Salter-Harris II injury of the proximal tibial epiphysis with both vascular compromise and compartment syndrome: a case report

We present a case of a Salter-Harris II injury to the proximal tibia associated with both vascular compromise and compartment syndrome. The potential complications of this injury are limb threatening and the neurovasular status of the limb should be continually monitored. Maintaining anatomic reduction is difficult and fixation may be needed to achieve optimal results

The Effects of Ethanol on the Pancreatic Cell Line Transcriptomes

Pancreatic Ductal Adenocarcinoma (PDAC) is a highly aggressive cancer that develops from cells in the pancreas. Currently, PDAC has a 5-year survival rate of only 10% and it makes up about 7% of all cancer deaths (1). Certain risk factors are associated with PDAC development, including family history of cancer, obesity, diabetes, pancreatitis, alcohol consumption, and smoking. While several studies have assessed alcohol consumption and its contribution to PDAC development, there is conflicting evidence to whether or not alcohol actually promotes PDAC. Work from our lab indicates that specific subtypes of pancreatic cancer are associated with a patient’s drinking status, which may influence treatment strategies and patient outcomes (2). This raises the question; How does alcohol affect cancerous and pre-cancerous pancreatic cells? In this study, we performed RNA-Sequencing on ethanol treated pancreatic cells in different stages of cancer progression may provide insight to the effects of ethanol on the etiology of this disease. We analyzed the protein coding genes that were differentially expressed between non-treated and ethanol treated cells and performed functional analysis to better understand the impact of ethanol on the biological processes in pancreatic cells.https://digitalcommons.unmc.edu/surp2020/1013/thumbnail.jp

Polytrauma in the elderly: predictors of the cause and time of death

<p>Abstract</p> <p>Background</p> <p>Increasing age and significant pre-existing medical conditions (PMCs) are independent risk factors associated with increased mortality after trauma. Our aim was to review all trauma deaths, identifying the cause and the relation to time from injury, ISS, age and PMCs.</p> <p>Methods</p> <p>A retrospective analysis of trauma deaths over a 6-year period at the study centre was conducted. Information was obtained from the Trauma Audit and Research Network (TARN) dataset, hospital records, death certificates and post-mortem reports. The time and cause of death, ISS, PMCs were analysed for two age groups (<65 years and ≥ 65 years).</p> <p>Results</p> <p>Patients ≥ 65 years old were at an increased risk of death (OR 6.4, 95% CI 5.2-7.8, p < 0.001). Thirty-two patients with an ISS of >15 and died within the first 24 hours of admission, irrespective of age, from causes directly related to their injuries. Twelve patients with an ISS of <16, died after 13 days of medical conditions not directly related to their injuries (p = 0.01). Thirty four patients had significant PMCs, of which 11 were <65 years (34.4% of that age group) and 23 were ≥ 65 years (95.8% of that age group) (p = 0.02). The risk of dying late after sustaining minor trauma (ISS <16) is increased if a PMC exists (OR 5.5, p = 0.004).</p> <p>Conclusion</p> <p>Elderly patients with minor injuries and PMCs have an increased risk of death relative to their younger counterparts and are more likely to die of medical complications late in their hospital admission.</p

Epidemiology and outcome of fractures in elderly and super-elderly patients

Introduction Over the next decade it is predicted that there will be an increase in the elderly (≥65 years old) population within Western society especially those aged 80 years or more (super-elderly). Associated with this there is an anticipated increase in the number of patients presenting with fractures in these age groups. There is a paucity of literature describing the outcome of fractures in the elderly and super-elderly, other than those affecting the hip. Aims To describe the epidemiology and outcome of common fractures in the elderly and super-elderly patients. Methods Two prospective fractures databases were used to describe the epidemiology and change in incidence of fractures sustained by elderly and super-elderly patients over a decade for the same patient population. Case-mix and outcome variables for 1310 super-elderly patients sustaining acute fractures were recorded. A cohort of 318 veryelderly (90+ years) patients was compared with a group of 992 elderly (80-89 years) patients. During a three-year period, a prospective consecutive series of 162 elderly patients that underwent internal fixation for an undisplaced intracapsular hip fracture was collected. An established database of proximal humeral fractures was used to describe epidemiology and outcome of these fractures in the elderly. Two hundred and twenty-eight displaced distal radial fractures in super-elderly patients were retrospectively identified from a prospective database of 4024 distal radial fractures. 937 elderly patients with pelvic fractures presenting to the study centre over a 15-year period were identified. Two hundred and thirty-three tibial diaphyseal fractures were prospectively compiled for 225 elderly patients over a ten-year period. One hundred and nineteen (5.1% of all elderly fractures) elderly patients presented with multiple fractures during a one-year period were used to describe the epidemiology and outcome. Results More than a third of all fractures occur in elderly (≥65 years) patients, of which half occur in super-elderly (≥80 years) patients. The risk of sustaining a fracture was significantly increased for elderly (odds ratio (OR) 2.3) and super-elderly patients (OR 2.7) relative to those aged 15 to 64 years old. More than 90% of fractures in the elderly were sustained after a fall from standing height. There was a significant increase in the incidence for the elderly (2025 vs 2318/105/yr, p<0.0001) and super-elderly (3733 vs 4045/105/yr, p=0.0003) fractures between the years 2000 and 2010. The elderly and super-elderly population increased during this time but so did the number of fractures which increased disproportionally. There was an increased incidence in distal radial, proximal humeral and ankle fractures for the elderly and super-elderly populations. The very-elderly (≥90 years) group accounted for only 0.6% of the overall population, but they represented 4.1% of all fractures and 9.3% of all orthopaedic admissions. Patients in the very-elderly cohort were more likely to require hospital admission, were less likely to return to independent living. Lower American Society of Anesthesiologists (ASA) grade and the presence of posterior tilt (p<0.0001) were significant independent predictors of fixation failure of undisplaced intracapsular hip fracture. More than a quarter of elderly patients sustaining proximal humeral fractures had a poor functional outcome, with those patients not living in their own home (p=0.04), participating in recreational activities (p=0.01), able to perform their own shopping (p<0.001) or ability to dress themselves (p=0.02) being at an increased risk of a poor outcome which was independent of fracture severity (p=0.001). The premanipulation dorsal angulation of distal radial fractures was a significant independent predictor of the degree of improvement in the final dorsal angulation (p<0.001) and ulnar variance (p=0.01). No significant difference was observed in activities of daily living (p=0.28), wrist pain (p=0.14), whether the wrist had returned to its normal level function (p=0.25), grip strength (p=0.31) or range of movement (p=0.41) between the malunion group and the non-malunion group. The incidence of pelvic fractures increased from 7.9/105/yr to 13.1/105/yr, of which the majority were fragility fractures of the pubic rami (84%). Pre-injury independence and mobility, socioeconomic status, associated fractures, energy of injury, and male gender were independent predictors of length of stay, return to original place of domicile and one-year mortality. Tibial diaphyseal fractures in the elderly (≥65 years) predominantly occurred in females (73%) after a fall (61%). The overall standardised mortality ratio (SMR) was significantly increased (4.4 p<0.0001) relative to the population at risk and was greatest for elderly female patients (8.1 p<0.0001). These frailer patients had more severe injuries with an increased rate of open fractures (30%) and suffered a greater non-union rate (10%). Distal radial, proximal humeral and pelvic fractures were associated with a significantly (p<0.0001) increased risk of sustaining associated fractures. 4.5% of patients after a simple fall sustained multiple fractures, but due to the frequency of falls in the elderly this mechanism resulted in 80.7% of all multiple fractures. The SMR at one year was significantly greater after sustaining multiple fractures which included fractures of the pelvis, proximal humerus and proximal femur (p<0.001). Conclusion The incidence of elderly and super-elderly fractures increased over the last decade. This increase in incidence was specifically observed for fractures involving the distal radius, proximal humerus, and ankle in the elderly and super-elderly populations. The very-elderly group form a small proportion of the population but are more likely to require hospital admission and are less likely to return to independent living with a longer hospital stay. Lower ASA grade and posterior tilt of the femoral neck were independent predictors of fixation failure of undisplaced intracapsular hip fractures. A poor functional outcome after a proximal humeral fracture was not independently influenced by age and factors associated with social independence were more predictive of outcome. Patients with a high risk of distal radial malunion or poor improvement in the fracture position can be identified pre-manipulation, however malunion does not seem to influence the functional outcome of independent superelderly patients. The incidence of elderly pelvic fractures is increasing, and patient demographics could be used to predict length of stay, return to domicile, and oneyear mortality after a pubic rami fracture. Tibial diaphyseal fractures in the elderly are more common in females after a fall, which are more likely to be open and are associated with a higher prevalence of non-union. There will be financial repercussions associated with the management and ongoing care for these frail elderly patients especially those sustaining multiple fractures, with high admission rates, prolonged length of stay, and the increased level of care needed upon discharge

Monotonic Gaussian Process for Spatio-Temporal Disease Progression Modeling in Brain Imaging Data

We introduce a probabilistic generative model for disentangling spatio-temporal disease trajectories from series of high-dimensional brain images. The model is based on spatio-temporal matrix factorization, where inference on the sources is constrained by anatomically plausible statistical priors. To model realistic trajectories, the temporal sources are defined as monotonic and time-reparametrized Gaussian Processes. To account for the non-stationarity of brain images, we model the spatial sources as sparse codes convolved at multiple scales. The method was tested on synthetic data favourably comparing with standard blind source separation approaches. The application on large-scale imaging data from a clinical study allows to disentangle differential temporal progression patterns mapping brain regions key to neurodegeneration, while revealing a disease-specific time scale associated to the clinical diagnosis

Supertubes in Bubbling Backgrounds: Born-Infeld Meets Supergravity

We discuss two ways in which one can study two-charge supertubes as components of generic three-charge, three-dipole charge supergravity solutions. The first is using the Born-Infeld action of the supertubes, and the second is via the complete supergravity solution. Even though the Born-Infeld description is only a probe approximation, we find that it gives exactly the same essential physics as the complete supergravity solution. Since supertubes can depend on arbitrary functions, our analysis strengthens the evidence for the existence of three-charge black-hole microstate geometries that depend on an infinite set of parameters, and sets the stage for the computation of the entropy of these backgrounds. We examine numerous other aspects of supertubes in three-charge, three-dipole charge supergravity backgrounds, including chronology protection during mergers, the contribution of supertubes to the charges and angular momenta, and the enhancement of their entropy. In particular, we find that entropy enhancement affects supertube fluctuations both along the internal and the spacetime directions, and we prove that the charges that give the enhanced entropy can be much larger than the asymptotic charges of the solution. We also re-examine the embedding of five-dimensional black rings in Taub-NUT, and show that in different coordinate patches a ring can correspond to different four-dimensional black holes. Last, but not least, we show that all the three-charge black hole microstate geometries constructed so far can be embedded in AdS_3 x S^3, and hence can be related to states of the D1-D5 CFT.Comment: 60 pages, 2 figures, LaTe

The Edinburgh variant of a talar body fracture: a case report

We describe a novel closed pantalar dislocation with an associated sagittal medial talar body and medial malleolus fractures. Closed reduction was attempted unsuccessfully. Open reduction was performed, revealing a disrupted talonavicular joint with instability of the calcaneocuboid joint. This configuration required stabilisation with an external fixator. There were no signs of avascular necrosis, or arthrosis at 15 months follow but is currently using a stick to mobilise

Monotonic Gaussian Process for Spatio-Temporal Disease Progression Modeling in Brain Imaging Data

International audienceWe introduce a probabilistic generative model for disentangling spatio-temporal disease trajectories from series of high-dimensional brain images. The model is based on spatio-temporal matrix factorization, where inference on the sources is constrained by anatomically plausible statistical priors. To model realistic trajectories, the temporal sources are defined as monotonic and time-reparametrized Gaussian Processes. To account for the non-stationarity of brain images, we model the spatial sources as sparse codes convolved at multiple scales. The method was tested on synthetic data favourably comparing with standard blind source separation approaches. The application on large-scale imaging data from a clinical study allows to disentangle differential temporal progression patterns mapping brain regions key to neurodegeneration, while revealing a disease-specific time scale associated to the clinical diagnosis