Repositie van supracondylaire humerusfracturen middels een tijdelijke Kirschner-draad

* Abstract Closed reduction and percutaneous pinning have become the standard method of treatment of displaced supracondylar humeral fractures in children. Precise anatomical reduction is crucial in order to get good treat­ ment results. Traditional closed reduction can be challenging for these multidirectional, unstable fractures. Our goal is to point out a closed reduction method for the treatment of displaced supracondylar humeral fractures using a temporal Kirschner­wire which is positioned in the proximal humeral fragment. This tech nique could reduce the amount of conversions to open reposition * Samenvatting Instabiele gedislokeerde supracondylaire humerusfracturen bij kinderen worden in opzet behandeld met gesloten repositie en fixatie middels Kirschner­draden. Het functionele resultaat is mede afhankelijk van een adequate repositie. Deze repositie kan met de conventionele repositiemethode lastig zijn bij deze soms multidirectioneel instabiele fracturen bij jonge kinderen. Het artikel beschrijft, aan de hand van een casus, een methode waarbij gebruik wordt gemaakt van een tijdelijke Kirschner­draad in het proximale humerusfragment. Zodra, middels manipulatie, de adequate repositie is bereikt wordt de fractuur op de gebruikelijke manier gefixeerd en de tijdelijke Kirschner­draad verwijderd. Deze techniek zou kunnen bijdragen aan het verkleinen van het aantal conversies naar een open repositie

The reliability and reproducibility of the Hertel classification for comminuted proximal humeral fractures compared with the Neer classification

_Introduction_ The Neer classification is the most commonly used fracture classification system for proximal humeral fractures. Inter- and intra-observer agreement is limited, especially for comminuted fractures. A possibly more straightforward and reliable classification system is the Hertel classification. The aim of this study was to compare the inter- and intra-observer variability of the Hertel with the Neer classification in comminuted proximal humeral fractures. _Materials and methods_ Four observers evaluated blinded radiographic images of 60 patients. After at least two months classification was repeated. _Results_ Inter-observer agreement on plain X-rays was fair for both Hertel and Neer. Inter-observer agreement on CT-scans was substantial for Hertel and moderate for Neer. Inter-observer agreement on 3D-reconstructions was moderate for both Hertel and Neer. Intra-observer agreement on plain X-rays was fair for both Hertel and Neer. Intra-observer agreement on CT-scans was moderate for both Hertel and Neer. Intra-observer agreement on 3D-reconstructions was moderate for Hertel and substantial for Neer. _Conclusions_ The Hertel and Neer classifications showed a fair to substantial inter- and intra-observer agreement on the three diagnostic modalities used. Although inter-observer agreement was highest for Hertel classification on CT-scans, Neer classification had the highest intra-observer agreement on 3D-reconstructions. Data of this study do not confirm superiority of either classification system for the classification of comminuted proximal humeral fractures

Reproducible radiomics through automated machine learning validated on twelve clinical applications

Radiomics uses quantitative medical imaging features to predict clinical outcomes. Currently, in a new clinical application, findingthe optimal radiomics method out of the wide range of available options has to be done manually through a heuristic trial-anderror process. In this study we propose a framework for automatically optimizing the construction of radiomics workflows perapplication. To this end, we formulate radiomics as a modular workflow and include a large collection of common algorithms foreach component. To optimize the workflow per application, we employ automated machine learning using a random search andensembling. We evaluate our method in twelve different clinical applications, resulting in the following area under the curves: 1)liposarcoma (0.83); 2) desmoid-type fibromatosis (0.82); 3) primary liver tumors (0.80); 4) gastrointestinal stromal tumors (0.77);5) colorectal liver metastases (0.61); 6) melanoma metastases (0.45); 7) hepatocellular carcinoma (0.75); 8) mesenteric fibrosis(0.80); 9) prostate cancer (0.72); 10) glioma (0.71); 11) Alzheimer’s disease (0.87); and 12) head and neck cancer (0.84). Weshow that our framework has a competitive performance compared human experts, outperforms a radiomics baseline, and performssimilar or superior to Bayesian optimization and more advanced ensemble approaches. Concluding, our method fully automaticallyoptimizes the construction of radiomics workflows, thereby streamlining the search for radiomics biomarkers in new applications.To facilitate reproducibility and future research, we publicly release six datasets, the software implementation of our framework,and the code to reproduce this study

Recurrence After Liver Resection of Colorectal Liver Metastases: Repeat Resection or Ablation Followed by Hepatic Arterial Infusion Pump Chemotherapy

Background: The aim of this study was to investigate the effectiveness of adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after complete resection or ablation of recurrent colorectal liver metastases (CRLM). Methods: A retrospective cohort study was conducted of patients from two centers who were treated with resection and/or ablation of recurrent CRLM only between 1992 and 2018. Overall survival (OS) and hepatic disease-free survival (hDFS) were estimated using the Kaplan–Meier method. The Cox regression method was used to calculate hazard ratios (HRs) with corresponding 95% confidence intervals (CI). Results: Of 374 eligible patients, 81 (22%) were treated with adjuvant HAIP chemotherapy. The median follow-up for survivors was 65 months (IQR 32–118 months). Patients receiving adjuvant HAIP were more likely to have multifocal disease and receive perioperative systemic chemotherapy at time of resection for recurrence. A median hDFS of 46 months (95% CI 29–81 months) was found in patients treated with adjuvant HAIP compared with 18 months (95% CI 15–26 months) in patients treated with resection and/or ablation alone (p = 0.001). The median OS and 5-year OS were 89 months (95% CI 52–126 months) and 66%, respectively, in patients treated with adjuvant HAIP compared with 57 months (95% CI 47–67 months) and 47%, respectively, in patients treated with resection and/or ablation only (p = 0.002). Adjuvant HAIP was associated with superior hDFS (adjusted HR 0.599, 95% CI 0.38–0.93, p = 0.02) and OS (adjusted HR 0.59, 95% CI 0.38–0.92, p = 0.02) in multivariable analysis. Conclusion: Adjuvant HAIP chemotherapy after resection and/or ablation of recurrent CRLM is associated with superior hDFS and OS

Adjuvant Hepatic Arterial Infusion Pump Chemotherapy After Resection of Colorectal Liver Metastases: Results of a Safety and Feasibility Study in The Netherlands

Background: The 10-year overall survival with adjuvant hepatic arterial infusion pump (HAIP) chemotherapy after resection of colorectal liver metastases (CRLMs) was 61% in clinical trials from Memorial Sloan Kettering Cancer Center. A pilot study was performed to evaluate the safety and feasibility of adjuvant HAIP chemotherapy in patients with resectable CRLMs. Study Design: A phase II study was performed in two centers in The Netherlands. Patients with resectable CRLM without extrahepatic disease were eligible. All patients underwent complete resection and/or ablation of CRLMs and pump implantation. Safety was determined by the 90-day HAIP-related postoperative complications from the day of pump placement (Clavien–Dindo classification, grade III or higher) and feasibility by the successful administration of the first cycle of HAIP chemotherapy. Results: A total of 20 patients, with a median age of 57 years (interquartile range [IQR] 51–64) were included. Grade III or higher HAIP-related postoperative complications were found in two patients (10%), both of whom had a reoperation (without laparotomy) to replace a pump with a slow flow rate or to reposition a flipped pump. No arterial bleeding, arterial dissection, arterial thrombosis, extrahepatic perfusion, pump pocket hematoma, or pump pocket infections were found within 90 days after surgery. After a median of 43 days (IQR 29–52) following surgery, all patients received the first dose of HAIP chemotherapy, which was completed un

Colorectal Liver Metastases: Intra-arterial Pump Chemotherapy

The objective of this thesis was to develop clinical trials on hepatic arterial infusion pump (HAIP) chemotherapy in patients with resectable colorectal liver metastases (CRLM), and to study factors that are associated with prognosis and prediction in CRLM patients. The results of this thesis will be evaluated in three parts. Part I focused on the outcomes of perioperative HAIP and systemic chemotherapy in patients with resectable CRLM. In Part II results off a phase II safety and feasibility study on HAIP chemotherapy in the Netherlands were discussed. Additionally, a trial protocol of a multicenter phase III randomized controlled trial (RCT) was presented. This trial is currently running in the Netherlands and was designed to investigate the efficacy of HAIP chemotherapy after resection compared to resection only in patients with CRLM confined to the liver and a low clinical risk score (CRS). Part III focused on the prognostic and predictive value of clinical and pathological factors after resection of CRLM. In addit

Bioelectrochemical Power-to-Gas: State of the art and future perspectives

Bioelectrochemical power-to-gas (BEP2G) is considered a potentially convenient way of storing renewable surplus electricity in the form of methane. In methane-producing bioelectrochemical systems (BESs), carbon dioxide and electrical energy are converted into methane, using electrodes that supply either electrons or hydrogen to methanogenic archaea. This review summarizes the performance of methane-producing BESs in relation to cathode potential, electrode materials, operational strategies, and inoculum. Analysis and estimation of energy input and production rates show that BEP2G may become an attractive alternative for thermochemical methanation, and biochemical methanogenesis. To determine if BEP2G can become a future power-to-gas technology, challenges relating to cathodic energy losses, choice of a suitable electron donor, efficient reactor design/operation, and experience with large reactors need to be overcome

Restoring nutrient circularity: A review of nutrient stock and flow analyses of local agro-food-waste systems

To reduce environmental issues resulting from excess nutrients, conserve valuable resources and safeguard future food security, natural nutrient cycles in agro-food-waste systems need to be restored. To this end, nutrient stock and flow analyses of the agro-food-waste system can be undertaken. There is currently no standardized method for the systematic analysis of nutrient stocks and flows to support nutrient circularity of those systems at a local scale. This review of 57 studies summarizes the current knowledge on nutrient stock and flow analysis of agro-food-waste systems in local areas and proposes a six-step framework. About a third of the reviewed studies analyzed the complete agro-food-waste system, including crop production, animal production, food and feed processing industry, consumption and waste management. Furthermore, the main focus tends to be on phosphorus (P), and to a lesser extent on nitrogen (N), potassium (K) and (organic) carbon (C). Only a few studies combined the analyses of different nutrients, even though nutrient use efficiency relies on obtaining the optimal stoichiometric balance. The proposed framework for nutrient stock and flow analyses encompasses the inclusion of the complete agro-food-waste system and simultaneous analysis of N, P, K and C to facilitate assessment of the full potential to restore local nutrient circularity. Moreover, the local study area needs to be sufficiently large to include all the subsystems and sufficiently small to facilitate transportation of nutrients. Following this six-step framework, analyses will be able to identify hotspots, based on which effective measures to restore local nutrient circularity can be developed.</p