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IntroductionAssessment of left atrial function via transthoracic echocardiography (TTE) is often performed by measuring the transmitral A wave in sinus rhythm. Left atrial (LA) fibrosis plays an important role in the pathogenesis and perpetuation of Atrial Fibrillation (AF). It may be identified by bipolar voltage (BiV) mapping, which can easily be performed at the beginning of a Pulmonary Vein Isolation (PVI) procedure. The relationship between the degree of LA fibrosis, characterized with mapping, and LA function, determined by echocardiography, has not previously been elucidated.MethodsPatients were enrolled in a project to evaluate the degree of fibrosis during PVI procedures. Pre-procedure TTEs of those presenting in sinus rhythm were assessed and the transmitral A wave was measured and compared to the degree of scarring seen. The high density electroanatomic maps (HD-EAMs) created during the PVIs were analyzed using a novel VHA algorithm after the procedure. All points with voltages < 0.5 mV were defined to have electrical scar. Patients were classified into 4 quartiles based on the levels of scar seen (figure 1).Abstract 10 Figure 1Examples of patients with voltage histogram analysis quantifying scarPanel A – Class 1; Panel B – Class II; Panel C – Class III; Panel D – Class IV. All views shown are anterposteriorResults39 patients were included in the evaluation. Average age was 60.6 ± 13.2 years. 32 (82.0%) of the patients were male. Mean CHADS2VASc score was 1.5. The mean percentage of scar was calculated as 19.6 ± 15.9%. The average A wave was 0.62 ± 0.18 ms-1. Pearson’s correlation coefficient showed no relationship between LA scar and either A wave velocities (r=0.26, p=0.11) or E:A ratio (r=-0.02, p=0.91) (figure 2). A significant correlation between A wave velocity and CHADS2VASc was observed (r=0.49, p=0.001).Abstract 10 Figure 2Boxplot showing A wave velocities by LA scar burden in quartilesConclusionOur study demonstrates no relationship between degree of LA scarring and reduced LA function on TTE as assessed by the A wave. It has been established that structural remodeling in AF (such as atrial dilatation) may occur independently of the electrical remodelling. A potential explanation for our findings is that the electrical scarring in AF, which results in alterations in refractory periods, precedes the negative remodeling which ultimately results in reduced atrial function. This hypothesis would need to be further evaluated in larger studies.

IntroductionPrevious research has identified the pattern of scarring associated with different aetiologies of myocardial infarction with non-obstructive coronary arteries (MINOCA). However, the association between the characteristics of scar and the impact these characteristics have on the strain of the myocardium has not been investigated. The purpose of this study is to investigate whether the left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) of the myocardium is affected by the amount and pattern of late gadolinium enhancement (LGE).Methods150 patients (mean age 59.0 ± 15.1 years) who were referred for cardiac MRI (CMR) were recruited retrospectively. Patients with known heart failure, previous myocarditis or not meeting the ESC working group definition of MINOCA were excluded. All patients were scanned at least 28 days after presentation. Their CMRIs were analysed for LVEF, GLS and amount of LGE. SPSS was used to run linear regression, T- test and Kolmogorov-Smirnov Test (K-S) for data analysis.Results57 of the 150 patients had LGE (mean LGE size 1.43g ± 2.89). There was no significant correlation between the amount of scarring and GLS (p=0.350) overall. However there was a significant association between the amount of ischaemic scar and worsening GLS (p=0.025). There was no significant difference in GLS between ischaemic and non- ischaemic patterns of LGE (t=0.914, p=0.188).ConclusionThe amount and pattern of scar do not independently have a direct impact on the GLS of the myocardium in MINOCA patients. Our data suggests that there is a significant correlation between the amount of ischaemic scar and the GLS.

\"Years ago, Clara survived a vicious bear attack. She's used to getting sympathetic looks around town, but meeting strangers is a different story. Yet her dreams go far beyond Knik, Alaska, and now she's got a secret that's both thrilling and terrifying--an acceptance letter from Columbia University. But it turns out her scars aren't as fixable as she hoped, and when her boyfriend begins to press for a forever commitment, she has second thoughts about New York. Then Rhodes, a student teacher in her English class, forces her to acknowledge her writing talent, and everything becomes even more confusing--especially with the feelings she's starting to have about him. Now all Clara wants to do is hide from the tough choices she has to make. When her world comes crashing down around her, Clara has to confront her problems and find her way to a decision. Will she choose the life of her dreams or the life that someone she loves has chosen? Which choice is scarier?\"--Provided by Amazon.com.

Midshaft clavicle fractures are common orthopedic injuries often requiring surgical intervention, with plate fixation (PF) and intramedullary fixation (IMF) being the primary treatment options. PF provides good stability but is associated with complications such as hypertrophic scars, painful scars, implant protrusion, and the need for hardware removal. Intramedullary fixation (IMF) offers a less invasive alternative, though its comparative effectiveness remains debated. This meta-analysis aimed to compare clinical outcomes between IMF and PF for midshaft clavicle fractures, incorporating studies published in the last five years. We systematically searched Google Scholar, MEDLINE, and the Cochrane Library for comparative studies. Primary outcomes included functional assessments (DASH and Constant scores), while secondary outcomes focused on VAS scores, surgical parameters, and complications. Nine studies were included. Functional outcomes were similar between groups for the DASH score, but IMF demonstrated a significant advantage in the Constant score, with the maximum improvement observed at 24 weeks (MD 4.38, 95% CI 3.47 to 5.28). IMF also resulted in lower VAS scores, indicating reduced pain, particularly at 1 and 7 days post-surgery. No significant difference was found in major complications, but IMF had a higher risk of implant irritation (OR 2.37, 95% CI 1.09 to 5.14) and a lower risk of hypertrophic scarring (OR 0.12, 95% CI 0.03 to 0.42). IMF has better improvement in all surgical parameters. In conclusion, IMF offers superior surgical efficiency, a more favorable pain profile, and fewer complications, making it an effective treatment option for midshaft clavicle fractures.

Hypertrophic scars and keloids are fibroproliferative disorders that may arise after any deep cutaneous injury caused by trauma, burns, surgery, etc. Hypertrophic scars and keloids are cosmetically problematic, and in combination with functional problems such as contractures and subjective symptoms including pruritus, these significantly affect patients’ quality of life. There have been many studies on hypertrophic scars and keloids; but the mechanisms underlying scar formation have not yet been well established, and prophylactic and treatment strategies remain unsatisfactory. In this review, the authors introduce and summarize classical concepts surrounding wound healing and review recent understandings of the biology, prevention and treatment strategies for hypertrophic scars and keloids.

Objectives: Arthrofibrosis following anterior cruciate ligament reconstruction (ACLR) is a complication resulting in loss or range of motion (ROM) and function. Classification and outcomes of treatment for arthrofibrosis vary as surgical approaches can be taken from the anterior and posterior aspects. The purpose of this study was to define categories of arthrofibrosis and report outcomes of arthroscopic anterior scar resection (SR) after an ACLR. Methods: Patients who had an arthroscopic anterior SR post ACLR enrolled into the study with the following exclusion criteria: SR not preceded by an ACLR and an ACLR on the opposite knee. The indication for surgery was a painful loss of motion due to a mechanical limitation of knee extension from anterior scarring. All patients participated in a standard rehabilitation protocol before and after surgery, aimed at maximizing knee extension first, followed by flexion and strength. Patients were classified, preoperatively and postoperatively, into 4 categories based on ROM compared to the opposite knee: category 1 = extension loss ≤10°/flexion loss of ≤5°; category 2 = extension loss ≤10°/flexion loss >5°; category 3 = extension loss >10°/flexion loss ≤25°; category 4 = extension loss >10°/flexion loss >25°. Outcomes assessed preoperatively and postoperatively were side to side differences in ROM, rate of having normal ROM, and International Knee Documentation Committee (IKDC) scores. Maximum IKDC scores and ROM preoperatively, within the 6 months leading up to the SR, and postoperatively, within the first 3 years after the SR, were used for analysis. Normal extension and flexion were defined as being within 2° and 5°, respectively, of the other side. Results: For the 166 patients, mean age was 22.5 ± 7.7 years, 56% were male, and 58% had a subacute ACLR; all of which were not statistically significantly different between the preoperative categories. The distribution of categories before surgery (1: 58%, 2: 35%, 3: 3%, 4: 4%) improved after surgery (1: 83%, 2: 17%, 3: 0%, 4: 0%). Preoperatively, normal extension was achieved by 82% for category 1, 48% for category 2, and 0% for categories 3 and 4, p< 0.001. Postoperatively, normal extension was achieved by 96% of the total population, specifically, 97% for category 1, 95% for category 2, and 100% for categories 3 and 4, p=0.839. Postoperatively, normal flexion was achieved by 83% of the total population, specifically, 88% for category 1, 71% for category 2, and 100% for categories 3 and 4, p=0.026. The difference in postoperative extension was not different based on preoperative category (1: -0.22°, 2: 0.17°, 3: 0.40°, 4: 0.17°), p=0.284. Preoperative category 1 remained category 1 88% of the time and regressed to category 2 12% of the time. For category 2, 71% improved to category 1 and the rest remained category 2. For categories 3 and 4, all patients improved to category 1. Based on preoperative category, preoperative IKDC scores were different (1: 63, 2: 45, 3: 16, 4: 32), p<0.001; however, they were the same after surgery (1: 81, 2: 81, 3: 83, 4: 100), p=0.800. Conclusions: Ninety-six percent of patients achieved normal extension after an anterior SR and this was not affected by their preoperative arthrofibrosis category. Most patients were able to improve their category and IKDC scores after surgery, with those having more severe arthrofibrosis preoperatively resulting in better gains.

The application of laser treatments beginning on the day of stitch removal has been demonstrated to improve scar quality. However, there are few guidelines for the treatment of immature scars (ISs), which are defined as “scars whose features are not yet expressed.” The purpose of this study was to extract information about early combination laser treatment (CLT) beyond what is currently known by analyzing 33 pairs of pre-treatment and post-treatment photographs of ISs. Two hundred fifty medical records of patients with scars were reviewed, and 33 scars were included in the study. The included scars were treated with vascular lasers (585 or 532 nm) followed by 1550-nm fractional lasers from May 2014 to July 2015 (fewer than 52 days after stitch removal, Fitzpatrick’s skin types III–IV, mean age = 16.0 years). Blinded evaluators (one plastic surgeon and two dermatologists) evaluated the pre-treatment and post-treatment photographs. The pre-treatment photographs were scored on a spectrum from “0,” when no difference with the surrounding unaffected skin was observed, to “100,” when the worst scarring was present. The pre-treatment and post-treatment photographs were compared, and the results were graded on a spectrum from 0, when no difference between the pre-treatment and post-treatment photographs was observed, to 100, when no difference was observed between the post-treatment skin and the surrounding unaffected skin. Statistical analyses were performed with PASW 17.0, SPSS Korea, Seoul, Korea ( p  < 0.05). The improvement scores (ImS) and weighted scores (Wtd: i.e., weighted according to the pre-treatment scores) were used as dependent variables. The average improvement score was 87.98 (median = 90). Seventeen cases were scored as 100-point improvements. The facial and non-facial scars exhibited differences in the ImS and Wtd scores. The Wtd scores were negatively correlated with the temporal gap (in days) between stitch removal and the beginning of CLT. No significant difference in the Wtd scores was demonstrated between the two vascular laser groups. Patient age and Wtd score were negatively correlated, and a significant difference was observed in the Wtd scores between the age groups (≥15 and <15 years old). CLT for ISs results in excellent outcomes. Better results are achieved with earlier CLT initiation following stitch removal. Better outcomes can be expected for younger patients and for facial scars. We found that 532 and 585-nm lasers are equally effective for CLT of ISs.

Introduction. Renal scarring is a serious complications of urinary tract infection and vesicoureteral reflux (VUR). The dimercaptosuccinic acid (DMSA) scan is the gold standard method for diagnosing renal scars but is an expensive procedure that risks ionizing materials and is not available to everyone. Neutrophil gelatinase-associated lipocalin (NGAL) increases following inflammation, infection, and acute kidney injury in the urine. The aim of this study was to evaluate the urinary level of NGAL and determine its diagnostic value in renal scarring. Methods. Patients aged 3 to 60 months with pyelonephritis were included in this study. Voiding cystourethrography (VCUG) was performed in the presence of hydronephrosis on ultrasonography. Children with VUR underwent DMSA scans six months after successful treatment of pyelonephritis., Patients were divided into two groups based on the result of DMSA scan: those with and those without renal scars. Levels of urinary NGAL were measured in both groups. Results. Ninety-two children with VUR (grades 2 to 5) were studied, of whom 40 had renal scars and 52 did not. The urinary level of NGAL at the cutoff point of 284 ng/dL had 70% sensitivity and 100% specificity for the detection of renal scars and was higher in patients with renal scars. (P < .05). Conclusion. The urinary level of NGAL is considerably higher in children with renal scarring. It is not a good test for screening and early diagnosis due to its low sensitivity, although it can identify renal scars caused by VUR with high specificity.DOI: 10.52547/ijkd.6951