MRI Predicts Residual Disease and Outcomes in Watch-and-Wait Patients with Rectal Cancer.

Background MRI plays a crucial role in restaging locally advanced rectal cancer treated with total neoadjuvant therapy (TNT); however, prospective studies have not evaluated its ability to accurately select patients for nonoperative management. Purpose To evaluate the ability of restaging MRI to predict oncologic outcomes and identify imaging features associated with residual disease (RD) after TNT. Materials and Methods This was a secondary analysis of the Organ Preservation in Rectal Adenocarcinoma (OPRA) trial, which randomized participants from April 2014 to March 2020 with stages II or III rectal adenocarcinoma to undergo either induction or consolidation TNT.

Recommendations for Imaging Patients With Cardiac Implantable Electronic Devices (CIEDs).

Historically, the presence of cardiac implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators (ICDs), was widely considered an absolute contraindication to magnetic resonance imaging (MRI). The recent development of CIEDs with MR Conditional labeling, as well as encouraging results from retrospective studies and a prospective trial on the safety of MRI performed in patients with CIEDs without MR Conditional labeling, have led to a reevaluation of this practice. The purpose of this report is to provide a concise summary of recent developments, including practical guidelines that an institution could adopt for radiologists who choose to image patients with CIEDs that do not have MR Conditional labeling.

Incorporating food web dynamics into ecological restoration: a modeling approach for river ecosystems.

Restoration is frequently aimed at the recovery of target species, but also influences the larger food web in which these species participate. Effects of restoration on this broader network of organisms can influence target species both directly and indirectly via changes in energy flow through food webs. To help incorporate these complexities into river restoration planning, we constructed a model that links river food web dynamics to in-stream physical habitat and riparian vegetation conditions.

Prospective intraoperative syndesmotic evaluation during ankle fracture fixation: stress external rotation versus lateral fibular stress.

Objectives: We hypothesized that the method of stress external rotation more accurately reproduces the mechanism of injury, and therefore this diagnostic method more likely detects ankle instability than the fibular stress examination.

Design: Prospective cohort comparison study.

Setting: Level 1 trauma center.

Substantial improvement in prophylactic antibiotic administration for open fracture patients: results of a performance improvement program.

Objectives: Administration of early and appropriate antibiotic in treating patients with open fractures is an important early factor in preventing infection and optimizing outcomes. The purpose of this study is to evaluate the effects of an orthopaedic trauma performance improvement program directed at early antibiotic administration for open fracture patients at our trauma center.

Design: Retrospective comparative cohort study of patients treated for an open fracture by before and after implementation of our performance improvement program specifically designed to address early open fracture care.

MALP-2 pre-treatment modulates systemic inflammation in hemorrhagic shock.

Background: TLR-2 is expressed on the surface of leucocytes, lung and liver tissue and initiates the activation of immune response after interaction with components of the bacterial cell wall. In this experiment we investigated whether immunostimulation with TLR-2 agonists under conditions of sterile inflammation (hemorrhagic shock (HS)) may affect the immune response and remote organ inflammation.

Methods: Male C57/BL6 mice were subjected to standardized pressure-controlled HS (MAP of 35 mmHg for 90 minutes).

Predictors of poor outcome after both column acetabular fractures: a 30-year retrospective cohort study.

Background And Purpose: Acetabular fractures are often combined with associated injuries to the hip joint. Some of these associated injuries seem to be responsible for poor long-term results and these injuries seem to affect the outcome independent of the quality of the acetabular reduction. The aim of our study was to analyze the outcome of both column acetabular fractures and the influence of osseous cofactors such as initial fracture displacement, hip dislocation, femoral head lesions and injuries of the acetabular joint surface.

Fibular fracture stabilization with a guidewire as supplementary fixation in tibia fractures.

We present a novel technique of intramedullary fixation of the fibula using a humeral guide wire as an adjunct to tibial fixation, in the setting of tibial shaft fracture. Not only does this technique aid in determining length, alignment, and rotation of the tibial fracture, but it may also help the support of the lower extremity as whole by stabilizing the lateral column. In addition, this technique can be used to help maintain reduction of the fibula when there is concern for the soft tissues of the lower extremity secondary to swelling or injury.

Outcome after thoracoscopic ventral stabilisation of thoracic and lumbar spine fractures.

Background And Purpose: Thoracoscopic-assisted ventral stabilisation for thoracolumbar fractures has been shown to be associated with decreased recovery time and less morbidity when compared with open procedures. However, there are a limited number of studies evaluating late clinical and radiological results after thoracoscopic spinal surgery.

Methods: We performed an analysis of the late outcomes of thoracolumbar fractures after minimally invasive thoracoscopic ventral instrumentation.

Increased morbidity and mortality after bilateral femoral shaft fractures: myth or reality in the era of damage control?

Introduction: Bilateral femoral shaft fractures have been reported to be an independent risk factor for morbidity and mortality; however, the value of these studies is limited due to small sample sizes and the timing of these studies before the establishment of damage control orthopaedics. The objective of this study was to compare the incidence of morbidity and mortality in patients with bilateral vs. unilateral femoral shaft fractures in the era of damage control orthopaedics.

Damage control orthopedics: current evidence.

Purpose Of Review: There is still an ongoing debate whether damage control orthopedics (DCO) or other treatment strategies should be favored in the treatment of multiply injured patients. This review gives an overview of the current literature concerning this important question in the treatment of severely injured patients.

Recent Findings: Several studies could show that DCO can reduce the inflammatory burden due to surgery (second hit).

Inhalative vs. systemic IL-10 administration: differences in the systemic inflammatory response and end-organ inflammation following hemorrhagic shock.

Interleukin-10 is known to modulate the systemic inflammatory response after trauma. This study investigates differences in the systemic and end-organ inflammation in animals treated with either inhalative or systemic IL-10 after experimental hemorrhagic shock (HS). Pressure controlled HS was performed in C57/BL6 mice for 1.

Fibula fracture stabilization with a guide wire as supplementary fixation in tibia fractures.

The tibia is the most commonly fractured long bone. Although the goals of fracture management are straightforward, methods for achieving anatomical alignment and stable fixation are limited. Type of management depends on fracture pattern, local soft-tissue involvement, and systemic patient factors.

The academic medical centre and nongovernmental organisation partnership following a natural disaster.

The global response to the 12 January 2010 earthquake in Haiti revealed the ability to mobilise medical teams quickly and effectively when academic medical centres partner non-governmental organisations (NGO) that already have a presence in a zone of devastation. Most established NGOs based in a certain region are accustomed to managing the medical conditions that are common to that area and will need additional and specialised support to treat the flux of myriad injured persons. Furthermore, an NGO with an established presence in a region prior to a disaster appears better positioned to provide sustained recovery and rehabilitation relief.

Complications of anterior subcutaneous internal fixation for unstable pelvis fractures: a multicenter study.

Background: Stabilization after a pelvic fracture can be accomplished with an anterior external fixator. These devices are uncomfortable for patients and are at risk for infection and loosening, especially in obese patients. As an alternative, we recently developed an anterior subcutaneous pelvic internal fixation technique (ASPIF).

Evolution of operative interventions by two university-based surgical teams in Haiti during the first month following the earthquake.

Background: The earthquake that struck Haiti on 10 January 2010, killed 200,000 persons and injured thousands more. Working with Partners in Health, a non-governmental organization already present in Haiti, Dartmouth College, and the University of Pennsylvania sent multidisciplinary surgical teams to hospitals in the villages of Hinche and Cange. The purpose of this report is to describe the injuries seen and evolution of treatments rendered at these two outlying regional hospitals during the first month following the earthquake.

Open tibial shaft fractures: II. Definitive management and limb salvage.

Definitive treatment of open fractures of the tibial diaphysis is challenging. The high-energy nature of these fractures, as well as the contamination of the fracture site and devitalization of the soft-tissue envelope, greatly increases the risk of infection, nonunion, and wound complications. The goals of definitive treatment include wound coverage or closure; prevention of infection; restoration of length, alignment, rotation, and stability; fracture healing; and return of function.

Open tibial shaft fractures: I. Evaluation and initial wound management.

Open fractures of the tibial diaphysis are often associated with severe bone and soft-tissue injury. Contamination of the fracture site and devitalization of the soft-tissue envelope greatly increase the risk of infection, nonunion, and wound complications. Management of open tibial shaft fractures begins with a thorough patient evaluation, including assessment of the bone and soft tissue surrounding the tibial injury.

Comprehensive adenosine stress perfusion MRI defines the etiology of chest pain in the emergency room: Comparison with nuclear stress test.

Purpose: To compare standard of care nuclear SPECT imaging with cardiac magnetic resonance imaging (MRI) for emergency room (ER) patients with chest pain and intermediate probability for coronary artery disease.

Materials And Methods: Thirty-one patients with chest pain, negative electrocardiogram (ECG), and negative cardiac enzymes who underwent cardiac single photon emission tomography (SPECT) within 24 h of ER admission were enrolled. Patients underwent a comprehensive cardiac MRI exam including gated cine imaging, adenosine stress and rest perfusion imaging and delayed enhancement imaging.

Ceramic hemi-unicondylar arthroplasty in an adolescent patient with idiopathic tibial chondrolysis.

Despite recent advances in cartilage regeneration and restoration procedures, isolated, large, full-thickness cartilage lesions in young patients continue to pose significant challenges to patients and orthopedic surgeons. Treatment options for this difficult problem have traditionally included arthrodesis, osteotomy, osteochondral allograft, and prosthetic reconstruction. We present a case of an adolescent patient with isolated idiopathic lateral tibial chondrolysis treated with a custom ceramic hemi-unicondylar hemiarthroplasty.

Prevalence and pathophysiologic attributes of ventricular dyssynchrony in arrhythmogenic right ventricular dysplasia/cardiomyopathy.

Objectives: This study sought to investigate the prevalence and mechanisms underlying right ventricular (RV) dyssynchrony in arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) using tissue Doppler echocardiography (TDE).

Background: An ARVD/C is characterized by fibrofatty replacement of RV myocardium and RV dilation. These pathologic changes may result in electromechanical dyssynchrony.

Stratifying risk of biliary complications in adult living donor liver transplantation by magnetic resonance cholangiography.

Background: Accurate preoperative assessment of biliary anatomy in live donor hepatectomy may be helpful to assess the suitability of a graft and to stratify risk of biliary complications.

Methods: A retrospective review of existing data among donor and recipients of 36 living donor transplants was performed to assess role of preoperative magnetic resonance cholangiography (MRC) for defining biliary anatomy and to stratify risk of biliary complications.

Results: Thirty-six living liver donors underwent MRC, and subsequently right lobectomy.

Kinase-independent functions for Itk in TCR-induced regulation of Vav and the actin cytoskeleton.

The Tec family kinase Itk is an important regulator of Ca(2+) mobilization and is required for in vivo responses to Th2-inducing agents. Recent data also implicate Itk in TCR-induced regulation of the actin cytoskeleton. We have evaluated the requirements for Itk function in TCR-induced actin polarization.

SAP regulates T(H)2 differentiation and PKC-theta-mediated activation of NF-kappaB1.

XLP is caused by mutations affecting SAP, an adaptor that recruits Fyn to SLAM family receptors. SAP-deficient mice recapitulate features of XLP, including increased T cell activation and decreased humoral responses post-infection. SAP-deficient T cells also show increased TCR-induced IFN-gamma and decreased T(H)2 cytokine production.