Defining prostate cancer size and treatment margin for focal therapy: does intralesional heterogeneity impact the performance of multiparametric MRI?

Objectives: To evaluate the impact of intralesional heterogeneity on the performance of multiparametric magnetic resonance imaging (mpMRI) in determining cancer extent and treatment margins for focal therapy (FT) of prostate cancer.

Patients And Methods: We identified men who underwent primary radical prostatectomy for organ- confined prostate cancer over a 3-year period. Cancer foci on whole-mount histology were marked out, coding low-grade (LG; Gleason 3) and high-grade (HG; Gleason 4-5) components separately.

Pediatric Emergency Medicine Simulation Curriculum: Vitamin K Deficiency in the Newborn.

Introduction: The American Academy of Pediatrics recommends vitamin K prophylaxis at birth for all newborns to prevent vitamin K deficiency bleeding (VKDB). Despite a lack of evidence for serious harms, barriers to prophylaxis, including parental refusal, are rising, as are cases of VKDB.

Methods: This simulation involved an infant presenting to the emergency department who decompensated due to a cerebral hemorrhage caused by VKDB and was treated by pediatric and emergency providers.

Clinical Outcomes of Open Versus Arthroscopic Broström Procedure for Lateral Ankle Instability: A Meta-analysis.

Arthroscopic repair of the anterior talofibular ligament is becoming increasingly popular as a surgical option for lateral ankle instability. However, studies directly comparing outcomes of open and arthroscopic anterior talofibular ligament repair continue to present conflicting conclusions. This review aims to compare the clinical outcomes of arthroscopic and open Broström procedure.

Evaluating the Prevalence of Pelvic Floor Disorders in Women in Nonmetropolitan Communities.

Introduction: Prevalence rates of pelvic floor disorders in women in nonmetropolitan communities compared with metropolitan communities are unknown. We hypothesize that the rates are higher in women in nonmetropolitan communities.

Methods: We accessed the health survey data from the NHANES (National Health and Nutrition Examination Survey) from 2009 to 2010 divided by geocodes into nonmetropolitan (<50,000 inhabitants) and metropolitan communities (>50,000).

Arthroscopic Treatment of Primary Synovial Chondromatosis of the Ankle: A Case Report and Review of Literature.

Background: Primary synovial chondromatosis is a rare disease characterized by the presence of metaplastic cartilaginous nodules arising from the synovia. Synovial chondromatosis has been widely described in the large joints, including elbow, hip, and knee joints, but very rarely in the foot or ankle. Data on the arthroscopic management of this condition in the ankle are also limited.

Racial variations in tooth pain and care-seeking in adolescents in Malaysia.

Objective: Tooth pain among adolescents is a common event that impacts substantially on quality of life. The purpose of this paper is to explore the role of race in the tooth pain experience and associated care-seeking.

Design: A cross-sectional questionnaire survey was conducted on 14-18 years from four different public schools in Kuala Lumpur.

Ensuring Business Continuity of Musculoskeletal Care During the COVID-19 Pandemic: Experience of a Tertiary Orthopaedic Surgery Department in Singapore.

On February 8, 2020, Singapore raised its Disease Outbreak Response System Condition (DORSCON) level to Orange, indicating that coronavirus 2019 (COVID-19) was a severe disease with high human transmissibility. Using lessons learned from the severe acute respiratory syndrome (SARS) outbreak in 2003, the orthopaedic surgery department at Singapore General Hospital, a tertiary-level referral center, was prepared to handle this pandemic through business-continuity planning. The business that we are referring to is the "business" of orthopaedic surgery, encompassing clinical care, education, research, and administration.

Biomarkers for Precision Urothelial Carcinoma Diagnosis: Current Approaches and the Application of Single-Cell Technologies.

Urothelial carcinoma (UC) is the most frequent malignancy of the urinary system and is ranked the sixth most diagnosed cancer in men worldwide. Around 70-75% of newly diagnosed UC manifests as the non-muscle invasive bladder cancer (NMIBC) subtype, which can be treated by a transurethral resection of the tumor. However, patients require life-long monitoring due to its high rate of recurrence.

Penile gangrene from calciphylaxis is salvageable with intravenous sodium thiosulfate and early total parathyroidectomy.

Penile gangrene is a rare but fatal complication of calciphylaxis in end-stage renal disease (ESRD). To date, there are no guidelines on its management, and outcomes are generally poor with high mortality rate. We present a case of a diabetic patient with ESRD presenting with dry gangrene of the glans penis due to calciphylaxis and successfully treated with intravenous sodium thiosulfate (STS) and early total parathyroidectomy.

Prostatic ductal adenocarcinoma variant predicts worse pathological and oncological outcomes: Insight from over 1000 consecutive patients from a large prospective uro-oncology registry.

Objective: To evaluate if prostatic ductal adenocarcinoma (PDA) independently predicts poorer pathological and oncological outcomes after radical prostatectomy (RP).

Methods And Materials: Utilizing a large prospective uro-oncology registry, clinicopathological parameters of 1027 consecutive patients who underwent RP (2008-2017) were recorded. Oncological outcomes were determined by failure to achieve unrecordable PSA postoperatively and biochemical failure (BCF).

Patient-reported Outcome Measures of Revision Total Hip Arthroplasty for Prosthetic Joint Infection is not Inferior to Aseptic Revision Total Hip Arthroplasty.

Introduction: This study aims to investigate whether patients undergoing two-stage revision total hip arthroplasty (THA) for prosthetic joint infection (PJI) and one-stage revision THA for aseptic reasons have similar clinical outcomes and patient satisfaction during their post-operative follow-up. We hypothesise that the two-stage revision THA for PJI is associated with poorer outcomes as compared to aseptic revision THA.

Materials And Methods: We reviewed prospectively collected data in our tertiary hospital arthroplasty registry and identified patients who underwent revision THA between 2001 and 2014, with a minimum of two years follow-up.

Primary Peritonitis Secondary to in a Young Female Adult-A Case Report and Literature Review.

Primary spontaneous bacterial peritonitis (SBP) is a rare cause of acute abdomen in previously healthy patients, even more unusually caused by a group A Streptococcus (GAS) (also known as ) infection. We report a young, otherwise healthy female who presented with generalized abdominal pain that was initially managed conservatively as gastroenteritis, with a computed tomography (CT) scan showing a ruptured corpus luteal cyst. Upon subsequent readmission with worsened pain and symptoms, a repeat CT scan showed worsened free fluid with signs of peritonitis.

Single-Center Prospective Pilot Study of Sirolimus Drug-Coated Balloon Angioplasty in Maintaining the Patency of Thrombosed Arteriovenous Graft.

Purpose: To investigate the use of a sirolimus drug-coated balloon (DCB) in the management of a thrombosed arteriovenous graft (AVG).

Materials And Methods: A single-center prospective pilot study was conducted between October 2018 and October 2019. Twenty patients (age = 67.

A systematic scoping review and thematic analysis of interprofessional mentoring in medicine from 2000 to 2019.

Interprofessional mentoring in palliative care sees different members of the interprofessional team providing holistic, personalised andlongitudinal mentoring support, skills training and knowledge transfer as they mentor trainees at different points along their mentoring journeys. However, gaps in practice and their risk of potential mentoring malpractice even as interprofessional mentoring use continues to grow in palliative medicine underlines the need for careful scrutiny of its characteristics and constituents in order to enhance the design, evaluation and oversight of interprofessional mentoring programmes. Hence, a systematic scoping review on prevailing accounts of interprofessional mentoring in medicine is conducted to address this gap.

From "business continuity" to "back to business" for orthopaedic surgeons during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented challenges to healthcare systems worldwide. Orthopaedic departments have adopted business continuity models and guidelines for essential and non-essential surgeries to preserve hospital resources as well as protect patients and staff. These guidelines broadly encompass reduction of ambulatory care with a move towards telemedicine, redeployment of orthopaedic surgeons/residents to the frontline battle against COVID-19, continuation of education and research through web-based means, and cancellation of non-essential elective procedures.

Assessing Professionalism in Medicine - A Scoping Review of Assessment Tools from 1990 to 2018.

Background: Medical professionalism enhances doctor-patient relationships and advances patient-centric care. However, despite its pivotal role, the concept of medical professionalism remains diversely understood, taught and thus poorly assessed with Singapore lacking a linguistically sensitive, context specific and culturally appropriate assessment tool. A scoping review of assessments of professionalism in medicine was thus carried out to better guide its understanding.

"Angioplasty-First" Approach for Limb Salvage in Asian Patients with Critical Limb Ischemia: Outcomes from 3,303 Angioplasties on 2,402 Limbs in a Single Tertiary Hospital.

Purpose: To review outcomes of patients with critical limb ischemia (CLI) who underwent conventional percutaneous transluminal angioplasty (PTA) as first-line treatment for revascularization.

Materials And Methods: Retrospective review of 3,303 angioplasty procedures on 2,402 limbs in 1,968 patients with CLI was conducted. Mean patient age was 68 years ± 11, and 1,057 patients (54%) were male.

Concomitant abducens and facial nerve palsies: A rare presentation in anti-aquaporin-4 antibody-positive neuromyelitis optica.

Over the past decade, the discovery of disease-specific aquaporin-4 antibodies has led to a better understanding of the diverse spectrum of disorders that are associated with neuromyelitis optica. Brainstem manifestations have been increasingly recognized in this disease. However, multiple cranial nerve palsies as an initial presentation of neuromyelitis optica are uncommon.

Rep1 microsatellite length influences non-motor symptoms in early Parkinson's disease.

Long alpha-synuclein gene promoter (Rep1) allele-carriers are linked to higher risk for Parkinson's disease (PD) and faster motor progression. Non-motor symptoms including autonomic, neuropsychiatric, and sleep disorders are common in PD. However, the relationship between Rep1 microsatellite lengths and non-motor symptoms in early PD remains to be elucidated.

The Pivotal Role of Host Organizations in Enhancing Mentoring in Internal Medicine: A Scoping Review.

In undergraduate and postgraduate medical education, mentoring offers personalized training and plays a key role in continuing medical education and the professional development of healthcare professionals. However, poor structuring of the mentoring process has been attributed to failings of the host organization and, as such, we have conducted a scoping review on the role of the host organization in mentoring programs. Guided by Levac et al's methodological framework and a combination of thematic and content analysis, this scoping review identifies their "defining" and secondary roles.

Management of arterial dissections in 12 patients during transarterial chemoembolization and yttrium-90 selective internal radiotherapy for primary and secondary liver tumours.

Objective: To describe rates and management strategies of arterial dissections in transarterial chemoembolization (TACE) and Yttrium-90 selective internal radiotherapy (Y SIRT) for primary and secondary liver tumours.

Materials And Methods: This retrospective review included 1377 hepatic angiographies between May 2010 and June 2015 in a single centre for TACE and Y SIRT of liver tumours. The angiogram results, management, treatment outcomes and follow-up angiography/imaging findings were recorded.