Introduction: Family planning is one of the pillars of the Safe Motherhood Initiative which is aimed at reducing unwanted pregnancy and maternal death. Objective: To evaluate the uptake, efficacy, and safety profile o...Introduction: Family planning is one of the pillars of the Safe Motherhood Initiative which is aimed at reducing unwanted pregnancy and maternal death. Objective: To evaluate the uptake, efficacy, and safety profile of 68 mg etonogestrel subdermal implant in Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Ebonyi State. Materials and Methods: A 5-year retrospective descriptive analysis was carried out on 68 mg etonogestrel subdermal implant uptake among family planning attendees in AEFUTHA. The medical records of the clients that had 68 mg etonogestrel subdermal implant insertion were studied. Socio-demographic characteristics, side effects, discontinuation, and reasons for discontinuation were extracted and analyzed. Analysis was done with SPSS version 20. Data obtained were represented using frequency tables and pie chart. Results: During the study period, 2538 women accepted various methods of contraception, 14.3% (364) of the women used Implanon. The mean age of 68 mg etonogestrel subdermal implant users was 30.7 ± 13.4 years with a range of 20 - 44. Multiparous clients constituted 54.5%. The majority (55.2%) had secondary education as their highest level of education. Less than 20% of the acceptors had side effects, the commonest 24 (42.9%) being prolonged menstrual flow and followed by irregular menstrual flow 18 (32.1%). Discontinuation rate was 17.9%;desire to conceive. 40 (61.5%) was the commonest reason for discontinuation. Only one (0.3%) acceptor reported serious itching at the site of insertion. None of the women reported pregnancy during the period of use (Pearl Index = 0). Conclusion: The acceptance rate of 68 mg etonogestrel subdermal implant among the women is low, however, it is found be effective with good continuation rate in the center. Efforts should be made to increase its uptake so as to prevent unwanted pregnancy and associated sequelae.展开更多
Breast augmentation with implants is a popular cosmetic surgery that enhances breast volume and contour through various placement planes.In this review,we examine the impact of subglandular,subpectoral,and subfascial ...Breast augmentation with implants is a popular cosmetic surgery that enhances breast volume and contour through various placement planes.In this review,we examine the impact of subglandular,subpectoral,and subfascial implant planes on postoperative outcomes and complication rates.Subglandular placement offers simplicity but is associated with higher risks of capsular contracture,hematoma,and rippling in patients with low tissue coverage.The subpectoral plane,widely adopted for its natural appearance and reduced capsular contracture risk,may cause dynamic deformity due to muscle contraction.Although technically challenging,the subfascial plane combines the benefits of soft tissue support and reduced implant displacement.We highlight the importance of choosing an optimal implant plane tailored to each patient’s anatomical and aesthetic needs to enhance surgical outcomes and minimize complications.Further research is needed to validate long-term efficacy,particularly for subfascial placement.展开更多
BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can r...BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.展开更多
BACKGROUND Cancer patients with an implanted venous access port(IVAP)often manage their care at home during chemotherapy intervals,including maintaining the device,monitoring complications,and following medication ins...BACKGROUND Cancer patients with an implanted venous access port(IVAP)often manage their care at home during chemotherapy intervals,including maintaining the device,monitoring complications,and following medication instructions.Home care ensures continued support after discharge.However,due to factors such as age,gender,culture,psychological status,and family support,the quality of home care varies significantly.Understanding these factors can help provide targeted guidance to improve the care of cancer patients.AIM To explore IVAP chemotherapy on home care quality and its association with mental health and family support for cancer patients.METHODS This investigative study was based on a medical records system.It investigated the relationship between psychological status,family support,and home care quality in 180 patients with cancer undergoing IVAP chemotherapy.Psychological status was assessed using the State Anxiety Inventory(S-AI);family support was assessed using the Perceived Social Support Scale(PSSS),and home care quality was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30).Pearson’s correlation and Structural Equation Modeling were used to analyze the interplay between these factors.RESULTS The average S-AI score was 47.52±14.47,PSSS was 52.48±12.64,and EORTC QLQ-C30 was 70.09±17.32.A substantial inverse relationship was observed between the EORTC QLQ-C30 and S-AI scores(r=-0.712).A significant positive correlation was found between the EORTC QLQ-C30 and the PSSS,with a correlation coefficient of(r=0.744).The multiple linear regression analysis indicated that family social support,psychological status,and average monthly family income were the main factors influencing the variation in the quality of home care,explaining 71.9%of the variation.The Structural Equation Modeling results indicated that psychological status acted as a partial mediator in the association between family social support and home care quality of life,explaining 32.78%of the mediation effect.CONCLUSION Psychological status and family social support positively impacted cancer patients’home care quality,with psychology partially mediating this effect.展开更多
Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. T...Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.展开更多
Introduction: Cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are all...Introduction: Cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are allowed. The subject of this study is to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects by using 3D custom-made cranioprostheses versus hand-made bone cement implants. Patient and Methods: This is a prospective comparative study conducted on 20 patients of calvarial skull defects of different etiologies, sites and sizes, admitted in the neurosurgical departments of Cairo and Fayoum Universities in the period from August 2017 to February 2018. Patients are divided into two study groups: (group 1) 10 patients operated upon by 3D custom-made implant;(group 2) operated upon by hand-made bone cement implant. Statistical Analysis Used: Mann-Whitney test and Chi-square test. Results: Craniotomy using 3D custom-made implants gives better results than using bone cement in the functional restoration of skull shape and cranial protection with shorter operative time and less rate of postoperative complications. There is no statistically significant difference between the two study groups regarding cosmetic outcome. Conclusion: 3D custom-made implant is recommended for large and complex skull defects. Further and large studies might be needed.展开更多
Historically,the rapid degradation and massive gas release from magnesium(Mg)implants resulted in severe emphysema and mechanical failure.With the advent of new alloys and surface treatment methods,optimized Mg implan...Historically,the rapid degradation and massive gas release from magnesium(Mg)implants resulted in severe emphysema and mechanical failure.With the advent of new alloys and surface treatment methods,optimized Mg implants have re-entered clinics since last decade with reliable performance.However,the optimization aims at slowing down the degradation process,rather than exemption of the gas release.This study involved a systematic evaluation of current preclinical and clinical evidence,regarding the physical signs,symptoms,radiological features,pathological findings and complications potentially associated with peri±implant gas accumulation(PIGA)after musculoskeletal Mg implantation.The literature search identified 196 potentially relevant publications,and 51 papers were enrolled for further analysis,including 22 preclinical tests and 29 clinical studies published from 2005 to 2023.Various Mg-based materials have been evaluated in animal research,and the application of pure Mg and Mg alloys have been reported in clinical follow-ups involving multiple anatomical sites and musculoskeletal disorders.Soft tissue and intraosseous PIGA are common in both animal tests and clinical follow-ups,and potentially associated with certain adverse events.Radiological examinations especially micro-CT and clinical CT scans provide valuable information for quantitative and longitudinal analysis.While according to simulation tests involving Mg implantation and chemical processing,tissue fixation could lead to an increase in the volume of gas cavity,thus the results obtained from ex vivo imaging or histopathological evaluations should be interpreted with caution.There still lacks standardized procedures or consensus for both preclinical and clinical evaluation of PIGA.However,by providing focused insights into the topic,this evidence-based study will facilitate future animal tests and clinical evaluations,and support developing biocompatible Mg implants for the treatment of musculoskeletal disorders.展开更多
BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures,sparking ongoing discourse over whether to retain or remove asymptomatic implants.Achieving consensus on this matter is paramou...BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures,sparking ongoing discourse over whether to retain or remove asymptomatic implants.Achieving consensus on this matter is paramount for orthopedic surgeons.This study aims to quantify the impact of routine implant removal on patients and healthcare facilities.A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University(KFHU)was conducted and subjected to statistical scrutiny.Among these cases,44%necessitated hospitalization exceeding one day,while 56%required only a single day.Adults exhibited a 55%need for extended hospital stays,contrasting with 22.8%among the pediatric cohort.The complication rate was 6%,with all patients experiencing at least one complication.Notably,34.1%required sick leave and 4.8%exceeded 14 d.General anesthesia was predominant(88%).Routine implant removal introduces unwarranted complications,particularly in adults,potentially prolonging hospitalization.This procedure strains hospital resources,tying up the operating room that could otherwise accommodate critical surgeries.Clearly defined institutional guidelines are imperative to regulate this practice.AIM To measure the burden of routine implant removal on the patients and hospital.METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU,a tertiary hospital in Saudi Arabia.Data were collected in the orthopedic department at KFHU from February 2016 to August 2022,which includes routine asymptomatic implant removal cases across all age categories.Nonroutine indications such as infection,pain,implant failure,malunion,nonunion,restricted range of motion,and prominent hardware were excluded.Patients who had external fixators removed or joints replaced were also excluded.RESULTS Between February 2016 and August 2022,360 implants were retrieved;however,only 167 of those who met the inclusion criteria were included in this study.The remaining implants were rejected due to exclusion criteria.Among the cases,44%required more than one day in the hospital,whereas 56%required only one day.55%of adults required more than one day of hospitalization,while 22.8%of pediatric patients required more than one day of inpatient care.The complication rate was 6%,with each patient experiencing at least one complication.Sick leave was required in 34.1%of cases,with 4.8%requiring more than 14 d.The most common type of anesthesia used in the surgeries was general anesthesia(88%),and the mean(SD)surgery duration was 77.1(54.7)min.CONCLUSION Routine implant removal causes unnecessary complications,prolongs hospital stays,depletes resources and monopolizing operating rooms that could serve more critical procedures.展开更多
AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were exam...AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.展开更多
The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and susta...The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and sustained local release of Mg ions on bone metabolism or repair,which should not be ignored when developing Mg-based implants.Thus,it remains necessary to assess the biological effects of Mg implants in animal models relevant to clinical treatment modalities.The primary purpose of this study was to validate the beneficial effects of intramedullary Mg implants on the healing outcome of femoral fractures in a modified rat model.In addition,the mineralization parameters at multiple anatomical sites were evaluated,to investigate their association with healing outcome and potential clinical applications.Compared to the control group without Mg implantation,postoperative imaging at week 12 demonstrated better healing outcomes in the Mg group,with more stable unions in 3D analysis and high-mineralized bridging in 2D evaluation.The bone tissue mineral density(TMD)was higher in the Mg group at the non-operated femur and lumbar vertebra,while no differences between groups were identified regarding the bone tissue volume(TV),TMD and bone mineral content(BMC)in humerus.In the surgical femur,the Mg group presented higher TMD,but lower TV and BMC in the distal metaphyseal region,as well as reduced BMC at the osteotomy site.Principal component analysis(PCA)-based machine learning revealed that by selecting clinically relevant parameters,radiological markers could be constructed for differentiation of healing outcomes,with better performance than 2D scoring.The study provides insights and preclinical evidence for the rational investigation of bioactive materials,the identification of potential adverse effects,and the promotion of diagnostic capabilities for fracture healing.展开更多
Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving r...Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.展开更多
The subthalamic nucleus(STN)is considered the best target for deep brain stimulation treatments of Parkinson’s disease(PD).It is difficult to localize the STN due to its small size and deep location.Multichannel micr...The subthalamic nucleus(STN)is considered the best target for deep brain stimulation treatments of Parkinson’s disease(PD).It is difficult to localize the STN due to its small size and deep location.Multichannel microelectrode arrays(MEAs)can rapidly and precisely locate the STN,which is important for precise stimulation.In this paper,16-channel MEAs modified with multiwalled carbon nanotube/poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate)(MWCNT/PEDOT:PSS)nanocomposites were designed and fabricated,and the accurate and rapid identification of the STN in PD rats was performed using detection sites distributed at different brain depths.These results showed that nuclei in 6-hydroxydopamine hydrobromide(6-OHDA)-lesioned brains discharged more intensely than those in unlesioned brains.In addition,the MEA simultaneously acquired neural signals from both the STN and the upper or lower boundary nuclei of the STN.Moreover,higher values of spike firing rate,spike amplitude,local field potential(LFP)power,and beta oscillations were detected in the STN of the 6-OHDA-lesioned brain,and may therefore be biomarkers of STN localization.Compared with the STNs of unlesioned brains,the power spectral density of spikes and LFPs synchronously decreased in the delta band and increased in the beta band of 6-OHDA-lesioned brains.This may be a cause of sleep and motor disorders associated with PD.Overall,this work describes a new cellular-level localization and detection method and provides a tool for future studies of deep brain nuclei.展开更多
Bacterial colonization of orthopedic implants is one of the leading causes of failure and clinical complexities for load-bearing metallic implants. Topical or systemic administration of antibiotics may not offer the m...Bacterial colonization of orthopedic implants is one of the leading causes of failure and clinical complexities for load-bearing metallic implants. Topical or systemic administration of antibiotics may not offer the most efficient defense against colonization, especially in the case of secondary infection, leading to surgical removal of implants and in some cases even limbs. In this study, laser powder bed fusion was implemented to fabricate Ti3Al2V alloy by a 1:1 weight mixture of CpTi and Ti6Al4V powders. Ti-Tantalum(Ta)–Copper(Cu) alloys were further analyzed by the addition of Ta and Cu into the Ti3Al2V custom alloy. The biological,mechanical, and tribo-biocorrosion properties of Ti3Al2V alloy were evaluated. A 10 wt.% Ta(10Ta) and 3 wt.% Cu(3Cu) were added to the Ti3Al2V alloy to enhance biocompatibility and impart inherent bacterial resistance. Additively manufactured implants were investigated for resistance against Pseudomonas aeruginosa and Staphylococcus aureus strains of bacteria for up to 48 h. A 3 wt.% Cu addition to Ti3Al2V displayed improved antibacterial efficacy, i.e.78%–86% with respect to CpTi. Mechanical properties for Ti3Al2V–10Ta–3Cu alloy were evaluated, demonstrating excellent fatigue resistance, exceptional shear strength, and improved tribological and tribo-biocorrosion characteristics when compared to Ti6Al4V. In vivo studies using a rat distal femur model revealed improved early-stage osseointegration for alloys with10 wt.% Ta addition compared to CpTi and Ti6Al4V. The 3 wt.% Cu-added compositions displayed biocompatibility and no adverse infammatory response in vivo. Our results establish the Ti3Al2V–10Ta–3Cu alloy’s synergistic effect on improving both in vivo biocompatibility and microbial resistance for the next generation of load-bearing metallic implants.展开更多
In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from...In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.展开更多
Objective A high sodium(HS)diet is believed to affect bone metabolism processes.Clarifying its impact on osseointegration of titanium(Ti)implants holds significant implications for postoperative dietary management of ...Objective A high sodium(HS)diet is believed to affect bone metabolism processes.Clarifying its impact on osseointegration of titanium(Ti)implants holds significant implications for postoperative dietary management of implanted patients.Methods This investigation probed the impact of sodium ions(Na^(+))on neovascularization and osteogenesis around Ti implants in vivo,utilizing micro-computed tomography,hematoxylin and eosin staining,and immunohistochemical analyses.Concurrently,in vitro experiments assessed the effects of varied Na^(+)concentrations and exposure durations on human umbilical vein endothelial cells(HUVECs)and MC3T3-E1 cells.Results In vivo,increased dietary sodium(0.8%-6.0%)led to a substantial decline in CD34 positive HUVECs and new bone formation around Ti implants,alongside an increase in inflammatory cells.In vitro,an increase in Na^(+)concentration(140-150 mmol/L)adversely affected the proliferation,angiogenesis,and migration of HUVECs,especially with prolonged exposure.While MC3T3-E1 cells initially exhibited less susceptibility to high Na^(+)concentrations compared to HUVECs during short-term exposure,prolonged exposure to a HS environment progressively diminished their proliferation,differentiation,and osteogenic capabilities.Conclusion These findings suggest that HS diet had a negative effect on the early osseointegration of Ti implants by interfering with the process of postoperative vascularized bone regeneration.展开更多
Degenerative calcific aortic valve stenosis(AS)is the most common valvular heart disease in elderly.^[1] It is well documented that symptomatic severe AS follows a malignant course leading to cardiogenic shock(CS).
Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expecta...Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expectancy,as a key factor for selecting the most tailored treatment,has grown.The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement(AVR)vs.TAVI at our department.Methods From September 2017 to December 2020,673 consecutive patients with severe aortic valve stenosis were enrolled for AVR(n=283)or TAVI(n=390).Inclusion criteria was isolated severe aortic stenosis,while exclusion criteria were redo surgery,valve-in-valve procedure and the need for concomitant surgical procedures.Based on the Lee index,patients were divided into four groups according to their 4-year life expectancy.Four-year survival was assessed and reported using the Kaplan-Meier method.A multivariate regression analysis of risk factors for 4-year mortality was performed.Results Four years survival is always superior in the AVR patients(89.8%vs.75.6%,P<0.001).Surgery is associated with a higher incidence of acute kidney injury(23%vs.5.1%,P<0.001),while TAVI is related to a higher incidence of new onset left bundle branch block(0 vs.23.8%,P<0.001),pace-maker implantation(2.5%vs.11.8%,P=0,02)and mild-to-moderate paravalvular leak(0.3%vs.5.4%,P<0.001).The independent risk factors for 4-years mortality are post-procedural AKI,poor mobility and transcatheter procedure.Conclusion In our analysis,4 years survival is always superior in the AVR patients.Life expectancy is a key factor for selecting the most appropriate approach for each patient.A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.展开更多
Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reason...Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.展开更多
Dear Editor,We report a case of bacterial endophthalmitis following implantation of a Staar intraocular collamer lens(ICL)caused by Gordonia bronchialis.ICL implantation is an effective method to correct myopia which ...Dear Editor,We report a case of bacterial endophthalmitis following implantation of a Staar intraocular collamer lens(ICL)caused by Gordonia bronchialis.ICL implantation is an effective method to correct myopia which generally offers excellent safety.There are a few reports of ocular infection caused by Gordonia bronchialis,but no ICL-related endophthalmitis has been reported to date.We present the first case of delayed-onset endophthalmitis after ICL implantation caused by Gordonia bronchialis,identified by metagenomic next-generation sequencing(mNGS).展开更多
文摘Introduction: Family planning is one of the pillars of the Safe Motherhood Initiative which is aimed at reducing unwanted pregnancy and maternal death. Objective: To evaluate the uptake, efficacy, and safety profile of 68 mg etonogestrel subdermal implant in Alex Ekwueme Federal University Teaching Hospital Abakaliki (AEFUTHA), Ebonyi State. Materials and Methods: A 5-year retrospective descriptive analysis was carried out on 68 mg etonogestrel subdermal implant uptake among family planning attendees in AEFUTHA. The medical records of the clients that had 68 mg etonogestrel subdermal implant insertion were studied. Socio-demographic characteristics, side effects, discontinuation, and reasons for discontinuation were extracted and analyzed. Analysis was done with SPSS version 20. Data obtained were represented using frequency tables and pie chart. Results: During the study period, 2538 women accepted various methods of contraception, 14.3% (364) of the women used Implanon. The mean age of 68 mg etonogestrel subdermal implant users was 30.7 ± 13.4 years with a range of 20 - 44. Multiparous clients constituted 54.5%. The majority (55.2%) had secondary education as their highest level of education. Less than 20% of the acceptors had side effects, the commonest 24 (42.9%) being prolonged menstrual flow and followed by irregular menstrual flow 18 (32.1%). Discontinuation rate was 17.9%;desire to conceive. 40 (61.5%) was the commonest reason for discontinuation. Only one (0.3%) acceptor reported serious itching at the site of insertion. None of the women reported pregnancy during the period of use (Pearl Index = 0). Conclusion: The acceptance rate of 68 mg etonogestrel subdermal implant among the women is low, however, it is found be effective with good continuation rate in the center. Efforts should be made to increase its uptake so as to prevent unwanted pregnancy and associated sequelae.
基金supported by the Zhejiang Provincial Natural Science Foundation of China(grant no.LQ22H150005).
文摘Breast augmentation with implants is a popular cosmetic surgery that enhances breast volume and contour through various placement planes.In this review,we examine the impact of subglandular,subpectoral,and subfascial implant planes on postoperative outcomes and complication rates.Subglandular placement offers simplicity but is associated with higher risks of capsular contracture,hematoma,and rippling in patients with low tissue coverage.The subpectoral plane,widely adopted for its natural appearance and reduced capsular contracture risk,may cause dynamic deformity due to muscle contraction.Although technically challenging,the subfascial plane combines the benefits of soft tissue support and reduced implant displacement.We highlight the importance of choosing an optimal implant plane tailored to each patient’s anatomical and aesthetic needs to enhance surgical outcomes and minimize complications.Further research is needed to validate long-term efficacy,particularly for subfascial placement.
基金Supported by the Science and Technology Research Project of Jiangxi Provincial Education Department,No.GJJ2208202Science and Technology Program Project of Health Commission of Jiangxi Province,No.202510069+1 种基金Jiangxi Cancer Hospital Doctoral Start-up Fund,No.BSQDJ202309Jiangxi Province Gan Po Talent Support Program,No.20232BCJ23035.
文摘BACKGROUND This case report examines the challenges associated with removing a totally implantable venous access port(TIVAP)used for long-term chemotherapy in a patient with breast cancer.Prolonged use of TIVAPs can result in complications such as catheter kinking,thrombosis,and adhesions between the catheter and surrounding tissues,potentially complicating their removal.CASE SUMMARY A breast cancer patient with bone metastasis presented with difficulty aspirating blood from a TIVAP that had been placed in the right internal jugular vein for 3 years.Initial removal attempts at the Department of Venous Access Center were unsuccessful,likely due to adhesions,necessitating a subsequent successful catheter extraction in a hybrid operating room.Imaging revealed no abnor-malities,and the catheter was removed using a mosquito clamp to detach it from surrounding tissues.CONCLUSION This case highlights the challenges of removing TIVAPs inserted via the internal jugular vein,particularly when the catheter traverses the sternocleidomastoid muscle.Repeated neck movements might lead to significant adhesions around the catheter,complicating its removal.Careful consideration should be given during catheter placement to avoid muscle-related adhesions and facilitate smoother extraction in long-term use.
文摘BACKGROUND Cancer patients with an implanted venous access port(IVAP)often manage their care at home during chemotherapy intervals,including maintaining the device,monitoring complications,and following medication instructions.Home care ensures continued support after discharge.However,due to factors such as age,gender,culture,psychological status,and family support,the quality of home care varies significantly.Understanding these factors can help provide targeted guidance to improve the care of cancer patients.AIM To explore IVAP chemotherapy on home care quality and its association with mental health and family support for cancer patients.METHODS This investigative study was based on a medical records system.It investigated the relationship between psychological status,family support,and home care quality in 180 patients with cancer undergoing IVAP chemotherapy.Psychological status was assessed using the State Anxiety Inventory(S-AI);family support was assessed using the Perceived Social Support Scale(PSSS),and home care quality was evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30).Pearson’s correlation and Structural Equation Modeling were used to analyze the interplay between these factors.RESULTS The average S-AI score was 47.52±14.47,PSSS was 52.48±12.64,and EORTC QLQ-C30 was 70.09±17.32.A substantial inverse relationship was observed between the EORTC QLQ-C30 and S-AI scores(r=-0.712).A significant positive correlation was found between the EORTC QLQ-C30 and the PSSS,with a correlation coefficient of(r=0.744).The multiple linear regression analysis indicated that family social support,psychological status,and average monthly family income were the main factors influencing the variation in the quality of home care,explaining 71.9%of the variation.The Structural Equation Modeling results indicated that psychological status acted as a partial mediator in the association between family social support and home care quality of life,explaining 32.78%of the mediation effect.CONCLUSION Psychological status and family social support positively impacted cancer patients’home care quality,with psychology partially mediating this effect.
基金supported by grants from the National Natural Science Foundation of China (No. 81141022)the General Hospital of Chinese Liberation Army (No. 10KMM09)
文摘Summary： Preoperative planning of corrective osteotomy with traditional radiography has limitations in regards to determining the ideal osteotomy location and orientation in three-dimensional femoral de- formities. Though a successful operation can be planned preoperatively, intraoperative contingencies might adhere to the procedural plan in the performance of operation. To efficiently perform a planned procedure, proposed is a design to implement three-dimensional reconstruction photography, based on computer-tomography （CT） scan. A custom-made guide was designed to navigate the osteotomy as planned, and additionally, a personalized intramedullary nail was used for fixation after osteotomy. Three-dimensional （3D） photography of deformed femur was established based on the CT dataset and transferred into 3D photography processing software for further planning. Osteotomy planes were de- signed and adjusted at deformity sites to correct the 3D deformities. The methodology of a custom-made osteotomy guide was introduced in femoral corrective osteotomy, for the first time, to navigate the op- eration as planned. After the virtual osteotomy and reduction of bone segments, the parameters of a custom-made intramedullary nail were measured for manufacturing. Findings Virtual operation in computer shows complete correction of the 3D deformity. The osteotomy guide, obtained by rapid-prototyping techniques, navigates mimicking surgery on rapid-prototyping model of the involved femur as planned. Internal fixation was achieved using the custom-made intramedullary nail. Interpreta- tion three-dimensional visualization introduces an advantage in preoperative planning for corrective os- teotomy of 3D femoral deformity, and the custom-made osteotomy guide is crucial to realize such a de- liberate plan during the actual procedures. The internal fixator, such as an intramedullary nail, can be modified or personalized for fixation in unique cases.
文摘Introduction: Cranioplasty is the surgical repair of a bony defect or deformity in the skull that is caused after cranial surgery or trauma. It carries cosmetic and protective benefits. Many types of materials are allowed. The subject of this study is to compare the outcome of two different manufacturing processes in reconstruction of calvarial skull defects by using 3D custom-made cranioprostheses versus hand-made bone cement implants. Patient and Methods: This is a prospective comparative study conducted on 20 patients of calvarial skull defects of different etiologies, sites and sizes, admitted in the neurosurgical departments of Cairo and Fayoum Universities in the period from August 2017 to February 2018. Patients are divided into two study groups: (group 1) 10 patients operated upon by 3D custom-made implant;(group 2) operated upon by hand-made bone cement implant. Statistical Analysis Used: Mann-Whitney test and Chi-square test. Results: Craniotomy using 3D custom-made implants gives better results than using bone cement in the functional restoration of skull shape and cranial protection with shorter operative time and less rate of postoperative complications. There is no statistically significant difference between the two study groups regarding cosmetic outcome. Conclusion: 3D custom-made implant is recommended for large and complex skull defects. Further and large studies might be needed.
基金a grant from the state of Schleswig-Holstein and the European Union ERDF-European Regional Development Fund(Zukunftsprogramm Wirtschaft)。
文摘Historically,the rapid degradation and massive gas release from magnesium(Mg)implants resulted in severe emphysema and mechanical failure.With the advent of new alloys and surface treatment methods,optimized Mg implants have re-entered clinics since last decade with reliable performance.However,the optimization aims at slowing down the degradation process,rather than exemption of the gas release.This study involved a systematic evaluation of current preclinical and clinical evidence,regarding the physical signs,symptoms,radiological features,pathological findings and complications potentially associated with peri±implant gas accumulation(PIGA)after musculoskeletal Mg implantation.The literature search identified 196 potentially relevant publications,and 51 papers were enrolled for further analysis,including 22 preclinical tests and 29 clinical studies published from 2005 to 2023.Various Mg-based materials have been evaluated in animal research,and the application of pure Mg and Mg alloys have been reported in clinical follow-ups involving multiple anatomical sites and musculoskeletal disorders.Soft tissue and intraosseous PIGA are common in both animal tests and clinical follow-ups,and potentially associated with certain adverse events.Radiological examinations especially micro-CT and clinical CT scans provide valuable information for quantitative and longitudinal analysis.While according to simulation tests involving Mg implantation and chemical processing,tissue fixation could lead to an increase in the volume of gas cavity,thus the results obtained from ex vivo imaging or histopathological evaluations should be interpreted with caution.There still lacks standardized procedures or consensus for both preclinical and clinical evaluation of PIGA.However,by providing focused insights into the topic,this evidence-based study will facilitate future animal tests and clinical evaluations,and support developing biocompatible Mg implants for the treatment of musculoskeletal disorders.
文摘BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures,sparking ongoing discourse over whether to retain or remove asymptomatic implants.Achieving consensus on this matter is paramount for orthopedic surgeons.This study aims to quantify the impact of routine implant removal on patients and healthcare facilities.A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University(KFHU)was conducted and subjected to statistical scrutiny.Among these cases,44%necessitated hospitalization exceeding one day,while 56%required only a single day.Adults exhibited a 55%need for extended hospital stays,contrasting with 22.8%among the pediatric cohort.The complication rate was 6%,with all patients experiencing at least one complication.Notably,34.1%required sick leave and 4.8%exceeded 14 d.General anesthesia was predominant(88%).Routine implant removal introduces unwarranted complications,particularly in adults,potentially prolonging hospitalization.This procedure strains hospital resources,tying up the operating room that could otherwise accommodate critical surgeries.Clearly defined institutional guidelines are imperative to regulate this practice.AIM To measure the burden of routine implant removal on the patients and hospital.METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU,a tertiary hospital in Saudi Arabia.Data were collected in the orthopedic department at KFHU from February 2016 to August 2022,which includes routine asymptomatic implant removal cases across all age categories.Nonroutine indications such as infection,pain,implant failure,malunion,nonunion,restricted range of motion,and prominent hardware were excluded.Patients who had external fixators removed or joints replaced were also excluded.RESULTS Between February 2016 and August 2022,360 implants were retrieved;however,only 167 of those who met the inclusion criteria were included in this study.The remaining implants were rejected due to exclusion criteria.Among the cases,44%required more than one day in the hospital,whereas 56%required only one day.55%of adults required more than one day of hospitalization,while 22.8%of pediatric patients required more than one day of inpatient care.The complication rate was 6%,with each patient experiencing at least one complication.Sick leave was required in 34.1%of cases,with 4.8%requiring more than 14 d.The most common type of anesthesia used in the surgeries was general anesthesia(88%),and the mean(SD)surgery duration was 77.1(54.7)min.CONCLUSION Routine implant removal causes unnecessary complications,prolongs hospital stays,depletes resources and monopolizing operating rooms that could serve more critical procedures.
文摘AIM:To evaluate the efficacy of custom-made soft keratoconus(KC)lenses on corneal aberrations and photic phenomena in two different optical zones in patients with KC.METHODS:Sixty eyes of 42 patients with KC were examined at baseline and after fitting HydroCone(Toris K)soft silicone hydrogel lenses.Best spectacle-corrected visual acuity(BSCVA)and contact lens-corrected visual acuity(CLCVA)were recorded.Lower-and higher-order corneal aberrations(LOAs and HOAs)were measured with and without Toris K lenses and compared in central 4.5 mm and 7 mm zones.Mesopic pupil diameter and subjective photic phenomena were also assessed.RESULTS:Mean CLCVA was significantly improved compared to BSCVA(P<0.0001).Corneal curvature and refractive measurements were found to be significantly reduced by the use of Toris K lenses,except for posterior corneal curvature values.In the 4.5 mm central optical zone,all wavefront aberrations decreased significantly after lens fitting(P<0.0001).In contrast,in the 7 mm(peripheral)optical zone,values for HOAs,spherical and residual aberrations,and optical path differences were increased,while LOAs,trefoil,and quadrifoil coefficients were decreased.The rate of photic phenomena was significantly higher in participants with a pupil size>6.00 mm(85.7%).CONCLUSION:Toris K lenses provide good visual results and a significant reduction in central corneal aberrations in patients with KC but could cause an increase in peripheral aberrations.This practical and nonsurgical approach appears to be an effective method for the visual management of KC.
文摘The clinical application of magnesium(Mg)and its alloys for bone fractures has been well supported by in vitro and in vivo trials.However,there were studies indicating negative effects of high dose Mg intake and sustained local release of Mg ions on bone metabolism or repair,which should not be ignored when developing Mg-based implants.Thus,it remains necessary to assess the biological effects of Mg implants in animal models relevant to clinical treatment modalities.The primary purpose of this study was to validate the beneficial effects of intramedullary Mg implants on the healing outcome of femoral fractures in a modified rat model.In addition,the mineralization parameters at multiple anatomical sites were evaluated,to investigate their association with healing outcome and potential clinical applications.Compared to the control group without Mg implantation,postoperative imaging at week 12 demonstrated better healing outcomes in the Mg group,with more stable unions in 3D analysis and high-mineralized bridging in 2D evaluation.The bone tissue mineral density(TMD)was higher in the Mg group at the non-operated femur and lumbar vertebra,while no differences between groups were identified regarding the bone tissue volume(TV),TMD and bone mineral content(BMC)in humerus.In the surgical femur,the Mg group presented higher TMD,but lower TV and BMC in the distal metaphyseal region,as well as reduced BMC at the osteotomy site.Principal component analysis(PCA)-based machine learning revealed that by selecting clinically relevant parameters,radiological markers could be constructed for differentiation of healing outcomes,with better performance than 2D scoring.The study provides insights and preclinical evidence for the rational investigation of bioactive materials,the identification of potential adverse effects,and the promotion of diagnostic capabilities for fracture healing.
文摘Large oro-antral communication, associated with total maxillectomy, may lead speech and/or swallowing dysfunction. These surgical defects are packed with obuturator or prosthesis following surgery;however, achieving retention and stability is dependent on anatomical conditions. A 68-year-old Japanese female with large oro-antral communication arising because of bilateral total maxillectomy was referred for evaluating application of obturator. The temporary obturator was constructed as underlying 3 mm thick and covereing 1.5 - 2 mm thick ethylene vinyl acetate sheet (EVA). These two sheets formed the flexible hollow bulb portion, which aided retention and stability by engaging the undercut portion of the surgical defect. For the patients who have difficulty anatomical features for conventional prosthesis, this type of temporary obturator made with EVA sheets could be an effective solution in the early postoperative period.
基金funded by the National Natural Science Foundation of China(Nos.L2224042,T2293731,62121003,61960206012,61973292,62171434,61975206,and 61971400)the Frontier Interdisciplinary Project of the Chinese Academy of Sciences(No.XK2022XXC003)+2 种基金the National Key Research and Development Program of China(Nos.2022YFC2402501 and 2022YFB3205602)the Major Program of Scientific and Technical Innovation 2030(No.2021ZD02016030)the Scientific Instrument Developing Project of he Chinese Academy of Sciences(No.GJJSTD20210004).
文摘The subthalamic nucleus(STN)is considered the best target for deep brain stimulation treatments of Parkinson’s disease(PD).It is difficult to localize the STN due to its small size and deep location.Multichannel microelectrode arrays(MEAs)can rapidly and precisely locate the STN,which is important for precise stimulation.In this paper,16-channel MEAs modified with multiwalled carbon nanotube/poly(3,4-ethylenedioxythiophene):poly(styrene sulfonate)(MWCNT/PEDOT:PSS)nanocomposites were designed and fabricated,and the accurate and rapid identification of the STN in PD rats was performed using detection sites distributed at different brain depths.These results showed that nuclei in 6-hydroxydopamine hydrobromide(6-OHDA)-lesioned brains discharged more intensely than those in unlesioned brains.In addition,the MEA simultaneously acquired neural signals from both the STN and the upper or lower boundary nuclei of the STN.Moreover,higher values of spike firing rate,spike amplitude,local field potential(LFP)power,and beta oscillations were detected in the STN of the 6-OHDA-lesioned brain,and may therefore be biomarkers of STN localization.Compared with the STNs of unlesioned brains,the power spectral density of spikes and LFPs synchronously decreased in the delta band and increased in the beta band of 6-OHDA-lesioned brains.This may be a cause of sleep and motor disorders associated with PD.Overall,this work describes a new cellular-level localization and detection method and provides a tool for future studies of deep brain nuclei.
基金supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health under Award Numbers R01 AR067306 and R01 AR078241。
文摘Bacterial colonization of orthopedic implants is one of the leading causes of failure and clinical complexities for load-bearing metallic implants. Topical or systemic administration of antibiotics may not offer the most efficient defense against colonization, especially in the case of secondary infection, leading to surgical removal of implants and in some cases even limbs. In this study, laser powder bed fusion was implemented to fabricate Ti3Al2V alloy by a 1:1 weight mixture of CpTi and Ti6Al4V powders. Ti-Tantalum(Ta)–Copper(Cu) alloys were further analyzed by the addition of Ta and Cu into the Ti3Al2V custom alloy. The biological,mechanical, and tribo-biocorrosion properties of Ti3Al2V alloy were evaluated. A 10 wt.% Ta(10Ta) and 3 wt.% Cu(3Cu) were added to the Ti3Al2V alloy to enhance biocompatibility and impart inherent bacterial resistance. Additively manufactured implants were investigated for resistance against Pseudomonas aeruginosa and Staphylococcus aureus strains of bacteria for up to 48 h. A 3 wt.% Cu addition to Ti3Al2V displayed improved antibacterial efficacy, i.e.78%–86% with respect to CpTi. Mechanical properties for Ti3Al2V–10Ta–3Cu alloy were evaluated, demonstrating excellent fatigue resistance, exceptional shear strength, and improved tribological and tribo-biocorrosion characteristics when compared to Ti6Al4V. In vivo studies using a rat distal femur model revealed improved early-stage osseointegration for alloys with10 wt.% Ta addition compared to CpTi and Ti6Al4V. The 3 wt.% Cu-added compositions displayed biocompatibility and no adverse infammatory response in vivo. Our results establish the Ti3Al2V–10Ta–3Cu alloy’s synergistic effect on improving both in vivo biocompatibility and microbial resistance for the next generation of load-bearing metallic implants.
文摘In this editorial,we comprehensively summarized the preoperative risk factors of early permanent pacemaker implantation after transcatheter aortic valve replacement(TAVR)among patients with severe aortic stenosis from several renowned clinical studies and focused on the primary prevention of managing the modifiable factors,e.g.,paroxysmal atrial fibrillation before the TAVR.
基金funded by the Wenzhou Public Welfare Science and Technology Project(Y2020118)Zhejiang Provincial Science and Technology Project for Public Welfare(LQ23H140001)Wenzhou Medical University Basic Scientific Research Operating Expenses(KYYW202230).
文摘Objective A high sodium(HS)diet is believed to affect bone metabolism processes.Clarifying its impact on osseointegration of titanium(Ti)implants holds significant implications for postoperative dietary management of implanted patients.Methods This investigation probed the impact of sodium ions(Na^(+))on neovascularization and osteogenesis around Ti implants in vivo,utilizing micro-computed tomography,hematoxylin and eosin staining,and immunohistochemical analyses.Concurrently,in vitro experiments assessed the effects of varied Na^(+)concentrations and exposure durations on human umbilical vein endothelial cells(HUVECs)and MC3T3-E1 cells.Results In vivo,increased dietary sodium(0.8%-6.0%)led to a substantial decline in CD34 positive HUVECs and new bone formation around Ti implants,alongside an increase in inflammatory cells.In vitro,an increase in Na^(+)concentration(140-150 mmol/L)adversely affected the proliferation,angiogenesis,and migration of HUVECs,especially with prolonged exposure.While MC3T3-E1 cells initially exhibited less susceptibility to high Na^(+)concentrations compared to HUVECs during short-term exposure,prolonged exposure to a HS environment progressively diminished their proliferation,differentiation,and osteogenic capabilities.Conclusion These findings suggest that HS diet had a negative effect on the early osseointegration of Ti implants by interfering with the process of postoperative vascularized bone regeneration.
文摘Degenerative calcific aortic valve stenosis(AS)is the most common valvular heart disease in elderly.^[1] It is well documented that symptomatic severe AS follows a malignant course leading to cardiogenic shock(CS).
文摘Background In the last years,transcatheter aortic valve implantation(TAVI)indication has expanded to younger and lower risk patients.Consequently,interest in mid and long-term follow up and in the role of life expectancy,as a key factor for selecting the most tailored treatment,has grown.The aim of this retrospective study is to compare the 4-year survival of patients who underwent aortic valve replacement(AVR)vs.TAVI at our department.Methods From September 2017 to December 2020,673 consecutive patients with severe aortic valve stenosis were enrolled for AVR(n=283)or TAVI(n=390).Inclusion criteria was isolated severe aortic stenosis,while exclusion criteria were redo surgery,valve-in-valve procedure and the need for concomitant surgical procedures.Based on the Lee index,patients were divided into four groups according to their 4-year life expectancy.Four-year survival was assessed and reported using the Kaplan-Meier method.A multivariate regression analysis of risk factors for 4-year mortality was performed.Results Four years survival is always superior in the AVR patients(89.8%vs.75.6%,P<0.001).Surgery is associated with a higher incidence of acute kidney injury(23%vs.5.1%,P<0.001),while TAVI is related to a higher incidence of new onset left bundle branch block(0 vs.23.8%,P<0.001),pace-maker implantation(2.5%vs.11.8%,P=0,02)and mild-to-moderate paravalvular leak(0.3%vs.5.4%,P<0.001).The independent risk factors for 4-years mortality are post-procedural AKI,poor mobility and transcatheter procedure.Conclusion In our analysis,4 years survival is always superior in the AVR patients.Life expectancy is a key factor for selecting the most appropriate approach for each patient.A longer follow up is mandatory before extending TAVI indication to patients with a long-life expectancy.
文摘Objective: By observing the treatment and nursing care of a patient with Grade IV capsular contracture following breast cancer expander implantation and subsequent Stage II reconstruction, we aim to analyze the reasons for the formation of capsular contracture after Stage I expander implantation and prevent its recurrence following Stage II reconstruction. Methods: In May 2020, the patient noticed an increase in the size of a breast mass. In August, she underwent AC-THP neoadjuvant chemotherapy, followed by a “right breast-conserving nipple-areolar subglandular excision + right axillary lymph node dissection + expander implantation” surgery in November 2020. Radiation therapy began in January 2021. During radiation therapy, the patient experienced severe breast hardening, distortion, tenderness, and was diagnosed with Grade IV capsular contracture. To relieve the capsular contracture, the patient underwent a “contracted capsule incision and release procedure + removal of the right breast expander + right breast implantation” surgery in July 2021. Postoperatively, measures were taken to prevent incision infection, emphasizing aseptic techniques, ensuring smooth negative pressure drainage, reducing skin flap tension, monitoring skin flap blood supply, actively preventing subcutaneous effusion and hematoma, and applying appropriate compression dressings. Results: The patient was discharged after the removal of the drainage tube. During the postoperative follow-up at 3 and 6 months, there was no recurrence of capsular contracture, and the breast appeared full, upright, and relatively soft. There were no complications such as hematoma, infection, breast implant rupture, breast sagging, or displacement. The patient had a good outcome without additional financial or surgical burdens. Conclusion: The occurrence of Grade IV capsular contracture in the patient is generally related to infection after Stage I expander implantation, improper compression dressing, excessive saline injection causing content infiltration, and radiation therapy. Therefore, it is recommended to enhance the intraoperative and postoperative prophylactic use of antibiotics after Stage I expander implantation. Intermittent saline injection after surgery, with the amount of saline gradually increasing rather than filling all at once, is advisable. This helps the breast tissue gradually adapt to expansion, reducing the risk of capsular contracture. Postoperatively, patients should be instructed to wear pressure garments and breast elastic bandages while intensifying breast monitoring during radiation therapy and increasing postoperative follow-up.
基金Supported by“14th Five-Year Plan”Key Cultivated Medical Specialty Construction Project,Foshan City(No.FSPY145217).
文摘Dear Editor,We report a case of bacterial endophthalmitis following implantation of a Staar intraocular collamer lens(ICL)caused by Gordonia bronchialis.ICL implantation is an effective method to correct myopia which generally offers excellent safety.There are a few reports of ocular infection caused by Gordonia bronchialis,but no ICL-related endophthalmitis has been reported to date.We present the first case of delayed-onset endophthalmitis after ICL implantation caused by Gordonia bronchialis,identified by metagenomic next-generation sequencing(mNGS).
