1. Injuries of the sternum from flexion-compression violence are described and contrasted with injuries from direct violence. The characteristic feature of flexion-compression injuries is a dislocation or fracture at or near the manubrio-sternal joint with backward displacement of the manubrium. 2. Treatment is outlined, with special reference to the indications for open reduction and wire fixation. 3. The mechanism of flexion-compression injuries of the sternum is discussed. The opinion is expressed that most of the force is transmitted to the sternum by the ribsâespecially the upper ribs.
PurposeTo evaluate the prognostic value of 18F-FDG PET-CT performed in the third week (iPET) of definitive radiation therapy (RT) in patients with newly diagnosed locally advanced mucosal primary head and neck squamous-cell-carcinoma (MPHNSCC).MethodologySeventy-two patients with MPHNSCC treated with radical RT underwent staging PET-CT and iPET. The maximum standardised uptake value (SUVmax), metabolic tumour volume (MTV) and total lesional glycolysis (TLG) of primary tumour (PT) and index node (IN) [defined as lymph node(s) with highest TLG] were analysed, and results were correlated with loco-regional recurrence-free survival (LRFS), disease-free survival (DFS), metastatic failure-free survival(MFFS) and overall survival (OS), using Kaplan-Meier analysis.ResultsOptimal cutoffs (OC) were derived from receiver operating characteristic curves: SUVmax-PT = 4.25 g/mL, MTVPT = 3.3 cm3, TLGPT = 9.4 g, for PT, and SUVmax-IN = 4.05 g/mL, MTVIN = 1.85 cm3 and TLGIN = 7.95 g for IN. Low metabolic values in iPET for PT below OC were associated with statistically significant better LRFS and DFS. TLG was the best predictor of outcome with 2-year LRFS of 92.7 % vs. 71.1 % [p = 0.005, compared with SUVmax (p = 0.03) and MTV (p = 0.022)], DFS of 85.9 % vs. 60.8 % [p = 0.005, compared with SUVmax (p = 0.025) and MTV (p = 0.018)], MFFS of 85.9 % vs. 83.7 % [p = 0.488, compared with SUVmax (p = 0.52) and MTV (p = 0.436)], and OS of 81.1 % vs. 75.0 % [p = 0.279, compared with SUVmax (p = 0.345) and MTV (p = 0.512)]. There were no significant associations between the percentage reduction of primary tumour metabolic parameters and outcomes. In patients with nodal disease, metabolic parameters below OC (for both PT and IN) were significantly associated with all oncological outcomes, while TLG was again the best predictor: LRFS of 84.0 % vs. 55.3 % (p = 0.017), DFS of 79.4 % vs. 38.6 % (p = 0.001), MFFS 86.4 % vs. 68.2 % (p = 0.034) and OS 80.4 % vs. 55.7 % (p = 0.045).ConclusionThe metabolic parameters of iPET can be useful predictors of patient outcome and potentially have a role in adaptive therapy for MPHNSCC. Among the three parameters, TLG was found to be the best prognostic indicator of oncological outcomes.
This paper reports the results of an online survey done by Global Game Jam (GGJ) participants in January 2012. This is an expansion of an earlier survey of a local game jam event and seeks to validate and extend previous studies. The objectives of this survey were collecting demographic information about the GGJ participants, understanding their motivations, studying the effectiveness of GGJ as a learning and community-building experience, and understanding the process used by GGJ participants to make a computer game in extremely limited time. The survey was done in two phases: pre-jam and post-jam. Collectively, the information in this survey can be used to (1) plan different learning experiences, (2) revise the development process for professional and academic projects, and (3) provide additional elements to game jams or change their structures based on the participants' comments to make them more fruitful.
1. An operation is described for the relief of irreversible claw toes associated with prominent and painful metatarsal heads. 2. The operation is suggested as an alternative to amputation of the toes. 3. The results of the operation done on twenty patients who have been followed up for a year or longer are reported.
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