Normative values for internal and external glenohumeral rotation strength in rugby players: A systematic review with meta-analysis

This systematic review aims to provide normative values for internal and external glenohumeral rotation strength in rugby players. From the inception to March 2021, the search strategy was (strength OR torque) AND shoulder AND rugby using PubMed, Scopus, Web of Science, and SPORTDiscus databases, with no language restrictions. This systematic review includes 15 articles involving 573 rugby players and presenting internal or external glenohumeral rotation strength values. Two main methods are used to assess glenohumeral rotation strength in rugby players: isokinetic and isometric methods; in the isometric method, the upper arm is abducted at either 0° or 90°. Owing to differences in isokinetic procedures and a lack of studies assessing isometric strength when the upper arm is in a neutral position, normative internal or external glenohumeral rotation strength values are only provided for isometric contractions when the upper arm is abducted at 90° based on 311 shoulders of 163 male rugby union players, with 2.04 ± 0.15 N.kg-1 and 2.11 ± 0.13 N.kg-1 for internal and external glenohumeral rotation strength, respectively. These findings may help strength and conditioning coaches and physical therapists, provide objective evidence when deciding whether or not rugby union players should return to sport.

Commercially-available AI algorithm improves radiologists' sensitivity for wrist and hand fracture detection on X-ray, compared to a CT-based ground truth

OBJECTIVES

Algorithms for fracture detection are spreading in clinical practice, but the use of X-ray-only ground truth can induce bias in their evaluation. This study assessed radiologists' performances to detect wrist and hand fractures on radiographs, using a commercially-available algorithm, compared to a computerized tomography (CT) ground truth.

METHODS

Post-traumatic hand and wrist CT and concomitant X-ray examinations were retrospectively gathered. Radiographs were labeled based on CT findings. The dataset was composed of 296 consecutive cases: 118 normal (39.9%), 178 pathological (60.1%) with a total of 267 fractures visible in CT. Twenty-three radiologists with various levels of experience reviewed all radiographs without AI, then using it, blinded towards CT results.

RESULTS

Using AI improved radiologists' sensitivity (Se, 0.658 to 0.703, p < 0.0001) and negative predictive value (NPV, 0.585 to 0.618, p < 0.0001), without affecting their specificity (Sp, 0.885 vs 0.891, p = 0.91) or positive predictive value (PPV, 0.887 vs 0.899, p = 0.08). On the radiographic dataset, based on the CT ground truth, stand-alone AI performances were 0.771 (Se), 0.898 (Sp), 0.684 (NPV), 0.915 (PPV), and 0.764 (AUROC) which were lower than previously reported, suggesting a potential underestimation of the number of missed fractures in the AI literature.

CONCLUSIONS

AI enabled radiologists to improve their sensitivity and negative predictive value for wrist and hand fracture detection on radiographs, without affecting their specificity or positive predictive value, compared to a CT-based ground truth. Using CT as gold standard for X-ray labels is innovative, leading to algorithm performance poorer than reported elsewhere, but probably closer to clinical reality.

CLINICAL RELEVANCE STATEMENT

Using an AI algorithm significantly improved radiologists' sensitivity and negative predictive value in detecting wrist and hand fractures on radiographs, with ground truth labels based on CT findings.

KEY POINTS

• Using CT as a ground truth for labeling X-rays is new in AI literature, and led to algorithm performance significantly poorer than reported elsewhere (AUROC: 0.764), but probably closer to clinical reality. • AI enabled radiologists to significantly improve their sensitivity (+ 4.5%) and negative predictive value (+ 3.3%) for the detection of wrist and hand fractures on X-rays. • There was no significant change in terms of specificity or positive predictive value.

Histological staging and Dupuytren's disease recurrence or extension after surgical treatment: a retrospective study of 124 patients

Dupuytren's disease has a high rate of recurrence after treatment. In this study we have assessed the usefulness of histological staging in the prediction of recurrence. We have also verified whether there is a correlation between histological staging and features of Dupuytren's diathesis. We studied 139 hands in 124 Caucasian patients treated between 1997 and 2004. There was a significant difference in the recurrence rate between the three histological types (P = 0.04). Histological staging was independent of features of Dupuytren's diathesis. This study confirms that histological staging is a reliable method for predicting recurrence. However, it should be used in association with clinical data to determine precisely the prognosis of patients suffering from Dupuytren's contracture.

Comparison of the epidermal growth factor receptor gene and protein in primary non-small-cell-lung cancer and metastatic sites: implications for treatment with EGFR-inhibitors

BACKGROUND

Very recent studies have suggested that EGFR gene copy number and expression obtained by fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) should be used to predict which lung cancer patients are expected to respond to anti-EGFR treatments. However, it is still not known whether EGFR expression differs in metastases compared to primary non-small cell lung cancer (NSCLC).

PATIENTS AND METHODS

EGFR status was analysed by IHC and FISH on tumor samples of primary NSCLC and at least one distant metastatic lesion in 30 patients.

RESULTS

Ten cases (33.3%) showed primary tumor/metastasis discordance by IHC analysis (n = 30): in seven cases, EGFR was expressed in the primary tumor but not in the metastasis, while three samples showed EGFR expression in the metastasis but not in the primary tumor (Pearson correlation coefficient = 0.331, P = 0.0074). By FISH (n = 26), seven (27%) cases were discordant: six cases showed a high-level of EGFR polysomy in the primary tumor but not in the metastasis and one case showed a high-level of EGFR polysomy in the metastasis but not in the primary sample (Pearson correlation coefficient = 0.52, P = 0.007).

CONCLUSION

EGFR expression is not stable during metastatic progression in a significant proportion of NSCLC. These findings have to be considered in future prospective studies.

Structural and numerical aberrations of chromosome 22 in a case of follicular variant of papillary thyroid carcinoma revealed by conventional and molecular cytogenetics

This study reports a case of papillary carcinoma with vesicular components showing multiclonal aberrations of chromosome 22 as revealed by RHG-banding cytogenetics and by fluorescence in situ hybridization (FISH; whole chromosome 22 and BCR-ABL-specific locus probes, multi-FISH). Four clones with chromosome 22 changes as the sole abnormality were seen. The main abnormal clone lacked the whole chromosome 22. A del(22)(q11) was observed in a second group of cells. The third clone had an idic(22). Finally, FISH revealed a fourth abnormal cell population with a der(17)t(?17;22). Some of these chromosome 22 alterations have been described in other solid tumors such as meningiomas and neurinomas, suggesting a common genetic pathway of tumor progression occurring in a multistep process. Chromosome 22 changes do not seem to be involved in pure papillary thyroid tumors and therefore could be related to the maintenance of a follicular-type histological pattern.

[Efficacy of anti-digoxin antibodies in a premature neonate]

Through the case report of severe digitalis intoxication in a premature born after 27 weeks of gestation with a birthweight of 800 g, the authors show that anti-digoxin antibodies constitute a very efficacious therapeutic tool which, up to the present, has not been used in prematures.

[Demonstration of lipoprotein anomalies in leptospirosis. Prospective study in 10 patients]

Abnormalities of lipid metabolism have never been shown in human leptospirosis. A prospective study of plasma lipids was performed in 10 consecutive patients with leptospirosis. Significant increase of triglycerides with low levels of the high-density lipoproteins and cholesterol fraction was observed in 8 patients. Electrophoresis of lipoproteins showed a fusion of beta and pre-beta lipoproteins and a marked decrease of alpha lipoproteins. The respective role of bacteria, liver and kidney could be suggested to explain these abnormalities of lipoproteins in leptospirosis.

Action of trypsin on human plantar stratum corneum. An ultrastructural study

Incubation of human plantar stratum corneum (SC) with trypsin at various pH suppressed the typical "keratin pattern" in the cytoplasm of the horny cells and disclosed tonofilaments and desmosomal attachment plates as they are seen in living keratinocyts. Tonofilaments were 62-75 A wide and showed a 100-120 A periodicity. This effect was non-specific since it was also obtained by incubation of SC with citric acid or sodium citrate, but it was not due to hydration alone. Partial acantholysis was obtained by incubation with trypsin followed by citric acid. After simultaneous action of trypsin in sodium citrate and in citric acid, cell membranes were separated from the cytoplasm and many of them were broken around desmosomes with subsequent isolation of desmosomes. The role of trypsin in this effect was uncertain. These findings strongly suggest that the filamentous network built up by living keratinocytes remains almost unchanged during the keratinization process although no longer visible under E.M.