Abstract Introduction Surgical excision is the standard treatment for basal cell carcinoma (BCC). For locally advanced BCC (laBCC) not suitable for surgery or radiotherapy, Hedgehog pathway inhibitors (HHIs) such as sonidegib are important options. Clinical observations have shown that sonidegib may lead to pigmentation and scarring, which can affect treatment evaluation. We evaluated the efficacy and safety of sonidegib in Chinese patients with laBCC and examined discrepancies between clinical/dermoscopic assessments and pathological findings, including posttreatment pathological changes. Methods This single-center retrospective study included 54 patients with laBCC treated with sonidegib 200 mg/day for ≥ 3 months (October 2022–July 2025). Response assessment integrated VISIA-based planimetric lesion-area regression, standardized dermoscopy, and dermoscopy-guided multi-site biopsy as the pathological gold standard. The primary endpoint was objective response rate (ORR); secondary endpoints included disease control rate (DCR) and safety. Results At 3 months, ORR was 87% (complete response [CR] 48%; partial response [PR] 39%), and DCR was 100%. Pathology showed complete clearance in 48.1% and residual tumor in 51.9%, with six cases showing apparent histologic subtype shifts. Dermoscopy in patients with complete remission still demonstrated a high false-positive rate (branching blood vessels 53.8%, blue-gray dots 61.5%), leading to decreased diagnostic specificity. Adverse events occurred in 81.5% of patients; 70.4% reported multiple events, most commonly muscle cramps (66.7%), dysgeusia (59.3%), and alopecia (55.6%). All events were grade 1–3, and no patient discontinued treatment as a result of toxicity. Conclusion In this real-world Chinese laBCC cohort, sonidegib produced a clinically meaningful response with a favorable safety profile. However, clinical and dermoscopic assessments showed substantial false positives due to posttreatment changes; pathological biopsy remains essential to confirm tumor clearance. Advanced noninvasive imaging (e.g., reflectance confocal microscopy) may further improve monitoring. Prospective studies with longer follow-up are warranted.
Conventional electroencephalogram (EEG) has been the most common method to detect and manage seizure episodes. Limitations to its use in the intraoperative period during neurosurgical cases have made detecting intraoperative seizure almost impractical, especially in the presence of a neuromuscular blocking agent. Using an EEG-based monitor like bispectral index (BIS) can add a new dimension to intraoperative neuromonitoring in patients at risk of seizure. Apart from other indices, it also displays the real-time raw EEG waveform, which can be valuable in diagnosing an intraoperative seizure and guide the therapeutic achievement of burst suppression. An increase in the BIS value has also been reported during intraoperative seizures. Here, we present the cases of three patients posted for excision of intracranial space-occupying lesions who developed intraoperative seizures, which were diagnosed and managed with the aid of a BIS monitor. This case series highlights the utility of BIS in detecting and managing intraoperative seizures, apart from its role in depth of anesthesia monitoring.
Abstract Background Osteomyelitis (OM) is a bone disease that can leave people disabled. Eukaryotic translation initiation factor (EIF5A) is involved in cell proliferation, apoptosis, differentiation, and inflammation, but the role of EIF5A in staphylococcus aureus (S. aureus)-infected OM remains unclear. Methods The mRNA and proteins were detected by qRT-PCR and western blot. Cell viability was examined by CCK8 assay. The reactive oxygen species (ROS), malondialdehyde (MDA), ferrous iron (Fe2+), and glutathione (GSH) levels were analyzed using the ROS, MDA, GSH, and Fe2+ detection kits. The levels of tumor necrosis factor-alpha (TNF-α), interleukin-1β (IL-1β), and Interleukin-6 (IL-6) were examined using Enzyme-linked immunosorbent (ELISA) kits. The binding between FOS and promoter of EIF5A was detected by chromatin immunoprecipitation (CHIP) assay. The interaction between EIF5A and Fos proto-oncogene (FOS) was detected by dual-luciferase reporter assay. The diagnostic values of EIF5A and FOS were analyzed with blood of S. aureus-infected OM patients and healthy volunteers by ROC curve. Results The EIF5A was up-regulated in S. aureus-infected OM. EIF5A knockdown promoted cell viability in S. aureus-infected MG-63 cells and reduced ROS, MDA, and Fe2+ levels, and increased GSH levels. Meanwhile, silencing EIF5A could increase expression of glutathione peroxidase 4 (GPX4), and ferritin heavy chain1 (FTH1) and reduce acyl-CoA synthetase long-chain family member 4 (ACSL4) expression, and silencing EIF5A could reduce immune factors (TNF-α, IL-1β, and IL-6) levels. FOS could bind to EIF5A. Silencing FOS promoted cell viability, and increased GSH levels in S. aureus-infected MG-63 cells, but reduced ROS, MDA, and Fe2+ levels. Meanwhile, promoted GPX4 and FTH1 expression, inhibited ACSL4 expression, and reduced immune factor levels in S. aureus-infected MG-63 cells. Interestingly, EIF5A overexpression could weaken the actions. FOS promotes ferroptosis and inflammation via EIF5A in S. aureus-infected MG-63 cells. Besides, the EIF5A and FOS might be potential molecular diagnostic markers in the progression of OM. Conclusion FOS promotes ferroptosis and inflammation via EIF5A in S. aureus-infected OM. This study is first to report the role of FOS and EIF5A in S. aureus-infected OM, but we found that there are still some limitations in our work, such as not covering all possible types of infection, which is the focus of future research.
Orthopedic surgery, Diseases of the musculoskeletal system
Study Design Retrospective cohort study. Purpose This study aimed to investigate trends in postoperative complications for posterior cervical fusions from 2012 to 2022. Overview of Literature Previous studies analyzing the longitudinal outcomes of posterior cervical fusion from 2003 to 2013 have demonstrated relatively improved postoperative outcomes despite the increasing volume, complexity, and age of the patient population. However, few studies have evaluated these outcomes since 2013. Methods The American College of Surgeons National Surgical Quality Improvement Program database was queried for patients undergoing posterior cervical fusion between 2006 and 2022. Patients aged >18 years with current procedural terminology code 22600 for posterior cervical fusion were included. Patient demographics and comorbidities were recorded, including age, race, body mass index, diabetes mellitus, and hypertension. Annual 30-day complication rates were reported, including wound infection, readmission, reoperation, length of stay, intraoperative blood transfusions, and mortality. Results In total, 25,537 patients undergoing posterior cervical fusion from 2012 to 2022 were included. Variations in the rates of urinary tract infection, deep vein thrombosis, sepsis, reoperation, and mortality were not significant. Wound infection rates increased from 2.4% in 2012 to 4.0% in 2022 (p=0.003). Pneumonia rates increased from 1.2% in 2012 to 1.6% in 2022 (p=0.011). Intraoperative blood transfusion rates decreased consistently from 5.6% in 2012 to 2.8% in 2022 (p<0.001). Readmission rates increased from 6.4% in 2012 to 6.7% in 2022 (p<0.001). The average length of stay decreased from 4.18 days in 2012 to 3.97 days in 2019, before increasing between 2020 and 2022 to 4.17 days in 2022. Conclusions Rates of comorbidities including age, diabetes mellitus, and hypertension have increased among patients undergoing posterior cervical fusion between 2012 and 2022, whereas complication rates have remained relatively similar. The length of stay has shortened despite the higher medical complexity of the patients who underwent surgery.
Cecocolic intussusceptions are a rare condition of acute colic in horses requiring immediate surgical intervention due to persistent uncontrollable pain and ongoing ischemic cecal necrosis. Particularly in cases where reduction of the intussusception is surgically not feasible surgical interventions such as partial typhlectomy through colotomy (partial cecal amputation) combined with or without cecal bypass techniques are described. Alternatively, surgical interventions can also be performed without partial typhlectomy via incomplete bypass ileocolostomy. Information regarding applicable techniques and outcomes base on sparse literature of single case reports or small case series. Therefore, this case series aims to add more cases treated with incomplete bypass ileocolostomy without typhlectomy to existing literature and to compare the outcome by reviewing medical records from January 2009 to March 2024 in context to literature. Five horses were surgically treated and were followed-up between 1 and 9 years. Minor short-term complications were recorded during hospitalization such as transient mild colic and febrile episodes. Long-term outcome revealed that horses received or exceed their previous level of use. By adding the hereby presented cases to published data horses treated with ileocolostomy without partial typhlectomy had a long-term survival rate of 100%. However, numbers of published cases are still low with 49 horses being included in the literature review whereof 42 recovered from surgery. The overall long-term survival rate was 53%. The added value of this study is based on the comprehensive documentation of a cohort of five horses successfully treated with an incomplete bypass procedure, demonstrating favorable long-term outcomes. Furthermore, the study advances the surgical technique by implementing the closure of mesenteric gap. The evidence for the application of the surgical technique has been strengthened.
André Braz, MD, Camila Cazerta de Paula Eduardo, MD, Alexander Pierce, BSc
et al.
Background:. HA/CaHa (HArmonyCa, Allergan Aesthetics, an AbbVie Company) is a hybrid injectable filler developed for aesthetic purposes that contains calcium hydroxyapatite microspheres suspended in a hyaluronic acid gel. This review describes preclinical and clinical data, recommendations for use based on the primary author’s clinical experience, and case studies that illustrate implementation of product use recommendations and patient outcomes.
Methods:. Preclinical data on the lift capacity and tissue integration of the HA/CaHa hybrid injectable and clinical data on its safety, efficacy, and real-world use were extracted from poster presentations, published literature, manufacturer instructions for use, and proprietary data files. Case studies were presented based on clinical experience.
Results:. The HA component of HA/CaHa provides an immediate and noticeable filling and lifting effect, whereas CaHa microspheres result in neocollagenesis. In preclinical studies, HA/CaHa demonstrated higher lift capacity (P < 0.05) and faster tissue integration than a CaHa filler and led to collagen I gene and protein expression. Clinical studies showed clinical safety and effectiveness with high patient satisfaction. The most common adverse event was injection-site response. Clinician recommendations for achieving desired aesthetic results while minimizing or preventing adverse events are reviewed, including patient selection and assessment, treatment approaches based on face shape, injection technique, and postprocedure care.
Conclusion:. The novel hybrid injectable consisting of HA with incorporated CaHa microspheres in a single marketed product may help achieve aesthetic goals by immediately restoring volume and potentially improving skin architecture and soft-tissue quality over time.
Abstract Background A fixed screw-retained full-arch restoration supported by four implants is a popular treatment option for edentulous arches. Optimal alignment of implants is quite challenging in extremely atrophied edentulous cases, and a small amount of deviation is expected during guided surgery. This study aimed to compare implant accuracy among edentulous jaws with various levels of atrophy. Methods Five separate copies of each Cawood and Howell model (III–V) were produced for the maxilla and mandible. A total of 120 implants (30 models). The implant accuracy was assessed based on angular deviations at the base (angle, 3D offset, distal, vestibular, and apical) and tip (3D offset, distal, vestibular, and apical). Results The atrophy level of the jaws had a statistically significant effect on deviation; implants showed greater deviation from the planned location as the atrophy level increased. Conclusion Given that implant deviation increased with the degree of atrophy, a greater safety margin from important anatomical structures is recommended when planning implant location for guided surgery in Cawood and Howell V cases.
Background and objectives: Otitis media with effusion is a common but treatable cause of hearing impairment in children. It leads to delays in speech acquisition and poor performance at school. Correct diagnosis at an early stage with history and clinical examination and tympanometry is needed We evaluated the role of tympanometry; type B, flat curve; in predicting middle ear effusion by comparing the findings with those of myringotomies in children with otitis media with effusion.
Methods: This is a prospective case-series study conducted at the department of ENT, Rizgary Teaching Hospital. The test population comprised 39 boys and 21 girls, ages ranged (2years- 12 years). Patients with suspicion of otitis media with effusion underwent tympanom- etry. Its findings were compared with findings of the respective myringotomies. From the data collected sensitivity, specificity, positive predictive value and negative predictive values were estimated
Results: A total of 120 ears from 60 patients were operated. The commonest age group affected by otitis media with effusion was 5-9 years. Type B tympanogram with flat curve and normal canal volume was obtained in 80.0% of the ears. The diagnostic value of tympanometry was; Sensitivity 90.8%, Specificity 68.2%, positive predictive value 92.7%, negative predictive value 62.5%.
Conclusions: Otitis media with effusion is common in age group 5-9 years. We concluded that tympanometry is a valid test providing a high sensitivity, specificity and positive predictive value for middle ear effusion.
PurposeThe imaging diagnosis of fracture-related infection is often challenging. The aim of this study was to evaluate the value of 18F-FDG PET/CT for the diagnosis of fracture-related infection (FRI) with internal fixation after orthopedic surgery in lower extremities.MethodsA total of 254 consecutive patients who underwent 18F-FDG PET/CT scans with suspected FRI with internal fixation in lower extremities were retrospectively investigated 18F-FDG PET/CT images were semiquantitatively evaluated with multiple metabolic parameters. Additionally, morphological information of the inguinal draining lymph nodes (DLN) with the highest SUV value was also collected and analyzed.ResultsPatients were divided into two groups according to final diagnosis: the infected (N=197) and the non-infected group (N=57). The differences in the inguinal DLN-related parameters, including the long diameter, short diameter, maximum cross-sectional area, maximum standardized uptake value (SUVmax), metabolic volume (MV) 60%, MV70%, MV80%, total lesional glycolysis (TLG) 60%, TLG70%, TLG80%, and the infection suspected area related parameters, including SUVmax, MV25%, MV30%, MV35%, MV40%, MV50%, and TLG70%, between the two groups were statistically significant. We then compared the highest area under the curves (AUCs) among the morphological parameters of DLN, metabolic parameters of DLN, and metabolic parameters of the suspected infection area. The result demonstrated that SUVmax of the inguinal DLN showed the best diagnostic performance with an AUC of 0.939 (P<0.05).ConclusionSemiquantitative analysis (especially SUVmax) of the inguinal DLN in 18F-FDG PET/CT images could be a promising method for the diagnosis of suspected FRI with internal fixation after orthopedic surgery in lower extremities.
Matthew Bradley, Angela Kindvall, Rex Atwood
et al.
Introduction An institution-wide protocol for uncomplicated acute appendicitis was created to improve compliance with best practices between the emergency department (ED), radiology and surgery. Awareness of the protocol was spread with the publication of a smartphone application and communication to clinical leadership. On interim review of quality metrics, poor protocol adherence in diagnostic imaging and antimicrobial stewardship was observed. The authors hypothesised that two further simple interventions would result in more efficient radiographic diagnosis and antimicrobial administration.Materials and methods Surgery residents received targeted in-person education on the appropriate antibiotic choices and diagnostic imaging in the protocol. Signs were placed in the emergency and radiology work areas, immediately adjacent to provider workstations highlighting the preferred imaging for patients with suspected appendicitis and the preferred antibiotic choices for those with proven appendicitis. Protocol adherence was compared before and after each intervention.Results Targeted education was associated with improved antibiotic stewardship within the surgical department from 30% to 91% protocol adherence before/after intervention (p<0.005). Visible signs in the ED were associated with expedited antimicrobial administration from 50% to 90% of patients receiving antibiotics in the ED prior to being brought to the operating room before/after intervention (p<0.005). Diagnostic imaging after the placement of signs showed improved protocol adherence from 35% to 75% (p<0.005).Conclusion This study demonstrates that smartphone-based applications and communication among clinical leadership achieved suboptimal adherence to an institutional protocol. Targeted in-person education reinforcement and visible signage immediately adjacent to provider workstations were associated with significantly increased adherence. This type of initiative can be used in other aspects of acute care general surgery to further improve quality of care and hospital efficiency.
Jaymie A. Henry, Angela S. Volk, Sicily K. Kariuki
et al.
While there has been overall progress in addressing the lack of access to surgical care worldwide, untreated surgical conditions in developing countries remain an underprioritized issue. Significant backlogs of advanced surgical disease called neglected surgical diseases (NSDs) result from massive disparities in access to quality surgical care. We aim to discuss a framework for a public health rights-based initiative designed to prevent and eliminate the backlog of NSDs in developing countries. We defined NSDs and set forth six criteria that focused on the applicability and practicality of implementing a program designed to eradicate the backlog of six target NSDs from the list of 44 Disease Control Priorities 3rd edition (DCP3) surgical interventions. The human rights-based approach (HRBA) was used to clarify NSDs role within global health. Literature reviews were conducted to ascertain the global disease burden, estimated global backlog, average cost per treatment, disability-adjusted life-years (DALYs) averted from the treatment, return on investment, and potential gain and economic impact of the NSDs identified. Six index NSDs were identified, including neglected cleft lips and palate, clubfoot, cataracts, hernias and hydroceles, injuries, and obstetric fistula. Global definitions were proposed as a starting point towards the prevention and elimination of the backlog of NSDs. Defining a subset of neglected surgical conditions that illustrates society’s role and responsibility in addressing them provides a framework through the HRBA lens for its eventual eradication.
Orthodontists correct dental malocclusion, but major facial skeleton deformations (skeletal malocclusion) are often subject to surgical correction. Several speech pathologies are associated with both of the occlusal anomalies mentioned above. The majority of articulation disorders and primary functions cannot be improved without skeletal correction. This study aimed to investigate the outcome of the multimodal and logopaedics treatment of Polish adults affected by skeletal malocclusion and speech-language pathology. A total of 37 adults affected by skeletal Class II and III malocclusion were included, along with the relationship between the malocclusion and speech deficiency (20 phonemes tested) in the subjects before and after surgical correction. The impact of surgery on pronunciation improvement and types of Polish phonemes most often misarticulated by Polish adults were also examined. Patients underwent combined treatment and received a full speech pathology examination. The treatment improved speech (<i>p</i> < 0.05), but the study did not prove that a specific surgery type was associated with pronunciation improvement. Some patients were provided with speech therapy during childhood, yet most had some minor difficulties with lip and tongue movements. Palatal, alveolar (<i>p</i> < 0.05), fricatives (<i>p</i> < 0.05), and labiodental consonant pronunciation (<i>p</i> < 0.05) improved. The surgical correction of malocclusion leads to better articulation of Polish consonants in adults and improves some primary functions.
Abubakar Sani Lugga, Bello Muhammad Sulaiman, Lawal Magaji Ibrahim
et al.
Burn injuries are rare in the neonatal period. Most of the cases reported in the literature are iatrogenic. We report the case of a 7-h old female neonate who presented with domestic accidental scald burns involving 18% of the total body surface area. She sustained the burns during a traditional bath with hot water. She was resuscitated with intravenous fluid, and urine output was monitored. She was nursed under a radiant heater and was given analgesics and tetanus antitoxin. She had wound sepsis from Pseudomonas species which was successfully treated with intravenous antibiotic (ceftazidime). She also had anemia which was corrected with packed red blood cell transfusion. Wound dressing was done with antibiotic-impregnated gauze until the wounds were satisfactorily healed. She was discharged from the hospital on the 29th-day postburn.
An audit of the antibiotic prophylaxis in surgical procedures is the basic area of antimicrobial stewardship programme. The current research aimed to evaluate the adherence-proportion of the pre-operative antibiotic prophylaxis (PAP) practices in common elective surgical procedures. It was an eight-month (January 2017 to August 2017) observational cross-sectional patients' treatment record-based study conducted at two tertiary care teaching hospitals of Islamabad, Pakistan. We investigated the three most commonly performed elective general surgical procedures at the hospitals in adults aged > 18 years with no previous infection or surgery. The required data were extracted from the medical charts. Current prescribing practices were compared with the standard prescribing guidelines. A total of 660 (Government Hospital (GH), n = 330 and Private Hospital (PH), n = 330) procedures were observed. The most commonly performed elective general surgical procedures were laparoscopic cholecystectomy 307/660 (46.5%), followed by direct inguinal hernia 197/660 (29.8%) and total thyroidectomy 156/660 (23.6%). Non-use of PAP was observed in 64/660 (9.7%) cases. PAP was given to 90.3% (n = 596/660) cases (300/330 (90.9%) patients in GH and 296/330 (89.7%) in PH; P = 0.599). Based on the existing guidelines, the choice of antibiotics was correct in only 4.2% (25/596) patients (10/300; 3.3% cases at GH and 15/296; 5% at PH). The appropriate use of antibiotics was significantly greater in direct inguinal hernia (n = 19/193; 9.8%) cases compared with that in total thyroidectomy (n = 4/152; 2.6%) and laparoscopic cholecystectomy (n = 2/251; 0.8%) cases; P = 0.001. Compliance to the timing was only 51% (n = 304/596) of the total patients received PAP which was significantly lower in GH 97/300 (32.3%) as compared with that in PH 207/296 (69.9%); P = 0.001. Administration timing of antibiotics was observed to be more appropriate in total thyroidectomy (n = 79/152; 51.9%) cases than in laparoscopic cholecystectomy (n = 130/251; 51.8%) and direct inguinal hernia (n = 95/193; 49.2%) cases; P = 0.001. The route and dose were appropriate in accordance with the guidelines in all cases (100%). Most of the patients received ceftriaxone, a third-generation cephalosporin that is no longer recommended by the latest international guidelines. The current analysis revealed an alarmingly poor adherence rate with the guidelines in the three elective surgical procedures at both hospitals. To improve the situation, training and awareness programs about the antimicrobial stewardship interventions on the institutional level may be valuable.
A.A. Bespalenko, A.A. Buryanov, Ie. V. Tsema
et al.
The aim – to identify and analyze causes for reamputations in military personnel with limb amputations due to ATO in East Ukraine. Patients and methods. All military personnel of the AFU within ATO was eligible for the study with diagnosis of limb amputations in the period from 01.06.2014 to 30.06.2016, and which were treated in hospitals of the Ministry of Defense of Ukraine. Among 7091 patients with injuries, 152 patients with limb amputations were identified.
Results and discussion. Out of 152 patients, 25 (16%) underwent limbs reamputation, whereas 127 (84%) patients underwent amputation once. Patients in the study groups did not differ in age. Amputation was performed on the upper limb in 41 (32%) in the group of patients with amputations, which is significantly higher as compared to 2 (8%) patients in the reamputation group (p = 0.014). Analyses the level of amputations of the upper extremity showed no difference in the parameters. In 23 (92%) patients in the group with reamputation amputation of the lower limbs were diagnosed significantly more often as compared to 86 (68%) patients in the amputation group (p = 0.014). Analyses of the level of amputation of the lower extremity revealed that almost 3 times more often amputation was performed at the level of the ankle in the group of patients with reputations - 8 (32%) patients, as compared to 15 (12%) patients in the amputation group (p = 0.03). However, linear regression did not show a significant difference of these parameters in reamputations. Amputation of one upper extremity in the reamputation group was diagnosed 7 times less frequent - 1(4%) patient less often than in the amputation group - 37(29%) patients (p = 0.005).
Conclusions: The results of the study of the injured in a hybrid war indicate that reamputations are more often associated with amputations at the level of the upper limb, but are less often diagnosed in patients with amputation of the lower extremity. Reamputations are more often performed with trauma of one limb. Clinical features in patients injured in the ATO zone in the East Ukraine demonstrate the frequency and characteristics of re-arrests that are different from other armed conflicts.