We also recorded any complications, such as reoperation.

The mean Japanese Society for Surgery of the Hand score was 12.8 (range, 5-17). Six patients had poor results, 7 had fair results, and 2 had good results; however, none of the patients had an excellent result. Satisfaction with thumb function and appearance was reported in 11 (50%) and 6 (27%) cases, respectively. Thirteen of 22 (59.1%) cases involved reoperations, and the most common reason for reoperation was interphalangeal joint deviation of the remaining thumb.

Ulnar component excision and radial component reconstruction are rare operative choices in preaxial polydactyly of the hand. Surgeons and patients should be aware that a considerable number of patients treated with this method required reoperations and had low clinical outcome scores.

Prognostic IV.

Prognostic IV.

Trauma patient care is complex. Clustering these patients within the hospital seems intuitive. This study’s purpose was to explore the benefits of trauma patient clustering, hypothesizing these patients will have decreased costs and better outcomes.

This was an analysis of all adult (18-99 years) trauma patients admitted from 1/2017-1/2019 without an intensive care unit stay. Patients were grouped into those admitted to the trauma unit (TU) versus non-trauma units (NTU). Outcomes evaluated between groups were baseline demographics, direct costs, complication rates (using our TQIP registry), and discharge location. T-test, median test, and chi squared test were used. Linear regression was performed. Significance was set at p<0.05.

1481 patients (684 TU and 797 NTU) were analyzed. TU patients were younger. Injury Severity Score, mortality, and hospital length of stay were similar between groups. Direct hospital costs were decreased for TU patients ($4941(±$4740) versus $5639(±$4897), p=0.006). Fewer TU patients experienced inpatient complications (7.8% versus 13.5%, p<0.001). More TU patients were discharged to home (78.9% versus 73.8%, p=0.02). Linear regression analysis demonstrated admission to NTUs predicted a direct cost increase of $766.35 (p<0.001).

Clustering minorly injured trauma patients on a dedicated unit resulted in reduced costs, decreased complications, and higher likelihood for discharge to home.

Clustering minorly injured trauma patients on a dedicated unit resulted in reduced costs, decreased complications, and higher likelihood for discharge to home.

Current screening options for colorectal cancer (CRC) are either invasive (colonoscopy) or have lower sensitivity to identify pre-malignant lesions (fecal immunochemical test). We proposed to identify protein profiles in tears of patients with both pre-malignant polyps and CRC; these profiles could have potential as a noninvasive screening test.

Colonoscopy patients were divided into „high risk” group (CRC and tubular adenomatous polyp) and „low risk” (normal and hyperplastic polyps). Tear fluids from patients were analyzed by Liquid Chromatography Mass Spectrometry/Mass Spectrometry. The data were analyzed for protein expression, protein-protein interaction and gene set enrichment.

The results showed 80 proteins (18 up-regulated and 62 down-regulated) significantly differentiated in „high-risk” compared to „low-risk”; Twenty-eight of these show protein-protein interactions, 9 of which were associated with pathways demonstrated to be altered in CRC patients.

Our pilot data, though limited, demonstrated tear protein profiling could distinguish the groups of patients with and without colon lesions.

Our pilot data, though limited, demonstrated tear protein profiling could distinguish the groups of patients with and without colon lesions.

Hand-foot syndrome (HFS) is a common adverse event in patients receiving capecitabine therapy for breast cancer, and the symptoms of HFS significantly impair patient quality of life. However, currently there are no effective drugs or measures to prevent and alleviate the occurrence of HFS.

To assess the effectiveness of a novel soaking solution, a mixture solution of dexamethasone, gentamicin and vitamin B12, in patients with grade 2-3 HFS after capecitabine treatment for breast cancer.

Patients with grade 2-3 HFS according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) were enrolled in this randomized, single-center, self-controlled trial. Each patient’s right and left hands or feet were individually randomized to soak in either a novel soaking solution (treated hands or feet) or a placebo liquid (control hands or feet) for three times a day, each time for 15 minutes and for four weeks. Effectiveness was evaluated according to CTCAE grades, defined as a reduction of 1 or more CTCAE grades.

A total of 60 patients were enrolled. The HFS CTCAE grade of the treated hands and feet at 4 weeks of HFS treatment was significantly decreased compared to that of the control hands and feet (P=.005). Significant differences were also observed between the treatment conditions in terms of the HFS effectiveness rate treated group 80% and placebo group 51.7% (P=.001). No adverse or unexpected events were observed during the whole trial.

Soaking affected hands or feet in a novel soaking solution safely and effectively reduced the severity of HFS following treatment with capecitabine for breast cancer.

Soaking affected hands or feet in a novel soaking solution safely and effectively reduced the severity of HFS following treatment with capecitabine for breast cancer.

Proximal femoral nail anti-rotation (PFNA) and Gamma nail were recommended for intertrochanteric fracture, however, with high rate of post-operation complications. The triangular support intramedullary nail (TSIN) was designed to reduce the risk of postoperative complications related to Gamma nail and PFNA, and the aim is to compare the biomechanical characters of Gamma nail, PFNA and TSIN for fixation of intertrochanteric fracture and prove the rationality of the concept of triangle fixation in the treatment of intertrochanteric fractures.

The finite element model of proximal femur was constructed according to the CT data of femur. Intertrochanteric fracture models with Evans type Ⅰ and Ⅳ were established and fixed with Gamma nail, PFNA and TSIN by UG-NX 12.0. The finite element analysis software was used to compare the stress distribution and displacement of three implants fixation models.

Under axial loading of 600N, the peak stress and maximum displacement of intact proximal femur was 13.78MPa and 1that triangle fixation concept help to reduce the risk of post-operative complications associated with PFNA and Gamma nail and improve the clinical effect of intertrochanteric fracture.

Patients with Hirschsprung disease (HD) mostly undergo surgery around the age of three to six months. While awaiting surgery, therapy to treat the obstruction such as transanal irrigation (TAI) or laxatives is applied. The aim of this study was to gain insight in the prevalence and severity of complications occurring while awaiting surgery and to identify patient characteristics associated with the development of these complications.

This study retrospectively analyzed data of patients with HD operated in our center between 2000 and 2021. Complications emerging while awaiting surgery were graded using Clavien-Dindo (CD). Patient characteristics as predictor of a complication were tested using logistic regression analysis.

Twenty-two of 132 (17%) included patients (preoperative treatment 94% TAI; 2% laxatives; 2% other therapy) developed 45 complications while awaiting surgery, including predominantly major complications (91%). Bowel perforation occurred most frequently (n=9, 7%) wherefrom six caused by TAI (5%), including three patients with total colon aganglionosis (TCA) (2%) counting one life-threatening and one lethal perforation. The other perforations were caused by meconium ileus (n=2) and Hirschsprung associated enterocolitis (HAEC) (n=1). Other frequent complications were sepsis (5%), ileus (4%) and persistent obstruction (4%). Predictive factor for developing complication was TCA (OR 9.905, CI 2.994-32.772, p<0.001).

We found a complication rate of 17% in patients while awaiting surgery, reporting bowel perforation most frequently. We found this complication in patients with TCA being highly dangerous causing one life-threatening and one lethal perforation. Therefore, we advise in patients with (suspected) TCA to limit the time awaiting surgery.

level III.

level III.INTRODUCTION Optic disc edema has been well documented in astronauts both during and after long-duration spaceflight and is hypothesized to largely result from increased pressure within the orbital subarachnoid space brought about by a generalized rise in intracranial pressure or from sequestration of cerebrospinal fluid within the orbital subarachnoid space with locally elevated optic nerve sheath pressure. In addition, a recent prospective study documented substantial spaceflight-associated peripapillary choroidal thickening, which may be a contributing factor in spaceflight-associated neuro-ocular syndrome. In the present article, based on the above, we offer a new perspective on the pathogenesis of microgravity-induced optic disc edema from a choroidal point of view. We propose that prolonged microgravity exposure may result in the transudation of fluid from the choroidal vasculature, which, in turn, may reach the optic nerve head, and ultimately may lead to fluid stasis within the prelaminar region secondary to impaired ocular glymphatic outflow. If confirmed, this viewpoint would shed new light on the development of optic disc edema in astronauts.Wostyn P, Gibson CR, Mader TH. Optic disc edema in astronauts from a choroidal point of view. Aerosp Med Hum Perform. 2022; 93(4)396-398.BACKGROUND High +Gz exposure is known to cause spinal problems in fighter pilots, but the amount of tolerable cumulative +Gz exposure or its intensity is not known. The aims of this study were to assess possible breaking points during a flight career and to evaluate possible determinants affecting pilots’ spines.METHODS Survival analysis was performed on the population who started their jet training in 1995-2015. The endpoint was permanent flight duty restriction due to spinal disorder. Then the quantified Gz exposure and possible confounding factors were compared between those pilots with permanent flying restriction and their matched controls. Cumulative Gz exposure was measured sortie by sortie with fatigue index (FI) recordings. FI is determined by the number of times certain levels of Gz are exceeded during the sorties.RESULTS The linear trend of the survival curve indicates an annual 0.86% drop out rate due to spinal problems among the fighter pilot population. A conditional logistic regression did not find any difference in the FI between cases and controls (OR 0.96, 95%CI 0.87-1.06). No statistical difference was found for flight hours, a sum of intensive flying periods, fitness tests, or with nicotine product use. Additionally, a maximum +Gz limitation without airframe restriction was assessed and is presented as a useful tool to manage loading and developed symptoms.DISCUSSION No particular breaking point during follow-up or individual factor was found for Gz induced spinal disorders. The results of the study outline the multifactorial nature of the problem. Thus, multifactorial countermeasures are also needed to protect pilots’ health.Sovelius R, Honkanen T, Janhunen M, Mäntylä M, Huhtala H, Leino T. +Gz exposure and flight duty limitations. Aerosp Med Hum Perform. 2022; 93(4)390-395.