Traumatic Bone Bruises in the Athlete’s Knee

Context: Mobile water within the bone marrow is a physiological phenomenon that is identifiable on magnetic resonance (MR) imaging, and signal changes can result from blood pooling, reactive hyperemia, edema, and microfracture. When these MR lesions are associated with an acute traumatic event, the findings are referred to as bone bruises and so represent a unique manifestation of injury. This review discusses bone bruises in anterior cruciate ligament (ACL) tears, patella dislocations, occult fractures, and contusions. Methods: A PubMed search of the literature from 1982 to December 2009 was conducted with the terms knee and bone bruise. Results:: Bone bruises are associated with ACL tears, patella dislocations, occult fractures, and contusions. For each injury, a unique pattern of bone bruising is found on MR imaging, which results from the acute trauma. When acute trauma produces a subchondral lesion with low T1-weighted and high T2-weighted signal intensity, the resulting bony contusion is best described as a bone bruise. Conclusions:: Bone marrow edema is identified using MR imaging and may result from traumatic or atraumatic causes. Bone bruises can be characterized by their pattern at presentation, by the mechanism of injury, and by their associated injuries. This type of bone edema can accompany contact and noncontact ACL ruptures as well as patella dislocations. Although increased marrow edema can be associated with an occult fracture, the long-term significance of these lesions is unclear

Preliminary evaluation of a robotic apparatus for the analysis of passive glenohumeral joint kinematics

Background: The shoulder has the greatest range of motion of any joint in the human body. This is due, in part, to the complex interplay between the glenohumeral (GH) joint and the scapulothoracic (ST) articulation. Currently, our ability to study shoulder kinematics is limited, because existing models isolate the GH joint and rely on manual manipulation to create motion, and have low reproducibility. Similarly, most established techniques track shoulder motion discontinuously with limited accuracy. Methods: To overcome these problems, we have designed a novel system in which the shoulder girdle is studied intact, incorporating both GH and ST motions. In this system, highly reproducible trajectories are created using a robotic actuator to control the intact shoulder girdle. High-speed cameras are employed to track retroreflective bone markers continuously. Results: We evaluated this automated system’s capacity to reproducibly capture GH translation in intact and pathologic shoulder conditions. A pair of shoulders (left and right) were tested during forward elevation at baseline, with a winged scapula, and after creation of a full thickness supraspinatus tear. Discussion The system detected differences in GH translations as small as 0.5 mm between different conditions. For each, three consecutive trials were performed and demonstrated high reproducibility and high precision

Blended learning for teacher professional learning

Lärare behöver professionellt lärande för att skolresultaten ska förbättras. För att det ska göra skillnad för alla elever så behöver alla lärare delta i den. Samtidigt visas en brist på organiserat professionellt lärande för lärare (Skolverket, 2013). Digitaliseringen skapar nya möjligheter. Lärande online kännetecknas av att vara flexibel tids- och rumsmässigt. Något som kan möta det tidsmässiga hinder som skolledare uttrycker (Skolinspektionen, 2015). Forskning, av Means et al. (2009), visar att lärande med blended learning; där undervisning och lärande i det fysiska rummet kombineras med undervisning och lärande online, ger bättre effekt än lärande helt fysiskt respektive helt online. Denna studie har tittat på hur de olika undervisningsmiljöerna i blended learning; fysiskt respektive online, kan tillämpas för att skapa förutsättningar för ett framgångsrikt professionellt lärande. Metoden metasyntes har använts för att sätta samman resultat från olika studier i syfte att skapa en samling vetenskapligt grundade råd; en best practice att luta sig på vid framtida planering. Studien är teoretiskt influerad av ett sociokulturellt perspektiv på lärande. Metasyntesen visar att blended learning kan vara en god form att tillämpa. Det är tydligt att de båda undervisningsmiljöerna; fysiskt och online, är viktiga. Vid de fysiska träffarna vårdas och stärks sociala relationer, medan onlinemiljön erbjuder en betydelsefull tids- och rumsmässig flexibilitet. Förutsättningar för ett framgångsrikt professionellt lärande med blended learning är att strukturella resurser som god IT-miljö och avsatt tid för lärandet finns. Metasyntesen är tänkt som ett stöd för skolledare och andra beslutsfattare inför planering av framtida professionellt lärande för grundskollärare.Teachers need professional learning opportunities to improve school results. To have impact for all students, all teachers need to participate. However, there is currently an acknowledged lack of organized professional learning for teachers (Skolverket, 2013). Technology creates new possibilities. Online learning is known to be flexible in terms of time and space, a feature that can help meet the time-related obstacles that school leaders report (Skolinspektionen, 2015). Research, by Means et al. (2009), shows that blended learning, a method where teaching and learning face-to-face is combined with teaching and learning online, has a better effect then exclusively face-to-face or online approaches. This study has explored how the different teaching environments in a blended learning approach; face-to-face and online, can be used to create successful professional learning opportunities. The method used is research synthesis to combine results from different studies in order to create an overarching account of best practice to draw on during future planning. The study is theoretical influenced by a sociocultural view of learning. The research synthesis shows that blended learning can be a promising approach. It is clear that both the teaching environments; face-to-face and online, are important. It shows that social relationships are particularly strengthened by face-to-face meetings, while online solutions offer increased flexibility in terms of time and space. The results also show that necessary conditions for successful blended learning initiatives include structural resources such as good ICT and allocated time for learning. This research synthesis is intended to support school leaders and policymakers in the planning of future teacher professional learning

Personalized Nutrition as a Key Contributor to Improving Radiation Response in Breast Cancer

Understanding metabolic and immune regulation inherent to patient populations is key to improving the radiation response for our patients. To date, radiation therapy regimens are prescribed based on tumor type and stage. Patient populations who are noted to have a poor response to radiation such as those of African American descent, those who have obesity or metabolic syndrome, or senior adult oncology patients, should be considered for concurrent therapies with radiation that will improve response. Here, we explore these populations of breast cancer patients, who frequently display radiation resistance and increased mortality rates, and identify the molecular underpinnings that are, in part, responsible for the radiation response and that result in an immune-suppressive tumor microenvironment. The resulting immune phenotype is discussed to understand how antitumor immunity could be improved. Correcting nutrient deficiencies observed in these populations should be considered as a means to improve the therapeutic index of radiation therapy

Trial Publication after Registration in ClinicalTrials.Gov: A Cross-Sectional Analysis

Joseph Ross and colleagues examine publication rates of clinical trials and find low rates of publication even following registration in Clinicaltrials.gov

Liver trauma: WSES 2020 guidelines

Abstract: Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology. The management of liver trauma should be multidisciplinary including trauma surgeons, interventional radiologists, and emergency and ICU physicians. The aim of this paper is to present the World Society of Emergency Surgery (WSES) liver trauma management guidelines

Understanding the superior clear space in the adult ankle

BACKGROUND: The width of the medial clear space often is used to determine the integrity of the deltoid ligament, the primary medial stabilizer of the ankle joint. The normal clinical relationship of the superior clear space to the medial clear space is not well described. This investigation sought to determine if the superior clear space constitutes an accurate point of comparison for the medial clear space and a means for assessing ligamentous stability in an adult ankle. METHODS: A retrospective review of consecutive ankle radiographs for a 4-month period of time was completed using a university-based radiology database. Using a digitally calibrated ruler, the widths of the medial and superior clear spaces were measured on the mortise view. These values were compared using a Student\u27s t-test. RESULTS: Digital radiographs of 564 consecutive ankles were reviewed retrospectively and 94 cases were without evidence of trauma, surgery, or degenerative disease. The medial and superior clear spaces were measured on the mortise view and found to be 2.7 mm (standard deviation 0.5; range 1.3 mm to 4.3 mm; 95% confidence interval 1.7 mm to 3.8 mm) and 3.6 mm (standard deviation 0.6; 2.0 to 5.3; CI 2.4 mm to 4.7 mm), respectively. The average absolute difference was 0.9 mm (standard deviation 0.5; -0.7 to 1.5; CI -0.1 mm to 1.8 mm) and in 92 of 94 ankles (98%), the superior clear space was greater than or equal to the medial clear space. CONCLUSIONS: Understanding the normal radiographic relationship of the superior and medial clear spaces may help in the diagnosis of ligamentous instability in the ankle and may obviate the need for additional diagnostic tests

Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling

AIM To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. METHODS Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL’s anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft’s outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip stitched, quadrupled and shaped to match the diameter of the prepared femoral tunnel. If the diameter of the patient’s autologous hamstring graft is insufficient to fill the prepared femoral tunnel, the autograft may be supplemented with an allograft. The remainder of the reconstruction is performed according to surgeon preference. RESULTS The presence of retained hardware presents a challenge for surgeons treating patients with knee instability. In cruciate ligament reconstruction, distal femoral and proximal tibial implants hardware may confound tunnel placement, making removal of hardware necessary, unless techniques are adopted to allow for anatomic placement of the graft. CONCLUSION This report demonstrates how the femoral tunnel can be created using the anteromedial portal instead of a transtibial approach for reconstruction of the ACL