•Plate fixation and IMN are both viable treatment options for distal tibia fractures, each with its advantages and disadvantages.•Intramedullary nailing is associated with a slightly increased risk ...of mal-union and anterior knee pain.•Plating, however, results in a slightly higher rate of infection.•The treatment of distal tibia fractures should, therefore, be based on a personalized approach and rely on shared decision-making.
Treatment for distal diaphyseal or metaphyseal tibia fractures is challenging and the optimal surgical strategy remains a matter of debate. The purpose of this study was to compare plate fixation with nailing in terms of operation time, non-union, time-to-union, mal-union, infection, subsequent re-interventions and functional outcomes (quality of life scores, knee- and ankle scores).
A search was performed in PubMed/Embase/CINAHL/CENTRAL for all study designs comparing plate fixation with intramedullary nailing (IMN). Data were pooled using RevMan and presented as odds ratios (OR), risk difference (RD), weighted mean difference (WMD) or weighted standardized mean difference (WSMD) with a 95% confidence interval (95%CI). All analyzes were stratified for study design.
A total of 15 studies with 1332 patients were analyzed, including ten RCTs (n = 873) and five observational studies (n = 459). IMN leads to a shorter time-to-union (WMD: 0.4 months, 95%CI 0.1 – 0.7), shorter time-to-full-weightbearing (WMD: 0.6 months, 95%CI 0.4 – 0.8) and shorter operation duration (WMD: 15.5 min, 95%CI 9.3 – 21.7). Plating leads to a lower risk for mal-union (RD: -10%, OR: 0.4, 95%CI 0.3 – 0.6), but higher risk for infection (RD: 8%, OR: 2.4, 95%CI 1.5 – 3.8). No differences were detected with regard to non-union (RD: 1%, OR: 0.7, 95%CI 0.3 – 1.7), subsequent re-interventions (RD: 4%, OR: 1.3, 95%CI 0.8 – 1.9) and functional outcomes (WSMD: -0.4, 95%CI -0.9 – 0.1). The effect estimates of RCTs and observational studies were equal for all outcomes except for time to union and mal-union.
Satisfactory results can be obtained with both plate fixation and nailing for distal extra-articular tibia fractures. However, nailing is associated with higher rates of mal-union and anterior knee pain while plate fixation results in an increased risk of infection. This study provides a guideline towards a personalized approach and facilitates shared decision-making in surgical treatment of distal extra-articular tibia fractures. The definitive treatment should be case-based and aligned to patient-specific needs in order to minimize the risk of complications.
Coherent elastic neutrino-nucleus scattering (CEvNS) is calculated to be the dominant neutrino scattering channel for neutrinos of energy Eν<100 MeV. We report a limit for this process from data ...collected in an engineering run of the 29 kg CENNS-10 liquid argon detector located 27.5 m from the pion decay-at-rest neutrino source at the Oak Ridge National Laboratory Spallation Neutron Source (SNS) with 4.2×1022 protons on target. The dataset provided constraints on beam-related backgrounds critical for future measurements and yielded <7.4 candidate CEvNS events which implies a cross section for the process, averaged over the SNS pion decay-at-rest flux, of <3.4×10−39 cm2, a limit within twice the Standard Model prediction. This is the first limit on CEvNS from an argon nucleus and confirms the earlier CsINa nonstandard neutrino interaction constraints from the collaboration. This run demonstrated the feasibility of the ongoing experimental effort to detect CEvNS with liquid argon.
Spout–fluid beds find a widespread application in the process industry for efficient contacting of large particles with a gas. However, detailed understanding of the complex behavior of these systems ...is lacking, which leads to significant scale-up problems in industry. In this paper we report results of a combined experimental and simulation study on the various regimes, which can be encountered during spout–fluid bed operation.
A regime map for a 3D spout–fluid bed was composed employing spectral analysis of pressure drop fluctuations and fast video recordings. In addition 3D Euler–Lagrange computations were performed to assess the capability of the model to reproduce the experimentally observed flow regimes.
The influence of the drag closure on the model results was assessed and the influence of the computational grid was studied using a new method for the implementation of the two-way coupling, which is proposed in this paper.
For most regimes our model is able to predict the appropriate regime. The frequency, at which the largest power is found, is overpredicted by the model. Contrary to the experimental observations, our model did not predict any large slugs in the slugging bed regime.
The remaining differences between the simulated and experimentally observed bed behavior is most likely related to the representation of the effective fluid–particle interaction in our model, which relies on local spatial homogeneity.
Traditional response criteria in myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML) are based on bone marrow morphology and may not accurately reflect clonal tumor burden in patients ...treated with non-cytotoxic chemotherapy. We used next-generation sequencing of serial bone marrow samples to monitor MDS and AML tumor burden during treatment with epigenetic therapy (decitabine and panobinostat). Serial bone marrow samples (and skin as a source of normal DNA) from 25 MDS and AML patients were sequenced (exome or 285 gene panel). We observed that responders, including those in complete remission (CR), can have persistent measurable tumor burden (that is, mutations) for at least 1 year without disease progression. Using an ultrasensitive sequencing approach, we detected extremely rare mutations (equivalent to 1 heterozygous mutant cell in 2000 non-mutant cells) months to years before their expansion at disease relapse. While patients can live with persistent clonal hematopoiesis in a CR or stable disease, ultimately we find evidence that expansion of a rare subclone occurs at relapse or progression. Here we demonstrate that sequencing of serial samples provides an alternative measure of tumor burden in MDS or AML patients and augments traditional response criteria that rely on bone marrow blast percentage.
Secondary CNS involvement (SCNS) is a profoundly adverse complication of diffuse large B-cell lymphoma. Evidence from older series indicated a median overall survival (OS) < 6 months; however, data ...from the immunochemotherapy era are limited.
Patients diagnosed with SCNS during or after first-line immunochemotherapy were identified from databases and/or regional/national registries from three continents. Clinical information was retrospectively collected from medical records.
In total, 291 patients with SCNS were included. SCNS occurred as part of first relapse in 254 (87%) patients and 113 (39%) had concurrent systemic relapse. With a median post-SCNS follow-up of 48 months, the median post-SCNS OS was 3.9 months and 2-year OS rate was 20% (95% CI: 15–25). In multivariable analysis of 173 patients treated with curative/intensive therapy (such as high-dose methotrexate HDMTX or platinum-containing regimens), age ≤60 years, performance status 0–1, absence of combined leptomeningeal and parenchymal involvement, and SCNS occurring after completion of first-line therapy were associated with superior outcomes. Patients ≤60 years with performance status 0–1 and treated with HDMTX-based regimens for isolated parenchymal SCNS had a 2-year OS of 62% (95% CI: 36–80). In patients with isolated SCNS, the addition of rituximab to HDMTX-based regimens was associated with improved OS. Amongst patients with isolated SCNS in CR following intensive treatment, high-dose chemotherapy and autologous stem cell transplantation did not improve OS (P = 0.9).
In this large international cohort of patients treated with first-line immunochemotherapy, outcomes following SCNS remain poor. However, a moderate proportion of patients with isolated SCNS who received intensive therapies achieved durable remissions.
•The overall prognosis of secondary CNS relapse of diffuse large B-cell lymphoma remains poor.•Few patients achieve favourable long-term outcomes with current therapies.•Younger patients with parenchymal SCNS and no systemic involvement have a relatively good prognosis after intensive therapies.•The addition of rituximab to HDMTX-based regimens seems to improve outcomes.
Background and purpose
We previously reported that certain optical coherence tomography (OCT) measures were sensitive and reliable in identifying idiopathic intracranial hypertension (IIH). This ...prospective study aimed to define OCT measures that allow differentiation of IIH with and without papilledema, thereby helping clinical decision‐making.
Methods
Eight patients with IIH with papilledema, nine without papilledema and 19 with other neurological diseases were included. OCT measures were obtained before lumbar puncture and within 2 h, 1, 3 and 6 months after lumbar puncture with cerebrospinal fluid (CSF) removal.
Results
All patients with papilledema had increased retinal nerve fiber layer (RNFL) thickness and elevated CSF pressure. All patients without papilledema had normal RNFL but elevated CSF pressure. After CSF removal, reduced RNFL thickness was registered in all eight patients with IIH with papilledema. No significant change in RNFL thickness after CSF removal was observed in IIH without papilledema or in patients with other neurological diseases, although reduced CSF pressure was documented. RNFL thickness tended to be normal in patients with IIH with papilledema at 3–6 months after CSF removal. All patients with IIH showed increased rim area and rim thickness, but reduced optic cup volume regardless of RNFL thickness or papilledema.
Conclusions
Retinal nerve fiber layer thickness is sensitive for monitoring acute IIH and evaluating treatment effect. Increased rim area and rim thickness and decreased optic cup volume are reliable parameters that indicate persistently increased CSF pressure and risk of relapse. OCT measures are sensitive and reliable for diagnosing subtle IIH even in the absence of papilledema.
Using an 185-kg NaITl array, COHERENT has measured the inclusive electron-neutrino chargedcurrent cross section on 127I with pion decay-at-rest neutrinos produced by the Spallation Neutron Source at ...Oak Ridge National Laboratory. Iodine is one the heaviest targets for which low-energy (≤ 50 MeV) inelastic neutrino-nucleus processes have been measured, and this is the first measurement of its inclusive cross section. After a five-year detector exposure, COHERENT reports a flux-averaged cross section for electron neutrinos of ${9.2}_{—1.8}^{+2.1}$ × 10—40 cm2. This corresponds to a value that is ~41% lower than predicted using the MARLEY event generator with a measured Gamow-Teller strength distribution. In addition, the observed visible spectrum from charged-current scattering on 127I has been measured between 10 and 55 MeV, and the exclusive zero-neutron and one-or-more-neutron emission cross sections are measured to be ${5.2}_{—3.1}^{+3.4}$ × 10—40 and ${2.2}_{—2.2}^{+3.5}$ × 10—40 cm2, respectively.
PDF
