Background:
There are currently a variety of patient-reported outcomes (PROs) for elbow pathology, without any established gold standard. The Single Assessment Numeric Evaluation (SANE) is a single ...question assessment of the patient’s perceived overall function compared with normal. The SANE score has been correlated with PROs from the shoulder and knee literature.
Purpose:
To correlate the SANE score for a variety of elbow pathologies with a traditionally reported elbow outcome measure, the American Shoulder and Elbow Surgeons–Elbow score (ASES-E).
Study Design:
Cohort study (diagnosis); Level of evidence, 3.
Methods:
A retrospective review was performed of all patients identified at a single center between April 2016 and January 2019 who presented as a new patient with elbow pathology. All patients prospectively completed the ASES-E along with the SANE score for elbow (SANE-E) at the time of initial consultation. Spearman correlations (r) were performed to evaluate the correlation between the ASES-E and the SANE-E score for specific elbow pathology, along with descriptive data such as age, sex, and chronicity of the problem.
Results:
A total of 555 patients (166 women, 29.9%) with a mean ± SD age of 51.0 ± 11.7 years with the diagnoses of medial epicondylitis (n = 72; 13.0%), lateral epicondylitis (n = 224; 40.4%), biceps tendon rupture (n = 139; 25.0%), triceps tendon rupture (n = 21; 3.8%), and elbow arthritis (n = 99; 17.8%) were included in this analysis. There was moderate correlation between the SANE-E and the ASES-E (r = 0.623; P < .001), with strongest correlation with the visual analog scale (VAS) (r = −0.518; P < .001) compared with any individual question and moderate to strong correlations based on specific diagnoses. SANE-E and ASES-E scores for the entire cohort were 42.9 ± 26.7 and 56.9 ± 21.4, respectively (P < .001). Age (r = 0.027; P = .526), sex (r = 0.026; P = .555), VAS (r = −0.106; P = .013), and chronicity of the problem (r = −0.037; P = .384) were not found to be correlated with differences in ASES-E and SANE-E.
Conclusion:
The SANE-E score is a simple way to assess patient-perceived function relative to normal. The findings of this study demonstrated moderate to strong correlation between the ASES-E and the SANE-E score for a variety of commonly encountered elbow conditions.
The object of this study was to compare organ dose and image quality effects of using bismuth and barium vinyl in-plane shields with standard and low tube current thoracic CT protocols. A RANDO ...phantom was scanned using a 64-slice CT scanner and three different thoracic protocols. Thermoluminescent dosemeters were positioned in six locations to record surface and absorbed breast and lung doses. Image quality was assessed quantitatively using region of interest measurements. Scanning was repeated using bismuth and barium vinyl in-plane shields to cover the breasts and the results were compared with standard and reduced dose protocols. Dose reductions were most evident in the breast, skin and anterior lung when shielding was used, with mean reductions of 34, 33 and 10 % for bismuth and 23, 18 and 11 % for barium, respectively. Bismuth was associated with significant increases in both noise and CT attenuation values for all the three protocols, especially anteriorly and centrally. Barium shielding had a reduced impact on image quality. Reducing the overall tube current reduced doses in all the locations by 20-27 % with similar increases in noise as shielding, without impacting on attenuation values. Reducing the overall tube current best optimises dose with minimal image quality impact. In-plane shields increase noise and attenuation values, while reducing anterior organ doses primarily. Shielding remains a useful optimisation tool in CT and barium is an effective alternative to bismuth especially when image quality is of concern.
Aim To examine how the location where reading takes place and the availability of prior images can affect performance in breast test-set reading. Materials and methods Under optimized viewing ...conditions, 10 expert screen readers each interpreted a reader-specific set of images containing 200 mammographic cases. Readers, randomly divided into two groups read images under one of two pairs of conditions: clinical read with prior images and laboratory read with prior images; laboratory read with prior images and laboratory read without prior images. Region-of-interest (ROI) figure-of-merit (FOM) was analysed using JAFROC software. Breast side-specific sensitivity and specificity were tested using Wilcoxon matched-pairs signed rank tests. Agreement between pairs of readings was measured using Kendall's coefficient of concordance. Results Group performances between test-set readings demonstrated similar ROI FOMs, sensitivity and specificity median values, and acceptable levels of agreement between pairs of readings were shown ( W = 0.75–0.79, p < 0.001) for both pairs of reading conditions. On an individual reader level, two readers demonstrated significant decreases ( p < 0.05) in ROI FOMs when prior images were unavailable. Reading location had an inconsistent impact on individual performance. Conclusion Reading location and availability of prior images did not significantly alter group performance.
Growing evidence shows that expression of non‐coding repetitive sequences, or repetitive element (RE) transcripts, increases with age and may be related to biological aging itself. In fact, RE ...transcript levels can be used to accurately predict age, and they are reduced by healthy aging interventions. However, the exact mechanistic links between RE dysregulation and aging are unknown. Some evidence indicates that RE transcripts may stimulate age‐related inflammation (via formation of RE‐derived double‐stranded RNA, an innate immune activator) but there is currently no evidence of this in human subjects. Therefore, we determined if serum interleukin 6 (IL‐6), a key circulating marker of inflammation, was associated with RE transcript expression (assessed via RNA‐seq) in 92 healthy, middle aged to older adults (64 ± 7 years, 47M/ 45F). We found that serum IL‐6 was positively related to expression of every major type of RE (LINEs, SINEs, DNA transposons, LTRs, and Satellites; mean r value = 0.4, p < 0.0005). To examine transcriptome/gene expression differences associated with high vs. low serum IL‐6, we analyzed differential gene expression in subjects with the highest vs. lowest IL‐6 levels (6 per group, age/sex‐matched). We then performed gene ontology analysis to determine biological processes associated with differentially expressed genes. Interestingly, we found that higher IL‐6 was associated with reduced gene expression signatures of immune function and increased gene expression signatures related to cell death and differentiation. To assess a potential upstream link between RE expression and inflammation, we looked for correlations among RE and innate immune sensor transcript levels. We found a positive relationship between RE expression and levels of IFIH1, the gene that encodes MDA5, a proinflammatory sensor of double‐stranded RNA (p < 0.0005, mean r value = 0.5). MDA5 expression correlated weakly with LINE expression (r = 0.36), but more strongly with satellite and LTR expression (r = 0.66), suggesting that these RE types may be involved in age‐associated inflammation. These are the first data to show a relationship between IL‐6 and global RE expression in older adults, and to characterize the possible mechanisms underlying this relationship.
Wound Dehiscence Following Cubital Tunnel Surgery McEntee, Richard M.; Henry, Tyler W.; Bhatt, Shivangi D. ...
The Journal of hand surgery (American ed.),
June 2023, 2023-Jun, 2023-06-00, 20230601, Letnik:
48, Številka:
6
Journal Article
Recenzirano
Cubital tunnel syndrome is the second most common upper-extremity compressive neuropathy, and persistent symptoms can necessitate operative treatment. Surgical options include simple decompression ...and ulnar nerve transposition. The cause of wound dehiscence after surgery is not well known, and the factors leading to the development of these complications have not been previously described.
Patients undergoing ulnar nerve surgery from January 1, 2016, to December 31, 2019, were retrospectively evaluated for the development of wound dehiscence within 3 months of surgery. There were 295 patients identified who underwent transposition and 1,106 patients who underwent simple decompression. Patient demographics and past medical history were collected to evaluate the risk factors for the development of wound dehiscence.
The overall rate of wound dehiscence following surgery was 2.5%. In the simple decompression group, the rate of wound dehiscence was 2.7% (30/1,106), which occurred a mean of 21 days (range, 2–57 days) following surgery. In the transposition group, the rate of wound dehiscence was 1.7% (5/295), which occurred a mean of 20 days (range, 12–32 days) following surgery. The difference in rates of dehiscence between the decompression and transposition groups was not significant. Five patients in the simple decompression group and 1 patient in the transposition group required a secondary surgery for closure of the wound. Age, body mass index, smoking status, and medical comorbidities were not found to contribute to the development of wound dehiscence.
Wound dehiscence can occur following both simple decompression and transposition, even after postoperative evaluation demonstrates a healed wound. Surgeons should be aware of this possibility and specifically counsel patients about remaining cautious with, and protective of, their wound for several weeks after surgery. Dehiscence may be related to suboptimal vascularity in the soft tissue envelope in the posteromedial elbow. When it occurs, dehiscence can generally be treated by allowing healing by secondary intention.
Therapeutic IV.
Recently, self-directed physical therapy (SDPT) programs have gained popularity following total knee arthroplasty (TKA). This study evaluated the safety and efficacy of the routine use of an SDPT ...program in a nonselect patient population.
This is a single-surgeon, retrospective study of 296 consecutive patients from August 2016 to October 2017 discharged home after primary, unilateral TKA and enrolled in a web-based SDPT program. Patients were seen 2 weeks after surgery and outpatient physical therapy (OPPT) was prescribed if flexion was less than 90°, upon patient request, or inability to use the web-based platform.
Overall, 195 of 296 (65.9%) patients did not require OPPT (SDPT-only) while 101 of 296 were prescribed OPPT (34.1%, SDPT + OPPT). In SDPT + OPPT, 66.3% were for flexion <90°, 27.7% by patient request, 5.0% received a prescription but did not attend OPPT, and 1.0% due to inability to use the web-based platform. The rate of manipulation under anesthesia was 2.36% overall (SDPT + OPPT, 6.93%; SDPT-only, 0.0%). Multivariate analysis identified elevated Charlson comorbidity index, elevated body mass index, higher preoperative SF12 mental score, and loss of flexion at 2 weeks as independent predictors associated with the need for OPPT.
Web-based SDPT is safe and effective for most patients eligible for home discharge after TKA. It is difficult to preoperatively predict those patients who will require OPPT; therefore, we recommend close follow-up. It is critical to preserve these services for patients who require them after TKA as up to a third of patients required OPPT.
Laboratory observer performance measurements, receiver operating characteristic (ROC) and free-response ROC (FROC) differ from actual clinical interpretations in several respects, which could ...compromise their clinical relevance. The objective of this study was to develop a method for quantifying the clinical relevance of a laboratory paradigm and apply it to compare the ROC and FROC paradigms in a nodule detection task.
The original prospective interpretations of 80 digital chest radiographs were classified by the truth panel as correct (C=1) or incorrect (C=0), depending on correlation with additional imaging, and the average of C was interpreted as the clinical figure of merit. FROC data were acquired for 21 radiologists and ROC data were inferred using the highest ratings. The areas under the ROC and alternative FROC curves were used as laboratory figures of merit. Bootstrap analysis was conducted to estimate conventional agreement measures between laboratory and clinical figures of merit. Also computed was a pseudovalue-based image-level correctness measure of the laboratory interpretations, whose association with C as measured by the area (rAUC) under an appropriately defined relevance ROC curve, is as a measure of the clinical relevance of a laboratory paradigm.
Low correlations (e.g. κ=0.244) and near chance level rAUC values (e.g. 0.598), attributable to differences between the clinical and laboratory paradigms, were observed. The absolute width of the confidence interval was 0.38 for the interparadigm differences of the conventional measures and 0.14 for the difference of the rAUCs.
The rAUC measure was consistent with the traditional measures but was more sensitive to the differences in clinical relevance. A new relevance ROC method for quantifying the clinical relevance of a laboratory paradigm is proposed.
Aging is the primary risk factor for most neurodegenerative diseases, including Alzheimer's disease. Major hallmarks of brain aging include neuroinflammation/immune activation and reduced neuronal ...health/function. These processes contribute to cognitive dysfunction (a key risk factor for Alzheimer's disease), but their upstream causes are incompletely understood. Age‐related increases in transposable element (TE) transcripts might contribute to reduced cognitive function with brain aging, as the reverse transcriptase inhibitor 3TC reduces inflammation in peripheral tissues and TE transcripts have been linked with tau pathology in Alzheimer's disease. However, the effects of 3TC on cognitive function with aging have not been investigated. Here, in support of a role for TE transcripts in brain aging/cognitive decline, we show that 3TC: (a) improves cognitive function and reduces neuroinflammation in old wild‐type mice; (b) preserves neuronal health with aging in mice and Caenorhabditis elegans; and (c) enhances cognitive function in a mouse model of tauopathy. We also provide insight on potential underlying mechanisms, as well as evidence of translational relevance for these observations by showing that TE transcripts accumulate with brain aging in humans, and that these age‐related increases intersect with those observed in Alzheimer's disease. Collectively, our results suggest that TE transcript accumulation during aging may contribute to cognitive decline and neurodegeneration, and that targeting these events with reverse transcriptase inhibitors like 3TC could be a viable therapeutic strategy.
Age‐related increases in transposable element transcripts may contribute to brain aging and neurodegeneration by stimulating neuroinflammation. Targeting these transcripts with the reverse transcriptase inhibitor 3TC has the potential to improve cognitive function by reducing immune activation/neuroinflammation.
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