MR imaging of the acutely injured patient with cervical traction

Magnetic resonance (MR) imaging of the patient with acute cervical injury is important because of the potential prognostic significance of the appearance of the spinal cord at the time of injury. However, cervical traction may involve equipment incompatible with the magnetic environment, and transferring the patient to the imaging table may make it difficult to maintain traction. The authors describe a simple, inexpensive, and reliable method for providing cervical traction within the magnet room.     

Endothelial lipase and reverse cholesterol transport in type 2 diabetes mellitus

Aims/Introduction:  Endothelial lipase (EL) plays an important role in high‐density lipoprotein (HDL) metabolism and experimental data suggest that EL might be proatherogenic. We have investigated whether serum EL concentration is associated with changes in serum capacity to induce cholesterol efflux and arterial stiffness in type 2 diabetes.Materials and Methods:  Serum EL was assayed by ELISA in 172 diabetic patients and 175 controls. The ability of serum to induce cholesterol efflux was measured using a cell culture system and arterial stiffness was determined by measuring pulse wave velocity (PWV) between carotid and femoral arteries.Results:  Diabetic patients had significantly higher C‐reactive protein (CRP) and EL (27.7 ± 16.6 ng/mL vs 24.0 ± 11.3, P < 0.05). Cholesterol efflux to serum mediated through scavenger receptor class B type I was impaired (15.1 ± 2.5%vs 16.7 ± 3.1, respectively, P < 0.01). In controls, serum EL correlated with cholesterol efflux to serum (r = −0.16, P = 0.025), but only a trend was seen in the diabetic patients. Linear regression showed that in controls, HDL, serum EL and waist circumference were major independent determinants of cholesterol efflux; whereas in the diabetic cohort, the major independent determinants of cholesterol efflux were HDL, CRP and age. PWV was increased in the diabetic patients (P < 0.01), but no association between serum EL and PWV was seen in either groups.Conclusions:  Serum EL was increased in diabetic patients, but impaired serum capacity to induce cholesterol efflux in these patients was mainly related to low HDL and subclinical inflammation. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00016.x, 2010)     

Radiographic assessment of uncemented total hip arthroplasty: reliability of the Engh Grading Scale

Background

Radiographic evaluation has a prominent place in the follow-up of long-term results of uncemented total hip arthroplasty (THA). The most prominent scale reported in studies is the Engh Grading Scale, but there is a lack of literature on the reliability of the scale.

Methods

We evaluated intra- and interrater reliability of the Engh Grading System for uncemented THA using 26 follow-up radiographs of patients who had primary uncemented THAs. Four evaluators with different skill levels and specialties participated: 2 arthroplasty surgeons, an orthopedic resident and a radiologist. Reliability was measured using a weighted κ coefficient for paired comparisons among the evaluators.

Results

Intrarater reliability was dependent on the skill and specialty of the evaluator, with the highest values achieved for the arthroplasty surgeons (κ = 0.52 and κ = 0.68) and the lowest values for the radiologist (κ = 0.14). Interrater reliability was comparable among participants, regardless of skill or specialty, and rated a moderate level of reliability (κ = 0.29–0.41) for all pairings.

Conclusion

The Engh Grading Scale appears to be reliable when used by a single, experienced arthroplasty surgeon. Caution must be exercised when multiple raters are used, regardless of experience, as the interrater reliability achieved lower ratings.