Partial Thickness Research Articles

Redefining superior escape of the humeral head: A radiographic and magnetic resonance imaging study

Background The underlying shoulder pathology in radiographic superior escape of the humeral head and association between acromiohumeral interval (AHI) on radiographs and magnetic resonance imaging (MRI) are poorly understood. Methods A retrospective review of shoulder radiographs and MRI scans was undertaken. AHI was measured using both modalities. Deltoid bulk, long head of biceps brachii subluxation/tear, and rotator cuff disease (tendon involvement, severity, fatty infiltration) were noted using MRI. Results A total of 167 patients were included. MRI measurements of AHI were significantly smaller than radiographic measurements ( p = 0.010). AHI was significantly smaller in patients with at least one partial or full thickness rotator cuff tear ( p < 0.0001) and in patients with increased fatty infiltration based on Goutallier grade ( p = 0.004). In the presence of two or more tendon tears, long head of biceps brachii rupture was associated with superior escape ( p < 0.001). In patients with superior escape (AHI <6 mm), the number of rotator cuff tendon tears ranged from 0 to 3 and Goutallier grades from 0 to 4 representing a wide disease spectrum. Discussion Radiographic superior escape of the humeral head is correlated with full thickness rotator cuff tears, fatty infiltration, and long head of biceps brachii rupture. However, superior escape can occur with a single or no tendon injury with minimal fatty infiltration. Level of evidence Level III; Retrospective Case-Control Design; Prognosis Study.

Iterative refinement of a histologic algorithm for burn depth categorization based on 798 consecutive burn wound biopsies

IntroductionOur group previously reported a burn biopsy algorithm (BBA-V1) for categorizing burn wound depth. Here, we sought to promulgate a newer, simpler version of the BBA (BBA-V2). MethodsBurn wounds undergoing excision underwent 4 mm biopsies procured every 25 cm2. Serial still photos were obtained at enrollment and at excision intraoperatively. Burn wounds assessed as likely to heal by 21 days were imaged within 72 h of injury and at 21 days. A sample of 798 burn wound biopsies were classified by both BBAV1 and BBAV2 algorithms. For nonoperative burn wounds, the proportion of healing versus nonhealing pixels at 21 days after injury were compared. ResultsThe 798 biopsies were classified by BBAV1 as 24% SPT, 47% DPT, 28% FT and by BBAV2 as 3% SPT, 67% DPT, and 30% FT (p < 0.0001). Overall, the proportion of biopsies whose wound reclassification changed from a nonoperative to operative pathway was 21% (95% CI: 18–24%). Nonoperative wounds judged at injury as being SPT contained 12.8 million pixels. Repeat 21-day imaging revealed 11.3 million healed pixels (accuracy = 89.6% (95% CI: 89.59–89.62)). ConclusionsBBA-V2 was associated with a significantly higher concordance with visual assessment for burn wounds clinically judged as deep partial and full thickness.

Treatment of rectosigmoid endometriosis by laparoscopic reverse submucosal dissection (LRSD): TheSydney partial thickness discoid excision technique.

Laparoscopic reverse submucosal dissection (LRSD) is a standardised surgical technique for removal of rectosigmoid endometriosis which optimises the anatomical dissection plane for excision of endometriotic nodules. This cohort study assesses the outcomes of the first cohort of women treated by LRSD, for deeply infiltrating rectosigmoid endometriosis. Primary outcomes assessed were complication rate as defined by the Clavien-Dindo system, and completion of the planned LRSD. Secondary outcomes include mucosal breach, specimen margin involvement, length of hospital admission, and a comparison of pre-operative and post-operative pain, bowel function and quality of life surveys. These included the Endometriosis Health Profile Questionnaire (EHP-30), the Knowles-Eccersley-Scott Symptom Questionnaire (KESS) and the Wexner scale. Of 19 patients treated, one required a segmental resection. The median length of hospital admission was two days (range 1-5) and no post-operative complications occurred. Median pain visual analogue scales (scale 0-10) were higher prior to surgery (dysmenorrhoea 9.0, dyspareunia 7.5, dyschezia 9.0, pelvic pain 6.0) compared to post-surgical median scores (dysmenorrhoea 5.0, dyspareunia 4.0, dyschezia 2.0, pelvic pain 4.0) at a median of six months (range 4-32). Quality of life studies suggested improvement following surgery with pre-operative median EHP-30 and KESS scores (EHP-30: 85 (5-106), KESS score 9 (0-20)) higher than post-operative scores (EHP-30: 48.5 (0-80), KESS score: 3 (0-19)). This series highlights the feasibility of LRSD with low associated morbidity as a progression of partial thickness discoid excision (rectal shaving) for the treatment of rectosigmoid deep infiltrating endometriosis.

Comparison of the Effectiveness of Lyophilized Amniotic Membranes in the Partial Thickness Wound Healing Process in Mus musculus

Background: Currently, tulle or gentamicin ointment is generally used to prevent wound infections in wound care. Human amniotic membrane has been used in medical fields such as wound care. So far, there is no comparative evidence of the effectiveness of each ingredient. This study aimed to compare the effectiveness of lyophilized amniotic membrane, tulle, and 0.1% gentamicin ointment in the wound healing process. partial thickness on Mus musculus clinically and histologically.&#x0D; Methods: This type of research is experimental with a post-test-only control group design. There were 24 rats divided into each group. This research was conducted at the anatomical pathology laboratory, Faculty of Medicine, Universitas Andalas, and INA lab in July - September 2023 using rats (Mus musculus), which were divided into 3 treatment groups and one control group.&#x0D; Results: Clinically, lyophilized amniotic membrane, 0.1% gentamicin ointment, and tulle provided better results than controls regarding erythema variables. Histologically, the results showed that the lyophilized amniotic membrane group had the thinnest epidermis and dermis, as well as better histological scores for granulation, fibroblasts, and collagen than the 0.1% gentamicin ointment, tulle, and control groups. In this study, significant differences in effectiveness were found in terms of erythema, skin thickness, granulation, fibroblast, and collagen histological scores, with better results in the lyophilized amniotic membrane group.&#x0D; Conclusion: Clinically, lyophilized amniotic membrane, tulle, and 0.1% gentamicin ointment were more effective than controls for wound treatment due to faster reduction in erythema. However, histologically, the lyophilized amniotic membrane was proven to be more effective than tulle, 0.1% gentamicin ointment, and control in terms of epidermis and dermis thickness, granulation level, fibroblasts, and collagen.

Peranan Sekuen Stir Pada Pemeriksaan MRI Shoulder Dengan Klinis Supraspinatus Injury Di Instalasi Radiologi Rumah Sakit Umum Pusat Persahabatan Jakarta Timur

Magnetic Resonance Imaging (MRI) is a diagnostic examination modality in medical science using a magnetic field without using X-rays. MRI has the advantage of being able to create images and showing clearer and more sensitive anatomical differences in soft tissues in the body such as the extremities, brain, bone marrow and musculoskeletal to establish a clinical diagnosis, one of which is Supraspinatus Injury to the Shoulder. Supraspinatus is a tear or rupture of the tendon of the supraspinatus muscle. The supraspinatus is part of the shoulder rotator cuff. Most of the time, it is accompanied by another rotator cuff muscle tear. This can occur due to trauma or repeated microtrauma and appears as a partial or full thickness tear. The rotator cuff is a fibrous connective tissue that surrounds the top of the humerus bone and functions to maintain the stability of the glenohumeral joint by pulling the humerus towards the scapula. The research method used is qualitative descriptive research with an observational approach. Data collection was carried out from 08 August 2023 to 07 September 2023 using the Mri Philips Achieva 1.5 Hestia aircraft. The patient sample used in this study was a patient with shoulder complaints. Data collection was carried out through observation, interviews and documentation. Shoulder MRI examination in Supraspinatus Injury Cases using a Philips 1.5 Hestia MRI aircraft has an examination procedure with a sequential design Survey, STIR_TSE_Tra, T1W_TSE_Tra, T1W_TSE_TRA_FS, STIR_TSE_Cor, COR_T2W_FFE, STIR_TSE_Sag, T1W_TSE_Cor, PDW_TSE_Sag

Full-thickness versus sliced cartilage in type I tympanoplasty, comparative study

IntroductionThe use of cartilage in type I tympanoplasty is associated with concern about a poor audiological outcome. Slicing the cartilage could be a tool to overcome such a feared problem.ObjectiveTo compare the healing and hearing outcomes of using sliced cartilage to full-thickness cartilage in type I tympanoplasty.MethodsSeventy patients with small to medium-sized central dry tympanic membrane perforation were included in this prospective study. The patients were randomly assigned to one of these two groups: group A: full-thickness cartilage tympanoplasty was done, and group B: partial thickness cartilage tympanoplasty was done. The assessment of healing and hearing was done at 3 and 12 months postoperatively.ResultsThe healing was achieved in 88.2% and 90.9% in group A and group B, respectively. In group A, the mean ABG was 23.44 dB preoperatively and 14.2 dB, and 12.6 dB in the first and second follow-ups, respectively. In group B, preoperative ABG was 23.58 dB compared to 7.9 dB and 6.93 dB in the two follow-ups, respectively. The results were significantly better in group B rather than group A at both follow-ups.ConclusionHearing results are better when sliced cartilage is used in tympanoplasty type I than full-thickness cartilage.

Two Cases of Posterior Uterine Rupture After Foetal Pillow Use; Is It Time To Think Twice About Using the Foetal Pillow?

Introduction: The incidence of caesarean section at full dilatation is increasing, with 10% being emergency cases. The Fetal Pillow device helps elevate the foetal head during such caesarean sections, potentially reducing blood loss and neonatal complications, however the evidence for this has recently been called into question. The authors presented 2 cases of possible complications associated with fetal pillow use. Case 1: A 40-year-old woman with a history of one previous caesarean section opted for vaginal birth after caesarean. After induced labor, the patient experienced fetal distress during pushing, leading to an emergency caesarean section using a Fetal Pillow. During the surgery, a 10cm vertical full-thickness posterior uterine wall rupture was noted, but the baby was delivered safely. The woman recovered well, but in future pregnancies, the patient was advised to have a planned caesarean section at 37 weeks. Case 2: A 36-year-old woman with two previous vaginal deliveries presented in spontaneous labor and ruptured membranes. An emergency caesarean section using a Fetal Pillow was performed due to a delay in the second stage of labour. Intraoperatively a 6cm vertical partial thickness posterior wall dehiscence was noted. The patient delivered a healthy baby boy with an uneventful recovery and was advised for a planned caesarean section in future pregnancies. Discussion: Posterior uterine wall ruptures are very rare but known to occur in labour. The authors reported the first 2 cases in the literature following Fetal Pillow use, raising the question as to whether the Fetal Pillow had any role in causing this rare uterine injury. Evidence on the efficacy and safety of Fetal Pillow remains limited and recent concerns have led to a recall of a significant study. These complications should be reported to ensure patient safety and regulatory awareness. Conclusion: This report presents two cases of posterior uterine wall rupture following the use of Fetal Pillow. It calls for a larger, well run, randomized control trial to analyze the safety of Fetal Pillow use and suggests that all Obstetricians should be educated on alternative strategies for foetal head disimpaction during cesarean sections.

Strength symmetry after autograft anterior cruciate ligament reconstruction

ObjectiveTo compare postoperative isometric quadriceps strength indices (QI%) and hamstring strength limb symmetry indices (HI%) between partial thickness quadriceps tendon (pQT), full thickness quadriceps tendon (fQT), and bone-patellar-tendon bone (BPTB) autograft anterior cruciate ligament reconstruction (ACLR). MethodsPatients with primary ACLR with pQT, fQT, or BPTB autograft with the documentation of quantitative postoperative strength assessments between 2016 and 2021 were included. Isometric Biodex data, including QI% and HI% (calculated as the percentage of involved to uninvolved limb strength) were collected between 5 and 8 months and between 9 and 15 months postoperatively. ResultsIn total, 124 and 51 patients had 5–8- and 9–15-month follow-up strength data, respectively. No significant difference was detected between groups for sex. However, patients undergoing fQT were found to be older than those undergoing BPTB (24.6±7 vs 20.2±5; ​p = 0.01). There were no significant differences in the number of concomitant meniscus repairs between the groups (pQT vs. fQT vs. BPTB). No significant differences were detected in median (min–max) QI% between pQT, fQT, and BPTB 5–8 months [87 ​% (44%–130 ​%), 84 ​% (44%–110 ​%), 82 ​% (37%–110 ​%) or 9–15 months [89 ​% (50%–110 ​%), 89 ​% (67%–110 ​%), and 90 ​% (74%–140 ​%)] postoperatively. Similarly, no differences were detected in median HI% between the groups 5–8 months or 9–15 months postoperatively. ConclusionThe study was unable to detect differences in the recovery of quadriceps strength between patients undergoing ACLR with pQT, fQT, and BPTB autografts at 5–8 months and 9–15-months postoperatively. Level of evidenceIII.

Skeletal muscle extracellular matrix structure under applied deformation observed using second harmonic generation microscopy

The mechanical and structural properties of passive skeletal muscle are important for musculoskeletal models in impact biomechanics, rehabilitation engineering and surgical simulation. Passive properties of skeletal muscle depend strongly on the architecture of the extracellular matrix (ECM), but the structure of ECM and its realignment under applied deformation remain poorly understood. We apply second harmonic generation (SHG) microscopy to study muscle ECM in intact muscle samples both under deformation and in the undeformed state. A method for regional relocation was developed, so that the same ECM segment could be viewed before and after applying deformations. Skeletal muscle ECM was viewed at multiple scales and in three states: undeformed, under compression and under tension. Results show that second harmonic generation microscopy provides substantial detail of skeletal muscle ECM over a wide range of length scales, especially the perimysium structure. We present images of individual portions of skeletal muscle ECM both undeformed and subjected to tensile/compressive deformation. We also present data showing the response of the perimysium to a partial thickness cut applied to a section under tensile deformation. Statement of significanceSecond Harmonic Generation (SHG) microscopy is an imaging technique which takes advantage of a non-linear and coherent frequency doubling optical effect that is present in a small number of biological molecules, primarily collagen Type I, II and myosin. Collagen I is the most abundant collagen type in skeletal muscle, making SHG a promising option for visualisation of the skeletal muscle extracellular matrix (ECM). SHG microscopy does not require fixing or staining. This short communication presents the application of SHG microscopy to skeletal muscle ECM to improve our understanding of how collagen fibres reorganise under applied tensile and compression, including microscopic observations of collagen fibre reorganisation for intact samples by using a method to re-identify specific regions in repeated deformation tests.

Impact of Quadriceps Tendon Graft Thickness on Electromechanical Delay and Neuromuscular Performance After ACL Reconstruction.

Both partial- and full-thickness quadriceps tendon (QT) graft harvests are used for anterior cruciate ligament reconstruction (ACLR). To evaluate the impact of QT graft harvest depth (full or partial thickness) on electromechanical delay (EMD), peak torque (PT), and rate of torque development (RTD) after ACLR. Controlled laboratory study. A total of 26 patients who underwent either partial-thickness (n = 14) or full-thickness (n = 12) autograft QT ACLR were recruited between June and November 2021 (>1 year before participation). Patients performed isokinetic knee extension testing with surface electromyography of the quadriceps muscles. Mixed repeated-measures analysis of variance with least significant difference post hoc testing was used to determine significant differences (mean difference [MD] ± SE) or interactions for all variables. A significant speed×depth interaction was seen for the vastus medialis (P = .005). Pairwise analyses showed significantly longer EMD for the partial-thickness graft than the full-thickness graft (MD ± SE, 19.92 ± 6.33 ms; P = .006). In the partial-thickness graft, the EMD was significantly longer at 90 deg/s versus 180 deg/s (MD ± SE, 19.11 ± 3.95 ms; P < .001) and 300 deg/s (MD ± SE, 16.43 ± 5.30 ms; P = .006). For PT, the full-thickness graft had a significantly lower PT on the operated versus nonoperated side at all speeds (MD ± SE: 90 deg/s, -57.0 ± 10.5 N·m, P < .001; 180 deg/s, -26.0 ± 10.2 N·m, P = .020; 300 deg/s, -20.3 ± 8.9 N·m, P = .034). For RTD, the full-thickness graft showed significantly Slower RTD for the operated versus nonoperated side at all time points (MD ± SD: RTD0-25 (0-25% of the range of motion), -131.3 ± 50.9 N·m/s, P = .018; RTD25-50, -197.0 ± 72.5 N·m/s, P = .014; RTD50-75, -113.3 ± 39.8 N·m/s, P = .013; RTD75-100, -149.4 ± 35.9 N·m/s, P < .001). Compared with partial-thickness QT, full-thickness QT showed a shorter vastus medialis EMD at higher loading, and therefore greater stiffness, as well as slower RTD and lower PT across all testing speeds. The impact of full-thickness QT autograft on EMD and neuromuscular performance should be considered for ACLR.

Endometriosis with colonic and rectal involvement: surgical approach and outcomes in 142 patients.

Endometriosis involving the colon and/or rectum (CRE) is operatively managed using various methods. We aimed to determine if a more limited excision is associated with 30-day complications, symptom improvement, and/or recurrence. This is a retrospective review of consecutive cases of patients who underwent surgical management of CRE between 2010 and 2018. Primary outcomes were the associations between risk factors and symptom improvement, 30-day complications, and time to recurrence. Multivariable logistic regression assessed the independent risk factors. Of 2681 endometriosis cases, 142 [5.3%of total, mean age 35.4 (31.0; 39.0) years, 73.9% stage IV] underwent CRE excision (superficial partial = 66.9%,segmental = 27.5%,full thickness = 1.41%). Minor complications (14.8%) were associated with blood loss [150 (112; 288) vs. 100 (50.0; 200) mls, p = 0.046], Sigmoid involvement [45.5% vs. 12.2%, HR 5.89 (1.4; 22.5), p = 0.01], stoma formation[52.6% vs. 8.9%, HR 10.9 (3.65; 34.1), p < 0.001], and segmental resection [38.5% vs. 5.8%, HR 9.75 (3.54; 30.4), p < 0.001]. Superficial, partial-thickness resections were associated with decreased risk [(4.2% vs. 36.2%), HR 0.08 (0.02; 0.24), p < 0.001]. Factors associated with major complications (8.5%) were blood loss [250 (100; 400) vs. 100 (50.0; 200) mls, p = 0.03], open surgery [31.6% vs. 4.9%, HR 8.74 (2.36; 32.9), p = 0.001], stomaformation [42% vs. 3.3%, HR 20.3 (5.41; 90.0), p < 0.001], and segmental colectomy [28.2% vs. 0.9%, HR 34.6 (6.25; 876), p < 0.001]. Partial-thickness resection was associated with decreased risk ([.05% vs. 23.4%, HR 8.74 (2.36; 32.9), p < 0.001]. 19.1% experienced recurrence. Open surgery [5.2% vs. 21.3%, HR 0.14 (0.02; 1.05), p = 0.027] and superficial partial thickness excision [23.4% vs. 10.6%, HR 2.86 (1.08; 7.59), p = 0.027] were associated. Segmental resection was associated with decreasedrecurrence risk [7.6% vs. 23.5%, HR 0.27 (0.08; 0.91), p = 0.024]. Limiting resection to partial-thickness or full-thickness disc excision compared to bowel resection may improve complications but increase recurrence risk.

Rat Microvascular Model is Tolerant to Technical Errors.

Extensive studies have been conducted using the rat model to understand the potential technical errors that lead to anastomotic failure. However, current literature indicates that the rat model has excellent tolerance to diverse errors committed by microsurgeons. The error-investigating rat model is often created by one or two experienced surgeons, and only one isolated technical error is examined. These biases may potentially cause limitations of the results from previous studies. Meanwhile, venous anastomoses have rarely been investigated in previous literature. Therefore, it is important to elucidate this topic with a more comprehensive study design. Ninety-four arterial and 94 venous anastomoses on Sprague-Dawley rat femoral vessels that were performed by 47 microsurgeons who participated in the microsurgery course at the Columbia University and the University of Thessaloniki were evaluated. In total, 10 technical errors were examined: (1) disruption of suture line, (2) back-wall stitch, (3) oblique stitch, (4) wide bite, (5) partial thickness bite, (6) unequal suture distance, (7) tear in vessel wall, (8) excessively tight suture, (9) suture threads in lumen, and (10) large edge overlap. The frequency of each error committed, and the 30-minute postoperative patency was also recorded. The underlying causal relationship between these errors, potential interaction, and the short-term anastomosis patency was analyzed statistically. Only the back-wall stitch was found to have a significant causal effect on arterial anastomosis failure (p < 0.001). Back-wall stitch, wide bite, and partial thickness bite significantly impact venous anastomosis patency (p < 0.001). No other statistically significant result was found. Overall, the rat model is highly resilient to various technical errors despite these mistakes being often considered clinically unacceptable. Therefore, researchers need to consider the resilience of the rat model when designing and analyzing future studies. In addition, microsurgery instructors should focus on individual stitch quality rather than the final patency.

Outcome Evaluation of Burn Injury Management: A Study of Selective Traditional Home Remedies.

Background Clinicians classify burns as epidermal, partial thickness (superficial and deep), or full thickness, according to the depth of tissue damage. Although skin is considered the largest organ in the human body, studies investigating burns, their types, and their management has revealed that the background knowledge of burn aid the community possesses remains unsatisfactory. Thus, in this study, we aimed to evaluate the effect of various traditional home remedies, taking into account the type of burns and the nature of the remedies usedfrom a cosmetic point of view. Materials and methods This is an original retrospective study conducted at Dr. Soliman Fakeeh Hospital in Jeddah from June through December 2022. Using the Vancouver Scar Scale (VSS), eligible patients who met our inclusion criteria were invited to participate in the study after a review of their patient history, an assessment of basic vital signs, and a physical examination. Results Fifty-two participants met our inclusion criteria and successfully completed the study. A total of 80 wounds of varying severity in various locations were evaluated. Participants were divided into three categories according to VSS scores indicating good, intermediate, or poor healing. None of the eight cases treated with water resulted in poor healing. However, tomato paste resulted in poor healing for six cases (60%) but moderate and good healing for two cases (20%). Conclusion The safest and most effective initial management for burns among all the reviewed remedies was the application of cool running water, followed by seeking medical attention for evaluation and proper treatment, whereas tomato paste had a markedly poor effect.

Human amniotic membranes as an allogenic biological dressing for the treatment of burn wounds: Protocol for a randomized-controlled study

BackgroundBurn wounds pose significant challenges in medical treatment due to their devastating nature and resource-intensive requirements. Temporary coverage of burn wounds using synthetic or biological dressings allows for reepithelization before definitive skin grafting. Allogenic skin grafts have been widely used but come with drawbacks such as rejection and disease transmission. The use of amniotic membranes (AMs) offers a promising alternative for temporary coverage, as they possess biological properties that promote faster healing and improved scar quality. The various components of the amniotic membrane, including pluripotent stem cells, extracellular matrix proteins, and regenerative factors, contribute to cell growth, migration, and differentiation, as well as preservation of the original epithelial phenotype. ObjectiveReliable information on the treatment of burn wounds with AM is needed. The knowledge gained in this project may help to include this advantageous modern concept of biological dressings in clinical practice. The purpose of this study is to use human amniotic membranes from our in hospital laboratory, as an allogenic biological dressing after enzymatic debridement in superficial partial thickness, deep partial thickness or full thickness burn wounds. MethodsWe will include 30 patients in a randomized-controlled trial with each patient receiving the study intervention and the control intervention. Two 7 × 7 cm burn wound areas will be compared regarding percentage of skin graft take, healing time, healing percentage value and total healing time. Human amniotic membranes will be compared to allogenic skin grafts.

A Machine Learning Model Demonstrates Excellent Performance in Predicting Subscapularis Tears Based on Pre-Operative Imaging Parameters Alone

To develop a machine learning model capable of identifying subscapularis tears before surgery based on imaging and physical examination findings. Between 2010 and 2020, 202 consecutive shoulders underwent arthroscopic rotator cuff repair by a single surgeon. Patient demographics, physical examination findings (including range of motion, weakness with internal rotation, lift/push-off test, belly press test, and bear hug test), and imaging (including direct and indirect signs of tearing, biceps status, fatty atrophy, cystic changes, and other similar findings) were included for model creation. Sixty percent of the shoulders had partial or full thickness tears of the subscapularis verified during surgery (83% of these were upper third). Using only preoperative imaging-related parameters, the XGBoost model demonstrated excellent performance at predicting subscapularis tears (c-statistic, 0.84; accuracy, 0.85; F1 score, 0.87). The top 5 features included direct signs related to the presence of tearing as evidenced on magnetic resonance imaging (MRI) (changes in tendon morphology and signal), as well as the quality of the MRI and biceps pathology. In this study, machine learning was successful in predicting subscapularis tears by MRI alone in 85% of patients, and this accuracy did not decrease by isolating the model to the top features. The top five features included direct signs related to the presence of tearing as evidenced on MRI (changes in tendon morphology and signal), as well as the quality of the MRI and biceps pathology. Last, in advanced modeling, the addition of physical examination or patient characteristics did not make a significant difference in the predictive ability of this model. Level III, diagnostic case-control study.

Accuracy of MRI in Assessment of High-Grade Partial Distal Biceps Tears.

Magnetic resonance imaging (MRI) is commonly used to diagnose and assess the extent of partial distal biceps injuries. The aim of this study was to report on the accuracy of MRI and the effect of injury history and study timing on its performance. A retrospective review of all patients who underwent surgical treatment of partial thickness distal biceps tears at a single center by multiple surgeons was performed. Inclusion criteria consisted of the performance of a preoperative MRI and documentation of the intraoperatively visualized extent of the tear, and 68 patients met the criteria for inclusion. A chart review was completed to evaluate the symptom duration, injury history, and tear extent. All patients had distal biceps tears of greater than 50% intraoperatively. However, MRI did not indicate any tearing in 20 (29%) patients, and its sensitivity for high-grade tear was 44%. Magnetic resonance imaging was significantly less likely to be read as high-grade tears in patients with insidious onset of their symptoms in comparison with patients who reported a traumatic onset (27% vs 55%, P = .024). However, the time from symptom onset to MRI did not significantly correlate with diagnosis of a high-grade tear on MRI (r = -0.15, P = .21). These results indicate that MRI can underreport partial distal biceps tear extent, and this more commonly occurs in patients with insidious onset of pain.

Hazards Of Monopolar Diathermy Plate In Surgery.

Respected Madam, I would like to draw attention to the hazard of severe skin burns from the using the monopolar diathermy plate electrode during surgical procedures. Diathermy operates in two modes. The monopolar mode where the current enters the patient’s body through an active electrode and exits via a grounding pad attached to the patient.(1) During a recent total abdominal hysterectomy with bilateral salpingo-oophorectomy of a 30-year-old lady with a complex mass, the grounding pad for the electro-cautery had been applied to the left foot, which was found to have third degree burns after completion of the procedure. Similarly, an elderly diabetic lady presented to our outpatient department with the history of a 32 days old non-healing lesion on her left thigh and a Pfannenstiel incision on her abdomen. She had undergone a complete abdominal hysterectomy in another health care centre. During the surgery, the grounding pad was placed on her left thigh which suffered partial thickness burns. According to the patient’s history, the lesion was coin sized at the beginning, but due to poor glycemic control, it continued to involve the surrounding healthy tissue, including the bone. She had previously undergone multiple debridements for the lesion and was advised hip disarticulation after a thorough assessment by the senior management at our department. Even though the procedure was carried out, she, unfortunately, could not survive a few days following the disarticulation. The reason for the burns was a loose application of the grounding pad to the skin of the patient resulting in heat generation and sparking at the site preventing the current to pass safely causing skin burns. To prevent this, the grounding pad should be firmly applied to the skin preferably with crepe bandage. Some other ways to help prevent such complications are adhesive grounding pads and utilization of diathermy machines alarm system.(1)Surgical briefing with the entire perioperative team is necessary so that each individual understands their role in preventing electrosurgical hazards.(2) In addition to this, case reporting of surgical burns to the national database is necessary for implementation of such preventive measures.(3)

Characteristics of pediatric ocular trauma in a tertiary hospital in Israel 2011-2020 - How can public prevention policy be improved?

To describe and analyze characteristics and trends of pediatric ocular trauma during 2011-2020. Retrospective descriptive study. Data were collected on all pediatric ocular trauma cases that presented to a Rambam Health Care Campus during 2011-2020. Data included age, gender, visual acuity, diagnosis, injury mechanism and surgical repair. Median BCVA at presentation was 0.96 (logMAR). Males and non-adolescent males specifically were the most prominent groups (70.6% and 44.7%, respectively). The ratio of ocular trauma cases to total pediatric emergency department (ED) visits was stable during 2011-2020 (p = 0.714) regardless of gender (p = 0.832 and p = 0.545 for boys and girls, respectively). The leading causes were partial thickness eyelid laceration, periorbital hematoma, and extraocular muscle contusion, all of which were stable over the study period (p = 0.678, p = 0.203 and p = 0.398, respectively). Falls and children play were the most common mechanisms (25.8% and 18.4%, respectively), but differed between age groups. Most patients did not require consecutive operation and were treated conservatively (p < 0.01). Pediatric ocular injuries to pediatric ED visits ratio remained stable during 2011-2020, regardless of gender. Non-adolescent males accounted for nearly half of all cases, with different mechanisms for each age group. Consecutive surgery was rarely necessary.

3D Bioprinting of Acellular Corneal Stromal Scaffolds with a Low Cost Modified 3D Printer: A Feasibility Study

Purpose Loss of corneal transparency is one of the major causes of visual loss, generating a considerable health and economic burden globally. Corneal transplantation is the leading treatment procedure, where the diseased cornea is replaced by donated corneal tissue. Despite the rise of cornea donations in the past decade, there is still a huge gap between cornea supply and demand worldwide. 3D bioprinting is an emerging technology that can be used to fabricate tissue equivalents that resemble the native tissue, which holds great potential for corneal tissue engineering application. This study evaluates the manufacturability of 3D bioprinted acellular corneal grafts using low-cost equipment and software, not necessarily designed for bioprinting applications. This approach allows access to 3D printed structures where commercial 3D bioprinters are cost prohibitive and not readily accessible to researchers and clinicians. Methods Two extrusion-based methods were used to 3D print acellular corneal stromal scaffolds with collagen, alginate, and alginate-gelatin composite bioinks from a digital corneal model. Compression testing was used to determine moduli. Results The printed model was visually transparent with tunable mechanical properties. The model had central radius of curvature of 7.4 mm, diameter of 13.2 mm, and central thickness of 0.4 mm. The compressive secant modulus of the material was 23.7 ± 1.7 kPa at 20% strain. 3D printing into a concave mold had reliability advantages over printing into a convex mold. Conclusions The printed corneal models exhibited visible transparency and a dome shape, demonstrating the potential of this process for the preparation of acellular partial thickness corneal replacements. The modified printing process presented a low-cost option for corneal bioprinting.

Feasibility of feline coxofemoral arthroscopy using a supratrochanteric lateral portal: A cadaveric study.

To evaluate the feasibility of feline diagnostic coxofemoral arthroscopy. Ex vivo feline cadaveric descriptive study. Seven feline cadavers (14 hips). Gross dissection of two feline hips was performed to evaluate anatomic landmarks, guide arthroscopic portal development, and determine optimal limb positioning. A 1.9 mm, 0° arthroscope, inserted through a supratrochanteric lateral portal, was used to assess intraarticular structures in 12 feline cadaver hips. Arthroscopy was followed by gross dissection of periarticular soft tissues. Relative portal locations and damage to periarticular structures were recorded. Hips were disarticulated, and an India ink assay was performed to assess whether there was iatrogenic cartilage injury (ICI). Scope insertion was achieved in all hips. Articular cartilage of the femoral head and acetabulum, round ligament, joint capsule, transverse acetabular ligament, and dorsal acetabular rim were identified arthroscopically in all hips. Probe insertion and intra-articular structure palpation was achieved in all hips. Scope and instrument portals resulted in minimal periarticular muscle trauma. No sciatic nerve damage was detected. Minor partial thickness ICI was observed in all hips at the site of scope insertion. Focal full thickness ICI was noted in one hip. Arthroscopy of the feline coxofemoral joint allowed visual and probe evaluation of intra-articular structures without evidence of major periarticular neurovascular trauma. Iatrogenic cartilage injury occurred in all hips but severity of lesions was considered mild. Coxofemoral arthroscopy is feasible in cats and can be utilized as a diagnostic tool for minimally invasive joint evaluation.