Operative Treatment of Flail Chest Injuries Does Not Reduce Pain or In-Hospital Opioid Requirements: Results from a Multicenter Randomized Controlled Trial.

Background: A previous randomized controlled trial (RCT) evaluating operative versus nonoperative treatment of acute flail chest injuries revealed more ventilator-free days in operatively treated patients who had been ventilated at the time of randomization. It has been suggested that surgery for these injuries may also improve a patient's pain and function. Our goal was to perform a secondary analysis of the previous RCT to evaluate pain and postinjury opioid requirements in patients with operatively and nonoperatively treated unstable chest wall injuries.

The role of N-glycans in regulatory T cells in autoimmunity.

Regulatory T cells (Tregs) have a key role in the maintenance of immune tolerance and in the prevention of autoimmunity. Recent studies have shown an association between decreased Treg frequency and a deficient suppressive activity with the development of many autoimmune diseases. Although glycosylation, which consists in the addition of glycans to proteins and lipids on the cell surface, is recognized as a critical modification for T cell development and function, the relevance of glycans in Treg biology and activity, as well as their impact in the immunopathogenesis of autoimmune diseases, deserves more attention, as it is far from being fully understood.

A quality improvement project on implementing a standardized pain assessment and opioid stewardship guidance at a level IV NICU.

Background: Balancing between adequate analgesia and preventing the harmful side effects of opioids in the NICU is an important clinical conundrum. Lack of awareness among caregivers and guidance on pain management are the key limiting factors. By initiating this quality improvement (QI) project, we aimed to reduce the usage of opioids in a quaternary NICU care by 5% within 1 year.

Effects of Middle Ear Status on Rotary Chair Outcomes in Children.

Objective: Middle ear dysfunction is common in young children. There are varying reports on the effects of middle ear dysfunction on the vestibular system; however, it is unknown the extent to which abnormal middle ear function affects vestibular function tests, which could lead to misdiagnosis and improper medical management. Therefore, the purpose of this study is to evaluate how middle ear status affects rotary chair outcomes in young children (6 months to 6 years).

Distal femur replacement for infected bone defects due to end-stage periprosthetic joint infection or trauma: a staged strategy protocol using the stemless Compress® device protected with a fast resorbable antibiotic-loaded hydrogel.

Background: Distal femur replacement (DFR) with a stemmed megaprosthesis represents a challenge due to high rates of loosening and limited reconstructive options if the implant fails. Such an unfavourable scenario is even more complex where there are also infected bone defects. The Compress® device was developed to provide an alternative to traditional intramedullary stems.