Imaging the Postoperative Elbow

Evaluation of postoperative images of any joint can be a daunting task, and the elbow is no exception. Patients may be imaged with a complication of the repair, or the postoperative changes may be incidentally observed as the patient is imaged for other reasons. We divide the postoperative elbow into soft tissue procedures (covering ligament and tendon repairs, as well as compartmental release and nerve transposition), joint-related procedures (osteochondral lesion treatment, ostectomy, and joint replacement), and bone procedures (fracture fixation). We summarize the procedures and their indications, show normal imaging appearances, and finally cover common complications.

Prevalence of High-Risk Human Papillomavirus Infections before and after Cervical Lesion Treatment, among Women Living with HIV

Even when receiving combination antiretroviral therapy, women living with HIV are at high risk of human papillomavirus (HPV) infection and/or cervical lesions, including cancer. Using data from the PapilloV prospective cohort, we evaluated the prevalence of high-risk HPV (HR-HPV) infections after cervical lesion treatment and investigated factors associated with their carriage. Women were followed up for three years with annual Pap smear and HPV genotyping. We offered treatment to women presenting either a Pap smear with high-grade squamous intraepithelial lesion or higher, and/or a biopsy showing cervical intraepithelial neoplasia II or III. We compared the prevalence of HR-HPV infection at the time of first treatment indication and at the end of follow-up among women who received treatment and those who did not. Overall, 46 women had treatment indication. HR-HPV prevalence significantly decreased from 67% to 27% (p value = 0.001) in the 30 women who received treatment, while it did not significantly decrease (from 56% to 38%) in the 16 women who did not (p value = 0.257). Due to lack of statistical power, the 40% relative difference in HR-HPV carriage between treated and untreated women was not significant. In women living with HIV, the treatment of a cervical lesion may be beneficial for clearing HR-HPV infections.

Metabolic Rewiring in Radiation Oncology Toward Improving the Therapeutic Ratio

To meet the anabolic demands of the proliferative potential of tumor cells, malignant cells tend to rewire their metabolic pathways. Although different types of malignant cells share this phenomenon, there is a large intracellular variability how these metabolic patterns are altered. Fortunately, differences in metabolic patterns between normal tissue and malignant cells can be exploited to increase the therapeutic ratio. Modulation of cellular metabolism to improve treatment outcome is an emerging field proposing a variety of promising strategies in primary tumor and metastatic lesion treatment. These strategies, capable of either sensitizing or protecting tissues, target either tumor or normal tissue and are often focused on modulating of tissue oxygenation, hypoxia-inducible factor (HIF) stabilization, glucose metabolism, mitochondrial function and the redox balance. Several compounds or therapies are still in under (pre-)clinical development, while others are already used in clinical practice. Here, we describe different strategies from bench to bedside to optimize the therapeutic ratio through modulation of the cellular metabolism. This review gives an overview of the current state on development and the mechanism of action of modulators affecting cellular metabolism with the aim to improve the radiotherapy response on tumors or to protect the normal tissue and therefore contribute to an improved therapeutic ratio.

Evaluation of the Effectiveness of Laser Therapy in Complex Treatment of periodontal Diseases

Aim: The object of the study is to increase the efficiency of treatment in patients with generalized periodontitis by using a laser in complex treatment. Materials and Methods: Eighty patients underwent for instrumental and X-ray examination of the oral cavity, bacteriological studies of the microbiota of periodontal pockets, clinical analysis of peripheral blood that was taken from the ulnar vein and capillary blood that taken from the gums, as a local treatment carried lesion treatment portion of diode laser. Results: It was determined that opportunistic microflora, dominating before treatment in the contents of periodontal pockets, was not isolated in all patients, but on the 10th day of treatment, the microflora of periodontal pockets had stabilized. Both in the main group and in the comparison group, among neutrophils and monocytes, the populations of phagocytes with a low digesting ability prevailed, however, the proportions of medium- and highly active phagocytes after laser treatment were higher than after treatment with standard conservative therapy. Conclusions: The use of a laser for the therapeutic stage of the complex treatment of patients with generalized periodontitis of the I-II degree, chronic course contributes to the acceleration of reparative processes, a decrease in the degree of destruction in bone tissue, a decrease in the intensity of pain syndrome, a decrease in collateral edema, has an antibacterial effect and a longer stabilization of the periodontal condition.

Developing a fully 3d animated educational application to teach bifurcation lesion treatment

Background Coronary bifurcation lesions make up around 15 to 20 percent of interventions. Especially for younger interventionalists, they pose a steep difficulty curve due to the daunting set of ways treatment can diverge from the initial plan based on plaque shift or other complications. Purpose BifurcAID 3D was designed to intuitively show some of the key phenomena during bifurcation lesion treatment. Plaque shift, the importance of proximal optimization, the opening of a jailed side branch, and the overlapping layers of stent in the Culotte technique are among some of the aspects of bifurcation lesion treatment that can benefit from a clear visual format. Methods Iterating on the bifurcation algorithm developed at a high volume metropolitan PCI center, this fully animated application has many branching points where plaque shift is assessed and the treatment plan and animation varies accordingly to show reactive balloon angioplasty, stenting, or entirely switching to dedicated two stent techniques. Results The resulting application is an easy-to-navigate algorithm for left and non left main bifurcation lesion treatment with fully animated clear depictions of bifurcation lesion treatments including provisional, bail-out strategies, and dedicated two stent techniques alongside descriptive text. Conclusions Creating free educational content for aspiring and current physicians serves to elevate the field and lower the barriers to entry. BifurcAID 3D will make available intuitive education on complex bifurcation lesion treatment worldwide. Representative Images of BifurcAID 3D Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott Vascular Education Grant

Tubercular splenic abscess and recurrent acute on chronic tubercular pancreatitis: a rare coincidence in an immune competent child

Tubercular splenic abscess in association with chronic tubercular pancreatitis is scarcely reported in an immune competent child. 12 years old boy had presented with recurrent attacks of upper abdominal pain radiating towards left shoulder. He had multiple hospitalizations with similar complaints. The child had associated anorexia and significant weight loss during the period of his illness. Clinical examination revealed tenderness and muscle guard over the epigastric region. The pancreatic enzymes were markedly raised. Abdominal CT scan had suggested chronic pancreatitis with multiple splenic abscesses. The cartridge- based nucleic acid amplification test (CBNAAT) of the pus aspirated from the abscess confirmed the presence of pan sensitive mycobacterium tuberculosis. Image guided fine needle aspiration biopsy revealed the presence of caseating granulomatous lesion. Treatment with anti-tubercular drugs led to complete clinical recovery and normalization of pancreatic enzymes at follow up. An immunocompetent child had chronic tubercular pancreatitis associated with tubercular splenic abscess.