Revision of Unicompartmental to Total Knee Arthroplasty: Does the Unicompartmental Implant (Metal-Backed vs All-Polyethylene) Impact the Total Knee Arthroplasty?

Background

The aim of this study is to investigate differences in implant requirement, outcomes, and re-revision when total knee arthroplasty (TKA) was performed following unicompartmental knee arthroplasties (UKAs) with metal-backed (MB) compared to all-polyethylene (AP) tibial components.

Five‐Millimeter and Smaller Embryos Without Embryonic Cardiac Activity

Objective. The purpose of this study was to assess outcomes in embryos with a crown‐rump length (CRL) of 5 mm or less without embryonic cardiac activity (ECA) among pregnant women with vaginal bleeding in the first trimester. Methods. A retrospective study of all first‐trimester sonograms in women with vaginal bleeding from 1999 to 2002 was conducted. Results. Thirty‐seven embryos without detectable ECA that had a CRL of 5 mm or less were identified. All resulted in pregnancy failure. The breakdown of these embryos by CRL was as follows: 13 were 5 mm; 10 ranged from 4 to 4.9 mm; 11 ranged from 3 to 3.9 mm; and 3 ranged from 2 to 2.9 mm. Conclusions. In pregnant women with vaginal bleeding, embryos of 5 mm and smaller without a heartbeat all resulted in pregnancy failure.     

Image distortion correction in fMRI: A quantitative evaluation

A well-recognized problem with the echo-planar imaging (EPI) technique most commonly used for functional magnetic resonance imaging (fMRI) studies is geometric distortion caused by magnetic field inhomogeneity. This makes it difficult to achieve an accurate registration between a functional activation map calculated from an EPI time series and an undistorted, high resolution anatomical image. A correction method based on mapping the spatial distribution of field inhomogeneities can be used to reduce these distortions. This approach is attractive in its simplicity but requires postprocessing to improve the robustness of the acquired field map and reduce any secondary artifacts. Furthermore, the distribution of the internal magnetic field throughout the head is position dependent resulting in an interaction between distortion and head motion. Therefore, a single field map may not be sufficient to correct for the distortions throughout a whole fMRI time series. In this paper we present a quantitative evaluation of image distortion correction for fMRI at 2T. We assess (i) methods for the acquisition and calculation of field maps, (ii) the effect of image distortion correction on the coregistration between anatomical and functional images, and (iii) the interaction between distortion and head motion, assessing the feasibility of using field maps to reduce this effect. We propose that field maps with acceptable noise levels can be generated easily using a dual echo-time EPI sequence and demonstrate the importance of distortion correction for anatomical coregistration, even for small distortions. Using a dual echo-time series to generate a unique field map at each time point, we characterize the interaction between head motion and geometric distortion. However, we suggest that the variance between successively measured field maps introduces additional unwanted variance in the voxel time-series and is therefore not adequate to correct for time-varying distortions.     

A pre-operative clinical scoring system to distinguish perforation risk with pediatric appendicitis

Importance

Appendicitis is a common, potentially serious pediatric disease. An important factor in determining management strategy [whether/when to perform appendectomy, duration of antibiotic therapy/hospitalization, etc.] and predicting outcome is distinguishing whether perforation is present.

A comparison of viral microneutralization and haemagglutination inhibition assays as measures of seasonal inactivated influenza vaccine immunogenicity in the first year after reduced intensity conditioning,lymphocyte depleted allogeneic haematopoietic stem cell transplant

Traditionally, immune response to influenza vaccines has been measured using the haemagglutination inhibition (HAI) assay. A broader repertoire of techniques including the sensitive viral microneutralization (VMN) assay is now recommended by the European Medicines Agency (EMA). Comparing HAI and VMN, we determined immune response to a trivalent 2015–2016 seasonal inactivated influenza vaccine (SIIV) administered to 28 recipients of allogeneic haematopoietic stem cell transplant (HSCT). Vaccination was within the first-year post-transplant at a median of 78.5 (24–363) days. The proportion of patients with baseline and post-vaccination HAI titres?≥?1:40 were 28.6% and 25% for A(H1N1)pdm09, 14.3% at both timepoints for A(H3N2), and 32.1% and 25% for B(Phuket). Pre and Post-vaccination geometric mean titres(GMT) were higher by VMN than HAI for A(H1N1)pdm09 and A(H3N2), but lower for B(Phuket)(p=<0.05). Geometric mean ratios(GMR) of baseline and post-vaccination titres were similar by HAI and VMN(p?>?0.05) for all components. A single seroconversion to A(H1N1) was detected by ELISA-VMN. None of patient age, lymphocyte count, days from transplant to vaccination, donor type, or graft-versus-host disease (GVHD) or immunosuppressive therapy (IST) at vaccination correlated with baseline or post-vaccination titres by either assay. This absence of seroresponse to SIIV in the first-year post HSCT highlights the need for novel immunogenic vaccination formulations and schedules in this high-risk population.     

Trends in Lumpectomy and Oncoplastic Breast-Conserving Surgery in the US, 2011–2016

Background

Oncoplastic breast surgery aims to optimize efficacy of surgical resection and cosmesis to maximize patient satisfaction; however, despite the benefits, oncoplastic techniques have not been widely adopted in the US. This study examined trends in the incidence of lumpectomy (partial mastectomy) with or without oncoplastic techniques from 2011 to 2016.

Methods

This was a retrospective analysis of claims from the Optum Clinformatics database (January 2010–March 2017). Female patients with no history of breast surgery in the prior year were categorized into three independent cohorts: isolated lumpectomy (Lx), lumpectomy with tissue transfer (LxTT), or lumpectomy with mammaplasty and/or mastopexy (LxMM). Oncoplastic techniques (in cohorts two and three) were performed at either time of the initial lumpectomy or during 90-day follow-up.

Results

Overall, 19,253 patients met the inclusion criteria (91.1% Lx, 5.2% LxTT, and 3.7% LxMM). Significantly fewer patients with Lx had a family history of breast cancer compared with patients with oncoplastic techniques (26.4% vs. 33.7% and 37.9%, respectively; p?<?0.001). The incidence of Lx declined significantly from 2011 (92.9%) to 2016 (88.1%), while LxTT and LxMM increased from 4.2 to 7.2% and 2.8 to 4.7%, respectively (both p?<?0.001). The greatest utilization of oncoplastic techniques was observed in the Pacific census division (19.2%), while lowest utilization was in the East South Central division (3.2%; p?<?0.001).

Conclusions

While increased adoption of oncoplastic techniques was observed, the compound annual growth rate remained below 10% and varied significantly by region. Further adoption of oncoplastic techniques is necessary to improve cosmetic outcomes and patient satisfaction following breast-conserving surgery.