A comparison of the diagnostic accuracy of MARS MRI and ultrasound of the painful metal-on-metal hip arthroplasty

Background and purpose

Metal artifact reduction sequence (MARS) MRI and ultrasound scanning (USS) can both be used to detect pseudotumors, abductor muscle atrophy, and tendinous pathology in patients with painful metal-on-metal (MOM) hip arthroplasty. We wanted to determine the diagnostic test characteristics of USS using MARS MRI as a reference for detection of pseudotumors and muscle atrophy.

Patients and methods

We performed a prospective cohort study to compare MARS MRI and USS findings in 19 consecutive patients with unilateral MOM hips. Protocolized USS was performed by consultant musculoskeletal radiologists who were blinded regarding clinical details. Reports were independently compared with MARS MRI, the imaging gold standard, to calculate predictive values.

Results

The prevalence of pseudotumors on MARS MRI was 68% (95% CI: 43–87) and on USS it was 53% (CI: 29–76). The sensitivity of USS in detecting pseudotumors was 69% (CI 39–91) and the specificity was 83% (CI: 36–97). The sensitivity of detection of abductor muscle atrophy was 47% (CI: 24–71). In addition, joint effusion was detected in 10 cases by USS and none were seen by MARS MRI.

Interpretation

We found a poor agreement between USS and MARS MRI. USS was inferior to MARS MRI for detection of pseudotumors and muscle atrophy, but it was superior for detection of joint effusion and tendinous pathologies. MARS MRI is more advantageous than USS for practical reasons, including preoperative planning and longitudinal comparison.Approximately 1.5 million metal-on-metal (MOM) hip arthroplasties have been implanted worldwide since 1996 (FDA 2012). A high early failure rate for these prostheses has recently been demonstrated (Smith et al. 2012). The pattern of failure appears to differ from other hip arthroplasty types, with adverse reactions to wear-related metal debris being a prominent feature (Pandit et al. 2008, Kwon et al. 2011). These solid or cystic lesions have been termed pseudotumors (Pandit et al. 2008). A wide spectrum of adverse tissue reactions have been described. Histologically, using their pseudocapsules, these have been termed aseptic lymphocytic vasculitis-associated lesions (ALVALs) (Willert et al. 2005).Health regulatory guidelines recommend investigation with cross-sectional imaging, using either metal artifact reduction sequence (MARS) MRI or ultrasound scanning (USS), to evaluate the periprosthetic soft tissues. A number of advantages and disadvantages have been reported (Sabah et al. 2011, Liddle et al. 2013). The high-resolution capability of USS allows detailed imaging of solid or cystic extra-articular lesions and also detection of muscle atrophy (Sofka et al. 2004), joint effusions, gluteal tendon avulsion, and iliopsoas or trochanteric bursitis (Long et al. 2012). USS is also commonly used during guided anesthetic injection or fluid aspiration.

Table 1.

A comparison of the advantages and disadvantages of MARS MRI and ultrasound imaging of metal-on-metal hips

Frequency and Predictors of Non-compliance to Dietary Recommendations Among Hypertensive Patients

Compliance to dietary recommendations among hypertensive people is a major health care issue. Non-compliance can nullify the effects of even the most scientific and optimum treatment plan. The main aim of this study was to determine the frequency and predictors of non-adherence in our region. We also investigated the possible factors based on patient opinions that could increase compliance. A sample of 400 adult patients, diagnosed with hypertension for at least 3 years, who visited Civil Hospital during the time period April–June 2013 were included in this cross sectional study. Patient data and opinions were collected by two trained interviewers using a pre-coded questionnaire. Compliance was assessed based on patients self report. More than three quarters (n = 310, 77.5 %) of the hypertensive patients were non-compliant. More than one social gathering in a week, peer-influence, no friends to follow the recommended diet plan and lack of believe regarding diet as an effective measure to control blood pressure were found to be the significant predictors of non-compliance (P values <0.0001). Counseling was thought to be the most effective way by the patients to increase adherence. Non-compliance to dietary recommendations is a major problem prevalent especially in Pakistan. There is an urgent need for doctors and nurses to counsel their patients effectively to prevent future morbidities and mortalities because of non-compliance.     

Double cascade dressed MOSFET from doped Eu3+and Pr3+ in a host YPO4

In this paper, we study double cascade dressed optical metal oxide semiconductor field-effect transistor (MOSFET) by exploiting enhancement and suppression for mixed-phase (hexagonal + tetragonal) of Eu³⁺:YPO₄ and different phases (hexagonal + tetragonal and pure tetragonal) of Pr³⁺:YPO₄ crystals. We report variation of fine structure energy levels in different doped ions (Eu³⁺ and Pr³⁺) in the host YPO crystal. We compared multi-level energy transition from a single dressing laser with single level energy transition from double cascade dressing lasers. Gate delay facilitates multi-energy level dressed transition and is modeled through a Hamiltonian. Based on the results of double cascade dressing, we have realized MOSFET for logic gates (inverter and logic not and gate) with a switching contrast of about 92% using a mixed phase of Pr³⁺:YPO₄.

By changing different parameters of single and double lasers, we observed the dressed energy level transition from single to multi-level with a single laser. Each sample responded based on their ions'' structure and phase symmetry in the host YPO crystal.     

Endophytic Microbes from Diverse Wheat Genotypes and Their Potential Biotechnological Applications in Plant Growth Promotion and Nutrient Uptake

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Endophytic microbes residing inside the tissues of plants play a significant role to enhance the growth and...     

Behavioral interventions to promote adaptive eating behavior and lifestyle changes following surgery for obesity: Results of a two-year outcome evaluation

Bariatric surgery for extreme obesity requires eating behavior and lifestyle changes that behavioral interventions may facilitate. Surgery patients were randomly assigned to a minimal intervention control group (n = 15) or a behavioral treatment group (n = 17), who participated in monthly behavioral consultations and received biweekly weight management materials for 6 months. Interviews assessed subjects' eating behavior, psychosocial functioning, and physical status for 6 months after surgery. Both groups showed significant weight loss during the first year after surgery, but the groups did not differ significantly. Subjects did not lose additional weight by 2 years following surgery. Treatment subjects reported higher postoperative psychosocial functioning and physical activity and consumed less fat and protein than did control subjects. These findings suggest that behavioral interventions enhance postoperative adjustment in behavioral and lifestyle variables, but do not add to the substantial weight losses produced by surgery alone.     

Trends and Spatial Pattern Analysis of Dengue Cases in Northeast Malaysia

ObjectivesDengue remains hyperendemic in Malaysia despite extensive vector control activities. With dynamic changes in land use, urbanisation and population movement, periodic updates on dengue transmission patterns are crucial to ensure the implementation of effective control strategies. We sought to assess shifts in the trends and spatial patterns of dengue in Kelantan, a north-eastern state of Malaysia (5°15’N 102°0’E).MethodsThis study incorporated data from the national dengue monitoring system (eDengue system). Confirmed dengue cases registered in Kelantan with disease onset between January 1, 2016 and December 31, 2018 were included in the study. Yearly changes in dengue incidence were mapped by using ArcGIS. Hotspot analysis was performed using Getis-Ord Gi to track changes in the trends of dengue spatial clustering.ResultsA total of 10 645 dengue cases were recorded in Kelantan between 2016 and 2018, with an average of 10 dengue cases reported daily (standard deviation, 11.02). Areas with persistently high dengue incidence were seen mainly in the coastal region for the 3-year period. However, the hotspots shifted over time with a gradual dispersion of hotspots to their adjacent districts.ConclusionsA notable shift in the spatial patterns of dengue was observed. We were able to glimpse the shift of dengue from an urban to peri-urban disease with the possible effect of a state-wide population movement that affects dengue transmission.     

Durability Improvement of Biocemented Sand by Fiber-Reinforced MICP for Coastal Erosion Protection

Soil improvement via MICP (microbially induced carbonate precipitation) technologies has recently received widespread attention in the geoenvironmental and geotechnical fields. The durability of MICP-treated samples remains a critical concern in this novel method. In this work, fiber (jute)-reinforced MICP-treated samples were investigated to evaluate their durability under exposure to distilled water (DW) and artificial seawater (ASW), so as to advance the understanding of long-term performance mimicking real field conditions, along with improvement of the MICP-treated samples for use in coastal erosion protection. Primarily, the results showed that the addition of fiber (jute) improved the durability of the MICP-treated samples by more than 50%. Results also showed that the wet–dry (WD) cyclic process resulted in adverse effects on the mechanical and physical characteristics of fiber-reinforced MICP-treated samples in both DW and ASW. The breakdown of calcium carbonates and bonding effects in between the sand particles was discovered to be involved in the deterioration of MICP samples caused by WD cycles, and this occurs in two stages. The findings of this study would be extremely beneficial to extend the insight and understanding of improvement and durability responses for significant and effective MICP treatments and/or re-treatments.     

The Impact of “COVID-19” and “Webinar Pandemic” on Plastic Surgery Practice in Teaching Institutes and Resident Training—A Multicentric Perspective

Introduction  The study was carried out to quantify the changes induced by the pandemic in plastic surgery practice and training and to study the impact of the webinars on plastic surgery education from a residents’ perspective. Methods  In this multicentric study, the number and type of surgeries, cause of injuries, and their regional variation during the coronavirus disease 2019 (COVID-19) period (February–September 2020) were compared with pre–COVID-19 time. An online survey on the impact of webinars was conducted for plastic surgery trainees across the country. Results  There was a significant reduction in total number of surgeries ( p = 0.003). The procedures for hand ( p = 0.156), faciomaxillary injuries ( p = 0.25), and replantations ( p = 0.46) were comparable; there was a significant reduction in combined orthopedic-plastic-surgical procedures ( p = 0.009) during the pandemic. There was a significant reduction in road accidents ( p = 0.007) and suicidal injuries ( p = 0.002) and increase in assault ( p = 0.03) and domestic accidents ( p = 0.01) during the COVID-19 period. A usefulness score of >8 was given for the webinars by 68.7% residents. There was no significant difference in perception of utility when correlated with the academic program at their institutes ( p = 0.109); 92% opined webinars should continue in post-COVID times. Conclusion  There was a drastic reduction in number of elective and emergency procedures during the COVID-19 time, negatively affecting resident training program. Majority of residents felt that webinars could prove a useful adjunct to training in formal training program in post-COVID-19 scenario.