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Liu S, Bush K, Bertini J, FU Y, Lewis J, Pham D, Yang Y, Niedermayr T, Skinner L, Xing L, Beadle B, Hsu A, Kovalchuk N. Optimizing Efficiency and Safety in External Beam Radiotherapy Using Automated Plan Check (APC) Tool and Six Sigma Methodology. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Obana KK, Murgai RR, Schur M, Broom AM, Hsu A, Kay RM, Pace JL. Synovial fluid cell counts and its role in the diagnosis of paediatric septic arthritis. J Child Orthop 2019; 13:417-422. [PMID: 31489049 PMCID: PMC6701437 DOI: 10.1302/1863-2548.13.190022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Clinical presentation of paediatric septic arthritis (SA) can be similar to other joint pathologies. Despite potential for infection in all major joints, most diagnostic criteria are based on values from the hip. This study identifies the best joint aspirate values in diagnosing SA in all joints. METHODS In all, 166 patients who underwent 172 joint aspirations at the authors' institution between 01 September 2004 and 01 September 2014 were retrospectively identified. Recorded measures included age, sex, duration of symptoms, fever history, weight-bearing status, aspiration results, serum results and antibiotic administration. Patients were placed in the following four categories: 'culture confirmed SA' (C-SA), 'suspected SA' (S-SA), 'Other' and 'Other-rheumatologic' (Other-R), a subcategory of 'Other'. RESULTS Most common sites of aspiration were the knee (55%) and hip (29%). Diagnostic grouping was as follows: C-SA = 44, S-SA = 45, Other = 83 (Other-R = 21). Fever and non-weight-bearing prior to admission were useful predictors of SA, though in C-SA patients, 21% did not have a fever and 23% could weight bear at the time of admission. Aspirate white blood cell (WBC) count was significantly greater in both C-SA (92 000 cells/hpf) and S-SA (54 000) than in Other (10 000) and Other-R (18 000) patients. The percentage of polymorphonuclear (%PMN) was also significantly greater in C-SA (81.1%) and S-SA (80.9%) than in Other (57.9%) and Other-R (63.3%). CONCLUSION Joint aspirate values, especially %PMN, are valuable in diagnosing SA. Additionally, antibiotics pre-aspiration did not affect %PMN, facilitating subsequent diagnosis of infection. Lastly, while aspirate WBC count was a valuable indicator of SA, this finding is not as definitive as previous research suggests. LEVEL OF EVIDENCE IV Case Series.
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Chrisman SPD, Whitlock KB, Mendoza JA, Burton MS, Somers E, Hsu A, Fay L, Palermo TM, Rivara FP. Pilot Randomized Controlled Trial of an Exercise Program Requiring Minimal In-person Visits for Youth With Persistent Sport-Related Concussion. Front Neurol 2019; 10:623. [PMID: 31316446 PMCID: PMC6611408 DOI: 10.3389/fneur.2019.00623] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/28/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: To evaluate feasibility and acceptability of a sub-threshold exercise program with minimal in-person visits to treat youth with persistent sport-related concussion, and explore efficacy for improving concussive symptoms, health-related quality of life, and fear-avoidance. Study design: We conducted a pilot randomized controlled trial comparing a 6 week sub-threshold exercise program requiring only two in-person visits to active control (stretching) for 12-18 year old youth with persistent sport-related concussion. We measured moderate-to-vigorous physical activity pre- and post-intervention using accelerometry, and increased goals weekly via phone contact. We examined feasibility and acceptability using qualitative interviews. We used exponential regression to model differences in trajectory of concussive symptoms by experimental group, and linear regression to model differences in trajectory of health-related quality of life and fear-avoidance of pain by experimental group. Results: Thirty-two subjects randomized, 30 completed the study (n = 11 control, n = 19 intervention), 57% female. Youth and parents reported enjoying participating in the study and appreciated the structure and support, as well as the minimal in-person visits. Exponential regression modeling indicated that concussive symptoms declined more rapidly in intervention youth than control (p = 0.02). Health-related quality of life and fear-avoidance of pain improved over time, but were not significantly different by group. Conclusions: This study indicates feasibility and potential benefit of a 6 week subthreshold exercise program with minimal in-person visits for youth with persistent concussion. Potential factors that may play a role in improvement such as fear-avoidance deserve further study.
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Skarupa D, Madbak F, Ebler D, Hsu A, Torres MB, Johnson D, Rahmathulla G, Kerwin AJ, Ra J, Shiber J, Crandall M. Prolonged Antibiotics for Drains After Spine Injury Instrumentation for Trauma: Not Prophylactic or Necessary. World Neurosurg 2019; 128:e552-e555. [PMID: 31051302 DOI: 10.1016/j.wneu.2019.04.193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/20/2019] [Accepted: 04/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Antibiotics after spine instrumentation are often extended while the surgical drain is in place, particularly for traumatic injuries. We sought to study if continuing antibiotics past 24 hours affected outcomes. METHODS We performed a retrospective observational study of all patients who underwent spine fixation with hardware and surgical drains for trauma at our institution. We compared the effect of perioperative (≤24 hours of antibiotics) versus prolonged (>24 hours) antibiotics on surgical outcomes. Bivariate and multivariable logistic and linear regression statistics were performed. RESULTS Three hundred and forty-six patients were included in the analysis. On multivariate analysis, antibiotic duration >24 hours did not predict surgical site infection (odds ratio, 2.68; 95% confidence interval, 0.88-8.10, P = 0.08) or mortality (odds ratio, 0.59; 95% confidence interval, 0.10-3.44; P = 0.56). CONCLUSIONS Continuing antibiotics past 24 hours after traumatic spine instrumentation was not associated with improved outcomes. A prospective study to verify these findings may be warranted.
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Kohli N, Hsu A. Young Physician Leaders Represent MSMA at AMA. MISSOURI MEDICINE 2018; 115:505. [PMID: 30643331 PMCID: PMC6312151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Hsu A, Desai N, Paldino MJ. The Unwound Cochlea: A Specific Imaging Marker of Branchio-Oto-Renal Syndrome. AJNR Am J Neuroradiol 2018; 39:2345-2349. [PMID: 30385470 DOI: 10.3174/ajnr.a5856] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Branchio-oto-renal syndrome is an important syndromic cause of hearing loss. Our aim was to determine the test characteristics of the unwound cochlea on temporal bone CT for the diagnosis of branchio-oto-renal syndrome in a cohort of children with hearing loss. MATERIALS AND METHODS Patients were identified retrospectively with a clinical diagnosis of branchio-oto-renal syndrome and CT imaging of the temporal bones. Age-matched controls were also identified with sensorineural hearing loss not related to a diagnosis of branchio-oto-renal syndrome and CT imaging of the temporal bones. All examinations were reviewed by 2 neuroradiologists blinded to the diagnosis of branchio-oto-renal syndrome versus controls for the absence/presence of an unwound cochlea defined as anteromedial rotation and displacement of the middle and apical turns away from the basal turn. RESULTS The final study group comprised 9 patients with branchio-oto-renal syndrome (age range, 1-14 years; mean age, 8.0 ± 4.3 years) and 50 control patients (age range, 1-16 years; mean age, 7.9 ± 4.1 years). The cochlea was subjectively abnormal in all 9 patients. In 8 patients (89%), imaging demonstrated a typical unwound cochlear morphology. By contrast, none of the control subjects demonstrated an unwound cochlea on either side. Statistically, the unwound cochlea was significantly more frequent in the branchio-oto-renal group compared with controls (P < .001). The unwound cochlea was 89% sensitive and 100% specific for the diagnosis of branchio-oto-renal syndrome. CONCLUSIONS The unwound cochlea is a specific imaging marker of branchio-oto-renal syndrome. These findings further support the diagnostic accuracy and therefore the utility of temporal bone imaging in the diagnosis of this disorder.
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Kerwin AJ, Mercel A, Skarupa DJ, Tepas JJ, Ra JH, Ebler D, Hsu A, Shiber J, Crandall ML. Alternative payment models: can (should) trauma care be bundled? Trauma Surg Acute Care Open 2018; 3:e000132. [PMID: 30023432 PMCID: PMC6018872 DOI: 10.1136/tsaco-2017-000132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/17/2018] [Indexed: 01/26/2023] Open
Abstract
Background Recent legislation repealing the Sustainable Growth Rate mandates gradual replacement of fee for service with alternative payment models (APMs), which will include service bundling. We analyzed the 2 years’ experience at our state-designated level I trauma center to determine the feasibility of such an approach for trauma care. Methods De-identified data from all injured patients treated by the trauma service during 2014 and 2015 were reviewed to determine individual patient injury profiles. Using these injury profiles we created the ‘trauma bundle’ by concatenating the highest Abbreviated Injury Scale score for each of the six body regions to produce a single ‘signature’ of injury by region for every patient. These trauma bundles were analyzed by frequency over 2 years and by each year. The impacts of physiology and resource consumption were evaluated by determination of the correlation of the mean and SD of calculated survival probability (Ps) and intensive care unit length of stay (ICU LOS) for each profile group occurring more than 12 times in 2 years. Results The 5813 patients treated over 2 years produced 858 distinct injury profiles, only 8% (71) of which occurred more than 12 times in 2 years. Comparison of 2014 and 2015 profiles demonstrated high frequency variation among profiles between the 2 years. Analysis of injury patterns occurring >12 times in 2 years demonstrated an inverse correlation between the mean and SD for Ps (R2=0.68) and a direct correlation for ICU LOS (R2=0.84). Discussion These data indicate that the disease of injury is too inconsistent a mix of injury pattern and physiologic response to be predictably bundled for an APM. The inverse correlation of increasing SD with increasing ICU LOS and decreasing Ps suggests an opportunity for measurable process improvement. Level of evidence Economic and value-based evaluations, level IV. Study type Economic/decision.
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Hsu A, Kohli N. YPS Report: The Role of Private Equity in Medicine. MISSOURI MEDICINE 2018; 115:333. [PMID: 30228757 PMCID: PMC6140252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Nielsen ES, Hsu A, Patil S, Colwell CW, D'Lima DD. Second-Generation Electronic Ligament Balancing for Knee Arthroplasty: A Cadaver Study. J Arthroplasty 2018; 33:2293-2300. [PMID: 29555494 DOI: 10.1016/j.arth.2018.02.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 02/12/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Knee instability is emerging as a major complication after total knee arthroplasty (TKA), with ligament laxity and component alignment listed as important contributory factors. Knee balancing remains an art and is largely dependent on the surgeon's subjective "feel." The objectives were to measure the accuracy of an electronic balancing device to document the magnitude of correction in knee balance after soft-tissue releases and measure change in knee laxity after medial release. METHODS The accuracy of a second-generation electronic ligament-balancing device was compared with that of 2 mechanical balancing instruments. TKA was performed in 12 cadaver knees. Soft-tissue balance was measured sequentially before TKA, after mounting a trial femoral component, after medial release, and after resecting the posterior cruciate ligament. Coronal laxity of the knee under a 10 Nm valgus moment was measured before and after medial release. RESULTS The electronic balancing instrument was more accurate than mechanical instruments in measuring distracted gap and distraction force. On average, before TKA, the flexion gap was wider than the extension gap, and the medial gap was tighter than the lateral gap. Medial release increased the medial gap in flexion and increased passive knee valgus laxity. Posterior cruciate ligament release increased the tibiofemoral gap in both flexion and extension with a greater increase in the lateral gap. CONCLUSION The second-generation electronic balancing device was significantly more accurate than mechanical instruments and could record knee balance over the entire range of flexion. More accurate soft-tissue balance may enhance outcomes after TKA.
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Hsu A. The Case for Organized Medicine: Why You Should Get Involved. MISSOURI MEDICINE 2018; 115:201. [PMID: 30228720 PMCID: PMC6140169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Keneally RJ, Shields CH, Hsu A, Prior HI, Creamer KM. Pediatric Thoracic Trauma in Iraq and Afghanistan. Mil Med 2018; 183:e596-e602. [DOI: 10.1093/milmed/usy044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Indexed: 12/25/2022] Open
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Chan H, Hsu A, Angle J. 3:54 PM Abstract No. 207 Identifying risk factors for rebleeding after embolization for rectus sheath hematoma. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Kransdorf E, Patel J, Kittleson M, Czer L, Chang D, Dimbil S, Levine R, Hsu A, Davis T, Norland K, Trento A, Kobashigawa J. Does a History of Malignancy Prior to Heart-transplant Increase Post-transplant Risk? J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.1091] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Wang J, Zhong H, van Soest J, Rosenthal D, Axelrod R, Galvin J, Dekker A, Zhang Z, Garden A, Michalski J, Huth B, Hsu A, Trotti A, Gore E, Beitler J, Bonner J, Xiao Y. A Feasibility Study on Incorporating Clinical Trial Quality Assurance Parameters into Outcome Prediction in Head and Neck Radiation Therapy Treatment. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kaplan C, Houser D, Kemp F, Nielson N, Hsu A, Legris K, Brattich G, Xiang H, Ahene A, Jeffry U, Bellovin D, Borges L. FPA150, a novel B7-H4 therapeutic antibody with checkpoint blockade and ADCC activities. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx361.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Zagadailov P, Hsu A, Seifer DB, Stern JE. Differences in utilization of Intracytoplasmic sperm injection (ICSI) within human services (HHS) regions and metropolitan megaregions in the U.S. Reprod Biol Endocrinol 2017; 15:45. [PMID: 28606175 PMCID: PMC5469007 DOI: 10.1186/s12958-017-0263-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 06/04/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Anecdotal evidence suggests that US practice patterns for ART differ by geographical region. The purpose of this study was to determine whether use of ICSI differs by region and to evaluate whether these rates are correlated with differences in live birth rates. METHODS Public data for 2012 were obtained from the Centers for Disease Control and Prevention. Clinics with ≥100 fresh, non-donor cycles were grouped by 10 nationally recognized Department of Health & Human Services regions and 11 metropolitan Megaregions and were compared for use of ICSI, frequency of male factor infertility, and live birth rate in women <35 years. RESULTS There were 274 clinics in the Health & Human Services regions and 247 in the Megaregions. ICSI utilization rates in Health & Human Services groups ranged between 52.5-78.2% (P < 0.0001). Live birth rates per cycle in women <35 years differed (34.1-47.6%; P < 0.0001) but did not correlate with rates of ICSI (R2 = 0.2096; P = 0.18) per cycle. For Megaregions, rates of ICSI per cycle differed (63.4%-93.5%, P < 0.0001) as did live birth rates per cycle for women <35 (36.0%-59.0%, P = 0.001) but there was only minimal correlation between them (R2 = 0.5347; P = 0.01). Highest rates of ICSI occurred in Front Range (93.5%) and Gulf Coast (83.1%) Megaregions. Lowest rates occurred in the Northeast (63.4%) and Florida (64.8%) Megaregions. Male factor infertility rates did not differ across regions. CONCLUSIONS ICSI utilization and live birth rates per cycle for each clinic group were significantly different across geographical regions of the U.S. However, higher ICSI utilization rate was not associated with higher rates of male factor infertility nor were they strongly correlated with higher live birth rates per cycle. Studies are needed to understand factors that may influence ICSI overutilization in the U.S.
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Hsu A, Hung-Chih H, Chen HC, Chen SJ. 199P Circulating tumor DNA as a dynamic marker for disease burden in patients with metastatic colorectal cancer. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hsu A, Hung-Chih H, Chen HC, Chen SJ. 199P Circulating tumor DNA as a dynamic marker for disease burden in patients with metastatic colorectal cancer. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw581.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hsu A. Rare etiologies of sleep disordered breathing. Sleep Med 2015. [DOI: 10.1016/j.sleep.2015.02.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kondrashova O, Lunke S, Mileshkin L, Alsop K, Scott C, Hamilton A, Ananda S, Quinn M, Bowtell D, McNally O, Cowie T, Wakefield M, Hsu A, Taylor G, Waring P. 2773 ALLOCATE: sorting ovarian cancer patients into treatment categories based on genetic characteristics of their tumours. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)31539-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hadsell M, Holcombe C, Chin E, Hsu A. SU-E-T-746: The Use of Radiochromic Film Analyzed with Three Channel Dosimetry as a Secondary Patient-Specific QA Tool for Small SBRT Fields. Med Phys 2015. [DOI: 10.1118/1.4925110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Yu AS, Yang Y, Bush K, Fahimian B, Hsu A. SU-E-T-290: Dosimetric Accuracy of Acuros XB and Analytical Anisotropic Algorithm in Stereotactic Ablative Radiotherapy of Small Lung Lesions. Med Phys 2015. [DOI: 10.1118/1.4924652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Chin E, Otto K, Hoppe R, Million L, Loo B, Koong A, Xing L, Hsu A, Fahimian B. TU-CD-304-01: FEATURED PRESENTATION and BEST IN PHYSICS (THERAPY): Trajectory Modulated Arc Therapy: Development of Novel Arc Delivery Techniques Integrating Dynamic Table Motion for Extended Volume Treatments. Med Phys 2015. [DOI: 10.1118/1.4925570] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
UNLABELLED Surgically repairing acute Lisfranc injuries remains a difficult task, and the injury remains a challenging one for the treating surgeon. Although there are many proponents of acute arthrodesis for Lisfranc injuries, there remain a proportion of patients with low-energy trauma who may be best treated with open reduction internal fixation and joint salvaging procedures. Here, the authors present a case report and technique to anatomically fix Lisfranc injuries while preventing any concomitant articular damage in the process. They have found this to be a reliable and safe procedure in this demanding patient population. LEVELS Level IV-Case Report.
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Hsu A, Devocelle M, Ward J, Keely S. In vitro evaluation of a prodrug approach for Gly-D-P18, a host defence peptide and novel anticancer agent. BMC Proc 2015. [PMCID: PMC4306050 DOI: 10.1186/1753-6561-9-s1-a41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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