Grant Medical Center

Abstract Purpose This study sought to examine the role of frailty in predicting inpatient mortality following early surgical fixation of intertrochanteric (IT) fractures. Methods The ACS-TQIP (2017–21) database was queried for patients with intertrochanteric fractures undergoing surgical fixation within 48 h. Frailty status was determined using the 5-item modified frailty index (mFI-5) (0 = nonfrail, 1 = prefrail, and, 2 = frail, and > 2 = severely frail). The primary end point was inpatient mortality. Secondary end points were unplanned ICU admission and thromboembolic events (DVT or PE). Significance was considered a p -value < 0.05. Results Frailty, as determined by the mFI-5, was a significant predictor of inpatient mortality and unplanned ICU admissions. Frail and severely frail patients had higher odds of mortality (OR: 2.00 and 3.58, respectively) and ICU admission (OR: 1.66, 3.09, 3.83, respectively). When compared with nonoperative management in frail (OR: 0.561) and severely frail (OR: 0.665) patients, surgical intervention within 48 h significantly reduced the risk of mortality. Conclusion Increasing frailty status, as measured by the mFI-5, has increased odds for unplanned ICU admission and inpatient mortality following surgery within 48 h for IT fractures. Although operative management is required in these patients, these results suggest frailty may be used to preoperatively identify patients at high risk for adverse events. Future studies may seek to identify modifiable factors in the preoperative period to improve outcomes in frail patients.

Advancements in computed tomography (CT) technology, particularly the emergence of dual-energy CT (DE-CT) and photon-counting detector CT (PCD-CT), can improve detection, characterization, and treatment monitoring of focal liver lesions. DE-CT, through its ability to differentiate tissues with similar densities and produce diverse datasets, has enhanced lesion visibility and diagnostic precision. PCD-CT further advances imaging with superior spatial resolution and material decomposition capabilities, offering potential for complex diagnostic scenarios. This review aimed to highlight the role of CT in hepatic imaging and its application to focal liver lesions.DE-CT improves lesion detectability using low-energy virtual monochromatic images, which enhance iodine contrast and reduce radiation and contrast agent doses. It also facilitates treatment response evaluation after locoregional therapies for hepatocellular carcinoma by quantifying biomarkers, such as the extracellular volume fraction. This review underscores the transformative impact of DE-CT and PCD-CT on liver imaging, emphasizing their complementary roles alongside magnetic resonance imaging. These innovations have paved the way for more precise diagnostics, improved treatment planning, and enhanced patient outcomes in the management of liver diseases.

Introduction: Studies have shown hyperoxemia in intubated patients is associated with poor outcomes including increased mortality. The location where trauma patients most often experience hyperoxemia has not been well studied. Understanding where in the hospital patients are mostly likely to be exposed to hyperoxemia can allow for targeted quality improvement initiatives to improve the incidence of hyperoxemia. Methods: This was an institutional review board approved single-institution retrospective review of mechanically ventilated trauma patients between January 1st, 2023 and December 31st, 2024. Patients who expired in the trauma bay or were admitted to the medical ICU were excluded. The primary aims of this study were to determine the incidence of hyperoxemia (defined as PaO2 >100mmHg) within the first 72 hours of admission and to determine the location where hyperoxemia most commonly occurred. Four areas were examined: Emergency Room (ER), Operating Room, (OR), Intensive Care Unit (ICU), and ICU Stepdown Unit. Results: We present data from 1081 individual ABG results. 638 represent the first ABGs taken after intubation. 188 patients were in OR and had a higher average PaO2 (294mmHg) and a 93% rate of hyperoxemia. 179 patients in the Emergency Room had a higher average PaO2 level (232mmHg) than the 252 patients in the Intensive Care Unit (171mmHg), but a similar percentage of both ICU and ER patients were hyperoxemic (65% and 69%). 19 patients in the ICU Stepdown unit were recorded and had the lowest average PaO2 (116mmHg) and rate of hyperoxia (32%). 443 data points from a third ABG drawn after intubation show similar findings with patients in the OR being more likely to be hyperoxemic (84%) and patients in the ER having higher average PaO2 than those in the ICU (218mmHg, 140mmHg), but similar rates of hyperoxemia (65%, 60%). Conclusions: The initial rate of hyperoxemia after intubation exceeds 65% in the ER, OR, and ICU and the average PaO2 level in each area is supratherapeutic. Subsequent ABG draws show that this rate is not improved as time passes. While particular focus should be made on patients going to the Operating Room, attention needs to be paid in every area of the hospital where intubated critically ill patients reside in order to mitigate the rate of hyperoxemia.

Treatment of hepatitis C virus (HCV) is slowly being adopted into primary care clinical practice as a result of curative treatment options with less frequent monitoring and fewer adverse effects.1-2 However, many primary care clinicians defer care to specialists because of administrative burdens

The widespread adoption of photovoltaic systems in Belgium, that started in 2012 and was encouraged by a 2023 regulatory change, presents a significant challenge for Low Voltage networks, including overvoltages and frequent PV disconnections. This paper assesses the benefits of a data-driven balancing approach to enhance voltage profile and mitigate these PV disconnections. Thanks to a collaboration with RESA, a Belgian DSO, the approach has been implemented at a pilot site featuring 4 substations and 208 meters. Significant improvements in voltage profile and network balance have been measured over a three-month period following the intervention. Three key achievements have been highlighted: improved distribution of PV production over the three phases, preservation of existing consumption balance, and an increase in the total PV production.

Traumatic brain injury (TBI) can induce post-traumatic epilepsy (PTE), but early biomarkers for epileptogenesis are lacking. We used a repetitive diffuse TBI (rdTBI) model in mice with continuous video-EEG monitoring up to 4½ months post-injury to investigate electrographic biomarkers before and during post-traumatic seizure development. 25% of mice developed post-traumatic seizures with highly variable latency (5–126 days post-injury). Most significantly, we identified fast ripple-delta DOWN state coupling as an early biomarker that was detectable at 4 days post-TBI and appeared before seizure onset in all seizure-experiencing mice. This EEG signature distinguished seizure-experiencing from seizure-free TBI mice with high specificity. Power spectrum analysis revealed elevated delta and theta power, reduced physiological fast oscillations (alpha, beta, gamma) and increased pathological high-frequency oscillations (fast ripples) in seizure-experiencing animals, indicating network hyperexcitability. Spike analysis showed that while TBI itself increased cortical excitability, seizure onset triggered a dramatic further escalation in interictal activity. These electrographic signatures were remarkably consistent across all seizure-experiencing animals regardless of single or recurrent seizure pattern. Our results demonstrate that fast ripple-delta coupling represents a promising early biomarker detectable at 4 days post-TBI, before seizure onset, offering potential for early identification of post-traumatic seizure susceptibility. Importantly, this biomarker identified all seizure-prone animals regardless of whether they developed single or recurrent seizures, suggesting shared underlying mechanisms and clinical relevance for any post-traumatic seizure occurrence. These findings emphasize the utility of temporal EEG analysis for detecting early electrographic changes in post-traumatic epileptogenesis and may inform future intervention strategies.

To analyze the aesthetic and functional results of a dual-flap reconstruction protocol for nail expansion by recessing the nail fold to increase the exposed nail matrix after repair of finger pulp defect. A total of 18 patients who underwent a dual-flap reconstruction protocol were retrospectively reviewed. We increased nail bed exposure by recessing a Y-V flap of eponychium and reconstructed the pulp with volar V-Y advancement flaps or homodigital island flaps depending on the injury geometry. A controllable 0.3- to 0.45-cm-wide recession of eponychium was feasible. The eponychial Y-V recession flap was separated from the nail matrix and slid proximally to expose more nail matrix, thereby effectively lengthening the exposed nail bed. The flaps survived in all patients. The exposed nail beds were lengthened 0.3 to 0.45 cm. The fingertips had smooth and natural nail plates with inconspicuous scars on both the eponychium and pulp and no deformities. The mobility of injured and uninjured contralateral fingers did not differ statistically. All patients and observers were satisfied with the appearance and function of the reconstructed fingertips. The eponychial Y-V recession flap combined with volar soft tissue reconstruction provided for the aesthetic and functional restoration of the fingertip defects with partial nail bed defect.

Insertion of medial column intramedullary fixation during Charcot reconstruction relies on proper guidewire placement in preparation for reaming to optimize endosteal purchase. Although fluoroscopy and jigs assist with wire placement, no anatomical relationship between the center of the intramedullary canal and metatarsal head or base has been described, which this cadaver study aimed to identify. The first metatarsals from ten fresh-frozen cadavers were dissected. The height and width of the first metatarsal head and base as well as length were measured with digital calipers. Each metatarsal was placed in a three-dimensional printed gantry, where radiographs were taken. Image analysis software was used to identify the relationship between the metatarsal head and base and the center of the intramedullary canal. Metatarsals from six male and four female cadavers with an age of 68.6 ± 15.14 years were assessed. Metatarsal length was 62.71 ± 5.54 mm. The center point was 51.12 ± 3.51% and 66.85 ± 5.09% the height of the metatarsal head and base, respectively, with the inferior cortex as reference. Moreover, the center point was 53.40 ± 6.26% and 52.63 ± 2.90% the width of the metatarsal head and base, respectively, with the lateral cortex as reference. Longer metatarsals correlated with more superior base starting positions (r = 0.74; P = .02). Guidewire entry should be slightly superior and medial to the center of the first metatarsal head and directed proximally toward the superior third of the metatarsal base. These findings may assist with surgical technique and instrument design.