3-point System Research Articles

Performance of cone-beam computed tomography (CBCT) in comparison to conventional computed tomography (CT) and magnetic resonance imaging (MRI) for the detection of bone invasion in oral squamous cell cancer (OSCC): a prospective study

BackgroundOral squamous carcinoma (OSCC) is often diagnosed at late stages and bone erosion or invasion of the jawbone is frequently present. Computed tomography (CT) and magnetic resonance imaging (MRI) are known to have high diagnostic sensitivities, specificities, and accuracies in detecting these bone affections in patients suffering from OSCC. To date, the existing data regarding the impact of cone-beam computed tomography (CBCT) have been weak. Therefore, this study aimed to investigate whether CBCT is a suitable tool to detect bone erosion or invasion in patients with OSCC.MethodsWe investigated in a prospective trial the impact of CBCT in the diagnosis of bone erosion or invasion in patients with OSCC who underwent surgery. Every participant received a CBCT, CT, and MRI scan during staging. Imaging modalities were evaluated by two specialists in oral and maxillofacial surgery (CBCT) and two specialists in radiology (CT and MRI) in a blinded way, to determine whether a bone affection was present or not. Reporting used the following 3-point system: no bony destruction (“0”), cortical bone erosion (“1”), or medullary bone invasion (“2”). Histological examination or a follow-up served to calculate the sensitivities, specificities, and accuracies of the imaging modalities.ResultsOur results revealed high diagnostic sensitivities (95.6%, 84.4%, and 88.9%), specificities (87.0%, 91.7%, and 91.7%), and accuracies (89.5%, 89.5%, and 90.8%) for CBCT, CT, and MRI. A pairwise comparison found no statistical difference between CBCT, CT, and MRI.ConclusionOur data support the routine use of CBCT in the diagnosis of bone erosion and invasion in patients with OSCC as diagnostic accuracy is equal to CT and MRI, the procedure is cost-effective, and it can be performed during initial contact with the patient.

A Critical Scrutiny of Cinematic Lighting Technique in Cultural works of Selected Yoruba Nollywood Films

It could be reiterated that, of all the components of mise-en-cadre, cinematographic lighting is one of the most important features but this component had received little attentions from most Nigerian film critics or scholars. In most cases, this element is only used to explain or buttress relevant points in film theory and discourse. However, in this study, attention will be devoted on the deployment of cinematic lights and the various techniques used in selected Nollywood films. In the creative deployment of the 3-point lighting technique in selected cultural works of Yoruba Nollywood films, the researcher employed a library study, descriptive analytical cum studio diagnostic approaches as the basic methods of data gathering. The observation research method is deployed as secondary source of information. While a structuralist hypothetical approach is equally employed as a theoretical framework. In this exploration, the paper reviews the concepts of cinematic lighting before zooming on to discuss the key light, fill light and backlight as components of the 3-point lighting system. Practical analysis and demonstration are thus carried out with concrete sample shots from selected Yoruba films. Finally, it is recommended that a 3-point lighting technique should be creatively utilised as innovative device through which a director and the light-designer could create impressive and wonderful pictures and thus improve on the quality of Yoruba films. Keywords: 3-Point-Lighting, Cultural works, Nollywood, Yoruba films

ОБОБЩЕННАЯ МОДЕЛЬ ЗАЩИТЫ ОТ КИБЕРАТАК НА VOIP

The goal of the study creation of a protection model against cyberattacks on information and telecommunication resources used in practice Internet voice exchange services (VoIP). Research methods: analysis of Best Practices and scientific publications, system analysis, criterion comparison. Result: systematization of the cyberattacks main methods on VoIP and methods of protection against them, based on existing Best Practices and scientific publications. The investigation methodological scheme presented in a schematic form, is described. As a result, a list of 8 specialized and 9 main methods of cyberattacks, as well as 4 specialized and 10 main methods of protection was obtained, which made it possible to create a protection generalized model against cyberattacks on VoIP. The model representation in tabular form consists of 17 rows and 14 columns, which corresponds to the number of all cyberattack methods and protection methods. The cells of the table contain expertly obtained values of the effectiveness of counteracting cyberattacks by each of the protection methods according to a 3-point system. The model is extended with additional integral indicators of the danger of cyberattacks and the effectiveness of protection obtained analytically. 3 cyberattacks least amenable to protection and 3 most effective protection methods were identified. The scientific novelty consists in bringing together the whole set of cyberattacks methods on VoIP and protection against them methods into a single system that characterizes the effectiveness of countering.

The clinical performance of ultra-low-dose shoulder CT scans: The assessment on image and physical 3D printing models.

Evaluation of the clinical performance of ultra-low-dose computed tomography (CT) images of the shoulder joint on image-based diagnosis and three-dimensional (3D) printing surgical planning. A total of 93 patients with displaced shoulder fractures were randomly divided into standard-dose, low-dose, and ultra-low-dose groups. Three-dimensional printing models of all patients' shoulder joints were fabricated. The subjective image quality and 3D-printing model were evaluated by two senior orthopedic surgeons who were blinded to any scanning setting. A 3-point scale system was used to quantitatively assess the image quality and 3D printing model, where more than 2 points meant adequate level for clinical application. Compared with the standard dose protocol, ultra-low-dose technique reduced the radiation dose by 99.29% without loss of key image quality of fracture pattern. Regarding the subjective image quality, the assessment scores for groups of standard, low, and ultra-low doses were 3.00, 2.76, 2.00 points on scapula and humerus, and 3.00, 2.73, 2.44 points on clavicle. Scores of the three groups for the assessment of 3D printing models were 3.00, 2.80, 1.34 on scapula and humerus, and 3.00, 2.90, 2.06 on clavicle. In the ultra-low-dose group, 24 out of 33 (72.7%) 3D printing models of scapula and humerus received lower than 2 points of the evaluation score, while nearly 94% of the clavicle models reached the adequate level. An ultra-low-dose protocol is adequate for the diagnosis of either displaced or non-displaced fractures of the shoulder joint even though minor flaws of images are present. Three-dimensional printing models of shoulder joints created from ultra-low-dose CT scans can be used for surgical planning at specific bone like the clavicle but perform insufficiently in the overall surgical planning for shoulder injuries due to the significant geometric flaws.

Load-limiting in the lap belt reduces injury risks associated with new seating positions

The two objectives are to demonstrate technical feasibility for an advanced 3-point seatbelt system incorporating double lap belt pre-tensioning and load-limiting and to evaluate its injury risk reduction relative to that of a 3-point seatbelt without double lap belt load-limiting. Frontal sled tests were conducted at 50 km/h with a Hybrid III 50-percentile male in upright and reclined with the seat in a rearward position. The advanced 3-point seatbelt system satisfied all requirements and all injury risk metrics (from Euro NCAP and additional ones associated with the new seating positions) were reduced. In particular, the risk for head-to-thigh contact was substantially reduced. Therefore, the advanced 3-point seatbelt system is technically feasible and conveys substantial benefits. More research is needed to investigate the risk of submarining and sliding off the seat, using a wider range of occupant surrogates and more severe crash pulses.

The diagnostic reliability and validity of noninvasive imaging modalities to assess leptomeningeal collateral flow for ischemic stroke patients: A systematic review and meta-analysis.

Leptomeningeal collateral flow (LMF) is associated with infarct area and clinical outcome for ischemic stroke patients. Although LMF can be detected by multiple imaging methods, but their diagnostic performance is uncertain.The aim of this study was to evaluate the diagnostic validity or reliability of noninvasive image methods in assessing LMF.Databases included PubMed, Web of Science, Embase, and Cochrane Library.Original observational cohort studies.Ischemic stroke patients.Different noninvasive image methods to assess LMF.Newcastle–Ottawa Scale to evaluate the quality of the studies; forest plot to show pooled results; I2 and Egger test to evaluate the heterogeneity and publication bias.Thirty of the 126 selected studies were eligible. For CT angiography, the interobserver agreement ranged from 0.494 to 0.93 and weighted kappa was 0.888; for patients receiving thrombolysis or endovascular treatment, 0.68 to 0.91; 0.494 to 0.89 for the 2-point system, 0.60 to 0.93 for the 3-point system, 0.68 to 0.87 for the system of >4 points; area under the curve (AUC) was 0.78. For perfusion computed tomography (CTP), the interobserver agreement ranged from 0.724 to 0.872; for patients receiving thrombolysis or endovascular treatment, 0.74 to 0.872; 0.724 for the 2-point system, 0.783 to 0.953 for the 3-point system; the intraobserver agreement was 0.884; AUC was 0.826. For MRI-fluid attenuated inversion recovery (FLAIR), the interobserver agreement ranged from 0.58 to 0.86; for patients receiving thrombolysis or endovascular treatment, 0.75 to 0.86; 0.86 for the two-point system, 0.77 to 0.87 for the system of more than 5 points; AUC was 0.82.No pooled data of CTP and FLAIR. The difference cohort study had difference bias. The unpublished data were not included.CT angiography is a good tool for assessing LMF. CTP shows a good validity and reliability, but its diagnostic value needs more evidence. FLAIR is a good modality to assess LMF. These image methods had better validity and reliability to evaluate LMF of patients receiving thrombolysis or endovascular treatment than all ischemic stroke patients.

Proposing a new short screening test for upper limb apraxia

Background Apraxia has a major impact on activities of daily living in stroke patients. The proper assessment and treatment of apraxia is important for maintaining a good quality of life. We developed a short evaluation test for upper limb apraxia. Patients and Methods The present Screening Test of Gestures for Stroke consists of 10 items for each verbal instruction and imitation. Each item includes three meaningless gestures, three meaningful gestures and four pantomimes. The Screening Test of Gestures for Stroke is scored based on a 3-point system: 10, 5 or 0 (maximum score: 200). The test took approximately 2–5 min to complete. We recruited 65 patients admitted to our hospital with left hemisphere stroke and 50 healthy subjects. Results The reliability of the Screening Test of Gestures for Stroke was as follows: the intraclass correlation coefficient of intra-rater reliability was 0.93 for both verbal instructions and imitations, and the intraclass correlation coefficient total scores for inter-rater reliability for verbal instructions and for imitations were 0.97 and 0.95, respectively. The alpha coefficient was ≥0.80. Conclusions The Screening Test of Gestures for Stroke is a reliable and valid bedside test that has a short assessment time, does not require special equipment and can evaluate upper limb apraxia in stroke patients from the acute to the chronic phase.

Non-enhanced multimodal magnetic resonance imaging in assessment of iliac vein obstruction with or without thrombosis.

To evaluate the diagnostic accuracy of a contrast-free multimodal magnetic resonance (MR) protocol (including M2DIPEAR, THRIVE, BTFE-SPAIR, and FLAIR sequences) in the detection of iliac vein obstruction with or without thrombosis. From May 1st, 2015, to May 1st, 2016, a total of 73 patients (aged 51.33 ± 4.21 years) who received both digital subtraction angiography (DSA) and the multimodal MR imaging were included. The protocol of the multimodal MR included M2DIPEAR and BTFE-SPAIR for presenting iliac vein obstruction, and THRIVE and FLAIR for revealing the co-existed thrombosis. Three observers who were blinded to clinical and DSA results independently analyzed all multimodal MR datasets. Per-patient evaluations on presence or absence of iliac vein obstruction were performed to calculate the diagnostic performance of MR imaging (DSA regarded as gold reference) in terms of overall accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Capability to display the co-existing venous thrombus was also evaluated per-MR sequence using a 3-point scale system. Iliac vein obstruction was depicted with DSA in 64 patients. In per-patient evaluation, the multimodal MR imaging yielded accuracy of 95.9% (70/73), sensitivity of 96.9% (62/64), specificity of 88.9% (8/9), positive predictive value of 98.4% (62/63), and negative predictive value of 80% (8/10), respectively. In the multimodal MR sequences, balanced turbo field echo-spectral attenuated inversion recovery (BTFE-SPAIR) sequence was superior to other sequences in depicting the iliac vein configuration, but fluid attenuated inversion recovery (FLAIR) and T1 high-resolution isovolumetric examination (THRIVE) seemed superior in detecting co-existing venous thrombosis. M2DIPEAR and BTFE-SPAIR sequence can reveal iliac vein obstruction while THRIVE and FLAIR can detect the co-existed thrombosis. The proposed multimodal MR protocol can accurately depict the iliac vein obstruction and accurately detect the co-existing venous thrombosis comparable with that of DSA.

Evaluation of cervical ossification of the posterior longitudinal ligament with 3D broadband IR-prepared ultrashort echo-time imaging: a pilot study

We aimed to evaluate the feasibility of 3D broadband inversion-recovery-prepared ultrashort echo-time (3D IRP UTE) imaging for assessing ossification of the posterior longitudinal ligament (OPLL). The study consisted of 25 consecutive patients with cervical OPLL [13 women, 12 men; mean age 66.3 (47-84) years] who underwent CT, 3T conventional MR, and 3D IRP UTE imaging studies. Two readers independently assessed the 3D IRP UTE images for the type (mixed, continuous, circumscribed, segmental) and distribution of OPLL. All readers consensually assessed the diagnostic certainty of OPLL on conventional MR and 3D IRP UTE images by using a 3-point scale system. Interobserver and intermodality agreement was assessed by κ statistics. A Wilcoxon signed-rank test was used to evaluate the difference of diagnostic certainty between conventional MR and 3D IRP UTE imaging. Interobserver and intermodality agreements were good (κ = 0.73) and excellent (κ = 0.81) for the OPLL type, and excellent (κ = 0.85) and good (κ = 0.76) for the assessment of the distribution of OPLL, respectively. The mean level of the diagnostic certainty of OPLL was significantly higher for 3D IRP UTE than conventional MR imaging (p = 0.002). 3D IRP UTE imaging may be useful for assessing OPLL.

Combined use of laser therapy and autologous plasma with cells in patients with post-acne atrophic scars

Background. Acne scar formation is a common consequence of acne vulgaris, in most cases atrophic scars resulting from tissue loss caused by inflammation of the pilosebial units.
 Aims: To study the effectiveness of combined laser therapy with Nd:YAG laser and Er: YAG laser with autologous plasma with cells in patients with different phenotypes of post-acne atrophic scars.
 Materials and methods. Depending on the method of treatment of post-acne scars, the patients were divided into 2 groups: Group 1 (n=28) with ice pick scars 10 patients; boxcar 9 patients; rolling 9 patients and group 1 (n=30) among them with ice pick scars 10; boxcar 9; rolling 11 patients. In group 1A, phototherapy was performed using a combination of Nd:YAG laser and Er:YAG laser. Immediately after laser exposure, autologous plasma was applied to the skin of the face of group 1B patients. To assess the effectiveness, the Manchester scale of assessment of scar deformities was used. The effectiveness was also evaluated using the Global Aesthetic Scale (GAIS) on a 3-point system. In this study, cutometry and ultrasound were performed to assess the elasticity of the skin in the foci of atrophy.
 Results. The indicator "color" on the MSS scale improved in the 1st group by 54.8%, in the 2nd by 83.7%, the indicator "texture" by 57.1 and 78.1%, the indicator "relief" by 43.8 and 66.7%, the indicator "displacement" by 54.9 and 82.1%, respectively. There were no patients with a deterioration or lack of effect on the GAIS scale in any of the study groups. According to the ultrasound scan data, the greatest effectiveness was observed in the group of complex treatment .
 Conclusion. Complex treatment, including the use of combined laser therapy (erbium and neodymium lasers) and autologous plasma with cells, is a highly effective technique for the treatment of atrophic post-acne scars.

Improving the quantitative classification of Erlenmeyer flask deformities

The Erlenmeyer flask deformity is a common skeletal modeling deformity, but current classification systems are binary and may restrict its utility as a predictor of associated skeletal conditions. A quantifiable 3-point system of severity classification could improve its predictive potential in disease. Ratios were derived from volumes of regions of interests drawn in 50 Gaucher’s disease patients. ROIs were drawn from the distal physis to 2 cm proximal, 2 cm to 4 cm, and 4 cm to 6 cm. Width was also measured at each of these boundaries. Two readers rated these 100 femurs using a 3-point scale of severity classification. Weighted kappa indicated reliability and one-way analysis of variance characterized ratio differences across the severity scale. Accuracy analyses allowed determination of clinical cutoffs for each ratio. Pearson’s correlations assessed the associations of volume and width with a shape-based concavity metric of the femur. The volume ratio incorporating the metaphyseal region from 0 to 2 cm and the diametaphyseal region at 4–6 cm was most accurate at distinguishing femurs on the 3-point scale. Receiver operating characteristic curves for this ratio indicated areas of 0.95 to distinguish normal and mild femurs and 0.93 to distinguish mild and severe femurs. Volume was moderately associated with the degree of femur concavity. The proposed volume ratio method is an objective, proficient method at distinguishing severities of the Erlenmeyer flask deformity with the potential for automation. This may have application across diseases associated with the deformity and deficient osteoclast-mediated modeling of growing bone.

Characteristics of pre-school children’s creative activity

The article deals with the problem of preschool children’ formation of the creative activity. The author understands creative activity as integrative, qualitative characteristic of personality, which includes a complex of motivational, creative, volitional components. According to the selected indicators, a diagnostic methodology for the three main blocks was constructed. All indicators were evaluated by a 3-point system, in which each score expressed the content of the existing level of formation of diagnosed indicators. Four levels of creative activity of older preschool children are distinguished: high (creative), middle (research), below average (imitative), low (performing). It is established that the most unformed components of creative activity in preschool age are creative and volitional. It is substantiated that development of speed, flexibility and originality of thinking, as well as stimulation of children’s initiative and independence will allow to increase the level of creative activity.

A pilot study evaluating the 3-point and 4-point restraint system for pediatric occupants in nonstandard seating positions

The study systematically evaluates a traditional 3-point lap-shoulder belt versus a 4-point lap-shoulder belt in restraining a 6YO in booster child seats seated in nonstandard seating with adult oc...

Показники продуктів забою бичків залежно від селеновмісних добавок у раціоні

The results of researches of products of slaughter of Simmental bream bulls for various selenium-containing additives in the diet are presented. Determination of the morphological composition of carcasses has shown the advantages of experimental groups of animals before the control of the high content of pulp in the carcass (6.1-8.2 kg) and a slightly higher ratio of meat (0.05-0.08). In the carcasses of experimental bulls, bone content decreased (18.7-18.9% versus 20.1% in control). It should be noted that the best results from meat productivity were obtained in the group of animals fed with the diethylvanic preparation Devivit in the diet. In samples of meat of bulls of experimental groups, it was unambiguous, although biometric and unreliable (P>0.05), it was less on 0,28-0,55% of water (76,41-76,14 against 76,69%), and more on the same amount of dry matter. The introduction of selenium supplements in the diet of bulls of the 1st and 2nd experimental groups resulted in an increase compared with the control of muscle protein content by 2.9 and 4.4 absolute percent (P>0.05), while the concentration of fat in this case, on the contrary, fell by 14 and 17.1% respectively (P>0.05). The level of tryptophan in the animal meat of experimental groups was higher than control at 2.29-4.4 mg%, and oxyproline, which reflects the worst grades of meat, on the contrary, was less on 1.31-4.25 mg%. As a result, the protein-quality index (the ratio of tryptophan to oxyproline) in experimental samples of meat was different from the control at 0.2-0.5. At tasting meat estimation on qualitative indices of broth on a 3-point system, no significant difference between groups was found. However, the tasting score of boiled meat of bulls of experimental groups, which was conducted on a 5-point system, averaged 4.35, and controls - 4.17 points, which is 4.1% less than the evaluation of samples of meat experimental animals. There is a probable increase in the activity of aminotransferases in liver tissues - 2.28 ± 0.04 (p<0.05), as well as soluble protein in muscle tissues - 58.39 ± 2.33 (p<0.05) and 114, 76 ± 5,13 liver (p <0,01) of experimental bulls. According to the results of studies of some trace elements in the tissues of the longest muscle of the back, liver and heart of the bulls, no significant differences were observed between the control and experimental animals. In the fattening young, the selenium content in the oblong muscle of the back fluctuated within 0,042 (control) -0,087 mg / kg, which is completely acceptable and safe. From this it can be concluded that beef can be one of the sources of replenishment of the lack of selenium in the human diet. When comparing experimental animals with serum selenium control after 3 months after the start of the experiment, they exceeded the control at 0.031-0.047 μg / ml or 39.2-75.9%. And after 6 months the excess was already 0,033-0,067 μg / ml, or 38,8-58,7%.

Prognostic Utility of the IPS 3 Score for Predicting Outcomes in Advanced Hodgkin Lymphoma

BackgroundThe International Prognostic Scoring System (IPSS) consisting of 7 parameters (IPS7) has been the standard prognostic model used in advanced Hodgkin lymphoma (aHL). However, recent studies have questioned its discriminatory power. For retrospective analyses, its utility might be limited by missing parameters. A recent study has shown that the IPSS consisting of only 3 high-risk features (IPS3; stage IV, age 45 years or older, and hemoglobin <105 g/L) is a simple predictor of survival in aHL. However, there are limited data validating the IPS3. Patients and MethodsOutcomes of adults with aHL treated between 2001 and 2015 at a single center were retrospectively analyzed with data from medical records. The prognostic validity of various baseline parameters was assessed individually as well as in combination (IPS7 and IPS3 scores). The Kaplan–Meier method was used to describe the event-free survival (EFS) and overall survival (OS) and univariate (log rank) and multivariate (Cox regression) tests were performed to identify prognostic factors. ResultsWe identified 314 patients (median age, 32 [range, 18-60] years; male sex [n = 215; 68%]) treated during this period. IPS7 was available in 231 of 314 (73%) and IPS3 in all (100%) patients. Most (71%) were treated with 6 to 8 cycles of ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) and others received hybrid or cyclophosphamide, vincristine, procarbazine, prednisolone regimens, and 72 (23%) underwent interim positron emission tomography imaging with escalation to bleomycin, etoposide, adriamycin, cyclophosphamide, vincristine, procarbazine, prednisolone in 8 patients. After a median follow-up of 57 months (range, 1.3-167), the 5-year EFS and OS were 72% and 82%, respectively. IPS3 produced a wider separation of survival curves than IPS7 in univariate analysis. In multivariate analysis for EFS, IPS3 (scores of 2 or 3 vs. scores of 0 and 1; hazard ratio, 2.1; P = .004) was the only significant predictor. For OS, no factor emerged as significant. ConclusionThe IPS3 is a simple 3-point system that is very useful for prediction of outcomes in aHL and might be particularly suited for retrospective data analysis where all components of the IPS7 might not be available.

An Analysis of the Impact of the Change in Scoring System on Home Field Advantage Soccer Leagues

The impact of the scoring systems on home field advantage in the highest-level Turkish soccer division, Turkish Super League, between the 1959-1960 and 2016-2017 seasons, was aimed to be examined in this study. 2-point system was used in Turkish Soccer Leagues between 1959 and 1987. Since 1987-1988 season, the 3-point system has been started to be used in Turkey. A total of 33,244 games were analyzed and it was revealed that there was a remarkable decline in home field advantage rates after the change in scoring system in 1987-1988 season. In the Turkish Soccer League, the average home field advantage rate was 66,39% before the change in the scoring system, while this rate was found to be 61,40% after the change in scoring system (t=5,041, p=0,000). The results indicate that there is significant difference between 2-point and 3-point systems in terms of total points of home team at home (t=-11,83, p=0,000). The results of this study were also compared with a relevant study of the highest-level soccer league in Spain.

Success of Scaphoid Nonunion is Independent of Proximal Pole Vascularity

Grant received from: Orthopaedic Research and Education Foundation Resident Research Project Grant #15-038 Royalty: Elsevier; Extremity Medical (Wolfe) Consulting Fee: Coventus, Trimed (Wolfe) Scaphoid vascularity following nonunion is of considerable concern when planning screw fixation and is thought to correlate with likelihood of healing. We hypothesized that greater proximal pole vascularity would correspond with increased union rate and shorter time to union. Thirty-six scaphoid patients in a prospective registry were followed longitudinally. All nonunions were treated with curettage, nonvascularized autogenous grafting, and headless screw fixation. Preop MRIs in 23 were evaluated for proximal pole vascularity by a musculoskeletal radiologist according to a 3-point system. Bleeding points were assessed intraoperatively according to a 3-point scale. Proximal pole fragments were graded for presence of necrotic trabeculae (yes/no) and remodeling potential as evidenced by osteoblastic activity (none, focal, robust) by blind assessment of 2 independent musculoskeletal pathologists. Healing was assessed on CT scan as > 50% bony bridging. Chi-square and non-parametric Kruskal Wallis tests were used to evaluate associations between diagnostic tests. Non-parametric Mann Whitney U and Spearman’s rho tests were used to compare scoring for each diagnostic modality with healing. Agreement between pathologists was assessed with weighed Kappa analysis. Thirty-four (94%) patients healed by average 13 weeks. One experienced delayed union secondary to hardware failure and healed 18 weeks following revision ORIF. Another patient is at 22 weeks with gradual bony bridging. Thirty-nine percent of proximal poles demonstrated ischemia by MRI criteria, but none were infarcted. Fifteen percent had poor punctate bleeding intraoperatively. Forty-five percent proximal poles demonstrated > 50% necrosis on histopathologic analysis yet 91% demonstrated forcal or robust remodeling. Inter-observer agreement for pathology viability was 0.667. There was no significant association between time to union and histologic viability (P = 0.349), remodeling potential (P = 0.704), bleeding points (P = 0.959), MRI global viability (P = 0.507), or MRI signal (P = 0.419). There was no association between mean MRI viability or signal and pathology grading (P = 0.224, P = 0.743). There was also no association between MRI viability or signal and intraoperative bleeding (P = 0.364, P = 0.386), or between pathologic grading and intraoperative bleeding (P = 0.904). (Figs. 59-1, 59-2) •There was no correlation between time to union and any diagnostic modality. MRI and histology did not demonstrate a correlation, indicating that these two assessments measure different aspects of the dysvascular response to injury.•Despite pathological evidence of dysvascular bone in nearly half of our patients, removal of necrotic bone and non-vascularized bone grafting with rigid internal fixation led to healing in the overwhelming majority of cases.•We conclude that true proximal pole infarction is a decidedly rare occurrence, and that vascularized bone grafting is seldom required.Figure 59-2T2-weighted coronal proton-density MR image of the scaphoid proximal pole demonstrates foci of devitalized bone marrow and ischemia, but retained vascularity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Efficacy and safety of rebel reliever ® brace in patients with knee osteoarthritis – A phase III randomized controlled trial

Purpose: According to OARSI guidelines, management of knee osteoarthritis consists of a combination of both non-pharmaceutical and pharmaceutical treatments, including knee braces. However, evidence is still inconclusive for the benefits of bracing in the treatment of knee osteoarthritis. The aim of this randomized open-label clinical trial was to compare the efficacy of the Rebel Reliever® knee brace in combination with usual care to that of usual care alone, after a 6-week treatment period. Methods: 67 patients with symptomatic medial knee osteoarthritis (Kellgren-Lawrence grade II-IV) were randomized into 2 groups: Brace group (brace + usual care) and Control group (usual care alone). Rebel Reliever® is a lightweight aluminum knee brace which applies corrective forces by a 3-point pressure system, gradually adjustable. Usual care consisted of analgesics and self exercises program. Primary endpoint was the global last-24 h knee pain (assessed via a 100-mm visual analogic scale [VAS]) after 6 weeks of treatment. Secondary endpoints included pain during motion (100-mm VAS), function (Lequesne index), clinical global improvement according to both patients and investigators, responder rate (OARSI-OMERACT criteria), as well as observance. Results: Study population consisted of 67 patients aged 65.7 ± 9.6 years, mainly women (65.7%). Of them, 32 were assigned to the Brace group and 35 to the Control group. At baseline, last 24h-pain was 63.8 ± 10.6 mm in the Brace group and 64.7 ± 13.5 mm in the Control group. Pain during motion was 73.4 ± 12.7 mm and 71.9 ± 13.8 mm in the Brace and Control groups, respectively. Function (Lequesne index) was 13.42 ± 3.74 in the Brace group and 12.63 ± 3.22 in the Control group. After 6 weeks, last 24h-pain decrease in the Brace group was statistically higher compared to the Control group (−41.35 ± 3.37 mm vs. −15.37 ± 3.23 mm; p < 0.0001). Similarly, decrease in pain in motion was significantly higher in the Brace group than in the Control group (−51.91 ± 3.49 mm vs. −19.91 ± 3.34 mm; p < 0.0001). Improvement of algofunctional Lequesne index score was also significantly higher in the Brace group (−5.8 vs. −2.3; p < 0.001). Clinical global improvement was more pronounced in the Brace group, with more patients feeling ‘better’ to ‘considerably improved’ in the Brace group compared to the Control group (86.2% vs. 3.1%) and with investigators reporting more patients ‘much’ to ‘very much’ improved in the Brace group than in the Control group (82.1% vs. 3.1%). Responder rate (OARSI-OMERACT criteria) was significantly higher in the Brace group (72.4% vs. 34.4%; p = 0,003). These observed differences were clinically relevant. Observance to the brace was excellent ( > 90% of the actual/theoretical wearing days). Conclusions: Superiority of Rebel Reliever® knee brace + usual care compared to usual care alone was demonstrated. Combining Rebel Reliever® knee brace with usual care is a powerful non pharmacological therapeutic strategy to handle medial knee osteoarthritis. NCT02021136.

Prevalence of Sport Specialization in High School Athletics

Background: The prevalence of sport specialization in high school athletes is unknown. This information is needed to determine the scope of this issue in an active population. Purpose: To determine the prevalence of sport specialization in high school athletes and to determine if specialization is influenced by classification method, year in school, sex, and school size. A secondary purpose was to determine if highly specialized athletes would be more likely to report a history of lower extremity injuries. Study Design: Cross-sectional study; Level of evidence, 3. Methods: High school athletes between the ages of 13 and 18 years from 2 local high schools completed both a sport specialization survey and an injury history survey. Athletes were classified into low, moderate, or high specialization groups using a recently developed 3-point system and were also classified using a self-classification method. Results: A total of 302 athletes completed the surveys and were classified as low specialization (n = 105, 34.8%), moderate specialization (n = 87, 28.8%), or high specialization (n = 110, 36.4%). Athletes from the small school were more likely to be classified in the low specialization group (low, 43%; moderate, 32%; high, 25%) compared with those from the large school (low, 26%; moderate, 26%; high, 48%) (P < .001). Athletes in the high specialization group were more likely to report a history of overuse knee injuries (n = 18) compared with moderate (n = 8) or low specialization (n = 7) athletes (P = .048). Athletes who trained in one sport for more than 8 months out of the year were more likely to report a history of knee injuries (odds ratio [OR], 2.32; 95% CI, 1.22-4.44; P = .009), overuse knee injuries (OR, 2.93; 95% CI, 1.16-7.36; P = .018), and hip injuries (OR, 2.74; 95% CI, 1.09-6.86; P = .026). Using the self-classification method, more participants self-classified as multisport (n = 213, 70.5%) than single sport (n = 89, 29.5%). Athletes from the small school were more likely to classify themselves as multisport (n = 128, 86%) (P < .001) than those from the large school (n = 85, 56%). There were no differences in the history of hip, knee, or ankle injuries between athletes who self-classified as single sport (hip: n = 10, 3%; knee: n = 19, 6%; ankle: n = 35, 12%) versus those who self-classified as multisport (hip: n = 45, 8%; knee: n = 23, 15%; ankle: n = 98, 33%) (P > .370). Conclusion: Classification method and school size influenced the prevalence of specialization in high school athletes. Highly specialized athletes were more likely to report a history of overuse knee or hip injuries. Participating in a single sport for more than 8 months per year appeared to be an important factor in the increased injury risk observed in highly specialized athletes.

Blocking Dopaminergic Signaling Soon after Learning Impairs Memory Consolidation in Guinea Pigs.

Formation of episodic memories (i.e. remembered experiences) requires a process called consolidation which involves communication between the neocortex and hippocampus. However, the neuromodulatory mechanisms underlying this neocortico-hippocampal communication are poorly understood. Here, we examined the involvement of dopamine D1 receptors (D1R) and D2 receptors (D2R) mediated signaling on memory consolidation using the Novel Object Recognition (NOR) test. We conducted the tests in male Hartley guinea pigs and cognitive behaviors were assessed in customized Phenotyper home cages utilizing Ethovision XT software from Noldus enabled for the 3-point detection system (nose, center of the body, and rear). We found that acute intraperitoneal injections of either 0.25 mg/kg SCH23390 to block D1Rs or 1.0 mg/kg sulpiride to block D2Rs soon after acquisition (which involved familiarization to two similar objects) attenuated subsequent discrimination for novel objects when tested after 5-hours in the NOR test. By contrast guinea pigs treated with saline showed robust discrimination for novel objects indicating normal operational processes undergirding memory consolidation. The data suggests that involvement of dopaminergic signaling is a key post-acquisition factor in modulating memory consolidation in guinea pigs.