Straight Leg Raise Cannot Replace Computed Tomography in the Detection of Spinal Column Fractures.

INTRODUCTION: An active straight leg raise (SLR) is a weight bearing test which assesses pain upon movement and a patient's ability to load their pelvis, lumbar, and thoracic spine. Since many stable patients undergo computed tomography (CT) scanning solely for spinal tenderness, our hypothesis is that performing active straight leg raising could effectively rule out lumbar and thoracic vertebral fractures. METHODS: Blunt trauma patients ≥18 years of age with Glasgow Coma Scale 15 presenting in hemodynamically stable condition were screened. Patients remaining in the supine position were asked to perform SLR at 12, 18, and 24 inches above the bed. The patient's ability to raise the leg, baseline pain, and pain at each level were assessed. Patients also underwent standard CT scanning of the chest, abdomen and pelvis. The clinical examination results were then matched post hoc with the official radiology reports. RESULTS: 99 patients were screened, 65 males and 34 females. Spinal fractures were present in 15/99 patients (16%). Mechanisms of injury included motor vehicle collision 51%, pedestrian struck 25%, fall1 9%, and other 4%. The median pain score of patients with and without significant spinal fractures at 12, 18, 24 inches was 7.5, 7, 6 and 5, 5, 4, respectively. At 24 inches, active SLR had sensitivity of 0.47, a specificity of 0.59, a positive predictive value of 0.17, and an negative predictive value of 0.86. CONCLUSIONS: Although SLR has been discussed as a useful adjunct to secondary survey and physical exam following blunt trauma, its positive and more importantly negative predictive value are insufficient to rule out spinal column fractures. Liberal indications for CT based upon mechanism and especially pain and tenderness are necessary to identify all thoraco-lumbar spine fractures.

Neuromodulatory hacking: a review of the technology and security risks of spinal cord stimulation.

BACKGROUND: Spinal cord stimulation (SCS) is a neuromodulatory technique used to relieve chronic pain. Previous instances of malicious remote control of implantable medical devices, including insulin delivery pumps and implantable cardiac defibrillators, have been documented. Though no cases of neuromodulatory hacking have been recorded outside of the academic setting, an understanding of SCS technology and the possible consequences of manipulation is important in promoting safety. METHODS: We review the components and implantation protocol of a SCS system, the functionality and technological specifications for SCS systems in the global market based on their device manuals, and patient- and clinician-specific adjustable factors. Furthermore, we assess documented instances of implantable medical device hacking and speculate on the potential harms of targeting SCS systems. RESULTS: SCS systems from Abbott Laboratories, Boston Scientific, Medtronic, and Nevro have unique functionality and technological specifications. Six parameters in device control can potentially be targeted and elicit various harms, including loss of therapeutic effect, accelerated battery drainage, paresthesia in unintended locations, muscle weakness or dysfunction, tissue burn, and electrical shock. CONCLUSIONS: Based on the history of implantable medical device hacking, SCS systems may also be susceptible to manipulation. As the prevalence of SCS use increases and SCS systems continuously evolve in the direction of wireless control and compatibility with mobile devices, appropriate measures should be taken by manufacturers and governmental agencies to ensure safety.

Left brachiocephalic vein vascular ring on CT: A rare venous anomaly.

We present a case of a vascular ring formed by the left brachiocephalic vein. A left brachiocephalic vein ring or circum-aortic left brachiocephalic vein is a rare congenital vascular variant. Although it is usually an incidental finding on chest imaging studies, left brachiocephalic vein anomalies, particularly the ring variant, can be clinically significant during procedures requiring installation of transvenous implantable devices such as pacemakers. In this report, we illustrate the appearance on computed tomography of this rare anomaly and discuss an embryological hypothesis for the etiology.

Current Trends of Research Productivity among Students Matching at Top Ophthalmology Programs.

Importance San Francisco Match publishes no data on the research output of matched applicants to an ophthalmology residency. Objective The aim of this study was to examine the temporal trends in publication volume by medical students who successfully matched into a top ophthalmology residency. Methods This retrospective case series compared all residents in the top 30 ophthalmology residency programs from the class of 2022 and 2017. Publication volume from before September 15th of the residents' fourth year of medical school was recorded using PubMed and Google Scholar. We recorded total number of publications (any authorship), first/second author publications, and ophthalmology-specific publications. Using Welch's t -test, publication volumes were statistically compared against all others. Results One-hundred sixty-one residents from the class of 2022 and 145 residents from the class of 2017 were included. Total publications per matched applicant (mean ± standard deviation) were 3.04 ± 0.35 for the class of 2022 and 1.67 ± 0.23 for the class of 2017. Mean publications in ophthalmology journals were 1.07 ± 0.20 (2022) and 0.58 ± 0.13 (2017); mean first author publications were 1.00 ± 0.13 (2022) and 0.64 ± 0.11 (2017) and mean second author publications were 0.70 ± 0.10 (2022) and 0.37 ± 0.06 (2017). Research productivity in all four metrics (total, ophthalmology journals, first author, and second author publications) was significantly higher for the class of 2022 than the class of 2017 ( p = 0.001; p = 0.03; p = 0.03; p = 0.02, respectively) supporting the trend of increasing research output among students. Applicants with PhD degrees had statistically more total and first author publications in 2017 ( p = 0.01; p = 0.045), but only more first author publications in 2022 ( p = 0.01). International applicants produced significantly more total publications in 2022 ( p < 0.001). Conclusions Overall, after a 5-year period, the authors found matched applicants had significantly increased publications compared with those at the beginning of the period. We also identified several applicant factors that may have variable effects on research publication. This analysis emphasizes the growing importance of research in the match process and can help future applicants navigate the ophthalmology match.

Reporting of Research by Matched Otolaryngology Residency Applicants.

OBJECTIVES: Matching to an otolaryngology residency program is a competitive process for medical students, and research performed by students is considered as a factor for granting interviews by program directors. Because abstracts, presentations and publications are all reported in combination by the National Resident Matching Program's "Charting Outcomes in the Match" (ChOM) and may be weighted differently by PDs, we specifically investigated the number of publications by past applicants accepted to top otolaryngology residency programs. METHODS: The top 25 otolaryngology residency programs were identified using Doximity, sorting by reputation. Current residents were determined from the programs' websites. Using PubMed, each resident's number of publications, authorship status, and journal type were recorded. RESULTS: A total of 24 programs were included in the final analysis and the average number of manuscripts was 2.76 ± 4.01. The mean number of publications in otolaryngology journals was 1.03 ± 1.91. CONCLUSIONS: The difference between the investigated average number of publications (2.76) and those published by ChOM (10.4) represent a discrepancy due to the lack of delineation between abstracts, presentations and publications. The reported numbers for research may lead medical students to pursue alternate measures to increase their own research. Some options, such as adding a research year are not universally accessible. A clearer and more detailed approach to reporting research statistics would be beneficial to both applicants and PDs for otolaryngology programs.

Mantle cell lymphoma in the era of precision medicine-diagnosis, biomarkers and therapeutic agents.

Despite advances in the development of clinical agents for treating Mantle Cell Lymphoma (MCL), treatment of MCL remains a challenge due to complexity and frequent relapse associated with MCL. The incorporation of conventional and novel diagnostic approaches such as genomic sequencing have helped improve understanding of the pathogenesis of MCL, and have led to development of specific agents targeting signaling pathways that have recently been shown to be involved in MCL. In this review, we first provide a general overview of MCL and then discuss about the role of biomarkers in the pathogenesis, diagnosis, prognosis, and treatment for MCL. We attempt to discuss major biomarkers for MCL and highlight published and ongoing clinical trials in an effort to evaluate the dominant signaling pathways as drugable targets for treating MCL so as to determine the potential combination of drugs for both untreated and relapse/refractory cases. Our analysis indicates that incorporation of biomarkers is crucial for patient stratification and improve diagnosis and predictability of disease outcome thus help us in designing future precision therapies. The evidence indicates that a combination of conventional chemotherapeutic agents and novel drugs designed to target specific dysregulated signaling pathways can provide the effective therapeutic options for both untreated and relapse/refractory MCL.