Respiratory injury during or following hyperbaric oxygen treatment (HBOT) is rare, but associated pressure changes can cause iatrogenic pulmonary barotrauma with potentially severe sequelae such as pneumothoraces. Pulmonary blebs, bullae, and other emphysematous airspace abnormalities increase the risk of respiratory complications and are prevalent in otherwise healthy adults. HBOT providers may elect to use chest X-ray routinely as a pre-treatment screening tool to identify these anomalies, particularly if a history of preceding pulmonary disease is identified, but this approach has a low sensitivity and frequently provides false negative results. Computed tomography scans offer greater sensitivity for airspace lesions, but given the high prevalence of incidental and insignificant pulmonary findings among healthy individuals, would lead to a high false positive rate because most lesions are unlikely to pose a hazard during HBOT. Post-mortem and imaging studies of airspace lesion prevalence show that a significant proportion of patients who undergo HBOT likely have pulmonary abnormalities such as blebs and bullae. Nevertheless, pulmonary barotrauma is rare, and occurs mainly in those with known underlying lung pathology. Consequently, routinely using chest X-ray or computed tomography scans as screening tools prior to HBOT for low-risk patients without a pertinent medical history or lack of clinical symptoms of cardiorespiratory disease is of low value. This review outlines published cases of patients experiencing pulmonary barotrauma while undergoing pressurised treatment/testing in a hyperbaric chamber and analyses the relationship between barotrauma and pulmonary findings on imaging prior to or following exposure. A checklist and clinical decision-making tool based on suggested low-risk and high-risk features are offered to guide the use of targeted baseline thoracic imaging prior to HBOT.
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Background and Aims
Arachnoiditis is a rare but devastating disorder caused by a variety of insults, one purported to be local anesthetic (LA) neurotoxicity following neuraxial blockade. We examined reported cases of arachnoiditis attributed to LA neurotoxicity to characterize the strength of association.
Methods
A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and pre-registered through the Open Science Framework (https://osf.io/b6txa). The databases Medline, EMBASE, CINAHL, and Cochrane CENTRAL were searched (from inception to December 2022) for articles attributing arachnoiditis to LA following neuraxial anesthesia.
Results
We screened 1158 studies and 38 met inclusion criteria, all of which were case reports or series representing a total of 129 patient cases with ages ranging from 15-67 years. Over half of studies were published prior to this century and inconsistent with modern practice. Neuraxial techniques included 76 epidurals, 47 spinals, and 6 combined spinal-epidurals (table 1). Completeness of reported data was poor (figure 1). Studies reporting the greatest number of cases and/or originating from Western countries had the least complete data. Overall, more than half (74) of the 129 patients with arachnoiditis attributed to LA neurotoxicity experienced a complicated needle or catheter insertion, including memorable paresthesia, pain, or multiple attempts, irrespective of the type of neuraxial block.
Conclusions
The aggregate evidence attributing arachnoiditis to LA neurotoxicity is largely outdated, incomplete, or both, and insufficient to characterize the strength of association. However, there appears to be an association between complicated or traumatic insertion and arachnoiditis.
Endosc ����; ��: ���-��� Cryotherapy versus radiofrequency ablation in the treatment of dysplastic Barrett's esophagus with or without early esophageal neoplasia: a systematic review and meta-analysis Cryotherapy and radiofrequency ablation are equally effective in achieving complete eradication of intestinal metaplasia and dysplasia in patients with dysplastic Barrett's esophagus with or without early esophageal neoplasia.627 patients Majority: men, overweight/obese, average age of more than 60 years and a maximum average Barrett's length >3 cm in both groups of all the studies 399 radiofrequency 228 cryotherapy
# Intraoperative teaching styles: preferences of surgical residents {#article-title-2} There is variation in the way different surgeons teach in the operating room setting. Surgical residents in training may have preferences and opinions on how these teaching styles affect their learning. While
Abstract Background Delayed union and nonunion of the scaphoid is a common complication often requiring surgical reconstruction and bone grafting. Our goal was to systematically assess the healing time and clinical outcomes following arthroscopic-assisted versus open non-vascularized bone grafting of the scaphoid. Methods A comprehensive search of the MEDLINE, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and Cochrane Central databases was completed from inception to September 2023. We included randomized trials and observational studies that reported outcomes following scaphoid delayed union/nonunion comparing arthroscopic-assisted vs. open non-vascularized bone grafting. Two reviewers independently extracted data and assessed the risk of bias. One investigator assessed certainty of evidence and a senior investigator confirmed the assessment. We pooled effects using random-effects models, when possible, for all outcomes reported by more than 1 study. Results Overall, 26 studies and 822 patients were included in the study. Very low certainty evidence demonstrated that arthroscopic-assisted surgery may decrease healing time compared to open surgery (weighted mean difference [WMD] -7.8 weeks; 95%CI -12.8 to -2.8). Arthroscopic bone grafting did not result in an improvement in union rate (relative risk 1.01; 95%CI 0.9 to 1.09). The pooled data in arthroscopic graft group showed mean time to union of 11.4 weeks (95%CI: 10.4 to 12.5) with union rate of 95% (95%CI 91–98%). A single comparative study reported very low certainty evidence that arthroscopy-assisted vs. open surgery may not have an effect on pain relief (MD 0 cm, 95%CI -0.4 to 0.5 on VAS 10 cm for pain) or improving function (MD -1.2, 95% CI -4.8 to 2.3 on 100 points DASH). Conclusion and future directions Our results suggest that arthroscopic-assisted non-vascularized bone grafting may be associated with improved average weeks to heal in comparison with open surgery for scaphoid delayed union/nonunion reconstruction with overall comparable union rates. There is insufficient evidence to assess the effects of arthroscopic-assisted reconstruction on union rate, time to union, and patient-reported outcomes in patients with other important nonunion characteristics such as established humpback deformity.
Acute metatarsal fractures are a common extremity injury. While surgery may be recommended to reduce the risk of nonunion or symptomatic malunion, most fractures are treated with nonoperative manag...
As the global prevalence of allergic asthma continues to rise, there is growing interest in exploring the relationship between the gut microbiome of the host and the ability to regulate allergic inflammation. This was prompted by several studies that commonly demonstrated a correlation between the presence of microbial-rich environments and lower levels of childhood allergic asthma. With constant antigen exposure, the mucosal immune system of the gut must regulate environmental stimuli, such as bacteria and food antigens, to sustain immune homeostasis. This is achieved by maintaining immune tolerance to support the gut mucosa’s commensal microbiota and mounting a simultaneous, controlled immune response to eliminate pathogenic species. The immune patterns of the gut microbiome are thought to shape allergic asthma progression through its shared immunomodulatory role with the airway microbiome. Currently, studies are examining the role regulatory B cells play in allergic asthma through immune regulation. This review will discuss the relationship between regulatory B cells and the gut microbiome in maintaining immune homeostasis within the allergic disease framework.
