Fibrous Bands Research Articles

Advances in Viable Ice-free Cryopreservation of Heart Valves

Investigation of heart valve cryopreservation has been employed as a model for development of new methods of tissue preservation based upon vitrification and nanowarming using Fe nanoparticles. Cryoprotectant cytotoxicity can be reduced by performing the last cryoprotectant/nanoparticle exposure step below zero degrees centigrade at -10C. Tissue viability outcomes can be improved by supplementation of cryoprotectant formulations with disaccharides and nanowarming can rewarm such complex tissues with retention of cell viability from storage temperatures below -135oC to -25oC in 80-100 seconds. It is anticipated that ice-free tissue cryopreservation methods for tissues up to 50 mLs can be developed that do not require the use of nanowarming, since we are already close to achieving this with heart valves at 30 mL volumes. However, at larger volumes nanowarming will likely continue to be the best warming method for retention of tissue cell viability. Further studies to optimize cryopreservation of cardiac muscle, the somewhat fibrous muscle band at the base of heart valves, and pulmonary and aortic arteries need to be performed since it is clear that different heart valve components vary in their preservation requirements. It is anticipated that other complex tissues may also have components with different cryopreservation requirements including nanowarming.

Oral submucous fibrosis in North Gujarat: A demographic study

Background: Oral submucous fibrosis (OSMF) is a premalignant disorder, mainly caused by betel nut chewing in various forms. It is found in the Asian subcontinent, mostly India, Pakistan, Sri Lanka, and Bangladesh. The understanding of the exact role of alkaloids and other etiological agents with respect to pathogenesis will help in the management and treatment modalities.Aim: The purpose of the study is to evaluate the epidemiologic profile of patients with OSMF in the North Gujarat population.Materials and Methods: Patients of OSMF attending the OPD of Siddhpur Dental College were selected for the study. Total numbers of 100 cases of clinically diagnosed OSMF were included for this study. A detailed case history was taken and clinical examination was done in visible light. The patients having difficulty in opening the mouth along with associated blanched oral mucosa with palpable fibrous bands were diagnosed as OSMF patients were included in this study. This study was done on the basis of age group, habit duration, types of habit, and clinical grading of OSMF. After collecting data, they were analyzed statistically.Results: From 100 OSMF patients majority had Grade III interincisal mouth opening. Among the groups divided based on age, Group II (15–30 years age) showed more prevalence than the others. Gutkha and masala (main content areca nut) were a powerful etiological factor (4%) among other etiological factors.Conclusion: OSMF predominantly affects younger age group adults with male predilection and the majority of patients presented with a progressive and advanced form of disease. Thus, advancement in diagnostic aids is required to arrest the disease in its initial stages.

Endoscopic Assisted Transaxially Approach for First Rib Resection in Thoracic Outlet Syndromes

Thoracic outlet syndrome (TOS) is a complex of signs and symptoms resulting from compression of the nerves and vessels supplying the upper limb. Previous articles described that physicians who do not regularly treat patients with TOS may not have an accurate view of this disorder, its treatment, or the possible success rate of treatment. Roos reported that TOS is underdiagnosed. Difficulty in diagnosis of TOS correctly may cause unexplained various symptoms and less objective diagnostic criteria. Moreover, surgical management for TOS remains more challenging. Transaxillary first rib resection is a well-established surgical treatment for patients with symptomatic TOS. However, it does not allow an adequate exposure of the insertion of the scalene muscle to the first rib. Because surgery for TOS involves many complex and intimately related structures, theoretical complications are numerous and may be severe. There were reported complications including brachial plexus dysfunction and fatal subclavian artery or vein injury. Recent articles showed that with the help of the endoscope, more safety and less invasive surgery has been achieved. The purpose of this study is to access the feasibility of endoscopic assisted transaxially approach for first rib resection in TOS. Forty-eight cases of TOS (21 women and 27 men; mean age, 28.1 years; range, 13-57 years) who underwent endoscopic assisted first rib partial resection were reviewed retrospectively. Conventional transaxially approach described by Roos was underwent before identification of the first rib. A 4.0 mm 30°arthroscope was introduced with an additional small port placed anterior latissimus dorsi. The scope allowed for visual identification and confirmation of the first rib and the contents of the thoracic outlet. Endoscopic classification of neurovascular bundle patterns (NVB), that is, alignment of the nerve, artery, and vein were evaluated intraoperatively. In addition, distance between anterior and middle scalene muscle at the edge of the first clavicle was measured. The first rib was transected anteriorly near the costochondral junction and posteriorly as close to the transverse process as possible in a piece by piece fashion under good visualization with great care to avoid injury to the subclavian vein immediately anterior to the anterior scalene muscles. Roos and Wood score and DASH score was obtained postoperatively. Intraoperative endoscopic findings revealed 3 classifications of NVB patterns based on alignment of scalene muscles, nerve, and artery: parallel type (9 cases) in which the artery and nerve travel parallelly; oblique type (24 cases), in which the nerve was behind the artery; vertical type (15 cases), in which the nerve were totally behind the middle scalene muscle or abnormal band. Abnormal NVB patterns (24 oblique and 15 vertical type) were found in 39 cases (81.3%). In many patients, the interscalene distance was narrow (4.9 mm, range 0-13 mm). Of the congenital abnormal fibrous bands that were identified, 26 of 31 selectively were compressing the lower trunk of the brachial plexus. The insertion of the anterior or middle scalene exceeded the scalene tubercle and extended onto the superior surface of the rib in 13 cases and this was through to narrow the interscalene interval. Postoperative clinical findings showed that excellent or good results by Roos score were obtained in 38 cases (79.2%) and fair to poor results were recorded in 10 cases (20.8%). Pre- and postoperative mean DASH scores were, 35.1 (range 2-77) and 19 (0-72), respectively. No major complication was reported except one pneumothorax. Although transaxillary first rib resection is a well-established surgical treatment for patients with symptomatic TOS, this procedure requires meticulous technique with special attention to fine details to achieve the best results with the least complications. Therefore, many physicians may hesitate to diagnose and treatment TOS.

Prediction of Motor Recovery after Stroke by Assessment of Corticospinal Tract Wallerian Degeneration Using Diffusion Tensor Imaging.

Aim of the Study To predict motor recovery after stroke by detection of diffusion tensor imaging (DTI) fractional anisotropy (FA) changes of corticospinal tract (CST) and correlate findings with clinical scores to provide more effective treatment and rehabilitation. Subjects and Methods Thirty patients with cerebral stroke were enrolled and underwent conventional magnetic resonance imaging and DTI at admission and 1 month after stroke. Mean diffusivity (MD), FA, FA ratio (rFA), and fiber number (FN) values of CST were calculated at the pons at admission and after 1 month of stroke. Three-dimensional reconstruction of bilateral CST and the structural changes of fibrous bands were observed. Severity of limb weakness was assessed by using the motor sub-index scores of the National Institutes of Health Stroke Scale (NIHSS) at admission, and after 1, 6, and 9 months for severity of limb weakness. Results The mean age of our patients was 61.32 ± 4.34 years, 17/30 (56.6%) were females, and 13/30 (43.4%) were males. In our study, 18/30 (60%) were hypertensive, 19/30 (63.3%) were diabetic, and 12/30 (40%) were smokers. A significant negative correlation was found between rFA and FN in the ipsilateral CST of the cerebral infarction at the rostral part of pons after 1 month of infarction and NIHSS score at 6 months ( r = 0.377, p = 0.04 and r = 0.237, p = 0.02, respectively). However, a positive insignificant correlation was found between MD and NIHSS ( r = 0.345, p = 0.635). The initial NIHSS score at the time of injury was 19.2 ± 4.3, which changed to 7.9 ± 2.4, 4.6 ± 1.9, and 3.3 ± 1.4 at 1, 6, and 9 months, respectively. Conclusion DTI is a sensitive tool for early detection of Wallerian degeneration in the CST after stroke, and can predict motor performance to provide effective treatment and rehabilitation to improve quality of life.

Plaque Morphea at Distance from Breast Cancer Radiotherapy: A Cost of the Treatment?

Introduction. Morphea is a rare dermatological disease with no known cause, characterized by persistent inflammation, collagen deposition, fibrosis, and atrophy, as well as a considerable reduction in quality of life. Case presentation. An 89-year-old female patient, with a history of arterial hypertension, right mastectomy, and radiation therapy for breast cancer 10 years before, presented for the appearance of two erythematous plaques in the right submammary groove and right flank. The plaques are well-defined, with irregular margins, and have dimensions of 10/5 cm, and 13/8 cm respectively, were infiltrated, with areas of skin retraction and visible capillary network, itchy and painful. They were observed six months before presentation, as a single hyperpigmented lesion that gradually evolved into its current appearance and was treated as a subcutaneous hematoma, without resolution. Laboratory tests showed a nonspecific inflammatory syndrome and an increase in antinuclear antibodies. By corroborating the clinical and paraclinical data, the diagnosis of plaque morphea was made, and the systemic treatment with Penicillin G 2mil IU/12h, 311nm UVB phototherapy was initiated, with favorable evolution. At the subsequent hospitalization, after noticing the increase in the size of the plaques, with their extension to the left hemiabdomen, it was decided to start treatment with Methotrexate 7.5 mg/week, with a favorable evolution and the disappearance of fibrous bands. Conclusions. Although radiotherapy may be the trigger factor of morphea, the time until the onset of the disease (9 years) is consistent with the data presented in the literature (9.4 years).

Modern Diagnosis and Surgical Management of Thoracic Outlet Syndrome: A Comprehensive Review

Conventionally TOS has been thought to represent a group of diverse disorders that result in compression of the neurovascular bundle exiting the thoracic outlet. Until recently, TOS classification has been based on symptoms, rather than the underlying pathology, with the subgroups consisting of neurogenic (NTOS), venous (VTOS or PSS), and arterial (ATOS). Neurogenic TOS accounts for over 95% of the cases, followed by venous (3–5%) and arterial (1–2%). Neurogenic TOS (NTOS) has been further divided into True NTOS (TNTOS) and Disputed NTOS (DNTOS), with DNTOS reportedly representing 95–99% of all neurogenic cases. In order to decrease confusion and to improve therapeutic results with TOS, the disease should be classified based on the underlying pathologic entity. Acquired and traumatic abnormalities of the clavicle and first rib should be classified separately. Clearly after the more common and objectively supported diagnoses of conditions that result in neurovascular symptoms of the upper extremity, such as cervical spine disease, carpal tunnel disease, and nerve entrapment syndromes, have been ruled out, there remains a group of patients who are suspected of having TOS. In these patients, rather than the more usual classification such as arterial, venous, or neurogenic, the more accurate approach from a diagnostic and therapeutic approach is to classify them as: Cervical Rib Disease: Patients with cervical rib syndrome (CRS) can have complications relating to compression of the subclavian artery (previously referred to as ATOS) and the brachial plexus(previously referred to as True NTOS) secondary to a well-formed cervical rib, or to an incompletely formed first rib, fibrous band associated with a rudimentary cervical rib, or a giant transverse process of C7. Thoracic Outlet Disease or “Subclavian Vein Compression Syndrome”: In these patients an abnormal first rib at its junction with the sternum results in compression of the subclavian vein at the subclavian-innominate junction. Compression of the vein results in venous hypertension in the upper extremity and resultant neurologic symptoms. With prolonged compression of the subclavian-innominate junction, the vein clots giving rise to Paget–Schroetter syndrome. Therefore, patients who have been previously classified as Disputed Neurogenic and Venous TOS represent a variable symptomatic presentation of the same pathologic entity, which affects the subclavian vein. Presently MRA of the thoracic outlet with arm maneuvers is the test of choice in patients suspected of having TOS. This test shows the abnormal bony tubercle on the first rib with extrinsic compression of the subclavian innominate junction, which is exacerbated with elevation of the arm above the shoulder. Robotic resection of the medial aspect of the first rib along with disarticulation of the costo-sternal joint has the best reported results to date.

Thyroid fibrous band and levator glandulae thyroideae muscle: Two different structures associated with the pyramidal lobe of the thyroid gland

We investigated two structures that are in close association with the pyramidal lobe of the thyroid gland. Our investigation was performed using microdissection and histological examination in 106 human postmortem specimens. The first investigated structure was identified as the thyroid fibrous band that was present in 28.3% of cases. This band was always associated with the pyramidal lobe (which was significantly longer and thicker when associated with this band) and it had a constant hyo-pyramidal extension; it was located close to the midsagittal plane and predominantly composed of dense irregular connective tissue. The second investigated structure was the levator glandulae thyroideae muscle, which was associated with the pyramidal lobe in only 13.6% of cases. This muscle had a double extension, hyo-pyramidal and laryngo-pyramidal, located farther from the midsagittal plane, it was longer and thinner than the thyroid fibrous band and predominantly composed of striated muscle fibers. We confirmed our hypothesis that the thyroid fibrous band, which may be considered as the partial fibrous remnant of the thyroglossal duct and levator glandulae thyroideae, and which may be considered as infrahyoid or laryngeal muscle, are two different structures of the thyroid gland.

An 8-year retrospective analysis of oral submucous fibrosis in patients visiting dental College, Secunderabad

Background: Oral submucous fibrosis (OSMF) is a chronic, progressive, scarring precancerous condition of the oral cavity seen predominantly in the Indian subcontinent and South East Asia. In India, the prevalence of OSMF has been increased over the past four decades from 0.03% to 6.42%. Aim: The study aims to provide an 8-year retrospective analysis of OSMF in patients visiting dental college, Secunderabad. Materials and Methods: A retrospective analysis was conducted from 2008 to 2016 in dental college, Secunderabad. Data were collected from patient's outpatient records from the department of oral medicine and radiology, year wise in the perspective of demographic details, history of nutritional deficiency, adverse habits, symptoms, clinical features, site involved, and mouth opening. There were no inclusion or exclusion criteria. All the cases which were provisionally diagnosed to be OSMF were included. The data were analyzed with SPSS package version 24. Chi-square test has been applied to check the association of different parameters such as gender, nutritional deficiency, adverse habits, area, palpable fibrous bands, and mouth opening with age.P< 0.05 was considered statistically significant. Results: The total patients were found to be 107. The mean age of the patients was 38 ± 12. Among the total patients, 86% were males and 14% were females. Among them, 3.7% were unskilled workers. Almost all of them (99%) reported no nutritional deficiency. Majority (51.4%) were having betel nut chewing habit, followed by tobacco chewing, intake of spicy food, smoking, and alcohol. Nearly 43% had limited mouth opening, followed by burning sensation and other symptoms. Palpable fibrous bands were present in 4.1% of the patients. Nearly 83.2% have been affected with OSMF in the buccal mucosa site. Grade 1 (>20 mm) mouth opening was present in 12.1% of the patients, 7.5% were having Grade 2 (11–19 mm), and 3.7% had Grade 3 (<10 mm) mouth opening. A significant association was found between age and adverse habits (P = 0.023). There was no significant association between age and sex (P = 0.924), nutritional deficiency (P = 0.766), area (P = 0.567), palpable fibrous bands (P = 0.221), and mouth opening (P = 0.155). Conclusion: Majority of the patients with OSMF were males who were < 30 years, having betel nut chewing habit and Grade 1 mouth opening.

An Unusual Case of Nausea and Vomiting in Pregnancy: A Case Report

Malrotation of the gut is rare in adults. We discuss the case of a 30-year-old primiparous woman who presented to the acute gynecology ward at 19-weeks’ gestation with ongoing nausea and vomiting throughout pregnancy. She attended on a number of occasions with the same symptoms and was trialed on a number of different antiemetics. Initial biochemical investigations were unremarkable, however, the patient started to develop signs of ‘abdominal obstruction’. A magnetic resonance image (MRI) of the pelvis showed evidence of duodenal obstruction secondary to malrotation which may be secondary to a fibrous (Ladd’s) band. She was treated laparoscopically via a Ladd procedure and had an uneventful recovery. Interestingly, the patient presented again in her second pregnancy with very similar symptoms and underwent another Ladd procedure, but via a laparotomy. This is an interesting, rare and unusual case of nausea and vomiting in pregnancy.

Nutritional Assessment of Liver Cirrhosis Patients Visiting Public Hospital, Lahore

Cirrhosis is defined as the development of regenerative nodules surrounded by fibrous bands and inflammation of liver, which can cause portal hypertension or hepatic insufficiency that causes jaundice, hepatic encephalopathy or various complications. The important function of liver is to maintain the body metabolic homeostasis. It also helps in protein, carbohydrate, and fat metabolism, due to which the diet of a person is fully affected Objective: To assess the nutritional status of liver cirrhosis patients, visiting Public Hospitals, Lahore Methods: A cross-sectional study was performed at Sir Ganga Ram Hospital Lahore, for a period of 4 months and 100 patients of liver cirrhosis were selected by non-probability convenient sampling to conduct the study. Results: Of total 100 patients, 53% were males and 47% were females. The mean of age, body mass index and calories intake were (53.17±18.414), (19.12±4.743) and (544.88±437.195). Out of 100 patients only 7% of the patients were nourished, 58% are malnourished, and 35% patients were severely malnourished. Mostly patients were malnourished and lost weight due to disease. The mean BMI of patients was19.12±4.743, which shows that mostly patients were malnourished and undernourished. Sarcopenia was common in patients suffering from liver cirrhosis. Conclusions: Cirrhosis is complication of liver disease that involves loss of liver cells and irreversible scarring of the liver. It is more prevalent in males as compared to females.

Pyloric perforation in situs inversus totalis and Ladd’s band with dextrocardia: a collection of rare anomalies and associated operative challenge

Situs inversus totalis with dextrocardia is a rare entity where the liver and gall bladder are on the left side and the spleen on the right. It is an autosomal recessive mode of inheritance and the patients are usually asymptomatic with a normal life span. Ladd’s band on the other hand is a fibrous band of peritoneum lying over the duodenum to the caecum, which usually presents as intestinal malrotation and is most commonly diagnosed and treated with Ladd’s procedure in infancy itself. Asymptomatic adult cases presenting later in life are rarely seen. Here we present a case of a 22-year-old male who presented with symptoms of perforation peritonitis and was diagnosed on clinical and radiological examination to have situs inversus. Intra-operative findings later revealed presence of a Ladd’s band too.

Laparoscopic Treatment of Celiac Axis Compression Syndrome-Dunbar Syndrome

Dunbar syndrome or celiac artery compression syndrome was described for the first time by Harjola in 1963. It’s an infrequent clinical condition, with few criteria for diagnosis and with obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. This syndrome is as uncommon cause for upper abdominal angina. The classic sympthoms include vomiting associated to pos prandial pain, weight loss and soufle in the epigastric region. Diagnosis is made by abdominal angiotomography, arteriography and magnetic resonance imaging. Surgical ligament release is indicated in case of severe compression of the celiac trunk or in patient’s refractory to clinical treatment [1].

Fibrous Connection Between Cervical Nerve and Zygapophysial Joint and Implication of the Cervical Spondylotic Radiculopathy: An Anatomic Cadaveric Study.

Observational, anatomical, cadaveric study. We anatomically investigated the fibrous connection between the cervical nerves and the zygapophysial joint capsules. Cervical spondylotic radiculopathy is caused by the compression of the cervical nerves as the static factor and head and neck movements as the dynamic factor. To understand the dynamic pathology of cervical spondylotic radiculopathy, the anatomic relationship between the cervical nerves and the zygapophysial joints needs to be investigated in detail. In 11 cadavers, we dissected both sides from the C5 to C7. For macroscopic examination, we observed structures connecting the cervical nerves and the zygapophysial joints in 18 cervical nerves from three cadavers. In 14 sides of eight cadavers, we histologically analyzed the fibrous structures and their attachments. Macroscopically, the fibrous band connected the cranial surface of the cervical nerve to the lateral and inferior aspects of the transverse process. In four of 18 nerves, the fibrous bands were divided into two fascicles by loose connective tissues. In addition, the fibrous bands extended along the dorsal aspect of the posterior tubercle of the transverse process and attached to the zygapophysial joint capsule. Histologically, densely stained fibrous tissues overlaid the zygapophysial joint capsule and extended to the recess between the posterior tubercle and inferior articular process on the cranial vertebral body. We macroscopically and histologically clarified the fibrous bands connecting the cervical nerve to the zygapophysial joint capsule. The fibrous bands may help clarify the pathology of cervical spondylotic radiculopathy associated with the zygapophysial joints as dynamic factors.Level of Evidence: N/A.

Tobacco use and oral mucosal changes in Baiga tribals of Madhya Pradesh

Tobacco use leads to oral mucosal changes and submucous fibrosis. Use of tobacco products is common amongst primitive tribes for various purposes leading to high prevalence of oral lesions. To estimate the prevalence of oral mucosal changes amongst tobacco users, to identify the factors contributing to increased tobacco use and suggest strategies for prevention. A cross-sectional study was conducted amongst primitive Baiga tribe at Mandla block in Mandla district of Madhya Pradesh. Multistage random sampling method used to select the study villages with predominantly Baiga families. Prevalence of mucosal changes estimated by pilot study 41% was used to calculate sample size of 540. Data was elicited by interview and clinical examination after consent. Diagnosis was according to various stages of Pindborg classification for oral mucosal fibrosis. Data is analysed in MExcel and prevalence values presented as percentages. Chi sq test and odds ratio calculated to express association and risk estimate. All the 540 study subjects were of low socio economic status. A total of 256 (47.4%) developed oral mucosal changes as per the Pindborg classification for oral submucosal fibrosis. Amongst the 296 tobacco users 77% developed oral mucosal changes compared to 11.5% for non-users. (Odds ratio= 25.8. CI 16.03 to 41.71). Majority 59% had stage 1 changes in oral mucosa presenting as mucosal ulcers, erythema, melanotic pigmentation and petechiae ranging between 27 t0 18%, while 35% presented in stage 2 with fibrous bands in 19.3%. Leukoplakia observed in 5.8% The age group with maximum cases was 21-40 years but 53.6% amongst 10 to 19 years, had oral lesions. Extensive use of tobacco products (Nas&amp;Gudhaku) as dental cleanser and other purposes caused addictions from young age. Lack of awareness, social norm and easy availability aggravated the condition.The current study highlights the problem of oral mucosal changes and OSMF amongst those in the primitive Baiga tribals due to social norm, cheap colourful packets easily available in the local market, and finally addiction. The high prevalence and continued use noted in our study reflect the absence of any preventive and promotive measures by the health personnel for the tribe. The Tobacco Control Act need to be reinforced there and targeted intervention for the welfare of the tribe be introduced to manage the menance.

Role of diode laser in oral submucous fibrosis

Introduction: Oral submucous fibrosis is a precancerous condition affecting the oral cavity, oro-pharynx and rarely esophagus, tongue and commonly seen in those consuming betel nut. Its incidence has been reported 0.5% of the Indian population with a 7.6% potential for development of oral malignancy. Although various treatment modalities like medical and surgical are available, but there no single specific treatment modality for this condition. Case Report: A male patient of age 45-year-old diagnosed with oral submucous fibrosis was treated with diode laser under local anesthesia and followed for three months. Conclusion: Excision of the fibrous bands done by using diode laser followed by covering of collagen sheath on the raw surface of buccal mucosa gives uneventful healing with satisfactory results. Keywords: Oral submucous fibrosis, Trismus, Diode laser.

Chest CT imaging features of COVID-19 and its correlation with the PaO2/FiO2 ratio: a multicenter study in Upper Egypt

BackgroundThe main challenge in managing COVID-19 pandemic is containment of the infection by early detection of the disease and wide dissemination of diagnostic tests with high sensitivity and specificity. Various imaging features were identified by chest CT with different patterns from early disease to diffuse disease with complications. However, CT cannot be performed for all patients. The arterial oxygen partial pressure/fraction of inspired oxygen (PaO2/FiO2) ratio is evaluated as a rapid and widely available test for the preliminary assessment of disease severity. This study aimed to evaluate the clinical and chest CT imaging features of COVID-19 in Egyptian patients as well as assess the correlation between the chest CT total severity score and the PaO2/FiO2 ratio to determine its value for preliminary assessment of disease severity.ResultsThe most common symptoms were fever (83.2%), dry cough (77%), malaise (68.8%), prolonged headaches (48.5%), and dyspnea (37.6%). CT was positive in 79.2% of the patients. The CT features at presentation were ground-glass opacities only (40%), ground-glass opacities with consolidation (34.4%), and consolidation only (25.6%). Associated findings included crazy paving (17.5%), interlobular septal thickening (47.5%), air bronchogram (15%), bronchiectasis (12.8%), fibrous bands (8.1%), vascular enlargement within the lesion (45.6%), nodules (6.8%), pericardial thickening (5%), and pleural thickening (24.7%). The lesions were typically multilobar (50.5%), posterior (58.1%) with peripheral and central distribution (41.9%). Moderate negative correlation was observed between the CT total lung severity score and PaO2/FiO2 ratio with r = − 0.42 and P < 0.001.ConclusionThe most common pattern of COVID-19 pneumonia in multiple quarantine hospitals was peripheral and central ground-glass opacities with bilateral multilobe posterior involvement and fever was the most common symptom. PaO2/FiO2 ratio has a moderate negative correlation with the CT total severity score and thus can be used in the preliminary assessment of disease severity.

Analyse des facteurs anatomiques associés au syndrome du tunnel ulnaire

BackgroundPrevious studies demonstrated that soft tissues, such as retinaculum, fibrous band, and anconeus, cause ulnar nerve compression, whereas other studies showed that the bony structures strain the ulnar nerve that runs directly behind the medial epicondyle constituting the boundary of the cubital tunnel during elbow flexion. However, no studies have reported the association of the shape of the bony structure with cubital tunnel syndrome symptoms. Are computed tomography (CT) and magnetic resonance imaging (MRI)-measured parameters of the bony cubital tunnel related to idiopathic cubital tunnel syndrome symptoms? HypothesisWe hypothesized that CT and MRI-measured parameters of the bony cubital tunnel were related to idiopathic cubital tunnel syndrome symptoms. We aimed to investigate the relationship between the radiographic parameters based on CT and MRI and idiopathic cubital tunnel syndrome symptoms. Patients and methodsWe analyzed 224 elbows (77 affected elbows of patients with idiopathic cubital tunnel syndrome, 77 unaffected elbows of patients with cubital tunnel syndrome, 70 elbows of patients without cubital tunnel syndrome symptoms) using CT and MRI. Cubital tunnel cross-sectional area, cubital tunnel volume, and ulnar nerve cross-sectional area were measured in the three groups at flexion and extension. A new cubital tunnel center with a new boundary was proposed that could play a role in ulnar nerve compression symptoms. ResultsThe cross-sectional areas and volumes of the cubital tunnel measured in the elbow flexion state were the smallest among the group with the affected elbows in patients. There was no difference between unaffected elbows and the non-patient group. The cross-sectional area of the ulnar nerve highly correlated with cubital tunnel symptoms in the flexion state. DiscussionThe shape of the cubital tunnel is an important factor in cubital tunnel syndrome, and normal variations in the volume and cross-sectional area of the cubital tunnel and ulnar nerve could influence the occurrence of idiopathic cubital tunnel syndrome. Level of evidenceIII, Therapeutic study.

Fibrous bands associated with higher Masaoka stage and poor recurrence-free survival in patients with thymoma.

BackgroundFibrous bands (FBs) are one of the histological features in tumors which can be confirmed by hematoxylin and eosin (H&E)‐stained slides. FBs have been reported to correlate with malignancy in various tumors. This study aimed to investigate whether the presence of FBs is associated with malignancy in thymoma.MethodsA total of 123 consecutive patients with thymoma who underwent microscopically complete resections from January 2000 to December 2018 were enrolled into this study. H&E‐stained slides of all thymoma patients were re‐examined. Study patients were classified into two groups: with FBs (n = 36) and without FBs (n = 87). Clinicopathological characteristics, overall survival (OS), and recurrence‐free survival (RFS) were compared between the two groups. Furthermore, multivariate analyses were performed to identify whether the presence of FBs was associated with higher Masaoka stage and poor prognosis in patients with thymoma.ResultsThe Masaoka stage was found to be higher and recurrence more likely in thymoma patients with FBs than in those without. RFS was significantly poorer in thymoma patients with FBs than in those without, although no significant difference was observed in OS between them. The presence of FBs was significantly associated with higher Masaoka stage in the multivariate analysis using logistic regression. Additionally, the presence of FBs was an independent prognostic factor for poor RFS in multivariate analysis using Cox's proportional hazards model.ConclusionsThe presence of FBs in patients with thymoma was associated with higher Masaoka stage, higher recurrence rate, and poorer RFS.Key pointsSignificant findings of the studyFibrous bands (FBs) are bands of fibrosis dividing tumors into different‐sized irregular islands. The presence of FBs is associated with higher Masaoka stage and poor recurrence‐free survival in patients with thymoma.What this study addsThe presence of fibrous bands might be associated with the malignant behavior of thymoma. Confirming the presence or absence of FBs may result in personalized medication for patients with thymoma.

An Analysis of Patient-Reported Recovery Outcomes of Topical Tripeptide/Hexapeptide Formulations Utilized in a Prospective Randomized Double-Blind Split Neck and Body Study.

BackgroundPhysicians strive to improve the postsurgical experience and optimize patient-reported recovery outcome measures (PROMs) following elective cosmetic surgical procedures. Our previous pilot feasibility study demonstrated that twice daily postoperative topical body treatment with tripeptide and hexapeptide (TransFORM Body Treatment with TriHex Technology [TFB, Alastin Skincare, Inc., Carlsbad, CA]) reduced PROMs of swelling, induration, soft tissue fibrosis, and pain as well as improved visible and palpable skin quality. ObjectivesEvaluate whether adding a tripeptide/hexapeptide anhydrous gel (Regenerating Skin Nectar with TriHex Technology [RSN, Alastin Skincare, Inc., Carlsbad, CA]) pre- and post-procedure to the existing postsurgical regimen of TFB significantly improves 6 PROMs in patients undergoing neck and body contouring cosmetic surgical procedures.MethodsTen female patients underwent 15 neck and body contouring procedures and were blindly randomized to 1 of 2 topical treatment protocols (1 [TFB] and 2 [RSN/TFB]) pre- and post-procedure. Patient-reported scores of 5 skin parameters (skin discoloration, ecchymosis, edema, induration, and subcutaneous fibrous banding) and pain scores using the Visual Analog Scale were collected at 8 intervals for 12 weeks post-procedure.ResultsThe treatment side that used both topicals showed significantly reduced scores of edema, induration, and subcutaneous fibrous banding compared with the side that only used 1 topical, on days 5–7 and 10–14 (P < 0.05). All patients observed slower soft tissue recovery on the side that was treated with TFB alone and opted to break the code and use both topical treatments.ConclusionsPatients had statistically significant improved patient-reported measures of skin edema, skin induration, and subcutaneous banding on the operated side that used both topicals.Level of Evidence: 2

Surgical Observations of the Levator Aponeurosis Fibrotic Changes in Simple Congenital Ptosis Suggest Complex Pathogenesis.

To shed light upon the possible role of the levator aponeurosis (LA) developmental fibrotic changes as an added etiology for simple congenital ptosis, which causes limitation of the levator function (LF). This retrospective cohort study included patients with simple congenital ptosis who underwent skin approach LA resection as a primary intervention with an intraoperative photographic documentation of LA fibrotic changes. Preoperative demographics and clinical data were reviewed. The effect of LA fibrotic changes on the LF was assessed in different LA fibrotic changes with or without levator palpebrae superioris (LPS) muscle fatty infiltration. A total of 56 eyelids of 49 patients with a mean age (±SD) 6.7 (±3.2) years were enrolled in this study. The fibrotic changes of LA were observed as a sheet of fibrosis (19 eyelids) or fibrous bands (23 eyelids). Fatty infiltration of LPS was noticed in 28 eyelids, either with or without fibrotic changes of LA. Preoperative LF was diminished in LPS fatty infiltration compared with LA fibrotic sheets (P = 0.026). Postoperative LF improved significantly in both LA fibrotic sheets and LA fibrotic bands (9.4 ± 2.5 mm and 9.6 ± 2.8 mm, respectively) compared with LPS with fatty infiltration (6.4 ± 1.8 mm) (P = 0.004). Although our data are inconclusive due to lack of embryologic studies, the observed LA fibrotic changes may suggest a complex pathogenesis of simple congenital ptosis. The meticulous observation of the LA and the releasing of any adhesion or band to the surrounding structures could improve postoperative LF.