusual psychological demands related to the often isolated, confined, and extreme environments associated with ocean-going vessels. This necessitates optimal psychological adaptation to maintain individual well-being during the mission and afterwards. This study set out to explore whether psychometric measures could predict psychological adaptation of seafarers, specifically navy sailors, during and after maritime operations. It used emotional regulation as marker of adaptation, and examined the role of psychometric measures of dispositional resilience and emotional regulation to predict psychological adaptation at subsequent time-points.

MATERIALS AND METHODS

A total of 168 sailors completed the Brief Sailor Resiliency Scale, Dispositional Resilience Scale 15, and Mental Toughness Questionnaire 18 prior to departing for sea, as well as the Brunel Mood Scale at 5 time points over a 12-month operational cycle.

RESULTS

Higher resilience scores were consistently associated with more adaptive emotional regulation. Multiple linear regressions indicated that the Brief Sailor Resiliency Scale predicted emotional regulation over the shorter term, while the Mental Toughness Questionnaire 18 predicted emotional regulation over the longer term. Further, mid-mission emotional regulation also predicted emotional regulation at the end of deployments.

CONCLUSIONS

The findings support several practical applications. Firstly, formal organizational initiatives to promote resilience could be useful to enhance adaptation during and after missions. Secondly, measuring seafarers' dispositional resilience could allow the streaming of vulnerable individuals towards appropriate mental health support services. Thirdly, past indicators of adaptation could be useful to enhance decision- making regarding subsequent utilisation. This may be applicable to seafarers in both naval services and commercial shipping, and to personnel in remote weather stations or other isolated and inaccessible research facilities.

Evaluating the proportion of isolated cases among a spectrum of birth defects in a population-based registry

INTRODUCTION

Because the etiology and outcomes of birth defects may differ by the presence vs. absence of co-occurring anomalies, epidemiologic studies often attempt to classify cases into isolated versus non-isolated groupings. This report describes a computer algorithm for such classification and presents results using data from the Texas Birth Defects Registry (TBDR).

METHODS

Each of the 1,041 birth defects coded by the TBDR was classified as chromosomal, syndromic, minor, or "needs review" by a group of three clinical geneticists. A SAS program applied those classifications to each birth defect in a case (child/fetus), and then hierarchically combined them to obtain one summary classification for each case, adding isolated and multiple defect categories. The program was applied to 136,121 cases delivered in 2012-2017.

RESULTS

Of total cases, 49% were classified by the platform as isolated (having only one major birth defect). This varied widely by birth defect; of those examined, the highest proportion classified as isolated was found in pyloric stenosis (87.6%), whereas several cardiovascular malformations had low proportions, including tricuspid valve atresia/stenosis (2.3%).

DISCUSSION

This is one of the first and largest attempts to identify the proportion of isolated cases across a broad spectrum of birth defects, which can inform future epidemiologic and genomic studies of these phenotypes. Our approach is designed for easy modification for use with any birth defects coding system and category definitions, allowing scalability for different studies or birth defects registries, which often do not have resources for individual clinical review of all case records.

Synchronous isolated gastric metastases from ascending colon carcinoma: A case report

BACKGROUND

Gastric metastases (GMs) are rare and often accompanied with synchronous metastases of other organs. Synchronous isolated GMs from ascending colon carcinoma are uncommon and rarely studied. GMs may be confused with primary gastric tumors.

METHODS

A 45-year-old man presented to our hospital with abdominal distensionand anal pendant expansion. The abdominal physical examination was negative. The positive fecal occult blood test and the negative tumor marker were obtained. Colonoscopy and gastroduodenoscopy revealed a polypoidal lesion in the ascending colon and a polypoid mass in the gastric body, respectively. CT showed the thickened wall of ascending colon and polypoid mass in the gastric body with homogenous enhancement. Additionally, synchronous gastric metastases from the ascending colon carcinoma were confirmed by pathology after laparoscopic right hemicolectomy and partial gastrectomy. After 13 individual doses of fluorouracil (2.8 g/time), calcium leucovorin (0.8 g/time), and oxaliplatin (85 mg/time), the patient was discharged without any discomfort, without any additional metastases detected during the following 18 months.1.

RESULTS

A rare case of synchronous isolated gastric metastasis from ascending colon carcinoma was confirmed by computed tomography (CT) and pathological diagnosis.

CONCLUSION

GM may appear as a polypoid lesion. Surgery combined with chemotherapy may improve the prognosis in patients with synchronous isolated GM.

Living on the edge: How to prepare for it?

Introduction

Isolated, confined, and extreme (ICE) environments such as found at Antarctic, Arctic, and other remote research stations are considered space-analogs to study the long duration isolation aspects of operational space mission conditions.

Methods

We interviewed 24 sojourners that participated in different short/long duration missions in an Antarctic (Concordia, Halley VI, Rothera, Neumayer II) or non-Antarctic (e.g., MDRS, HI-SEAS) station or in polar treks, offering a unique insight based on first-hand information on the nature of demands by ICE-personnel at multiple levels of functioning. We conducted a qualitative thematic analysis to explore how sojourners were trained, prepared, how they experienced the ICE-impact in function of varieties in environment, provided trainings, station-culture, and type of mission.

Results

The ICE-environment shapes the impact of organizational, interpersonal, and individual working- and living systems, thus influencing the ICE-sojourners' functioning. Moreover, more specific training for operating in these settings would be beneficial. The identified pillars such as sensory deprivation, sleep, fatigue, group dynamics, displacement of negative emotions, gender-issues along with coping strategies such as positivity, salutogenic effects, job dedication and collectivistic thinking confirm previous literature. However, in this work, we applied a systemic perspective, assembling the multiple levels of functioning in ICE-environments.

Discussion

A systemic approach could serve as a guide to develop future preparatory ICE-training programs, including all the involved parties of the crew system (e.g., family, on-ground crew) with attention for the impact of organization- and station-related subcultures and the risk of unawareness about the impact of poor sleep, fatigue, and isolation on operational safety that may occur on location.

A Rare Presentation of Isolated IgM Deficiency in a 28-Year-Old Male: A Case Report

Immunoglobulin M (IgM) plays a regulatory role in subsequent immune response development, thereby accelerating the production of immunoglobulin G (IgG) with high affinity. Selective IgM deficiency (SIGMD) is a rare immune disorder that has been reported in association with serious infections, such as bacteremia. Patients commonly present with infections, atopy, septicemia, splenomegaly, neoplasia, and other autoimmune disorders. Treatment modalities and recommendations range from careful monitoring to vaccinations, aggressive management of respiratory infections, preventive and therapeutic antibiotics, and intravenous immunoglobulin (IVIG). There is insufficient information to generalize patients' prognosis with selective IgM deficiency due to the small number of patients and lack of prospective studies. We hereby present the case of a 28-year-old male with multiple recurrent boils, cellulitis, and osteomyelitis who has been diagnosed with selective IgM deficiency and is being treated with IVIG. This case report highlights the diagnostic evaluation and therapeutic care of patients with SIGMD and the need for follow-up.

Isolated Ankyloblepharon Filiforme Adnatum: A Case Report

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly consisting of partial or complete adhesion of the upper and lower eyelids, and it can be an isolated finding, or associated with other multisystemic anomalies. Its presence should alert the neonatologist of the need for a detailed systemic evaluation. We present a twenty day old baby who presented to our facility on the 8th of August 2019, with bilateral adhesions of the upper and lower eyelids, and had them excised with the use of McPherson's forceps and Vannas scissors, with no sedation or anesthesia. Timely separation of the lids is important to prevent the onset of stimulus deprivation amblyopia.

Implementing a Rural Natural Experiment: A Protocol for Evaluating the Impacts of Food Coops on Food Consumption, Resident's Health and Community Vitality

Background: Local food environments are recognized by experts as a determinant of healthy eating. Food cooperatives (coop) can promote the accessibility to healthier foods and thus improve the health of the population, particularly in remote rural communities. Objective: To measure the effects of implementing a food coop in a disadvantaged community with poor access to food. We have two main research questions: (1). Does the establishment of a food coop in rural areas described as food deserts have an impact on accessibility, frequency of use, food consumption, food quality, and ultimately the health of individuals? (2). Does the establishment of a food coop in rural areas described as food deserts have an impact on food security and community vitality? Design: A natural experiment with a mixed pre/post method will be used. The sample is composed of households that came from geographically isolated communities (population: 215 to 885 inhabitants) which qualified as food deserts and located in rural areas of Quebec (Canada). All communities plan to open a food coop (in the years 2022–2023), and as their opening will be staggered over time, participants from communities with a new food coop (intervention) will be compared to communities awaiting the opening of their food coop (control). Data collection was carried out at three time points: (1) before; (2) 1 to 5 months after; and (3) 13 to 17 months after the opening of the coop. Questionnaires were used to measure sociodemographic variables, dietary intake, residents’ health, and community vitality. Semi-structured interviews were conducted with community stakeholders. Results: Few natural experiments have been conducted regarding the impact of implementing food coops. Gathering concrete data on the effectiveness and processes surrounding these interventions through natural experiments will help to quantify their impact and guide knowledge users and policymakers to make more informed decisions.

PATHOLOGICALLY-CONFIRMED ISOLATED HYPOTHALAMO-PITUITARY SARCOIDOSIS REFRACTORY TO PULSE-DOSE GLUCOCORTICOIDS AND SUCCESSFULLY TREATED WITH METHOTREXATE

Isolated sarcoidosis of the hypothalamic-pituitary system is a very rare form of neurosarcoidosis. A high index of suspicion is required for diagnosis and the choice of therapy embodies another challenge due to lack of standardized protocols. Glucocorticoids are the mainstay of initial treatment, whereas the second and third-line therapy include immunomodulators and cytotoxic drugs, in addition to monoclonal antibodies. This report presents an unusual case of panhypopituitarism in a 32-year-old previously healthy male patient due to isolated hypothalamo-pituitary sarcoidosis confirmed histologically, refractory to pulse-dose glucocorticoids and then successfully treated by methotrexate. Based on our report, in patients requiring additional therapy usage of the methotrexate as the second line agent should be considered, however the time frame and the dosing schedule of methotrexate are still unknown and deserve further investigation.

Clinical outcomes and etiology of acquired sixth cranial nerve palsy

ABSTRACT

The objective of this study was to investigate the difference in clinical features according to age and factors affecting recovery of acquired sixth cranial nerve (CN6) palsy.A total of 156 patients with acute CN6 palsy between March 2016 and August 2021 who were followed up for at least 3 months were included in this study. Etiology, rate of recovery, and factors associated with recovery were retrospectively investigated.The average age of patients with CN6 palsy was about 60years and the mean duration of recovery was about 2.5 months. Of 156 patients, 72 (46.15%) had a microvascular etiology and 25 (16.03%) patients had a brain vascular lesions. Brain neoplasm, trauma, and "others" were found in 10 (6.41%), 11 (7.05%), and 15 (9.62%) patients, respectively. Among the total of 156 patients, 28 (17.95%) failed to completely recover. Non-isolated CN6 palsy with other cranial nerve palsies were recorded in 29 (18.59%) cases. Comparison of age (<50years vs ≥50years), between recovery and non-recovery groups showed that etiology was significantly different.The recovery rate of acquired CN6 palsy was about 82% and about 27% of patients had brain lesions. Also, varying rates and duration of recovery were found according to etiology, so we should be pay attention to diagnosis of causative disease in CN6 palsy patients.

Case Report: Anti-N-Methyl-D-Aspartate Receptor Encephalitis Manifesting With an Isolated Psychiatric Episode and Normal Ancillary Tests

The majority of patients with anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis present with psychiatric symptoms and subsequently develop neurological features. However, isolated psychiatric episodes occur in <5% of affected individuals, less frequent at disease onset (<1%) compared to relapse (4%). We report the case of a previously healthy 24-year-old female who presented with psychotic symptoms and behavioral alterations. Despite therapy, she showed no improvement and subsequently developed catatonic features. While the ancillary tests were normal, the clinical warning signs raised the suspicion of anti-NMDAR encephalitis which we later confirmed. Given its strong association with underlying tumors, we screened the patient and found an ovarian teratoma. Once removed, the patient displayed a substantial improvement in the mental status. Besides being extremely rare, this case illustrates the need to maintain clinical suspicion of anti-NMDAR encephalitis even in the absence of neurological features or paraclinical anomalies.

Unilateral Isolated Hypoglossal Nerve Palsy Secondary to Tonsillitis

Hypoglossal nerve palsy is usually associated with glossopharyngeal nerve, vagus nerve, and accessory nerve palsy, and the occurrence of hypoglossal nerve palsy alone is rare. We report a case of a 41-year-old man with unilateral isolated hypoglossal nerve palsy. The patient was aware of a leftward deviation of the tongue along with pharyngeal pain. The pharyngeal pain was quickly relieved by antibiotic treatment, but the deviation of the tongue did not improve, and the patient was referred to our hospital. As a result of the medical examination, a single paralysis of the left hypoglossal nerve and mild swelling of the left lingual tonsil up to the left palatine tonsil were observed. Various tests were performed, but there were no significant abnormal findings other than a suggestion of mild tonsillitis. We diagnosed the patient as idiopathic or tonsillitis-induced unilateral hypoglossal nerve palsy and started medical treatment with corticosteroids and methylcobalamin. The hypoglossal nerve palsy showed a tendency to improve after one month of onset and was almost cured by two months of onset.

Isolated Abdominal Aortitis Following a Urinary Tract Infection

A 49-year-old female with a history of sporadic episodes of scleritis was initially seen by her primary care physician (PCP) due to a two-day history of cramping abdominal pain, new elevated high blood pressure, increased urinary frequency, and urgency. The patient was diagnosed with an acute cystitis supported by a positive urine culture for a pan sensitive Escherichia coli; however, after two courses of antibiotics as an outpatient, her blood pressure (BP) remained markedly elevated, and her abdominal pain got worse which prompted a computed tomography (CT) abdomen and pelvis with contrast revealing inflammatory changes consistent with aortitis. The diagnosis was supported by a magnetic resonance angiography (MRA) which showed wall thickening and enhancement extending for approximately 4.8 cm involving the abdominal aortic wall just prior to the bifurcation. An extensive work up including CTA, US doppler of four-limbs, and fluorodeoxyglucose (FDG)-positron emission tomography (PET) confirmed the isolated abdominal aortitis. After infectious etiologies were ruled out, the patient was started on prednisone 60 mg daily which resulted in marked improvement of her symptoms. After a four-month taper of steroids, the patient had complete resolution of her symptoms, with no signs of recurrence.

Incidental Adrenal Mass in a Patient With Surgically Treated Lung Adenocarcinoma

Adrenal metastases are not uncommon in patients with widespread metastatic lung cancer. Isolated metachronous adrenal metastases in cases of surgically treated lung cancer without long-term evidence of disease are rare and may pose a diagnostic and treatment dilemma. The current literature suggests that in such cases, adrenalectomy provides better median and overall survival rates. This case presents an incidentally discovered isolated adrenal mass in a patient with a past medical history of lung adenocarcinoma that was surgically removed three years before metastasis discovery. The patient successfully underwent adrenalectomy and was disease-free with no apparent complications at her three-month follow-up visit. The case highlights the importance of long-term radiographic surveillance after surgical resection of lung adenocarcinoma for the prompt diagnosis and timely treatment of metachronous metastases.

Isolated solar angioedema: A systematic review of the literature

Solar urticaria is a well-recognized photodermatosis, sometimes accompanied by angioedema. However, isolated solar angioedema (ISA) is a rare and unrecognized entity. The purpose of our work was to systematically review the available data on ISA. Therefore, a systematic review of studies evaluating ISA was performed. Additionally, a case of a 21-years-old patient from our photodermatosis service is presented. The search yielded 421 publications, with 3 eligible for review. Together with our case, 5 cases were included overall. All patients were female. Four out of 5 patients first experienced ISA at childhood or early adulthood (age range 6-22 years). UVA photoprovocation was positive in the 3 out of the 4 patients who were tested. Improvement was noted following NB-UVB hardening (2 out of 5 patients) or a short course of oral prednisone (3 out of 5 patients) combined with regular sunscreen application. To conclude, ISA is an extremely rare entity, although it may be underdiagnosed due to lack of awareness. The clinician must consider ISA in the differential diagnosis of angioedema since it can have a detrimental effect on quality of life. Besides sun avoidance, there is no consensus regarding treatment.

Suture Anchor Augmentation for Acute Unstable Isolated Ankle Syndesmosis Disruption in Athletes

BACKGROUND

Isolated ankle syndesmosis disruption (without fibula fracture) causes acute pain and may cause chronic instability and pain. The aim of the present study was to evaluate the outcomes after anterior inferior tibiofibular ligament (AITFL) anatomical fixation using anchor sutures for unstable isolated syndesmosis disruption without fibular fractures.

METHODS

This study assessed 22 athletes who were diagnosed with unstable isolated syndesmosis disruption with a positive external rotation test, had more than 2-mm diastasis on ultrasound, and had complete AITFL rupture on magnetic resonance imaging between 2004 and 2020. Eighteen patients (82%) were elite-level athletes, and the remaining 4 were recreational athletes. Twelve patients (55%) were injured by an external rotation force. The athletes underwent open anatomical suture anchor fixation between the AITFL attachment sites, the fibula and tibia. The mechanism of injury, return-to-play time, and Foot and Ankle Outcome Score (FAOS) were evaluated.

RESULTS

All athletes returned to previous play except 1 retired elite athlete. Twenty-two athletes returned to jogging, team training, and official game play at an average of 62, 89, and 102 days, respectively. The final average follow-up FAOS symptom, pain, daily activity, sports activity, and quality of life scores were 98, 97, 100, 99, and 97, respectively. Two athletes were reinjured, and 1 required reoperation in the follow-up period.

CONCLUSION

Athletes with isolated syndesmosis disruption had a high likelihood to return to their previous activity level after suture anchor augmentation.

LEVEL OF EVIDENCE

Level IV, case series.

Interfacility Transfers for Isolated Craniomaxillofacial Trauma: Perspectives of the Facial Trauma Surgeon

STUDY DESIGN

Secondary overtriage is a burden to the medical system. Unnecessary transfers overload trauma centers, occupy emergency transfer resources, and delay definitive patient care. Craniomaxillofacial (CMF) trauma, especially in isolation, is a frequent culprit.

OBJECTIVE

The aim of this study is to assess the perspectives of facial trauma surgeons regarding the interfacility transfer of patients with isolated CMF trauma.

METHODS

A 31-item survey was developed using Likert-type scale and open-ended response systems. Internal consistency testing among facial trauma surgeons yielded a Cronbach's α calculation of .75. The survey was distributed anonymously to the American Society of Maxillofacial Surgeons, the North American Division of AO Craniomaxillofacial, and the American Academy of Facial Plastic and Reconstructive Surgery. Statistical significance in response plurality was determined by nonoverlapping 99.9% confidence intervals (P < .001). Sum totals were reported as means with standard deviations and z scores with P values of less than .05 considered significant.

RESULTS

The survey yielded 196 responses. Seventy-seven percent of respondents did not believe that most isolated CMF transfers required emergency surgery and roughly half (49%) thought that most emergency transfers were unnecessary. Fifty-four percent of respondents agreed that most patients transferred could have been referred for outpatient management and 87% thought that transfer guidelines could help decrease unnecessary transfers. Twenty-seven percent of respondents had no pre-transfer communication with the referring facility. Perspectives on the transfer of specific fracture patterns and their presentations were also collected.

CONCLUSION

Most facial trauma surgeons in this study believe that emergent transfer for isolated CMF trauma is frequently unnecessary. Such injuries rarely require emergent surgery and can frequently be managed in the outpatient setting without activating emergency transfer services. The fracture-specific data collected are a representation of the national, multidisciplinary opinion of facial trauma surgeons and correlate with previously published data on which specific types of facial fractures are most often transferred unnecessarily. The results of this study can serve as the foundation for interfacility transfer guidelines, which may provide a valuable resource in triaging transfers and decreasing associated health-care costs.

Isolated eosinophilic infiltration of the breast

We report the eighth case of eosinophilic mastitis and the first one without an association with peripheral eosinophilia or systemic involvement. A 51-year-old diabetic presented with a painful right breast lump. The mammogram, ultrasound, and magnetic resonance imaging suggested a diagnosis of periductal mastitis, however, a sinister etiology of breast carcinoma could not be ruled out. Diagnosis was made by vacuum assisted biopsy which revealed features of eosinophilic mastitis.

Diving for the Basketball: An Isolated Popliteus Rupture in an Adolescent Female with 6 Year Follow-Up

Popliteus tendon injuries most often occur in a traumatic setting with damage to multiple other knee structures. Isolated popliteal injuries, however, are rare. To our knowledge, there are no cases of a female pediatric patient with an intrasubstance popliteal tendon rupture in the current literature. This case report aims to illustrate symptoms, imaging, and treatment of an isolated popliteal tendon rupture in an adolescent female. An athletic 14-year-old female presented with right knee pain 4 weeks after a basketball injury in which she dove for the ball and fell, twisting and striking her knee. She had diffuse pain on both sides of the right knee for 3 weeks and pain with running, jumping or twisting. The knee exam was otherwise unremarkable. A right knee MRI demonstrated a complete rupture of the popliteal tendon. No other knee injuries were visualized. The patient was treated non-operatively and gradually returned to normal activities and sports at 6 weeks post injury. On 6-year follow up, the patient had no residual pain or instability and was able to play basketball without difficulty. Isolated popliteal tendon ruptures are extremely rare and difficult to diagnose given non-specific clinical exam findings. While these ruptures can be difficult to visualize on MRI, imaging can help to clarify the diagnosis by ruling out other injuries with similar clinical presentations. In the case of this young and active patient, diagnosis and full recovery without limitations were achieved with 6 weeks of conservative management.

Flatfoot Deformity Due to Isolated Spring Ligament Injury

Patients with acquired flatfoot deformity due to isolated injury of the spring ligament, with healthy posterior tibialis tendon, are rarely identified. Between December 2004 and September 2011 (6 years and 9 months), we treated 10 patients with acquired flatfoot deformity due to spring ligament injury without tibialis posterior tendon tear. One patient (10%) was lost to follow-up. The mean age of the patients was 44.33 ± 12.91 years; 4 (44.4%) were female, and 5 (55.56%) were male. Clinical presentation included mild to moderate hindfoot valgus and pain extending from the inferior part of the medial malleolus to the navicular, inferior to tibialis posterior. Forefoot abduction was not always present. Weightbearing radiographs and magnetic resonance imaging (MRI) scans were obtained in all cases. Six patients (66.66%) of the patients had a history of minor trauma. Spring ligament repair was performed in all cases, and 4 patients (44.44%) underwent adjunct procedures. After surgery, a cast was applied, and weightbearing was avoided for 6 weeks. The mean preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 39.66 ± 18.55, and this improved to 84.88 ± 12.41 after surgery (p = .023). No statistically significant differences were found between males and females or between isolated repairs and adjunct procedures. The mean duration of follow-up was 45.33 ± 37.11 months (range 15 to 120), and no complications were identified. Isolated injuries of the spring ligament with normal posterior tibialis tendon are rarely described and may be more prevalent than generally appreciated.

Perioperative Outcomes Following Combined Versus Isolated Colorectal and Liver Resections: Insights From a Contemporary, National, Propensity Score-Based Analysis

Our objective was to compare outcomes following combined versus isolated resections for metastatic colorectal cancer and/or liver metastases using a large, contemporary national database.

Background

Controversy persists regarding optimal timing of resections in patients with synchronous colorectal liver metastases.

Methods

We analyzed 11,814 patients with disseminated colorectal cancer and/or liver metastases who underwent isolated colon, rectal, or liver resections (CRs, RRs, or LRs) or combined colon/liver or rectal/liver resections (CCLRs or CRLRs) in the National Surgical Quality Improvement Program Participant Use File (2011-2015). We examined associations between resection type and outcomes using univariate/multivariate analyses and used propensity adjustment to account for nonrandom receipt of isolated versus combined resections.

Results

Two thousand four hundred thirty-seven (20.6%); 2108 (17.8%); and 6243 (52.8%) patients underwent isolated CR, RR, or LR; 557 (4.7%) and 469 (4.0%) underwent CCLR or CRLR. Three thousand three hundred ninety-five patients (28.7%) had serious complications (SCs). One hundred forty patients (1.2%) died, of which 113 (80.7%) were failure to rescue (FTR). One thousand three hundred eighty-six (11.7%) patients experienced unplanned readmission. After propensity adjustment and controlling for procedural complexity, wound class, and operation year, CCLR/CRLR was independently associated with increased risk of SC, as well as readmission (compared with LR). CCLR was also independently associated with increased risk of FTR and death (compared with LR).

Conclusions

Combined resection uniformly confers increased risk of SC and increased risk of mortality after CCLR; addition of colorectal to LR increases risk of readmission. Combined resections are less safe, and potentially more costly, than isolated resections. Effective strategies to prevent SC after combined resections are warranted.

The treatment of isolated Mason type II radial head fractures: a systematic review

BACKGROUND

Fractures of the radial head represent the most common bony injury of the elbow in adults. Radial head fractures are classified according to Mason or one of its classification modifications. Current literature does not indicate consensus on whether to treat isolated stable type II radial head fracture patterns with open reduction and internal fixation (ORIF) or nonoperatively, especially, when there is no mechanical block to motion.

METHODS

We systematically reviewed the available literature searching electronic databases, that is, MEDLINE using the PubMed interface and Embase, for studies published between 2011 and 2020. The primary objective was to contrast the outcome scores of these 2 different study groups and the pitfalls accompanied with the 2 different approaches. The PRISMA guidelines were applied.

RESULTS

The literature search left 11 studies for inclusion, all but 1 retrospective in design, comprising 319 patients. A total of 218 patients (68.3%) were treated with ORIF and 101 patients (31.7%) were treated nonoperatively. Our findings indicate that ORIF does not provide better results when compared to nonoperatively treated patients concerning functional outcome parameters. Treatment success, defined as excellent or good results according to the Mayo Elbow Performance Score or the Broberg and Morrey score, among the patients treated with ORIF was 90.9%; 7.1% were in need of subsequent surgery and 5.2% had radiologic osteoarthritic changes of the radial column. In addition, 95.1% of the nonoperative cohort were treated successfully, and osteoarthritis was present in 11.9%. Mean follow-up period of the ORIF and the nonoperative cohort was 73 and 39 months, respectively.

CONCLUSION

ORIF and nonoperative treatment of isolated Mason type II radial head fractures provide comparably satisfactory functional outcomes, without significant differences. Consideration of age, activity level and potential risks is recommended before making any treatment decision. Subsequent surgery rates were higher for patients treated with ORIF than for those treated nonoperatively and should be discussed. However, development of osteoarthritis of the radial column appears to be more likely after nonoperative treatment. The study pool remains limited, and implications of this review should be handled with caution.

Isolated renal hydatid disease: laparoscopic approach to an uncommon entity (case report)

Hydatidosis is a parasitic disease, endemic in various parts of the World. It frequently involves liver and lungs and, rarely, other organs as well. Isolated renal hydatidosis is a rare entity that accounts for less than 3% of all hydatid cases. Surgery remains the mainstay of treatment. We hereby report a case of isolated renal hydatid cyst involving left kidney that was managed by laparoscopic approach.

Can Viewing Nature Through Windows Improve Isolated Living? A Pathway Analysis on Chinese Male Prisoners During the COVID-19 Epidemic

Nature exposure is known to promote life satisfaction and well-being, and indirect exposure through windows is likely to benefit isolated populations. However, whether such type of exposure can benefit prisoners, the extremely isolated population, is unknown. In the current study, we investigated 326 male prisoners from three prisons in southwest China. Psychological variables including depression, anxiety, loneliness, distress tolerance, life satisfaction, and well-being were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale (GAD-7), short-form UCLA Loneliness Scale (ULS-6), Distress Tolerance Scale (DTS), Satisfaction with Life Scale (SWLS), and 5-item World Health Organization Well-Being Index (WHO-5), respectively. Structural equation modeling was employed to identify the pathways from the visibility of nature through windows to prisoners' life satisfaction and well-being. Our results demonstrated that visibility of nature promoted the frequency and duration of viewing nature through windows. The frequency directly affected well-being, but the duration did not effectively affect any measured variables. The visibility of nature enhanced life satisfaction mainly via direct effects but enhanced well-being mainly via indirect effects. Regarding the indirect pathways, the visibility of nature increased distress tolerance and thus reduced loneliness and mental health problems. The reduced mental health problem, in turn, promoted life satisfaction and well-being. Our findings suggest that nature exposure through windows is effective in enhancing prisoners' life satisfaction and well-being. The policymaker may need to consider nature-based solutions such as indirect nature exposure in prions to benefit isolated populations.

A rare case of recurrent isolated eyelid myxoma: Case report and review of literature

Myxoma, a benign mesenchymal tumour, can rarely present as an isolated eyelid swelling. A 33-year-old male presented with a progressively increasing swelling in the temporal part of the right upper eyelid of 5-month duration. The patient was misdiagnosed as chalazion and underwent incision and curettage locally. Subsequently, the patient presented with recurrence of the swelling and was treated with excision of the lesion. Histopathology showed the presence of spindle- to stellate-shaped cells in a myxoid matrix. Alcian blue stain was positive for mucin. The systemic evaluation did not show any components of Carney's complex. It is important to be aware of this entity of cutaneous eyelid myxoma as a rare cause of eyelid swelling and its propensity to recur rapidly after incomplete excision.

A Rare Presentation of an Isolated Radius Shaft Fracture in a Two-Month-Old Child: Dilemmas and Management

In this report, we discuss the case of a two-month-old boy with an isolated radius shaft fracture in the right forearm. The history and nature of the injury may be inconclusive in such injuries. A radiograph confirmed that the child had a fracture. We treated the boy conservatively, and the fracture united well in four weeks. Surgeons should be aware of this rare presentation in infants of this age. Inquiry into possible child abuse as well as clinical and metabolic workup is essential in these cases.