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Operative stabilization of flail chest has been shown to have several benefits over nonoperative management. Often, flail chest injuries will involve the anterior ribs and their associated costal cartilage. In certain cases, operative fixation with open reduction and internal fixation (ORIF) of anterior rib fractures involving the costal cartilage may be warranted. Currently, there is scant literature regarding the surgical approach and clinical outcomes of ORIF involving the costal cartilage. The purpose of this study is to describe the surgical approach and first reported clinical series for patients undergoing anterior rib ORIF involving the costal cartilage.

After Institutional Review Board approval was obtained, a retrospective case series was performed at a single urban level 1 trauma center including patients 18 years of age or older who underwent ORIF of anterior rib fractures involving the costal cartilage. All surgical approaches were performed with muscle-sparing techniques. Patients were follon reduction and internal fixation of anterior rib fractures involving the costal cartilage is a safe procedure with low complication rates and favorable postoperative outcomes including hospital length of stay, intensive care unit length of stay, postoperative pneumonia, need for tracheostomy, and mechanical ventilation time.

Open reduction and internal fixation of anterior rib fractures involving the costal cartilage is a safe procedure with low complication rates and favorable postoperative outcomes including hospital length of stay, intensive care unit length of stay, postoperative pneumonia, need for tracheostomy, and mechanical ventilation time.Cardiovascular implantable electronic device (CIED) infections are morbid, costly, and difficult to manage. This review explores the pathophysiology, diagnosis, and management of CIED infections. Diagnostic accuracy has been improved through increased awareness and improved imaging strategies. Pocket or bloodstream infection with virulent organisms often requires complete system extraction. Emerging prophylactic interventions and novel devices have expanded preventative strategies and options for re-implantation. A clear and nuanced understanding of CIED infection is important to the practicing electrophysiologist.

This study sought to evaluate the prognostic value of the time interval from left ventricular (LV) pacing to the earliest onset of QRS complex (S-QRS) for long-term clinical outcomes in patients who underwent cardiac resynchronization therapy (CRT).

The electrical latency during LV pacing evaluated by S-QRS is associated with local tissue property, and the S-QRS ≥37ms has been previously proposed as an independent predictor of mechanical response to CRT.

This study included 82 consecutive patients with heart failure with reduced LV ejection fraction (≤35%) and a wide QRS complex (≥120ms) who underwent CRT. Patients were divided into a short S-QRS group (SS-QRS;<37ms) and a long S-QRS group (LS-QRS;≥37ms). The primary endpoint was total mortality, including LV assist device implantation or heart transplantation, whereas the secondary endpoint was total mortality or HF hospitalization.

S-QRS was 25.9 ± 5.3ms in SS-QRS and 51.5 ± 13.7ms in LS-QRS (p<0.01), and baseline QRS duration and electrical activation at the LV pacing site (i.e., Q-LV) were similar. During mean follow-up of 44.5 ± 21.1months, 24patients (29%) reached the primary endpoint, whereas the secondary endpoints were observed in 47 patients (57%). LS-QRS had significantly worse event-free survival for both endpoints. selleck screening library LS-QRS was an independent predictor of total mortality (hazard ratio 2.6; 95% confidence interval 1.11 to 6.12; p=0.03) and the secondary composite events (hazard ratio 2.4; 95% confidence interval 1.31 to 4.33; p<0.01).

The S-QRS ≥37ms at the LV pacing site was a significant predictor of total mortality and HF hospitalization. S-QRS-guided optimal LV lead placement is critical in patients who receive CRT.

The S-QRS ≥37 ms at the LV pacing site was a significant predictor of total mortality and HF hospitalization. S-QRS-guided optimal LV lead placement is critical in patients who receive CRT.Shi et al. (2021) in “Short-term Western diet intake promotes IL-23-mediated skin and joint inflammation accompanied by changes to the gut microbiota in mice” show that Western diet (WD) exacerbates an IL-23 minicircle‒mediated model of psoriasis and psoriatic arthritis, with an expansion of IL-17A‒expressing γδ T cells and shifts to the gut microbial community. WD-associated inflammation is mitigated by diet manipulation or antibiotic administration. These results suggest that dietary manipulation may be useful in the treatment of IL-23‒mediated disease, possibly through the modulation of the gut microbiota.Single-cell RNA sequencing (scRNA-seq) provides an unprecedented ability to investigate cellular heterogeneity in entire organs and tissues, including human skin. Ascensión et al. (2020) combined and reanalyzed human skin scRNA-seq datasets to uncover new insights into fibroblast heterogeneity. This work demonstrates that new discoveries can be made from published data on the basis of principles of these three Rs Reuse, Refine, and Resource.The article by Shah et al. (2021) published in the Journal of Investigative Dermatology adds to the growing body of literature on disparities in melanoma care. The authors report that whereas melanoma is more common in the New York state’s counties with higher socioeconomic status (SES) and increased health-system access (HSA), counties with lower SES and decreased HSA have a relatively increased proportion of late-stage melanoma diagnoses. Increased understanding of the individual- and community-level factors contributing to adverse melanoma outcomes in certain populations is necessary to strategize targeted solutions.Most cutaneous squamous cell carcinomas (cSCCs) arise from actinic keratoses (AKs), making these premalignant lesions attractive targets for therapeutic intervention before transformation. In a new article of the Journal of Investigative Dermatology, Thomson et al. (2021) characterize the genetic alterations in AKs and identify significantly mutated drivers associated with risk factors such as UVR or azathioprine along with signaling pathways that may regulate the progression from AK to cSCC.