Dysuria, Rebound Tenderness, and a Palpable Mass-A Ticking Time Bomb.

A 37-year-old male presented to the emergency department with the complaint of periumbilical abdominal pain, radiating to just above pubic symphysis. The patient reported that the pain was worse with urination and associated with chills and nausea. This case reports discusses the Emergency Department (ED) course and subsequent treatment of a patient found to have an infected urachal cyst, a previously asymptomatic embryological anomaly in an otherwise healthy middle-aged adult male. This is a crucial diagnosis to make in order to avoid the potential for significant morbidity and/or mortality, given the unlikely symptomatic source.

Step-Down Task Identifies Differences in Ankle Biomechanics Across Functional Activities.

Currently, there is no clinical exam to evaluate ankle frontal plane kinematics. The purpose of this study was to determine whether individuals identified as "lateral" landing during a video-recorded step-down task have differences in ankle inversion as measured with 3-dimensional motion capture during walking, step-down, and jump-landing tasks compared to individuals identified as "non-lateral". Fifty-seven recreationally active adults completed the descriptive laboratory study. During walking, step-down, and jump-landing tasks, participants had their ankle frontal plane kinematics measured using a 3-dimensional motion capture system. In addition, during the step-down task, participants had a posterior view video of their foot recorded using a commercial camera. Following testing, a blinded-investigator scored the step-down video of all participants by classifying them as "lateral" landing or "non-lateral" landing. Ankle frontal plane kinematics during the walking, step-down, and jump-landing tasks were compared between the two groups (lateral (N=24) and non-lateral (N=33) using a binary logistic regression and time-series confidence interval analysis. During walking, stepping-down, and jump-landing, the lateral group had significantly more inversion at initial contact and during various other phases specific to each task. This study found that a clinical screening tool could identify individuals who have significantly more inversion during three tasks.

Acute lateral ankle sprain to chronic ankle instability: a pathway of dysfunction.

Lateral ankle sprains (LAS) have been reported as one of the most common musculoskeletal injuries observed in sports and in individuals who are recreationally active. Approximately 40% of individuals who sustain a LAS develop a condition known as chronic ankle instability (CAI). Years of research has identified numerous impairments associated with CAI such as decreases in range of motion (ROM), strength, postural control, and altered movement patterns during functional activities when compared to individuals with no LAS history. As a result, an impairment-based rehabilitation model was developed to treat the common impairments associated with CAI. The impairment-based rehabilitation model has been shown to be an effective rehabilitation strategy at improving both clinical and patient-oriented outcomes in patients with CAI. To date, the efficacy of an impairment-based rehabilitation model has not been evaluated in patients with an acute LAS. Prior to implementing an impairment-based model for the treatment of an acute LAS, similarities between impairments associated with acute LAS and CAI across the spectrum of the healing process is warranted. Therefore, the purpose of this review paper is to compare and contrast impairments and treatment techniques in individuals with an acute LAS, sub-acute LAS, and CAI. A secondary purpose of this review is to provide clinical commentary on the management of acute LAS and speculate how the implementation of an impairment-based rehabilitation strategy for the treatment of acute LAS could minimize the development of CAI. The main findings of this review were that similar impairments (decreased ROM, strength, postural control, and functional activities) are observed in patients with acute LAS, sub-acute LAS, and CAI, suggesting that the impairments associated with CAI are a continuation from the original impairments developed during the initial LAS. Therefore, the use of an impairment-based model may be advantageous when treating patients with an acute LAS.

A Comprehensive Characterization of Parameters Affecting High-Frequency Irreversible Electroporation Lesions.

Several focal therapies are being investigated clinically to treat tumors in which surgery is contraindicated. Many of these ablation techniques, such as radiofrequency ablation and microwave ablation, rely on thermal damage mechanisms which can put critical nerves or vasculature at risk. Irreversible electroporation (IRE) is a minimally invasive, non-thermal technique to destroy tumors. A series of short electric pulses create nanoscale defects in the cell membrane, eventually leading to cell death. Typical IRE protocols deliver a series of 50-100 µs monopolar pulses. High frequency IRE (H-FIRE) aims to replace these monopolar pulses with integrated bursts of 0.25-10 µs bipolar pulses. Here, we examine ablations created using a broad array of IRE and H-FIRE protocols in a potato tissue phantom model. Our results show that H-FIRE pulses require a higher energy dose to create equivalent lesions to standard IRE treatment protocols. We show that ablations in potato do not increase when more than 40 H-FIRE bursts are delivered. These results show that H-FIRE treatment protocols can be optimized to produce clinically relevant lesions while maintaining the benefits of a non-thermal ablation technique.