Background:The impact of sleep disorders on active-duty soldiers’medical readiness is not currently quantified.Patient data generated at military treatment facilities can be accessed to create research reports and th...Background:The impact of sleep disorders on active-duty soldiers’medical readiness is not currently quantified.Patient data generated at military treatment facilities can be accessed to create research reports and thus can be used to estimate the prevalence of sleep disturbances and the role of sleep on overall health in service members.The current study aimed to quantify sleep-related health issues and their impact on health and nondeployability through the analysis of U.S.military healthcare records from fiscal year 2018(FY2018).Methods:Medical diagnosis information and deployability profiles(e-Profiles)were queried for all active-duty U.S.Army patients with a concurrent sleep disorder diagnosis receiving medical care within FY2018.Nondeployability was predicted from medical reasons for having an e-Profile(categorized as sleep,behavioral health,musculoskeletal,cardiometabolic,injury,or accident)using binomial logistic regression.Sleep e-Profiles were investigated as a moderator between other e-Profile categories and nondeployability.Results:Out of 582,031 soldiers,48.4%(n=281,738)had a sleep-related diagnosis in their healthcare records,9.7%(n=56,247)of soldiers had e-Profiles,and 1.9%(n=10,885)had a sleep e-Profile.Soldiers with sleep e-Profiles were more likely to have had a motor vehicle accident(p OR(prevalence odds ratio)=4.7,95%CI 2.63–8.39,P≤0.001)or work/duty-related injury(p OR=1.6,95%CI 1.32–1.94,P≤0.001).The likelihood of nondeployability was greater in soldiers with a sleep e-Profile and a musculoskeletal e-Profile(p OR=4.25,95%CI 3.75–4.81,P≤0.001)or work/dutyrelated injury(p OR=2.62,95%CI 1.63–4.21,P≤0.001).Conclusion:Nearly half of soldiers had a sleep disorder or sleep-related medical diagnosis in 2018,but their sleep problems are largely not profiled as limitations to medical readiness.Musculoskeletal issues and physical injury predict nondeployability,and nondeployability is more likely to occur in soldiers who have sleep e-Profiles in addition to these issues.Addressing sleep problems may prevent accidents and injuries that could render a soldier nondeployable.展开更多
The objectives of this review were to 1)summarize the available evidence on the impact of hearing loss on quality of life(QOL)among U.S.active-duty service members,2)describe the QOL instruments that have been used to...The objectives of this review were to 1)summarize the available evidence on the impact of hearing loss on quality of life(QOL)among U.S.active-duty service members,2)describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life,3)examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members,and 4)provide recommendations for future studies that seek to quantify the impact of hearing loss in this population.There is a lack of literature that addresses the intersection of hearing impairment,the military population,and quality of life measures.For audiological research,U.S.military personnel offer a unique research population,as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions.This review recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.展开更多
BACKGROUND Epidemiological understanding of acute sternoclavicular(SC)dislocations secondary to sports across the United States is poorly defined.AIM To identify and assess epidemiological trends of SC dislocations oc...BACKGROUND Epidemiological understanding of acute sternoclavicular(SC)dislocations secondary to sports across the United States is poorly defined.AIM To identify and assess epidemiological trends of SC dislocations occurring secondary to sports-related mechanisms across United States over the past two decades.METHODS This cross-sectional,descriptive epidemiological study evaluates epidemiological trends of SC dislocations from sports that present to emergency departments(EDs)across the United States.Data were obtained from the National Electronic Injury Surveillance System database spanning two decades.Data on incidence,patient demographics,mechanisms of injury,dislocation types,incident locales,and patient dispositions were collected.RESULTS 1622 SC dislocations occurred nationwide from 2001 to 2020[incidence=0.262/1000000 people,confidence interval(CI)=0.250-0.275],comprising 0.1%of shoulder/upper trunk dislocations.Most patients were male(91%,n=1480)and aged 5-17(61%,n=982).Football,wrestling,and biking were the most frequently implicated sports,with contact sports responsible for 59%of athletic injuries(n=961).Recreational vehicle-related sports injuries,such as all-terrain vehicles,dirt bikes,and mopeds accounted for 7.8%of all injuries(n=126),with dirt bikes specifically comprising 3.7%(n=61).Ultimately,82%were discharged from the ED(n=1337),12%were admitted(n=194),and 6%were transferred(n=90).All recorded posterior dislocations were admitted or transferred from the ED.Patients sustaining SC dislocations from contact sports had a significantly increased risk of hospital admission or transfer rather than discharge from the ED as compared to patients whose injuries were from non-contact sports(incidence rate ratio=1.46,CI:=1.32-1.61,P<0.001).CONCLUSION SC dislocations from sports continue to be rare with a stably low incidence over the past two decades,likely comprising a smaller proportion of shoulder dislocations than previously thought.Contact sports are a frequent source of injury,especially among school-aged and teenage males.Most patients are discharged directly from the ED;however,a substantial number are hospitalized,many of which had documented posterior dislocations.Ultimately,understanding the epidemiology and mechanism-related trends of acute SC dislocations is important given the potential severity of these injuries,concentration in a specific population,and uncertainty linked to rare presentation.展开更多
AIMTo assess the effect of sofosbuvir (SOF) based regimens on glycemic and lipid control. METHODSThis is a retrospective analysis of hepatitis C virus (HCV)-infected patients treated and cured with a SOF regimen [SOF/...AIMTo assess the effect of sofosbuvir (SOF) based regimens on glycemic and lipid control. METHODSThis is a retrospective analysis of hepatitis C virus (HCV)-infected patients treated and cured with a SOF regimen [SOF/ribavirin/interferon, SOF/simeprevir, or SOF/ledipasvir (LDV) ± ribavirin] from January 2014 to March 2015. Patients with hemoglobin A1C (HbA1C) and lipid panels within six months before and six months after therapy were identified and included in our study. Due to the known hemolytic effect of ribavirin, HbA1C was obtained a minimum of three months post-treatment for the patients treated with a ribavirin regimen. Medical history, demographics, HCV genotype, pre-therapy RNA, and liver biopsies were included in our analysis. The patients who started a new medication or had an adjustment of baseline medical management for hyperlipidemia or diabetes mellitus (DM) were excluded from our analysis. RESULTSTwo hundred and thirty-four patients were reviewed, of which 60 patients met inclusion criteria. Sixty-three point three percent were male, 26.7% were Caucasian, 41.7% were African American and 91.7% were infected with hepatitis C genotype 1. Mean age was 60.6 ± 6.7 years. Thirty-nine patients had HbA1C checked before and after treatment, of which 22 had the diagnosis of DM type 2. HbA1C significantly decreased with treatment of HCV (pretreatment 6.66% ± 0.95% vs post-treatment 6.14% ± 0.65%, P vs 0.71% ± 0.83%, P = 0.070). Fifty-two patients had pre- and post-treatment lipid panels; there was a significant increase in low-density lipoprotein (LDL) and total cholesterol (TC) after treatment (LDL: 99.5 ± 28.9 mg/dL vs 128.3 ± 34.9 mg/dL, P vs 199.7 ± 40.0 mg/dL, P P = 0.684). CONCLUSIONEradication of HCV with a SOF regimen resulted in a significant drop in HbA1C and an increase in LDL and TC post therapy.展开更多
Indirect traumatic optic neuropathy(ITON) refers to optic nerve injury resulting from impact remote to the optic nerve. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, m...Indirect traumatic optic neuropathy(ITON) refers to optic nerve injury resulting from impact remote to the optic nerve. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, mitigation or treatment. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports- or motor vehicle-related concussion, rather than military-related ballistic or blast damage. Research in this field will likely require the development of robust databases to identify patients with ITON and follow related outcomes, in addition to both in-vivo animal and virtual human models to study the mechanisms of damage and potential therapies.展开更多
To assess dietary myo-inositol in reducing stem cell activation in colitis, and validate pβ-catenin<sup>S552</sup> as a biomarker of recurrent dysplasia.METHODSWe examined the effects of dietary myo-inosi...To assess dietary myo-inositol in reducing stem cell activation in colitis, and validate pβ-catenin<sup>S552</sup> as a biomarker of recurrent dysplasia.METHODSWe examined the effects of dietary myo-inositol treatment on inflammation, pβ-catenin<sup>S552</sup> and pAkt levels by histology and western blot in IL-10<sup>-/-</sup> and dextran sodium sulfate-treated colitic mice. Additionally, we assessed nuclear pβ-catenin<sup>S552</sup> in patients treated with myo-inositol in a clinical trial, and in patients with and without a history of colitis-induced dysplasia.RESULTSIn mice, pβ-catenin<sup>S552</sup> staining faithfully reported the effects of myo-inositol in reducing inflammation and intestinal stem cell activation. In a pilot clinical trial of myo-inositol administration in patients with a history of low grade dysplasia (LGD), two patients had reduced numbers of intestinal stem cell activation compared to the placebo control patient. In humans, pβ-catenin<sup>S552</sup> staining discriminated ulcerative colitis patients with a history of LGD from those with benign disease.CONCLUSIONEnumerating crypts with increased numbers of pβ-catenin<sup>S552</sup> - positive cells can be utilized as a biomarker in colitis-associated cancer chemoprevention trials.展开更多
Objective: The purpose of this work is to examine the usefulness of the topological approach for analysis of current density maps during ST-T interval in detection of coronary artery disease (CAD) in patients with pro...Objective: The purpose of this work is to examine the usefulness of the topological approach for analysis of current density maps during ST-T interval in detection of coronary artery disease (CAD) in patients with proved CAD but normal results of routine tests. Materials and Methods: The patient group included 123 patients. Coronary angiography was done due to chest pain. The control group consisted of 124 healthy volunteers. The MCG test was done by 4-channels MCG system installed at unshielded setting. An integral topological index Kideal, consisting of 4 parameters, has been counted. Results and Conclusions: It is shown that Kideal was higher in patient group compared to control one. Sensitivity was 87%, and specificity was 64%. The topological analysis of MCG current density maps is a valuable tool in noninvasive detection of CAD in difficult-to-diagnose patients with uninformative results of routine tests.展开更多
Traumatic axonal injury is a progressive process evoked by shear forces on the brain, gradually evolving from focal axonal alteration and cumulating in neural disconnection. Clinical classifiers and conventional neuro...Traumatic axonal injury is a progressive process evoked by shear forces on the brain, gradually evolving from focal axonal alteration and cumulating in neural disconnection. Clinical classifiers and conventional neuroimaging are limited in traumatic axonal injury detection, outcome prediction, and treatment guidance. Diffusion weighted imaging is an advanced magnetic resonance imaging (MRI) technique that is sensitive to the movement of water molecules, providing additional information on the micro-structural arrangement of tissue. Quantitative analysis of diffusion metrics can aid in the localization of axonal injury and/or de(dys)myelination caused by trauma. Diffusion MRI tractography is an extension of diffusion weighted imaging, and can provide additional information about white matter pathways and the integrity of brain neural networks. Both techniques are able to detect the early micro-structural changes caused by Traumatic Brain Injury (TBI), and can be used to increase understanding of the mechanisms of brain plasticity in recovery after brain injury and possibly optimize treatment planning of patients with Traumatic Brain Injury. This review focuses on the theoretical basis and applied advanced techniques of diffusion weighted imaging, their limitations and applications, and future directions in the application to TBI.展开更多
Objective:To evaluate the impact of prolonged post-thaw embryos culture on pregnancy outcome during frozen embryo transfer cycles.Methods:This prospective cohort study evaluated 324 thaw transfer cycles with 819 embry...Objective:To evaluate the impact of prolonged post-thaw embryos culture on pregnancy outcome during frozen embryo transfer cycles.Methods:This prospective cohort study evaluated 324 thaw transfer cycles with 819 embryos from 269 patients at the Center for Reproductive Endocrinology and Infertility of Hue University Hospital in Vietnam.These frozen embryo transfer cycles were divided into two groups at the time of thawing:the short culture group(2-hour post-thaw culture)and the overnight culture group(overnight culture for 18 h)before the embryo was transferred into the uterus.The rates of embryo intact,grade A embryo at frozen and transfer time and continuing cleavage were recorded.The clinical outcomes including serum beta-human chorionic gonadotropin,clinical pregnancy and implantation rate were evaluated after 14 days,4 weeks,6 weeks,respectively,after embryo transfer.Results:Human chorionic gonadotropin positive occurred in 39.5%of patients in the short culture group compared to 25.9%in the overnight culture group with risk difference(RD)=13.6%,relative risk(RR)=1.343,95%confidence interval(CI)1.085-1.663,P<0.01.Clinical pregnancy rate of the short culture group and overnight culture group was 33.3%and 24.1%,respectively(RD=9.2%,RR=1.242,95%CI 0.996-1.549,P=0.06)and the implantation rate in the short culture group and overnight culture group was 16.5%and 11.0%,respectively(RD=5.5%,RR=1.244,95%CI 1.046-1.479,P=0.01).In women of advanced age(≥35 years)and women who received 3 embryos,pregnancy outcomes were found to be significantly(P<0.05)higher in the short culture than in the overnight culture group.Conclusions:The prolonged post-thaw culture period does not increase pregnancy outcome in comparison with the short culture.展开更多
Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asy...Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asymptomatic, but symptoms range from a mild, self-limiting, non-specific febrile illness to fulminant respiratory and renal failure with a high mortality rate. The combination of jaundice, renal failure, and hemorrhage is known as Weil's disease and is the most characteristic pattern associated with severe leptospirosis. Clinical suspicion alone may be enough to warrant empiric antibiotic treatment in many cases. Serological methods are the most commonly used means of confirming a diagnosis of leptospirosis. The "gold standard" is the microscopic agglutination test. Typical treatment for mild causes is oral doxycycline, though azithromycin and oral penicillins are reasonable alternatives. Intravenous penicillin G has long been the standard of care for severe cases though limited studies show no benefit compared to third generation cephalosporins. We review the clinical presentation, diagnosis, treatment and prevention of leptospirosis.展开更多
Research evidence substantiating benefits of dental self-care habits is surprisingly limited. This study evaluated associations between dental self-care behaviors and oral health, specifically toothbrushing, flossing,...Research evidence substantiating benefits of dental self-care habits is surprisingly limited. This study evaluated associations between dental self-care behaviors and oral health, specifically toothbrushing, flossing, rinsing, chewing xylitol gum, and diet. Soldiers recently deployed to Iraq and Afghanistan had dental examinations and answered questionnaires on dental self-care habits. The DoD Oral Health and Readiness Classification System was used to categorize oral health （see manuscript for definitions）. Correlations were assessed between self-care habits and dental classification. Of 266 soldiers, 43 （16%） were Class 1 （excellent）, 191 （72%） Class 2 （acceptable）, 18 （7%） Class 3 （poor）, and 14 （5%） Class 4 （unknown）. Only 63% of soldiers brushed twice or more per day and only half flossed once or more per day. Dental classification improved with toothbrushing （P = 0.05） and adherence to a Mediterranean diet （P = 0.04）. Flossing trended toward correlation （P = 0.11）. Dental classification did not correlate with mouth rinse or xylitol chewing gum. These research findings help fill an evidence gap that toothbrushing and flossing in addition to a healthful eating pattem are associated with improved oral health.展开更多
The teratogenicity of thalidomide has been known since the early 1960s [1]. Thalidomide is currently used world wide, including the United States, to treat erythema nodosum leprosum, multiple myeloma, refractory Crohn...The teratogenicity of thalidomide has been known since the early 1960s [1]. Thalidomide is currently used world wide, including the United States, to treat erythema nodosum leprosum, multiple myeloma, refractory Crohn’s disease, aphthous stomatitis and HIV wasting syndrome. New cases of thalidomide phocomelia are being reported as well. We report a case of the anesthetic challenges of a 23 year-old parturient with thalidomide phocomelia and review the important anesthetic challenges it presents. Spontaneous vaginal delivery under continuous lumbar epidural was achieved in this challenging patient. However, it required careful planning for reliable intravenous access and the use of magnetic resonance imaging (MRI) of her pelvis and lumbar spine.展开更多
<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Neoadjuvant chemotherapy is used in gynecologic mali...<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Neoadjuvant chemotherapy is used in gynecologic malignancies as primary treatment for advanced disease and has demonstrated improvement in survival rates. However, the data for use in endometrial cancer is limited. </span><b><span style="font-family:Verdana;">Case:</span></b><span style="font-family:Verdana;"> This is a case of stage IV endometrial undifferentiated carcinoma with complete response to four cycles of neoadjuvant chemotherapy</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(carboplatin/paclitaxel) and no evidence of disease during the interval debulking surgery (robotic-assisted total laparoscopic hysterectomy with bilateral salpingoophorectomy, pelvic and paraaortic lymph node dissection, and cystoscopy). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Complete response to neoadjuvant chemotherapy prior to interval debulking surgery is only reported in a limited number of cases, and even less common in advanced stage high-grade endometrial cancers. The use of neoadjuvant chemotherapy may reduce tumor burden, increase opportunities for optimal debulking, and have an impact on survival. Further research is needed to understand the potential for neoadjuvant chemotherapy in these patients.</span></span></span></span>展开更多
Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery.Many different combinations of primary treatment methods and retreatment techniques have be...Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery.Many different combinations of primary treatment methods and retreatment techniques have been studied,however,few studies have investigated wavefront-optimized(WFO)technology for retreatment following primary refractive surgery.This study aimed to report the outcomes of WFO photorefractive keratectomy(PRK)retreatments of refractive error following previous laser refractive surgery with PRK,laser in situ keratomileusis(LASIK),or laser-assisted subepithelial keratectomy(LASEK).Methods:We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System(Alcon Surgical)between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical Center.Outcomes were recorded in terms of uncorrected distance visual acuity(UDVA),manifest refraction spherical equivalent(MRSE),corrected distance visual acuity(CDVA),and complications at 1 month(M),3 M,and 6 M post-op.Results:Seventy-eight patients(120 eyes)underwent WFO PRK retreatment during the study period.Primary surgery was surface ablation in 87 eyes(78 PRK,9 LASEK)and LASIK in 33 eyes.The mean spherical equivalent before retreatment was−0.79±0.94 D(−3.00 to 1.88 D).UDVA was≥20/20 in 69 eyes(60.0%)at 1 M,54 eyes(71.1%)at 3 M,and 27 eyes(73.0%)at 6 M follow-up.MRSE was within±0.50 D of emmetropia in 78 eyes(67.8%)at 1 M,59 eyes(77.6%)at 3 M,and 25 eyes(67.6%)at 6 M follow-up.CDVA was maintained within±1 line of pre-op in 113 of 115 eyes(98.3%)at 1 M,74 of 76 eyes(97.4%)at 3 M,and 37 eyes(100%)at 6 M follow-up.Conclusion:Although follow-up was limited beyond 3 M,WFO PRK retreatments in patients with residual refractive error may be a safe and effective procedure.Further studies are necessary to determine the long-term safety and stability of outcomes.展开更多
The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative i...The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.展开更多
Objective:To systematically review outcomes for cautery-assisted palatal stiffening operation (CAPSO) as a treatment for adult obstructive sleep apnea (OSA).Methods:Five databases (including PubMed/MEDLINE) were searc...Objective:To systematically review outcomes for cautery-assisted palatal stiffening operation (CAPSO) as a treatment for adult obstructive sleep apnea (OSA).Methods:Five databases (including PubMed/MEDLINE) were searched through July 12,2017.Results:Eight studies (307 patients) met criteria.Overall,CAPSO alone (80 patients) improved AHI from a mean ± standard deviation (M±SD) of (16.8±11.9) to (9.9±10.9) events/h (41.1% decrease).Mixed CAPSO with/without tonsillectomy (92 patients) improved AHI from a M] SD of (24.8 ± 12.6) to (10.6 ± 9.5) events/h (61.7% decrease).CAPSO with expansion pharyngoplasty (EP),(78 patients) improved AHI from a M ± SD of (26.3 ± 17.7) to (12.6 ± 5.8) events/h (52.1% decrease).CAPSO alone (90 patients) improved lowest oxygen saturation (LSAT) by 5.4 points.Mixed CAPSO with/without tonsillectomy (77 patients) improved LSAT by 10.6 points,and CAPSO with EP (78 patients) improved LSAT by 5.2 points.Sleepiness improved (182 patients) from an Epworth Sleepiness Scale score of 11.8 to 5.1,P < 0.001.Snoring reduced (120 patients) from 7.9 to 2.5 on visual analog scales (0-10 scale),P < 0.001.Conclusions:Apnea-hypopnea index has improved by 41.0% for CAPSO alone,61.7% for CAPSO with tonsillectomy and 52.1% for CAPSO with expansion pharyngoplasty.Additionally,lowest oxygen saturation,sleepiness and snoring have also improved after CAPSO.展开更多
Osseointegration(OI),targeted muscle reinnervation(TMR),and vascularized composite allotransplantation(VCA)are just a few ways by which our reconstructive ladder is evolving.It is important to recognize that amputatio...Osseointegration(OI),targeted muscle reinnervation(TMR),and vascularized composite allotransplantation(VCA)are just a few ways by which our reconstructive ladder is evolving.It is important to recognize that amputation does not necessarily denote failure,but surgeons should strive to find ways to provide these patients with means for obtaining better satisfaction and quality of life postoperatively.TMR and OI have added options for mutilating lower extremity injuries that necessitate amputation.More recently,the senior author(Levin LS)described the"penthouse"floor of the reconstructive ladder being VCA.Despite the advances in VCA over the last 20 years,there are many challenges that face this discipline including indications for patient selection,minimizing immunosuppressive regimens,standardizing outcome measures,establishing reliable protocols for monitoring,and diagnosing and managing rejection.Herein,the authors review TMR,OI,and VCA as additional higher rungs of the reconstructive ladder.展开更多
Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasin...Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.展开更多
基金The Department of Defense Military Operational Medicine Research Program(MOMRP)supported this study。
文摘Background:The impact of sleep disorders on active-duty soldiers’medical readiness is not currently quantified.Patient data generated at military treatment facilities can be accessed to create research reports and thus can be used to estimate the prevalence of sleep disturbances and the role of sleep on overall health in service members.The current study aimed to quantify sleep-related health issues and their impact on health and nondeployability through the analysis of U.S.military healthcare records from fiscal year 2018(FY2018).Methods:Medical diagnosis information and deployability profiles(e-Profiles)were queried for all active-duty U.S.Army patients with a concurrent sleep disorder diagnosis receiving medical care within FY2018.Nondeployability was predicted from medical reasons for having an e-Profile(categorized as sleep,behavioral health,musculoskeletal,cardiometabolic,injury,or accident)using binomial logistic regression.Sleep e-Profiles were investigated as a moderator between other e-Profile categories and nondeployability.Results:Out of 582,031 soldiers,48.4%(n=281,738)had a sleep-related diagnosis in their healthcare records,9.7%(n=56,247)of soldiers had e-Profiles,and 1.9%(n=10,885)had a sleep e-Profile.Soldiers with sleep e-Profiles were more likely to have had a motor vehicle accident(p OR(prevalence odds ratio)=4.7,95%CI 2.63–8.39,P≤0.001)or work/duty-related injury(p OR=1.6,95%CI 1.32–1.94,P≤0.001).The likelihood of nondeployability was greater in soldiers with a sleep e-Profile and a musculoskeletal e-Profile(p OR=4.25,95%CI 3.75–4.81,P≤0.001)or work/dutyrelated injury(p OR=2.62,95%CI 1.63–4.21,P≤0.001).Conclusion:Nearly half of soldiers had a sleep disorder or sleep-related medical diagnosis in 2018,but their sleep problems are largely not profiled as limitations to medical readiness.Musculoskeletal issues and physical injury predict nondeployability,and nondeployability is more likely to occur in soldiers who have sleep e-Profiles in addition to these issues.Addressing sleep problems may prevent accidents and injuries that could render a soldier nondeployable.
基金supported by the Air Force Research Laboratory under Contract No.FA8650-12-C-6358
文摘The objectives of this review were to 1)summarize the available evidence on the impact of hearing loss on quality of life(QOL)among U.S.active-duty service members,2)describe the QOL instruments that have been used to quantify the impact of hearing loss on quality of life,3)examine national population-level secondary databases and report on their utility for studying the impact of hearing loss on QOL among active-duty service members,and 4)provide recommendations for future studies that seek to quantify the impact of hearing loss in this population.There is a lack of literature that addresses the intersection of hearing impairment,the military population,and quality of life measures.For audiological research,U.S.military personnel offer a unique research population,as they are exposed to noise levels and blast environments that are highly unusual in civilian work settings and can serve as a model population for studying the impact on QOL associated with these conditions.This review recommends conducting a study on the active-duty service member population using a measurement instrument suitable for determining decreases in QOL specifically due to hearing loss.
文摘BACKGROUND Epidemiological understanding of acute sternoclavicular(SC)dislocations secondary to sports across the United States is poorly defined.AIM To identify and assess epidemiological trends of SC dislocations occurring secondary to sports-related mechanisms across United States over the past two decades.METHODS This cross-sectional,descriptive epidemiological study evaluates epidemiological trends of SC dislocations from sports that present to emergency departments(EDs)across the United States.Data were obtained from the National Electronic Injury Surveillance System database spanning two decades.Data on incidence,patient demographics,mechanisms of injury,dislocation types,incident locales,and patient dispositions were collected.RESULTS 1622 SC dislocations occurred nationwide from 2001 to 2020[incidence=0.262/1000000 people,confidence interval(CI)=0.250-0.275],comprising 0.1%of shoulder/upper trunk dislocations.Most patients were male(91%,n=1480)and aged 5-17(61%,n=982).Football,wrestling,and biking were the most frequently implicated sports,with contact sports responsible for 59%of athletic injuries(n=961).Recreational vehicle-related sports injuries,such as all-terrain vehicles,dirt bikes,and mopeds accounted for 7.8%of all injuries(n=126),with dirt bikes specifically comprising 3.7%(n=61).Ultimately,82%were discharged from the ED(n=1337),12%were admitted(n=194),and 6%were transferred(n=90).All recorded posterior dislocations were admitted or transferred from the ED.Patients sustaining SC dislocations from contact sports had a significantly increased risk of hospital admission or transfer rather than discharge from the ED as compared to patients whose injuries were from non-contact sports(incidence rate ratio=1.46,CI:=1.32-1.61,P<0.001).CONCLUSION SC dislocations from sports continue to be rare with a stably low incidence over the past two decades,likely comprising a smaller proportion of shoulder dislocations than previously thought.Contact sports are a frequent source of injury,especially among school-aged and teenage males.Most patients are discharged directly from the ED;however,a substantial number are hospitalized,many of which had documented posterior dislocations.Ultimately,understanding the epidemiology and mechanism-related trends of acute SC dislocations is important given the potential severity of these injuries,concentration in a specific population,and uncertainty linked to rare presentation.
文摘AIMTo assess the effect of sofosbuvir (SOF) based regimens on glycemic and lipid control. METHODSThis is a retrospective analysis of hepatitis C virus (HCV)-infected patients treated and cured with a SOF regimen [SOF/ribavirin/interferon, SOF/simeprevir, or SOF/ledipasvir (LDV) ± ribavirin] from January 2014 to March 2015. Patients with hemoglobin A1C (HbA1C) and lipid panels within six months before and six months after therapy were identified and included in our study. Due to the known hemolytic effect of ribavirin, HbA1C was obtained a minimum of three months post-treatment for the patients treated with a ribavirin regimen. Medical history, demographics, HCV genotype, pre-therapy RNA, and liver biopsies were included in our analysis. The patients who started a new medication or had an adjustment of baseline medical management for hyperlipidemia or diabetes mellitus (DM) were excluded from our analysis. RESULTSTwo hundred and thirty-four patients were reviewed, of which 60 patients met inclusion criteria. Sixty-three point three percent were male, 26.7% were Caucasian, 41.7% were African American and 91.7% were infected with hepatitis C genotype 1. Mean age was 60.6 ± 6.7 years. Thirty-nine patients had HbA1C checked before and after treatment, of which 22 had the diagnosis of DM type 2. HbA1C significantly decreased with treatment of HCV (pretreatment 6.66% ± 0.95% vs post-treatment 6.14% ± 0.65%, P vs 0.71% ± 0.83%, P = 0.070). Fifty-two patients had pre- and post-treatment lipid panels; there was a significant increase in low-density lipoprotein (LDL) and total cholesterol (TC) after treatment (LDL: 99.5 ± 28.9 mg/dL vs 128.3 ± 34.9 mg/dL, P vs 199.7 ± 40.0 mg/dL, P P = 0.684). CONCLUSIONEradication of HCV with a SOF regimen resulted in a significant drop in HbA1C and an increase in LDL and TC post therapy.
文摘Indirect traumatic optic neuropathy(ITON) refers to optic nerve injury resulting from impact remote to the optic nerve. The mechanism of injury is not understood, and there are no confirmed protocols for prevention, mitigation or treatment. Most data concerning this condition comes from case series of civilian patients suffering blunt injury, such as from sports- or motor vehicle-related concussion, rather than military-related ballistic or blast damage. Research in this field will likely require the development of robust databases to identify patients with ITON and follow related outcomes, in addition to both in-vivo animal and virtual human models to study the mechanisms of damage and potential therapies.
基金Supported by Veterans Affairs Merit Award,No.IO1CX001353(to Barrett TA)National Institutes of Health,No.2R01DK095662-06A1(to Barrett TA)+3 种基金the National Cancer Institute at the National Institutes of Health,No.N01-CN-35157(to Bergan R)the Training Program in Oncogenesis and Developmental Biology through the National Cancer Institute,No.NCI T32 CA080621(to Bradford EM)an Institutional Development Award from the National Institute of General Medical Sciences of the National Institutes of Health,No.8 P20GM103527-05American Physiological Society STEP-UP Fellowship(to Thompson CA)
文摘To assess dietary myo-inositol in reducing stem cell activation in colitis, and validate pβ-catenin<sup>S552</sup> as a biomarker of recurrent dysplasia.METHODSWe examined the effects of dietary myo-inositol treatment on inflammation, pβ-catenin<sup>S552</sup> and pAkt levels by histology and western blot in IL-10<sup>-/-</sup> and dextran sodium sulfate-treated colitic mice. Additionally, we assessed nuclear pβ-catenin<sup>S552</sup> in patients treated with myo-inositol in a clinical trial, and in patients with and without a history of colitis-induced dysplasia.RESULTSIn mice, pβ-catenin<sup>S552</sup> staining faithfully reported the effects of myo-inositol in reducing inflammation and intestinal stem cell activation. In a pilot clinical trial of myo-inositol administration in patients with a history of low grade dysplasia (LGD), two patients had reduced numbers of intestinal stem cell activation compared to the placebo control patient. In humans, pβ-catenin<sup>S552</sup> staining discriminated ulcerative colitis patients with a history of LGD from those with benign disease.CONCLUSIONEnumerating crypts with increased numbers of pβ-catenin<sup>S552</sup> - positive cells can be utilized as a biomarker in colitis-associated cancer chemoprevention trials.
文摘Objective: The purpose of this work is to examine the usefulness of the topological approach for analysis of current density maps during ST-T interval in detection of coronary artery disease (CAD) in patients with proved CAD but normal results of routine tests. Materials and Methods: The patient group included 123 patients. Coronary angiography was done due to chest pain. The control group consisted of 124 healthy volunteers. The MCG test was done by 4-channels MCG system installed at unshielded setting. An integral topological index Kideal, consisting of 4 parameters, has been counted. Results and Conclusions: It is shown that Kideal was higher in patient group compared to control one. Sensitivity was 87%, and specificity was 64%. The topological analysis of MCG current density maps is a valuable tool in noninvasive detection of CAD in difficult-to-diagnose patients with uninformative results of routine tests.
文摘Traumatic axonal injury is a progressive process evoked by shear forces on the brain, gradually evolving from focal axonal alteration and cumulating in neural disconnection. Clinical classifiers and conventional neuroimaging are limited in traumatic axonal injury detection, outcome prediction, and treatment guidance. Diffusion weighted imaging is an advanced magnetic resonance imaging (MRI) technique that is sensitive to the movement of water molecules, providing additional information on the micro-structural arrangement of tissue. Quantitative analysis of diffusion metrics can aid in the localization of axonal injury and/or de(dys)myelination caused by trauma. Diffusion MRI tractography is an extension of diffusion weighted imaging, and can provide additional information about white matter pathways and the integrity of brain neural networks. Both techniques are able to detect the early micro-structural changes caused by Traumatic Brain Injury (TBI), and can be used to increase understanding of the mechanisms of brain plasticity in recovery after brain injury and possibly optimize treatment planning of patients with Traumatic Brain Injury. This review focuses on the theoretical basis and applied advanced techniques of diffusion weighted imaging, their limitations and applications, and future directions in the application to TBI.
文摘Objective:To evaluate the impact of prolonged post-thaw embryos culture on pregnancy outcome during frozen embryo transfer cycles.Methods:This prospective cohort study evaluated 324 thaw transfer cycles with 819 embryos from 269 patients at the Center for Reproductive Endocrinology and Infertility of Hue University Hospital in Vietnam.These frozen embryo transfer cycles were divided into two groups at the time of thawing:the short culture group(2-hour post-thaw culture)and the overnight culture group(overnight culture for 18 h)before the embryo was transferred into the uterus.The rates of embryo intact,grade A embryo at frozen and transfer time and continuing cleavage were recorded.The clinical outcomes including serum beta-human chorionic gonadotropin,clinical pregnancy and implantation rate were evaluated after 14 days,4 weeks,6 weeks,respectively,after embryo transfer.Results:Human chorionic gonadotropin positive occurred in 39.5%of patients in the short culture group compared to 25.9%in the overnight culture group with risk difference(RD)=13.6%,relative risk(RR)=1.343,95%confidence interval(CI)1.085-1.663,P<0.01.Clinical pregnancy rate of the short culture group and overnight culture group was 33.3%and 24.1%,respectively(RD=9.2%,RR=1.242,95%CI 0.996-1.549,P=0.06)and the implantation rate in the short culture group and overnight culture group was 16.5%and 11.0%,respectively(RD=5.5%,RR=1.244,95%CI 1.046-1.479,P=0.01).In women of advanced age(≥35 years)and women who received 3 embryos,pregnancy outcomes were found to be significantly(P<0.05)higher in the short culture than in the overnight culture group.Conclusions:The prolonged post-thaw culture period does not increase pregnancy outcome in comparison with the short culture.
文摘Leptospirosis is a zoonotic disease with worldwide distribution and increasing prevalence. Infection is caused by the spirochete Leptospira, with common exposure being contaminated fresh water. Most infections are asymptomatic, but symptoms range from a mild, self-limiting, non-specific febrile illness to fulminant respiratory and renal failure with a high mortality rate. The combination of jaundice, renal failure, and hemorrhage is known as Weil's disease and is the most characteristic pattern associated with severe leptospirosis. Clinical suspicion alone may be enough to warrant empiric antibiotic treatment in many cases. Serological methods are the most commonly used means of confirming a diagnosis of leptospirosis. The "gold standard" is the microscopic agglutination test. Typical treatment for mild causes is oral doxycycline, though azithromycin and oral penicillins are reasonable alternatives. Intravenous penicillin G has long been the standard of care for severe cases though limited studies show no benefit compared to third generation cephalosporins. We review the clinical presentation, diagnosis, treatment and prevention of leptospirosis.
文摘Research evidence substantiating benefits of dental self-care habits is surprisingly limited. This study evaluated associations between dental self-care behaviors and oral health, specifically toothbrushing, flossing, rinsing, chewing xylitol gum, and diet. Soldiers recently deployed to Iraq and Afghanistan had dental examinations and answered questionnaires on dental self-care habits. The DoD Oral Health and Readiness Classification System was used to categorize oral health （see manuscript for definitions）. Correlations were assessed between self-care habits and dental classification. Of 266 soldiers, 43 （16%） were Class 1 （excellent）, 191 （72%） Class 2 （acceptable）, 18 （7%） Class 3 （poor）, and 14 （5%） Class 4 （unknown）. Only 63% of soldiers brushed twice or more per day and only half flossed once or more per day. Dental classification improved with toothbrushing （P = 0.05） and adherence to a Mediterranean diet （P = 0.04）. Flossing trended toward correlation （P = 0.11）. Dental classification did not correlate with mouth rinse or xylitol chewing gum. These research findings help fill an evidence gap that toothbrushing and flossing in addition to a healthful eating pattem are associated with improved oral health.
文摘The teratogenicity of thalidomide has been known since the early 1960s [1]. Thalidomide is currently used world wide, including the United States, to treat erythema nodosum leprosum, multiple myeloma, refractory Crohn’s disease, aphthous stomatitis and HIV wasting syndrome. New cases of thalidomide phocomelia are being reported as well. We report a case of the anesthetic challenges of a 23 year-old parturient with thalidomide phocomelia and review the important anesthetic challenges it presents. Spontaneous vaginal delivery under continuous lumbar epidural was achieved in this challenging patient. However, it required careful planning for reliable intravenous access and the use of magnetic resonance imaging (MRI) of her pelvis and lumbar spine.
文摘<strong>Background:</strong><span><span><span style="font-family:""><span style="font-family:Verdana;"> Neoadjuvant chemotherapy is used in gynecologic malignancies as primary treatment for advanced disease and has demonstrated improvement in survival rates. However, the data for use in endometrial cancer is limited. </span><b><span style="font-family:Verdana;">Case:</span></b><span style="font-family:Verdana;"> This is a case of stage IV endometrial undifferentiated carcinoma with complete response to four cycles of neoadjuvant chemotherapy</span></span></span></span><span><span><span style="font-family:""> </span></span></span><span><span><span style="font-family:""><span style="font-family:Verdana;">(carboplatin/paclitaxel) and no evidence of disease during the interval debulking surgery (robotic-assisted total laparoscopic hysterectomy with bilateral salpingoophorectomy, pelvic and paraaortic lymph node dissection, and cystoscopy). </span><b><span style="font-family:Verdana;">Conclusion:</span></b><span style="font-family:Verdana;"> Complete response to neoadjuvant chemotherapy prior to interval debulking surgery is only reported in a limited number of cases, and even less common in advanced stage high-grade endometrial cancers. The use of neoadjuvant chemotherapy may reduce tumor burden, increase opportunities for optimal debulking, and have an impact on survival. Further research is needed to understand the potential for neoadjuvant chemotherapy in these patients.</span></span></span></span>
文摘Background:Retreatments are sometimes necessary to correct residual or induced refractive errors following refractive surgery.Many different combinations of primary treatment methods and retreatment techniques have been studied,however,few studies have investigated wavefront-optimized(WFO)technology for retreatment following primary refractive surgery.This study aimed to report the outcomes of WFO photorefractive keratectomy(PRK)retreatments of refractive error following previous laser refractive surgery with PRK,laser in situ keratomileusis(LASIK),or laser-assisted subepithelial keratectomy(LASEK).Methods:We reviewed records of patients who underwent WFO PRK retreatments using the Allegretto Wave Eye-Q 400 Hz Excimer Laser System(Alcon Surgical)between January 2008 and April 2011 at Walter Reed Army Medical Center and Madigan Army Medical Center.Outcomes were recorded in terms of uncorrected distance visual acuity(UDVA),manifest refraction spherical equivalent(MRSE),corrected distance visual acuity(CDVA),and complications at 1 month(M),3 M,and 6 M post-op.Results:Seventy-eight patients(120 eyes)underwent WFO PRK retreatment during the study period.Primary surgery was surface ablation in 87 eyes(78 PRK,9 LASEK)and LASIK in 33 eyes.The mean spherical equivalent before retreatment was−0.79±0.94 D(−3.00 to 1.88 D).UDVA was≥20/20 in 69 eyes(60.0%)at 1 M,54 eyes(71.1%)at 3 M,and 27 eyes(73.0%)at 6 M follow-up.MRSE was within±0.50 D of emmetropia in 78 eyes(67.8%)at 1 M,59 eyes(77.6%)at 3 M,and 25 eyes(67.6%)at 6 M follow-up.CDVA was maintained within±1 line of pre-op in 113 of 115 eyes(98.3%)at 1 M,74 of 76 eyes(97.4%)at 3 M,and 37 eyes(100%)at 6 M follow-up.Conclusion:Although follow-up was limited beyond 3 M,WFO PRK retreatments in patients with residual refractive error may be a safe and effective procedure.Further studies are necessary to determine the long-term safety and stability of outcomes.
文摘The DrafⅢprocedure involves the creation of a common frontal sinus cavity.The most common indication for the DrafⅢprocedure is chronic rhinosinusitis of the frontal sinuses despite the failure of more conservative interventions such as bilateral DrafⅡa procedures.Primary DrafⅢmay be indicated in patients with a high risk of failures such as those with severe polyposis and those with a frontal sinus opening less than 4 mm on computed tomography imaging.Other indications for the DrafⅢinclude access for tumor removal and repair of traumatic fractures of the frontal sinus.The"inside-out"DrafⅢprocedure is the standard approach when the frontal recess anterior-posterior diameter is wide enough for instrument access,usually larger than 4-5 mm.The"outside-in"DrafⅢprocedure can be done when the frontal recess is too narrow to safely accommodate instruments.Regular follow-up with debridement should be done to prevent neo-ostium stenosis.
文摘Objective:To systematically review outcomes for cautery-assisted palatal stiffening operation (CAPSO) as a treatment for adult obstructive sleep apnea (OSA).Methods:Five databases (including PubMed/MEDLINE) were searched through July 12,2017.Results:Eight studies (307 patients) met criteria.Overall,CAPSO alone (80 patients) improved AHI from a mean ± standard deviation (M±SD) of (16.8±11.9) to (9.9±10.9) events/h (41.1% decrease).Mixed CAPSO with/without tonsillectomy (92 patients) improved AHI from a M] SD of (24.8 ± 12.6) to (10.6 ± 9.5) events/h (61.7% decrease).CAPSO with expansion pharyngoplasty (EP),(78 patients) improved AHI from a M ± SD of (26.3 ± 17.7) to (12.6 ± 5.8) events/h (52.1% decrease).CAPSO alone (90 patients) improved lowest oxygen saturation (LSAT) by 5.4 points.Mixed CAPSO with/without tonsillectomy (77 patients) improved LSAT by 10.6 points,and CAPSO with EP (78 patients) improved LSAT by 5.2 points.Sleepiness improved (182 patients) from an Epworth Sleepiness Scale score of 11.8 to 5.1,P < 0.001.Snoring reduced (120 patients) from 7.9 to 2.5 on visual analog scales (0-10 scale),P < 0.001.Conclusions:Apnea-hypopnea index has improved by 41.0% for CAPSO alone,61.7% for CAPSO with tonsillectomy and 52.1% for CAPSO with expansion pharyngoplasty.Additionally,lowest oxygen saturation,sleepiness and snoring have also improved after CAPSO.
文摘Osseointegration(OI),targeted muscle reinnervation(TMR),and vascularized composite allotransplantation(VCA)are just a few ways by which our reconstructive ladder is evolving.It is important to recognize that amputation does not necessarily denote failure,but surgeons should strive to find ways to provide these patients with means for obtaining better satisfaction and quality of life postoperatively.TMR and OI have added options for mutilating lower extremity injuries that necessitate amputation.More recently,the senior author(Levin LS)described the"penthouse"floor of the reconstructive ladder being VCA.Despite the advances in VCA over the last 20 years,there are many challenges that face this discipline including indications for patient selection,minimizing immunosuppressive regimens,standardizing outcome measures,establishing reliable protocols for monitoring,and diagnosing and managing rejection.Herein,the authors review TMR,OI,and VCA as additional higher rungs of the reconstructive ladder.
文摘Aim: Composite tissue defects encompassing bone and/or isolated bony defects can pose a surgical challenge;however, their reconstruction is critical for successful functional limb salvage. These cases become increasingly problematic as secondary defects, following multiple nonvascularized grafting attempts resulting in complex bony nonunion. Herein, our experience utilizing fibula vascularized bone grafts (VBGs) for bone restoration will be presented to demonstrate their utility in a variety of reconstructions for limb salvage. Methods: This is a case series describing a series of vascularized fibula grafts for extremity reconstruction performed by a single academic surgeon over multiple institutions in seven years. Results: Twenty-seven (27) total VBGs met inclusion criteria and underwent reconstruction for traumatic (16), oncologic (6) and chronic degenerative (5) etiologies. Bony union was achieved in 26 of 27 cases. Conclusion: The decision-making process for bony reconstruction in these scenarios is difficult and multivariable. Fibula VBGs can provide a single-stage solution for autologous bony and soft tissue replacement of large or complex bone defects and can often be superior options compared with non-vascularized bone grafts or non-bone internal fixation techniques. Their osteogenic potential is unmatched by allogenic or synthetic substitutions. These benefits are evident in a variety of clinical settings such as pediatrics, oncology and trauma.
