Are radiographic indices reliable indicators for quantitative bone mineral density and vitamin D status after femoral neck fractures? A retrospective study in 112 elderly patients

Background

Radiographic parameters and indices obtained from hip x-rays are a potential tool to promptly estimate bone quality in elderly hip fracture patients. Preoperative decision in whether to use cemented or cement augmented implants might be supported by this information and thus improve patient safety. Subsequently, this study was conducted to evaluate radiographic parameters as a prescreening tool for bone quality.

Methods

A retrospective analysis of 112 elderly patients with a femoral neck fracture after low-energy trauma was performed (81 % female, 19 % male). Three radiological indices were calculated on hip x-rays: cortical index antero-posterior CTI (ap), cortical index lateral CTI (lat) and canal to calcar ratio CCR. These indices were analyzed for correlations with DXA T-Scores and serum 25-hydroxyvitamin D (25(OH)D) using the Spearman test.

Results

Median age of patients was 80 (IQR 72–86) years. A linear correlation was found for CTI (lat) and T-Score at the total hip (p?<?0.001, r?=?0.589), femoral neck (p?=?0.005, r?=?0.405) and the lumbar spine (p?=?0.002, r?=?0.299). A significant correlation was also indicated between CTI (lat) and 25(OH)D (p?=?0.002, r?=?0.293). CTI (lat) at a cut-off level of 0.4 showed a sensitivity of 79 % and a specificity of 56 % in predicting a T-score?≤??2.5 at the total hip. Gender specific analysis revealed a higher sensitivity (100 %) and specificity (73 %) of CTI (lat) at a cut-off level of 0.4 for men. For severe vitamin D deficiency (<10 ng/ml) sensitivity and specificity were 75 % and 65 %.

Conclusion

Radiographic indices as the CTI (lat) exhibit a direct correlation to BMD and serum 25OH vitamin D levels. A CTI (lat) cut-off level of 0.4 is recommended for identifying patients at risk of osteoporosis expressed by T-Scores?≤??2.5 and severe vitamin D deficiency.

     

Neurohumoral mechanism involved in augmentation of canine jejunal absorption following oral rehydration solutions

Throughout the world diarrheal diseases kill over 5 million children annually. Oral rehydration therapy, initially using glucose-based solutions and more recently cereal-based solutions, prevents complications and death from dehydration. These experiments compared the effect of these two rehydration solutions and a mixed meal on jejunal water and ionic transport. Five dogs had 25-cm proximal jejunal Thiry-Vella fistulae constructed. Following recovery, jejunal absorption studies (N=40) were performed using an isotonic electrolyte solution containing [¹⁴C]PEG to calculate net fluxes of water, sodium, and chloride. Each study consisted of a 1-hr basal period, followed by a 3-hr experimental period. Each animal was randomly studied in each of four study groups: control, mixed meal, glucose-based and cereal-based rehydration solution. In the mixed meal, glucose-based, and cereal-based solution groups there were significant increases (P<0.0001) in jejunal Thiry-Vella fistula water and ion absorption following the stimuli, in the absence of direct luminal nutrient contact with the Thiry-Vella fistula. There were no differences between the observed responses to the glucose-based or cereal-based rehydration solutions. Glucose-based and cereal-based rehydration solutions were equally effective in stimulating jejunal absorption of water and electrolytes, but less effective than a mixed meal. Both food and oral rehydration solutions appear to increase jejunal absorption partially via a neurohumoral mechanism that is independent of luminal nutrient contact with the Thiry-Vella fistula.Presented in part at a poster session of the American Gastroenterological Association Meeting, San Antonio, Texas, May 1990, and published in part in abstract form inGastroenterology 98:A158, 1990.     

Improving Dengue Diagnostics and Management Through Innovative Technology

Purpose of Review

Dengue continues to be a major global public health threat. Symptomatic infections can cause a spectrum of disease ranging from a mild febrile illness to severe and potentially life-threatening manifestations. Management relies on supportive treatment with careful fluid replacement. The purpose of this review is to define the unmet needs and challenges in current dengue diagnostics and patient monitoring and outline potential novel technologies to address these needs.

Recent Findings

There have been recent advances in molecular and point-of-care (POC) diagnostics as well as technologies including wireless communication, low-power microelectronics, and wearable sensors that have opened up new possibilities for management, clinical monitoring, and real-time surveillance of dengue.

Summary

Novel platforms utilizing innovative technologies for POC dengue diagnostics and wearable patient monitors have the potential to revolutionize dengue surveillance, outbreak response, and management at population and individual levels. Validation studies of these technologies are urgently required in dengue-endemic areas.

     

Outcomes following selective fetoscopic laser ablation for twin-to-twin transfusion syndrome: a single-centre experience

INTRODUCTIONFetoscopic laser photocoagulation (FLP), a treatment option for twin-to-twin transfusion syndrome (TTTS) in monochorionic twin pregnancies, is currently the treatment of choice at our centre. We previously reported on our experience of FLP from June 2011 to March 2014. This paper audits our fetal surgery performance since then.METHODS15 consecutive patients who underwent FLP for Stage II–III TTTS before 26 weeks of gestation from June 2011 to January 2017 were retrospectively reviewed, consisting of five cases from our initial experience and ten subsequent cases. Perioperative, perinatal and neonatal outcomes were analysed.RESULTSOf 15 pregnancies, 10 (66.7%) and 5 (33.3%) were for Stage II and III TTTS respectively, with FLP performed at an earlier Quintero stage in the later cohort. Overall mean gestational ages at presentation, laser and delivery were comparable between the cohorts at 19.7 (15.4–24.3) weeks, 20.3 (16.3–25.0) weeks and 31.2 (27.6–37.0) weeks, respectively. 2 (13.3%) cases had intra-amniotic bleeding and 1 (6.7%) had iatrogenic septostomy. 1 (6.7%) case had persistent TTTS requiring repeat FLP, and another (6.7%) had preterm premature rupture of membranes at seven weeks post procedure. The overall perinatal survival rate was 21 (75.0%) out of 28 infants. One mother underwent termination of pregnancy for social reasons at 1.4 weeks post procedure. Double survival occurred in 8 (57.1%) out of 14 pregnancies, while 13 (92.9%) had at least one survivor.CONCLUSIONFLP requires a highly specialised team and tertiary neonatal facility. Continual training improves maternal and perinatal outcomes, ensuring comparable standards with international centres.     

Cervical Arthroplasty for Moderate to Severe Disc Degeneration: Clinical and Radiological Assessments after a Minimum Follow-Up of 18 Months: Pfirrmann Grade and Cervical Arthroplasty

Purpose

Clinical outcomes and radiologic results after cervical arthroplasty have been reported in many articles, yet relatively few studies after cervical arthroplasty have been conducted in severe degenerative cervical disc disease.

Materials and Methods

Sixty patients who underwent cervical arthroplasty (Mobi-C®) between April 2006 and November 2011 with a minimum follow-up of 18 months were enrolled in this study. Patients were divided into two groups according to Pfirrmann classification on preoperative cervical MR images: group A (Pfirrmann disc grade III, n=38) and group B (Pfirrmann disc grades IV or V, n=22). Visual analogue scale (VAS) scores of neck and arm pain, modified Oswestry Disability Index (mODI) score, and radiological results including cervical range of motion (ROM) were assessed before and after surgery.

Results

VAS and mean mODI scores decreased after surgery from 5.1 and 57.6 to 2.7 and 31.5 in group A and from 6.1 and 59.9 to 3.7 and 38.4 in group B, respectively. In both groups, VAS and mODI scores significantly improved postoperatively (p<0.001), although no significant intergroup differences were found. Also, cervical dynamic ROM was preserved or gradually improved up to 18 months after cervical arthroplasty in both groups. Global, segmental and adjacent ROM was similar for both groups during follow-up. No cases of device subsidence or extrusion were recorded.

Conclusion

Clinical and radiological results following cervical arthroplasty in patients with severe degenerative cervical disc disease were no different from those in patients with mild degenerative cervical disc disease after 18 months of follow-up.     

Aldosterone-producing adrenocortical carcinoma without hypertension

Although adrenocortical tumors are common, adrenocortical carcinomas are rare. Moreover, aldosterone-producing adrenocortical carcinomas without hypertension are exceedingly rare, with only two previously reported cases.