Brachytherapy for Soft Tissue Sarcoma: Maintaining Local Control While Minimizing Complications.

Background: This study aims to assess the clinical and oncologic outcomes of high-dose brachytherapy (BRT) versus both preoperative and postoperative external beam radiation therapy (EBRT) in the setting of high-grade soft tissue sarcoma.

Methods: This is a retrospective cohort study of 144 patients treated surgically for soft tissue sarcoma at the same institution from 2010 to 2021. Patients treated for a soft tissue sarcoma with surgery and radiation therapy in the form of BRT, Neoadjuvant EBRT (Neo-EBRT) or adjuvant EBRT (AD-EBRT) were included.

Large Nodular Fasciitis of the Shoulder Presenting as Soft Tissue Sarcoma: A Case Report.

Case: This case report describes a patient who presented with clinical and radiographic features of a soft tissue sarcoma of the shoulder. Despite having a painless and relatively large mass, a biopsy and resection revealed nodular fasciitis (NF).

Conclusion: This is an unusual case of a painless 10 cm mass that histopathologically was diagnosed as NF in the upper extremity with proximity to the axillary nerve and posterior humeral circumflex vessels.

Episode-of-care costs of total knee arthroplasty: Outpatient versus inpatient postoperative care protocol.

Background: Total knee arthroplasty (TKA) is the most commonly performed joint replacement procedure in North America. Few studies have successfully evaluated the episode-of-care cost (EOCC) of common elective orthopedic procedures using an activity-based costing (ABC) framework. The objective of this study is to compare the EOCC of same-day discharge versus inpatient TKA using an activity-based costing methodology.

Tourniquet Use and Local Tissue Concentrations of Cefazolin During Total Knee Arthroplasty: A Randomized Clinical Trial.

Importance: Prophylactic administration of antibiotics before skin incision is an important component in the prevention of periprosthetic joint infection in arthroplasty surgery. For antibiotics to be effective, the local tissue concentration (LTC) must exceed the minimum inhibitory concentration of typical infecting organisms; however, the LTC of cefazolin during arthroplasty is poorly understood.

Objective: To compare the systemic concentration of cefazolin in serum with the LTC in fat, synovium, and bone during primary total knee arthroplasty (TKA) while assessing the effect of tourniquet inflation.

Interventions for undergraduate and postgraduate medical learners with academic difficulties: A BEME systematic review update: BEME Guide No. 85.

Background: Clinical teachers often struggle to record trainee underperformance due to lacking evidence-based remediation options.

Objectives: To provide updated evidence-based recommendations for addressing academic difficulties among undergraduate and postgraduate medical learners.

Methods: A systematic review searched databases including MEDLINE, CINAHL, EMBASE, ERIC, Education Source, and PsycINFO (2016-2021), replicating the original Best Evidence Medical Education 56 review strategy.

Predictors of Episode-of-Care Costs for Ankle Fractures.

Ankle fractures are one of the most resource-consuming traumatic orthopedic injuries. Few studies have successfully evaluated the episode-of-care costs (EOCC) of common traumatic orthopedic injuries. The objective of this study was to determine the EOCC associated with the surgical management of ankle fractures.

Hospital episode-of-care costs for hip fractures: an activity-based costing analysis.

Background: Despite the large impact of hip fracture care on hospital budgets, accurate episode-of-care costs (EOCC) calculations for this injury remains a challenge. The objective of this article was to assess EOCC for geriatric patients with hip fractures using an activity-based costing methodology and identify intraoperative, perioperative, and patient-specific factors associated with higher EOCC.

Material And Methods: This is a retrospective cohort study involving a total of 109 consecutive patients with hip fracture treated surgically at a Canadian level-1 trauma center from April 2018 to February 2019.

Local tissue concentrations of cefazolin during total joint arthroplasty: a systematic review.

Background: Periprosthetic joint infections (PJI) following joint arthroplasty are now the leading cause of reoperation and are associated with serious morbidity to the patient, often requiring several staged operations and a prolonged course of parenteral antibiotics. Prophylactic administration of intravenous antibiotics before skin incision is arguably the most important measure to prevent PJI; however, the dose effectiveness of cefazolin in target tissue is not well known. We aimed to identify parameters affecting local tissue concentration (LTC) of cefazolin.

A novel method for quantification of cefazolin local tissue concentration in blood, fat, synovium, and bone marrow using liquid chromatography - mass spectrometry.

To be effective, the concentration of antibiotic used must exceed the minimum inhibitory concentration (MIC) against infecting organisms at and in the surgical site. Few studies follow antibiotic levels for tissues that are manipulated during surgery. The aim of this work was to develop and validate a novel LC-MS method as well as an efficient extraction technique for the quantification of cefazolin in local tissues and whole blood.

Diagnosis Accuracy for Compartment Syndrome: A Systematic Review and Meta-Analysis.

Objective: To evaluate whether published studies support basing the diagnosis of compartment syndrome of the lower leg on clinical findings, intracompartmental pressure (ICP) monitoring, or both.

Data Sources: A PubMed/MEDLINE, Web of Science, and Embase search of the English literature from 1966 to February 2022 was performed. This used "lower extremity" or "leg" or "tibia" and "compartment syndrome" and "pressure" as the subjects.

Episode-of-care costs of total hip arthroplasty: day surgery versus same-day admission.

Background: Although day surgery (DS) total hip arthroplasty (THA) has good patient satisfaction and a good safety profile, accurate episode-of-care cost (EOCC) calculations for this procedure compared to standard same-day admission (SDA) THA are not well known. We determined the EOCCs for patients who underwent THA, comparing DS and SDA pathways.

Methods: We evaluated the EOCCs for consecutive patients who underwent DS or SDA THA for osteoarthritis or osteonecrosis performed by a single surgeon at 1 academic centre from July 2018 to January 2020.

Novel digital continuous sensor for monitoring of compartment pressure: a case report.

Case: The American Academy of Orthopaedic Surgeons has recently identified continuous intracompartmental pressure monitoring as 1 of the few means to assist in ruling out acute compartment syndrome (ACS). There are very few methods that allow this measurement. This manuscript describes the use of a new digital monitoring system for ACS in 3 patients.

Proton Pump Inhibitor Use and Associated Infectious Complications in the PICU: Propensity Score Matching Analysis.

Objectives: We aimed to evaluate the association between proton pump inhibitor (PPI) exposure and nosocomial infection (NI) during PICU stay.

Design: Propensity score matched analysis of a single-center retrospective cohort from January 1, 2017, to December 31, 2018.

Setting: Tertiary medical and surgical PICU in France.

Cancellations and delays of emergent orthopedic operations at a Canadian level 1 trauma centre.

Background: Day-of surgery cancellation (DOSC) is considered to be a very inefficient use of hospital resources and results in emotional stress for the patient. To examine opportunities to minimize the incidence of preventable cancellations - an indicator of quality of care - we assessed the incidence of and reasons for DOSCs over 3 months among inpatients and outpatients at a trauma orthopedic service.

Methods: This was a prospective study of 2 cohorts of patients, inpatients and outpatients, scheduled for emergent orthopedic surgery at a Canadian tertiary level 1 trauma centre from Jan.

Predictors of Foot Acute Compartment Syndrome: Big Data analysis.

Acute compartment syndrome (ACS) in the foot is a challenging diagnosis and can lead to significant disabilities to patients. The present study aims to investigate the incidence, risk factors, demographics and association in the analysis of acute compartment syndrome (ACS) of the foot. We performed a retrospective review of the Trauma Quality Programs data from the American College of Surgeons including 70,525 patients who sustained a fracture of the foot from 2015 to 2018 (4 calendar years).

Time-to-Incision for Hip Fractures in a Canadian Level-1 Trauma Centre: Are We Respecting the Guidelines?

Background: Surgical intervention within 48 hours is recommended for hip fractures in the elderly in order to reduce post-operative complications and lower mortality rates. The purpose of this retrospective study is to explore the causes of surgical delays for acute geriatric hip fractures.

Methods: This is a retrospective cohort study involving a total of 109 consecutive geriatric patients who sustained proximal femur fractures ("hip fractures"), who subsequently underwent definitive fixation.

Tibial Tunnel Placement in ACL Reconstruction Using a Novel Grid and Biplanar Stereoradiographic Imaging.

Background: Nonanatomic graft placement is a frequent cause of anterior cruciate ligament reconstruction (ACLR) failure, and it can be attributed to either tibial or femoral tunnel malposition. To describe tibial tunnel placement in ACLR, we used EOS, a low-dose biplanar stereoradiographic imaging modality, to create a comprehensive grid that combines anteroposterior (AP) and mediolateral (ML) coordinates.

Purpose: To (1) validate the automated grid generated from EOS imaging and (2) compare the results with optimal tibial tunnel placement.

Telemedicine-guided forearm emergency decompressive fasciotomy for compartment syndrome.

Introduction: We highlight the utility of telemedicine and telementoring for the management of orthopaedic emergencies using a case of forearm compartment syndrome following a penetrating trauma in a northern Inuit community in Nunavik, Quebec, Canada.

Methods & Results: As in many cases of compartment syndrome in rural settings, the patient was at a high risk of developing irreversible complications. A prompt diagnosis followed by an emergency decompressive fasciotomy was warranted.

Femoral Tunnel Placement Analysis in ACL Reconstruction Through Use of a Novel 3-Dimensional Reference With Biplanar Stereoradiographic Imaging.

Background: The femoral-sided anatomic footprint of the anterior cruciate ligament (ACL) has been widely studied during the past decades. Nonanatomic placement is an important cause of ACL reconstruction (ACLR) failure.

Purpose: To describe femoral tunnel placement in ACLR through use of a comprehensive 3-dimensional (3D) cylindrical coordinate system combining both the traditional clockface technique and the quadrant method.

Simultaneous automatic segmentation of multiple needles using 3D ultrasound for high-dose-rate prostate brachytherapy.

Purpose: Sagittally reconstructed 3D (SR3D) ultrasound imaging shows promise for improved needle localization for high-dose-rate prostate brachytherapy (HDR-BT); however, needles must be manually segmented intraoperatively while the patient is anesthetized to create a treatment plan. The purpose of this article was to describe and validate an automatic needle segmentation algorithm designed for HDR-BT, specifically capable of simultaneously segmenting all needles in an HDR-BT implant using a single SR3D image with ~5 mm interneedle spacing.

Materials And Methods: The segmentation algorithm involves regularized feature point classification and line trajectory identification based on the randomized 3D Hough transform modified to handle multiple straight needles in a single image simultaneously.

The Effects of Glucose Therapy Agents-Apple Juice, Orange Juice, and Cola-on Enteral Tube Flow and Patency.

To develop evidence-based hypoglycemia treatment protocols in patients receiving total enteral nutrition, this study determined the effect on enteral tube flow of glucose therapy agents: apple juice, orange juice, and cola, and it also examined the effects of tube type and feed type with these glucose therapy agents. For this study, 12 gastrostomy tubes (6 polyethylene and 6 silicone) were set at 50 mL/h. Each feeding set was filled with Isosource HN with fibre or Novasource Renal.

Three-dimensional transrectal ultrasound guided high-dose-rate prostate brachytherapy: A comparison of needle segmentation accuracy with two-dimensional image guidance.

Purpose: Conventional transrectal ultrasound guided high-dose-rate prostate brachytherapy (HDR-BT) uses an axially acquired image set for organ segmentation and 2D sagittal images for needle segmentation. Sagittally reconstructed 3D (SR3D) transrectal ultrasound enables both organ and needle segmentation and has the potential to reduce organ-needle alignment uncertainty. This study compares the accuracy of needle tip localization between the conventional 2D sagittally assisted axially reconstructed (SAAR) and SR3D approaches.

Validation of a novel robot-assisted 3DUS system for real-time planning and guidance of breast interstitial HDR brachytherapy.

Purpose: In current clinical practice, there is no integrated 3D ultrasound (3DUS) guidance system clinically available for breast brachytherapy. In this study, the authors present a novel robot-assisted 3DUS system for real-time planning and guidance of breast interstitial high dose rate (HDR) brachytherapy treatment.

Methods: For this work, a new computer controlled robotic 3DUS system was built to perform a hybrid motion scan, which is a combination of a 6 cm linear translation with a 30° rotation at both ends.

Prostate: registration of digital histopathologic images to in vivo MR images acquired by using endorectal receive coil.

Purpose: To develop and evaluate a technique for the registration of in vivo prostate magnetic resonance (MR) images to digital histopathologic images by using image-guided specimen slicing based on strand-shaped fiducial markers relating specimen imaging to histopathologic examination.

Materials And Methods: The study was approved by the institutional review board (the University of Western Ontario Health Sciences Research Ethics Board, London, Ontario, Canada), and written informed consent was obtained from all patients. This work proposed and evaluated a technique utilizing developed fiducial markers and real-time three-dimensional visualization in support of image guidance for ex vivo prostate specimen slicing parallel to the MR imaging planes prior to digitization, simplifying the registration process.