Percutaneous renal artery revascularization after prolonged ischemia secondary to blunt trauma: pooled cohort analysis

Purpose:We aimed to identify factors related to technical and clinical success of percutaneous revascularization for blunt renal arterial trauma.Methods:All cases of percutaneous revascularization for blunt renal arterial trauma were searched in the available literature. We included a case of iatrogenic renal artery occlusion at our institution treated by percutaneous stenting 20 hours after injury. A pooled cohort analysis of percutaneous revascularization for blunt renal artery injury was then performed to analyze factors related to technical and clinical success. Clinical failure was defined as development of new hypertension, serum creatinine rise, or significant asymmetry in split renal function.Results:A total of 53 cases have been reported, and 54 cases were analyzed including our case. Median follow-up was 6 months. Technical success was 88.9% and clinical success was 75%. Of 12 treatment failures (25%), 66.7% occurred during the first postprocedure month. Time from injury to revascularization was not a predictor of clinical success (OR=1.00, P = 0.681). Renal artery occlusion was significantly associated with clinical failure (OR=7.50, P = 0.017) and postintervention antiplatelet therapy was significantly associated with treatment success (OR=0.16, P = 0.043). At 37-month follow-up, the stented renal artery in our case remained patent and the patient was normotensive with preserved glomerular filtration rate. Conclusion:Percutaneous revascularization for blunt renal arterial injury resulted in relatively high technical and clinical success. Time-to-revascularization was independent of successful outcomes. Clinical success was significantly associated with a patent renal artery at the time of intervention and with postprocedure antiplatelet therapy

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Gymnast's wrist in a 12-year-old female with MRI correlation

We describe a case of chronic overuse injury of the distal radial physis (gymnast’s wrist). While the radiographic appearance of this entity has been reported, there are limited studies highlighting the MR appearance of this entity. This lesion is being seen with increasing frequency in young, elite gymnasts. If this injury goes unrecognized, there is potential for abnormal osseous development, with premature physeal fusion, abnormal joint inclination and even Madelung deformity. Keywords: Gymnast’s wrist, Physeal injury, MR

The Epidemiology of Mountain Bike Park Injuries at the Whistler Bike Park, British Columbia (BC), Canada

Objective.—To describe the epidemiology of injuries sustained during the 2009 season at Whistler Mountain Bike Park. Methods.—A retrospective chart review was performed of injured bike park cyclists presenting to the Whistler Health Clinic between May 16 and October 12, 2009. Results.—Of 898 cases, 86% were male (median age, 26 years), 68.7% were Canadian, 19.4% required transport by the Whistler Bike Patrol, and 8.4% arrived by emergency medical services. Identification of 1759 specific injury diagnoses was made, including 420 fractures in 382 patients (42.5%). Upper extremity fractures predominated (75.4%), 11.2% had a traumatic brain injury, and 8.5% were transferred to a higher level of care: 7 by helicopter, 62 by ground, and 5 by personal vehicle. Two patients refused transfer. Conclusions.—Mountain bikers incurred many injuries with significant morbidity while riding in the Whistler Mountain Bike Park in 2009. Although exposure information is unavailable, these findings demonstrate serious risks associated with this sport and highlight the need for continued research into appropriate safety equipment and risk avoidance measures.Medicine, Faculty ofNon UBCEmergency Medicine, Department ofReviewedFacultyOthe

Active-MRI of the wrist during active ulnar-radial deviation.

<p>Snapshots of the coronal images of the wrist in the ulnar deviation (a), neutral (b) and radial deviation (c) positions during the continuous radial-ulnar deviation maneuver. SL interval and ulnar variance (see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0084004#pone-0084004-g002" target="_blank">Figure 2</a> for these definitions) were measured from the resulting images.</p

The forearm of a healthy volunteer in the wrist harness.

<p>The harness has been slid outwards for better visualization of both the harness and the MR coil.</p

Quantitative metrics derived from active-MRI images of the wrist during the pronation/supination maneuver.^*

<p>One volunteer unable to complete the pronation/supination motion protocol.</p><p>DRUJ subluxation ratio, as described by <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0084004#pone.0084004-Park1" target="_blank">[20]</a>.</p

Quantitative metrics derived from active-MRI images of the wrist during radial/ulnar deviation.

<p>Quantitative metrics derived from active-MRI images of the wrist during radial/ulnar deviation.</p