MRI evaluation of articular cartilage in patients with juvenile osteochondritis dissecans (JOCD) using T2∗ mapping at 3T.

OBJECTIVE: Evaluate articular cartilage by magnetic resonance imaging (MRI) T2∗ mapping within the distal femur and proximal tibia in adolescents with juvenile osteochondritis dissecans (JOCD). DESIGN: JOCD imaging studies acquired between August 2011 and February 2019 with clinical and T2∗ mapping MRI knee images were retrospectively collected and analyzed for 31 participants (9F/22M, 15.0 ± 3.8 years old) with JOCD lesions in the medial femoral condyle (MFC). In total, N = 32 knees with JOCD lesions and N = 14 control knees were assessed. Mean T2∗ values in four articular cartilage regions-of-interest (MFC, lateral femoral condyle (LFC), medial tibia (MT), and lateral tibia (LT)) and lesion volume were measured and analyzed using Wilcoxon-rank-sum tests and Spearman correlation coefficients (R). RESULTS: Mean ± standard error T2∗ differences observed between the lesion-sided MFC and the LFC in JOCD-affected knees (28.5 ± 0.9 95% confidence interval [26.8, 30.3] vs 26.3 ± 0.7 [24.8, 27.7] ms, P = 0.088) and between the affected- and control-knee MFC (28.5 ± 0.9 [26.8, 30.3] vs 28.5 ± 0.6 [27.1, 29.9] ms, P = 0.719) were nonsignificant. T2∗ was significantly increased in the lesion-sided MT vs the LT for the JOCD-affected knees (21.5 ± 0.7 [20.1, 22.9] vs 18.0 ± 0.7 [16.5, 19.5] ms, P = 0.002), but this same difference was also observed between the MT and LT in control knees (21.0 ± 0.6 [19.7, 22.3] vs 18.1 ± 1.1 [15.8, 20.4] ms, P = 0.037). There was no significant T2∗ difference between the affected- and control-knee MT (21.5 ± 0.7 [20.1, 22.9] vs 21.0 ± 0.6 [19.7, 22.3] ms, P = 0.905). T2∗ within the lesion-sided MFC was not correlated with patient age (R = 0.20, P = 0.28) or lesion volume (R = 0.06, P = 0.75). T2∗ values were slightly increased near lesions in later-stage JOCD subjects but without statistical significance. CONCLUSIONS: T2∗ relaxations times were not significantly different from control sites in the articular cartilage overlying JOCD lesions in the MFC or adjacent MT cartilage in early-stage JOCD.

Multiples and parents of multiples prefer same arm randomization of siblings in neonatal trials.

OBJECTIVE: Although common among Neonatal Intensive Care Units, multiples births are randomized inconsistently within trials, which can impact enrollment, analytical approach and trial outcomes. It is not known what randomization approach (same arm, different arm and independent randomization) is preferred by multiples and their families. STUDY DESIGN: Surveys distributed to parents of multiples and adult multiples addressed the preferences on randomization by eliciting the most desired method and likelihood of enrolling twins for each randomization approach. RESULT: Populations included 209 parents and 321 adult multiples. Seventy-eight percent of parents and 59% of multiples prefer same arm placement of multiples over other methods (both P<0.001), which also had highest likelihood of enrollment among both the groups. CONCLUSION: Parents of multiples and adult multiples prefer placement of multiples into same treatment arm in randomized trials, making such methodology a potential way to optimize consent rates while ethically approaching human subject research.

Methylene blue usage in horseshoe kidney graft separation: case report.

Definitive diagnostics and strict procedures during kidney donor qualification are required. Nowadays, precise and accurate imaging techniques are at hand for every diagnostician. However, many studies have described intraoperative occurrence of horseshoe kidney. Although the harvesting procedure in the case of horseshoe kidney is not technically difficult, graft separation for successful renal transplantation is a challenge. The complex anatomy of malformed organs causes issues during kidney separation. This procedure may lead to damage of the collecting urinary system as well as vascularization damage. Separate graft transplantation is probable when a thin isthmus in a horseshoe kidney is present. Otherwise, poor graft function may occur. We present a technique for horseshoe kidney separation with the use of methylene blue for vascularization determination. The above-mentioned procedure was performed with the methylene blue solution dose injected into a single renal graft artery. Even with the malformed organ's thick isthmus, the exact incision line was identified, exposing vascular perfusion asymmetry and allowing precise renal graft separation.

A student leadership model for promoting educational programs in organ donation and transplantation.

The global organ shortage is the strongest factor for the increase in transplant wait time and deaths on waitlists. Here we describe a model for involving high school students in education research around organ donation and transplantation and capitalize on the strength of a pre-existing educational program offered by the local organ procurement organization (OPO). While training in education research at Cleveland Clinic, a high school student embarked on a collaborative project with the local OPO. The project involved evaluating three educational programs, selecting the most appropriate program for administration at her school, coordinating with the student's school administration and teachers, administering an assessment tool for the effectiveness of the program, and analyzing the results. The local OPO program that was selected for implementation consisted of a video presentation entitled "Share your life, share your decision" prepared by the United States Health Resources and Services Administration (HRSA), lectures by invited speakers and an educational assessment (pre- and post-education). The assessment survey included 3 multiple choice and 7 true/false questions. Compared to the over 2500 programs administered in the last 5 years by the local OPO, this program had a higher volume of participation (n = 353 compared to an average of 150 students/day). Students correctly classified transplantation status of more organ and tissues post-education (P < .0001 for both). For 5 out of the 7 true/false questions, students correctly answered questions more frequently post-education (P ≤ .002 for all). This experience included for the first time a formal assessment of the program which will be utilized to address targeted areas for specific improvements. This student collaborative model of involving students in organ donation and transplantation related education research has the potential to promote and maximize the effectiveness of educational programs targeting their peers.

Crystal structure of N-(tri-O-acetyl-alpha-D-xylopyranosyl)pyridinium bromide.

The structure of N-(2,3,4-tri-O-acetyl-alpha-D-xylopyranosyl)pyridinium bromide was determined by X-ray crystallography and 1H NMR spectroscopy. Two xylopyranosyl moieties crystallize with three water molecules and there is a novel pattern of Br(-) and H(2)O contacts. Both xylopyranosyl rings in the asymmetric unit have the 1C(4) conformation, with all three axial O-Ac groups.

Molecular and crystal structures of N-(beta-D-galactopyranosyl)pyridinium bromide and its per-O-acetylated derivative.

1H NMR spectroscopy and X-ray diffraction data are described for N-(2,3,4,6-tetra-O-acetyl-beta-D-galactopyranosyl)pyridinium bromide and N-(beta-D-galactopyranosyl)pyridinium bromide. X-ray crystallography revealed that the O-acetylated salt crystallizes with two molecules of water and one molecule of ethanol.

Preparation, chemical and crystal structures of N-(2-acetamido-3,4,6-tri-O-acetyl-2-deoxy-beta-D-glucopyranosyl)pyridinium chloride.

Preparation and isolation of N-(2-acetamido-3,4,6-tri-O-acetyl-2-deoxy-beta-D-glucopyranosyl)pyridinium chloride are described. Its structure was determined by 1H NMR spectroscopy and X-ray analysis. X-ray crystallography revealed that the salt crystallizes with one molecule of water. Ab initio calculations were used to determine charges on atoms in the cation of the title compound.