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The clinical assessment of fibrosis is critical to the diagnosis and management of patients with systemic sclerosis. Current clinical standards for patient assessment is to use skin fibrosis as an indicator of organ involvement, though this approach is highly subjective and relies on manual palpation. The development of a new method for accurately quantifying collagen content may therefore significantly improve the accuracy of the traditional skin score in patients with systemic sclerosis and may additionally aid in the monitoring of anti-fibrotic therapies in clinical practice. Polarization-sensitive optical coherence tomography (PS-OCT) is a high-speed volumetric imaging modality that can be used to assess birefringent tissues including collagen. In this work we demonstrate a novel computational approach using PS-OCT for the assessment of fibrosis. This approach, based on the measured distribution of optic axis values associated with a given volume of collagen orientation, characterizes fibrotic changes independently from the depth of the region of interest in the tissue. This approach has the potential to accurately quantify collagen content and orientation faster and more robustly compared to traditional PS-OCT metrics. We investigate the viability of this approach for assessing the development of fibrosis in a bleomycin induced skin fibrosis mouse model. [ABSTRACT FROM AUTHOR]

Background and objective: In vivo evaluation of the microstructural differences between asthmatic and non‐asthmatic airways and their functional consequences is relevant to understanding and, potentially, treating asthma. In this study, we use endobronchial optical coherence tomography to investigate how allergic airways with asthma differ from allergic non‐asthmatic airways in baseline microstructure and in response to allergen challenge. Methods: A total of 45 subjects completed the study, including 20 allergic, mildly asthmatic individuals, 22 non‐asthmatic allergic controls and 3 healthy controls. A 3‐cm airway segment in the right middle and right upper lobe were imaged in each subject immediately before and 24 h following segmental allergen challenge to the right middle lobe. Relationships between optical airway measurements (epithelial and mucosal thicknesses, mucosal buckling and mucus) and airway obstruction (FEV1/FVC (forced expiratory volume in 1 s/forced vital capacity) and FEV1% (FEV1 as a percentage of predictive value)) were investigated. Results: Significant increases at baseline and in response to allergen were observed for all four of our imaging metrics in the asthmatic airways compared to the non‐asthmatic airways. Epithelial thickness and mucosal buckling exhibited a significant relationship to FEV1/FVC in the asthmatic group. Conclusion: Simultaneous assessments of airway microstructure, buckling and mucus revealed both structural and functional differences between the mildly asthmatic and control groups, with airway buckling seeming to be the most relevant factor. The results of this study demonstrate that a comprehensive, microstructural approach to assessing the airways may be important in future asthma studies as well as in the monitoring and treatment of asthma. [ABSTRACT FROM AUTHOR]

The article describes the diagnosis of subcutaneous forehead nodule (SFN). The authors note that if a SFN is determined preoperatively to be a button osteoma or frontalis-associated lipoma, each has a unique approach with which dermatologic surgeons should be proficient. They note that minimal specialized equipment is required for the button osteoma excision and none is required for the frontalis-associated lipoma.

BACKGROUND. Skin grafting has evolved in the past centuries to encompass numerous well-established reconstruction techniques that are uniquely able to restore structure, function, and cosmesis to a variety of surgical wounds. OBJECTIVE. To provide a detailed overview of the general principles of skin grafting geared for the dermatologist and the dermatologic surgeon. METHODS. Comprehensive review of the literature. RESULTS. A summary of the different applications and techniques of full- and split-thickness skin grafts, free cartilage grafts, and composite grafts is presented. Indications, advantages, disadvantages, techniques, and complications are discussed in depth. CONCLUSION. Skin grafting is a dynamic and versatile method of cutaneous reconstruction that can be accomplished successfully with a thorough understanding of the principles and techniques of grafting. [ABSTRACT FROM AUTHOR]

Summary: Background: Noradrenaline is a standard treatment for hypotension in acute care. The precise effects of noradrenaline on cerebral blood flow in health and disease remain unclear. Methods: We systematically reviewed and synthesised data from studies examining changes in cerebral blood flow in healthy participants and patients with traumatic brain injury and critical illness. Results: Twenty‐eight eligible studies were included. In healthy subjects and patients without critical illness or traumatic brain injury, noradrenaline did not significantly change cerebral blood flow velocity (‐1.7%, 95%CI ‐4.7–1.3%) despite a 24.1% (95%CI 19.4–28.7%) increase in mean arterial pressure. In patients with traumatic brain injury, noradrenaline significantly increased cerebral blood flow velocity (21.5%, 95%CI 11.0–32.0%), along with a 33.8% (95%CI 14.7–52.9%) increase in mean arterial pressure. In patients who were critically ill, noradrenaline significantly increased cerebral blood flow velocity (20.0%, 95%CI 9.7–30.3%), along with a 32.4% (95%CI 25.0–39.9%) increase in mean arterial pressure. Our analyses suggest intact cerebral autoregulation in healthy subjects and patients without critical illness or traumatic brain injury., and impaired cerebral autoregulation in patients with traumatic brain injury and who were critically ill. The extent of mean arterial pressure changes and the pre‐treatment blood pressure levels may affect the magnitude of cerebral blood flow changes. Studies assessing cerebral blood flow using non‐transcranial Doppler methods were inadequate and heterogeneous in enabling meaningful meta‐analysis. Conclusions: Noradrenaline significantly increases cerebral blood flow in humans with impaired, not intact, cerebral autoregulation, with the extent of changes related to the severity of functional impairment, the extent of mean arterial pressure changes and pre‐treatment blood pressure levels. [ABSTRACT FROM AUTHOR]

Postoperative delirium remains prevalent despite extensive research through randomised trials aimed at reducing its incidence. Understanding trial characteristics associated with interventions' effectiveness facilitates data interpretation. Trial characteristics were extracted from eligible trials identified through two systematic literature searches. Multivariable meta-regression was used to investigate trial characteristics associated with effectiveness estimated using odds ratios. Meta-analysis was used to investigate pooled effectiveness. We identified 201 eligible trials. Compared with China, trials from the USA/Canada (ratio of odds ratio, 1.89; 95% confidence interval, 1.45–2.45) and Europe/Australia/New Zealand (1.67; 1.29–2.18) had an 89% and 67% higher odds ratio, respectively, suggesting reduced effectiveness. The effectiveness was enhanced when the incidence of postoperative delirium increased (0.85; 0.79–0.92, per 10% increase). Trials with concerns related to deviations from intended interventions reported increased effectiveness compared with those at low risk (0.69; 0.53–0.90). Compared with usual care, certain interventions appeared to have reduced the incidence of postoperative delirium in low-risk trials with low-to-moderate certainty of evidence. However, these findings should be considered inconclusive because of challenges in grouping heterogeneous interventions, the limited number of eligible trials, the prevalence of small-scale studies, and potential publication bias. The effectiveness of postoperative delirium trials varied based on the region of trial origin, the incidence of delirium, and the risk of bias. The limitations caution against drawing definitive conclusions from different bodies of evidence. These findings highlight the imperative need to improve the quality of research on a global scale. PROSPERO (CRD42023413984). [ABSTRACT FROM AUTHOR]

D. C. ADAMS, MD, M. L. RAMSEY, MD, AND V. J. MARKS, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. [ABSTRACT FROM AUTHOR]

Background: The addition of clonidine to lidocaine intravenous regional anesthesia (IVRA) has been previously reported to improve postoperative analgesia in patients undergoing upper extremity surgery . Our objective was to perform a dose ranging study in order to determine the optimal dose of clonidine used with lidocaine in IVRA. Design & Setting: We performed a double-blinded randomized placebo-controlled study with 60 patients scheduled for elective endoscopic carpal tunnel release under IVRA with 50 ml lidocaine 0.5%. University-affiliated outpatient surgery center . Data collected in operating rooms, recovery room, and by telephone after discharge from surgery center . Materials & Methods: Sixty adult ASA I or II patients undergoing outpatient endoscopic carpal tunnel release under intravenous regional anesthesia. Patients were randomized into five study groups receiving different doses of clonidine in addition to 50 ml 0.5% lidocaine in their IVRA. Group A received 0 mcg/kg, group B 0.25 mcg/kg, group C 0.5 mcg/kg, group D 1.0 mcg/kg and group E 1.5 mcg/kg of clonidine. Intraoperative fentanyl, recovery room pain scores, time to first postsurgical analgesic, total number of acetaminophen/codeine tablets consumed postsurgery , incidence of sedation, hypotension and bradycardia. Results & Conclusions: There was no benefit from any dose of clonidine compared to placebo. There were no clonidine- related side effects seen within the dose range studied. In short duration minor hand surgery , the addition of clonidine to lidocaine-based intravenous regional anesthesia provides no measurable benefit. [ABSTRACT FROM AUTHOR]

The article provides information on a study which analyzed the July Phenomenon, wherein increased incidence of medical errors in teaching hospitals for anesthesiology and surgical residents at the beginning of the academic year was found.

Mycobacterium haemophilum is an emerging cutaneous and systemic pathogen in immunosuppressed adults. Reports in the pediatric literature prior to 2004, limited to immunocompetent children with lymphadenitis, offer a different clinical presentation from that of the immunosuppressed adult. We report an instance of this atypical mycobacterial infection occurring in an immunosuppressed boy with clinical findings similar to those described in immunosuppressed adults. [ABSTRACT FROM AUTHOR]

The article observes the revenue stream directly generated by the clinical activities of anesthesiology residents at academic anesthesiology programs during the time period July 1, 2011, through June 30, 2012.