Lateral Type Research Articles

Postmobilization Plain Radiography After Lateral Compression Type 1 Pelvic Ring Injury Does Not Affect Treatment.

The purpose of this study was to describe the practice of postmobilization radiography after lateral compression type 1 pelvis ring injury. We hypothesized that postmobilization radiographs would be more frequent over time and would not influence treatment. Displacement of pelvis ring injury on initial and final plain radiographs was measured. Frequency of postmobilization radiography was determined, and the impact on treatment and final radiographical outcome were assessed. Of the 156 patients reviewed, 98 (62.8%) were women and mean age was 60.1 years. Thirty-three of 156 patients (21.2%) had a postmobilization radiograph. Over 5 years, radiographs increased to 67% of presenting patients. None of the patients who received postmobilization plain radiographs (n = 33) had any change in clinical plan afterward; all continued with nonsurgical care. Initial fracture characteristics and alignment were no different for patients with postmobilization radiographs. Final alignment was unchanged in nearly 70%. Overall, 74% of all nonsurgical patients experienced no change in alignment, with similar rates among the patients with postmobilization radiographs. Patients with an lateral compression type 1 fracture demonstrated no changes in care after receiving postmobilization radiographs. However, the frequency of postmobilization radiographs increased over time, denoting opportunities to reduce costs and to improve efficiency and safety.

A Feasibility Study on the Lateral Behavior of a 3D-Printed Column for Application in a Wind Turbine Tower

Although 3D printing technology has been applied worldwide, the problem of connecting a printed structure and a foundation has rarely been examined. In particular, loads in the horizontal direction, such as wind loads and earthquake loads, can significantly affect the stability of a printed structure. Therefore, in this study, the effect of lateral loads on printed columns that were connected to a foundation by two types of connectors was investigated. A steel angle with bolts and couplers was used to connect the printed column to a concrete footing. In addition, two types of lateral reinforcement were applied to the printed column to enhance its bonding strength and shear resistance. The lateral reinforcements were attached to the interface of the printed layers at distances of 100 and 200 mm to investigate the effect of lateral reinforcement distance on the lateral behavior of the printed column. The results showed that the use of couplers as connections between the columns and foundation significantly improved the load capacity. Furthermore, the effects of the lateral reinforcement types and lateral reinforcement distances were assessed.

Morphological analysis of three-dimensional MR images of patellofemoral joints in asymptomatic subjects

The existing methods for analyzing patellofemoral (PF) osteoarthritis (OA) are limited. Our purpose was to clarify the frequency, localization, and morphological progression of PFOA by observing three-dimensional (3D) magnetic resonance (MR) images from a cohort population. The subjects were 561 patients aged 30–79 years from the Kanagawa Knee Study who had not visited a hospital for more than three consecutive months for knee symptoms. MR images of the PF joints, separated into the medial and lateral types, were presented in order of the highest to lowest patella cartilage area ratios. Cartilage defects in the patella were detected in 37 subjects (6.6%). Medial lesions (4.6%) were significantly more frequent than lateral lesions (2.0%) (p < 0.01). For both medial and lateral lesions, the patellar cartilage defects were divided into confined and unconfined types. The 3D MR images of the PF joint showed that the patellar cartilage defect occurred along each ridge of the femoral trochlea. The 3D MR images revealed a 6.6% prevalence of patellar cartilage defects, higher in the medial than lateral regions. The 3D MR images can easily determine PF morphology and cartilage defect location, making them useful in understanding the pathophysiology and etiology of PFOA.

Early Outcomes of Operative Versus Nonoperative Management of Stress-Positive Minimally Displaced Lateral Compression Type 1 Pelvic Ring Injuries.

To compare the early outcomes of patients with stress-positive minimally displaced lateral compression type 1 (LC1b) pelvic ring injuries managed with or without operative fixation. Retrospective comparison study. Level 1 trauma center. Forty-three patients with LC1b injuries. Operative versus nonoperative. Discharge to subacute rehabilitation (SAR); 2- and 6-week pain visual analog score, opioid use, assistive device use, percentage of normal single assessment numerical evaluation, SAR status; fracture displacement; and complications. The operative group did not differ in age, gender, body mass index, high-energy mechanism, dynamic displacement stress radiographs, complete sacral fractures, Denis sacral fracture classification, Nakatani rami fracture classification, follow-up length, or American Society of Anesthesiologists classification. The operative group was less likely to be using an assistive device at 6 weeks [observed difference (OD) -53.9%, 95% confidence interval (CI) -74.3% to -20.6%, OD/CI 1.00, P = 0.0005], less likely to remain in an SAR at 2 weeks (OD -27.5%, CI, -50.0% to -2.7%, OD/CI 0.58, P = 0.02), and had less fracture displacement at follow-up radiographs (OD -5.0 mm, CI, -9.2 to -1.0 mm, OD/CI 0.61, P = 0.02). There were no other differences in outcomes between treatment groups. Complications occurred in 29.6% (n = 8/27) of the operative group compared with 25.0% (n = 4/16) of the nonoperative group resulting in 7 and 1 additional procedures, respectively. Operative treatment was associated with early benefits over nonoperative management, including shorter time using assistive devices, less SAR use, and less fracture displacement at follow-up. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Post Post-Mobilization Films for LC1 Pelvic Ring Injuries: Follow up Stress Imaging Demonstrates Minimal Utility.

To assess the utility of outpatient postmobilization radiographs in the nonoperative treatment of lateral compression type I (LC1) (OTA/AO 61-B1) pelvic ring injuries. Retrospective series. Academic, Level 1 trauma center, 2008-2018. A series of 173 patients with nonoperatively treated LC1 pelvic ring injuries was identified. Of these, 139 received a complete set of outpatient pelvic radiographs with which to assess displacement. Outpatient pelvic radiographs to assess additional fracture displacement and potential need for surgical intervention. Rate of conversion to late operative intervention based on radiographic displacement. No patient in this cohort received late operative intervention. A majority of the patients sustained incomplete sacral fractures (82.6%) and unilateral rami fractures (75.1%), and 92.8% demonstrated less than 10 mm of displacement on their final radiographs. There is a low utility of repeat outpatient radiographs of stable, nonoperative LC1 pelvic ring injuries as they do not undergo late displacement. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Diagnostic Criteria of Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the mos common cause of peripheral vertigo. The pathophysiology of BPPV is canalolithiasis which includes free-floating otoconial debris within the endolymph of a semicircular canal, or cupulolithiasis comprising otoconial debris adherent to the cupula. The posterior and/or lateral semicircular canals are often affected in BPPV. It is characterized by a brief episode of rotatory vertigo associated with positional and/or positioning nystagmus, which is elicited by specific head positions or changes in head position relative to gravity. In the case of the posterior canal type of BPPV, torsional nystagmus is induced by the Dix-Hallpike test. In patients of lateral canal type of BPPV, horizontal geotropic or apogeotropic nystagmus is induced by the supine roll test. The observation of positional and/or positioning nystagmus is needed for the diagnosis of BPPV. The treatment of BPPV includes canalith repositioning procedure (CRP). By series of head position changes, the CRP moves the otoconial debris from the involved semicircular canal to the utricle. This review article presents operational diagnostic criteria for BPPV, formulated by the Committee for Classification of Vestibular Disorders of the Barany Society. This classification reflects the current knowledge of the clinical aspect and pathophysiology of BPPV. These diagnostic criteria will be helpful for the understanding of the disease and will lead to further development in the management of BPPV.

Comparison of the two surgery methods combined with accelerated rehabilitation in the treatment of lateral compression type 1 pelvic fractures in the elderly

BackgroundTreating lateral compression type 1 (LC1) pelvic ring injuries in older patients is controversial. This study evaluated surgical treatments combined with ERAS for treating LC1 pelvic fractures in the elderly.MethodsIn this retrospective study, patients who underwent surgery with INFIX (supra-acetabular spinal pedicle screws, and a subcutaneous connecting rod; the experimental group) or superior pubic ramus cannulated screw (the control group) fixation of LC1 pelvic fracture from January 2019 to January 2022 were reviewed. Injury radiography and computed tomography were performed to determine the Young–Burgess classification. All patients performed standardized early rehabilitation exercises after surgery and were followed up for > 12 months. After surgery, the Matta score and the visual analog scale (VAS) were evaluated, and the postoperative weight-bearing time and the length of stay (LOS) were recorded. The Barthel index and the Majeed score were evaluated at 4 months after surgery and at the last follow-up.ResultsFifty-three patients were included. Thirty-two patients included in the experimental group had a mean age of 75.0 ± 6.2 (range, 66–86) years, and the other 21 patients in the control group had a mean age of 74.6 ± 4.6 (range, 68–83) years. The mean follow-up time was 13.1 ± 1.6 (range, 12–18) months in the experimental group and 13.4 ± 1.3 (range, 12–16) months in the control group. There were no significant differences in follow-up time between the groups (P > 0.05). The mean VAS score, time to weight-bearing, and LOS were 2.0 ± 0.7 (range, 1–3), 1.1 ± 0.3 (range, 1–2) d, and 5.8 ± 0.9 (range, 4–7) d in the experimental group and 2.3 ± 1.2 (range, 1–5), 2.5 ± 1.6 (range, 1–7) d, and 6.1 ± 1.6 (range, 5–11) d in the control group, respectively. Between the two groups, there was a significant difference in the postoperative time to weight-bearing (P < 0.05), while there was no significant difference in the LOS (P > 0.05). No bedrest-related complications occurred in either group. The Matta score was 90.6% in the experimental group and 90.4% in the control group (P > 0.05). At the 4-months follow-up, the experimental group had a better Barthel index and Majeed score compared with the control group, which were 86.1 ± 6.2 (range, 70–95) vs. 81.2 ± 4.1 (range, 75–90) and 86.3 ± 3.3 (range, 78–91) vs. 80.3 ± 3.9 (range, 76–86), respectively. The experimental group had better early rehabilitation effect than the control group. There was no significant difference in Barthel index and Majeed score between the two groups at the last follow-up (P > 0.05).ConclusionBoth INFIX and intramedullary superior pubic ramus cannulated screws can successfully treat LC1 pelvic fractures and reduce bed rest complications among older patients.

Conservative versus operative treatment of FFP II fractures in a geriatric cohort: a prospective randomized pilot trial

A clear recommendation regarding treatment strategy of fragility fractures of the pelvic ring is missing. The most typical fracture pattern is a lateral compression type injury with non-displaced fractures of the anterior pubic rami and a unilateral os sacrum fracture (FFP II). We hypothesized that operative treatment would be superior to conservative treatment. From October 2017 to April 2020, a randomized prospective non-blinded trial with n = 39 patients was carried out. Two arms with 17 operative versus 22 conservative cases were created. Inclusion criteria were a posterior pelvic ring fracture FFP type II, age over 60 years and acute fracture (< 3 weeks). Barthel index, pain level (VAS), quality of life (EQ-5D-3L), and Tinetti–Gait Test were determined on admission, at discharge, and after 3, 6, 12 and 24 months. Median follow-up was 12.9 months. The Barthel index (= 0.325), VAS (p = 0.711), quality of life (p = 0.824), and Tinetti–Gait Test (p = 0.913) showed no significant differences between the two groups after 12 months. Two patients switched from the conservative to the operative arm due to persistent immobilization and pain. The one-year mortality rate showed no significant difference (p = 0.175). Our hypothesis that surgical treatment is superior was refuted. No significant benefit was shown in terms of quality of life, mortality and pain levels. The results suggest a more differentiated treatment approach in the future, with initial conservative treatment preferred. A larger multi-center trial is required to confirm these findings.Trial registration: The study was retrospectively registered with the German Clinical Trials Registry (DRKS00013703) on 10/12/2018.

Pelvic binder radiography detects occult instability in cadaveric simulated lateral compression type I (LC1) pelvic fractures

ObjectivesOccult instability in minimally displaced lateral compression (LC) pelvic ring injuries may have clinical relevance for treatment. We describe two novel LC pelvis fracture stress examinations – pelvic binder stress radiography (PBR) and pelvic binder stress bladder manometry (PBM) – which do not require sedation, anesthesia, patient transport, or radiation of personnel. MethodsA biomechanical study was performed with five fresh elderly cadavers. Sequential osteotomies of the pelvis simulated increasingly unstable LC pelvis fracture patterns (OTA/AO 61A2.2, 61B1.1a, 61B1.1b, 61B2.1). Compressive force was quantitatively applied using a pelvic binder and scale. Pelvis fracture displacement was measured on AP and inlet fluoroscopic views. Pelvic bladder pressure (PBM) was measured using a Foley catheter as a water column. ResultsFracture displacement strongly correlated with force applied (R2=0.600-0.963). PBR discriminated between simulated LC injuries. Mean displacement of 61B1.1b injuries >1cm was observed at 3.8kg on AP view and 5kg on inlet view. Mean displacement of 61B1.1a injuries >1cm was observed at 8.2kg on AP view and 9.3kg on inlet view. 61A2.2 injuries did not displace >1cm at forces up to 10kg. >95% of 61B1.1a and 61B1.1b injuries displaced >1cm at 10kg. PBM moderately correlated with force applied (R2=0.517-0.842) but did not discriminate between LC injuries. ConclusionsPBR is feasible, precisely quantified occult mechanical instability in simulated LC pelvis fractures in response to reproducible applied force, and discriminated between simulated LC pelvis fractures. PBM did not discriminate between simulated LC fractures. A clinical trial to validate the safety and efficacy of PBR for assessing occult instability in LC pelvis fracture is warranted.

Conservative treatment of supination and external rotation for type Ⅲ and Ⅳankle fracture by bone setting

To explore curative effect of conservative treatment of supination-lateral rotation (SER) with type Ⅲ and Ⅳ ankle fracture by bone setting technique. From January 2017 to December 2019, 64 patients diagnosed with SER with type Ⅲ and Ⅳ ankle fracture were treated with manipulative reduction and conservative treatment (manipulation group) and surgical treatment with open reduction and internal fixation (operation group), 32 patients in each group. In manipulation group, there were 17 males and 15 females, aged from 15 to 79 years old with an average of (51.42±13.68) years old;according to Lauge-Hansen classification, there were 8 patients with supination external rotation type Ⅲ and 24 patients with type Ⅳ. In operation group, there were 13 males and 19 females, aged from 18 to 76 years old with an average of (47.36±15.02) years old;7 patients with type Ⅲ and 25 patients with type Ⅳ. Displacement of ankle fracture was measured by Digimizer software, and compared before treatment, 3 and 12 months after treatment between two groups. Lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement were measured and compared between two groups. Mazur score was used to evaluate ankle joint function. All patients were followed up from 12 to 36 months with an average of (17.16±9.36) months. There were statistical differences in lateral medial malleolus displacement, lateral medial malleolus displacement, lateral malleolus displacement, lateral malleolus displacement, lateral malleolus contraction displacement and posterior malleolus displacement in manipulation group before and after reduction(P<0.05). Compared with operation group, there were no statistically significant differences in lateral malleolus shift, lateral malleolus shift, lateral malleolus contraction shift(P>0.05), while there were statistically significant differences in lateral malleolus shift, posterior malleolus shift up and down (P<0.05). Mazur scores of ankle joint at 3 months after treatment in manipulation group and operation group were 68.84±13.08 and 82.53±7.31, respectively, and had statistical differences(P<0.05), while there was no difference in evaluation of clnical effect(P>0.05). There were no differences in Mazur score and evaluation of clnical effect between two groups at 12 months after treatment (P>0.05). Bone setting technique could effectively correct lateral displacement of medial malleolus, lateral displacement of medial malleolus, lateral displacement of lateral malleolus and lateral contraction displacement of lateral malleolus in supination lateral rotation type Ⅲ and Ⅳ ankle fracture, and has good long-term clinical effect, which could avoid operation for some patients and restore ankle function after fracture.

IFNγ protects motor neurons from oxidative stress via enhanced global protein synthesis in FUS-associated amyotrophic lateral sclerosis.

Amyotrophic lateral sclerosis type 6 (ALS6) is a familial subtype of ALS linked to Fused in Sarcoma (FUS) gene mutation. FUS mutations lead to decreased global protein synthesis, but the mechanism that drives this has not been established. Here, we used ALS6 patient-derived induced pluripotent stem cells (hIPSCs) to study the effect of the ALS6 FUSR521H mutation on the translation machinery in motor neurons (MNs). We find, in agreement with findings of others, that protein synthesis is decreased in FUSR521H MNs. Furthermore, FUSR521H MNs are more sensitive to oxidative stress and display reduced expression of TGF-β and mTORC gene pathways when stressed. Finally, we show that IFNγ treatment reduces apoptosis of FUSR521H MNs exposed to oxidative stress and partially restores the translation rates in FUSR521H MNs. Overall, these findings suggest that a functional IFNγ response is important for FUS-mediated protein synthesis, possibly by FUS nuclear translocation in ALS6.

Lateral Distance From the Osteotomy Hinge Point to the Tibial Cortex Is Associated With Lateral Hinge Fracture Type and Fracture Occurrence Time After Medial Open-Wedge High Tibial Osteotomy

To verify whether the distance from the hinge point to the tibial cortex affects the occurrence time and characteristics of the lateral hinge fracture (LHF) in medial open-wedge high tibial osteotomy. We retrospectively reviewed 171 knees in 171 patients (121 women, 50 men; mean age, 53.9 years; range, 36-67 years) who had undergone medial open-wedge high tibial osteotomy with locking plate fixation between January 2011 and December 2020. Osteotomy hinge point and LHFs were identified on intraoperative fluoroscopy and immediate postoperative radiographs. LHF type was classified as suggested by Takeuchi etal. Acute fracture was defined as a fracture that occurred during surgery, and delayed fracture was defined as a fracture observed after 1 month postoperatively. The nearest distances from osteotomy hinge point to lateral, distal, and proximal cortex were measured on postoperative radiographs. We compared the distance between the different types and between acute and delayed LHFs. There were 55 LHFs (32%) (type I, 40 knees; type II, 14 knees; type III, 1 knee) that occurred acutely in 41 knees and were found as delayed fractures in 14 knees. The patient demographics were not significantly different between non-LHFs and each type of LHFs. Proximal and distal distances were not statistically different among fracture types and between occurrence times. However, lateral distances were significantly shorter in type I LHFs (6.2 ± 1.8 mm) and longer in type II LHFs (9.3 ± 2.3 mm) than in non-LHFs (7.1 ± 2.7 mm) (P= .020 and .004, respectively). The lateral cortical distances were also different between acute LHFs (6.4 ± 1.9 mm) and delayed LHF (9.0 ± 2.7 mm) (P < .001). In the case of fracture type, the frequency of type I decreases with increase in the lateral distance, whereas that of type II increases with increase in the lateral cortical distance. In acute fracture, type I was dominant (85.4%), whereas in delayed fracture, type II was dominant (57.2%). The lateral cortical distance from the hinge point was significantly associated with LHF occurrence. Shorter distance increased the risk for acute type I LHF, whereas longer distance increased the risk for delayed type II LHFs. Level III, retrospective comparative prognostic trial.

FTD/ALS Type 7-Associated Thr104Asn Mutation of CHMP2B Blunts Neuronal Process Elongation, and Is Recovered by Knockdown of Arf4, the Golgi Stress Regulator.

Frontotemporal dementia and/or amyotrophic lateral sclerosis type 7 (FTD/ALS7) is an autosomal dominant neurodegenerative disorder characterized by the onset of FTD and/or ALS, mainly in adulthood. Patients with some types of mutations, including the Thr104Asn (T104N) mutation of charged multivesicular body protein 2B (CHMP2B), have predominantly ALS phenotypes, whereas patients with other mutations have predominantly FTD phenotypes. A few mutations result in patients having both phenotypes approximately equally; however, the reason why phenotypes differ depending on the position of the mutation is unknown. CHMP2B comprises one part of the endosomal sorting complexes required for transport (ESCRT), specifically ESCRT-III, in the cytoplasm. We describe here, for the first time, that CHMP2B with the T104N mutation inhibits neuronal process elongation in the N1E-115 cell line, a model line undergoing neuronal differentiation. This inhibitory phenotype was accompanied by changes in marker protein expression. Of note, CHMP2B with the T104N mutation, but not the wild-type form, was preferentially accumulated in the Golgi body. Of the four major Golgi stress signaling pathways currently known, the pathway through Arf4, the small GTPase, was specifically upregulated in cells expressing CHMP2B with the T104N mutation. Conversely, knockdown of Arf4 with the cognate small interfering (si)RNA recovered the neuronal process elongation inhibited by the T104N mutation. These results suggest that the T104N mutation of CHMP2B inhibits morphological differentiation by triggering Golgi stress signaling, revealing a possible therapeutic molecular target for recovering potential molecular and cellular phenotypes underlying FTD/ALS7.

Nonoperative management of minimally displaced lateral compression type 1 (LC1) injuries with comminuted rami fractures is associated with late displacement.

Rami comminution has been found to be predictive of lateral compression type 1 (LC1) injury instability on examination under anesthesia (EUA) and lateral stress radiographs (LSR). The purpose of this study was to evaluate how rami comminution and subsequent operative vs. nonoperative management impact the late displacement of these injuries. Retrospective review of a prospectively collected LC1 database was performed to identify all patients with minimally displaced LC1 injuries (< 1cm) and follow-up radiographs over a four-year period (n = 125). Groups were separated based on the presence of rami comminution and subsequent management, including rami comminution/operative (n = 49), rami comminution/nonoperative (n = 54), and no comminution/nonoperative (control group, n = 22). The primary outcome was late fracture displacement, analyzed as both a continuous variable and as late displacement ≥ 5mm. As a continuous variable, late fracture displacement was lower in the comminuted rami/operative group as compared to the comminuted rami/nonoperative group (PD: -3.0mm, CI: -4.8 to -1.6mm, p = 0.0002) and statistically non-different from control. Late displacement ≥ 5mm was significantly more prevalent in the comminuted rami/nonoperative group than in the comminuted rami/operative and no comminution/nonoperative groups (control)(PD: -33.9%, CI: -49.0% to -16.1%, p = 0.0002 and PD: -30.0%, CI: -48.2% to -6.5%, p = 0.02, respectively). Late fracture displacement was greatest in the group with rami comminution/nonoperative management. Rami comminution, which has been previously associated with dynamic displacement on EUA and LSR, is also associated with a higher incidence of late displacement when managed nonoperatively. Level III, prognostic retrospective cohort study.

Enhancing unreinforced masonry wall resilience through nano-silica modified steel fiber reinforced mortar: A study on in-plane cyclic loading

Strengthening existing unreinforced masonry (URM) structures with plaster is a common technique used to improve the structural integrity and durability of buildings. However, using a thin layer of plaster alone may not provide sufficient reinforcement to adequately enhance the URM wall’s resistance to lateral or other types of loading. Therefore, incorporating additional materials, such as steel fibers and nano-silica, into the plaster mix has been explored in this study to further improve the URM wall’s resilience performance. The effect of nano-silica modified steel fibers reinforced (NS-SFR) mortar plastering on the axial and lateral load capacity of concrete masonry walls was experimentally investigated. The investigated URM walls were constructed with a dimension of 830 × 810 × 100 mm (length × width × thickness) using hollow concrete masonry blocks. These walls were categorized as a reference wall, plastered on one side only wall, and plastered on both sides wall. During the experimental testing, each sample was exposed to a combination of precompression and cyclic in-plane loading to assess its shear capacity. The tests also involved closely observing and identifying any cracks or types of failures that occurred. The results of the tests indicated that the walls that were strengthened with NS-SFR mortar exhibited a significant improvement in their compressive strength, shear strength capacity, and stiffness, in comparison to the walls that were not strengthened. Applying NS-SFR mortar as a plaster on the URM wall resulted in significant improvements in both compressive strength and shear capacity. Specifically, for the one-side plastered wall, the use of NS-SFR mortar increased compressive strength and shear capacity by 18.5 % and 40 %, respectively, while for the two sides plastered wall, the increase was even more significant, with improvements of 86.5 % and 132 % in compressive strength and shear capacity, respectively.

Yeast Models of Amyotrophic Lateral Sclerosis Type 8 Mimic Phenotypes Seen in Mammalian Cells Expressing Mutant VAPBP56S.

Amyotrophic lateral sclerosis (ALS) is a complex neurodegenerative disease that results in the loss of motor neurons and can occur sporadically or due to genetic mutations. Among the 30 genes linked to familial ALS, a P56S mutation in VAPB, an ER-resident protein that functions at membrane contact sites, causes ALS type 8. Mammalian cells expressing VAPBP56S have distinctive phenotypes, including ER collapse, protein and/or membrane-containing inclusions, and sensitivity to ER stress. VAPB is conserved through evolution and has two homologs in budding yeast, SCS2 and SCS22. Previously, a humanized version of SCS2 bearing disease-linked mutations was described, and it caused Scs2-containing inclusions when overexpressed in yeast. Here, we describe a yeast model for ALS8 in which the two SCS genes are deleted and replaced with a single chromosomal copy of either wild-type or mutant yeast SCS2 or human VAPB expressed from the SCS2 promoter. These cells display ER collapse, the formation of inclusion-like structures, and sensitivity to tunicamycin, an ER stress-inducing drug. Based on the phenotypic similarity to mammalian cells expressing VAPBP56S, we propose that these models can be used to study the molecular basis of cell death or dysfunction in ALS8. Moreover, other conserved ALS-linked genes may create opportunities for the generation of yeast models of disease.

The EMS stress view: occult pelvic instability revealed by pre-hospital pelvic binder placement.

To describe and evaluate the serendipitous pelvic binder stress radiographs of lateral compression type (LC) pelvic ring injuries. This was a retrospective case series performed at a single, level I academic trauma center from 2016 to 2018. All patients presenting with a minimally displaced LC pelvic ring injury were reviewed (< 10cm displacement on static pelvic radiographs). Patients with X-rays (XR) in a pelvic binder (EMS stress) and with the pelvic binder removed were included. Pelvic ring stability was determined by attending surgeon evaluation of EMS stress radiographs versus static XR of the pelvis. Patients were treated non-operatively and allowed to weight bear or taken to the operating room for exam under anesthesia (EUA) and potential operative fixation. Clinical success of treatment was determined by evaluation of further displacement at the completion of their most recent follow-up. Thirty-seven patients of the initial 398 reviewed met inclusion criteria. Fourteen of 37 patients (38%) were categorized as stable with no significant pelvis displacement seen on EMS stress and were treated non-operatively without further sequelae (4.6 months mean follow-up). The remaining 23/37 (62%) were treated operatively. Occult instability was identified on EMS stress in 14 (61%) of those 23 patients and the remainder were determined to be unstable based upon fracture pattern or EUA. All patients went on to successful treatment without significant pelvic deformity (7.8 months mean follow-up). The EMS stress XR is a valuable, opportunistic evaluation in LC pelvic ring injuries. This evaluation is a useful diagnostic adjunct to alert the provider that additional stress imaging may be indicated to evaluate for occult pelvic ring instability.

Geological and topographical analysis of Anshar Sulcus, Ganymede: Implications for grooved terrain formation

The formation of grooved terrains on the icy surface of Ganymede is still debated and it could involve extensive rifting or spreading, strike-slip tectonics, and minor cryovolcanic resurfacing. Anshar Sulcus is a terminal portion of a groove network imaged at high resolution by the Galileo Solid State Imaging subsystem (SSI). To investigate the origin and evolution of the grooved terrains, we performed a geomorphological and structural analysis of Anshar Sulcus producing a geomorphological map of the study area in 1:500,000 scale, and we conducted a topographical analysis producing a Digital Elevation Model (DEM) of this region. We found several indicators that the formation of Anshar Sulcus' grooved terrain is the result of two tectonic events, the first being a right lateral strike-slip type and the second a crustal spreading. We found that the right lateral strike-slip movement that divided the dark terrain of this area into two distinct regions represents the precursor of the formation of the sulcus, and that the crustal spreading subsequently occurred through transtensional movement of the regions. We also found that the grooves were formed within the solid-state raised material by brittle fracturing and tilting of the newly formed crust.

Operative management of stress-positive minimally displaced lateral compression type 1 (LC1) pelvic ring injuries: Analysis of outcomes before and after implementation of a departmental stress protocol.

To compare the hospital course of patients with minimally displaced (<1 cm) lateral compression type 1 (LC1) injuries treated before and after implementation of lateral stress radiographs (LSR) to determine management. Retrospective comparative cohort. Urban level one trauma centerPatients/Participants: Isolated LC1 injuries managed before (n=33) and after implementation of LSR (n=40) to determine management. Patients in a pre-stress cohort managed nonoperatively versus patients in a LSR cohort managed operatively if stress-positive (≥1cm displacement on LSR). Physical therapy (PT) clearance before discharge, discharge location, hospital length of stay (LOS), inpatient opioid morphine milligram equivalents (MME). The pre-stress and LSR protocol groups were similar in demographic/injury characteristics (age, sex, mechanism, ASA score, Nakatani classification, bilateral/unilateral injury, Denis zone, sacral fracture completeness, sacral comminution). 45.0% of LSR protocol patients were stress-positive (n=18) and managed operatively. The LSR protocol group was more likely to clear PT by discharge (97.5% vs. 75.8%, proportional difference (PD): 21.7%, 95% confidence interval (CI): 5.1% to 36.8%, p=0.009), less likely to discharge to a rehabilitation facility (2.5% vs. 18.2%, PD: -15.7%, CI: -30.0 to -0.5%, p=0.04), and had no difference in LOS (MD: 0.0, CI :-1.0 to 1.0, p=0.57) or inpatient opioid MME (MD: 9.0, CI: -60.0 to 101.0, p=0.71). Implementation of a LSR protocol to determine management of minimally displaced stress-positive LC1 injuries was associated with increased rates of operative management, PT clearance by discharge, and a reduction in the number of patients discharging to rehabilitation facilities.

An anatomical study of persistent trigeminal artery detected by computed tomography angiography and magnetic resonance angiography: proposal for a modified classification and a novel basilar artery grading system.

The purpose of this study is to investigate the anatomical characteristics of persistent trigeminal artery (PTA) detected by computed tomography angiography (CTA) and magnetic resonance angiography (MRA), propose a modified classification and a novel grading system for basilar artery (BA). Patients who underwent head CTA or MRA in our hospital between August 2014 and August 2022 were reviewed retrospectively. The prevalence, sex, and course of PTA were evaluated. PTA types were modified based on Weon's classification. Type I to IV were similar to those in Weon's classification except the presence of intermed fetal-type posterior cerebral artery (IF-PCA). Type V was the same as that in Weon's classification. Type VI included subtypes of VIa (concomitant IF-PCA based on type I to IV) and VIb (other variants). BA was assessed based on a scale of 0 to 5 compared with PTA's caliber (0, BA aplasia; 1 and 2, BA non-dominant; 3, equilibrium; 4 and 5, BA dominant). A total of 57 patients (0.06%) with PTA, including 36 females and 21 males, were detected in 94,487 patients. Six patients (10.5%) were medial type and 51 patients (89.5%) were lateral type. Thirty-seven patients (64.9%) were type I, 1 (1.8%) as type II, 13 (22.8%) as type III, 3 (5.3%) as type IV, 1 (1.8%) as type V, and 2 (3.5%) as type VI. For BA grading, 4 (7.0%), 21 (36.8%), 17 (29.8%), 6 (10.5%), 6 (10.5%), and 3 (5.3%) of the patients were grade 0, 1, 2, 3, 4, and 5, respectively. Fifteen patients (26.3%) had intracranial aneurysms. One cases (1.8%) had a fenestration of the PTA. The prevalence of PTA in our study was lower than that in most previous reports. The modified PTA classification and BA grading system can be used to better understand the vascular structure of PTA patients.