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Comparison of Fibula Plating Versus Fibula Nailing: A Systematic Review With Meta-analysis of all Current Comparative Literature
Get PDFAnkle fracture surgeries are common orthopaedic procedures. Fibular fixation is often an important component in restoring ankle stability. Fibular intramedullary nailing (fIMN) has gained recent interest as an alternative technique to fibular plating. This systematic review and meta-analysis was performed to compare the outcomes of fibular nailing versus fibular plating for all current available literature. A PRISMA-compliant systematic review was conducted across MEDLINE/Pubmed, Cochrane, and Embase databases for cohort and clinical trial studies comparing outcomes of fibular nailing and fibular plating of ankle fractures. Demographics and results of the studies were extracted from the articles. Outcomes of interest extracted included operative time, functional outcomes scores, hardware/loss of reduction, malunion/nonunion, re-operations, and wound complications. Meta-analysis of included studies used odds ratios and standardized mean difference when appropriate. Nine studies were included in this systematic review. Eight studies were then used for meta-analysis comparison. fIMN showed equivalent operating times to fibular plating. fIMN had equivalent outcomes when compared with fibular plating for hardware failure/loss of reduction, Olerud and Molander Ankle Score, malunion/nonunion, and re-operations. Fibular nailing showed a decrease in wound complications (OR: 0.35 [0.18, 0.66] (p = .001)) when compared with fibular plating. fIMN showed equivalent outcomes and decreased wound complications compared to fibular plating. fIMN is a safe and effective alternative treatment method that can be used by surgeons to treat distal fibula fractures
Impact of Tyrosine Kinase Inhibitors on Thyroid Function in Chronic Myeloid Leukemia: A Systematic Review
Get PDFTyrosine kinase inhibitors (TKIs) have significantly improved outcomes in chronic myeloid leukemia (CML), shifting it from a fatal to a manageable chronic condition. Despite their clinical benefits, TKIs have been increasingly associated with endocrine-related adverse effects, most notably thyroid dysfunction. This systematic review explores the prevalence, clinical features, underlying mechanisms, and prognostic implications of TKI-induced thyroid abnormalities in CML patients. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, a comprehensive literature search was conducted across four databases, namely, PubMed, Excerpta Medica database (Embase), ClinicalKey, and Google Scholar, yielding 4,803 records. After applying inclusion and exclusion criteria and quality assessments using the Newcastle-Ottawa Scale (NOS) and A Measurement Tool to Assess Systematic Reviews (AMSTAR 2), eight studies (six observational studies and two systematic reviews) were included in the final analysis. Subclinical hypothyroidism emerged as the most frequently reported thyroid dysfunction, particularly associated with imatinib and second-generation TKIs such as nilotinib and dasatinib. Proposed mechanisms include destructive thyroiditis, reduced iodide uptake, regression of thyroid vasculature via vascular endothelial growth factor (VEGF) inhibition, inhibition of monocarboxylate transporter 8 (MCT8)-mediated thyroid hormone transport, and increased deiodinase activity leading to hormone inactivation. Notably, several studies identified an association between autoimmune thyroiditis and improved molecular response to TKIs, suggesting a potential role for thyroid autoimmunity as a biomarker of therapeutic efficacy. While most thyroid abnormalities were subclinical and did not necessitate treatment, overt hypothyroidism required thyroid hormone replacement and endocrine follow-up. This review emphasizes the importance of routine thyroid function monitoring during TKI treatment and highlights the potential prognostic implications of thyroid autoimmunity. Future large-scale, prospective studies are needed to establish standardized monitoring protocols and clarify the clinical significance of thyroid changes in optimizing CML management
Osteopathic Graduates in Plastic Surgery: How Can We Improve the Pipeline?
Get PDFBackground: Integrated plastic surgery residency is one of the most competitive specialties for medical students to match into. This study was performed to identify trends in osteopathic applicants to plastic surgery and current osteopathic trainees within the field. Furthermore, we explore osteopathic students’ perception of plastic surgery and identify methods that our national societies can utilize to foster exposure to the field.
Methods: All integrated and independent plastic surgery training programs were identified from the Accreditation Council for Graduate Medical Education. Trainees’ medical education was obtained via program websites and public profiles. An anonymous survey was distributed to Student Affairs directors of all 43 osteopathic medical schools, who were asked to forward the survey to their respective student bodies. The survey consisted of 35 questions, inquiring about exposure and barriers to surgical education opportunities, and overall perception of plastic surgery.
Results: A total of 1245 plastic surgery trainees were included in analysis. Within integrated programs, osteopathic graduates account for 1.2% of current postgraduate year 1–5 residents. Our survey gauging osteopathic students’ perception of plastic surgery received 252 responses from 7 osteopathic schools; 87.4% of students believed that exposure is lacking at their institution and 92.6% of students interested in subinternships experienced barriers arranging these experiences.
Conclusions: Osteopathic graduates represent a minority of plastic surgery trainees, which may be attributed to barriers encountered by osteopathic students when seeking exposure to plastic surgery during their undergraduate medical education. Early exposure and increased opportunities for mentorship and away rotations may encourage more osteopathic students to pursue plastic surgery
Postoperative Angiotensin II Receptor Blocker Use is Associated With Reduced 2-Year Reoperation Rates in Male Patients Undergoing Arthroscopic Rotator Cuff Repair
Get PDFBackground
Angiotensin II receptor blockers (ARBs) antagonize the effects of transforming growth factor-b1, a cytokine mediator for fibrosis and fatty infiltration in skeletal muscle. The objective of this study was to determine (1) if postoperative ARB use is associated with reduced rates of secondary surgery 2 years following arthroscopic rotator cuff repair, and (2) whether there are differences in these outcomes within male-, female-, and nonesex-specific cohorts.
Methods
The TriNet X national database was queried to identify patients between 2015 and 2022 who were prescribed an ARB (losartan, valsartan, or olmesartan) within 3 months of arthroscopic rotator cuff repair. ARB patients were propensity matched 1:1 with a non-ARB control. Analyses were conducted to assess outcomes differences within male-, female-, and nonesex-specific cohorts. Two-year secondary surgery rates (manipulation under anesthesia, revision rotator cuff repair, conversion to reverse or anatomic total shoulder arthroplasty, and non-rotator cuff repair arthroscopic shoulder procedures) were evaluated and compared using odds ratios (OR).
Results
In total, 2,883 matched ARB and non-ARB rotator cuff repair patients were included, with a mean age of 62.5 years, and 42% female in each cohort. In the nonesex-specific analysis, within 2 years after surgery, the non-ARB cohort had similar rates of revision rotator cuff repair as the control. In the female-specific analysis, 1,228 matched ARB and non-ARB females were included, with an average age of 63.2 years, and there were no statistically significant differences in secondary surgery rates. In the malespecific analysis, 1,562 matched males were included, with an average of 62 years. The male non-ARB cohort reported significantly higher rates of undergoing revision rotator cuff repair (OR 1.33, 95% confidence interval [1.01-1.75], P ¼ .039) and significantly higher rates of undergoing total nonerotator cuff repair arthroscopic shoulder procedures (OR 1.35, 95% [confidence interval] [1.04-1.75], P ¼ .025) compared to the ARB male cohort.
Conclusion
The findings of this study suggest that ARB use may be associated with lower rates of secondary shoulder surgeries in patients undergoing rotator cuff repair, with the effects predominantly observed in male patients
Regions of Interest Assessment of Prenatal Exposure to Tobacco on Adolescent Cortical Thickness and Sulcal Depth
No full textMaternal tobacco use during pregnancy (MTDP) remains a global and domestic public health issue. This study seeks to investigate the long-term impact of MTDP on brain morphology during late childhood and early adolescence using the Adolescent Brain Cognitive Development (ABCD) dataset. Children aged 9–10 were enrolled using the ABCD school selection probability sample method for national representation. Participants and their parents or guardians underwent interviews and surveys, and children underwent Magnetic Resonance Imaging (MRI) at baseline and 2-year follow-up. Morphometric brain measures of cortical thickness and sulcal depth across 34 regions of interest on T1-weighted MRI images were analyzed. Of 11,448 at baseline, 1607 children fell into the MTDP group. Intracranial volume (p \u3c 0.001), total cortical surface area, and volume (p \u3c 0.0001) were significantly lower among MTDP children (vs. control) at both waves 1 and 2. A sustained difference was found in mean cortical thickness at the parahippocampal gyrus as well as sulcal depth at the isthmus cingulate, parahippocampal, lateral occipital, and lingual gyri. Several regions of interest demonstrated differences in the cortical thickness and sulcal depth at single time points. An association between MTDP and long-term outcomes of regional morphometric differences in cortical thickness and sulcal depth on MRI was found at both baseline among 9–10 years old and at 2-year follow-ups. Taken together with NIH cognitive testing from the same population comparison, the results suggest longstanding cognitive deficits corresponding to specific brain regions
