Hurricane Ida Emergency Medicine Resident Disaster Response.

This report describes the medical response, action plan, and after-action summary adopted by the Louisiana State University (LSU) New Orleans - Emergency Medicine (EM) Residency Program in response to Hurricane Ida which occurred in New Orleans, Louisiana (USA) late August through early September 2021. New Orleans has an estimated 385,000 people within the 350 square miles surrounding the metropolitan area, with greater than one million residents in all of Louisiana. In the two-week time span during and following the event, residents, nurses, attendings, ancillary staff, and Emergency Medical Services (EMS) managed a substantial intensification in daily EM activities due to a substantial lack of resources (ie, food, electricity, water, housing, medications, oxygen, and primary care). This report outlines the redistribution of emergency department (ED) residents within the primary clinical site, University Medical Center New Orleans (UMCNO); describes the daily communication flow from the chief residents and program director; describes the daily EM response; describes the pre- and post-action plans based on those efforts during hurricane operations; and summarizes the obtained information.

The Ratio of the Distal Femur Width to the Tibial Plateau Width with Advancing Age.

Historically, intraoperative analysis of knee fracture procedures relied upon a fluoroscopic reduction assessment by the surgeon. This is a subjective assessment due to the lack of linear measurement reference data. Compared with the knee, the ankle and wrist have well-established bony anatomical relationships to guide reduction assessment during fracture treatment. The purpose of this study was to (1) determine the width ratios in the knee (plateau to femur) with aging, and (2) determine knee width changes with aging. One-hundred and fifty consecutive uninjured knee radiographs were reviewed. In all age groups, the width ratio of the articular distal femoral (ADF) to the articular tibial plateau (ATP) is greater than 1.0 and between 1.03 and 1.05. The tibia plateau width is on average 9.34 mm wider and the femoral width is 8.0 mm wider in the 61 to 80 age group than the ATP and the ADF in the younger age groups. In conclusion, the articular tibial plateau width and the articular distal femoral width are nearly equal across ages 20 to 80 years. An absolute articular width value by age cannot be assigned because articular widths change with aging.

Thermal Output of Oscillation Versus Forward Drilling of Bone.

This study's objective was to identify a difference in maximum temperature change during forward versus oscillating drilling of cadaveric bone. Paired femurs were dissected from the soft tissue of five cadavers. Each cadaver had one femur assigned to forward and the other to oscillation. The first drill hole was 2.5 cm distal to the lesser trochanter and the remaining 10 holes were evenly spaced 2 cm apart. A System 7 drill and 3.5 mm drill bit were attached to an Instron 5500R to provide a progressive force of 50 Newtons per minute for each drill hole. A thermal camera recorded each drilling. A new drill bit was used for each femur. Fifty bicortical drillings were analyzed in each group. The average time to complete forward drilling (45.0 seconds) was shorter compared to oscillation (55.5 s, p < 0.001). The average force required for forward drilling (27.7 N) was lower than for oscillation (44.3N, p < 0.001). The maximum change in temperature during the drilling process was similar (oscillating 100.2° F vs. forward 100.7° F, p = 0.871). The maximum change in temperature at the near cortex was lower for oscillation (78.1°F) compared to forward drilling (89.1°F, p = 0.011), while the maximum change at the far cortex was lower for forward drilling (89.3°F) compared to oscillation (95.8°F, p = 0.115) but not significantly. Overall, there is no difference in the thermal output between techniques. Oscillation may be beneficial in proximity to vital structures or to navigate narrow bony corridors, but it requires additional time and force. (Journal of Surgical Orthopaedic Advances 31(4):233-236, 2022).

Technical Trick: Dual Plate Fixation of Periprosthetic Distal Femur Fractures.

SUMMARY: Treatment of periprosthetic distal femur fractures remains challenging due to assuring adequate distal fixation. Traditional treatment options include lateral locked plating and retrograde nailing, although recently dual implant constructs have been explored with promising results. Allowing immediate weight-bearing in this patient population has benefits with regards to rehabilitation and outcome. Recent literature has focused on nail-plate constructs, however plate-plate constructs are preferred at our institution as they do not require arthroplasty component compatibility, facilitate the coronal plane reduction, and allow for immediate weight-bearing.

Evaluation of the spatter-reduction effectiveness and aerosol containment of eight dry-field isolation techniques.

OBJECTIVE: The novel coronavirus that was first identified in Wuhan, China, in December 2019, created a pandemic that has the potential to change the paradigm of health care delivery. Of interest to the dental community is the presence of SARS-CoV-2 in the saliva of the affected patients that can potentially cause transmission of COVID-19 via droplets. The highly infectious nature of the pathogen has created a sense of urgency and a need for extra caution to prevent the spread of the disease and the potential infection of patients and the entire dental team. Spatter consists of droplets up to 50 µm in size that are effectively stopped by barriers such as gloves, masks, and gowns. Aerosols are defined as droplet particles smaller than 5 µm that can remain airborne for extended periods and that have been reported to be significant in viral respiratory infections. In this study, aerosol represented by particulate matter with a size of 2.5 µm (PM2.5) was measured. METHOD AND MATERIALS: Eight dry-field isolation methods were tested in a setup that included a realistic dental manikin and a high-speed handpiece that generated air-water spray. Environmental noise generated by the suction devices, suction flow rate of each setup, and the amount of environmental spatter and aerosols, were measured. RESULTS: The experimental setups showed significant variability in the suction flow rate, but this was not correlated to the level of sound generated. Some experimental setups caused a short-term level of noise that exceeded the NIOSH (National Institute for Occupational Safety and Health) guidelines and were close to the OSHA (Occupational Safety and Health Administration) recommended thresholds. It is also worth noting that the variability in the flow rate is not reflected in the efficacy of the experimental setups to mitigate spatter. All experimental setups, except the IsoVac system, provided statistically significantly better spatter mitigation compared to the control. All experimental setups also were efficient in mitigating aerosols compared with the positive control (P < .0001) and most systems yielded results similar to the negative control ambient PM (P > .05). CONCLUSION: Results indicate that spatter reduction was significantly better amongst the setups in which an additional high-volume evacuator (HVE) line was used. All setups were efficient at mitigating PM2.5 aerosols in comparison to the control. The conclusions of this study should be interpreted with caution, and additional mitigation techniques consistent with the Centers for Disease Control and Prevention recommendations must be implemented in dental practices.

Cubital tunnel syndrome: a surgical modification to in situ decompression to improve results.

BACKGROUND: The gold standard for surgical treatment of cubital tunnel syndrome is in situ decompression. However, this procedure does not come without complications. Subluxation of the ulnar nerve and ulnar nerve neuritis from adhesion formation remain 2 potential complications after this procedure. It has been shown in the literature that young, active, male patients are most likely to have these complications postoperatively. We have developed a modification to in situ decompression by developing a fascial turnover flap and using a porcine submucosa extracellular matrix (Axogen) to help reduce both ulnar nerve subluxation and adhesion formation postoperatively. METHODS: Thirteen patients underwent cubital tunnel surgery by the highlighted technique to prevent postoperative ulnar nerve subluxation and adhesion formation. Patient outcomes including elbow range of motion, functional status, paresthesia, and grip strength were recorded. RESULTS: Of the 13 patients, 10 had excellent results, 1 had a good result, and 2 required revision with anterior transposition of the nerve. The mean Mayo Elbow Performance Score of the 11 patients not needing revision was 92.7. CONCLUSION: The described surgical technique provides surgeons with the ability to directly decompress the ulnar nerve while decreasing postoperative complications such as instability and adhesion formation.

The effect different substrates have on the trueness and precision of eight different intraoral scanners.

OBJECTIVE: This in vitro study compares the newest generation of intraoral scanners to their older counterparts, and tests whether material substrates affect the trueness and precision of intraoral scanners (IOS). MATERIAL AND METHODS: A custom model, used as the reference standard, was fabricated with teeth composed of different dental materials. The reference standard scan was obtained using a three-dimensional (3D) optical scanner, the ATOS III. Experimental scans were obtained using eight different IOS, operated by experienced clinicians, using the manufacturer's recommended scanning strategy. A comprehensive metrology program, Geomagic Control X, was used to compare the reference standard scan with the experimental scans. RESULTS: For all scanners tested, except Trios3, the substrate does influence the trueness and precision of the scan. Furthermore, differences exist when comparing the same substrate across different scanners with some of the latest generation scanners clearly leaping ahead of the older generation regarding both trueness and precision. CONCLUSIONS: Substrate type affects the trueness and precision of a scan. Active Triangulation scanners are more sensitive to substrate differences than their parallel confocal counterparts. Some scanners scan certain substrates better, but in general the new generation of scanners outperforms the old, across all substrates. CLINICAL SIGNIFICANCE: The substrates being scanned play an import role in the trueness and precision of the 3D model. The new generation of scanners is remarkably accurate across all substrates and for complete-arch scanning.

Paranasal sinus opacification-to-pneumatization ratio applied as a rapid and validated clinician assessment.

BACKGROUND: The utility of clinician-applied instruments, particularly the Lund-Mackay score, in the assessment of paranasal sinus computed tomography (CT) in chronic rhinosinusitis (CRS) remains incompletely defined. The purpose of this study was to determine if a new approach to the evaluation of sinus CT could accurately predict the extent of opacification while remaining simple for clinician use. METHODS: Twenty-four sinus CT scans were measured for the percent of sinus opacification using three-dimensional (3D) volumetric analyses. The same scans were also evaluated using the Lund-Mackay score to measure opacification and the Assessment of Pneumatization of the Paranasal Sinuses (APPS) score to measure total sinus volume (TSV). Correlation analysis was performed for the Lund-Mackay to APPS score ratio as a predictor of percent opacification. Validation analysis was also performed to determine the optimal orientation for Lund-Mackay scoring, which has not previously been described. RESULTS: The Lund-Mackay to APPS score ratio was very strongly correlated with the percentage of sinus opacification measured by 3D volumetric analysis (r = 0.862, r2 = 0.743, p < 0.001). Lund-Mackay scoring was not statistically different between axial-only, coronal-only, or triplanar groups for interrater (p = 0.379) and intrarater reliability (p = 0.312). CONCLUSION: The Lund-Mackay score is validated for rater reliability in multiple orientations. Using the APPS score as a measure of TSV, the Lund-Mackay-to-APPS ratio very strongly correlates with the percentage of sinus opacification by 3D volumetric analysis. Further study will be required to determine if this ratio is predictive of symptom severity.

Clinician assessment of paranasal sinus pneumatization is correlated with total sinus volume.

BACKGROUND: The Assessment of Pneumatization of the Paranasal Sinuses (APPS) score is a novel and validated instrument for comprehensively evaluating the pneumatization pattern of the sinuses. Previous studies on the relationship between sinus pneumatization and clinical parameters have been hindered by cumbersome volume analysis. The purpose of this study was to determine whether the APPS score correlates with total sinus volume. METHODS: Semiautomated 3-dimensional (3D) volume analysis of 20 consecutive sinus computed tomography (CT) scans was performed. Total paranasal sinus volume (TSV) for each scan was then calculated. Relative total paranasal sinus volume (RTSV) was calculated by dividing TSV by the volume of the right globe. An independent reviewer then scored each CT scan using the APPS instrument. The elapsed time to perform 3D analysis and APPS scoring was recorded for each CT scan. RESULTS: The APPS score was strongly correlated with TSV by Pearson's correlation coefficient (r = 0.893). The coefficient of determination (r2 ) was 0.797. The APPS score was also strongly correlated with RTSV (r = 0.851, r2 = 0.724). The mean elapsed time of 3D volume analysis for each CT scan was significantly greater than for APPS scoring (1187 vs. 37 seconds, p < 0.001). CONCLUSION: The APPS score correlates strongly with both TSV and RTSV. Evaluation of paranasal sinus pneumatization by APPS score is also significantly faster than a semiautomated method for 3D volumes. The APPS instrument can be used to study large populations for relationships between clinical parameters and sinus volume.

Evaluation of the Marginal Fit of CAD/CAM Crowns Fabricated Using Two Different Chairside CAD/CAM Systems on Preparations of Varying Quality.

PURPOSE: This study evaluated the marginal gap of crowns fabricated using two new chairside computer-aided design/computer-aided manufacturing systems on preparations completed by clinicians with varying levels of expertise to identify whether common preparation errors affect marginal fit. The null hypothesis is that there is no difference in the mean marginal gaps of restorations of varying qualities and no difference in the mean marginal gap size between restorations fabricated using the PlanScan (D4D, Richardson, TX, USA) and the CEREC Omnicam (Sirona, Bensheim, Germany). MATERIAL AND METHODS: The fit of 80 lithium disilicate crowns fabricated with the E4D PlanScan or CEREC Omnicam systems on preparations of varying quality were examined for marginal fit by using the replica technique. These same preparations were then visually examined against common criteria for anterior all-ceramic restorations and placed in one of four categories: excellent, good, fair, and poor. Linear mixed modeling was used to evaluate associations between marginal gap, tooth preparation rating, and fabrication machine. RESULTS: The fit was not significantly different between both systems across all qualities of preparation. The average fit was 104 µm for poor-quality preparations, 87.6 µm for fair preparations, 67.2 µm for good preparations, and 36.6 µm for excellent preparations. CONCLUSION: The null hypothesis is rejected. It can be concluded that preparation quality has a significant impact on marginal gap regardless of which system is used. However, no significant difference was found when comparing the systems to each other. CLINICAL SIGNIFICANCE: Within the limitations of this in vitro study, it can be concluded that crown preparation quality has a significant effect on marginal gap of the restoration when the clinician uses either CEREC Omnicam or E4D PlansScan.

Synthesis of a 2-aryl-3-aroyl indole salt (OXi8007) resembling combretastatin A-4 with application as a vascular disrupting agent.

The natural products colchicine and combretastatin A-4 are potent inhibitors of tubulin assembly, and they have inspired the design and synthesis of a large number of small-molecule, potential anticancer agents. The indole-based molecular scaffold is prominent among these SAR modifications, leading to a rapidly increasing number of agents. The water-soluble phosphate prodrug 33 (OXi8007) of 2-aryl-3-aroylindole-based phenol 8 (OXi8006) was prepared by chemical synthesis and found to be strongly cytotoxic against selected human cancer cell lines (GI50 = 36 nM against DU-145 cells, for example). The free phenol, 8 (OXi8006), was a strong inhibitor (IC50 = 1.1 µM) of tubulin assembly. The corresponding phosphate prodrug 33 (OXi8007) also demonstrated pronounced interference with tumor vasculature in a preliminary in vivo study utilizing a SCID mouse model bearing an orthotopic PC-3 (prostate) tumor as imaged by color Doppler ultrasound. The combination of these results provides evidence that the indole-based phosphate prodrug 33 (OXi8007) functions as a vascular disrupting agent that may prove useful for the treatment of cancer.

Synthesis, in vitro, and in vivo evaluation of phosphate ester derivatives of combretastatin A-4.

Combretastatin A-4 disodiumphosphate (CA4P), a prodrug formulation of the natural product combretastatin A-4 (CA4), is currently in clinical investigation for the treatment of cancer. In vivo, CA4P is rapidly enzymatically converted to CA4, a potent inhibitor of tubulin polymerization (IC(50)=1-2 microM), and rapidly causes bloodflow shutdown in tumor tissues. A variety of alkyl and aryl di- and triesters of CA4P have been synthesized and evaluated as potential CA4 prodrugs and/or stable CA4P analogues.

2-(3-tert-Butyldimethylsiloxy-4-methoxyphenyl)-6-methoxy-3-(3,4,5-trimethoxybenzoyl)indole.

In the crystal structure of the title compound, C(32)H(39)NO(7)Si, all geometric parameters fall within experimental error of expected values. The analysis of molecular-packing plots reveals an infinite two-dimensional linear array running parallel to the b axis, formed by one N[bond]H...O intermolecular hydrogen-bonding interaction. Several potential C[bond]H...O interactions are also present.