Relationships among subjective patient-reported outcome,quality of life,and objective gait characteristics using wearable foot inertial-sensor assessment in foot–ankle patients

European Journal of Orthopaedic Surgery & Traumatology - This study aimed to determine the relationships between subjective validated patient-reported outcomes and health-related quality of...     

Critical three-dimensional factors affecting outcome in osteochondral lesion of the talus

Purpose

This study aimed to investigate the relationship between clinical outcomes, patient demographics and the 3D-geometric profiles of the osteochondral lesion of the talus (OLT) following arthroscopic debridement and bone marrow stimulation.

Methods

Between 2005 and 2011, arthroscopic debridement and bone marrow stimulation were performed on 50 ankles with OLT mean age of 36.0 (19.1) years and mean follow-up time of 35.5 (20.2) months. Clinical data were assessed using validated Japanese Society of Surgery of the Foot scoring. An outcome was deemed unsatisfactory if the JSSF score was less than 80. Magnetic resonance imaging and X-rays were used to assess the 3D-geometric profiles of the OLT.

Results

The mean preoperative and postoperative scores were 73.4 (13.6) and 89.6 (11.5), respectively (p < 0.001). Unsatisfactory outcomes were identified in 12 % of patients. Linear regression analyses showed that lesion depth and patient age were significantly negatively correlated with postoperative scores (p < 0.001). High prognostic significances were attributed to defect depth and age of patient, and cut-off values of 7.8 mm and 80 years, respectively, were recommended to avoid a postoperative score less than 80. No significant correlations between poor clinical outcome and the other lesion profiles or demographic factors were identified.

Conclusion

Using 3D-geometric and demographic profiles, defect depth and age of patient are essential prognostic factors in OLT and may act as a basis for preoperative surgical decisions. A lesion depth ≥7.8 mm and age ≥80 years predict an unsatisfactory outcome following arthroscopic debridement and bone marrow stimulation.

Level of evidence

Retrospective comparative study, Level III.     

In situ gelling hydrogels incorporating microparticles as drug delivery carriers for regenerative medicine

Aqueous solutions of blends of biodegradable triblock copolymers, composed of poly(D,L-lactide-co-glycolide) (PLGA) and poly(ethylene glycol) (PEG) with varied D,L-lactide to glycolide ratios, displayed thermosensitivity and formed a gel at body temperature. The gel window of the blend solutions could be tuned by varying the blending ratio between the two components. Furthermore, the storage modulus of the resultant hydrogel from the copolymer blends at body temperature was higher than that of each individual component. Incorporation of poly(D,L-lactide) (PDLLA) microparticles (0.5-40% w/v) within the in situ gelling hydrogel did not change the sol-gel transition temperatures of the polymer solutions, while the mechanical strength of the resultant hydrogels was enhanced when the content of the microparticles was increased up to 30% and 40%. Incorporation of proteins into both the gel and microparticle components resulted in composites that controlled the kinetics of protein release. Protein within the gel phase was released over a 10-day period whilst protein in the microparticles was released over a period of months. This system can be used to deliver two drugs with differing release kinetics and could be used to orchestrate tissue regeneration responses over differing timescales.     

Differentiation of benign and malignant ampullary obstruction by multi-row detector CT

Purpose

To determine useful CT parameters to differentiate ampullary carcinomas from benign ampullary obstruction.

Materials and methods

This study included 93 patients who underwent abdominal CT, 31 patients with ampullary carcinomas, and 62 patients with benign ampullary obstruction. Two radiologists independently evaluated CT parameters then reached consensus decisions. Statistically significant CT parameters were identified through univariate and multivariate analyses.

Results

In univariate analysis, the presence of ampullary mass, asymmetric, abrupt narrowing of distal common bile duct (CBD), dilated intrahepatic bile duct (IHD), dilated pancreatic duct (PD), peripancreatic lymphadenopathy, duodenal wall thickening, and delayed enhancement were more frequently in ampullary carcinomas observed (P?<?0.05). Multivariate logistic regression analysis using significant CT parameters and clinical data from univariate analysis, and clinical symptom with jaundice (P?=?0.005) was an independent predictor of ampullary carcinomas. For multivariate analysis using only significant CT parameters, abrupt narrowing of distal CBD was an independent predictor of ampullary carcinomas (P?=?0.019). Among various CT criteria, abrupt narrowing of distal CBD and dilated IHD had highest sensitivity (77.4%) and highest accuracy (90.3%).

Conclusion

The abrupt narrowing of distal CBD and dilated IHD is useful for differentiation of ampullary carcinomas from benign entity in patients without the presence of mass.