A formal, structured handover process for pediatric patients transitioning to the intensive care unit after cardiac surgery can reduce medical errors that occur during the admission process and improve teamwork among caregivers.

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Study Objective: Determine near-optimal dose, safety, and efficacy of nerindocianine in pelvic ureter detection with near-infrared fluorescence imaging in women undergoing minimally invasive pelvic surgery with 3 Food and Drug Administration−cleared imaging systems. Design: Open label, phase 1/2a study. Setting: University of Alabama at Birmingham. Patients: Forty-one female subjects undergoing minimally invasive gynecologic surgery. Interventions: Subjects received a single dose of nerindocianine sodium, starting at 0.06-mg/kg body weight and increased/ decreased until the near-optimal dose was determined (part A). Examine the degree of concordance between endoscopic and robotic devices (part B). Measurements and Main Results:In part A, composite scores were collected every 10 minutes for 30 minutes and then every 15 minutes through 90 minutes using a scale measuring the anatomy/laterality of ureter visualization. In part B (paired imaging system efficacy), 2 cohorts of 8 subjects each received the near-optimal dose. Composite scores for visualization of the ureter were collected at 10 and 30 minutes postinfusion with the Firefly Imaging System and either the PINPOINT or 1588 AIM endoscope. Composite scores were compared to examine the degree of concordance between devices. Part A comprised 25 total subjects enrolled in dosing groups 1, 2, and 3 (0.06-, 0.12-, and 0.045-mg/kg, respectively). Median time to first ureter visualization was 10 minutes (all groups). The nerindocianine 0.06-mg/kg and 0.12-mg/kg groups had longer length of time of visualization than the 0.045-mg/kg group, resulting in the selection of 0.06 mg/kg as the near-optimal dose. Part B enrolled 16 total subjects in 2 groups dosed at 0.06 mg/kg. Efficacy analysis showed no statistically significant difference in composite scores with Firefly versus PINPOINT or 1588 AIM. Conclusion: Nerindocianine was well tolerated with visualization of the ureter demonstrated in 88.9% of the subjects through 90 minutes postdosing. No meaningful visualization differences were observed among the Food and Drug Administration−cleared surgical imaging systems used.

The results of treatment of severe injuries to the proximal interphalangeal joint are unsatisfactory. The methods of joint reconstruction are discussed, including fusion, implant arthroplasty, perichondrial grafting and vascularized joint transfer. A patient is presented with a severe crush injury to the dorsum of the index finger with loss of skin and extensor tendon and proximal interphalangeal joint disruption. Immediate reconstruction of the finger is described using a composite free flap of skin, extensor tendon and proximal interphalangeal joint from the second toe. Follow-up at two years is described, demonstrating proximal interphalangeal motion and finger function.

Lacunar strokes account for about a fourth of all ischemic strokes. Pontine infarcts often present with stuttering symptoms, referred to as pontine warning syndrome (PWS). Patients presenting with fluctuating symptoms can appear to have rapidly improving symptoms and thus often go untreated despite the risk of recurrent deficits. MRI carries a higher sensitivity in detecting posterior circulation strokes compared to computed topagraphy, but does not always indicate irreversible injury. Here we present the first description of a stuttering lacune, captured radiographically on serial magnetic resonance imaging (MRI), that was initially averted with the administration of intravenous (IV) tissue plasminogen activator (tPA), only to return a month later and progress on imaging despite re-administration of tPA. During the first admission, our patient had spontaneous resolution of symptoms with complete reversal on restricted diffusion soon after IV tPA administration. On the second admission, the stuttering symptoms returned as did the same pontine lesion. Although his stuttering lesions lasted for several days, and the pontine lesion did ultimately progress to partial infarction on MRI, he was discharged home without neurologic deficits. Our case suggests that tPA may be of benefit in patients with lacunar pontine strokes even if symptoms rapidly improve or resolve.

The Russian Revolution occurred in two stages toward the close of World War I. It led to the overthrow of the Romanov dynasty and the establishment of the world’s first communist regime. Although the Revolution in 1917 was the first to overthrow the Romanovs, imperial Russia had a long history of rebellions against the autocratic rule of the tsars. During the seventeenth century, Ivan Bolotnikov (1565–1608) and Stenka Razin (1630–1671) led two separate peasant rebellions nearly fifty years apart. In the following century, Kondraty Bulavin (1660–1708) and Yemelyan Pugachev (1742–1775) led uprisings of their own. In the nineteenth century, Russia faced the Decembrist Revolt in 1825 following the death of Alexander I. In 1863, parts of Poland and Lithuania rebelled to gain more cultural freedom. The reign of Nicholas II (1894–1917) worsened the relationship between the tsar and the Russian public. On the day of his coronation, a mass was held at Khodynka Field near Moscow. When some attendees heard that not everyone would receive the promised free food and drink, they trampled others, leaving an estimated thirteen hundred dead and thirteen hundred injured. Nicholas and Alexandra still held their celebration banquet, however, and this earned him the sobriquet ‘Bloody Nicholas’.

This article examines temporary labour migration to Moscow from 1971 to 1991, paying particular attention to relationships between state actors and young migrant workers. State officials not only provided young workers with housing and educational opportunities but also fostered Soviet socialist values among the young workers. The policies of Glasnost and Perestroika altered this relationship since state policies shifted towards embracing neoliberal practices. Such practices diminished social security for young migrants, leaving this once important social group vulnerable in a time of economic uncertainty.

A 26-year-old infantryman developed right hand and arm weakness while deployed to Iraq. Extension of the right second digit worsened over 2 weeks, followed by difficulty extending digits 3-5 over the following weeks. He reported muscle twitching in the right upper extremity over the same period, and that his thumb would lock or cramp in an opposed position during use. He denied pain, motor, or sensory symptoms in other extremities. Nine months prior, he sustained an injury while parachuting during airborne school, resulting in a concussion, headache, and neck and back pain, but no weakness.