Assessment of changing patterns of Le fort fracture lines using computed tomography scan: an observational study

Objectives. To assess the changing mid-face fracture patterns using a computed tomography scan. Methodology: Fifty patients with mid-face trauma requiring open reduction and fixation were studied using 1.6 mm axial, sagittal, coronal and 3D images. Images were evaluated clinically, intra-operatively and finally were compared with standard Le Fort lines. Results. The male population dominated the female at a ratio of 11.5:1. The majority of the mid-face fractures were seen in the age group of 21–30 years. Road traffic accident (78%) was the major etiological factor followed by work-related accidents (12%) and assaults (10%). The CT scan analysis included categorizing the patients into three groups: (1) Fracture patterns resembling Le Fort lines (24%); (2) Fracture patterns partially resembling Le Fort lines (56%); and (3) Fracture patterns that do not resemble Le Fort lines (20%). Conclusion. With the change in the velocity of wounding object, there is a change in the mid-face fracture patterns. The majority of the cases present as a variant of classical Le Fort fractures. Computed tomography is a valuable diagnostic tool in assessing the fractures of the mid-face. 2D images are more sensitive than 3D images. However, both the images are required in delivery of an optimal treatment plan.     

Transverse Aortic Arch to Descending Aorta Ratio: A New Echocardiographic Parameter for Management of Coarctation of the Aorta in the Infant

Objective. The purpose of this study was to establish an objective criterion to help assess adequacy of the transverse arch in newborns with coarctation and thereby optimize preoperative surgical decision making. Methods. Echocardiograms of 47 patients <6 months of age who underwent coarctation repair from September 2005 to November 2008 and 47 age‐matched healthy infants were reviewed. The proximal and distal transverse aortic arch to descending aorta ratios (TAA : DAO ratio) were calculated from the end‐systolic proximal and distal transverse aortic arch diameters and diameter of the descending aorta at the diaphragm. Results. Both the proximal and distal TAA : DAO ratios were significantly lower in the study vs. control group (P= .001) and in patients who underwent patch reconstruction of the aorta vs. extended end‐to‐end anastomosis (P= .014; P= .015). All patients who underwent patch reconstruction had a proximal and/or distal TAA : DAO <0.65. A cutoff of 0.65 was derived based on our analyses and an algorithm was developed to guide decision making. Forty‐six out of 47 patients were free from reintervention. Conclusion. The TAA : DAO ratio appears to be an accurate parameter by which the adequacy of the transverse arch can be assessed preoperatively using the proposed algorithm, and thus help determine the type of surgical intervention and approach.     

INAUGURAL ARTICLE by a Recently Elected Academy Member:Plant immunity: Rice XA21-mediated resistance to bacterial infection

In this article, we describe the development of the plant immunity field, starting with efforts to understand the genetic basis for disease resistance, which ∼30 y ago led to the discovery of diverse classes of immune receptors that recognize and respond to infectious microbes. We focus on knowledge gained from studies of the rice XA21 immune receptor that recognizes RaxX (required for activation of XA21 mediated immunity X), a sulfated microbial peptide secreted by the gram-negative bacterium Xanthomonas oryzae pv. oryzae. XA21 is representative of a large class of plant and animal immune receptors that recognize and respond to conserved microbial molecules. We highlight the complexity of this large class of receptors in plants, discuss a possible role for RaxX in Xanthomonas biology, and draw attention to the important role of sulfotyrosine in mediating receptor–ligand interactions.

Perception of extracellular signals by cell-surface receptors is of central importance to eukaryotic development and immunity. For example, in the absence of an adaptive immune system, plants rely on a repertoire of innate immune receptors to recognize potential pathogens and initiate defensive responses. A key research focus of the P.R. laboratory is to understand the principles and mechanisms that underlie the processes governing the immune response.Here we describe our 30-y effort to dissect the genetic and molecular basis of the innate immune response in the staple food crop and model organism rice Oryza sativa.     

Reforms in VUmc School of Medical Sciences Amsterdam: Student engagement,a Minor elective semester and stakeholder collaboration in improving the quality of assessments

Abstract

Background: At VUmc School of Medical Sciences, major curricular reforms occurred in 2005 and 2015, related to the introduction of a Bachelor-Master structure, a new legislation from the Ministry of Education, the changing societal context, and taking note of students’ and teachers’ needs.

Summary of work: Along with the introduction of the Bachelor-Master system, the period between 2005 and 2009 saw the movement from traditional lecture-based teaching to small group teaching in a competency-based curriculum, in which the students were responsible for their learning. Student engagement grew through students’ designing learning modules and conducting some of the teaching. In the Bachelor program, an elective “Minor”, was designed to broaden and deepen the knowledge of our students beyond the core learning outcomes, in a discipline of their choice. The examination board (EB), responsible for maintaining the quality of assessment, was split into the General EB, which handled overall strategy issues, and the Executive EB, which handled student requests and monitored the quality of assessments.

Lessons learned: Students develop a sense of what education is about if they are provided opportunities in designing teaching and conducting it. A Minor elective in the medical study can provide the students with an opportunity to learn outside the medical field. Collaborative working between different stakeholders in a medical school is crucial for safeguarding the quality of assessments. Curricular reforms need time to be accepted and integrated into the culture of the medical school. The educational vision needs to be refreshed regularly in alignment with the changing societal context.     

Artificial Intelligence Based Skin Classification Using GMM

The number of computer game users is increasing as computers and various IT devices in connection with the Internet are commonplace in all ages. In this research, in order to find the relevance of behavioral activity and its associated biosignal, biosignal changes before and after as well as during computer games were measured and analyzed for 31 subjects. For this purpose, a device to measure electrocardiogram, photoplethysmogram and skin temperature was developed such that the effect of motion artifacts could be minimized. The device was made wearable for convenient measurement. The game selected for the experiments was League of Legends?. Analysis on the pulse transit time, heart rate variability and skin temperature showed increased sympathetic nerve activities during computer game, while the parasympathetic nerves became less active. Interestingly, the sympathetic predominance group showed less change in the heart rate variability as compared to the normal group. The results can be valuable for studying internet gaming disorder.     

Managing rheumatoid arthritis during COVID-19

Clinical Rheumatology - The outbreak of coronavirus in the world has led to an uncertainty about treatment of patients with autoimmune disorders because of their weakened immune system coupled with...