'Having regard to the findings made by the referrer': medicolegal implications of case SC (2020) for hospital clinicians.

A case concerning the management of a child with meningitis in a hospital paediatrics department provided a judgement that has significant potential implications for medical practice. The case establishes that the examination findings of a previous clinician must be taken into account when investigating and treating patients. This case is of medicolegal relevance to clinicians practising in tertiary centres and who receive patients from other hospitals.

Impact of 2013 ACGME Minimum Case Requirements on Orthopedic Resident Operative Volume.

In 2013, the Accreditation Council for Graduate Medical Education (ACGME) mandated orthopedic surgery residents to perform at least 1000 surgical cases during residency and specified "case minimums" for 15 core procedure categories. We assessed trends in the volume and variability of graduating orthopedic surgery resident caseload since the implementation of these case minimums. We performed a retrospective linear regression analysis of ACGME-published case log data of US orthopedic residents graduating from 2014 to 2019, with trend analysis, comparison of case volume between residents in 10th and 90th percentiles, and comparison of logged cases vs case minimums for core procedures.

Chest CT Has Higher Yield for Infection than CT Sinus in Febrile Neutropenic Patients.

Objective: Chest and sinus CT imaging among cancer patients undergoing chemotherapy and bone marrow transplant in the setting of neutropenic fever is not uncommon, yet the utility of routine imaging surveillance remains unclear. We aim to compare the rates of acute infection detected on CT chest and CT sinus exams performed in this clinical setting.

Methods: Reports of 1059 consecutive CT chest and sinus examinations for the clinical indication of neutropenic fever on 262 patients performed between January through June 2017 were retrospectively reviewed.

And whatsoever I shall see or hear …I will never divulge. Confidentiality and disclosure for intensivists.

Police requests to provide information about unconscious patients frequently cause difficulty for intensivists. This article reviews the circumstances where an intensive care doctor may and should disclose information about unconscious patients to the police. It first considers what constitutes private and confidential information and explains why this information should be protected.

Imaging features of vertebral artery fenestration.

Purpose: Vertebral artery fenestration (VAF) is a rare congenital vascular anomaly which has been associated with intracranial aneurysm. VAF can share some similar imaging features with vertebral artery dissection (VAD), which may confound diagnosis of the latter on CT and MR angiography. The purpose of this investigation is to assess the prevalence of VAF, evaluate its association with other vascular anomalies, and identify imaging features to help in distinguishing VAF and VAD.

Preoperative Clinical and Radiographic Variables Predict Postoperative C5 Palsy.

Background: Postoperative C5 palsy affects 8% of patients undergoing posterior cervical decompression. It is associated with a period functional disability that may exceed 12 months and increase direct care costs > $2000.

Methods: All patients undergoing posterior cervical decompression at a single tertiary-care facility for degenerative conditions were evaluated for preoperative imaging, clinical presentation, surgical operation, and postoperative course.

Diagnostic and therapeutic values of intraoperative electrophysiological neuromonitoring during resection of intradural extramedullary spinal tumors: a single-center retrospective cohort and meta-analysis.

Objective: With the advent of intraoperative electrophysiological neuromonitoring (IONM), surgical outcomes of various neurosurgical pathologies, such as brain tumors and spinal deformities, have improved. However, its diagnostic and therapeutic value in resecting intradural extramedullary (ID-EM) spinal tumors has not been well documented in the literature. The objective of this study was to summarize the clinical results of IONM in patients with ID-EM spinal tumors.

Cutting-edge analysis of extracellular microparticles using ImageStream(X) imaging flow cytometry.

Interest in extracellular vesicle biology has exploded in the past decade, since these microstructures seem endowed with multiple roles, from blood coagulation to inter-cellular communication in pathophysiology. In order for microparticle research to evolve as a preclinical and clinical tool, accurate quantification of microparticle levels is a fundamental requirement, but their size and the complexity of sample fluids present major technical challenges. Flow cytometry is commonly used, but suffers from low sensitivity and accuracy.

Evaluation of neck pain with (18)F-NaF PET/CT.

Aim: (18)F-Sodium fluoride ((18)F-NaF) PET/computed tomography (CT) has improved spatial resolution in the cervical spine compared with single photon emission computed tomography/CT techniques using traditional tracers. Limited data are available, however, on its effectiveness in the management of the symptomatic cervical spine, and the aim of this study was therefore to elucidate this issue.

Patients And Methods: A retrospective study was carried out between April 2011 and April 2012.

Relationship between Mycobacterium tuberculosis genotype and the clinical phenotype of pulmonary and meningeal tuberculosis.

We used large sequence polymorphisms to determine the genotypes of 397 isolates of Mycobacterium tuberculosis from human immunodeficiency virus-uninfected Vietnamese adults with pulmonary (n = 235) or meningeal (n = 162) tuberculosis. We compared the pretreatment radiographic appearances of pulmonary tuberculosis and the presentation, response to treatment, and outcome of tuberculous meningitis between the genotypes. Multivariate analysis identified variables independently associated with genotype and outcome.

Quantitative ultrasonic tissue characterization as a new tool for continuous monitoring of chronic liver remodelling in mice.

Background/aim: Recognition of the limitations of liver biopsies has led to the need for non-invasive tests to assess liver fibrosis from intensity and kinetic point of views. The aim of the present study was to evaluate non-invasive ultrasonic tissue characterization for the continuous monitoring of this process in mice.

Methods: Twelve-week-old male and female C57Bl6/J mice were submitted to repetitive carbon-tetrachloride (CCl4) intraperitoneal injections during 8 weeks or analysed 28 days after common bile duct ligation (BDL).

Methylprednisolone increases urinary nitrate concentrations and reduces subclinical renal injury during infrarenal aortic ischemia reperfusion.

Objective: This study tests the hypothesis that methylprednisolone may influence eNOS activity in renal arterial and venous vascular beds and impede subclinical renal injury.

Summary Background Data: Acute renal failure is a major complication of cardiovascular surgery. Renal damage arises in part from excessive vasoconstriction mediated by an imbalance of vasoconstrictive ET-1 and vasodilatory NO produced by eNOS.

Prolonged ovalbumin exposure attenuates airway hyperresponsiveness and T cell function in mice.

Background: Continuous exposure of sensitized mice to an innocuous antigen, such as OVA, does not lead to chronic airway eosinophilia, but induces antigen unresponsiveness and resolution of the inflammatory response. In this study we explored mechanisms underlying attenuation of the airway inflammatory response, assessed whether the phenomenon is strain-specific, and determined its consequences to airway physiology.

Methods: Mice were sensitized and exposed to OVA for two and four weeks.

Management of asymptomatic cholelithiasis for patients awaiting renal transplantation.

Background: There is no consensus regarding the most appropriate management of asymptomatic cholelithiasis in patients awaiting renal transplantation. Cholecystectomy is considered before renal transplantation because of potential worsened complications from cholelithiasis with posttransplantation immunosuppression. This study reviewed the outcomes for operative and nonoperative management of asymptomatic cholelithiasis in patients awaiting renal transplantation.

Concomitant airway expression of granulocyte-macrophage colony-stimulating factor and decorin, a natural inhibitor of transforming growth factor-beta, breaks established inhalation tolerance.

We previously showed that granulocyte-macrophage colony-stimulating factor (GM-CSF) breaks tolerance induction. The objective of this study was to determine whether GM-CSF breaks established inhalation tolerance. To induce tolerance, BALB/c mice were exposed to aerosolized ovalbumin (OVA) for 10 consecutive days.

An unexplained case of elevated blood lead in a Hispanic child.

A 6-month-old child presented to a local pediatrician with an elevated blood lead level (BLL) of 41 microg/dL. The child was treated as an outpatient for chelation therapy by a toxicologist. Subsequent BLLs obtained at 8 and 13 months of age were 40 microg/dL and 42 microg/dL, respectively.

Integrated backscatter during harmonic and fundamental frequency imaging--effect of depth, mechanical index, and tissue anisotropy: implications for myocardial tissue characterization.

Objective: To explore the potential advantages of tissue harmonic imaging (THI) versus fundamental frequency imaging (FFI) when applied to tissue characterization.

Methods: A Philips Medical Systems Sonos 5500 echocardiograph equipped with a broadband transducer (S4) and an on-line quantitative analysis software package (Acoustic Densitometry) was used for imaging. The effect of mechanical index (MI), imaging depth, and anisotropy on relative backscatter amplitude was evaluated.

Gut mucosal injury is attenuated by recombinant bactericidal/permeability-increasing protein in hind limb ischemia-reperfusion injury.

Lower limb ischemia-reperfusion injury (IRI) is associated with increased gut permeability to endotoxin, which not only directly damages enterocytes but also stimulates a systemic inflammatory response syndrome (SIRS), compounding gut injury. Recombinant bactericidal/permeability-increasing protein (rBPI21) is a novel anti-endotoxin therapy with proven benefit in sepsis. Its potential role in modulating remote gut injury in hind limb IRI was studied.

Reperfusion injury is greater with delayed restoration of venous outflow in concurrent arterial and venous limb injury.

Background: Complex limb trauma often involves combined arterial and venous injury, and the resultant ischaemia-reperfusion injury (IRI) causes both local and remote organ injury. This study assessed the influence of the timing of restoration of venous drainage on IRI.

Methods: Male New Zealand white rabbits (n = 36) were randomized into six groups: sham operation (group 1) and unilateral hind limb arterial and venous occlusion for 1 h followed by no reflow for 2 h (group 2), arterial and venous reflow for 2 h (group 3), arterial reflow alone for 2 h (group 4), arterial reflow alone for 1 h followed by arterial and venous (delayed) reflow for a further 1 h (group 5), and pretreatment with an enteral combination antioxidant before occlusion of both artery and vein and delayed venous reflow (group 6).