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Introduction: Reversible Cerebral Vasoconstriction Syndrome (RCVS) is described as reversible constriction of cerebral arteries, presenting with severe headaches and associated with hemorrhagic or ischemic strokes. There is a dearth of the literature on demographics and risk factors associated with intracranial hemorrhage (ICH) in patients with RCVS in the US. Methods: All patients with a primary or secondary diagnosis of RCVS in 2016 Nationwide Readmission Database (NRD) using ICD-10 code I67.841 after excluding cerebral angiitis (N=57). Unique patients were included using a unique patient identifier. Weighted discharges were used to generate national estimates. ICH was defined as both intraparenchymal and subarachnoid hemorrhage. A multivariable logistic model was used to identify ICH predictors. Results: Among total 1,152 RCVS patients, 25.7% (296) patients developed ICH. Patients with ICH mean age was (years) (Mean±SE) 47.8 ±1.2 vs. 47.0±1.1 (P=0.62), female 85.4% vs. 78.0% (P=0.06), longer inpatient LOS 12.1±0.9 vs. 6.4±0.5 days (P Conclusion: This nationally representative sample suggests that increasing age and female gender were independent predictors of ICH. There is no difference in comorbidities including migraine contrary to prior literature, modifiable lifestyle risk factors and pregnancy in this cohort. Excellent outcome was observed as the majority of patients were discharged home. Higher LOS and cost were reported in ICH cohort.

Introduction: Previous studies have yielded inconsistent results on whether weekend admission impacts the utilization of EVT and IV-rtPA. There is limited data available of whether age groups difference affects on use of IV-rtPA and EVT admitted during the off-hours. Our study aimed to investigate whether admission during the off-hours has any effect on the EVT & IV-rtPA utilization and is distributed uniformly across all age groups? Method: All adults admitted to US hospitals from 2005-2015 with a primary diagnosis AIS (n=4,520,516) were identified from the Nationwide Inpatient Sample using ICD-9 CM codes. Discharge weights were used to generate national estimates. On-hours vs. off-hours were defined using the weekend variable. Age groups were divided into 18-39, 40-59, 60-79 and ≥80 years. An age groupwise multivariable logistic regression models were used to compare odds of EVT and IV-rtPA use between on-hours vs. off-hours. Result: Total 4.5 million AIS population comprised 2.1% of 18-39 years, 20.0% of 40-59 years, 44.1% of 60-79 years and 34.0% of ≥80 years. Off-hours admissions comprised 25.7% of total AIS. Univariate analysis of off-hours vs. on-hours effects showed EVT utilization was 2.2% vs. 2.3% (P=0.50) and IV-tPA use was 7.9% vs. 7.3% (P=0.18) in 18-39 years. In 40-59 years age group, EVT 1.19% vs. 1.17% (P=0.74) and IV-tPA 6.2% vs. 5.7% (P Conclusion: Our study concludes that there is a lower rate of EVT performed during off-hours in the age groups of 60-79 and ≥ 80 years old. However, There was no difference reported in the use of EVT in the younger population. It’s also interesting to note that there is a higher use of IV-rtPA during the off-hours in all age groups except age group 18-39 years.

The effects of a partial lateral meniscectomy on knee kinematics and forces in the lateral meniscus are critical to understand. The purpose of this study was to quantify the effects of varying sizes of partial lateral meniscectomies of the posterior horn and a total lateral meniscectomy on knee kinematics and resultant forces in the lateral meniscus.Using a robotic testing system, loads (134-N anterior tibial load + 200-N axial compression, 5-Nm internal tibial torque + 5-Nm valgus torque, and 5-Nm external tibial torque + 5-Nm valgus torque) were applied to 10 fresh-frozen cadaveric knees. The resulting joint motion and resultant forces in the lateral meniscus were determined for 4 knee states: intact, one-third and two-thirds partial lateral meniscectomies of the posterior horn, and total lateral meniscectomy.A decrease in lateral translation of the tibia (up to 166.7%) was observed after one-third partial lateral meniscectomies of the posterior horn compared with the intact knee, in response to an anterior load at all knee flexion angles tested (p0.05). One-third partial lateral meniscectomies of the posterior horn decreased the resultant forces in the lateral meniscus compared with the intact knee at all knee flexion angles tested in response to an anterior load (p0.05) and to an internal tibial torque (p0.05). The results of two-thirds partial lateral meniscectomies of the posterior horn were similar to those of one-third partial meniscectomies (p0.05). Total lateral meniscectomies further decreased the lateral translation of the tibia (up to 316.6%) compared with the intact knee in response to an anterior load (p0.05).The changes in joint motion and meniscal forces observed in this study after even small partial lateral meniscectomies may predispose knees to further injury.Surgeons should always consider repairing and minimizing the resection of even small lateral meniscal tears to prevent the potential deleterious effects of partial meniscectomy reported in this cadaveric study.

We study zero-sum (combinatorial) games, within the framework of so-called Richman auctions (Lazarus et al. 1996) namely, we modify the alternating play scoring ruleset Cumulative Subtraction (CS) (Cohensius et al. 2019), to a discrete bidding scheme (similar to Develin and Payne 2010). Players bid to move and the player with the highest bid wins the move, and hands over the winning bidding amount to the other player. The new game is dubbed Bidding Cumulative Subtraction (BCS). In so-called unitary games, players remove exactly one item out of a single heap of identical items, until the heap is empty, and their actions contribute to a common score, which increases or decreases by one unit depending on whether the maximizing player won the turn or not. We show that there is a unique bidding equilibrium for a much larger class of games, that generalize standard scoring play in the literature. We prove that for all sufficiently large heap sizes, the equilibrium outcomes of unitary BCS are eventually periodic, with period 2, and we show that the periodicity appears at the latest for heaps of sizes quadratic in the total budget., Comment: 26 Pages, 6 figures

There have been proposals and even some successful deployments (by official bodies) of various road safety and traffic control systems. Emerging technologies like the Internet of Things (IoT) and Image Processing have found effective uses for developing the same. Although road security hasn’t been considered a very pushing topic. Particular motorways hold severe significance when it comes to a nation; security concerns. And hence it is very crucial for these motorways to have security systems in place and sometimes even have officials deployed for checking all passing vehicles which seem vulnerable to them using barriers and other equipment. Two peculiar problems that come into the picture when considering road security are first, lack of availability of automated, intelligent and feasible systems on motorways that can detect vulnerabilities in passing automobiles and second, knowability and visibility of any security mechanism used for checking the vehicles is an easy task for anyone traveling by the road under surveillance. The prior makes it easy for malevolent individuals (one’s carrying any illegal weapons, equipment, etc.) to escape and the latter makes them well aware about which security-checks they will have to tackle to surpass the checking zones without being caught red-handed. Hence need for a system which eliminates these two problems becomes vital to increase the security of motorways. This chapter introduces an intelligent cop assisting system TIE (The Invisible Eye). The system senses parameters that aren’t direct knowable by anyone at their first glance on the vehicle like weight, etc. and make them available to the security personnel(s) deployed to check those vehicles. Also, the system would provide a vulnerability index and it can be deployed in an unnoticeable way.

Context: To investigate the feasibility of combining the lower-limb exoskeleton and body weight unweighing technology for assisted walking in tetraplegia following spinal cord injury (SCI). Findings: A 66-year-old participant with a complete SCI at the C7 level, graded on the American Spinal Injury Association Impairment Scale (AIS) as AIS A, participated in nine sessions of overground walking with the assistance from exoskeleton and body weight unweighing system. The participant could tolerate the intensity and ambulate with exoskeleton assistance for a short distance with acceptable and appropriate gait kinematics after training. Conclusion: This report showed that using technology can assist non-ambulatory individuals following SCI to stand and ambulate with assistance which may promote general physical and psychological health if used in the long term.

Penile cancer (PC) is a relatively rare malignancy in the United States (US) but a greater concern in developing nations. Lymph node imaging remains critical to the staging and treatment of this disease as metastases develop in a predictable, anatomic fashion. Early surgical intervention remains a mainstay in treatment and imaging often aids in decision making. This review highlights the indications for imaging in both low-stage and advanced disease. Furthermore, we discuss the benefits and limitations of currently available imaging for staging of inguinal and pelvic lymph nodes in PC and novel modalities in development.

Objectives The purpose of this investigation was to identify clinical and demographic variables that may predict compliance, defined as patient follow-up at 1-year and 2-year postoperative appointments, after anterior cruciate ligament reconstruction (ACLR). Methods A total of 107 patients undergoing primary ACLR across four centres were prospectively followed for 2 years. Demographic and clinical data were recorded preoperatively and postoperatively, including patient-reported outcomes such as the Marx Activity Rating Scale, Cincinnati Occupational Rating Scale (CORS), International Knee Documentation Committee Subjective Knee Evaluation Form and Activities of Daily Living Scale (ADLS). Compliance was retrospectively defined using the presence or lack of outcome measures at 1-year and 2-year postoperative visits. Univariate analysis was done to compare demographic and clinical variables between compliant and non-compliant patients at 1-year and 2-year follow-up. Significant variables were entered into a logistic regression model. Significance was set at p Results The overall rate of compliance at 1-year and 2-year postoperative appointments was 83.2% (89/107) and 57.0% (61/107), respectively. Regression analysis showed that residence in Kobe, Japan compared with Pittsburgh, USA (OR 10.28; 95% CI 1.0003 to 105.28), and ‘very strenuous' (OR 16.74; 95% CI 3.21 to 87.43) and ‘strenuous' (OR 18.78; 95% CI 2.01 to 175.78) preinjury activity level were independent factors associated with compliance at 1-year follow-up. At 2 years follow-up, younger age (OR 0.95; 95% CI 0.91 to 0.997), and greater preoperative score on CORS (OR 1.03; 95% CI 1.01 to 1.06) and on ADLS (OR 1.04; 95% CI 1.01 to 1.07) were independently associated with compliance. Conclusion While patients with greater level of strenuous activity were more likely to follow-up after ACL surgery at 1 year, patients who were younger and had higher preoperative function measured by CORS and ADLS were more likely to follow-up at 2 years. Differences in follow-up rates among the USA, Italy, Sweden and Japan may highlight important cultural, socioeconomic and infrastructural differences across international healthcare systems. Orthopaedic surgeons may consider the results of this study during preoperative discussion with their patients and design of future ACL clinical research trials. Level of evidence Level III, prospective cohort.

Purpose While the aetiology of rheumatoid arthritis (RA) remains unclear, many of the inflammatory components are well characterised. For diagnosis and therapy evaluation, in vivo insight into these processes would be valuable. Various imaging probes have shown value including dynamic contrast-enhanced (DCE) MRI and PET/CT using 18F-fluorodeoxyglucose (18F-FDG) or tracers targeting the translocator protein (TSPO). To evaluate 18F-GE-180, a novel TSPO PET tracer, for detecting and quantifying disease activity in RA, we compared 18F-GE-180 uptake with that of 18F-FDG and DCE-MRI measures of inflammation. Methods Eight RA patients with moderate-to-high, stable disease activity and active disease in at least one wrist were included in this study (NCT02350426). Participants underwent PET/CT examinations with 18F-GE-180 and 18F-FDG on separate visits, covering the shoulders and from the pelvis to the feet, including hands and wrists. DCE-MRI was performed on one affected hand. Uptake was compared visually between tracers as judged by an experienced radiologist and quantitatively using the maximum standardised uptake value (SUVmax). Uptake for both tracers was correlated with DCE-MRI parameters of inflammation, including the volume transfer coefficient Ktrans using Pearson correlation (r). Results PET/CT imaging with 18F-GE-180 in RA patients showed marked extra-synovial uptake around the affected joints. Overall sensitivity for detecting clinically affected joints was low (14%). 18F-GE-180 uptake did not or only weakly correlate with DCE-MRI parameters in the wrist (r = 0.09–0.31). 18F-FDG showed higher sensitivity for detecting symptomatic joints (34%), as well as strong positive correlation with DCE-MRI parameters (SUVmax vs. Ktrans: r = 0.92 for wrist; r = 0.68 for metacarpophalangeal joints). Conclusions The correlations between DCE-MRI parameters and 18F-FDG uptake support use of this PET tracer for quantification of inflammatory burden in RA. The TSPO tracer 18F-GE-180, however, has shown limited use for the investigation of RA due to its poor sensitivity and ability to quantify disease activity in RA.

Intratumoural metabolic demands result in excessive angiogenic cytokine release leading to unorganised vasculature. Resultant fluid dynamics oppose blood flow and drug penetration due to a marked increase in interstitial fluid hydrostatic pressure. It is hypothesised that anti-angiogenic therapy may function to 'prune' vasculature and lead to improved chemotherapeutic penetration. Subcutaneous, OSC19 tumour bearing mice (n = 5/dose/agent) were administered varying doses of an anti-mouse VEGFR2 (DC101) or an anti-mouse VEGFR3 (31C1) -3 d, -1 d, 0 d, +1 d and +3 d prior to 200 µg of cetuximab fluorescently labelled with IRDye800CW. Fluorescence imaging of tumours was performed 10 d post cetuximab-IRDye800CW dose to monitor therapeutic uptake. Co-administration of dual anti-angiogenic agents at 50-50%, 75-25% and 25-75% using optimal dose and time (-1 d 10 mg/kg anti-VEGFR2 and -1 d 40 mg/kg anti-VEGFR3) was also evaluated. In order to establish vessel normalisation, NG2 (pericyte marker) and CD31 (endothelial cells) ratios were assessed during immunohistochemical staining of tumour sections. Twenty-mg/kg anti-VEGFR3 + 5 mg/kg anti-VEGFR2 significantly (p

Objective Two major teaching methods available for learning the pivot shift test are active teaching with real-time feedback from an instructor and passive teaching through the use of instructional textbooks or videos. The purpose of this study was to determine the effect of active and passive teaching methods on the execution of the proper technique of the pivot shift test. Methods Six orthopaedic surgery residents each performed 110 pivot shift tests on a fresh-frozen, cadaveric pelvis-to-toe specimen with anterior cruciate ligament insufficiency and lateral meniscectomy. Participants performed 10 repetitions before teaching and a total of 100 repetitions after either active or passive teaching. Six degree-of-freedom kinematics of the knee defined by the Grood/Suntay coordinate system were recorded after every fifth repetition using an electromagnetic tracking system. Anterior/posterior translation of the lateral knee compartment during the reduction event was also quantified. Depending on the normality of the data, a two-tailed t-test or Wilcoxon rank-sum test was used for comparisons of kinematics between the active and passive teaching groups and between successful and unsuccessful trials within each teaching group. Statistical significance was set at p Results The success rate after active teaching was 31.7% compared with 30.0% after passive teaching. However, the starting position of the reduction event in the active teaching group was rotated by more than twice the amount of valgus rotation compared with the passive group (7.4°±3.3° vs 3.0°±2.7°; p Conclusion Successful pivot shift tests can be performed after passive teaching, but the standard technique is not as effectively learnt through passive teaching since traditional external rotation during the reduction event was not used as in the active teaching group. Level of evidence V.

We consider continuation criteria for the three-dimensional relativistic Vlasov–Maxwell system. When the particle density, f ( t , x , p ) , is compactly supported at t = 0 , we prove ‖ p 0 18 5 r − 1 + β f ‖ L t ∞ L x r L p 1 ≲ 1 , where 1 ≤ r ≤ 2 and β > 0 is arbitrarily small, is a continuation criteria. Our continuation criteria is an improvement in the 1 ≤ r ≤ 2 range to the previously best known criteria ‖ p 0 4 r − 1 + β f ‖ L t ∞ L x r L 1 p ≲ 1 due to Kunze [7] . We also consider continuation criteria when f ( 0 , x , p ) has noncompact support. In this regime, Luk–Strain [9] proved that ‖ p 0 θ f ‖ L x 1 L p 1 ≲ 1 is a continuation criteria for θ > 5 . We improve this result to θ > 3 . Finally, we build on another result by Luk–Strain [8] . The authors proved boundedness of momentum support on a fixed two-dimensional plane is a sufficient continuation criteria. We prove the same result even if the plane varies continuously in time.

Introduction: It is a study of biological plating at various situations. Biological is a least contact plate designed for use in specific anatomical regions such as the proximal & distal femur, proximal & distal tibia. Minimal invasive plate osteo-synthesis by biological plate has the potential of becoming one of the main stays of fracture management in the years to come. Biological fixation principles advocate realigning by manipulation at a distance to the fracture site, leaving comminuted fragments out of the mechanical construct, preserving soft tissues with limited operative exposure. Materials and method: The study consists of 30 patients with fractures at different locations in the lower limb such as proximal femur, distal femur, proximal tibia and distal tibia. We have treated patients with anatomical plate for respective fracture in the bone. Clinical outcome and function results were evaluated by Harris Hip Score for proximal femur fracture, Knee Society score for distal femur and proximal tibia fracture, Olerud and Molander score for distal tibia fracture. Result: Out of the 30 patients included in the study, 18 cases were operated with open method and 12 patients were operated with closed method. Average radiological union time was 21.36 week. We have achieved 83.3% of excellent result. Conclusion: Anatomical plates are pre-contoured plate as per shape of the bone. Anatomical reduction is possible as well as length of the limb is maintained and axial alignment and rotational stability is provided. As plates have groove on inner surface so it preserves the periosteal blood supply which will help in faster healing of the bone. Anatomical plates are best proven option for the comminuted intra-articular fractures of the long bones.

Penile and scrotal entrapment from a metal ring placed at the base of the penis is a rare, but important clinical dilemma encountered in urology. Emergent presentation to the urologist, after ring placement far longer than safely practiced, risks ischemic and permanent injury to penile, scrotal, and intrascrotal structures. Treating urologists should be aware of the prevalence of metal ring use, their potential complications, and the surgical approach to their safe removal. We present two patients who were identified at our institution with strangulating injuries of retained penile rings. The first patient was a healthy, 43-year-old male with a metal ring retained for 24 hours that was safely removed with industrial bolt cutters. The second patient, a 74-year-old male, died as a result of sepsis from injuries secondary to penoscrotal ischemia after >48 hour ring retention despite prompt removal at emergent presentation. Although rare, sexual practices may include the use of penoscrotal rings. When retained, ischemic injury and edema may lead to strangulation. Emergent removal may require industrial equipment that is not within the confines of normal operating room tools. Tissue injury may be severe and sepsis life-threatening, even after ring removal.

Objective To determine whether patient-related factors, concomitant injuries and preoperative knee laxity could predict a patient acceptable symptom state (PASS) in the International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) at 1 and 2 years follow-up after anterior cruciate ligament (ACL) reconstruction in a multicentre cohort. Methods Patients between 14 and 50 years of age who underwent single-bundle ACL reconstruction with hamstring tendon autograft within 1 year from the index injury were eligible. Additionally, only patients who completed the IKDC-SKF questionnaire at 1 or 2 years of follow-ups were included. Preoperative knee laxity assessment of patients in the awake state was performed using rolimeter, the Lachman and the pivot-shift test. The pivot shift was graded according to the IKDC criteria and also quantified by the use of non-invasive technology for (1) lateral tibial translation and (2) tibial acceleration. The quantitative pivot shift (QPS) was examined in the awake state and under anaesthesia (EUA). Univariable logistic regression models were performed with achieving PASS in the IKDC as the dependent variable. Results A total of 86 patients had complete data on the IKDC-SKF score at 1-year follow-up, of which 67 patients (77.9%) achieved PASS (age 24.8±9.3 years, 43% females). Two-year data were available for 50 patients, of which 39 patients (78.9%) achieved PASS (age 23.9±9.2 years, 42.0% females). A low-grade manual pivot shift according to IKDC grading had increased odds of achieving PASS at 1 year (OR=2.96 (95% CI 1.01 to 8.66), P Conclusion Almost four in every five patients were able to achieve PASS 1 and 2 years after anatomic single-bundle ACL reconstruction. The presence of preoperative low-grade pivot shift increased the odds of achieving an acceptable level of knee function 1 year after ACL reconstruction compared with high-grade pivot shift; however, QPS did not confirm achievement of PASS in this study. Level of evidence Level III, prospective cohort.

Background: We report the diagnosis and management of a pyelovenous fistula that was detected 5 days after a renal gunshot wound (GSW). Case Presentation: A 16-year-old boy presented to the trauma center with a single GSW to the right flank. CT scan revealed a shattered right kidney with active contrast extravasation and ureteral discontinuity, metal fragments in the L1 vertebra, and a bullet lodged in the upper pole of the left kidney. The patient was taken for emergent exploratory laparotomy. A right nephrectomy was performed. A left retrograde pyelogram demonstrated an intact collecting system. A left Double-J stent was placed to protect against delayed thermal injury. Repeat pyelogram on postoperative day 5 revealed a pyelovenous fistula and a stent was left in place. At 6 weeks, interval pyelogram showed complete resolution of the pyelovenous fistula and the stent was removed. At 6 months the patient was asymptomatic and normotensive with an unremarkable left kidney on ultrasonography. Conclusion: Pyelovenous fistula is a rare complication of a retained bullet in the kidney. Conservative management with ureteral stenting was effective in resolving the fistula.

Background: Secondary malignancies of the ureter are uncommon. We report the diagnosis and management of metastatic colon cancer to the bifurcation of a bifid ureter. Case Presentation: A 59-year-old man presented with diffuse metastasis with right hydronephrosis in both renal moieties of a partially duplicated system and an enhancing lesion within the proximal common ureter. Ureteral biopsy was positive for colorectal adenocarcinoma. The patient was subsequently started on palliative chemoradiation. Conclusion: The ureter is a rare location for hematogenous/lymphatic metastases. When a ureteral mass is present on imaging, ureteroscopy should be performed to characterize the extent of tumor and to rule out secondary malignancy.

We report a 44 year old previously healthy premenopausal woman who presented with a three month history of vaginal bleeding and a 5 cm vaginal mass obscuring the cervix on physical examination. Ultrasound evaluation was non diagnostic. Pelvic MRI demonstrated a 6 cm soft tissue mass in the vagina prolapsed from the uterine cavity with a visible connecting stalk, which is termed the broccoli sign. The initial radiological differential diagnosis included prolapsed uterine malignancy or leiomyoma. Surgical pathology revealed a polypoid adenomyoma. We conclude polypoid adenomyoma should be included in the differential diagnosis for prolapsed uterine tumor demonstrating the broccoli sign.

Percutaneous nephrolithotomy (PCNL) is an established technique for removal of large stones from the upper urinary tract. It is a complex multistep procedure requiring several classes of instruments that are subject to operator misuse and device malfunction. We report device-related adverse events during PCNL from the Manufacturer and User Facility Device Experience (MAUDE) database using a recently developed standardized classification system.The MAUDE database was queried for "percutaneous nephrolithotomy" from 2006 to 2016. The circumstances and patient complications associated with classes of devices used during PCNL were identified. We then utilized a novel MAUDE classification system to categorize clinical events. Logistic regression analysis was performed to identify associations between device classes and severe adverse events.A total of 218 device-related events were reported. The most common classes included: lithotripter 53 (24.3%), wires 43 (19.7%), balloon dilators 30 (13.8%), and occlusion balloons 28 (12.8%). Reported patient complications included need for a second procedure 12 (28.6%), bleeding 8 (19.0%), retained fragments 7 (16.7%), prolonged procedure 4 (9.5%), ureteral injury 2 (4.8%), and conversion to an open procedure 3 (7.1%). Using a MAUDE classification system, 176 complications (81%) were Level I (mild/none), 26 (12%) were Level II (moderate), 15 (7%) were Level III (severe), and 1 (0.5%) was Level IV (life threatening). On univariate analysis, balloon dilators had the highest risk of Level II-IV complications compared with the other device classes [odds ratio: 4.33, confidence interval: 1.978, 9.493, p 0.001]. The device was evaluated by the manufacturer in 93 (42.7%) cases, with 54.8% of reviewed cases listing the source of malfunction as misuse by the operator.PCNL is subject to a wide range of device-related adverse events. A MAUDE classification system is useful for standardized, clinically-relevant reporting of events. Our findings highlight the importance of proper surgeon training with devices to maximize efficiency and decrease harm.

Recent studies have shown that cigarette smoke (CS)-induced oxidative stress impairs autophagy, resulting in aggresome-formation that correlates with severity of chronic obstructive pulmonary disease (COPD)-emphysema, although the specific step in autophagy pathway that is impaired is unknown. Hence, in this study, we aimed to evaluate the role of master autophagy transcription factor EB (TFEB) in CS-induced COPD-emphysema pathogenesis.We first observed that TFEB accumulates in perinuclear spaces as aggresome-bodies in COPD lung tissues of tobacco smokers and severe emphysema subjects, compared with non-emphysema or nonsmoker controls. Next, Beas2b cells and C57BL/6 mice were exposed to either cigarette smoke extract (CSE) or subchronic-CS (sc-CS), followed by treatment with potent TFEB-inducing drug, gemfibrozil (GEM, or fisetin as an alternate), to experimentally verify the role of TFEB in COPD. Our in vitro results indicate that GEM/fisetin-mediated TFEB induction significantly (p 0.05) decreases CSE-induced autophagy-impairment (Ub/LC3B reporter and autophagy flux assay) and resulting aggresome-formation (Ub/p62 coexpression/accumulation; immunoblotting and staining) by controlling reactive oxygen species (ROS) activity. Intriguingly, we observed that CS induces TFEB accumulation in the insoluble protein fractions of Beas2b cells, which shows a partial rescue with GEM treatment. Moreover, TFEB knockdown induces oxidative stress, autophagy-impairment, and senescence, which can all be mitigated by GEM-mediated TFEB induction. Finally, in vivo studies were used to verify that CS-induced autophagy-impairment (increased Ub, p62, and valosin-containing protein in the insoluble protein fractions of lung/cell lysates), inflammation (interleukin-6 [IL-6] levels in bronchoalveolar lavage fluid and iNOS expression in lung sections), apoptosis (caspase-3/7), and resulting emphysema (hematoxylin and eosin [HE]) can be controlled by GEM-mediated TFEB induction (p 0.05).CS exposure impairs autophagy in COPD-emphysema by inducing perinuclear localization of master autophagy regulator, TFEB, to aggresome-bodies.TFEB-inducing drug(s) can control CS-induced TFEB/autophagy-impairment and COPD-emphysema pathogenesis. Antioxid. Redox Signal. 27, 150-167.

Osteoclasts play key roles in bone remodeling and pathologic osteolytic disorders such as inflammation, infection, bone implant loosening, rheumatoid arthritis, metastatic bone cancers, and pathological fractures. Osteoclasts are formed by the fusion of monocytes in response to receptor activators of NF-κB-ligand (RANKL) and macrophage colony stimulating factor 1 (M-CSF). Calreticulin (CRT), a commonly known intracellular protein as a calcium-binding chaperone, has an unexpectedly robust anti-osteoclastogenic effect when its recombinant form is applied to osteoclast precursors in vitro or at the site of bone inflammation externally in vivo. Externally applied Calreticulin was internalized inside the cells. It inhibited key pro-osteoclastogenic transcription factors such as c-Fos and nuclear factor of activated T cells, cytoplasmic 1 (NFATc1)-in osteoclast precursor cells that were treated with RANKL in vitro. Recombinant human Calreticulin (rhCRT) inhibited lipopolysaccharide (LPS)-induced inflammatory osteoclastogenesis in the mouse calvarial bone in vivo. Cathepsin K molecular imaging verified decreased Cathepsin K activity when rhCalreticulin was applied at the site of LPS application in vivo. Recombinant forms of intracellular proteins or their derivatives may act as novel extracellular therapeutic agents. We anticipate our findings to be a starting point in unraveling hidden extracellular functions of other intracellular proteins in different cell types of many organs for new therapeutic opportunities. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2658-2666, 2017.

Congenital heart disease (CHD) is an important cause of childhood mortality. Despite the widespread use of ultrasonography (US) as a screening tool, the prenatal detection rate is suboptimal. Improvement of the initial screening examination, which is performed in low-risk populations and often interpreted by community radiologists, targets a point in the screening process that is likely to have the largest population effect. If the goal of community-based screenings is to detect cases that may be abnormal and refer those to specialized centers for complete assessment, it is logical to use a checklist to confirm normal anatomy. This article presents a stepwise process to evaluate fetal cardiac anatomy using comparison with computed tomography (CT) and magnetic resonance (MR) images, which are more familiar to radiologists in busy general practices. In addition, this article presents a checklist for assessment of the four-chamber view and demonstrates the expected normal appearance of the outflow tract views as well as the additional views required for complex obstetric US. These additional views include the aortic arch and bicaval views, three-vessel view (3VV), and three-vessel trachea view (3TV). CHD may be isolated, but it may indicate aneuploidy or a syndrome that, if present, determines the prognosis. In isolated CHD, the prognosis is determined by the exact nature of the abnormalities. In particular, duct-dependent disease if undiagnosed results in circulatory collapse in the infant once the ductus closes. If the heart does not look normal, the patient should be referred for detailed evaluation. Timely diagnosis of significant CHD allows for development of a personalized pregnancy management plan. © RSNA, 2017.

Purpose: Minimizing surgical morbidity after local fl ap reconstruction is important in the management of cutaneous defects. Controversy exists in current literature regarding the effects of radiation and chemotherapy on fl ap perfusion. Neoadjuvant treatments can damage the microvasculature of the surgical bed through fi brosis, endothelial cell damage, and reduced cell proliferation, which collectively increase the likelihood of postoperative fl ap failure.

While medial patellofemoral ligament reconstructions result in a high rate of return to sports, there is still a high reported complication rate. One area of controversy regarding the technique for the reconstruction is the knee flexion angle to use during graft fixation. Currently, more evidence is needed to determine whether there is a significant benefit to using a particular flexion angle during graft fixation.

Balloon aortic valvuloplasty (BAV) is commonly used in patients with severe decompensated aortic stenosis (AS) and provides symptomatic improvement without any benefit in overall survival [(1)][1]. Outcomes following BAV are often short-lived due to development of valvular restenosis [(2)][2], which

Triplication of the ureter is a rare urologic finding that has been well described in the literature. Patients can present with urinary tract infections, incontinence, and calculi. We present the case of a patient with extensive stone burden with right trifid and left bifid collecting systems. Stone management was performed with a multimodal approach using a combination of endoscopic and percutaneous approaches. Our systematic and staged approach highlights a method for efficacious stone treatment in a complex endourologic case.

Cor triatriatum dexter (CTD) is a rare congenital cardiac anomaly in which a membranous structure divides the right atrium (RA) into two chambers. Persistence of the right valve of the sinus venosus, which usually regresses as a part of normal embryological development, is responsible for membranous partition. There is a high incidence of right-sided congenital abnormalities of the heart associated with this condition. Clinical manifestations vary depending on the degree of partitioning or septation of the RA. We present a case of CTD discovered as an incidental finding during transthoracic echocardiography and further discuss the role of two-dimensional echocardiography as a noninvasive diagnostic tool.

International Journal of Advanced Research (IJAR)

The purpose of these guidelines is to assist specialists in Nuclear Medicine and Radionuclide Radiology in recommending, performing, interpreting and reporting 18F-fluciclovine PET/computed tomography. It should be recognised that adherence to the guidance in this document will not assure an accurate diagnosis or a successful outcome. These guidelines will assist individual departments in the formulation of their own local protocols. The guidelines apply to studies on adults. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources and the needs of the patient in order to deliver effective and safe medical care.

Penile fracture is a rupture of the tunic albugenia of corpus cavernosum that occurs when the penis is erect. The fracture can also involve the corpus spongiosum and urethra. We report a case of a 35 year old man who presented with acute penile pain, penile swelling with clicking sound during intercourse and the inability to pass urine. On exploration we found bilateral partial rupture of the corpus cavernosum with complete urethral and corpus spongiosum disruption. At 1 year follow up patient was having normal erection and voiding function. Penile fracture\'s emergent management preserves erectile and voiding function.

Introduction and Objectives: Percutaneous nephrolithotomy (PCNL) is a complex multistep surgery that has shown a steady increase in use for the past decade in the United States. We sought to evaluate the trends and factors associated with PCNL usage across New York State (NYS). Our goal was to characterize patient demographics and socioeconomic factors across high-, medium-, and low-volume institutions. Materials and Methods: We searched the NYS, Statewide Planning and Research Cooperative System (SPARCS) database from 2006 to 2014 using ICD-9 Procedure Codes 55.04 (percutaneous nephrostomy with fragmentation) for all hospital discharges. Patient demographics including age, gender, race, insurance status, and length of hospital stay were obtained. We characterized each hospital as a low-, medium-, or high-volume center by year. Patient and hospital demographics were compared and reported using chi-square analysis and Student's t-test for categorical and continuous variables, respectively, with statistical significance as a p-value of

Introduction and Objectives: Multiple surgical therapies for benign prostatic hyperplasia (BPH) have been developed to decrease complications and increase provider efficiency. We investigated contemporary BPH treatment device-related adverse events by searching a publicly available database. Materials and Methods: The Manufacturer and User Facility Device Experience (MAUDE) database was queried for contemporary BPH treatments. All devices were evaluated for malfunction, patient complications, and manufacturer review. The MAUDE adverse event classification system was used to standardize complications. Univariate analysis was performed to identify associations between BPH devices and adverse events. Results: A total of 2567 reports were identified: transurethral resection of the prostate (TURP) 197 (7.67%), holmium laser enucleation of the prostate (HoLEP) 39 (1.52%), GreenLight™ 2315 (90.2%), and UroLift(®) 16 (0.62%). The most common deviations for each modality included cutting loop detachment during TURP 116 (58.9%), morcellator dysfunction for HoLEP 23 (58.9%), tip fracture/detachment for GreenLight (68.8%), and failure to deploy during UroLift 10 (62.5%). Only 18 (0.7%) patients required medical/surgical management (MAUDE II–IV) due to a device complication. No significant relationship was seen between each modality and complications; however, morcellator use (27.8%) was observed in higher grade complications. Manufacturer review occurred in 61.7% of cases, with 41.3% of reviewed cases finding the operator the cause of the malfunction. Conclusion: Each BPH modality investigated had minimal patient harm with over 99% of patients experiencing no complication after device malfunction. Of note, great care should be taken with morcellator use during HoLEP as it had the greatest number of MAUDE II to IV complications among all devices. Manufacturer review revealed that over 40% of cases were due to misuse by the user. Therefore, urologists should select the modalities they are most familiar with to decrease patient harm and prevent device malfunctions.

Background: Saliva and tear flow rates and minor salivary gland biopsy are typically used to assess gland function and disease activity in primary Sjogren’s syndrome (pSS); however, these have limitations. Imaging methods can directly visualize and generate quantitative values in individual glands. 18F-FDG-PET/CT (18F-FDG) measures glucose metabolism, a potential surrogate for inflammation; 11C-methionine-PET/CT (11C-met) is an amino acid PET tracer that assesses protein synthesis, a potential surrogate for gland synthetic function. Objectives: Explore the potential of molecular imaging and multi-parametric MRI to characterize and quantify pSS disease manifestations. Methods: In this pilot imaging study (203818), patients with pSS diagnosed per AECG criteria, with a EULAR Sjogren’s syndrome disease activity index score ≥5, and basal salivary flow >0.0 mL/min or stimulated salivary flow rate ≥0.05 mL/min, underwent 18F-FDG and 11C–met and dynamic contrast-enhanced and diffusion-weighted MRI, followed by minor salivary gland biopsy for histological analysis. Age- and sex-matched healthy volunteers (HV) underwent MRI and 11C-met. HV-pSS mean differences (m-diff; 95% confidence intervals [CI]) were calculated and Pearson’s correlation coefficients (r) estimated. Peak PET standard uptake values (SUVpeak) were used in the correlations and SUVmax values were recorded. All methods were compared with routine clinical and laboratory tests. Results: 12 patients had MRI, 18F-FDG and 11C–met; while HV (n=12) had MRI (n=12) and 11C–met (n=8). A lower 11C-met SUVpeak was seen in the parotid (m-diff: 1.4 g/mL [0.4, 2.3]) and submandibular (m-diff: 2.0 g/mL [0.9, 3.2]) glands in pSS versus HV, as was a trend for lower lacrimal gland uptake (m-diff: 0.5 g/mL [-0.2, 1.3]) in patients with pSS. On structural MRI, the fat fraction (mean%) was higher in pSS vs HV in the submandibular glands (m-diff: -14.8 [CI: -29.3, -0.4]), with similar trends observed in the parotid glands (-11.2 [-24.3, 1.9]). There was a negative correlation between 11C-met uptake and fat fraction (r: -0.7 [-0.9, -0.4]) in the combined parotid glands. There was positive correlation between 11C-met uptake and stimulated salivary flow (r: 0.5 [0.03, 0.8]) and negative correlation for stimulated salivary flow and fat fraction (r: -0.5 (-0.8, -0.1)] in the parotid glands; similar correlations were also seen in the submandibular glands. There was negative correlation between the global lymphoid aggregation score on minor salivary gland biopsy and the combined salivary gland fat fraction (r: -0.7 [-0.9, -0.2]). Parotid gland SUVmax 18F-FDG uptake was higher than historical control values (mean: 1.9 g/ml, [SD: 0.5]1) in some patients (pSS mean SUVmax: 2.8 g/mL [SD: 0.8, range 1.7–4.6]), with positive correlation between 18F–FDG and 11C-met uptake (r: 0.7 [0.2, 0.9]) in the combined salivary glands. Conclusion: Imaging showed clear differences between pSS and HV and correlated with clinical endpoints. Low 11C-met uptake and high fat fraction on MRI may indicate poor residual gland function, while high 18F-FDG and stable 11C-met uptake may define a subpopulation that responds well to anti-inflammatory therapies. References [1] Basu S, et al. Nucl Med Commun 2008; 29:367–73. Acknowledgement: Study/editorial support by Fishawack Indicia Ltd, UK funded by GSK. Disclosure of Interests: Michele Bombardieri Grant/research support from: Celgene, Consultant for: Medimmune, Coziana Ciurtin: None declared, Michalis Kostapanos Consultant for: Is an NHS consultant seconded to the GSK Clinical Cambridge Unit (50%) and has nothing to disclose., Elisa Astorri: None declared, Anwar Tappuni: None declared, Natasha Jordan: None declared, Saleem Azeem Shareholder of: GSK, Teresa Fuller Shareholder of: GSK, Employee of: GSK, Kathleen Port Shareholder of: GSK, Employee of: GSK, Nirav Ratia Shareholder of: GSK, Employee of: GSK, Andre van Maurik Shareholder of: GSK, Employee of: GSK, Calum Gray: None declared, Lucy Kershaw: None declared, Rob Janiczek Shareholder of: GSK, Employee of: GSK, Graham Searle: None declared, Paul Galette Shareholder of: GSK, Employee of: GSK, Marius de Groot Shareholder of: GSK, Employee of: GSK, Neel Patel Shareholder of: GSK, Employee of: GSK, Nicolas Wisniacki Shareholder of: GSK, Employee of: GSK, Mats Bergstrom Shareholder of: GSK, Consultant for: acted as external consultant to GSK, Employee of: GSK, Pilar Jimenez-Royo Shareholder of: GSK, Employee of: GSK, Ruth Tarzi Shareholder of: GSK, Employee of: GSK

Genomic databases are substantially biased towards European ancestry populations, and this bias contributes to health disparities. Here, we quantify how well 66,971 experimentally characterized human protein 3D structures represent the diversity of protein sequences observed across the 1000 Genomes Project. More than 85% of available structures do not match a sequence observed in at least one individual, and on average structures match the sequence of 74% of individuals. Nearly 23% of human structures do not matchanyobserved sequences; however, after masking engineered/known mutations, this decreases to ~4%. African ancestry sequences are modestly, but significantly, less likely to be represented by structures (73.5% vs. 74.0%). These differences are mainly driven by the greater genetic diversity of African populations. We identify thousands of variants unrepresented in available structures that influence protein structure and function. Thus, the use of a single structure as representative of “the wild type” protein will often bias results against many individuals. The diversity of protein sequence and structure must be considered to enable accurate, reproducible, and generalizable conclusions from structural analyses.

Background: The HEART score was developed to predict major adverse cardiac events (MACE) within 6 weeks in patients evaluated for chest pain. In the established score, age is scored as 65 y/o = 2 points. The average age of patients in the original study by Backus et al was 61.2 y/o. Our aim is to evaluate the prognostic value of the HEART score in patients >65 y/o. We hypothesized that elderly patients are at increased risk of MACE unaccounted for by the established age scoring system. Methods: We retrospectively reviewed 668 emergency room visits for chest pain (excluding STEMI) between 2016 to 2018 at a single tertiary, urban medical center. HEART scores were calculated based on presenting data. The primary outcome was MACE (MI, PCI, CABG, or death) within 6 weeks. Patients >65 y/o were stratified to 65-74 y/o, 75-84 y/o, and >85 y/o. Primary outcomes were compared between these age groups. Differences in HEART scores between age groups were controlled by comparing patients within the same HEART score brackets (4-6, 7-8, 9-10). Chi squared analysis was used to determine statistically significant differences in MACE (p Results: The average age was 60.2 y/o and average HEART score 5.56. There was statistically significant increase in MACE between 65 y/o (47.4%), as outlined by the established HEART score (p85 y/o (48.8%), increasing age did not correlate with increasing rate of MACE (p=0.90). When controlled for differences in HEART scores, there was again no statistically significant increase rates of MACE between 65-74 y/o, 75-84y/o, and >85 y/o across all HEART score brackets (4-6, 7-8, 9-10). Conclusion: In patients >65 y/o, increasing age did not correlate with increasing rate of MACE refuting our hypothesis. This represents that the other components of the HEART score have greater impact on prognosis than age in this elderly patient population. Our findings support the current age stratification of the established HEART score and show that even in the very elderly, the HEART score adequately accounts for age as a contributor to MACE.

INTRODUCTION AND OBJECTIVES:Ureteroscopy for renal and ureteral stone disease is a low-risk procedure with minimal risks of serious complications, however, the rate of postoperative sepsis can be a...

INTRODUCTION AND OBJECTIVES:Ureteral reconstruction of long-segment proximal and middle ureteral strictures not amenable to primary excision and anastomosis is technically difficult. Although surgi...

The objective was to report the effect of obesity, utilizing a body mass index (BMI) threshold of 35 kg/m2, on outcomes and complications of multiple ligament knee injury (MLKI). It was hypothesized that obese patients would have longer intraoperative times and hospital length of stay, greater estimated blood loss, and higher rates of wound infection requiring irrigation and debridement (I&D) and revision ligament surgery. A retrospective review was performed on 143 individuals who underwent surgery for an MLKI between 2011 and 2018 at a single academic center. Patients were included if there was a plan for potential surgical repair/reconstruction of two or more ligaments. Patients with prior surgery to the affected knee or intra-articular fracture requiring reduction and fixation were excluded. Comparisons between obese and nonobese patients were made using two-sample t-test and either chi-square or Fisher's exact test for continuous and categorical variables, respectively. Significance was set at p

Background Grading of the pivot shift test varies significantly depending on the examiner’s technique. Thus, the purpose of this study was to determine the influence of knee starting position and the magnitude of motion during the reduction event on the magnitude of the pivot shift test. Methods Twenty-five clinical providers each performed a total of twenty pivot shift tests on one of two fresh-frozen cadaveric full lower extremity specimens with different grades of rotatory knee laxity. By means of ACL transection and lateral meniscectomy, one specimen was prepared to have a high-grade pivot shift and one to have a low-grade pivot shift. Six-degree-of-freedom kinematics were recorded during each pivot shift test using an electromagnetic-tracking-system. Successful pivot shift tests were defined and selected using an automated, mathematical algorithm based on the exceeding of a threshold value of anterior translation of the lateral knee compartment. The kinematics were correlated with the magnitude of anterior translation of the lateral knee compartment based on varying degrees of rotatory knee laxity using the Pearson correlation coefficient. Results Only mild correlations between anterior translation of the lateral knee compartment and internal tibial rotation at the start of the reduction event were observed in both specimens. The ability to generate a successful reduction event was significantly dependent on the rotatory knee laxity, with a 54% success rate on the high-laxity specimen compared to a 30% success rate on the low-laxity specimen (p

Goals. The goal of this study was to develop an objective and detailed scoring system to assess the quality of bowel preparation. Background. The quality of bowel preparation impacts the success of the colonoscopy. We developed and compared a new bowel preparation scoring system, the New Jersey Bowel Preparation Scale (NJBPS), with existing systems that are limited by a lack of detail and objectivity in the Boston Bowel Preparation Scale (BBPS) and the Ottawa Bowel Preparation Scale (OBPS). Methods. This was a single-center, prospective, dual-observer study performed at Rutgers New Jersey Medical School University Hospital. Patients who were at medium risk for colorectal cancer and undergoing outpatient screening colonoscopy were enrolled in the study, and their bowel preparation was assessed separately by an attending and a fellow using each of the bowel preparation scoring systems. Results. 98 patients were analyzed in the study, of which 59% were female. Most of the patient population was African American (65%) or Hispanic (25%). The average age of the patient was 60 years. Chi-squared analysis using SPSS software revealed intraclass correlation coefficient values between attending and fellow scores for each scale. The NJBPS had the highest value at 0.988, while the BBPS and OBPS had values of 0.883 and 0.894. Limitations. Single-center study. Conclusions. The NJBPS and BBPS scores demonstrated a statistically significant agreement with each other. Overall, there was good interobserver agreement for all three scoring systems when comparing attendings to fellows for the same scoring system. However, the NJBPS possessed a stronger correlation.

Critical evaluation of each section of a paper is needed in order to properly assess the purpose and quality of the paper and to understand the degree to which the results can influence clinical practice. Reviewing a paper is a skill that is best honed by practice, but there is no real formal training during medical school or residency on what to evaluate during a review and what the review process involves for a journal. Thus, this chapter will highlight the major points to review in each section of a paper and will provide a guide for young investigators to use while interpreting the findings of a paper. Additionally, the components of a review submission to a journal will be outlined.

Late-phase clinical trials investigating metformin as a cancer therapy are underway. However, there remains controversy as to the mode of action of metformin in tumors at clinical doses. We conducted a clinical study integrating measurement of markers of systemic metabolism, dynamic FDG-PET-CT, transcriptomics, and metabolomics at paired time points to profile the bioactivity of metformin in primary breast cancer. We show metformin reduces the levels of mitochondrial metabolites, activates multiple mitochondrial metabolic pathways, and increases 18-FDG flux in tumors. Two tumor groups are identified with distinct metabolic responses, an OXPHOS transcriptional response (OTR) group for which there is an increase in OXPHOS gene transcription and an FDG response group with increased 18-FDG uptake. Increase in proliferation, as measured by a validated proliferation signature, suggested that patients in the OTR group were resistant to metformin treatment. We conclude that mitochondrial response to metformin in primary breast cancer may define anti-tumor effect.

Waste seaweed that is collected at coastal regions of maritime provinces in Canada is creating ecological problems as it promotes an anoxic event, which produces nearly zero dissolved oxygen in water along with hydrogen sulfide emission. The work done in this study attempts to address this issue by producing a coal-like solid hydrochar and nutritious liquid slurry (processed water) by employing a rather recent thermo-chemical process called hydrothermal carbonization (HTC) on the seaweed. The HTC was carried out in a batch reactor system for three different reaction temperatures, 180 °C, 200 °C, 220 °C, and three different reaction times, 30, 60, and 120 min. Each of the produced hydrochars was characterized by different analytical methods. The effects of the process conditions on the yield and the properties of the hydrochar and process water were examined. The hydrochar produced at 220 °C and 120 min showed the highest carbon content (48.5%) and heating value (18.93 MJ/kg). The energy density and carbon to nitrogen (C/N) ratio in the hydrochar increased significantly as compared to raw seaweed. Moreover, HTC reduced the ash yield and volatile compounds of the seaweed. Thus, hydrochar can be used as a fuel for direct combustion, in soil remediation, or in carbon sequestration applications.

Purpose The purpose was to analyze mandibular angle fractures by examining epidemiologic trends and mechanisms of injury and to determine whether a statistically meaningful relation existed between certain treatment modalities and patient outcomes. Materials and Methods A retrospective chart analysis was performed, and data were limited to 1 operator. Treatment variables were methods of fixation, postoperative intermaxillary fixation (IMF), and retention versus extraction of teeth in the line of fracture. Outcomes were rates of postoperative infection, fracture healing, and overall patient comfort. Analysis was performed using the Fisher exact test, Wald test, and χ 2 test, with a P value less than .05 considered significant. Results One hundred three patients were included in this study. The mean age was 30.4 years, most patients were men, and most injuries occurred during physical altercations and on the left side of the face. The most common concomitant fracture was of the contralateral parasymphysis. A statistically meaningful relation was noted between methods of fixation and healing and overall patient comfort, with the Champy technique and reconstruction plate being associated with the highest rates of bony union and patient comfort. No statistically relevant correlation was found between methods of fixation and rates of infection. There was no statistically relevant link for extraction versus retention of healthy teeth in the line of fracture or use of IMF with patient comfort, postoperative infection, or fracture healing. Conclusion Although the Champy technique and reconstruction plates were associated with better postoperative outcomes, such as patient comfort and fracture healing, these should not be used interchangeably. IMF and extraction versus retention of teeth in the line of fracture did not influence any of the outcomes.

The purpose of this study was to assess the potential of U.S. Food and Drug Administration-cleared devices designed for indocyanine green-based perfusion imaging to identify cancer-specific bioconjugates with overlapping excitation and emission wavelengths. Recent clinical trials have demonstrated potential for fluorescence guided surgery, but the time and cost of the approval process may impede clinical translation. To expedite this translation, we explored the feasibility of repurposing existing optical imaging devices for fluorescence-guided surgery. Methods: Consenting patients (n = 15) scheduled for curative resection were enrolled in a clinical trial evaluating the safety and specificity of cetuximab-IRDye800 (NCT01987375). Open-field fluorescence imaging was performed preoperatively and during the surgical resection. Fluorescence intensity was quantified using integrated instrument software, and the tumor-to-background ratio characterized fluorescence contrast. Results: In the preoperative clinic, the open-field device demonstrated potential to guide preoperative mapping of tumor borders, optimize the day of surgery, and identify occult lesions. Intraoperatively, the device demonstrated robust potential to guide surgical resections, as all peak tumor-to-background ratios were greater than 2 (range, 2.2-14.1). Postresection wound bed fluorescence was significantly less than preresection tumor fluorescence (P