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Effects of head positions on awake fiberoptic bronchoscope oral intubation: a randomized controlled trial.

BMC Anesthesiol 2021 Jun 23;21(1):176. Epub 2021 Jun 23.

Department of Anesthesiology, the First hospital of Qinhuangdao, N.O. 258, Wenhua Road, Qinhuangdao, Hebei, China.

Background: There are many factors affecting the success rate of awake orotracheal intubation via fiberoptic bronchoscope. We performed this study was to investigate the effects of head positions on awake Fiberoptic bronchoscope oral intubation.

Methods: Seventy-five adult patients, received general anaesthesia were included in this study. Read More

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Simultaneous Clavicle Fracture and Acromioclavicular Joint Dislocation: Novel Surgical Technique: A Case Report.

JBJS Case Connect 2021 06 23;11(2). Epub 2021 Jun 23.

Department of Orthopaedic Surgery, Begoña Hospital, Gijón, Spain.

Case: A 41-year-old man sustained a midshaft clavicle fracture with associated type IV ipsilateral acromioclavicular joint (ACJ) dislocation. The clavicle was fixed with a locking plate and ACJ stabilized with a novel technique: 2 metal anchors with preloaded suture fixed at the coracoid process, looping the sutures over the clavicle, and passing through the plate holes without clavicle bone drilling. Excellent functional outcomes for range of motion, pain, and functional scores persisted 2 and a half years after surgery. Read More

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Harefuah 2021 Jun;160(6):358-360

Orthopaedic Surgery Division, Hillel Yaffe Medical Center, Israel.

Introduction: Both the direct and anterior approach (DAA) for total hip replacement (THR) surgery have gained much popularity in recent years. The suggested benefits of the muscle-sparing and nerve-sparing approach which could lead to a faster and easier recovery process, have led to an increase in the prevalence of the anterior approach in THR. These potential benefits have drawn the attention of both orthopaedic surgeons as well as patients as a faster return to their active lifestyle. Read More

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Diving-related disorders in commercial breath-hold divers (Ama) of Japan.

Diving Hyperb Med 2021 Jun;51(2):199-206

Department of Environmental Medicine, Kurume University School of Medicine, Kurume, Japan.

Decompression illness (DCI) is well known in compressed-air diving but has been considered anecdotal in breath-hold divers. Nonetheless, reported cases and field studies of the Japanese Ama, commercial or professional breath-hold divers, support DCI as a clinical entity. Clinical characteristics of DCI in Ama divers mainly suggest neurological involvement, especially stroke-like cerebral events with sparing of the spinal cord. Read More

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Arthroscopic Repair of a PASTA of the Shoulder Using a Bursal Split.

Arthrosc Tech 2021 May 22;10(5):e1403-e1408. Epub 2021 Apr 22.

Department of Orthopaedic Surgery, University of Arizona, Tucson, Arizona, U.S.A.

PASTA (partial articular supraspinatus tendon avulsion) lesions are a subset of partial rotator cuff tears that are commonly treated by surgeons. Multiple surgical techniques exist for managing these lesions, including debridement, transtendinous repair, and completion of the tear and repair. Each of these techniques provides its own set of advantages and disadvantages, and currently there is no consensus on which method provides the best clinical outcomes or ease of procedure. Read More

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Massive pulmonary embolism and thrombus-in-transit via a patent foramen ovale: a case report of successful use of extracorporeal membrane oxygenation to manage post-embolectomy severe right ventricular dysfunction.

Eur Heart J Case Rep 2021 Apr 19;5(4):ytab100. Epub 2021 Apr 19.

Department of Cardiothoracic Anaesthesia, Mohammed Bin Khalifa Bin Salman Al Khalifa Specialist Cardiac Centre, Road 4524, Block 945, Al Riffa, Awali, Kingdom of Bahrain.

Background: Pulmonary embolism with thrombus-in-transit through a patent foramen ovale is rare. It may present with neurological sequalae and rapid diagnosis is needed to prevent mortality and morbidity. The European Society of Cardiology (ESC) published guidelines in 2019 for diagnosis and management of acute pulmonary embolism which were useful in this case. Read More

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Which ethical values underpin England's National Health Service reset of paediatric and maternity services following COVID-19: a rapid review.

BMJ Open 2021 06 8;11(6):e049214. Epub 2021 Jun 8.

Law and Philosophy, Faculty of Humanities and Social Sciences, University of Liverpool, Liverpool, UK.

Objective: To identify ethical values guiding decision making in resetting non-COVID-19 paediatric surgery and maternity services in the National Health Service (NHS).

Design: A rapid review of academic and grey literature sources from 29 April to 31 December 2020, covering non-urgent, non-COVID-19 healthcare. Sources were thematically synthesised against an adapted version of the UK Government's Pandemic Flu Ethical Framework to identify underpinning ethical principles. Read More

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[Glioma Surgery and Surgical Supporting Technology].

Kuniaki Saito

No Shinkei Geka 2021 May;49(3):536-548

Department of Neurosurgery, Kyorin University Faculty of Medicine.

Maximum safe resection is the principal goal of glioma surgery to improve patient prognosis, and various skills and techniques are available to achieve this. First, detailed preoperative image assessment of the tumor, arteries, veins, and white matter is helpful in developing the surgical plan. Second, surgical supporting technology, such as a navigation system, electrophysiological monitoring, awake craniotomy, and fluorescence-guided surgery, are vital for glioma surgery. Read More

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The new imaging findings: "Passing spine" without kissing.

Medicine (Baltimore) 2021 Jun;100(22):e26191

Laboratory of Statistics, Graduate School of Medicine, Osaka City University, Osaka, Japan.

Abstract: Case-control studies by examining the lumbar spine computed tomography (CT) findings focusing on the spinous processes."Passing spine" was defined as a lumbar degenerative change observed on CT images. In contrast, kissing spine, which is also an image finding, has been acknowledged as an established clinical condition. Read More

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Unusual giant pleural lipomas: imaging features.

BMJ Case Rep 2021 Jun 2;14(6). Epub 2021 Jun 2.

Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India.

Pleural lipomas are rarely encountered in the thoracic cavity. Sometimes, they infiltrate the intercostal space to have a component on either side of the intercostal space forming a hourglass configuration. They are generally solitary, small and asymptomatic. Read More

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Ectopic right thoracic kidney associated with Bochdalek hernia as the cause of diagnostic confusion.

Forensic Sci Med Pathol 2021 Jun 1. Epub 2021 Jun 1.

Institute of Forensic Medicine, University of Belgrade - School of Medicine, Belgrade, Serbia.

A 61-year-old man who was a psychiatric patient and an alcoholic was admitted to hospital after a fall in his bathroom. He showed signs of hemorrhagic shock, and CT scans showed the presence of the right kidney and part of the right retroperitoneum in the right hemithorax, surrounded by liquid. Surgery showed that the right hemidiaphragm was intact and that no intraabdominal viscera prolapsed into thoracic cavity. Read More

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When multidisciplinary surgical trans-orbital approaches should be considered to reach the skull base.

Acta Otorhinolaryngol Ital 2021 Apr;41(Suppl. 1):S59-S66

Otolaryngology Unit, Department of Surgical, Medical, Molecular Pathology and Emergency Medicine, University Hospital of Pisa, Italy.

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Single-Stage Composite Reconstruction Of Complex Electrical Burn Defects By Microvascular Techniques - A Prospective Study.

K Monga P Goil

Ann Burns Fire Disasters 2021 Mar;34(1):75-82

Department of Plastic Surgery, S.M.S Hospital, Jaipur, Rajasthan, India.

Electrical burn constitutes a major proportion of patients admitted to the burn ward with life- as well as limb-threatening complications. Due to the severity of an electric current passing through the body, local tissues are greatly damaged. These patients require multiple debridements and surgeries to cover the composite defect resulting from a high voltage electrical contact burn. Read More

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Whole consultation simulation in undergraduate surgical education: a breast clinic case study.

BMC Med Educ 2021 May 28;21(1):305. Epub 2021 May 28.

Medical Education Research Unit, Faculty of Medicine, Imperial College London, London, SW7 2AZ, UK.

Background: Safe and effective clinical outcomes (SECO) clinics enable medical students to integrate clinical knowledge and skills within simulated environments. This realistic format may better prepare students for clinical practice. We aimed to evaluate how simulated surgical clinics based on the SECO framework aligned with students' educational priorities in comparison with didactic tutorials. Read More

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Plasma-based S100B testing for management of traumatic brain injury in emergency setting.

Pract Lab Med 2021 Aug 12;26:e00236. Epub 2021 May 12.

Department of Neuroradiology, University Medicine Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany.

Background: Serum biomarker S100B has been explored for its potential benefit to improve clinical decision-making in the management of patients suffering from traumatic brain injury (TBI), especially as a pre-head computed-tomography screening test for patients with mild TBI. Although being already included into some guidelines, its implementation into standard care is still lacking. This might be explained by a turnaround time (TAT) too long for serum S100B to be used in clinical decision-making in emergency settings. Read More

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Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations.

Am J Rhinol Allergy 2021 May 26:19458924211020549. Epub 2021 May 26.

Department of Otorhinolaryngology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, Italy.

Background: Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS.

Objective: To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation. A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). Read More

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SBRT treatment of abdominal and pelvic oligometastatic lymph nodes using ring-mounted Halcyon Linac.

J Appl Clin Med Phys 2021 Jun 25;22(6):162-171. Epub 2021 May 25.

Medical Physics Graduate Program, Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA.

Purpose/objectives: This work seeks to evaluate the plan quality, treatment delivery efficiency, and accuracy of single-isocenter volumetric modulated arc therapy (VMAT) of abdominal/pelvic oligometastatic lymph nodes (LNs) stereotactic body radiation therapy (SBRT) on Halcyon Linac.

Materials And Methods: After completing the in-house multitarget end-to-end phantom testing and independent dose verification using MD Anderson's single-isocenter/multi-target (lung and spine target inserts) thorax phantom, eight patients with two to three abdominal/pelvic oligometastatic LNs underwent highly conformal single-isocenter VMAT-SBRT treatment using the Halcyon Linac 6MV flattening filter free (FFF) beam. Targets were identified using an Axumin PET/CT scan co-registered with planning CT images and a single-isocenter was placed between/among the targets. Read More

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Validation of virtual water phantom software for pre-treatment verification of single-isocenter multiple-target stereotactic radiosurgery.

J Appl Clin Med Phys 2021 Jun 24;22(6):241-252. Epub 2021 May 24.

Servicio de Oncología Radioterápica, Hospital Quirónsalud, Barcelona, Spain.

The aim of this study was to benchmark the accuracy of the VIrtual Phantom Epid dose Reconstruction (VIPER) software for pre-treatment dosimetric verification of multiple-target stereotactic radiosurgery (SRS). VIPER is an EPID-based method to reconstruct a 3D dose distribution in a virtual phantom from in-air portal images. Validation of the VIPER dose calculation was assessed using several MLC-defined fields for a 6 MV photon beam. Read More

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The effects of implementation of a stepwise algorithmic protocol for nutrition care process in gastro-intestinal surgical children in Pediatric Intensive Care Unit (PICU).

Clin Nutr ESPEN 2021 Jun 22;43:250-258. Epub 2021 Apr 22.

Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Electronic address:

Introduction: Malnutrition is known as one of the major health problems among critically ill children; optimum nutrition support is considered as a therapeutic strategy to improve clinical outcomes and minimize the length of Pediatric Intensive Care Unit (PICU) staying as well as its costs. Implementation of an algorithmic protocol can result in the upgrade of the quality of nutrition support system in PICU.

Method: In this study, we developed a stepwise algorithmic nutrition care protocol for PICU patients in two phases as follows: a critical review of past literature and an expert discussion panel. Read More

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Determination of misoprostol acid in plasma samples by UPLC-MS/MS with application in a maternal-fetal pharmacokinetic study following a low misoprostol dose vaginally to induce labor.

J Pharm Biomed Anal 2021 Aug 11;202:114138. Epub 2021 May 11.

Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil. Electronic address:

Misoprostol is a prostaglandin E1 synthetic analogous used for elective interruptions of early pregnancy, treatment of incomplete abortion, postpartum hemorrhage and induction of full-term labor. Its a lipophilic drug, passing by extensive and rapid pre-systemic metabolism into the active metabolite, misoprostol acid (MA). The objective of this study was to develop and validate a highly sensitive method for MA determination in plasma using UPLC-MSMS, with application in a study of maternal-fetal pharmacokinetics in healthy parturients women (n = 10) after administration of 25 μg misoprostol vaginally. Read More

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Global community perception of 'surgical care' as a public health issue: a cross sectional survey.

BMC Public Health 2021 05 20;21(1):958. Epub 2021 May 20.

Office of Global Health, University of Texas Southwestern Medical Centre, Dallas, TX, USA.

Background: In the last decade surgical care has been propelled into the public health domain with the establishment of a World Health Organisation (WHO) designated programme and key publications. The passing of the historic World Health Assembly Resolution (WHA) acknowledged surgical care as a vital component towards achieving Universal Health Coverage (UHC). We conducted the first worldwide survey to explore the perception of surgical care as a public health issue. Read More

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Chorioretinitis sclopetaria and orbital emphysema caused by a high-velocity liquid missile.

Retin Cases Brief Rep 2021 May 15. Epub 2021 May 15.

Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota Department of Otolaryngology and Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota.

Purpose: To highlight a case of chorioretinitis sclopetaria, with concomitant macular hole formation and orbital emphysema, caused by a commercial-grade pressure washer.

Patient: A 19-year-old male presented to the emergency department with a left eye injury, incurred after being sprayed with a commercial-grade pressure washer. He endorsed ipsilateral blurred vision, pain, and linear floaters. Read More

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Case Report: as a Rare Pathogen of Mitral Endocarditis.

Front Cardiovasc Med 2021 29;8:648213. Epub 2021 Apr 29.

Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.

complex (SBSEC) is a group of that colonizes both humans and animals. Due to gastrointestinal disease, they can switch in opportunistic pathogens passing through intestinal mucosal barrier and may cause bacteremia and distant organs damage. Despite infective endocarditis (IE), extra-cardiac manifestations of organs damage include osteoarticular infections, meningitis, and biliary infections among others; moreover, the association with colonic pathological lesions has been largely described. Read More

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Interlocked Pins Increase Strength by a Lateral Spread of Load in Femoral Neck Fixation: a Cadaver Study.

Acta Chir Orthop Traumatol Cech 2021 ;88(2):144-152

Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.

PURPOSE OF THE STUDY To improve the important torsional, bending and compressive stability in femoral neck fixation, locking plates have been the latest contribution. However, increased strength by restricted fracture motion may come at expense of an altered load distribution and failure patterns. Within locking plate technology, the important intermediate fracture compression may principally be achieved by multiple sliding screws passing through a sideplate fixed to the femur or connected to an interlocking plate not fixed to the femur laterally, sliding "en bloc" with the plate. Read More

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Coblation cryptolysis method in treatment of tonsil caseum-induced halitosis.

Am J Otolaryngol 2021 Apr 21;42(6):103075. Epub 2021 Apr 21.

Inonu University, Faculty of Medicine, Department of Biostatistics and Medical Informatics, Malatya, Turkey.

Purpose: Halitosis, is a social problem affecting many patients seeking help from clinicians. Tonsil stones can cause halitosis and especially occur in crypts of palatine tonsils. Coblation cryptolysis is an alternative method for tonsil caseum treatment. Read More

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The Infratemporal Retro-Eustachian Transposition of the Temporoparietal Fascial Flap for Clival Reconstruction After Endoscopic Endonasal Approach: An Anatomic Conceptual Technique.

Oper Neurosurg (Hagerstown) 2021 Jun;21(1):E15-E21

Department of Neurosurgery, Stanford Medical Center, Stanford, California, USA.

Background: Reconstruction after endoscopic endonasal approaches is a key element. Lower clivus reconstruction is difficult and most of the times a pedicled flap is not available. As the complexity and the dimensions of the exposure increase, a reliable reconstruction technique becomes more and more important. Read More

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Three-dimensional printing for heart diseases: clinical application review.

Biodes Manuf 2021 Apr 30:1-13. Epub 2021 Apr 30.

Department of Cardiovascular Surgery, Xijing Hospital, Airforce Medical University, Xi'an, 710032 China.

Heart diseases remain the top threat to human health, and the treatment of heart diseases changes with each passing day. Convincing evidence shows that three-dimensional (3D) printing allows for a more precise understanding of the complex anatomy associated with various heart diseases. In addition, 3D-printed models of cardiac diseases may serve as effective educational tools and for hands-on simulation of surgical interventions. Read More

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Portal Annular Pancreas With Common Hepatic Artery Trajectory Abnormality: A Case Report and Review of the Literature.

Pancreas 2021 Apr;50(4):639-644

From the Department of Surgery, Sapporo Kosei General Hospital, Sapporo, Japan.

Abstract: Portal annular pancreas (PAP) is a rare congenital pancreatic anomaly, in which the uncinate process of the pancreas fuses to the body of pancreas behind the portal vein. Here, we report a case of PAP with common hepatic arterial anomaly, which was identified during surgery. A 57-year-old man who had branch type intraductal papillary mucinous neoplasm in the head of the pancreas developed a nodule in the cystic lesion. Read More

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Comparison of GFAP and UCH-L1 Measurements from Two Prototype Assays: The Abbott i-STAT and ARCHITECT Assays.

Neurotrauma Rep 2021 7;2(1):193-199. Epub 2021 Apr 7.

Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Glial fibrillary acidic protein (GFAP) and ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1) may aid in the evaluation of traumatic brain injury (TBI). The objective of this analysis was to compare GFAP and UCH-L1 values measured using a handheld device compared with a core laboratory platform. We analyzed plasma samples from patients with TBI and healthy controls enrolled in the Transforming Research and Clinical Knowledge in TBI (TRACK-TBI) cohort study. Read More

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Endoscopic Carpal Tunnel Release Without Invading the Tunnel: A New Transretinacular Technique.

Tech Hand Up Extrem Surg 2021 May 3. Epub 2021 May 3.

Centro di Chirurgia Sant'Anna Department of Orthopedic Surgery, General Hospital, Merano Humanitas University Medical School, Pieve Emanuele (Milan), Italy.

Established endoscopic carpal tunnel release (ECTR) techniques carry a not entirely eludible risk of iatrogenic complications, mainly because of incomplete view of the cutting blade and intraoperative pressure increase inside the carpal tunnel (CT). We describe a novel single-portal ECTR method, conceived to reduce these risks, by optimizing visual control and avoiding dilatation of the CT. After incising the well exposed proximal third of the transverse carpal ligament (TCL), transection of the remainder is completed using a pediatric urethrotome. Read More

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