Play in the reading room: Utilizing soft modeling compound to teach musculoskeletal anatomy and pathology.

PROBLEM DESCRIPTION: Musculoskeletal (MSK) anatomy and pathology from a radiology perspective can be difficult to conceptualize and understand due to the challenge of visualizing 3D structures in stacks of 2D imaging. Consequently, trainees may benefit from inexpensive methods that can help trainees better visualize MSK anatomy and pathology. The purpose of this study is to provide proof of concept for inexpensive methodology to help learners such as radiology residents quickly and inexpensively understand musculoskeletal anatomy and pathology. This can help trainees become better at applying musculoskeletal knowledge to clinical practice. INSTITUTIONAL METHODOLOGY: Soft-modeling compounds such as Play-Doh® was utilized in a variety of colors with pottery tools to recreate 3D models of challenging MSK anatomy and pathology for trainees. Qualitative feedback from the residents was collected. RESULTS: Eighteen different pathological conditions across six major bone structures were modeled with a soft modeling compound. Residents qualitatively identified the experience as educational in terms of helping them better understand MSK pathology and positive in terms of making learning fun, less stressful, and memorable due to uniqueness of the learning modality. Residents report challenges modeling complex anatomical features and pathology via this methodology. CONCLUSION: Radiology residents and other learners can enhance their knowledge of musculoskeletal anatomy and pathology via utilization of inexpensive soft modeling compounds. This may offer a cheaper and more time sensitive alternative to current 3-dimensional hardware and software technologies being developed for educational purposes. Additional work needs to be done to examine the utility of this methodology across larger and diverse groups of learners.

The Die Punch Fragment: Analysis of Fragment Geometry and Need for Fixation.

Introduction Die punch (DP) fragments are among the most common fracture fragments to lose reduction after volar locked plating of articular distal radius fractures (DRFs). We aimed to report the number of patients in our institution who had a computed tomography (CT)-confirmed DP fragment and who had open reduction and internal fixation (ORIF) through a dorsal approach; to report the length of the radioulnar portion of the DP fragment relative to the total distal radioulnar joint (DRUJ) length; and to identify if an association exists between this length and the choice for a volar versus a dorsal operative approach to the DP fragment. Materials and Methods We performed measurements on the preoperative CT scans of 94 skeletally mature patients with a DP fragment. We also collected data related to their demographics, injury, and treatment. Of the 94 patients in this study, 84 (89%) had AO type C fractures. Results Thirteen out of 94 patients (14%) who had ORIF of their DRF with a DP fragment had a separate dorsal incision. The mean proportion of the DP fragment length relative to the total DRUJ length was 0.51 ± 0.19. There was no association between the length of the DP fragment and volar versus dorsal approach. Conclusion DP fragment size is not an indicator of the need for or use of a dorsal approach in DRF fixation. Level of Evidence This is a Level IV,-retrospective study.

Thoracic Duct Embolization: Analysis of Practice Patterns.

BACKGROUND: Thoracic duct embolization (TDE) has become the standard treatment for atraumatic and traumatic chylothoraces. Numerous approaches to embolization including intranodal lymphangiography, transabdominal, and retrograde catheterization of the thoracic duct have become the preferred methods for the treatment of chyle leaks. The purpose of this study was to determine training, treatment techniques, outcomes, and practice patterns of practitioners performing TDE. METHODS: From September to October of 2017, a 34-question survey focusing on training, treatment techniques, outcomes, and practice patterns of TDE was distributed through the Open Forum of the Society of Interventional Radiology Connect website. Fifty-four practitioners completed the entire survey. Percentages were calculated for answers to the questions. Chi-squared analysis was performed, comparing data from academic center respondents, private practice settings, and hybrid practice settings. P values < 0.5 were considered statistically significant. RESULTS: All responses were from interventional radiologists. Forty-seven practitioners (87.0%) performed TDE in the United States, and 1 performed (1.9%) abroad; 6 practitioners (11.1%) did not perform TDE. Of all, 88.9% (n = 48) performed TDE in academic (n = 24; 50%), private (n = 17; 35.4%), or hybrid (n = 6; 12.5%) practice settings. For diagnostic lymphangiography, 100% (n = 48) performed intranodal pelvic lymphangiography. A 25-gauge needle was used by 77.1% (n = 37) to access pelvic lymph nodes, and most (83.3%; n = 40) reported using manual hand injection to administer ethiodized oil. Nine of 24 (37.5%) respondents in academic practice and 15 of 23 (65.2%) in private practice were successful in cannulating the thoracic duct >80% of the time. Most referrals were from thoracic surgery (n = 47; 97.9%). CONCLUSIONS: TDE is performed by practitioners in both academic and private practice settings. Treatment techniques were similar for a majority of operators. Technical success rates were higher in private practice. Most referrals were from thoracic surgery.

NF-κB mediated miR-26a regulation in cardiac fibrosis.

Micro-RNAs (miRNAs) are a class of small non-coding RNAs, recently emerged as a post-transcriptional regulator having a key role in various cardiac pathologies. Among them, cardiac fibrosis that occurs as a result from an imbalance of extracellular matrix proteins turnover and is a highly debilitating process that eventually lead to organ dysfunction. An emerging theme on is that miRNAs participate in feedback loop with transcription factors that regulate their transcription. NF-κB, a key transcription factor regulator controls a series of gene program in various cardiac diseases through positive and negative feedback mechanism. But, NF-κB mediated miRNA regulation in cardiac fibrosis remains obscure. Bioinformatics analysis revealed that miR-26a has targets collagen I and CTGF and possesses putative NF-κB binding element in its promoter region. Here, we show that inhibition of NF-κB in cardiac fibroblast restores miR-26a expression, attenuating collagen I, and CTGF gene expression in the presence of Ang II, conferring a feedback regulatory mechanism in cardiac fibrosis. The target genes for miR-26a were confirmed using 3'-UTR luciferase reporter assays for collagen I and CTGF genes. Using NF-κB reporter assays, we determine that miR-26a overexpression inhibits NF-κB activity. Finally, we show that miR-26a expression is restored along with the attenuation of collagen I and CTGF genes in cardiac specific IkBa triple mutant transgenic mice (preventing NF-κB activation) subjected to 4 weeks transverse aortic banding (TAC), compared to wild type (WT) mice. The data indicate a potential role of miR-26a in cardiac fibrosis and, offer novel therapeutic intervention.