Cone-beam computed tomography arthrography: an innovative modality for the evaluation of wrist ligament and cartilage injuries

Purpose

Cone-beam computed tomography (CBCT) has become an important modality in dento-facial imaging but remains poorly used in the exploration of the musculoskeletal system. The purpose of this study was to prospectively evaluate the performance and radiation exposure of CBCT arthrography in the evaluation of ligament and cartilage injuries in cadaveric wrists, with gross pathology findings as the standard of reference.

Materials and methods

Conventional arthrography was performed under fluoroscopic guidance on 10 cadaveric wrists, followed by MDCT acquisition and CBCT acquisition. CBCT arthrography and MDCT arthrography images were independently analyzed by two musculoskeletal radiologists working independently and then in consensus. The following items were observed: scapholunate and lunotriquetral ligaments, triangular fibrocartilage complex (TFCC) (tear, integrity), and proximal carpal row cartilage (chondral tears). Wrists were dissected and served as the standard of reference for comparisons. Interobserver agreement, sensitivity, specificity, and accuracy were determined. Radiation dose (CTDI) of both modalities was recorded.

Results

CBCT arthrography provides equivalent results to MDCT arthrography in the evaluation of ligaments and cartilage with sensitivity and specificity between 82 and 100%, and interobserver agreement between 0.83 and 0.97. However, radiation dose was significantly lower (p?Conclusion CBCT arthrography appears to be an innovative alternative to MDCT arthrography of the wrist as it allows an accurate and low radiation dose evaluation of ligaments and cartilage.     

Relationship between sports participation and the level of motor coordination in childhood: A longitudinal approach

ObjectivesThis study examined the stability of motor coordination and the relationship between motor coordination and organized sports participation over time.DesignLongitudinal design.MethodsA total of 371 children between six and nine years of age at initial testing completed a test battery measuring motor coordination in three consecutive years and a questionnaire on their club sports participation in year 1 and year 3 of testing.ResultsCorrelation coefficients revealed the motor coordination of children to be a highly stable factor, ranging from 0.662 (6–8 years) to 0.873 (7–9 years). Results of the Repeated Measures ANOVA indicated that children who consistently practiced sports in a club environment over the three years of testing displayed better coordination levels than children who only partially participated or did not participate in a club environment at all. Moreover, stability was further indicated as consistent sports participation over time and changes or lack thereof did not substantially influence the development of motor coordination over time. In addition, the basic level of motor coordination and the amount of club sports participation significantly predicted sports participation two years later.ConclusionThe importance of the stability of motor coordination levels in childhood and its role in determining organized sports participation may have implications for talent identification purposes as well as potential health-related benefits in childhood and throughout the lifespan.     

Physically active individuals look for more: An eye-tracking study of attentional bias

Attentional capture by exercise-related stimuli is important for the regulation of physical activity. Attentional processing underlying this capture has been investigated with indirect behavioral measures based on reaction times. To investigate more direct measures of visual spatial attention toward physical activity (vs. inactivity) stimuli, we used eye-tracking and a visual dot probe task in 77 young adults with various level of physical activity. Reaction times to detect a dot appearing in the area previously occupied by a physical activity (vs. inactivity) stimulus were an indirect measure of attentional bias. The first picture gaze and viewing time were more direct measures of attentional orienting and attentional engagement, respectively. Pupil dilation was an indicator of arousal. Reaction times revealed a two-way interaction between the location of the dot and participants’ usual level of physical activity. Only participants with a high level of physical activity more quickly detected a dot when it appeared in the area previously occupied by a physical activity stimulus. Eye-tracking results showed greater odds of first gazing at physical activity stimuli and for a longer time, and a greater decrease in pupil size when viewing physical activity stimuli when usual level of physical activity was moderate or high, but not low. The variance explained in the outcomes ranged from 13.9% (pupil dilation) to 40% (reaction times). Overall, as hypothesized, compared to less physically active participants, participants who were more physically active demonstrated indirect (reaction times) and direct (first gaze, viewing time) evidence of a more pronounced attentional bias toward physical activity. Physical activity stimuli biased attention, with a pronounced effect when the level of physical activity was higher. These findings suggest that physical activity stimuli are relevant to the current concerns of moderately and highly active individuals.     

Psychotropic Drug Use in a Cohort of Workers 4 Years After an Industrial Disaster in France

Two years after the 2001 Toulouse industrial disaster, a longitudinal study was set up to evaluate the impact of the disaster. The current substudy examines the medium‐term impact (5 years) the incident had on the mental health of 3,004 participants. As part of the monitoring, data relating to the psychotropic drug use of 2,494 participants were collected from administrative databases 4 years after the disaster. Use of psychotropics was higher among women for anxiolytics (10.4% for men and 15.0% for women), hypnotics (10.5% and 17.0%), and antidepressants (7.6% and 11.2%). Exposure to the disaster, especially proximity to the exposure, was significantly associated with the use of antidepressants in men, OR = 3.22, 95% CI[1.57, 6.61]. This was also the case for other exposure factors (saw dead or injury, injured, home damage, death or injury loved one, psychological disorders, exposure toxic fumes): range of OR 1.75 to 2.52 in men, 1.48 to 1.62 in women. In conclusion, this study highlights the medium‐term psychological impact of an industrial disaster on psychotropic drug use and the potential for using medical records data as a means for tracking postdisaster mental health.     

Conversion to mammalian target of rapamycin inhibitors increases risk of de novo donor‐specific antibodies

In kidney transplantation, conversion to mammalian target of rapamycin (mTOR) inhibitors may avoid calcineurin inhibitor (CNI) nephrotoxicity, but its impact on post‐transplant allo‐immunization remains largely unexplored. This retrospective cohort study analyzed the emergence of donor‐specific antibodies (DSA) in kidney transplant recipients relative to their immunosuppressive therapy. Among 270 recipients without pretransplant immunization who were screened regularly for de novo DSA, 56 were converted to mTOR inhibitors after CNI withdrawal. DSA emergence was increased in patients who were converted to mTOR inhibitors (HR 2.4; 95% CI 1.06–5.41, P = 0.036). DSA were mainly directed against donor HLA‐DQB1 antigens. The presence of one or two DQ mismatches was a major risk factor for DQ DSA (HR 5.32; 95% CI 1.58–17.89 and HR 10.43; 95% CI 2.29–47.56, respectively; P < 0.01). Rejection episodes were more likely in patients converted to mTOR inhibitors, but this difference did not reach significance (16% vs. 7.9%, P = 0.185). Concerning graft function, no significant change was observed one year after conversion (P = 0.31). In conclusion, conversion to mTOR inhibitors may increase the risk of developing class II DSA, especially in the presence of DQ mismatches: this strategy may favor chronic antibody‐mediated rejection and thus reduce graft survival.     

Potential drug–drug interactions associated with drugs currently proposed for COVID-19 treatment in patients receiving other treatments

Patients with COVID-19 are sometimes already being treated for one or more other chronic conditions, especially if they are elderly. Introducing a treatment against COVID-19, either on an outpatient basis or during hospitalization for more severe cases, raises the question of potential drug–drug interactions. Here, we analyzed the potential or proven risk of the co-administration of drugs used for the most common chronic diseases and those currently offered as treatment or undergoing therapeutic trials for COVID-19. Practical recommendations are offered, where possible.