How real is a virtual interview? Perspectives of orthopaedic surgery residency directors

OBJECTIVE

As a result of COVID-19 pandemic, the 2021 US residency MATCH was devoid of the traditional in-person interviews. Herein, we assess the impact of Virtual Interviews (VIs) on resident selection, from the perspectives of Orthopedic Surgery (OS) Program Directors (PDs).

MATERIALS AND METHODS

A 14-item survey was sent to PDs of ACGME-accredited OS residencies. Questions were designed to assess the pros, cons, and robustness of VIs compared to their antecedent in-person format.

RESULTS

Forty-seven PDs responded to our survey. VIs antagonized PDs' ability to assess applicants' fit to program (76.6%), commitment to specialty (64%), and interpersonal skills (68.1%). This led to heavier dependence upon applicants' portfolios (64%). Almost all respondents (97.9%) found VIs to be more cost-efficient, saving a median of $3000 in interview-related expenses. Overall, only 8.5% of PDs were willing to conduct exclusive VIs in future cycles, compared to the majority in favor of dual formats (51.5%) or exclusive in-person interviews (40.4%).

CONCLUSIONS

VIs have been an overall success, making most PDs opt for dual interview formats in future cycles. How this technology is further implemented in the future remains to be seen.

Improved calendar disc scheduler for LTE advanced networks with HARQ

Long Term Evolution Advanced (LTE-A) is a broadband wireless technology that supports variety of services with different data rate. In order to achieve this the evolved Node B (eNB) uses different features provided in the 3GPP standards. Features like Carrier Aggregation (CA), Multiple input and Multiple output (MIMO) and Hybrid Automatic Repeat Request (HARQ) help to increase the throughput and spectral efficiency. In this paper, a novel two-level calendar disc algorithm with HARQ is introduced at the eNB for effectively scheduling real time and non-real time traffic with different service types. The algorithm also uses a burst profile management module that analyzes the current user profile and notifies the scheduler about the need to change in profile based on power boosting. The Calendar Disc Scheduler (CDS) is improved by adding HARQ retransmission index as a parameter in calculating the metric weight. The scheduler was tested for both adaptive and non-adaptive methods of HARQ in both synchronous and asynchronous modes. The proposed improved CDS scheduler was simulated with LTESim simulator and compared with calendar disc algorithm without HARQ improvements. Results show that the proposed scheduling method provides increased performance in terms of goodput, delay and spectral efficiency.

Can subcentimetre ultrasound detected angiomyolipomas be safely disregarded?

AIM

To optimise follow-up by dismissing lesions on baseline ultrasound (US) if renal lesions conform to US criteria of an angiomyolipoma (AML).

METHOD AND MATERIALS

The present study was a 10-year retrospective review of patients who were found to have incidental hyperechoic renal lesions on US to ascertain the outcome from subsequent imaging, clinical encounters, and cancer registrations. Exclusions included renal calculi, tuberous sclerosis, Von-Hippel-Lindau, or a known cancer.

RESULTS

After excluding 39 patients, 1,493 patients were identified. One hundred and sixty had more than one lesion with 87 patients having bilateral lesions. Regardless of indication, 889 patients had subsequent imaging within 5 years (59.5%). The average size of all AMLs was 13.2 mm. In the group with lesions that were <10 mm (807), 438 had imaging follow-up with an average follow-up time of 1.5 years. Mean lesion size in this group was 7 mm, with an average increase of <0.5 mm on follow-up. No lesions were found to be malignant on subsequent imaging nor did any of these patients have a subsequent renal cancer diagnosis registered at local multidisciplinary team meetings.

CONCLUSION

No incidental subcentimetre hyperechoic renal lesion with imaging characteristics of an AML demonstrated significant growth or developed into a malignancy on follow-up.

PI-RADS version 2.1: one small step for prostate MRI

Multiparametric (mp) prostate magnetic resonance imaging (MRI) is playing an increasingly prominent role in the diagnostic work-up of patients with suspected prostate cancer. Performing mpMRI before biopsy offers several advantages including biopsy avoidance under certain clinical circumstances and targeting biopsy of suspicious lesions to enable the correct diagnosis. The success of the technique is heavily dependent on high-quality image acquisition, interpretation, and report communication, all areas addressed by previous versions of the Prostate Imaging-Reporting and Data System (PI-RADS) recommendations. Numerous studies have validated the approach, but the widespread adoption of PI-RADS version 2 has also highlighted inconsistencies and limitations, particularly relating to interobserver variability for evaluation of the transition zone. These limitations are addressed in the recently released version 2.1. In this article, we highlight the key changes proposed in PI-RADS v2.1 and explore the background reasoning and evidence for the recommendations.

Assessment of the inferior mesenteric vein diameter as a surrogate marker to evaluate response to neoadjuvant chemoradiotherapy for locally advanced rectal adenocarcinoma

AIM

Neoadjuvant chemoradiotherapy for locally advanced rectal cancer aims to downstage prior to definitive management. Repeat imaging assessment of the tumour post-therapy has implications for treatment. Our aim was to assess if the inferior mesenteric vein (IMV) diameter measured on CT can be used as a surrogate marker for evaluation of tumour response to neoadjuvant treatment.

METHOD

IMV diameter was assessed in patients with and without locally advanced rectal cancer, pre- and post-radiotherapy, to ascertain if IMV diameter is a surrogate marker of tumour response.

RESULTS

IMV diameter was 5.9 mm in patients with rectal cancer vs 4.7 mm in patients without (P = 0.0001). The baseline IMV diameter was significantly higher for cases with local lymphadenopathy [N0 5.2 mm vs N1/2 6 mm (P = 0.0059)] and extramural venous invasion (EMVI) [negative 5.4 mm vs positive 6.4 mm (P = 0.0001)]. Post-radiotherapy there was a significant decrease in the IMV diameter in cases with treatment response compared to non-responders: the percentage change in IMV diameter was a 17.54% decrease vs 1.39% increase (P = 0.0001). These results were reproduced on comparing between magnetic resonance tumour regression grades using ANOVA (P = 0.0001). There was also a significant decrease in IMV diameter when assessing lymph node (LN) and EMVI response vs non-responders (P = 0.0001 and 0.0001 respectively).

CONCLUSION

Patients with rectal cancer have a dilated IMV compared with patients without rectal cancer. We confirm that IMV diameter is a potential surrogate marker of LN status and EMVI at baseline. IMV diameter is also a marker of tumour, LN and EMVI response to chemoradiotherapy.

Kimura's disease: A case presentation of postauricular swelling

Kimura's disease (KD) is a rare chronic inflammatory disease of subcutaneous tissues and occurs predominantly in head and neck region. It is seen primarily in young Asian males. Typical clinical presentations are painless subcutaneous masses, regional lymph node enlargement, blood and tissue hypereosinophilia, and increased serum IgE levels. Here, we present a case of a 27-year-old female who presented with unilateral single nodular swelling in the right postauricular region. The diagnosis of KD was done based on characteristic histopathologic finding in conjunction with peripheral eosinophilia and increase in serum IgE levels.

Central mucoepidermoid carcinoma

Central mucoepidermoid carcinomas (MECs) are extremely rare tumors, comprising 2-3% of all MECs reported in the literature. We report a rare case of clear cell variant of central MEC with calcifications occurring in the left posterior mandible in a 37-year-old male patient.

Vascular malformations of central nervous system: A series from tertiary care hospital in South India

Aims and Objectives:

To describe clinicopathological features of surgically resected vascular malformations (VMs) of central nervous system (CNS).

Materials and Methods:

Histologically diagnosed cases of VMs of CNS during April 2010–April 2014 were included. Demographic data, clinical and radiological features were obtained. Hematoxylin and eosin slides were reviewed along with Verhoeff-Van Gieson (VVG), Masson's trichrome, periodic acid-Schiff, and Perls' stains. Morphologically, cavernomas and arteriovenous malformations (AVMs) were distinguished on the basis of vessel wall features on VVG and intervening glial parenchyma.

Results:

Fifty cases were diagnosed as VMs of CNS with an age range of 14–62 years. These included 36 cavernomas, 12 AVMs, 2 mixed capillary-cavernous angiomas. Most of the cavernoma patients (15/36) presented with seizures, whereas AVM patients (8/12) had a headache as the dominant symptom. Twenty-nine patients were reliably diagnosed on radiological features. Microscopic evidence of hemorrhage was seen in 24/36 cavernomas and 6/12 AVMs, as opposed to radiologic evidence of 10 and 4, respectively. Reactive gliosis was seen in 16 cavernomas.

Conclusions:

Histological features are important for classifying the VMs of CNS as there are no specific clinical and radiological features. Type of VM has a bearing on management, prognosis, and risk of hemorrhage.

Evaluation of palatal rugae pattern in establishing identification and sex determination in Nalgonda children

BACKGROUND

Establishing individual identification of a decedent only by dental means is a mammoth task in forensic odontology. Palatal rugae's uniqueness, its resistance to heat, and stability throughout life have been proved by its use as an alternative aid in individual identification where comparison of fingerprints and other records is difficult.

AIMS AND OBJECTIVES

The aim of the present study was to analyze the role of palatal rugoscopy in personal identification and sex determination of Nalgonda pediatric population.

MATERIALS AND METHODS

The study group consisted of 100 children having mixed dentition within the age range of 8-11 years, residing in Nalgonda district. Palatal rugae pattern, shape of the incisive papillae, length of the median palatal raphae, and shape of the dental arches were analyzed using Chi-square and Mann-Whitney tests between males and females.

RESULTS

Wavy and curved patterns appeared to be most prevalent in both males and females but with no significant difference. The number of primary rugae in females and secondary rugae in males, on left side of the palate, was significantly more than their counterparts (P < 0.05). When rugae unification was observed, diverging type was significantly more in males than in females. Parabolic dental arch form, elliptical type of incisive papilla, and medium length of median palatal raphae was observed in majority of the subjects.

CONCLUSION

The present study hypothesizes the uniqueness of the rugae in personal identification as no two palates showed similar type of rugae in either of the genders. The rugae pattern also contributes minimally towards sex determination as there was no significant difference observed between the two variables.