Emerging innovations and advancements in the treatment of extremity and truncal soft tissue sarcomas.

In this special edition update on soft tissue sarcomas (STS), we cover classifications, emerging technologies, prognostic tools, radiation schemas, and treatment disparities in extremity and truncal STS. We discuss the importance of enhancing local control and reducing complications, including the role of innovative imaging, surgical guidance, and hypofractionated radiation. We review advancements in systemic and immunotherapeutic treatments and introduce disparities seen in this vulnerable population that must be considered to improve overall patient care.

Evaluation of a modified radiographic union scale for tibial fractures scoring system in staged bilateral tibial plateau leveling osteotomy procedures and comparison of first and second side radiographic bone healing.

OBJECTIVE: To evaluate the inter- and intra-rater reliability of the tibial plateau leveling osteotomy (TPLO) modified radiographic union scale for tibial fractures (mRUST), a semiquantitative scoring system, as compared with the subjective evaluation of radiographic union for staged TPLOs. STUDY DESIGN: Retrospective study. ANIMALS: Forty-eight dogs, 96 stifles. METHODS: Medical records were reviewed for dogs with bilateral cranial cruciate ligament injuries diagnosed at presentation that underwent staged bilateral TPLOs within 6 months and had both immediate and recheck postoperative radiographs. Radiographs were anonymized, reviewers were blinded, radiographic union was evaluated subjectively, and TPLO mRUST scores were assigned. RESULTS: The subjective evaluation's intra-rater reliability was 0.72 (Kappa 95% CI 0.65-0.79) and inter-rater reliability was 0.33 (Kappa 95% CI 0.28-0.39). The TPLO mRUST scoring system intra-rater reliability was 0.73 (95% CI 0.68-0.78) and inter-rater reliability was 0.56 (95% CI 0.41-0.68). There was no difference in the degree of bone healing quantified by the TPLO mRUST scoring system (95% CI - 0.1-1.2, P = .09) or subjective evaluation (P = .48) between the first and second side TPLOs. The TPLO mRUST scores were positively correlated with subjective healing (r = 0.94, 95% CI 0.92-0.96, P < .0001, and for scores ≥10/12, 99%, 244/246) were subjectively assigned as radiographically healed. CONCLUSION: The TPLO mRUST scoring system improved inter-rater reliability compared to subjective evaluation of radiographic union. CLINICAL SIGNIFICANCE: The TPLO mRUST scoring system should be considered as a semiquantitative supplemental tool for evaluating radiographic union.

Improving the performance of spray operators through monitoring and evaluation of insecticide concentrations of pirimiphos-methyl during indoor residual spraying for malaria control on Bioko Island.

BACKGROUND: Quality control of indoor residual spraying (IRS) is necessary to ensure that spray operators (SOs) deposit the correct concentration of insecticide on sprayed structures, while also confirming that spray records are not being falsified. METHODS: Using high-performance liquid chromatography (HPLC), this study conducted quality control of the organophosphate insecticide pirimiphos-methyl (Actellic 300CS), during the 2018 IRS round on Bioko Island, Equatorial Guinea. Approximately 60 SOs sprayed a total of 67,721 structures in 16,653 houses during the round. Houses that were reportedly sprayed were randomly selected for quality control testing. The SOs were monitored twice in 2018, an initial screening in March followed by sharing of results with the IRS management team and identification of SOs to be re-trained, and a second screening in June to monitor the effectiveness of training. Insecticide samples were adhesive-lifted from wooden and cement structures and analysed using HPLC. RESULTS: The study suggests that with adequate quality control measures and refresher training, suboptimal spraying was curtailed, with a significant increased concentration delivered to the bedroom (difference = 0.36, P < 0.001) and wooden surfaces (difference 0.41, P = 0.001). Additionally, an increase in effective coverage by SOs was observed, improving from 80.7% in March to 94.7% in June after re-training (McNemar's test; P = 0.03). CONCLUSIONS: The ability to randomly select, locate, and test houses reportedly sprayed within a week via HPLC has led to improvements in the performance of SOs on Bioko Island, enabling the project to better evaluate its own performance.

The first potential energy surfaces for the C6H(-)-H2 and C6H(-)-He collisional systems and their corresponding inelastic cross sections.

Molecular anions have recently been detected in the interstellar and circumstellar media. Accurate modeling of their abundance requires calculations of collisional data with the most abundant species that are usually He atoms and H2 molecules. In this paper, we focus on the collisional excitation of the first observed molecular anion, C6H(-), by He and H2. Theoretical calculations of collisional cross sections rely generally on ab initio interaction potential energy surfaces (PESs). Hence, we present here the first PESs for the C6H(-)-H2 and C6H(-)-He van der Waals systems. The ab initio energy data for the surfaces were computed at the explicitly correlated coupled cluster with single, double, and scaled perturbative triple excitations level of theory. The method of interpolating moving least squares was used to construct 4D and 2D analytical PESs from these data. Both surfaces are characterized by deep wells and large anisotropies. Analytical models of the PESs were used in scattering calculations to obtain cross sections for low-lying rotational transitions. As could have been anticipated, important differences exist between the He and H2 cross sections. Conversely, no significant differences exist between the collisions of C6H(-) with the two species of H2 (para- and ortho-H2). We expect that these new data will help in accurately determining the abundance of the C6H(-) anions in space.

Comparison of bupivacaine and dexmedetomidine femoral and sciatic nerve blocks with bupivacaine and buprenorphine epidural injection for stifle arthroplasty in dogs.

OBJECTIVE: To compare the quality of anesthesia and analgesia from femoral and sciatic nerve blocks (FS) with bupivacaine and dexmedetomidine with that from an epidural injection (EPI) with bupivacaine and buprenorphine in dogs undergoing unilateral stifle arthroplasty. STUDY DESIGN: Prospective, blinded, randomized, clinical comparison. ANIMALS: Twenty-six dogs weighing 36 ± 10 kg and aged 5 (1-11) years. METHODS: Dogs were randomly assigned to either FS [n = 13; bupivacaine 0.5% (0.5 mg kg(-1) ) plus dexmedetomidine (0.1 µg kg(-1) ) for each nerve] or EPI [n = 13; bupivacaine 0.5% (1 mg kg(-1) ) plus buprenorphine (4 µg kg(-1) )]. Data collected included intraoperative cardiopulmonary variables and postoperative pain scores (Glasgow Composite Pain Scale), sedation scores, opioid consumption, time to urination and time to return of various behaviors. Rescue analgesia (hydromorphone 0.05 mg kg(-1) ) was administered intravenously whenever pain scores were ≥ 6/24. Subsequent data from rescued dogs were excluded from further analysis. RESULTS: No differences were found for any of the variables evaluated during and after anesthesia. Over 60% (nine dogs in FS, eight dogs in EPI) of patients from either group did not need additional analgesia within the 24 hour observational period. Three and four patients in FS and EPI, respectively, that required rescue analgesia did so within the first 30 minutes after extubation; only one patient in EPI required supplemental analgesia more than 4 hours after extubation. One patient in each group did not urinate spontaneously for 24 hours. CONCLUSIONS AND CLINICAL RELEVANCE: Both techniques have the potential to provide sufficient analgesia for up to 24 hours in approximately two-thirds of dogs. Careful observation for signs of pain and preparedness to intervene is still recommended. The incidence of urinary retention was low in both groups. These techniques show promise for providing high-quality analgesia for stifle arthroplasty.

Correlations between changes in cytokines and clinical outcomes for early phase (proof of concept) trials in active diffuse systemic sclerosis using data from an imatinib study.

OBJECTIVE: Data from a small study testing imatinib to treat SSc were used to determine if cytokine changes were related to differences in clinical parameters to model future early phase trials pairing cytokine changes and clinical parameters. METHODS: Plasma and punch skin biopsy specimens collected at baseline and 6 months were analysed for levels of 26 fibrotic and inflammatory cytokines using multiplexed immunoassays and ELISA. Seven of nine patients on active treatment had paired data. Biopsies were biopulverized and standardized to protein levels in the tissue homogenate. Plasma was frozen at -80°C and analysed using multiplexed immunoassays or ELISAs standardized to CRP. Correlations between fold changes in cytokines and differences in clinical parameters (skin score, physician and patient global assessments and HAQ) were performed. P < 0.01 was considered significant. RESULTS: After 6 months of imatinib treatment, plasma levels of soluble vascular cell adhesion molecule 1 decreased significantly (P < 0.001), while tissue levels of soluble intercellular adhesion molecule 1 increased (P < 0.01). Some significant correlations between fold changes in certain plasma fibrotic and inflammatory cytokines and changes in clinical parameters after 6 months of treatment were found: patient global scores and IL-13 (r = 0.964, P < 0.0001); ESR and IL-12p70 (r = -0.903, P < 0.01); in tissue samples, patient global score and soluble E-selectin (r = 0.913, P < 0.01); and physician global score with sCD40L (r = -0.883, P < 0.01). CONCLUSION: Some serum and tissue cytokines may have a role in early phase clinical trials of SSc, correlating with changes in clinical parameters. Serum and tissue samples could be analysed in early phase trials to determine whether they support the clinical observations. TRIAL REGISTRATION: http://clinicaltrials.gov/show/NCT01545427.

Comparative analysis of the Potter Tower and a new Track Sprayer for the application of residual sprays in the laboratory.

BACKGROUND: Efforts to evaluate the residual efficacy of new indoor residual spraying (IRS) formulations have identified limitations with the industry standard laboratory sprayer, the Potter Spray Tower (PT). Calibrating the PT can be time-consuming, and the dosing of surfaces may not be as accurate or uniform as previously assumed. METHODS: To address these limitations, the Micron Horizontal Track Sprayer with Spray Cabinet (TS) was developed to provide higher efficiency, ease of operation and deposition uniformity equal to or better than the PT. A series of studies were performed using a fluorescent tracer and three IRS formulations (Actellic® 300CS, K-Othrine WG250 and Suspend PolyZone) sprayed onto surfaces using either the PT or the TS. RESULTS: Deposition volumes could be accurately calibrated for both spray systems. However, the uniformity of spray deposits was higher for the TS compared to the PT. Less than 12% of the volume sprayed using the PT reaches the target surface, with the remaining 88% unaccounted for, presumably vented out of the fume hood or coating the internal surfaces of the tower. In contrast, the TS deposits most of the spray on the floor of the spray chamber, with the rest contained therein. The total sprayed surface area in one run of the TS is 1.2 m2, and the operational zone for spray target placement is 0.7 m2, meaning that 58% of the applied volume deposits onto the targets. The TS can treat multiple surfaces (18 standard 15 × 15 cm tiles) in a single application, whereas the PT treats one surface at a time and a maximum area of around 0.0225 m2. An assessment of the time taken to perform spraying, including the setup, calibration and cleaning, showed that the cost of application using the TS was around 25-35 × less per tile sprayed. Standard operating procedures (SOPs) for calibration and use of both the Potter Tower and Track Sprayer have been developed. CONCLUSIONS: Overall, the TS represents a significant improvement over the PT in terms of the efficiency and accuracy of IRS formulation applications onto test substrates and offers a useful additional tool for researchers and manufacturers wanting to screen new active ingredients or evaluate the efficacy of IRS or other sprayable formulations for insect control.

Comparison of select hematology and serum chemistry analtyes between wild-caught and aquarium-housed lake sturgeon (Acipenser fulvescens).

Hematology and serum chemistry analytes were compared between wild-caught and aquarium-housed lake sturgeon (Acipenser fulvescens) to potentially improve understanding of medical issues in lake sturgeon. Blood samples were taken from 30 lake sturgeon exhibited in 11 institutions in the United States and from 23 experimentally stocked lake sturgeon caught in gill nets in the lower Genesee River in Rochester, New York, USA. For hematology, only segmented neutrophil count was significantly different, with wild-caught fish having a higher number of circulating neutrophils. For clinical chemistry analytes, chloride, uric acid, calcium, phosphate, glucose, aspartate aminotransferase, triglycerides, and creatine kinase were significantly different between the two cohorts. These differences are likely not clinically significant and are attributable to handling stress, variability in environmental parameters, or differences in nutritional status. This is the first report of hematology and serum chemistry values in aquarium-housed lake sturgeon and provides useful reference intervals for clinicians.

Novel 3D-printed foot orthoses with variable hardness: A comfort comparison to traditional orthoses.

Custom foot orthoses are used to treat a variety of foot pathologies. However, orthotic production requires significant hands-on fabrication time and expertise to produce orthoses that are both comfortable and effective. This paper introduces a novel 3D printed orthosis and fabrication method that utilizes custom architectures to produce variable-hardness regions. These novel orthoses are compared to traditionally fabricated orthoses during a 2-week user comfort study. Twenty (n = 20) male volunteers underwent orthotic fitting for both traditional and 3D-printed foot orthoses prior to engaging in treadmill walking trials and 2 weeks of wear. Each participant undertook a regional comfort, acceptance, and comparison analysis of the orthoses at three time points throughout the study (0, 1, and 2 weeks). Both the 3D-printed and the traditionally fabricated foot orthoses demonstrated statistically significant increases in comfort when compared to the factory fabricated shoe insert. Additionally, the two orthosis groups were not significantly different from each other in comfort rankings both regionally and overall at any time point. The similar comfort achieved by the 3D-printed orthosis to the traditionally fabricated orthosis after 7 days and 14 days emphasizes the potential of the future use of the more reproducible and adaptable 3D-printed orthosis manufacturing methodology.

Preventing and curing citrulline-induced autoimmune arthritis in a humanized mouse model using a Th2-polarizing iNKT cell agonist.

Invariant natural killer T (iNKT) cells are innate lymphocytes with unique reactivity to glycolipid antigens bound to non-polymorphic CD1d molecules. They are capable of rapidly releasing pro- and/or anti-inflammatory cytokines and constitute attractive targets for immunotherapy of a wide range of diseases including autoimmune disorders. In this study, we have explored the beneficial effects of OCH, a Th2-polarizing glycolipid agonist of iNKT cells, in a humanized mouse model of rheumatoid arthritis (RA) in which citrullinated human proteins are targeted by autoaggressive immune responses in mice expressing an RA susceptibility human leukocyte antigen (HLA) DR4 molecule. We found for the first time that treatment with OCH both prevents and cures citrulline-induced autoimmune arthritis as evidenced by resolved ankle swelling and reversed histopathological changes associated with arthritis. Also importantly, OCH treatment blocked the arthritogenic capacity of citrullinated antigen-experienced splenocytes without compromising their global responsiveness or altering the proportion of splenic naturally occurring CD4(+)CD25(+)FoxP3(+) regulatory T cells. Interestingly, administering the Th1-promoting iNKT cell glycolipid ligand α-C-galactosylceramide into HLA-DR4 transgenic mice increased the incidence of arthritis in these animals and exacerbated their clinical symptoms, strongly suggesting a role for Th1 responses in the pathogenesis of citrulline-induced arthritis. Therefore, our findings indicate a role for Th1-mediated immunopathology in citrulline-induced arthritis and provide the first evidence that iNKT cell manipulation by Th2-skewing glycolipids may be of therapeutic value in this clinically relevant model, a finding that is potentially translatable to human RA.

Intracranial atherosclerosis is associated with progression of neurological deficit in subcortical stroke.

BACKGROUND: Progression of neurological deficit (PND) is a frequent complication of acute subcortical ischemic stroke (SCS). The role of intracranial atherosclerosis (IAS) in PND is controversial. Our goal was to evaluate IAS on admission, as predictor of PND in SCS patients. METHODS: SCS patients were identified from our prospective database from 2004 to 2008. Clinical and laboratory data were collected from charts, and radiographic data from original radiographs. The proximal intracranial arteries were graded as patent, irregular, stenotic, or occlusion. IAS was defined as irregularity or stenosis. PND was defined as a change in the National Institutes of Health Stroke Scale >1 point. RESULTS: Two hundred and two SCS patients were identified. In 14%, PND occurred at a median of 2 days from onset. Univariate analysis by infarct location showed the following to be associated with PND: for anterior circulation infarcts (centrum semiovale/basal ganglia), M1 atherosclerosis (p = 0.042); for posterior circulation infarcts, vertebral artery atherosclerosis (p = 0.018). For both groups, we found a non-significant association with age (p = 0.2) and HbA1c levels (p = 0.095). No association was found with admission glucose levels. Multivariate analysis showed the following association with PND: for anterior circulation infarcts, M1 atherosclerosis (OR 4.7; 95% CI 1.2-18.8; p = 0.03); for pontine infarcts, vertebral artery atherosclerosis (OR 5.8; 95% CI 1.1-29.4; p = 0.033). There was an increase in PND likelihood with an increasing number of atherosclerotic vessels. DISCUSSION: In our cohort of SCS patients, PND was associated with IAS of the responsible vessels. These results suggest a role for IAS in the pathogenesis of PNF in SCS patients.

Imaging of glaucoma drainage devices.

Previously reserved for patients with refractory glaucoma, glaucoma drainage devices (GDDs) are being used more frequently as a primary treatment option. Several types of GDDs are currently manufactured, only one of which is radiopaque. Knowledge of their typical imaging appearance in addition to pertinent background information is therefore vital for radiologists. We present a case of bilateral glaucoma drainage devices and briefly review the surgical aspect of implantation.

A high-throughput HPLC method for simultaneous quantification of pyrethroid and pyriproxyfen in long-lasting insecticide-treated nets.

Long-lasting insecticide-treated nets (LLINs) play a crucial role in preventing malaria transmission. LLINs should remain effective for at least three years, even after repeated washings. Currently, monitoring insecticides in LLINs is cumbersome, costly, and requires specialized equipment and hazardous solvents. Our aim was to develop a simple, high-throughput and low-resource method for measuring insecticides in LLINs. To extract insecticides, polyethylene-LLIN samples were heated at 85 °C for 45 min in a non-hazardous solvent mix containing dicyclohexylphthalate as an internal standard. The extraction solvent was reduced from 50 to 5 ml using a 0.2 g sample, 90% smaller than the recommended sample size. By optimizing HPLC chromatography, we simultaneously detected pyrethroid and pyriproxyfen insecticides with high sensitivity in LLIN's extract. The method can quantify levels ≥ 0.0015% permethrin, 0.00045% alpha-cypermethrin and 0.00025% pyriproxyfen (w/w) in polyethylene, allowing for insecticide tracking before and after the use of LLINs. This method can be used to assess LLINs with 1% pyriproxyfen (pyriproxyfen-LLIN) or 2% permethrin (Olyset® Net), 1% pyriproxyfen and 2% permethrin (Olyset® Duo), or 0.55% pyriproxyfen and 0.55% alpha-cypermethrin (Royal Gaurd®). One can run 120 samples (40 nets) simultaneously with high precision and accuracy, improving throughput and reducing labour, costs, and environmental impact.

Enhancing the Quality of Spray Application in IRS: Evaluation of the Micron Track Sprayer.

Indoor residual spraying (IRS) has changed little since its introduction in the 1940s. Manual spraying is still prone to variation in insecticide dose. To improve the application of IRS in experimental hut trials, an automated track sprayer was developed, which regulates the speed of application and the distance of the nozzle from the wall, two key sources of variation. The automated track sprayer was compared to manual spraying, firstly using fluorescein solution in controlled indoor settings, and secondly in experimental huts in Tanzania using several IRS products. Manual spraying produced greater variation with both fluorescein and insecticide applications. Both manual and automated spray methods under-dosed the actual dose sprayed compared to the target dose. Overall, the track sprayer treats surfaces more consistently, offering a potential improvement over manual spraying for experimental hut evaluation of new IRS formulations.

Intraoperative Cryotherapy in the Treatment of Metastatic Renal Cell Carcinoma of the Bone.

Osseous metastases in renal cell carcinoma (RCC) are a heterogeneous mix of cells with hypervascular and rapidly destructive properties that frequently exhibit resistance to both radiation and chemotherapy. Despite this, some patients with isolated and oligometastatic disease have the potential to be cured. Regardless, aggressive metastatic control is critical to minimizing morbidity and mortality for all patients with metastatic RCC. Percutaneous cryoprobes were developed as a minimally invasive technique for both pain relief and tumor control. However, there is little evidence describing an alternative use of this technology in the operating room to assist with open tumor resections, and no formal role for its use in orthopedics exists. Therefore, the authors added this modality to their intraoperative treatment of osseous RCC to investigate whether it would influence their ability to obtain local metastatic control. The authors performed a retrospective chart review of prospectively obtained data to evaluate the role of intraoperative cryotherapy in the treatment of osseous RCC. From 2004 to 2017, cryotherapy was used in 43 procedures, alleviating the need for additional radiation 84% (36 of 43) of the time. Local tumor control was achieved in 100% (43 of 43) of cases. There were 2 wound-related complications and 1 pathologic fracture. Despite the study's limitations, the authors believe that cryotherapy contributed to the reliability and reproducibility of their intralesional resections. Given the palliative, and potentially curative, opportunities afforded by complete locoregional tumor control, the authors support further investigation into the use of intraoperative cryotherapy to treat osseous metastases secondary to RCC. [Orthopedics. 2021;44(5):e645-e652.].

Bilateral ovarian metastasis of clear-cell renal cell carcinoma: A case report.

Renal cell carcinoma (RCC) accounts for 2-3% of all adult malignancies. Clear-cell type RCC is the most common type, accounting for approximately 75% of all renal cancer cases. The most common sites of metastasis include the lung, bone, and liver. Ovarian metastasis of RCC is an exceptionally rare occurrence with only 41 cases reported in the literature with only 11 of these cases involving the bilateral ovaries. Here we present a case of clear-cell RCC arising from the left kidney with metastatic involvement of bilateral ovaries in a 48-year-old woman.

The impact of local health professions education grants: is it worth the investment?

BACKGROUND: Local grants programs are important since funding for medical education research is limited. Understanding which factors predict successful outcomes is highly relevant to administrators. The purpose of this project was to identify factors that contribute to the publication of local medical education grants in a Canadian context. METHODS: Surveys were distributed to previous Department of Innovation in Medical Education (DIME) and Department of Medicine (DOM) grant recipients (n = 115) to gather information pertaining to PI demographics and research outcomes. A backward logistic regression was used to determine the effects several variables on publication success. RESULTS: The overall publication rate was 64/115 (56%). Due to missing data, 91 grants were included in the logistic regression. Variables associated with a higher rate of publication; cross departmental compared to single department OR = 2.82 (p = 0.04), being presented OR = 3.30 (p = 0.01), and multiple grant acquisition OR = 3.85 (p = 0.005). CONCLUSION: Although preliminary, our data suggest that increasing research publications from local grants may be facilitated by pooling funds across departments, making research presentations mandatory, and allowing successful researchers to re-apply.

OBJECTIF: Les programmes de subventions locales sont importants car le financement de la recherche en éducation médicale est limité. Il est très important pour les administrateurs de comprendre quels sont les facteurs de réussite. Le but de ce projet était d'identifier les facteurs qui, dans le contexte canadien, contribuent à la publication d'articles à l'aide de subventions locales pour l'éducation médicale. MÉTHODES: Un sondage a été réalisé auprès des anciens récipidendaires de subventions du Department of Innovation in Medical Education (DIME) et du Department of Medicine (DOM) (n=115) afin de recueillir des informations relatives à la démographie des chercheurs principaux et aux résultats de la recherche. Une régression logistique descendante a été utilisée pour déterminer les effets de plusieurs variables sur le succès des publications. RÉSULTATS: Le taux de publication global était de 64/115 (56 %). En raison de données manquantes, 91 subventions ont été incluses dans la régression logistique. Variables associées à un taux de publication plus élevé; OR inter-départements comparé à un seul département = 2,82 (p = 0,04), soumis OR = 3,30 (p = 0,01) et OR l''obtention de plusieurs subventions = 3,85 (p = 0,005). CONCLUSION: Bien que préliminaires, nos données suggèrent que la publication de recherches à l'aide de subventions locales pourrait être facilitée en regroupant les fonds des divers départements, en rendant la présentation de recherches obligatoire et en permettant aux chercheurs dont l'article a été retenu de faire une nouvelle soumission.

Experimental Simulation Study to Assess Pressure Distribution of Different Compression Applications Applied Over an Innovative Primary Wound Dressing.

INTRODUCTION: Compression is integral to the management of edema and the prevention of venous leg ulcers (VLUs). OBJECTIVE: The aim of this study is to assess the sub-bandage pressure distribution under 3 compression applications as well as to assess the impact of an innovative primary wound dressing, applied under the compression products, on pressure distribution. MATERIALS AND METHODS: A series of controlled tests were performed using a simulated leg model (SLM). A pressure mapping sensor and system software was used to measure the interface pressure (IP) and pressure distribution created by the application of 3 different compression systems with and without the addition of an elastic longitudinal stockinette (fuzzy wale compression; FWC). These included: (1) 2-layer cohesive wrap; (2) 3-layer compression application; and (3) 4-layer compression application. The IP was pressure between the SLM and the innovative dressing over which the compression applications were applied. Seven different configurations were tested, including the compression applications alone and in combination with the FWC. In addition to the IP measurements, pressure mapping visualizations were captured with the pressure mapping sensor and system software. A custom MATLAB program was written for data analysis, differentiations in discrete high- and low-pressure locations across the compressed area, and graphing of the pressure readings. RESULTS: The overall average pressure for each testing setup without FWC ranged from 34.65 ± 4.84 mm Hg for the 2L configuration to 63.92 ± 7.08 mm Hg for the 4L configuration. The addition of the FWC resulted in a 19% increase for the 2L, 9% increase for the 3L, and 7% increase for the 4L compression systems. Additionally, it was noted that the inclusion of FWC resulted in a significant change in pressures vertically oriented under the 2-, 3-, and 4-layer compression applications of 34.52 ± 9.06 mm Hg, 99.21 ± 29.81 mm Hg, and 128.96 ± 22.97 mm Hg, respectively. The pressure distribution under the compression alone was observed to be largely uniform except for areas of overlap that produce horizontal bands of elevated pressures. The presence of the primary wound dressing did not have a significant impact on the IP measurements. The addition of FWC to all compression applications demonstrated a vertical distribution of compression along the sensor with alternating areas of little or no compression. CONCLUSIONS: The unique alternating pressure distribution observed in the in vitro pressure testing with the use of FWC in a clinical setting has been observed to produce better edema management and wound edge migration that mirrors the vertical pressure distribution observed in the study. Additional in vitro and in vivo research to evaluate the biophysical impact of IP created by the use of a combination of primary wound dressings and compression applications with focus on the total pressure and the distribution across the surface of intact tissue and open wound bed is warranted.

The IVH score: a novel tool for estimating intraventricular hemorrhage volume: clinical and research implications.

OBJECTIVE: Intraventricular extension of intracerebral hemorrhage (IVH) is an independent predictor of poor outcome. IVH volume may be important in outcome prediction and management; however, it is difficult to measure routinely. DESIGN AND PATIENTS: We reviewed the charts and computed tomographies of a cohort of consecutive patients with IVH. The cohort was divided into two groups: index and validation by random sampling. IVH and intracerebral hemorrhage (ICH) volume were measured manually in all patients. IVH was also graded using a simple classification system termed IVH score (IVHS). Clinical outcome was determined by the modified Rankin Scale (mRS) at discharge and in-hospital death. Poor outcome was defined as mRS 4-6. MAIN RESULTS: One hundred seventy-five patients were analyzed, 92 in the index group and 83 in the validation group. Exponential regression yielded the following formula for estimating IVH volume (mL): eIVHS/5 (R = .75, p < 0.001). The IVH estimation formula was then verified in the validation group (R = .8, p < 0.001). The following correlations with mRS were obtained: IVH volume R = .305; ICH volume R = .468; total volume [TV] R = .571 (p < 0.001 for all three correlations). Partial correlation of TV with mRS controlling for ICH volume yielded R = .3 for TV (p < 0.001). Logistic regression model comparing ICH and TV association with poor outcome yielded the following: ICH odds ratio = 5.2, 95% confidence interval 2.3-11.6, p < 0.001; TV odds ratio = 41.6, 95% confidence interval 9.6-180.6, p < 0.001. Substituting TV for ICH volume in the ICH score resulted in a significant increase in the specificity from 64% to 87% for predicting mortality. CONCLUSIONS: IVHS enables clinicians to rapidly estimate IVH volume. The addition of IVH to ICH volume increases its predictive power for poor outcome and mortality significantly. IVHS and TV may be used in clinical practice and clinical trials of patients with ICH.

Characteristics and outcomes in a prospective cohort of patients with histologically diagnosed aortitis.

OBJECTIVES: Our aim was to evaluate characteristics and prospective adverse aortic outcomes in a cohort of patients with non-infectious histological aortitis. METHODS: Patients with histological aortitis, diagnosed at the Ottawa Hospital after surgical repair of thoracic aortic aneurysms or dissections, consented to enrolment in a prospective observational cohort. Patients were assessed for an underlying inflammatory condition and followed prospectively with periodic clinical, laboratory and radiographic assessments. Aortic outcomes during follow-up included significant events, defined as new thoracic or abdominal aortic aneurysms, dissections, ruptures or other complications requiring aortic intervention, in addition to aortic branch ectasias, aneurysms and stenosis. RESULTS: Sixteen patients with histological aortitis from surgical procedures performed between 2010 and 2017 were included; nine had idiopathic and seven had secondary aortitis. Idiopathic patients were more likely to have smoked (100 vs 43%, P = 0.02) and had more associated arch or descending aortic aneurysms on pre-operative baseline imaging compared with secondary aortitis (6 vs 0, P = 0.01). At the median 3.6 years of follow-up, eight patients (50%) had 10 significant aortic events. The incidence of aortic dissection was higher in the first year post-surgery, compared with subsequent years, whereas incident aneurysms occurred throughout follow-up. Elevated inflammatory markers during follow-up trended towards association with accumulation of severe aortic damage. CONCLUSION: This is the first reported prospective study in patients with histological aortitis. Within the limitations of a small cohort, we report a high incidence of aortic complications. Studies with a larger sample size and longer follow-up are needed to corroborate these findings.