Cost-effectiveness of magnetic resonance imaging and enteroclysis in the diagnostic imaging of Crohn's disease

OBJECTIVES: To compare the cost-effectiveness of magnetic resonance imaging (MRI) and enteroclysis in patients with Crohn's disease (CD). METHODS: A decision analytic model was performed considering the correct diagnoses of CD and complications such as fistulas and abscesses as effects. Costs were estimated in Euro([symbol: see text]) using German fee schedules. RESULTS: MRI was more effective and more costly compared with enteroclysis. Incremental cost-effectiveness of MRI versus enteroclysis was [symbol: see text]1,595 per additional correctly diagnosed patient. CONCLUSIONS: The use of MRI in the work-up of patients with CD cannot be generally recommended from an economical perspective, but results of sensitivity analysis suggest that in patients with high prevalence of complications, MRI becomes as cost-effective as enteroclysis, which is accepted standard diagnostic imaging.     

Elevated proto-oncogene and collagen mRNA expression in PVR retinas

PURPOSE: Retinal detachment is often accompanied by proliferation and migration of retinal cells and by increased synthesis of structural proteins, known as proliferative vitreoretinopathy (PVR). Herein we investigate the messenger RNA (mRNA) expression of proto-oncogenes responsible for cell proliferation and of structural proteins that have a role in membrane formation. METHODS: Retinal samples were obtained from patients undergoing vitreoretinal surgery for the treatment of retinal detachment complicated by PVR. Normal human control retinas were obtained from cornea donors. The mRNA expression of the proto-oncogenes c- myc, c- fos and the proliferation marker Ki67, as well as of collagen type III and type IV, were investigated using the ribonuclease protection assay. RESULTS: Ki67 mRNA expression was not detectable in either sample type, but c- fos and c- myc mRNA expression was found in normal and PVR retinas. Whereas the expression of c- myc showed a marginal increase, the up-regulation in c- fos expression was strongly significant (5.07-fold). The mRNA of collagen type III was detectable at widely varying levels in all the PVR retinas but was found in only 2 of the 16 analysed normal samples. Collagen type IV mRNA was expressed in both PVR and control samples but was higher (2.21-fold) in the PVR retinas. CONCLUSIONS: These results indicate that an up-regulation of the proto-oncogene c- fos occurs in human PVR retinas. An increase in mRNA expression of collagen types III and IV takes place simultaneously. These changes in mRNA expression appear to be mainly connected to the initiation of cell proliferation, dedifferentiation and formation of tractional membranes.     

The effects of prosthetic foot roll-over shape arc length on the gait of trans-tibial prosthesis users

The Shape&Roll prosthetic foot was used to examine the effect of roll-over shape arc length on the gait of 14 unilateral trans-tibial prosthesis users. Simple modifications to the prosthetic foot were used to alter the effective forefoot rocker length, leaving factors such as alignment, limb length, and heel and mid-foot characteristics unchanged. Shortening the roll-over shape arc length caused a significant reduction in the maximum external dorsiflexion moment on the prosthetic side at all walking speeds (p < 0.001 for main effect of arc length), due to a reduction in forefoot leverage (moment arm) about the ankle. Roll-over shape arc length significantly affected the initial loading on the sound limb at normal and fast speeds (p = 0.001 for the main effect of arc length), with participants experiencing larger first peaks of vertical ground reaction forces on their sound limbs when using the foot with the shortest effective forefoot rocker arc length. Additionally, the difference between step lengths on the sound and prosthetic limbs was larger with the shortest arc length condition, although this difference was not statistically significant (p = 0.06 for main effect). It appears that prosthesis users may experience a drop-off effect at the end of single limb stance on prosthetic feet with short roll-over shape arc lengths, leading to increased loading and/or a shortened step on the contralateral limb.