Introduction: The combination of posterior elbow dislocation, radial head fracture, and coronoid fracture has been named "terrible triad" as this injury is difficult to treat and yield poor outcomes. Some studies compared the results of radial head fixation to replacement in isolated radial head fractures, very few reports have tried to compare both treatment modalities in the setting of a terrible triad injury.The aim of this study was to compare the functional outcome of radial head fixation vs replacement in terrible triad injuries of the elbow.

Methods: A single-center, prospective cohort study was conducted at an academic Level 1 Trauma Center from April 2016 to April 2019.A total of 30 patients with terrible triad injury of the elbow were enrolled. The primary outcome was the Quick Disability of Arm, Shoulder and Hand (Quick-DASH) at 1 year. The secondary outcomes were to report the Mayo Elbow Performance Score (MEPS) at 1 year and elbow range of motion.

Results: At final follow up for each patient (13.4 ± 1.2 months) The Quick-DASH score at 1 year for fixation group was 5 ± 2.3, for the replacement group it was 7.1 ± 7.1. The MEPS at 1 year for fixation group was 93.6 ± 8.4, for the replacement group it was 90.9 ± 9.4.Loss of elbow extension at 1 year for fixation group was 17.1° ± 10.7°, for replacement group it was 18.75° ± 11.5°.

Conclusion: A systematic approach to address the bony and soft tissue components of terrible triad elbow injury is crucial to obtain satisfactory outcome. Our study shows that radial head repair and replacement, in the setting of terrible triad injury, yields comparable results.

Level of evidence: Level II, Therapeutic study.

Present study compares two different 3D radiotherapy techniques: three-dimensional conformal radiotherapy (3D-CRT) and 3D external-beam radiation dose fields from computerized treatment plans, produced for 30 prostate cancer patients. All of the patients were the subject of treatment at the National Cancer Institute in Egypt. Evaluation was made of dose homogeneity within the target volume and the dose to critical organs (organs at risk, OAR). The plans were based on CT scans, all for cases of localized prostate cancer (all stage T2N0M0), with the CT scans transferred to the treatment planning systems. Comparison of the two different 3D radiation techniques was made in terms of isodose distributions and dose-volume histograms. The percentage of the planning target volume receiving 95% (V95) and 107% (V107) of the prescribed dose were obtained. For the 3D-CRT technique, the mean values for these were respectively 90.6% and 5.7% while for the other 3D technique they were 94.9% and 3.8%. In examining the dose received by the OAR, use of the 3D-CRT technique was found to provide the preferred dose distribution, with much greater sparing of the bladder, rectum and head of both femora. For the rectum the mean V70, V75 and D95 values (the latter referring to doses to 95% of the treatment volume) for the 3D-CRT technique were 35.5%, 32.2% and 34% while for the other 3D technique these were 8.4%, 0.2% and 12% respectively. For the bladder, the mean V40 and V65 values obtained using the 3D-CRT technique were 80.8% and 74.9% while for the alternative 3D technique they were 20.4% and 17% respectively. Thus for the particular cohort, the 3D-CRT technique provided superior target coverage and reduction of dose to the OAR.

The effects of radiation exposure and drug treatment on the immediate type of hypersensitivity reaction were studied. Guinea-pigs were sensitized by s.c. injections of antigen. The animals were killed 3 weeks later and the lungs were perfused through the pulmonary artery. The perfusate was allowed to superfuse a guinea-pig ileum to estimate its total content of mediators. Results revealed that the mere injection of antigen to the perfused lung resulted in the release of spasmogens which caused contraction of the guinea-pig ileum. Analysis of the effluent showed an increase in the amount of PGs (measured biologically) and histamine (measured fluorimetrically) released during challenge. The response of the ileum to the antigen challenge was inhibited by the infusion of diclofenac (20 micrograms.ml-1) or piroxicam (25 micrograms.ml-1). The drugs also inhibited the release of PGs and histamine from the perfused lungs. Exposure of animals to gamma-radiation, before sensitization, caused a reduction in the amount of mediators released during challenge. On the other hand, in nonsensitized animals, a single radiation dose level of 2 Gy caused fluctuation in the amount of PGs and histamine released during challenge throughout the 3 weeks period of the experiment. Diclofenac and piroxicam effectively reduced the amount of mediators released from sensitized perfused lung isolated from both nonirradiated and irradiated animals. This may, at least partly, explain their protective effect against the exaggerated inflammatory response following gamma-irradiation exposure.

The effects of radiation exposure and drug treatment on the immediate type of hypersensitivity reaction were studied. Guinea-pigs were sensitized by s.c. injections of antigen. The animals were killed 3 weeks later and the lungs were perfused through the pulmonary artery. The perfusate was allowed to superfuse a guinea-pig ileum to estimate its total content of mediators. Results revealed that the mere injection of antigen to the perfused lung resulted in the release of spasmogens which caused contraction of the guinea-pig ileum. Analysis of the effluent showed an increase in the amount of PGs (measured biologically) and histamine (measured fluorimetrically) released during challenge. The response of the ileum to the antigen challenge was inhibited by the infusion of diclofenac (20 micrograms.ml-1) or piroxicam (25 micrograms.ml-1). The drugs also inhibited the release of PGs and histamine from the perfused lungs. Exposure of animals to gamma-radiation, before sensitization, caused a reduction in the amount of mediators released during challenge. On the other hand, in nonsensitized animals, a single radiation dose level of 2 Gy caused fluctuation in the amount of PGs and histamine released during challenge throughout the 3 weeks period of the experiment. Diclofenac and piroxicam effectively reduced the amount of mediators released from sensitized perfused lung isolated from both nonirradiated and irradiated animals. This may, at least partly, explain their protective effect against the exaggerated inflammatory response following gamma-irradiation exposure.

The effects of radiation exposure and drug treatment on the immediate type of hypersensitivity reaction were studied. Guinea-pigs were sensitized by s.c. injections of antigen. The animals were killed 3 weeks later and the lungs were perfused through the pulmonary artery. The perfusate was allowed to superfuse a guinea-pig ileum to estimate its total content of mediators. Results revealed that the mere injection of antigen to the perfused lung resulted in the release of spasmogens which caused contraction of the guinea-pig ileum. Analysis of the effluent showed an increase in the amount of PGs (measured biologically) and histamine (measured fluorimetrically) released during challenge. The response of the ileum to the antigen challenge was inhibited by the infusion of diclofenac (20 micrograms.ml-1) or piroxicam (25 micrograms.ml-1). The drugs also inhibited the release of PGs and histamine from the perfused lungs. Exposure of animals to gamma-radiation, before sensitization, caused a reduction in the amount of mediators released during challenge. On the other hand, in nonsensitized animals, a single radiation dose level of 2 Gy caused fluctuation in the amount of PGs and histamine released during challenge throughout the 3 weeks period of the experiment. Diclofenac and piroxicam effectively reduced the amount of mediators released from sensitized perfused lung isolated from both nonirradiated and irradiated animals. This may, at least partly, explain their protective effect against the exaggerated inflammatory response following gamma-irradiation exposure.

Double-strand breaks (DSBs) are repaired by two distinct pathways, non-homologous end joining (NHEJ) and homologous recombination (HR). The endonuclease Artemis and the PIK kinase Ataxia-Telangiectasia Mutated (ATM), mutated in prominent human radiosensitivity syndromes, are essential for repairing a subset of DSBs via NHEJ in G1 and HR in G2. Both proteins have been implicated in DNA end resection, a mandatory step preceding homology search and strand pairing in HR. Here, we show that during S-phase Artemis but not ATM is dispensable for HR of radiation-induced DSBs. In replicating AT cells, numerous Rad51 foci form gradually, indicating a Rad51 recruitment process that is independent of ATM-mediated end resection. Those DSBs decorated with Rad51 persisted through S- and G2-phase indicating incomplete HR resulting in unrepaired DSBs and a pronounced G2 arrest. We demonstrate that in AT cells loading of Rad51 depends on functional ATR/Chk1. The ATR-dependent checkpoint response is most likely activated when the replication fork encounters radiation-induced single-strand breaks leading to generation of long stretches of single-stranded DNA. Together, these results provide new insight into the role of ATM for initiation and completion of HR during S- and G2-phase. The DSB repair defect during S-phase significantly contributes to the radiosensitivity of AT cells.