Principales dificultades de los proyectos de investigación de la especialidad Medicina General Integral / Main Difficulties of Research Projects of the General Comprehensive Medicine Specialty

Introducción: El residente de Medicina General Integral, una vez graduado, ejecutará investigaciones en correspondencia con las necesidades actuales del Sistema Nacional de Salud y a partir de los problemas de salud predominantes en su comunidad. Objetivo: Describir las principales dificultades en los proyectos de investigación de los residentes de la Especialidad de Medicina General Integral. Métodos: Se realizó un estudio observacional descriptivo transversal en la Facultad de Ciencias Médicas de Sagua la Grande en el período 2020-2021. La población objeto de análisis quedó constituida por un total de 69 proyectos de investigación provenientes de 5 policlínicos docentes de 3 municipios del territorio (Corralillo, Quemado de Güines y Sagua la Grande). Se revisó el proyecto de investigación, se confeccionó un modelo para la recogida de datos extraídos de los mismos y se elaboró una base de datos para su almacenamiento. Resultados: Las principales dificultades estuvieron dadas en no sustentar adecuadamente la investigación, en la redacción del problema científico, específicamente la relación entre el problema y el tipo de investigación, la conceptualización y/o operacionalización de las variables, la selección y elaboración de los métodos, técnicas e instrumentos para la recogida de la información y la acotación de la bibliografía por normas de Vancouver. Conclusiones: Resulta de vital importancia que los residentes de esta especialidad desarrollen habilidades investigativas desde el primer año de formación, lo que contribuirá a un mejor desempeño profesional a partir de la aplicación del método científico en la solución de los problemas de salud que se presenten en su quehacer diario(AU)

Introduction: The family medicine resident, once graduated, will do research in correspondence with the current needs of the national health system and considering the predominant health problems in her/his community. Objective: To describe the main difficulties in the research projects of residents in the General Comprehensive Medicine specialty. Methods: A cross-sectional, descriptive and observational study was carried out in the medical school of Sagua la Grande Municipality, in the period 2020-2021. The population under analysis consisted of a total of 69 research projects from five teaching polyclinics in three municipalities of the territory (Corralillo, Quemado de Güines and Sagua la Grande). Each research project was reviewed, a model was prepared for collecting the data extracted from them, and a database was elaborated for their storage. Results: The main difficulties were not supporting the research adequately, as well as in writing the scientific problem, specifically the relation between the problem and the type of research; also, the conceptualization or operationalization of variables, the selection and elaboration of methods, the techniques and instruments for the collection of information, and the bibliographical adjustment by the Vancouver norms. Conclusions: It is of vital importance that residents of this specialty develop research skills from the first year of training, which will contribute to better professional performance from the application of the scientific method in the solution of health problems that appear in their daily work(AU)

Aplicación móvil para la organización de las referencias bibliográficas por las normas de Vancouver / Mobile Application for the Organization of Bibliographic References by the Vancouver Standards

Introducción: Frecuentemente se identifican dificultades en la organización de las referencias bibliográficas por las Normas de Vancouver. Objetivo: Desarrollar la aplicación para dispositivos móviles Normas de Vancouver-APK para la organización de las referencias bibliográficas. Método: Se utilizó HTML5, CSS3, JavaScript, Java, Visual Studio Code, Android Studio y adobe Photoshop. Resultados: En este trabajo se muestra el prototipo de aplicación Normas de Vancouver-APK para dispositivos móviles, sus ventajas, la dirección electrónica donde se puede descargar, y el manual de usuario para generar y recuperar las referencias bibliográficas a través del llenado del formulario según el tipo de documento utilizado. Conclusiones: La aplicación contribuye a la organización de las referencias bibliográficas por las Normas de Vancouver de una manera más fácil, limitando la complejidad para el que lo redacta(AU)

Introduction: Difficulties are frequently identified in the organization of bibliographic references by the Vancouver Standards. Objective: To develop the Vancouver Rules-APK application for mobile devices for the organization of bibliographic references. Method: HTML5, CSS3, JavaScript, Java, Visual Studio Code, Android Studio and Adobe Photoshop were used for its construction. Results: This work shows the Vancouver Standards-APK application prototype for mobile devices, its advantages, the electronic address where it can be downloaded, and the user manual to generate and retrieve bibliographic references by filling in the form according to the type of document used. Conclusions: The application contributes to the organization of the bibliographic references by the Vancouver Standards in an easier way for the one who writes it(AU)

The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study

ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

Sequential therapy by local injection of triamcinolone acetonide and lattice CO 2 laser for hypertrophic scar / 中华医学美学美容杂志

Objective:To determine the clinical effect of sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser for hypertrophic scar. Methods:A total of 80 hypertrophic scar patients, including 45 male and 35 female, in our clinic were randomly divided into test ( n=40) and control ( n=40) groups from March 2019 to May 2020. Patients aged from 18-42 years with average age 28.1. Patients in test groups were treated with triamcinolone acetonide and lattice CO 2laser sequentially. After final treatments, third-party blind evaluation, Vancouver scar scale, visual analog scale and dermatology life quality index were performed. Results:Test group acquired more satisfied result in third-party blind evaluation (82.5% vs. 52.5%, χ2=8.216, P<0.05). Vancouver scar scale, visual analog scale and dermatology life quality index were not significantly different before treatment for both groups while test group acquired better improvement after treatment ( P<0.05). Conclusions:Sequential therapy by local injection of triamcinolone acetonide and lattice CO 2laser is effective for hypertrophic scar and worths wide application in the clinic.

Study on the effect of combined action of topical silicone gel and pressure therapy in hypertrophic scar management

Background: Widespread hypertrophic scars usually resulting from burn injuries or extensive soft tissue trauma is a common problem presented to plastic OPD. Non-invasive treatment like Pressure/compression therapy and siliconee sheets and gels are well-accepted, evidence-based recommendations for a long time. Very few studies are there for their combined effect on hypertrophic widespread scars. Aims and objectives of the study was to see the outcome of hypertrophic scar management following application of combined therapy of silicone gel and pressure garment.Methods: In the present study we have taken patients, who were randomly allotted in two groups. In one group only silicone gel was used for scar management while other group we applied silicone gel along with customized pressure garment locally for 6 months. Patients are seen in OPD monthly and after 6 months final results were analyzed, to see the effect of combined therapy.Results: Although silicone gel is alone is effective in widespread post burn scar, pressure garment provides a synergistic effects when used together. There is no significant change in colour and vascularity, but changes in scar thickness and pliability are most significant in combined therapy group.Conclusions: For small linear scar silicone gel treatment is alone sufficient, but for widespread hypertrophic scar this should always be used along with pressure garment therapy.

Botulinum toxin a injection in the prevention of facial trauma or postoperative hypertrophic scar: A systemic review of effectiveness and safety / 中国组织工程研究

BACKGROUND: Facial scars are mainly caused by trauma or surgery, which greatly affect the appearance. Dermatologists and plastic surgeons have tried many ways to change the appearance of scars. Botulinum toxin A injection is widely used in clinical practice for prevention of scars, but the efficacy and safety are not proved. OBJECTIVE: To evaluate the effectiveness and safety of botulinum toxin A injection in the prevention of facial trauma or postoperative hypertrophic scar. METHODS: PubMed, EMbase, the Cochrane library, CNKI, CBM, WanFang, and VIP were searched for randomized controlled trials regarding botulinum toxin A injection in the prevention of facial scars. Manual retrieval was done for supplement of incomplete data. Two doctors were responsible for literature screen and evaluation. Finally, 11 randomized controlled clinical trials were included. The experimental group was injected with botulinum toxin A, and the control group was given saline or nothing. Part of the data was analyzed using Revman 5.3 software for meta-analysis, and the data that could not be analyzed using software were subjected to a descriptive analysis. RESULTS AND CONCLUSION: Eleven randomized controlled trials were included, involving 436 patients with 518 wounds. Meta-analyses showed that Vancouver scar scale score, visual analogue scale score and width of scars in the botulinum toxin A group were significantly better than those in the control group (weighted mean difference (WMD)=-1.61, 95% confidence interval (CI)=-2.06 to -0.26, P = 0.02; WMD=1.7, 95%CI=0.38 to 3.02, P = 0.01; WMD=-0.17, 95%CI=-0.22 to -0.12, P < 0.000 1). Incidence of adverse reactions of botulinum toxin A group was higher than that in the control group (χ2 =8.335, P=0.004), but they were all slight and easy to release. There were no serious adverse events in both groups. It seems that botulinum toxin A injection can reduce the width of scars, improve Vancouver scale and visual analogue scale scores. However, it is suggested to make clear communication before and after the operation and take measures to deal with various adverse reactions in advance.

Treatment of Periprosthetic Femoral Fractures after Hip Arthroplasty

Although the incidence of postoperative periprosthetic femoral fractures after hip arthroplasty is expected to increase, these complex fractures are still challenging complications. To obtain optimal results for these fractures, thorough clinical and radiographic evaluation, precise classification, and understanding of modern management principles are mandatory. The Vancouver classification system is a simple, effective, and reproducible method for planning proper treatments of these injuries. The fractures associated with a stable femoral stem can be effectively treated with osteosynthesis, though periprosthetic femoral fractures associated with a loose stem require revision arthroplasty. We describe here the principles of proper treatment for the patients with periprosthetic femoral fractures as well as how to avoid complications.

Pautas para la citación de bibliografía según normas Vancouver / Guidelines for citation of bibliography according to Vancouver standards

[]

A prospective study of scars after breast implantation with different incisions / 中华整形外科杂志

Objective@#To compare the scar condition after breast implantation with axillary, periareolar and inframammary fold (IMF) incisions.@*Methods@#The consecutive patients who were diagnosed as breast hypoplasia and underwent breast implantation surgeries between May 2012 to December 2014 were included in the research. The scars were assessed at 1, 6 and 12 months after surgery with VSS and patient satisfaction scoring. The results were analyzed with Variance and Kruskal-Wallis test based on the data type.@*Results@#The scars of 173 patients were assessed 3 times with the follow-up rate being 82.4%. The VSS scores of every incision declined with time, and the patient satisfaction scores increased gradually. At one month after surgery, the media VSS scores were 6 in axillary group and 4 in periareolar and IMF groups, the differences had statistical significance (P<0.05). The media scores of patients satisfaction were 8 in periareolar group and 7 in axillary and IMF groups. The scores of periareola group were higher than those of axillary with statistical significance(P<0.05). When 6 months after surgery, the media VSS scores were 4 in axillary group and 3 in periareolar and IMF groups. The scores of axillary group were higher than those of IMF with statistical significance(P<0.05). The media scores of patients satisfaction were 8 in 3 groups. When 12 months after surgery, the media VSS scores were 0.5 and 1 in periareolar group (left and right respectively), and 2 in axillary and IMF groups. The media scores of patients satisfaction were 9 in 3 groups. No differences were found in VSS and patients satisfaction scores among three kinds of incisions (P>0.05).@*Conclusions@#The scars of three incisions achieved similar cosmetic effects and patient satisfaction at long-time follow-up.

Therapeutic effect of mucopolysaccharide polysulfate cream in prevention of postoperative scars / 中南大学学报(医学版)

Objective:To assess the therapeutic effect of mucopolysaccharide polysulfate cream in prevention of postoperative scars.Methods:One hundred postoperative patients were divided into an experimental group and a control group (each n=50).After stitch removal,the experimental group wiped mucopolysaccharide polysulfate cream,and the control group wiped urea cream.The scars of the two groups were evaluated by Vancouver Scar Scale (VSS) on the day of stitch removal and in the 4th,8th,12th,16th,20th,24th,28th,and 32th weeks during the treat process.Results:At the beginning of treatment,the total VSS scores in the experimental group were always lower than that in the control group (P＜0.05).There was no difference between the two groups in the color scores at each time point of follow-up (P＞0.05).Form the 20th week,the vascular distribution scores in the experimental group were lower than that in the control group (P＜0.05).And the thickness and flexibility scores in the experimental group were lower at each time point of follow-up (P＜0.05).There were no differences between the two groups in wounds in head,face,or neck in the total VSS scores and all index scores (P＞0.05),and the total VSS scores in the experimental group,who had wounds in chest,shoulder,or back,or had wounds in waist,abdomen,or hip,or had wounds in extremity,were lower than that in the control group (P＜0.05).The vascular distribution and thickness scores in the experimental group,who had wounds in chest,shoulder,or back,were better than that in the control group (P＜0.05).Conclusion:Wiping mucopolysaccharide polysulfate cream after operation as soon as possible can effectively prevent scar hyperplasia,and it is worth to be widely applied in clinic.

Clinical effects of nasal alar sailboat resection combined with catgut embedding therapy for severe hypertrophy of nasal alar / 中华医学美学美容杂志

Objective To study the clinical effects of sailboat resection of nasal alar flap combined with catgut embedding in the treatment of severe hypertrophy of the nasal alar.Methods Patients with severe alar hypertrophy were photographed before operation,and the length of alar,the height of nasal ala,the length of nostrils and the width of nostrils were measured.After one month and half a year follow-up,the length of alar,nasal alar height,nostril length,nostril width and nasal width were measured,and the local scar condition was scored according to Vancouver scar scale (VSS).Results Through the combination of two kinds of surgical treatment of severe nasoalar hypertrophy,the surgical effect of satisfaction showed that,with the comparison before and after surgery,nose length and height,length and width of the nostril and the nasal base width were significantly reduced (P＜0.05) after half a year and one month after operation.The data showed no significant changes (P＞0.05),and so the postoperative effect could be sustained;local scar scale,after half a year and one month after operation,were significantly decreased (P＜0.05),and the postoperative long-term scar was not obvious.Conclusions The effect of alar sailboat-resection combined with catgut embedding therapy is satisfactory for the treatment of severe alar hypertrophy.It is one of the ways to treat severe alar hypertrophy.

Treatment of Periprosthetic Femoral Fractures Following Hip Arthroplasty / 대한고관절학회지

PURPOSE: This study was performed to assess potential improvements in clinical outcomes when applying recent advanced hip arthroplasty surgical techniques and understand the potential relationship between bone mineral density (BMD) and surgical outcomes. MATERIALS AND METHODS: Among 37 cases of periprosthetic femoral fractures after hip arthroplasty treated between March 2014 and September 2016, all included a follow-up of at least one year and were included in this study. Outcomes were evaluated using the Beals and Tower's criteria. BMD was examined in 27 of 37 cases and the relationship between osteoporosis and treatment outcomes was analyzed. Advanced hip arthroplasty surgical approaches varied depending on the fracture type: i) open reduction with wiring for Vancouver A, ii) open reduction with double plate fixation for Vancouver B1, iii) revision THA with long stem for Vancouver B1-Nonunion, B2 and B3, and iv) open reduction with double plate fixation for Vancouver C. RESULTS: When assessed using the Beals and Tower's criteria, 33 out of 37 (89.2%) patients were excellent and 4 (10.8%) were poor. These outcomes were an improvement compared with series I (81.8%). When analyzed according to the Vancouver classification, patients with type A (n=8), type B1 (n=16), and type B2 (n=2) were all excellent, the patients with type B3 were excellent (n=1) and poor (n=1), and the patients with type C were excellent (n=6) and poor (n=3). The mean BMD was −2.6 (T-score) in 27 of 37 cases and −4.4 in 4 cases with poor prognosis. Osteoporosis was statistically correlated to those classified as poor by Beals and Tower. CONCLUSION: The results of the analysis suggest that applying new surgical hip arthroplasty treatment approaches leads to improved outcomes compared with the author's previous study. When treating periprosthetic femoral fractures following total hip arthroplasty, an appropriate internal fixation method should be selected, at least in part based on the Vancouver classification. In addition, osteoporosis may be a major prognostic factor for the outcomes of surgical treatment.

Finite element-based mechanical analysis of internal fixation for vancouver type B1 periprosthetic femoral fractures / 第二军医大学学报

Objective To apply finite element method for analyzing the biomechanics status and stability of internal fixation for Vancouver type B1 periprosthetic femoral fractures. Methods CT image data of the lett femur from 30 healthy middle-aged or elderly volunteers and the profile data of femur prosthesis and locking compression plate were collected and used for 3D reconstruction. Three different types of internal fixation methods for Vancouver type B1 periprosthetic femoral fracture were simulated. The proximal part of the prosthesis was fixed with cable cerclage, single- cortical locking screw and a combination of both, and the load simulating full load or partial load was applied. Then the maximum displacement and Von Mises stress were observed. Results There was no significant difference in the maximum displacement or Von Mises stress between cable cerclage fixation and single-cortical locking screw fixation under full and partial loads. The maximum displacement and Von Mises stress were decreased and the internal fixation was more stable when the two fixations combined together, with significant difference found between cable cerclage fixation and single-cortical locking screw fixation (P<0. 05, P<0. 01). Conclusion Combination of cable cerclage and single-cortical locking screw is the first choice for internal fixation in the treatment of Vancouver type B1 periprosthetic femoral fracture.

Observation on the clinical application effects of skin distractor on the treatment of scars / 中华烧伤杂志

Objective@#To explore clinical application effects of skin distractor on the treatment of scars and to observe effects of skin distractor with different pull speeds on different parts scars of human body.@*Methods@#One hundred and four patients with scars, conforming to the study criteria, were hospitalized in our unit from January 2014 to June 2015. Patients were divided into 2 mm/d group and 4 mm/d group according to the random number table, with 52 patients in each group. After admission, skin distractors were pasted on scars in face and neck, trunk, and extremities of patients in 2 groups, with inner edges of pasteboards close to outside edges of longer sides of scars. Skin distractors in 2 mm/d group and 4 mm/d group were pulled to scars axis direction as speeds of 2 mm/d and 4 mm/d, respectively. Pull time equals values of pull speeds divided by width of scars. Scars were resected after finishing pulling. Immediately after scars resection, skin distractors were pasted again with inner edges of pasteboards close to outside edges of longer sides of incision and removed when stitches were taken out. Scars of patients were scored by Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) was used to record scores of patient scar assessment scale (PSAS), observer scar assessment scale (OSAS) and overall scores of patients and observers of scars of patients before and one year after scars resection. Data were processed with χ2 test, independent samples t test, paired samples t test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test.@*Results@#(1) Scores of all scars of patients in 2 groups before scars resection were close (with t values from -1.384 to 0.622, P values above 0.05), obviously higher than those of one year post scars resection (with t values from 11.085 to 24.835, P values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (with Z values from -1.651 to -0.035, t values from -1.549 to 0.219, P values above 0.05), significantly higher than those of one year post scar resection (with Z values from -2.992 to -2.555, t values from 8.739 to 19.076, P values below 0.01). (2) Scores of all scars of patients in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with t values from -2.583 to -2.018, P values below 0.05). PSAS scores of scars in face and neck and trunk in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with Z values respectively -2.385 and -2.198, P values below 0.05), other scores of scars in face and neck and trunk of patients in 2 groups of one year post scars resection were close (with Z values from -1.841 to -0.363, P values above 0.05). VSS scores, PSAS scores, OSAS scores, patients′ overall scores, and observers′ overall scores in 2 mm/d groups were (4.6±0.8), (28±4), (28±4), (4.7±0.7), (4.8±1.4) points, respectively, lower than those in 4 mm/d group[(5.2±0.8), (32±4), (31±6), (5.5±1.2), (5.5±1.0) points, respectively, with t values from -3.712 to -2.105, P<0.05 or P<0.01].@*Conclusions@#Skin distractor has better effects on the treatment of scars, and treatment effects of skin distractor in extremities pulled by 2 mm/d are better than those pulled by 4 mm/d.

Estilos de citas y referencias bibliográficas en revistas odontológicas SciELO: un elemento crítico de la escritura científica / Styles for citations and referencing in dental SciELO journals: a critical element of scientific writing

Uno de los problemas más comunes en las revistas científicas, es el incumplimiento de los estilos al hacer citas y escribir las referencias bibliográficas, debido al descuido o bien al desconocimiento de los diferentes sistemas existentes y sus características. El objetivo fue revisar los estilos de citas y referencias utilizados por revistas odontológicas indexadas en la red SciELO, con el fin describir los más utilizados y evidenciar las diferencias existentes entre las revistas. Fueron revisados 100 artículos pertenecientes a 20 revistas diferentes, seleccionados aleatoriamente por afijación proporcional. El estilo más utilizado para las citas y referencias bibliográficas correspondió al sistema Vancouver. Sólo una revista, International Journal of Odontostomatology publica sus artículos bajo el sistema Harvard. Estos estilos sirven como un sello de las revistas, pero constituyen una carga de trabajo adicional significativa, ya que la atención a los detalles que se requieren para asegurar que las citas y referencias se ajusten a los estilos individuales de las revistas es fundamental. Cualquiera sea el estilo de la revista, es importante utilizarlo de una manera consistente. La responsabilidad de la exactitud en las citas y referencias bibliográficas es de los autores, por lo que deben preocuparse de ello al redactar el artículo, en su revisión final previo al envío, así como en las pruebas de imprenta.

One of the most common problems in scientific journals, it is the failure of the styles to make citations and references due to carelessness or ignorance of the different systems and their characteristics. The aim was to review the different styles of citations and references used by dental journals indexed in SciELO, to describe the most used and highlight the differences between journals. One hundred articles randomly selected by proportional allocation, belonging to 20 different journals were reviewed. The most commonly used format for citations and references corresponded to the Vancouver system. Only a journal, International Journal of Odontostomatology publishes his articles under the Harvard system. These styles serve as a hallmark for journals, but they are a significant additional workload as the attention to detail required to ensure that citations and references fit individual styles of the journals is fundamental. Whatever the style of the journals, it is important to use it in a consistent manner. The responsibility for the accuracy in citations and references belongs to the authors, so they should worry about it in drafting version, its final revision, as well as proofs of the article.

The Clinical and Radiological Results of Vancouver Type B1 and C Periprosthetic Fractures

PURPOSE: The purpose of this study is to evaluate the clinical and radiologic results of plate fixation in the Vancouver B1 and C periprosthetic femoral fracture (PFF). MATERIALS AND METHODS: Twenty patients who had sustained a Vancouver type B1 and C periprosthetic fracture after hip arthroplasty (years 2002-2012) were identified. The mean age was 66.0 years (range, 43-85 years) and the mean follow-up duration of the group was 38 months (range, 12-102 months). The dynamic compression plate (DCP) group included 12 patients and the locking compression plate (LCP) group included eight patients. Harris hip score (HHS) and walking ability, knee joint range of motion (ROM) were compared before injury and last follow-up. Fracture union rate and period were compared. RESULTS: The mean HHS score was 90.7 (64-96). There was no statistical difference between the two groups. At the last follow-up, knee joint ROM was 103.3degrees (105degrees-140degrees) in the DCP group and 118.4degrees (110degrees-140degrees) in the LCP group, showing good results in the LCP group (p=0.043). No significant difference in the fracture union rate and union periods was observed between the two groups. CONCLUSION: A better result for the postoperative knee flexion exercise capacity was observed in the LCP group. Use of LCP plate fixation is a good option in management of Vancouver classification B1 and C PFF.

Differences in Hypertrophic Scar Fibroblasts according to Scar Severity: Expression of Transforming Growth Factor beta1 at the mRNA and Protein Levels

BACKGROUND: Hypertrophic scars result from excessive collagen deposition and increased transforming growth factor beta-1 (TGF-beta1) levels. We hypothesized that the expression of TGF-beta1 mRNA and protein would increase with the clinical severity of hypertrophic scars. METHODS: Primary dermal fibroblasts were isolated from cultures of normal skin and hypertrophic scars. The hypertrophic scars were classified by grade based on the Vancouver Scar Scale. After 96 hours of serum starvation, TGF-beta1 levels in the supernatant were determined using solid-phase, enzyme-linked immunosorbent assay (ELISA). Quantitative reverse transcription-polymerase chain reaction was performed to quantify TGF-beta1 mRNA expression. RESULTS: TGF-beta1 protein levels of hypertrophic scars tended to increase with increasing severity of the scars, according to the Vancouver Scar Scale. The differences between the normal dermal tissue (NS), hypertrophic scar grade (HS) 1, and HS4 groups were statistically significant (P<0.01). The TGF-beta1 mRNA levels of hypertrophic scars also tended to increase according to scar severity. The differences between the NS, HS1, HS2, HS3, and HS4 groups were statistically significant (P<0.01). CONCLUSIONS: The classification of hypertrophic scars according to the Vancouver Scar Scale usually matches the severity of the microenvironment of the hypertrophic scar.

Rhombic Flap Reconstruction after Mohs Micrographic Surgery for Premalignant Lesions and Skin Cancer / 대한피부과학회지

BACKGROUND: Recently, increasing attention in the field of dermatological surgery has been paid to treating skin cancers, including both premalignant and malignant lesions. The rhombic flap, one of the transposition flaps, is an outstanding method for reconstructing small- to medium-sized defects after skin surgery. OBJECTIVE: The aim of this study was to evaluate our clinical results with the rhombic flap for reconstruction after Mohs micrographic surgery (MMS), including the cosmetic aspects, complete surgical excision, and recurrence. METHODS: Between June 2010 and September 2013, 37 patients who were diagnosed with premalignant and malignant lesions on the face and extremities were treated with rhombic flaps for the reconstruction of primary cutaneous defects following lesion excisions. We reviewed the medical records and evaluated the clinical aspects and surgical treatment outcomes, and the cosmetic results were scored as excellent, good, fair, or poor. In addition, we assessed the surgical treatment outcomes using the Vancouver Scar Scale (VSS). RESULTS: Thirty-seven patients received 37 rhombic flaps. The cosmetic results of the reconstructions were gratifying, and 28 of 37 patients (75.7%) showed good to excellent results. Specifically, the cosmetic results of the modified rhombic flaps were great, and 27 of 30 patients (90.0%) showed good to excellent results. The cosmetic results on the VSS showed a high mean score (2.9). CONCLUSION: Our study showed that the rhombic flap is a simple reconstruction method and provides aesthetically pleasing results. Therefore, it could be a useful option for reconstructing defects of the face and extremities.

Treatment Results of a Periprosthetic Femoral Fracture Case Series: Treatment Method for Vancouver Type B2 Fractures Can Be Customized

BACKGROUND: Currently, an algorithmic approach for deciding treatment options according to the Vancouver classification is widely used for treatment of periprosthetic femoral fractures after hip arthroplasty. However, this treatment algorithm based on the Vancouver classification lacks consideration of patient physiology and surgeon's experience (judgment), which are also important for deciding treatment options. The purpose of this study was to assess the treatment results and discuss the treatment options using a case series. METHODS: Eighteen consecutive cases with periprosthetic femoral fractures after total hip arthroplasty and hemiarthroplasty were retrospectively reviewed. A locking compression plate system was used for osteosynthesis during the study period. The fracture type was determined by the Vancouver classification. The treatment algorithm based on the Vancouver classification was generally applied, but was modified in some cases according to the surgeon's judgment. The reasons for modification of the treatment algorithm were investigated. Mobility status, ambulatory status, and social status were assessed before the fracture and at the latest follow-up. Radiological results including bony union and stem stability were also evaluated. RESULTS: Thirteen cases were treated by osteosynthesis, two by revision arthroplasty and three by conservative treatment. Four cases of type B2 fractures with a loose stem, in which revision arthroplasty is recommended according to the Vancouver classification, were treated by other options. Of these, three were treated by osteosynthesis and one was treated conservatively. The reasons why the three cases were treated by osteosynthesis were technical difficulty associated with performance of revision arthroplasty owing to severe central migration of an Austin-Moore implant in one case and subsequent severe hip contracture and low activity in two cases. The reasons for the conservative treatment in the remaining case were low activity, low-grade pain, previous wiring around the fracture and light weight. All patients obtained primary bony union and almost fully regained their prior activities. CONCLUSIONS: We suggest reaching a decision regarding treatment methods of periprosthetic femoral fractures by following the algorithmic approach of the Vancouver classification in addition to the assessment of each patient's hip joint pathology, physical status and activity, especially for type B2 fractures. The customized treatments demonstrated favorable overall results.

Femoral Stem Revision for Vancouver type B2 and B3 Periprosthetic Fractures / 대한정형외과학회잡지

PURPOSE: We evaluated the outcome of femoral stem revision for Vancouver B2 and B3 periprosthetic femoral fractures. MATERIALS AND METHODS: We conducted a retrospective assessment of 15 patients who had received treatment for a periprosthetic unstable femoral fracture after primary hip arthroplasty between May 1997 and September 2009. According to Vancouver classification, 11 patients were type B2 and four were B3. Open reduction and long stem revision were performed in all 15 cases. In Vancouver type B3 fractures, we treated patients with open reduction and long stem revision with an allogenic cancellous bone graft, which is the same as in that used in Vancouver type B2 fractures. An allogenic onlay cortical bone graft was used when additional stability was required. The mean age of patients was 67.1 years at the time of surgery and the mean duration of follow-up was 31.5 months. We described the clinical and radiographic results. RESULTS: Using Beals and Tower's criteria, fair to good clinical and radiologic results were observed at the latest follow up, with an average Harris hip score of 94.4 points. Fractures were united in all 15 patients. One patient had non-union of the greater trochanter of the femur, one patient had superficial infection, and one patient had non-union of onlay bone graft, however, there were no further complications, such as dislocations, periprosthetic infections, or nerve injuries. There was no loosening of the femoral stems. CONCLUSION: In Vancouver type B2 and B3 fractures, when there is loosening of the femoral stems, open reduction and long stem revision with allogenic cancellous bone graft provided a satisfactory result. However, long-term follow up is needed.