Iatrogenic Peroneal Nerve Palsy Rates Secondary to Open Reduction Internal Fixation for Tibial Plateau Fractures Using an Intraoperative Distractor

Objective: To report the rate of peroneal nerve palsy after routine use of intraoperative distraction during open reduction internal fixation (ORIF) for lateral unicondylar and bicondylar tibial plateau fracture (TPF) repairs. Design: Retrospective chart review Setting: Level I trauma center Patients: Patients with traumatic TPF treated with ORIF between 2007 and 2017 Intervention: ORIF for lateral unicondylar and bicondylar TPF. Main Outcome Measurement: Presence and resolution of neurovascular injury Results: There were a total of 21 lateral unicondylar and 40 bicondylar TPFs repaired via ORIF in 60 patients identified during the study period with one year follow up and complete records for review. Thirty-six patients had staged external fixation prior to ORIF while 24 were treated with ORIF initially. Of the staged patients, 9 of 36 (25%) developed nerve palsy while those undergoing initial ORIF (not staged) developed palsy in only one case (1 of 24, or 4%). Of the patients who developed nerve palsy 9 of 10 (90%) were staged with an initial external fixator prior to ORIF. The incidence of iatrogenic peroneal nerve palsy secondary to intraoperative distraction was 16.4% (10 of 61). Only 60% (6 of 10) of peroneal nerve palsies recovered clinically with a mean recovery time of approximately 14 weeks. Comparison of demographics in patients with peroneal nerve palsy versus those without yielded no significant difference by sex (p = 0.08), age (p =0.27), fracture type (p = 0.29), tobacco use (p = 0.44) or alcohol use (p = 0.78). Conclusions: Peroneal nerve palsy is a common sequela of ORIF for TPFs involving the lateral compartment utilizing an intraoperative distractor. Staged external fixation followed by definitive ORIF using intra-operative distraction, was associated with significant risk for developing nerve palsy (9/10). Many patients (40%) who develop peroneal nerve palsies do not recover, leading to permanent loss of motor and/or sensory function for 7% of patients studied. None of the epidemiologic variables evaluated yielded predictive value for development of peroneal nerve palsy or subsequent resolution. Caution should be exercised in avoiding over distraction when using intraoperative distraction, especially in those cases that had staged fixation, most notably bicondylar injuries

Determination of ifosfamide by gas chromatography-mass spectrometry

Ifosfamide, an oxazaphosphorine, is thermally stable during elution in gas chromatography (GC) at temperatures above 200 °C, in contrast to its structural isomer cyclophosphamide. Both 2.65-µm and 0.32-µm OV-1 columns were efficient for GC of ifosfamide without derivatization. Mass spectrometry (MS), showed that intact ifosfamide was eluted without interference from naturally occurring metabolites in blood plasma. Ifosfamide can be monitored, by capillary GC—MS without derivatization, in blood plasma from cancer patients treated with the drug. Only a liquid-liquid extraction is required before injection of the sample. A single peak of ifosfamide is detected with molecular mass 260; fragmentation starts with loss of CH2Cl ([M — CH2Cl], m/z 211). The limit of determination for ifosfamide in human plasma was about 50 nM (10 ng ml-1). Recovery, quality of calibration curves and reproducibility were suitable for the rapid determination of ifosfamide in the range 0.01–1000 µg ml-1

Prevalence of Femoroacetabular Impingement “at-risk” Radiographic Parameters in Young Asymptomatic Chinese and Caucasian Subjects

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Melting and refreezing beneath Roi Baudouin Ice Shelf (East Antarctica) inferred from radar, GPS, and ice core data

Ice-penetrating radar profiles across the grounding line of a small ice-rise promontory located within the Roi Baudouin Ice Shelf in the Dronning Maud Land sector of East Antarctica show downward dipping englacial radar-detected reflectors. Model results indicate that this reflector pattern is best fit by including basal melting of at least 15 cm a-1. This rate of melting is low compared with rates observed on larger ice shelves in both West and East Antarctica. Ice cores extracted from a rift system close to the ice-rise promontory show several meters of marine ice accreted beneath the shelf. These observations of low rates of basal melting, and limited distribution of accreted marine ice suggest that either Antarctic surface water may reach the ice shelf base or that circulation beneath the shelf is likely dominated by the production of high salinity shelf water rather than the incursion of circumpolar deep water, implying a weak sub-shelf circulation system here. Many of the ice shelves located along the coast of Dronning Maud Land are, like Roi Baudouin Ice Shelf, characterized by frequent ice rises and promontories. Therefore, it is highly likely that these are also of shallow bathymetry and are subject to similarly weak side-shelf basal melting and refreezing

Mangroves facing climate change: landward migration potential in response to projected scenarios of sea level rise

Mangrove forests prominently occupy an intertidal boundary position where the effects of sea level rise will be fast and well visible. This study in East Africa (Gazi Bay, Kenya) addresses the question of whether mangroves can be resilient to a rise in sea level by focusing on their potential to migrate towards landward areas. The combinatory analysis between remote sensing, DGPS-based ground truth and digital terrain models (DTM) unveils how real vegetation assemblages can shift under different projected (minimum (+9 cm), relative (+20 cm), average (+48 cm) and maximum (+88 cm)) scenarios of sea level rise (SLR). Under SLR scenarios up to 48 cm by the year 2100, the landward extension remarkably implies an area increase for each of the dominant mangrove assemblages except for Avicennia marina and Ceriops tagal, both on the landward side. On the one hand, the increase in most species in the first three scenarios, including the socio-economically most important species in this area, Rhizophora mucronata and C. tagal on the seaward side, strongly depends on the colonisation rate of these species. On the other hand, a SLR scenario of +88 cm by the year 2100 indicates that the area flooded only by equinoctial tides strongly decreases due to the topographical settings at the edge of the inhabited area. Consequently, the landward Avicennia-dominated assemblages will further decrease as a formation if they fail to adapt to a more frequent inundation. The topography is site-specific; however non-invadable areas can be typical for many mangrove settings

Out FOXing Parkinson Disease: Where Development Meets Neurodegeneration

The central survival role of FOX proteins may allow a unified view of the genetic and environmental factors that cause Parkinson disease