scholarly journals The Impact of Subspecialty Training on Procedural Timing in Facial Fracture Repair

2021 ◽  
Vol 233 (5) ◽  
pp. S212
Author(s):  
Aksha Parray ◽  
Bryan Le ◽  
Chris B. Choi ◽  
Boris Paskhover
Keyword(s):  
Fracture Repair ◽  
Subspecialty Training ◽  
Facial Fracture ◽  
The Impact

scholarly journals Clinical Decision Support for Ovarian Carcinoma Subtype Classification: A Pilot Observer Study With Pathology Trainees

2019 ◽  
Vol 144 (7) ◽  
pp. 869-877 ◽  
Author(s):  
Marios A. Gavrielides ◽  
Meghan Miller ◽  
Ian S. Hagemann ◽  
Heba Abdelal ◽  
Zahra Alipour ◽  
...  
Keyword(s):  
Decision Support ◽  
Ovarian Carcinoma ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Subspecialty Training ◽  
Reference Standard ◽  
Observer Study ◽  
Subtype Classification ◽  
The Impact ◽  
Whole Slide Images

Context.— Clinical decision support (CDS) systems could assist less experienced pathologists with certain diagnostic tasks for which subspecialty training or extensive experience is typically needed. The effect of decision support on pathologist performance for such diagnostic tasks has not been examined. Objective.— To examine the impact of a CDS tool for the classification of ovarian carcinoma subtypes by pathology trainees in a pilot observer study using digital pathology. Design.— Histologic review on 90 whole slide images from 75 ovarian cancer patients was conducted by 6 pathology residents using: (1) unaided review of whole slide images, and (2) aided review, where in addition to whole slide images observers used a CDS tool that provided information about the presence of 8 histologic features important for subtype classification that were identified previously by an expert in gynecologic pathology. The reference standard of ovarian subtype consisted of majority consensus from a panel of 3 gynecologic pathology experts. Results.— Aided review improved pairwise concordance with the reference standard for 5 of 6 observers by 3.3% to 17.8% (for 2 observers, increase was statistically significant) and mean interobserver agreement by 9.2% (not statistically significant). Observers benefited the most when the CDS tool prompted them to look for missed histologic features that were definitive for a certain subtype. Observer performance varied widely across cases with unanimous and nonunanimous reference classification, supporting the need for balancing data sets in terms of case difficulty. Conclusions.— Findings showed the potential of CDS systems to close the knowledge gap between pathologists for complex diagnostic tasks.

The impact of subspecialty training on the management of advanced ovarian cancer

1992 ◽  
Vol 47 (2) ◽  
pp. 203-209 ◽  
Author(s):  
Scott M. Eisenkop ◽  
Nick M. Spirtos ◽  
Thomas W. Montag ◽  
Richard H. Nalick ◽  
He-Jing Wang
Keyword(s):  
Ovarian Cancer ◽  
Advanced Ovarian Cancer ◽  
Subspecialty Training ◽  
The Impact

scholarly journals Lack of Obvious Influence of PLLA Nanofibers on the Gene Expression of BMP-2 and VEGF during Growth and Differentiation of Human Mesenchymal Stem Cells

2009 ◽  
Vol 9 ◽  
pp. 313-319 ◽  
Author(s):  
Markus D. Schofer ◽  
S. Fuchs-Winkelmann ◽  
C. Wack ◽  
M. Rudisile ◽  
R. Dersch ◽  
...  
Keyword(s):  
Gene Expression ◽  
Growth Factor ◽  
Time Course ◽  
Negative Impact ◽  
Fracture Repair ◽  
Bone Morphogenetic Protein 2 ◽  
Vegf Gene ◽  
Down Regulation ◽  
Artificial Graft ◽  
The Impact

Growth factors like bone morphogenetic protein 2 (BMP-2) and vascular endothelial growth factor (VEGF) play an important role in bone remodeling and fracture repair. Therefore, with respect to tissue engineering, an artificial graft should have no negative impact on the expression of these factors. In this context, the aim of this study was to analyze the impact of poly(L-lactic acid) (PLLA) nanofibers on VEGF and BMP-2 gene expression during the time course of human mesenchymal stem cell (hMSC) differentiation towards osteoblasts. PLLA matrices were seeded with hMSCs and cultivated over a period of 22 days under growth and osteoinductive conditions, and analyzed during the course of culture, with respect to gene expression of VEGF and BMP-2. Furthermore, BMP-2–enwoven PLLA nanofibers were used in order to elucidate whether initial down-regulation of growth factor expression could be compensated. Although there was a great interpatient variability with respect to the expression of VEGF and BMP-2, PLLA nanofibers tend to result in a down-regulation in BMP-2 expression during the early phase of cultivation. This effect was diminished in the case of VEGF gene expression. The initial down-regulation was overcome when BMP-2 was directly incorporated into the PLLA nanofibers by electrospinning. Furthermore, the incorporation of BMP-2 into the PLLA nanofibers resulted in an increase in VEGF gene expression. Summarized, the results indicate that the PLLA nanofibers have little effect on growth factor production. An enhancement in gene expression of BMP-2 and VEGF can be achieved by an incorporation of BMP-2 into the PLLA nanofibers.

ASA Physical Status Classification and Complications Following Facial Fracture Repair

2021 ◽  
pp. 000348942110595
Author(s):  
Parisorn Thepmankorn ◽  
Chris B. Choi ◽  
Sean Z. Haimowitz ◽  
Aksha Parray ◽  
Jordon G. Grube ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Surgical Site Infection ◽  
Fracture Repair ◽  
Site Infection ◽  
Class Iii ◽  
Facial Fracture ◽  
Asa Classification ◽  
Physical Status Classification ◽  
Deep Surgical Site Infection ◽  
Status Classification

Background: To investigate the association between American Society of Anesthesiologists (ASA) physical status classification and rates of postoperative complications in patients undergoing facial fracture repair. Methods: Patients were divided into 2 cohorts based on the ASA classification system: Class I/II and Class III/IV. Chi-square and Fisher’s exact tests were used for univariate analyses. Multivariate logistic regressions were used to assess the independent associations of covariates on postoperative complication rates. Results: A total of 3575 patients who underwent facial fracture repair with known ASA classification were identified. Class III/IV patients had higher rates of deep surgical site infection ( P = .012) as well as bleeding, readmission, reoperation, surgical, medical, and overall postoperative complications ( P < .001). Multivariate regression analysis found that Class III/IV was significantly associated with increased length of stay ( P < .001) and risk of overall complications ( P = .032). Specifically, ASA Class III/IV was associated with increased rates of deep surgical site infection ( P = .049), postoperative bleeding ( P = .036), and failure to wean off ventilator ( P = .027). Conclusions: Higher ASA class is associated with increased length of hospital stay and odds of deep surgical site infection, bleeding, and failure to wean off of ventilator following facial fracture repair. Surgeons should be aware of the increased risk for postoperative complications when performing facial fracture repair in patients with high ASA classification.

scholarly journals Complications of clavicle fracture surgery in patients with concomitant chest wall injury: a retrospective study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Tsung-Han Yang ◽  
Huan-Jang Ko ◽  
Alban Don Wang ◽  
Wo-Jan Tseng ◽  
Wei-Tso Chia ◽  
...  
Keyword(s):  
Chest Wall ◽  
Hospital Readmission ◽  
Clavicle Fracture ◽  
Flail Chest ◽  
Fracture Repair ◽  
Rib Fractures ◽  
Readmission Rates ◽  
Hospital Readmission Rates ◽  
Chest Wall Injury ◽  
The Impact

Abstract Background The impact of associated chest wall injuries (CWI) on the complications of clavicle fracture repair is unclear to date. This study aimed to investigate the complications after surgical clavicle fracture fixation in patients with and without different degrees of associated CWI. Methods A retrospective review over a four-year period of patients who underwent clavicle fracture repair was conducted. A CWI and no-CWI group were distinguished, and the CWI group was subdivided into the minor-CWI (three or fewer rib fractures without flail chest) and complex-CWI (flail chest, four or more rib fractures) subgroup. Demographic data, classification of the clavicle fracture, number of rib fractures, and associated injuries were recorded. Overall complications included surgery-related complications and unplanned hospital readmissions. Univariate analysis and stepwise backward multivariate logistic regression were used to identify potential risk factors for complications. Results A total of 314 patients undergoing 316 clavicle fracture operations were studied; 28.7% of patients (90/314) occurred with associated CWI. Patients with associated CWI showed a significantly higher age, body mass index, and number of rib fractures. The overall and surgical-related complication rate were similar between groups. Unplanned 30-day hospital readmission rates were significantly higher in the complex-CWI group (p = 0.02). Complex CWI and number of rib fractures were both independent factor for 30-day unplanned hospital readmission (OR 1.59, 95% CI: 1.00–2.54 and OR 1.33, 95% CI: 1.06–1.68, respectively). Conclusion CWI did not affect surgery-related complications after clavicle fracture repair. However, complex-CWI may increase 30-day unplanned hospital readmission rates.

scholarly journals MiR-144-5p, an exosomal miRNA from bone marrow-derived macrophage in type 2 diabetes, impairs bone fracture healing via targeting Smad1

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Dong Zhang ◽  
Yifan Wu ◽  
Zonghuan Li ◽  
Hairen Chen ◽  
Siyuan Huang ◽  
...  
Keyword(s):  
Bone Marrow ◽  
Fracture Healing ◽  
Bone Regeneration ◽  
Osteogenic Differentiation ◽  
Fracture Repair ◽  
Osteogenic Potential ◽  
Patients With Diabetes ◽  
The Impact

Abstract Background Patients with diabetes have an increased risk of nonunion and delayed union of fractures. Macrophages have been shown as a key player in diabetic complications. However, it remains obscure how diabetic milieu affects macrophage-derived exosomes and its implications on osteogenic differentiation of BMSCs. In this study, we aim to define the impact of diabetic milieu on macrophage-derived exosomes, role of extracellular vesicles in intercellular communication with BMSCs, and subsequent effects on osteogenic differentiation and fracture repair. Results The osteogenic potential and the ability of fracture repair of exosomes derived from diabetic bone marrow-derived macrophages (dBMDM-exos) were revealed to be lower, as compared with non-diabetic bone marrow-derived macrophages (nBMDM-exos) in vitro and in vivo. Interestingly, miR-144-5p levels were sharply elevated in dBMDM-exos and it could be transferred into BMSCs to regulate bone regeneration by targeting Smad1. In addition, the adverse effects of dBMDM-exos on the osteogenic potential and the ability of fracture repair were reversed through the suppression of miR-144-5p inhibition in vitro and vivo. Conclusions The results demonstrated an important role of exosomal miR-144-5p in bone regeneration, offering insight into developing new strategy for the improvement of fracture healing in patients with diabetes mellitus. Graphic Abstract

scholarly journals The role of international partnerships in improving urethral reconstruction in low- and middle-income countries

2019 ◽  
Vol 38 (12) ◽  
pp. 3003-3011 ◽  
Author(s):  
Maahum Haider ◽  
Mohamed Jalloh ◽  
Jiaqi Yin ◽  
Amadou Diallo ◽  
Nancy Puttkammer ◽  
...  
Keyword(s):  
Data Collection ◽  
Success Rate ◽  
Urethral Stricture ◽  
Urethral Reconstruction ◽  
Subspecialty Training ◽  
Middle Income ◽  
Middle Income Countries ◽  
Urethral Stricture Disease ◽  
The Impact ◽  
Low And Middle Income

Abstract Purpose To explore the impact of education and training in international surgical partnerships on outcomes of urethral stricture disease in low- and middle-income countries. To encourage data collection and outcomes assessments to promote evidence-based and safe surgical care. Methods Qualitative data were collected through observation of a reconstructive surgical workshop held by IVUmed at a host site in Dakar, Senegal. Quantitative data were collected through a retrospective review of 11 years of hospital data to assess surgical outcomes of urethral stricture disease before and after IVUmed started reconstructive workshops at the site. Results In the 11-year study period, 569 patients underwent 774 surgical procedures for urethral strictures. The numbers and types of urethroplasty techniques increased after IVUmed started its workshops. The average number of urethroplasties increased from 10 to 18.75/year. There was a statistically significant improvement in the mean success rate of urethroplasties from 12.7% before to 29% after the workshops. Anastomotic urethroplasty success rates doubled from 16.7 to 35.1%, but this was not statistically significant (p = 0.07). The improved success rate was sustained in cases performed without an IVUmed provider. Conclusions Urethral stricture disease treatment in low- and middle-income countries is fraught with challenges due to complex presentations and limited subspecialty training. Improper preoperative management, lack of specialty instruments, and suboptimal wound care all contribute to poor outcomes. International surgical groups like IVUmed who employ the “teach-the-teacher” model enhance local practitioner expertise and independence leading to long-term improvements in patient outcomes. Tailoring practice guidelines to the local resource framework and encouraging data collection and outcomes assessment are vital components of providing responsible care and should be encouraged.

Sign in / Sign up

Export Citation Format

Share Document