Evidence Of Consolidation Research Articles

Surgical management of supracondylar fracture femur by retrograde intramedullary Green Seligson Henry nail: a clinical study

Background: Femoral shaft fractures in young people are frequently due to some type of high-energy collision. The most common cause of femoral fracture is a motor vehicle crash. Treatment for the femoral shaft is at most priority. Hence, the study is aimed to evaluate the results of the retrograde femoral nailing in supracondylar femoral fractures concerning knee flexion, mobilization of patients, and early weight-bearing. Methods: The study is conducted from October 2019 to October 2021 with 25 patients having supracondylar fractures of the femur. The age group of patients was 15-70 years. Patients with midshaft femur fractures, nonunion, malunion, and pathological fractures were excluded. Chest X-ray post anterior view electrocardiography was performed in patients. Operative procedure was followed and postoperative management was done for all the patients. Radiological evidence of callus and consolidation was analyzed. Neer’s rating system and Sander’s functional evaluation scale were used to find the points for pain, working and walking capacity, range of motion and radiological appearance, etc. Results: In the study, 25 patients are admitted with supracondylar fractures of the femur. The closed or open reduction method and the retrograde intramedullary supracondylar Green Seligson Henry (GSH) nail were used for internal fixation. The patients were followed for a period of 3 to 24 months. The results of Neers and Sander’s evaluation scoring system determined good to excellent results in 65% of cases. Conclusion: To conclude from the study results, it was noted that retrograde intramedullary supracondylar nail is an ideal fixation system for distal third femoral fractures, especially the extraarticular type.

Morphological prediction of lethal outcomes in the evaluation of lung tissue structural changes in patients on respiratory support with СOVID-19: Ukrainian experience.

The impact of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on lung tissue in patients on respiratory support is of significant scientific interest in predicting mortality. This study aimed to analyze post-mortem histological changes in the lung tissue of COVID-19 patients on respiratory support using vital radiology semiotics. A total of 41 autopsies were performed on patients who died of SARS-CoV-2 and had confirmed COVID-19 by polymerase chain reaction (PCR) and radiological evidence of lung tissue consolidation and ground glass opacity. The results showed that the duration of COVID-19 in patients on respiratory support was significantly associated with the development of all stages of diffuse alveolar damage, acute fibrous organizing pneumonia, pulmonary capillary congestion, fibrin thrombi, perivascular inflammation, alveolar hemorrhage, proliferating interstitial fibroblasts, and pulmonary embolism. The prediction model for lethal outcomes based on the duration of total respiratory support had a sensitivity of 68.3% and a specificity of 87.5%. In conclusion, for COVID-19 patients on long-term respiratory support with radiological signs of ground glass opacity and lung consolidation, post-mortem morphological features included various stages of diffuse alveolar lung damage, pulmonary capillary congestion, fibrin clots, and perivascular inflammation.

Occupation Choice in the Rural Labor Market from the Córdoba Department in Colombia

This article aims to establish if the rural labor market of the Department of Córdoba holds structural problems that encourage members of the rural labor force to search for other work alternatives in the urban area, by identifying factors related to supply conditions, such as human capital, age, home location area [dominion], gender, and others that affect the choice of the kind of work. A multinomial Logit econometric model was estimated to achieve this purpose, using statistical information from the Great Integrated Household Survey (GIHS) carried out by DANE from the third quarter of 2019, whereby the employment choice of men and women in rural and urban areas was analyzed among four categories, i.e. low manual (1), high manual (2), low non-manual (3), and high non-manual (4). Results reveal that the estimated model shows a good fit and that the education, gender, and domain variables are statistically significant with confidence levels greater than 95%. Similarly, figures of the marginal effects, which reveal changes in probabilities of choosing one job or another, may be evidence of the little consolidation that the rural labor market has to motivate its inhabitants to choose countryside activities, allowing to conclude that the migration phenomenon from the countryside to the city is largely explained by the search for better jobs, thus revealing the structural problems of the rural labor market in the Cordoba Department.

THE DECAF SCORE: PREDICTING HOSPITAL MORTALITY IN EXACERBATIONS OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Backgrounds Chronic Obstructive Pulmonary Disease (COPD) represents a major public health challenge and is an important cause of chronic morbidity and mortality worldwide. This study aims to assess the association between Dyspnoea, Eosinopenia, Consolidation, Academia, and Atrial Fibrillation (DECAF) scores and the prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in terms of mortality and length of hospital stay and to explore the effectiveness of different cut-off values in risk stratication of patients with AECOPD. This cross-sectional study was conducted in the hospitals attached to Bangalore me Methods dical college and research Institute. 65 patients with acute exacerbation of COPD who satised the inclusion criteria were included. Data was collected in the form of history, clinical examination, and relevant investigations. Statistical analysis was performed using SPSS software, p value of <0.5 being signicant. Out Results: of 65 patients, 76% were males and 24% were females and majority of the patients (32%) were aged 62 to 71 years. Mean FEV1 was 62.18% predicted, Mean duration of hospital stay 4.26 days, mean BMI was 24.6 kg/m2. 83% had radiographic evidence of consolidation. Chi-square test showed statistically signicant association between DECAF score and in-hospital mortality(p=0.00). Out of the 65 patients,7 patients had DECAF score of 1 ,22 patients had DECAF score of 2, 26 patients had DECAF score of 3, 7 patients had DECAF score of 4 and 3 patients had DECAF score of 5. 72.4% (47)- discharged 27.6% (18) in-hospital mortality. Chi-square test showed statistically signicant association between DECAF score and length of hospital stay (p=0. 005). Hypertension (12.2%) and Type 2 DM (5.8%) were the most common comorbidities. There Conclusions: was signicant correlation between DECAF score and prognosis of COPD patients in terms of in hospital mortality and duration of hospital stay. Hence, our study shows that higher DECAF score at admission indicates higher severity of the disease. It helps clinicians to triage place and level of care to improve outcomes in this common condition

Functional Outcome of Distal Humerus Fractures Treated With Open Reduction and Internal Fixation With Bicolumnar Plating in a Tertiary Care Setting.

Introduction Fractures of the distal humerus in the adult comprise approximately one-third of all humeral fractures. Over the past 20 years, nonoperative treatment for these fractures has been substituted by anatomic reduction and internal fixation based on the Association for Osteosynthesis (AO)/Association for the Study of Internal Fixation (ASIF) philosophy of plate fixation which resulted in early mobilization and superior performance. Pre-contoured, anatomically designed locking plates are anticipated to offer sufficient stability, permit early elbow range of motion, and safeguard the soft tissue.In comparison to any other joint, the elbow's good anatomical alignment, perfect stability, and early mobilization principles are of utmost significance. Methodology A hospital-based consecutive case series of distal humerus fracture patients managed surgically with bicolumnar plating at R.L. Jalappa Hospital Centre, from June 2021 to June 2022 was chosen. Patients were clinically assessed by measuring the range of motion of the elbow with a goniometer. A six-week post-operative review was the first one. Routine checkups were scheduled every four weeks up until there was evidence of fracture consolidation radiologically. Clinically Mayo Elbow Performance score (MEPS) was analyzed at the end of six-month follow-up and tabulated. Institutional Ethical committee permission was taken prior to the study. Results In the study, 47% of cases had an Excellent MEPSfollowed by 33% of patients having a good MEPS and 13% having a Fair MEPS rating. Only 7% of patients had poor MEPS. Among the patients, 33.3% had 90 MEPS followed by 16.6% cases had 85 MEPS. Only 2 patients had55 MEPSin the study. The fracture pattern configuration based on AO classification in our study was C2>C1>C3>A2.3=A3.3. Conclusion Due to an increase in road traffic accidents, complicated distal humeral fractures are becoming more common among younger people. In terms of stability and arc of motion, excellent to good functional outcomes were attained in around 80% of the study group.Because of the extremely stable build system produced by parallel plating, there have been no reported instances of implant failure or non-union.

Spinal Instrumentation in the Setting of Nontuberculous Spondylodiscitis: A Prospective Analysis

Study Design: This was a prospective cohort study. Purpose: The purpose of this study was to evaluate the efficacy of surgical treatment in nontuberculous spondylodiscitis and its effects on the functional and radiological outcomes and define a treatment algorithm. Overview of Literature: Most of the available literature on surgical management of nontuberculous spondylodiscitis is retrospective in nature. A prospective study analyzing functional (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS]) and radiological outcomes of surgical intervention is scanty in the literature. Materials and Methods: A prospective analysis of 22 patients was performed who underwent surgical intervention for biopsy-proven nontuberculous spondylodiscitis. Preoperative ODI and VAS scores were compared with that at 1-year postoperative follow-up. Microbiological details of each patient were noted. Radiological evidence of healing was reported at the final 1-year follow-up. Results: Of 22 patients, 12 were male and the remaining were female, with a ratio of 1.2:1. The average age was 58 years. The most common region of involvement was lumbosacral followed by dorsal and cervical. All the patients underwent single-stage surgery. Microbiological studies showed growth in only 16 patients (72.7%). Staphylococcus aureus was the most common organism isolated. The mean VAS score before surgery was 8.9 which improved to 2.05 at 1-year follow-up. Similarly, the mean ODI score improved from 86.64% to 20.65% at 1-year follow-up with significant P < 0.01. Two patients needed revision for implant loosening. At the final follow-up, all patients had radiological evidence of bony consolidation. Conclusions: The study highlights improved outcomes with surgical intervention combined with appropriate antibiotics. With minimal complication rates, increased stability achieved following surgery alludes to good pain control and hence early mobilization. However, there is a grave concern about culture-negative spondylodiscitis which can lead to poor outcomes. Hence there is a need for further multicentre studies to strategize management of these cases.

Електоральна активність як індикатор суспільної консолідації

The article is devoted to the analysis of the level of electoral activity of Ukrainian citizens in the national elections during the years of independence. A statistical analysis of voter participation in presidential, parliamentary elections, local self-government elections, and nationwide referenda held over the past decades has shown significant differences in the indicators of electoral activity. The dependence of the level of indicators of this activity on the urgency of the socio-political situation at the time of the elections was revealed. It is shown that the key factors in increasing the level of electoral activity are voters’ awareness of challenges and threats to the processes of state formation, as well as the desire to influence the vectors of the country’s civilizational development, the choice of ways and forms of state policy implementation.The thesis about the determinism of the level of electoral activity during the national elections by the public demand for the correction of the domestic and foreign political directions of further development is substantiated. It is shown that the low level of electoral activity during local self-government elections is an evidence of awareness of the priority of reforming power relations at the central level and a demonstration of the dependence of local authorities on them. The need to strengthen the decentralization reform, as well as the development of potentially effective forms of direct democracy – nationwide and local referendums as effective tools for studying and taking into account public opinion, fulfilling the needs and interests of citizens, is emphasized. Mobilization is defined as a key aspect of citizens’ electoral activity – as a form of public reaction to the aggravation of political situation in the country. It is shown that the level of electoral activity largely depends on motivational and meaningful prerequisites – a set of motives, values, beliefs, attitudes, interests and other factors that influence the electoral behavior of citizens.A significant increase in the level of electoral activity against the background of threats to democratic development and state-building processes indicates the rooting of democratic values in the mass consciousness, the attitude to the realization of not only personal or group, but also socially significant interests. It is argued that the level of social consolidation increases in the conditions of challenges to the democratic progress of the country, the emergence of threats to its independence or the strengthening of foreign political influences. It has been proven that precisely in such key periods of state formation, electoral activity becomes an evidence of social consolidation, a peculiar indicator of it.

Two Birds, One Stone: Awake Extracorporeal Life Support.

Case A 55 year old female, no previous medical history, underwent out-of-hospital cardiac arrest. Advanced cardiac life support (ACLS) was initiated, with return of spontaneous circulation after 30’ of conventional resuscitation efforts. At first hospital arrival coronary angiography and successful percutaneous transluminal angioplasty were performed to treat right coronary artery stenosis. Incidentally, lung computed tomography (CT) revealed signs of aspiration pneumonia (Figure 1). Moreover, as a result of improper out-of-hospital endotracheal tube (ETT) positioning (ID 7.5/OD 10.7 mm) during ACLS, the patient suffered iatrogenic airway injury, as confirmed by bronchoscopy (12 x 19 mm respectively sagittal and longitudinal axis, Figures 1 and 2).Figure 1.: Tracheal injury (white arrow) and aspiration pneumonia at CT scan performed at hospital admission: distal end of the endotracheal tube in the main right bronchus (white arrow); retrocarinal pneumomediastinum (black arrow); evidence of basal consolidation in the left lung. CT, computed tomography.Figure 2.: Evolution of tracheal injury (white arrows) at fiberoptic bronchoscopy. A: day 1 large tear in the pars membranacea (posterior wall) of the trachea, extended to the emergence of the main right bronchus (white arrow), with hyperemic peripheral area; (B) day 7: partial re-epithelialization of the posterior wall, and decreased mucosal hyperemia; (C) day 24 evidence of resolution of the injury, with a residual linear scar. ECMO, extracorporeal membrane oxygenation; LMB, left main bronchus; RMB, right main bronchus.Pneumonia worsened rapidly to acute respiratory distress syndrome (ARDS) over subsequent days, and the presence of tracheal injury complicated mechanical ventilation management, so femoro-femoral veno-venous extracorporeal membrane oxygenation (V-V ECMO) was initiated in referring hospital (details in online supplement, Supplemental Digital Content 1, https://links.lww.com/ASAIO/A876). After cannulation the patient was transferred to referral center. For the first 2 days deep sedation and neuromuscular blockade were deemed necessary to provide lung protective ventilation (settings detailed in online supplement, Supplemental Digital Content 1, https://links.lww.com/ASAIO/A876). Due to the location of the distal end of the ETT cuff tube, the intracuff pressure was strictly monitored and maintained at 20 mm Hg. On minimal ECMO support gas exchange rapidly improved. To improve tracheal tear healing the patient was extubated on third day of ECMO, and high flow nasal oxygen (HFNO) initiated. After 8 days successful weaning trial was attempted, and decannulation performed. Follow up CTs demonstrated progressive resolution of lung disease and airway injury, with reabsorption of pneumodediastinum. Since ECMO weaning the patient remained eupneic; she was discharged home with almost complete lung recovery and intact tracheal wall (evolution of injury and clinical course are depicted in supplementary figures 1 and 2, Supplemental Digital Content 1, https://links.lww.com/ASAIO/A876). Full neurologic recovery was achieved, with no signs of physical impairment.

Triple osteotomy for patients with Legg-Calve-Perthes disease

OperationszielDurch die Osteotomie des Ischium‑, Pubis- und Iliumknochens kann das Acetabulum über den Hüftkopf geschwenkt werden, sodass der meist anterolateral vorstehende Anteil des Hüftkopfes wieder überdacht wird. Das Ziel ist der Erhalt des Containments der Hüfte, hiermit ist die Wiederherstellung der Kongruenz zwischen dem lateralisierten Hüftkopf und dem Acetabulum gemeint. Das Acetabulum wirkt so als eine Art Schablone für den Hüftkopf, um eine möglichst sphärische Ausheilung des Hüftkopfes zu erreichen.IndikationenSchwere Morbus-Perthes-Erkrankung mit radiologisch sichtbarer Lateralisation des Hüftkopfes und Head-at-risk-Zeichen. Voraussetzung ist, dass der Hüftkopf sich konzentrisch reponieren lässt (Abduktionsaufnahme oder Arthrographie).Kontraindikationen„Hinged abduction“. Keine konzentrische Reposition des Hüftkopfes möglich.OperationstechnikArthrographie des Hüftgelenkes zur Bestätigung der Operationsindikation. Darstellung und Osteotomie des Ischiums über einen modifizierten Ludloff-Zugang, Osteotomie des Iliums und Pubis über einen modifizierten Smith-Petersen-Zugang. Verbesserung der Hüftkopfüberdachung durch Schwenken des Acetabulums über den Hüftkopf. Fixation des azetabulären Fragmentes mit Vollgewinde-Kirschner-Drähten oder 3,5-mm-Kortikalisschrauben.WeiterbehandlungMobilisation an Gehstöcken (kleine Kinder im Rollstuhl). Abstellen des Fußes erlaubt. Teilbelastung für 4 bis 6 Wochen (je nach Alter des Patienten). Danach bei im Röntgen guten Konsolidationszeichen Belastungsaufbau innerhalb 1 bis 2 Wochen.ErgebnisseSehr gute Ergebnisse hinsichtlich Operationstechnik und Ausheilung in der eigenen Klinik. In einer eigenen noch nicht veröffentlichten Studie mit einem durchschnittlichen Untersuchungszeitraum von 5 Jahren zeigten sich bei 30 Patienten sehr gute klinische und radiologische Ergebnisse nach Tripleosteotomie bei Morbus Perthes.

Retrospective review of Osteoradionecrosis cases treated with virtual surgical planning following review of received irradiation dose to the mandible

Osteoradionecrosis of the mandible represents a cohort of patients that are notoriously difficult to treat. Complications are commonplace following free tissue transfer reconstructive surgery, including non-osseous union at the osteotomy site.We retrospectively reviewed a cohort of patients that were treated with fibula free tissue transfer reconstruction utilising virtual surgical planning. It was possible to deform previously delivered radiation dosimetry data onto the virtual mandible and superimpose the osteotomy site. This enabled the delivered radiation dose at the osteotomy site to be determined, plus the volume of mandible remaining that had received above 50Gy of irradiation.Two out of the four patients with appropriate follow up demonstrated evidence of bony consolidation at the osteotomy site between the native mandible and the composite fibula reconstruction. On retrospective review of the dosimetry mapping, one patient's resection margins were performed in areas of the mandible with a received irradiation dose of less than 50Gy. The second patient had a received dose of just over 50Gy at the resection margin, with only 0.1 cm [3] of affected mandible remaining at the osteotomy site.Two patients demonstrated a non-osseous union at a resection margin through an area of the mandible that received an irradiation dose way in excess of 50Gy, with one patient demonstrating a high volume of retained mandible receiving a radiation dose in excess of 50Gy.In this known cohort of difficult to manage patients, any technique that aids in the reduction of complications is a welcome addition.

Measuring the American farm size distribution

AbstractThis paper develops a measure of farm size as a share‐weighted sum of farm sizes, called the Share Weighted Size Index (SWSI), which introduces new evidence of farm consolidation from 1959 to 2017. Our Share Weighted Size Index provides more reasonable estimates of the entire farm size distribution than simple averages and is useful for comparing farm size across crops at one point in time or for comparing farm sizes for a given crop over time. Although previous measures have relied on confidential or hard‐to‐access farm‐level records, the Share Weighted Size Index is derived exclusively from publicly available Census of Agriculture data. Unlike average farm size, the Share Weighted Size Index reveals consistent evidence of rising farm size, the importance of returns to scale for most commodities, and the rising importance of specialization on a small number of crops within farms. Contrary to past studies that argued rising off‐farm wages increase farm size, we find evidence that proximity to off‐farm opportunities results in smaller farms.

Learning from the Physical Consequences of Our Actions Improves Motor Memory.

Actions have consequences. Motor learning involves correcting actions that lead to movement errors and remembering these actions for future behavior. In most laboratory situations, movement errors have no physical consequences and simply indicate the progress of learning. Here, we asked how experiencing a physical consequence when making a movement error affects motor learning. Two groups of participants adapted to a new, prism-induced mapping between visual input and motor output while performing a precision walking task. Importantly, one group experienced an unexpected slip perturbation when making foot-placement errors during adaptation. Because of our innate drive for safety, and the fact that balance is fundamental to movement, we hypothesized that this experience would enhance motor memory. Learning generalized to different walking tasks to a greater extent in the group who experienced the adverse physical consequence. This group also showed faster relearning one week later despite exposure to a competing mapping during initial learning, evidence of greater memory consolidation. The group differences in generalization and consolidation occurred although they both experienced similar magnitude foot-placement errors and adapted at similar rates. Our results suggest the brain considers the potential physical consequences of movement error when learning and that balance-threatening consequences serve to enhance this process.

P29 A retrospective multi-centre review of antimicrobial usage in patients diagnosed with aspiration pneumonia

BackgroundOver-diagnosis of infective aspiration pneumonia is common in healthcare settings and represents a potential for misuse of antimicrobial therapy.MethodsA retrospective analysis was undertaken of all hospitalized patients treated for aspiration pneumonia within a multicentre Acute NHS Trust (April–May 2021, London, UK). Data collected included: age, initial antibiotics prescribed, duration of therapy, relevant microbiology (sputum samples or blood cultures) and chest X-ray. Treatment response was analysed including body temperature after 24 h of antimicrobials, use of oxygen support after 48 h, any escalation of antimicrobial therapy and 30 day in-hospital mortality. The study was registered as service evaluation project.ResultsIn total, 94 patients treated for aspiration pneumonia were included; median age 82 years (IQR 67–89). Co-amoxiclav monotherapy was the most frequently prescribed treatment (67/94); cephalosporins (8/94) and ciprofloxacin (4/94) were also commonly used. Duration (median) of treatment was 4.4 days (IQR 1–6.7); 32/94 patients received <48 h. Radiological evidence of consolidation, O2 support at 48 h and fever at 24 h was present in 32/94, 25/94 and 12/94 patients, respectively. A microbiological diagnosis to confirm infection was present in 12/94. Consolidation [OR 2.36 (95% CI 1.04–10.25); P = 0.037] and O2 support at 48 h [OR 3.22 (95% CI 1.02–10.25); P = 0.044], but not fever at 24 h [OR 0.94 (95% CI 0.18–4.80)], were associated with treatment escalation. No association between O2 support/fever and total duration was evident. The 30 day in-hospital mortality was 17% (16/94).ConclusionsAspiration pneumonia has high in-hospital mortality and often necessitates antibacterial treatment. The true incidence of bacterial pneumonia is unclear, and many patients may benefit from early cessation of antibacterial treatment.

Simultaneous Closure of the Cleft Alveolus and Hard Palate with Concomitant Bone Grafting

Summary:Cleft repair has been in constant evolution since its inception. Conventional repair of the cleft hard palate involves closure of nasal and oral mucosa without bony reconstitution. In many instances, this approach is adequate, but, particularly in complete clefts, the lack of bony support can lead to collapse of the maxillary arch, dental crowding, and posterior cross-bite. To address these shortcomings, our institution performs a two-staged palatoplasty with concomitant bone grafting of the alveolus and hard palate in the second stage. A retrospective review of children who underwent a two-staged palatoplasty at our institution was performed. These patients’ records and images were reviewed for complications and changes in maxillary morphology. Fourteen patients with complete clefts had a two-staged palatoplasty with bone grafting in the second stage. The mean age at surgery was 37.5 months, and the mean follow-up was 16 months. One patient had resorption of the alveolar bone graft requiring additional bone grafting. The remaining patients were without complications and had good consolidation of the bone graft on follow-up imaging. Our early results support that there is a low complication rate (7% regrafting) in those patients who underwent bone grafting at the time of cleft palate repair with early evidence of bony consolidation on imaging and clinical examination. Wide exposure during the repair allows complete grafting of the maxillary bony deficit, which is not possible with traditional alveolar cleft repair and may alleviate the shortcoming of soft-tissue closure only. Future study is necessary to determine long-term outcomes.

Исихазм в культуре Московской Руси XIV–XV вв.

The “hesychast disputes” that unfolded in Byzantium and influenced other Orthodox countries came to be the critical event of the 14th century for the Christian world. The doctrine of synergy, the theory of the “deification” (“theosis”) of a person and the metaphysics of light, developed by the hesychast Gregory Palamas, were creatively reworked in the consciousness of Muscovite Rus’ in the 14th–15th centuries. As a result, the original Old Russian Hesychasm emerged, transforming the doctrine of synergy into the veneration of the Holy Trinity. For the young Orthodox state, which was in the process of establishing its statehood, the Holy Trinity became the personification of national unity and breaking dependence on the conquerors. The doctrine of St. Sergius of Radonezh about the Trinity, the Trinity concept of Epiphanius the Wise, the growing popularity of the Trinity theme in icon painting, the special celebration of the Trinity Day, the construction of Trinity temples act as evidence of the strong consolidation of the cult of the Holy Trinity in Moscow culture. Another important theme for the Old Russian culture of the 14th–15th centuries was the concept of “deification” of a person as the highest form of his creativity. It found its theoretical form in the teachings of Gregory Palamas, while its visible expression became the iconography of Andrei Rublev and Dionysius. Old Russian icon painters were able to convey the moral ideal of hesychasm — the ideal of the transformed man who achieves a new ontological status of existence through deification. The doctrine of deification was intimately connected with the hesychast metaphysics of Tabor light, reflected in the Old Russian aesthetics of light and color.

Granulomatous Polyangiitis With Renal Involvement: A Case Report and Review of Literature

Granulomatosis with polyangiitis (GPA), formerly named Wegner’s granulomatosis is an antineutrophilic cytoplasmic antibody (ANCA) associated vasculitis of the small vessels. GPA can affect several organ systems even though predominantly affects respiratory and renal systems. Pathogenesis is initiated by activation of the immune system to produce ANCA, Cytoplasmic (C-ANCA) antibody, which thereby leads to widespread necrosis and granulomatous inflammation. Multisystem involvement with varied symptomatology makes GPA diagnosis more challenging. Early diagnosis and management are vital and can alter the prognosis of the disease. We present a literature review and a clinical scenario of a 26-year-old male with a history of chronic sinusitis, testicular carcinoma in remission, recent onset of worsening cough, epistaxis, hoarseness of voice, weight loss, and dark-colored urine. Workup revealed high titers of C-ANCA, C-reactive protein, procalcitonin, CT chest evidence of mass-like consolidation, and bronchoscopy findings of friable tissue that was not amenable for biopsy. Methylprednisolone and rituximab (RTX) were administered, which resulted in marked clinical improvement. Therefore, a keen eye for details is necessary to diagnose GPA early, which can improve disease outcomes dramatically.

Minimally Invasive Tibiotalocalcaneal Arthrodesis with Blocked Retrograde Intramedullary Nail - Report of Three Cases.

Ankle osteoarthritis (AOA) is associated with pain and variable functional limitation, demanding clinical treatment and possible surgical indication when conservative measures are ineffective - arthrodesis has been the procedure of choice, because it reduces pain, restores joint alignment and makes the segment stable, preserving gait. The present study reports 3 cases (3 ankles) of male patients between 49 and 63 years old, with secondary AOA, preoperative American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS AHS) of 27 to 39 points, treated by minimally invasive tibiotalocalcaneal arthrodesis using blocked retrograde intramedullary nail. Hospital stay was of 1 day, and the patients were authorized for immediate loading with removable ambulation orthotics, as tolerated. The physical therapy treatment, introduced since hospitalization, was maintained, prioritizing gait training, strength gain, and proprioception. Clinical and radiographic follow-up was performed at weeks 1, 2, 6, 12 and 24. After evidence of consolidation (between the 6 th and 10 th weeks), the orthotics were removed. One patient complained of pain in the immediate postoperative period and, at the end of the 1 st year, only one patient presented pain during rehabilitation, which was completely resolved with analgesics. Currently, the patients do not present complaints, returning to activities without restrictions - one of them, to the practice of soccer and rappelling. The postoperative AOFAS AHS was from 68 to 86 points.

Real-time fiscal policy responses in the OECD from 1997 to 2018: Procyclical but sustainable?

This paper presents empirical evidence of asymmetric fiscal policy along the business cycle, using a real-time panel dataset on 19 OECD countries from 1997 to 2018. We estimate various specifications of fiscal policy reactions, in which ex ante fiscal policy has two major objectives: macroeconomic stabilization and fiscal consolidation. First, we find evidence in favour of asymmetric fiscal policy along the business cycle, in particular regarding the response to output gap. Second, fiscal policy appears to be procyclical in downturns and a-cyclical in upturns. Third, we find evidence that fiscal policy is sustainable but we do not find evidence of stronger fiscal consolidation in downturns. Our results are robust to alternative estimators, to an alternative measure of business cycle and to country exclusion. In particular, the procyclical bias of fiscal policy during downturns seems largely driven by the years following the Global Financial Crisis.

Quantitative Analysis of Practice Size Consolidation in Radiation Oncology: A Trend Toward Bigger and Fewer Practices

PurposeThere is evidence of practice consolidation in US health care in recent years. To our knowledge, a detailed quantitative study of recent changes in radiation oncology practice size has not been performed. We aim to evaluate radiation oncology practice size changes between 2012 and 2020 in the United States. Materials and MethodsUsing the Medicare Physician Compare Database, we identified practices employing radiation oncologists using their taxpayer identification number and individual radiation oncologists using their national provider identifier. We grouped individual radiation oncologists into categories by practice size (which includes the number of physicians of all specialties) and compared the number of radiation oncologists in each category between 2012 and 2020. Further analyses by US geographic census region, single-specialty practice, academic practice, and high- and low-population density areas were performed. ResultsBetween 2012 and 2020, the total number of practicing radiation oncologists increased by 9%, and the number of practices employing radiation oncologists decreased by 11.5%. The number of radiation oncologists in practices of size 1 to 2, 3 to 9, 10 to 24, and 25 to 49 decreased by 3.7%, 4.7%, 4.9%, and 2%, respectively, and the number of radiation oncologists in practices of size 50 to 99, 100 to 499, and 500+ increased by 1.4%, 2.1%, and 11.8%, respectively (all 500+ practices are multispecialty groups). The increase in practice size was significant in all regions, for single-specialty and multispecialty practices, academic and nonacademic practices, and for practices in high-, middle-, and low-population density areas (P < .05 for all comparisons). The proportion of single-specialty practices has decreased significantly (P < .001), and the proportion of academic practices increased significantly (P = .004). Additionally, the proportion of practices and physicians in high- and low-population density regions remained stable during this period (P > .05). ConclusionsOur analysis suggests that practice size consolidation has occurred within the US radiation oncology workforce from 2012 to 2020. The impact of this consolidation on quality, cost, and patient access deserves further attention.

Making sense of firms for ocean governance

Making sense of firms for ocean governance