Acetabular cartilage delamination: performance of MRI using arthroscopy as the standard of reference

BACKGROUND

Femoroacetabular impingement (FAI) frequently leads to acetabular chondral delamination. Early identification and treatment of these cases is crucial to prevent further damage to the hip.

PURPOSE

To evaluate the accuracy of morphological signs of cartilage acetabular delamination in non-arthrographic magnetic resonance imaging (MRI) using intra-articular arthroscopic findings in patients undergoing FAI surgery.

MATERIAL AND METHODS

All hip MRI scans were assessed individually by three independent radiologists. Images were assessed for signs of delamination including the presence of a linear area of bright signal intensity along the acetabular subchondral bone and an area of darker tissue at the surface of the acetabular cartilage. All FAI patients underwent surgery; arthroscopy served as the standard of reference.

RESULTS

The mean age of participants was 36.1±10.9 years with 36 (48.6%) women. In the FAI group, arthroscopic surgery showed acetabular chondral delamination in 37 hips. In all hips (including the controls), MRI signs of acetabular cartilage delamination showed an average sensitivity across the three raters of 73.0% with a specificity of 71.0%. In a separate analysis of only the FAI patients, a slightly higher sensitivity (77.7%) but lower specificity (66.7%) was demonstrated. The interrater reliability showed a moderate agreement (average [k]) across the raters (0.450).

CONCLUSION

Performance of non-arthrographic MRI in diagnosing acetabular chondral delamination showed good results, yet inter-observer reproducibility among different radiologists was only moderate. Our results suggest that an increased level of awareness, for signs of delamination using MRI, will be helpful for detecting chondral delamination in patients with a history of FAI.

Contact ratio and adaptations in the maxillary and mandibular dentoalveolar joints in rats and human clinical analogs

Spatial maps of function-based contact areas and resulting mechanical strains in bones of intact fibrous joints in preclinical small-scale animal models are limited. Functional imaging in situ on intact dentoalveolar fibrous joints (DAJs) in hemimandibles and hemimaxillae harvested from 10 male Sprague-Dawley rats (N = 5 at 12 weeks, N = 5 at 20 weeks) was performed in this study. Physical features including bone volume fraction (BVF), bone pore diameter and pore density, and cementum fraction (CF) of the molars in the maxillary and mandibular joints were evaluated. Biomechanical testing in situ provided estimates of joint stiffness, changes in periodontal ligament spaces (PDL-space) between the molar and bony socket, and thereby localization of contact area in the respective joints. Contact area localization revealed mechanically stressed interradicular and apical regions in the joints. These anatomy-specific contact stresses in maxillary and mandibular joints were correlated with the physical features and resulting strains in interradicular and bony socket compartments. The mandibular joint spaces, in general, were higher than maxillary, and this trend was consistent with age (younger loaded: Mn - 134 ± 55 μm, Mx - 110 ± 47 μm; older loaded: Mn - 122 ± 49 μm, Mx - 105 ± 48 μm). However, a significant decrease (P < 0.05) in mandibular and maxillary joint spaces with age (younger unloaded: Mn - 147 ± 51 μm; Mx - 125 ± 42 μm; older unloaded: Mn - 134 ± 46 μm; Mx - 116 ± 44 μm) was observed. The bone volume fraction (BVF) of mandibular interradicular bone (IR bone) increased significantly with age (P < 0.05) with the percent porosity of coronal mandibular bone lower than its maxillary counterpart. The contact ratio (contact area to total surface area) of maxillary teeth was significantly greater (P < 0.05) than mandibular teeth; both maxillary interradicular and apical contact ratios (IR bone: 41%, 56%; Apical bone: 4%, 12%) increased with age, and were higher than the mandibular (IR bone: 19%, 44%; Apical bone: 1%, 4%) counterpart. Resulting higher but uniform strains in maxillary bone contrasted with lower but higher variance in mandibular strains at a younger age. Anatomy-specific colocalization of physical properties and functional strains in bone provided insights into form-guided adaptive dominance of the maxilla compared to material property-guided adaptive dominance of the mandible. These age-related trends from the preclinical animal model paralleled with age- and tooth position-specific variabilities in mandibular craniofacial bones of adolescent and adult patients following orthodontic treatment.

Subject-specific biomechanical analysis to estimate locations susceptible to osteoarthritis-Finite element modeling and MRI follow-up of ACL reconstructed patients

The aims of this case-control study were to: (1) Identify cartilage locations and volumes at risk of osteoarthritis (OA) using subject-specific finite element (FE) models; (2) Quantify the relationships between the simulated biomechanical parameters and T₂ and T_1ρ relaxation times of magnetic resonance imaging (MRI). We created subject-specific FE models for seven patients with anterior cruciate ligament (ACL) reconstruction and six controls based on a previous proof-of-concept study. We identified locations and cartilage volumes susceptible to OA, based on maximum principal stresses and absolute maximum shear strains in cartilage exceeding thresholds of 7 MPa and 32%, respectively. The locations and volumes susceptible to OA were compared qualitatively and quantitatively against 2-year longitudinal changes in T₂ and T_1ρ relaxation times. The degeneration volumes predicted by the FE models, based on excessive maximum principal stresses, were significantly correlated (r = 0.711, p < 0.001) with the degeneration volumes determined from T₂ relaxation times. There was also a significant correlation between the predicted stress values and changes in T₂ relaxation time (r = 0.649, p < 0.001). Absolute maximum shear strains and changes in T_1ρ relaxation time were not significantly correlated. Five out of seven patients with ACL reconstruction showed excessive maximum principal stresses in either one or both tibial cartilage compartments, in agreement with follow-up information from MRI. Expectedly, for controls, the FE models and follow-up information showed no degenerative signs. Our results suggest that the presented modelling methodology could be applied to prospectively identify ACL reconstructed patients at risk of biomechanically driven OA, particularly by the analysis of maximum principal stresses of cartilage.

P-120 Microfluidic sperm selection device increases clinical pregnancy rate in IVF/ PGT-A cycles

Study question

Evaluate the influence of sperm selection according to the sorting technique, and its effects in clinical and laboratory parameters in IVF/PGT-A cycles.

Summary answer

Cycles that used microfluidic sperm selection device presented an increase in clinical pregnancy rates.

What is known already

A common genomic anomaly detected in subfertile men is the Sperm DNA fragmentation. It is resulted of a high concentation of free radicals produced causing oxidative stress in sperm cells. In order to achieve a normal embryonic development is necessary good spermatozoa with intact genetic material. In fact, embryonic quality parameters as lower fertilization, blastocyst formation and pregnancy rates has been related with Sperm DNA fragmentation increased cases. The microfluidic sperm selection device has been commercialized promising to select spermatozoa with a low level of DNA fragmentation and suggest a relationship between embryo quality, euploidy and pregnancy rates.

Study design, size, duration

A case-control study involving 494 IVF/PGT-A cycles that resulted in embryo biopsy between June, 2020 and November, 2021 at a Brazilian private practice unit (Instituto Ideia Fertil) were included in this analysis.

Participants/materials, setting, methods

All cycles that would perform PGT-A were splitted in two groups considering the sperm sorting technique: case - Microfluidic sperm selection device (245 cycles) and control - Density gradient centrifugation + swim-up (249 cycles) were included. The variables considered in this analysis were patient age, sperm concentration, fertilization, D3 top quality, blastocyst top quality, blastulation, ploidy and pregnancy rates. This data were analysed between groups and female age (until 37; 38-40 and over 41).

Main results and the role of chance

The mean age of the female and male patients found were 38.05 and 38.2 respectively and there was not statistically significant different between groups. Fertilization rate compared between case (72.4%) and control (76.5%) groups (p &lt; 0.05) demonstrated statistically significant difference, but when stratified accordingly to the age, only the female age until 37 years old group showed significant difference (73.25%; 76.43%; p &lt; 0.05). The variables analyzed as D3 Top Quality, Blastocyst Top Quality, blastulation and ploidy did not present difference (p = 0.552; 0.699; 0.378). The clinical pregnancy rate analyzed revealed in case group 65.33% and control 56.38% (p &lt; 0.05), demonstrating statistically significant difference. When groups were splitted according to the female age (until 37 years old; 38-40 and over 41) the findings behaved in the same characteristics, increasing only the clinical pregnancy rate. The tests used was Mann-Whitney and Kruskal-wallis.

Limitations, reasons for caution

The DNA fragmentation test was not evaluated because not all patients had this test performed. Besides that, another parameter that will be analysed is live birth rate.

Wider implications of the findings

Microfluidic sperm sorting device made possible to select high quality spermatozoa according to motility, morphology, and low rates of fragmentation, showing the importance of having a good sperm in clinical pregnancy rate.

Trial registration number

none

Constructing evidence-based clinical intrapartum care algorithms for decision-support tools

AIM

To describe standardised iterative methods used by a multidisciplinary group to develop evidence-based clinical intrapartum care algorithms for the management of uneventful and complicated labours.

POPULATION

Singleton, term pregnancies considered to be at low risk of developing complications at admission to the birthing facility.

SETTING

Health facilities in low- and middle-income countries.

SEARCH STRATEGY

Literature reviews were conducted to identify standardised methods for algorithm development and examples from other fields, and evidence and guidelines for intrapartum care. Searches for different algorithm topics were last updated between January and October 2020 and included a combination of terms such as 'labour', 'intrapartum', 'algorithms' and specific topic terms, using Cochrane Library and MEDLINE/PubMED, CINAHL, National Guidelines Clearinghouse and Google.

CASE SCENARIOS

Nine algorithm topics were identified for monitoring and management of uncomplicated labour and childbirth, identification and management of abnormalities of fetal heart rate, liquor, uterine contractions, labour progress, maternal pulse and blood pressure, temperature, urine and complicated third stage of labour. Each topic included between two and four case scenarios covering most common deviations, severity of related complications or critical clinical outcomes.

CONCLUSIONS

Intrapartum care algorithms provide a framework for monitoring women, and identifying and managing complications during labour and childbirth. These algorithms will support implementation of WHO recommendations and facilitate the development by stakeholders of evidence-based, up to date, paper-based or digital reminders and decision-support tools. The algorithms need to be field tested and may need to be adapted to specific contexts.

TWEETABLE ABSTRACT

Evidence-based intrapartum care clinical algorithms for a safe and positive childbirth experience.

Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case-control study of 237 young adult football players with and without hip and groin pain

Objective

Football players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players.

Methods

For this case–control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score.

Results

Greater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189–0.937)

Conclusion

Cam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.

B-lines by lung ultrasound is associated with pulmonary symptoms and cardiac function in acute malaria: a prospective cohort study

Background

Malaria patients are at risk of cardiopulmonary complications, but diagnosis and management are difficult in resource limited environments. B-lines by lung ultrasonography (LUS) can identify pulmonary alterations, however, little is known about the usefulness in malaria.

Purpose

We aimed to investigate the occurrence of B-lines in acute malaria patients at baseline and at follow-up, and whether they are associated with shortness of breath and impaired left ventricular ejection fraction (LVEF).

Methods

Adult patients with non-severe acute malaria were prospectively enrolled from June to December 2020 in community healthcare clinics in a remote area. Patients were age- and sex-matched to controls without a prior history of malaria. We examined patients prior to anti-malaria treatment and at follow-up. Malaria treatment was administered according to national guidelines. Patients were excluded if they were pregnant, had concomitant infections or recent chest trauma. Patients underwent LUS (8-zones), echocardiography and peripheral blood smear. Measurements were blinded to clinical variables and outcomes.

Results

We included a total of 99 patients (median age 40±15 years, 55% men). Patients suffered from Plasmodium vivax (n=75), P. falciparum (n=22), and a mix of the two (n=2) and median parasite density was 1,595 parasites/mL (interquartile range [IQR] 528–6,585/mL). Follow-up was completed in 71 patients and the median follow-up time was 31 days (IQR 27–40 days).

Patients with acute malaria had significantly more B-lines at baseline than matched controls (P-value&lt;0.001) and fewer B-lines at follow-up (P-value&lt;0.001) (Figure 1). In acute malaria patients, number of B-lines at baseline correlated significantly with shortness of breath (OR 1.20, [1.04 to 1.39], P-value=0.01) and with LVEF (adjusted for age and sex: +8% [+1% to +15%], P-value=0.016 per 1% decrease in LVEF). There was no correlation between number of B-lines and parasite density (+2% [−5% to +11%], P-value=0.53 per 1000 increase in parasite density).

Conclusion

B-lines detected by LUS are more frequent in patients with acute malaria than in age- and sex-matched controls and decrease in response to treatment. B-lines also correlate with shortness of breath and lower LVEF at baseline. Because LUS is a quick and accessible examination, it may potentially facilitate risk stratification and therapeutic decisions regarding cardiopulmonary complications in patients with acute malaria.

Funding Acknowledgement

Type of funding sources: Foundation. Main funding source(s): Danish Heart Association

Patient-Reported Activity Levels Correlate With Early Cartilage Degeneration After Anterior Cruciate Ligament Reconstruction

BACKGROUND

The association between activity level after anterior cruciate ligament (ACL) reconstruction (ACLR) and development of posttraumatic osteoarthritis (PTOA) remains unclear. This study investigated the relationship of patient-reported outcomes and progressive cartilage degenerative changes at 3 years after ACLR.

HYPOTHESIS

Higher activity levels, as measured by Marx scores, are significantly correlated with early cartilage degeneration after ACLR.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 35 patients (16 women; mean age, 31.0 ± 7.6 years) with isolated ACLR and without pre-existing arthritis were prospectively enrolled. Patients reported Marx activity scores and Knee injury and Osteoarthritis Outcome Score (KOOS) scores and underwent T₁ρ magnetic resonance imaging (MRI) preoperatively, 6 months, 1 year, 2 years, and 3 years after ACLR with soft tissue graft (22 autograft). The change in cartilage relaxation times between preoperative and 3-year imaging was used to identify cartilage degeneration, defined as an increase in T₁ρ values by 14.3%. Correlation between Marx activity levels, KOOS scores, and T₁ρ degeneration was performed with the Spearman rank test. The Fisher exact test was used to test for association between Marx activity score cutoffs and degeneration. The Student t test was used to compare Whole-Organ Magnetic Resonance Imaging Score (WORMS) and T₁ρ relaxation times. Significance was defined as P < .05.

RESULTS

Sixteen patients (45.7%) showed evidence of cartilage degeneration at 3 years, most frequently in the medial compartment (n = 12; 34%). Higher Marx activity scores at 3 years correlated with cartilage degeneration in the medial femur (rho = 0.34; P = .045), and medial tibia (rho = 0.43; P = .01). A Marx score of 11 or greater at 3 years was significantly associated with medial compartment degeneration (P = .03), with a positive predictive value of 52.6%. No Marx score cutoff at years 1 or 2 predicted future cartilage degeneration. The KOOS Quality of Life score was inversely correlated with cartilage degeneration (rho = 0.38; P = .02). WORMS did not correlate with degeneration of the medial compartment.

CONCLUSION

Increased activity at 3 years after ACLR was significantly associated with increased risk of medial compartment PTOA. While further research is needed to fully define these relationships, patients may be counseled that return to Marx activity levels of greater than 11 may be associated with a higher risk of medial compartment cartilage degeneration.

Computer-Aided Detection AI Reduces Interreader Variability in Grading Hip Abnormalities With MRI

BACKGROUND

Accurate interpretation of hip MRI is time-intensive and difficult, prone to inter- and intrareviewer variability, and lacks a universally accepted grading scale to evaluate morphological abnormalities.

PURPOSE

To 1) develop and evaluate a deep-learning-based model for binary classification of hip osteoarthritis (OA) morphological abnormalities on MR images, and 2) develop an artificial intelligence (AI)-based assist tool to find if using the model predictions improves interreader agreement in hip grading.

STUDY TYPE

Retrospective study aimed to evaluate a technical development.

POPULATION

A total of 764 MRI volumes (364 patients) obtained from two studies (242 patients from LASEM [FORCe] and 122 patients from UCSF), split into a 65-25-10% train, validation, test set for network training.

FIELD STRENGTH/SEQUENCE

3T MRI, 2D T2 FSE, PD SPAIR.

ASSESSMENT

Automatic binary classification of cartilage lesions, bone marrow edema-like lesions, and subchondral cyst-like lesions using the MRNet, interreader agreement before and after using network predictions.

STATISTICAL TESTS

Receiver operating characteristic (ROC) curve, area under curve (AUC), specificity and sensitivity, and balanced accuracy.

RESULTS

For cartilage lesions, bone marrow edema-like lesions and subchondral cyst-like lesions the AUCs were: 0.80 (95% confidence interval [CI] 0.65, 0.95), 0.84 (95% CI 0.67, 1.00), and 0.77 (95% CI 0.66, 0.85), respectively. The sensitivity and specificity of the radiologist for binary classification were: 0.79 (95% CI 0.65, 0.93) and 0.80 (95% CI 0.59, 1.02), 0.40 (95% CI -0.02, 0.83) and 0.72 (95% CI 0.59, 0.86), 0.75 (95% CI 0.45, 1.05) and 0.88 (95% CI 0.77, 0.98). The interreader balanced accuracy increased from 53%, 71% and 56% to 60%, 73% and 68% after using the network predictions and saliency maps.

DATA CONCLUSION

We have shown that a deep-learning approach achieved high performance in clinical classification tasks on hip MR images, and that using the predictions from the deep-learning model improved the interreader agreement in all pathologies.

LEVEL OF EVIDENCE

3 TECHNICAL EFFICACY STAGE: 1 J. Magn. Reson. Imaging 2020;52:1163-1172.

Continuing Education in Health: interprofessional practices in the field of Collective Health

Family Health Support Centres (NASFs, in Portuguese) aim to develop interprofessional practices anchored in the assumptions of Primary Health Care, guided by the criteria of shared care specific professional interventions, management processes, interdisciplinarity, intersectoriality, Continuing Education in Health and health promotion. This health management methodology (Matrix Support) still represents a challenge to workers and managers, as it switches the logic of clinical thought from individual-centred, ambulatory and disciplinary care to collective, territory and interdisciplinary care. This study might illustrate and allow sharing of experiences about a work management format for multidisciplinary teams in Primary Health Care. A partnership between the University and the state health department was established in order to elaborate a collaborative, educational and supportive action. We formed a group of workers in the target area (24 municipalities and 18 teams) who had a focus on Continuing Education in Health using Institutional Analysis as theoretical reference. The main goal of the action was to provide spaces to share experiences and learning in the perspective of Continuing Education in Health. How does Continuing Education in Health support interprofessional practices in the field of Collective Health? Among the main results, we list: reflection about organisation practices of multiprofessional work, reflection about care practices and clinic management in the technical-assistance and pedagogic perspectives of Matrix Support; encouragement to improve the services offered in this level of care and their relationship with other points of the network. This experience showed us the importance of three main aspects: Continuing Education in Health, as a strategy of critical analysis about work and workers; the partnership and integration between teaching and service; and interprofessional formation processes (necessary to NASF and Collective Health).

Key messages

Continuing Education in Health is a strategy to deal with challenges and possibilities of interprofessional practices in the field of Collective Health. Enabling experiences and providing spaces for health professionals to share experience and learning.

Chronic thromboembolic and pulmonary arterial hypertension share right ventricular and pulmonary artery CMR features

BACKGROUND

Cardiac magnetic resonance (CMR) imaging has gained importance in pulmonary hypertension (PH) and studies have demonstrated its use as a surrogate marker and in following treatment of these patients. The pathophysiology of PH differs between pulmonary arterial hypertension (PAH, group 1) and chronic thromboembolic PH (CTEPH, group 4).

OBJECTIVES

The present study tested the hypothesis that PAH and CTEPH display different characteristics on CMR imaging.

METHODS

46 patients were evaluated for pulmonary vascular disease in the French National Reference Center for PH (23 PAH and 23 CTEPH matched for age and gender). All patients had the right heart catheterization (RHC) and CMR imaging performed within 48h. CMR imaging was performed on a 1.5 T scanner.

RESULTS

PAH and CTEPH had similar body surface area and similar invasive hemodynamics, including mean pulmonary arterial pressure, cardiac index, pulmonary vascular resistance and right atrial pressure. PAH and CTEPH had similar CMR data. Right ventricular (RV) morphology and function and pulmonary artery (PA) data were also similar.

CONCLUSION

Age- and sex-matched PAH and CTEPH patients displayed similar values of the CMR indices of RV and PA morphology and function, suggesting that the RV-PA responses are similar in both groups, mostly related to the overall increase in after load.

Critical analysis of aortic dysmorphism in Marfan Syndrome

Introduction: Marfan syndrome (OMIM #154700) was described for the first time in 1896 by Antoine Bernard-Jean Marfan. It is characterized by its autosomal dominant inheritance pattern, affects 1:5000 of those born alive, and involves the gene that codifies the structural protein fribrillin-1. Fibrillin-1 is critical for the formation of the elastic system backbone and for the negative regulation of the cytokine transforming growth factor beta 1 (TGF-β1). In the syndrome this fibrillar component causes the degeneration of the fibers of the elastic system, which no longer sequesters matrix TGF-β, causing disorganization of the collagen fibers and vascular smooth muscles. The disease affects mainly the cardiovascular system, cardiovascular problems being the main cause of death. This is because arteries have large amounts of elastic fibers that rupture in an adverse process, causing mainly dissections and aneurisms, which have been better clariied in experimental studies with mice. Objective: The objective of this study was to conduct an etiopathogenic and molecular review to describe the advances in the understanding of blood vessel dysmorphism in the syndrome, especially of the aorta. Materials and Methods: For this purpose the literature of the last 35 years was extensively reviewed. Conclusion: The origin of the aortic dysmorphism in the syndrome stems from a number of events that begin with the mutation of the gene fibrillin-1, causing fragmentation of the aortic elastic fibers. Excess cytokine TGF-β increases the amount of metalloproteinases and of vascular smooth muscle cell apoptosis, leading to matrix remodeling and increasing the susceptibility of the vessel to an aneurysm or dissecting process.

Ultrathin Monolithic Zirconia Veneers: Reality or Future? Report of a Clinical Case and One-year Follow-up

Yttria-stabilized polycrystalline zirconia ceramics have greatly advanced over the past few years. High-translucent zirconia is a newly introduced ceramic that affords high strength and esthetics and that has significantly increased the clinical indications of monolithic zirconia restorations. Thus, the purpose of this case report was to evaluate the performance of ultrathin monolithic zirconia veneers adhesively luted to enamel surfaces after minimally invasive preparations; in addition, we aimed at presenting a clinical protocol for zirconia surface treatment in order to promote bonding effectiveness to resin cement. This type of restoration presented very acceptable esthetic results and decreased the risk of fracturing the veneer during try-in and clinical use. The results were still satisfactory after one-year follow-up. However, randomized, prospective, controlled clinical trials are required to determine the long-term clinical durability of this treatment.

Electromyographic study on the sternocleidomastoid and pectoralis major muscles during respiratory activity in humans

Introduction: This study aimed to evaluate the simultaneous and maximum activities ofthe sternocleidomastoid (SCM) and pectoralis major (PM) muscles, to determine how the two types of breathing patterns (normal and forced) can affect these activities , and to verify which of these muscles could be used to establish an evaluation protocol for patients undergoing mechanical ventilation. Methods: Eleven healthy men, aged 18 to 25 years, participated in this study. The individuals remained in supine position using a respiratory belt to monitor both inspiratory and expiratory phase during shifts in the rib cage, performing three repetitions for the normal and forced respiratory movements, while keeping the breathing rhythm with a standard metronome. Electromyographic signals were captured using bipolar surface electrodes placed on the lower third of the SCM muscle and on the lower PM muscle fibers. Electromyographic signals were analyzed and the root mean square (RMS) values were calculated for a complete respiratory cycle. The EMG values were analyzed using the Bonferroni test for multiple comparisons. The homogeneity of variances was verified using the logarithmic transformation (LOG). The level of statistical significance was set at 5% (SPSS 19.0). Results: The values showed that there are signiicant differences between the EMG values of the SCM muscle during normal and forced respiration and the EMG values of the ECM and PM muscles during forced respiration. Conclusion: These results showed that the SCM muscle can be an indicator for the development of parameters to be used in the analysis of patients with respiratory failure.

Validation of scoring hip osteoarthritis with MRI (SHOMRI) scores using hip arthroscopy as a standard of reference

PURPOSE

To validate SHOMRI gradings in preoperative hip magnetic resonance imaging (MRI) with intra-arthroscopic evaluation of intraarticular hip abnormalities.

METHODS

Preoperative non-arthrographic 3.0-T MRIs of 40 hips in 39 patients (1 patient with bilateral hip surgery) with femoroacetabular impingement (FAI) syndrome (mean age, 34.7 years ± 9.0; n = 16 females), refractory to conservative measures, that underwent hip arthroscopy were retrospectively assessed by two radiologists for chondrolabral abnormalities and compared with intra-arthroscopic findings as the standard of reference. Arthroscopically accessible regions were compared with the corresponding SHOMRI subregions and assessed for the presence and grade of cartilaginous pathologies in the acetabulum and femoral head. The acetabular labrum was assessed for the presence or absence of labral tears. For the statistical analysis sensitivity and specificity as well as intraclass correlation (ICC) for interobserver agreement were calculated.

RESULTS

Regarding chondral abnormalities, 58.8% of the surgical cases showed chondral defects. SHOMRI scoring showed a sensitivity of 95.7% and specificity of 84.8% in detecting cartilage lesions. Moreover, all cases with full-thickness defects (n = 9) were identified correctly, and in n = 6 cases (out of n = 36 with partial-thickness defects) the defective cartilage was identified but the actual depth overestimated. Labral tears were present in all cases and the MR readers identified 92.5% correctly. ICC showed a good interobserver agreement with 86.3% (95% CI 80.0, 90.6%) CONCLUSION: Using arthroscopic correlation, SHOMRI grading of the hip proves to be a reliable and precise method to assess chondrolabral hip joint abnormalities.

KEY POINTS

• Assessment of hip abnormalities using MRI with surgical correlation. • Comparing surgery and MRI by creating a hybrid anatomic map that covers both modalities. • Non-arthrographic use of 3.0-T MRI provides detailed information on cartilage and labral abnormalities in hip joints.

Exploring the genomic diversity of black yeasts and relatives (Chaetothyriales, Ascomycota)

The order Chaetothyriales (Pezizomycotina, Ascomycetes) harbours obligatorily melanised fungi and includes numerous etiologic agents of chromoblastomycosis, phaeohyphomycosis and other diseases of vertebrate hosts. Diseases range from mild cutaneous to fatal cerebral or disseminated infections and affect humans and cold-blooded animals globally. In addition, Chaetothyriales comprise species with aquatic, rock-inhabiting, ant-associated, and mycoparasitic life-styles, as well as species that tolerate toxic compounds, suggesting a high degree of versatile extremotolerance. To understand their biology and divergent niche occupation, we sequenced and annotated a set of 23 genomes of main the human opportunists within the Chaetothyriales as well as related environmental species. Our analyses included fungi with diverse life-styles, namely opportunistic pathogens and closely related saprobes, to identify genomic adaptations related to pathogenesis. Furthermore, ecological preferences of Chaetothyriales were analysed, in conjuncture with the order-level phylogeny based on conserved ribosomal genes. General characteristics, phylogenomic relationships, transposable elements, sex-related genes, protein family evolution, genes related to protein degradation (MEROPS), carbohydrate-active enzymes (CAZymes), melanin synthesis and secondary metabolism were investigated and compared between species. Genome assemblies varied from 25.81 Mb (Capronia coronata) to 43.03 Mb (Cladophialophora immunda). The bantiana-clade contained the highest number of predicted genes (12 817 on average) as well as larger genomes. We found a low content of mobile elements, with DNA transposons from Tc1/Mariner superfamily being the most abundant across analysed species. Additionally, we identified a reduction of carbohydrate degrading enzymes, specifically many of the Glycosyl Hydrolase (GH) class, while most of the Pectin Lyase (PL) genes were lost in etiological agents of chromoblastomycosis and phaeohyphomycosis. An expansion was found in protein degrading peptidase enzyme families S12 (serine-type D-Ala-D-Ala carboxypeptidases) and M38 (isoaspartyl dipeptidases). Based on genomic information, a wide range of abilities of melanin biosynthesis was revealed; genes related to metabolically distinct DHN, DOPA and pyomelanin pathways were identified. The MAT (MAting Type) locus and other sex-related genes were recognized in all 23 black fungi. Members of the asexual genera Fonsecaea and Cladophialophora appear to be heterothallic with a single copy of either MAT-1-1 or MAT-1-2 in each individual. All Capronia species are homothallic as both MAT1-1 and MAT1-2 genes were found in each single genome. The genomic synteny of the MAT-locus flanking genes (SLA2-APN2-COX13) is not conserved in black fungi as is commonly observed in Eurotiomycetes, indicating a unique genomic context for MAT in those species. The heterokaryon (het) genes expansion associated with the low selective pressure at the MAT-locus suggests that a parasexual cycle may play an important role in generating diversity among those fungi.

A comprehensive in vivo kinematic, quantitative MRI and functional evaluation following ACL reconstruction--A comparison between mini-two incision and anteromedial portal femoral tunnel drilling

BACKGROUND

Multiple techniques are used for femoral tunnel drilling in ACL reconstruction, including the Mini-two Incision Method (MT) and Anteromedial Portal Technique (AM). Both techniques allow for independent placement of the femoral tunnel, though there are no reports comparing kinematics and cartilage health after these reconstructions. We hypothesized that both techniques would result in the restoration of normal knee kinematics and show no evidence of early cartilage degeneration.

METHODS

A total of 20 patients were evaluated one year after ACL reconstruction, including 10 patients after MT and 10 patients after AM. MR-imaging was acquired bilaterally with the knee loaded in extension and flexion to evaluate the kinematics of the reconstructed knee compared with the normal knee. Quantitative cartilage imaging was obtained and compared with 10 matched control subjects. The Marx Activity Rating Scale and KOOS survey were administered.

RESULTS

The tibia was positioned significantly more anteriorly in extension and flexion relative to the contralateral knee for the MT group. The tibial position in the AM group was not significantly different from the patient's contralateral knee. T1ρ values in the central-medial tibia were significantly elevated in the MT group compared with the Control group. KOOS Symptom scores were significantly better for the MT group compared with the AM group.

CONCLUSIONS

We have observed in vivo differences in knee kinematics and early cartilage degeneration between patients following MT and AM ACL reconstructions. Both techniques allow for anatomic ACL reconstruction, though the MT group shows significant early differences compared with the patient's normal knee.

Three-dimensional MRI-based statistical shape model and application to a cohort of knees with acute ACL injury

OBJECTIVE

The aim of this study is to develop a novel 3D magnetic resonance imaging (MRI)-based Statistical Shape Modeling (SSM) and apply it in knee MRIs in order to extract and compare relevant shapes of the tibia and femur in patients with and without acute Anterior cruciate ligament (ACL) injuries.

METHODS

Bilateral MR images were acquired and analyzed for 50 patients with acute ACL injuries and for 19 control subjects. A shape model was extracted for the tibia and femur using an SSM algorithm based on a set of matched landmarks that are computed in a fully automatic manner.

RESULTS

Shape differences were detected between the knees in the ACL-injury group and control group, suggesting a common shape feature that may predispose these knees to injury. Some of the detected shape features that discriminate between injured and control knees are related to intercondylar width and posterior tibia slope, features that have been suggested in previous studies as ACL morphological risk factors. However, shape modeling has the great potential to quantify these characteristics with a comprehensive description of the surfaces describing complex 3D deformation that cannot be represented with simple geometric indexes.

CONCLUSIONS

3D MRI-based bone shape quantification has the ability to identify specific anatomic risk factors for ACL injury. A better understanding of the role in bony shape on ligamentous injuries could help in the identification of subjects with an increased risk for an ACL tear and to develop targeted prevention strategies, including education and training.

Reproducibility measurements of three methods for calculating in vivo MR-based knee kinematics

PURPOSE

To describe three quantification methods for magnetic resonance imaging (MRI)-based knee kinematic evaluation and to report on the reproducibility of these algorithms.

MATERIALS AND METHODS

T2 -weighted, fast-spin echo images were obtained of the bilateral knees in six healthy volunteers. Scans were repeated for each knee after repositioning to evaluate protocol reproducibility. Semiautomatic segmentation defined regions of interest for the tibia and femur. The posterior femoral condyles and diaphyseal axes were defined using the previously defined tibia and femur. All segmentation was performed twice to evaluate segmentation reliability. Anterior tibial translation (ATT) and internal tibial rotation (ITR) were calculated using three methods: a tibial-based registration system, a combined tibiofemoral-based registration method with all manual segmentation, and a combined tibiofemoral-based registration method with automatic definition of condyles and axes. Intraclass correlation coefficients and standard deviations across multiple measures were determined.

RESULTS

Reproducibility of segmentation was excellent (ATT = 0.98; ITR = 0.99) for both combined methods. ATT and ITR measurements were also reproducible across multiple scans in the combined registration measurements with manual (ATT = 0.94; ITR = 0.94) or automatic (ATT = 0.95; ITR = 0.94) condyles and axes.

CONCLUSION

The combined tibiofemoral registration with automatic definition of the posterior femoral condyle and diaphyseal axes allows for improved knee kinematics quantification with excellent in vivo reproducibility.

Características de carcaça de cabritos criados em dois sistemas de terminação

Avaliaram-se as características da carcaça de cabritos Saanen confinados, Saanen e 7/8 Boer - 1/8 Saanen semiconfinados, bem como a influência de grupo genético e sistema de terminação sobre o rendimento comercial, índice de compacidade, não constituintes, área de olho de lombo, força de cisalhamento, gordura, teor de umidade e teor de extrato etéreo. Utilizaram-se 31 machos inteiros, com aproximadamente 128 dias de idade e 22,9±2,4kg de peso vivo. Destes, 22 eram da raça Saanen e nove animais eram mestiços 7/8 Boer - 1/8 Saanen. Os animais da raça Saanen foram divididos em dois grupos de 11 animais, sendo um grupo mantido em confinamento e outro em semiconfinamento, enquanto os mestiços foram mantidos em semiconfinamento. Compararam-se os sistemas de terminação na raça Saanen, e os grupos genéticos no sistema semiconfinado. Os animais confinados receberam 3,5% do PV em ração completa peletizada; os semiconfinados tiveram acesso à pastagem e suplementação de 1,5% do PV em ração concentrada peletizada. Aos 47 dias de terminação, os animais foram abatidos e as características de carcaça determinadas por meio de uma amostra de lombo dissecado. Foram observadas diferenças entre sistemas de terminação para rendimento comercial de carcaça, índice de compacidade da carcaça, não constituintes de carcaça, área de olho de lombo, força de cisalhamento, gordura, teor de umidade e de extrato etéreo. Entre os grupos genéticos, foram observadas diferenças para área de olho de lombo, espessura de gordura e matéria mineral. O sistema de terminação exerceu influência sobre as características de carcaça avaliadas. A raça Saanen pode ser utilizada para a produção de carne quando submetida ao confinamento.

Simultaneous acquisition of T1ρ and T2 quantification in knee cartilage: repeatability and diurnal variation

PURPOSE

To develop a robust sequence that combines T1ρ and T2 quantifications and to examine the in vivo repeatability and diurnal variation of T1ρ and T2 quantifications in knee cartilage.

MATERIALS AND METHODS

Six healthy volunteers were scanned in the morning and afternoon on 2 days using a combined T1ρ and T2 quantification sequence developed in this study. Repeatability of T1ρ and T2 quantification was estimated using root-mean-square coefficients-of-variation (RMS-CV). T1ρ and T2 values from morning scans were compared to those from afternoon scans using paired t-tests.

RESULTS

The overall RMS-CV of in vivo T1ρ and T2 quantification was 5.3% and 5.2%, respectively. The RMS-CV of am scans was 4.2% and 5.0% while the RMS-CV of pm scans was 6.0% and 6.3% for T1ρ and T2 , respectively. No significant difference was found between T1ρ or T2 values in the morning and in the afternoon.

CONCLUSION

A sequence that combines T1ρ and T2 quantification with scan time less than 10 minutes and is robust to B0 and B1 inhomogeneity was developed with excellent repeatability. For a cohort with low-level daily activity, although no significant diurnal variation of cartilage MR relaxation times was observed, the afternoon scans had inferior repeatability compared to morning scans.

The role of bile acids in the neoplastic progression of Barrett's esophagus - a short representative overview

Barrett's esophagus (BE) is an intestinal metaplasia of the distal esophagus in which squamous cells are replaced by a columnar epithelium. It is considered as a premalignant lesion, which can lead to esophageal adenocarcinoma, a very aggressive type of cancer, and can often be found in patients with gastro-esophageal reflux disease (GERD). In spite of the widespread use of acid-suppressing therapy with proton pump inhibitors, the incidence of adenocarcinoma has been steadily rising during the last 30 years. So, it can strongly be suggested that refluxed material other than acid might contribute to the progression of cancer within Barrett's esophagus. Along with gastric acid, bile acids enter the esophagus during an episode of reflux, and bile acids may be important in carcinogenesis. In their refluxates, patients with GERD and BE show high concentrations of the hydrophobic bile salt deoxycholic acid (DCA), which has cytotoxic effects and is able to induce DNA damage in different cell types. Other bile acids, like the hydrophilic urodeoxycholic acid (UDCA), have been therapeutically used to treat cholestatic liver diseases and to prevent colon carcinoma. This article reviews the effects of bile acids and points out new perceptions in the progression of Barrett's-associated carcinogenesis.

Effect of inactive dry yeast from sugar cane as protein source on rumen fermentation in Saanen goats

Five castrated and ruminally cannulated Saanen goats (±48.19kg) were used to evaluate intake, digestibility and rumen fermentation parameters of diets with inactive dry yeast as a soybean meal substitute (0, 25, 50, 75 and 100%). Goats were randomly assigned to a 5×5 (five levels of dry yeast x five periods) Latin square design. Diets were composed of corn silage (40%), ground corn, soybean meal and/or dry yeast and mineral supplement. The intake and digestibility of DM, OM, CP, NDF and TC were not influenced by the treatments. However, EE intake showed negative linear effect. The TDN content did not change with the inclusion of dry yeast in the diets. The pH, N-NH3 concentration and rumen short-chain fatty acids content did not differ among diets. Rumen content scanning electron microscopy observations did not suggest microbial colonization and degradation changes. Dry yeast from sugar cane can replace soybean meal in diets for Saanen goats without changing the rumen fermentation pattern, intake and digestibility.

Rapid ecological assessment of benthic indicators of water quality: a successful capacity-building experience for Brazilian postgraduate students in ecology

Rapid Ecological Assessment protocols are important tools for the training of postgraduate students, as well as the collection of data on poorly-known and protected areas with the potential for the preservation of water supplies for urban areas. The objective of this study was to perform a survey of water quality and diversity of benthic macroinvertebrates in two sub-basins at the Mata do Junco Wildlife Refuge in the Brazilian state of Sergipe. The collection of data in the field, laboratory processing, and the interpretation and discussion of data were conducted in groups by students from two postgraduate programmes in Ecology and Conservation (UFMG and UFS), personnel of the state environment agency (SEMARH), school teachers from the local town of Capela, and members of the reserve's voluntary fire brigade. The results of the assessment were organised, analysed, and presented at the reserve headquarters in the form of posters, for the development of environmental education activities with pupils from local schools, as well as contributing to a SEMARH seminar. Samples were characterised by distinct taxonomic compositions and diversity, as confirmed by MDS and additive partitioning of diversity analyses. The gravel substrate presented the lower mean taxonomic richness in each sampling unit (a1 = 28%), while the average difference among samples (b1 diversity) was elevated for both substrates (39% for leaf litter, 41% for gravel), reflecting the pronounced variation among samples, even adjacent ones within the same stream. Diversity between streams was lower in the case of leaf litter in comparison with gravel (b2 = 21 and 31%, respectively). A total of 57 fish specimens were collected with a predominance of individuals of the orders Characiformes (62%) and Perciformes (21%). This rapid ecological assessment confirmed the importance of the conservation unit and emphasised the need for its continuation, given its importance for the maintenance of water quality and its other ecological services, such as the conservation of the region's aquatic biodiversity and providing the local town of Capela (circa 20,000 inhabitants) with its water supply, the Mata do Junco being its only source.

Pulmonary hypertension diagnosed by right heart catheterisation in sickle cell disease

Recent studies have recognised the importance of pulmonary hypertension (PH) in sickle cell disease (SCD). The aim of this study was to determine the prevalence and prognostic impact of PH and its features in patients with SCD. 80 patients with SCD underwent baseline clinical evaluation, laboratory testing, 6-min walk tests (6MWTs) and echocardiography. Patients with a peak tricuspid regurgitant jet velocity (TRV) of ≥ 2.5 m·s(-1) were further evaluated through right heart catheterisation (RHC) to assure the diagnosis of PH. Our study evidenced a 40% prevalence of patients with elevated TRV at echocardiography. RHC (performed in 25 out of 32 patients) confirmed PH in 10% (95% CI 3.4-16.5%) of all patients, with a prevalence of post-capillary PH of 6.25% (95% CI 0.95-11.55%) and pre-capillary PH of 3.75% (95% CI -0.4-7.9%). Patients with PH were older, had worse performance in 6MWTs, and more pronounced anaemia, haemolysis and renal dysfunction. Survival was shorter in patients with PH. Our study reinforced the use of echocardiography as a screening tool for PH in SCD and the mandatory role of RHC for proper diagnosis. Our findings confirmed the prognostic significance of PH in SCD as its association to pronounced haemolytic profile.

Systematic review: the role of bile acids in the pathogenesis of gastro-oesophageal reflux disease and related neoplasia

BACKGROUND

Factors other than acid may play a role in gastro-oesophageal reflux disease (GERD) and its complications.

AIM

To assessed the role of bile acids in the pathogenesis of GERD, Barrett's oesophagus and Barrett's-related neoplasia.

METHODS

We conducted a systematic review of computerised bibliographic databases for original articles involving humans or human oesophageal tissue or cells that assessed exposure to or manipulation of bile acids. Outcomes assessed included GERD symptoms; gross oesophageal injury; Barrett's oesophagus and related neoplasia; and intermediate markers of inflammation, proliferation or neoplasia.

RESULTS

Eighty-three original articles were included. In in vivo studies, bile acids concentrations were higher in the oesophageal aspirates of patients with GERD than controls, and bile acids infusions triggered GERD symptoms, especially in high concentrations or in combination with acid. In ex vivo/in vitro studies, bile acids stimulated squamous oesophageal cells and Barrett's epithelial cells to produce inflammatory mediators (e.g., IL-8 and COX-2) and caused oxidative stress, DNA damage and apoptosis. They also induced squamous cells to change their gene expression pattern to resemble intestinal-type cells and caused Barrett's cells to increase expression of intestinal-type genes.

CONCLUSIONS

In aggregate, these studies suggest that bile acids may contribute to the pathogenesis of symptoms, oesophagitis and Barrett's metaplasia with related carcinogenesis in patients with GERD. However, all study results are not uniform and substantial differences in study parameters may explain at least some of this variation.