Changes in Intra-pelvic Obliquity Angle 0–2 Years After Total Hip Arthroplasty and Its Effects on Leg Length Discrepancy: A Retrospective Study

Background:

Total hip arthroplasty (THA) is one of the most effective treatments for phase III and IV hip arthrosis. Lower limb length balancing is one of the determining factors of a successful surgery, particularly in patients with developmental dysplasia of the hip (DDH). The purpose of this study was to evaluate the postoperative change in intra-pelvic obliquity (intra-PO) angle in the coronal plane and its effects on leg length discrepancy (LLD) within 2 years.

Methods:

A total of 78 patients (70 females, 8 males) were enrolled in this study. All patients were suffering from DDH with varying degrees of LLD. Pelvic plain radiographs were collected before and after the operation. The intra-PO angles were measured 0, 0.5, 1 and 2 years after THA. At the same time, postoperative LLD was measured with blocking test.

Results:

PO changed significantly in the first year after THA surgery (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01), and the changing value of intra-PO angle (ΔPO) slowed down substantially during the first 2 years after THA (0.5 year vs. 0.5–1 year, P < 0.01; 0.5–1 year vs. 1–2 years, P < 0.01). With the change in intra-PO angle, LLD also got narrow within the 1st year (0 year vs. 0.5 year, P < 0.01; 0.5 year vs. 1 year, P < 0.01). Elderly patients had a smaller intra-PO angle reduction (Group A vs. Group B, P = 0.01; Group B vs. Group C, P < 0.01).

Conclusions:

Intra-PO angle and LLD gap narrowed with time after THA surgery. In particular, elderly patients had smaller change in intra-PO angle.     

The impact of a discrepancy between actual and preferred living arrangements on life satisfaction among the elderly in China

OBJECTIVES:

To explore the effects of a discrepancy between actual and preferred living arrangements on the relationship between living arrangements and life satisfaction among the elderly in China.

METHODS:

Secondary analysis of the 2005 dataset of the Chinese Longitudinal Healthy Longevity Survey was performed. A binary logistic regression model was used to analyze the relationship between life satisfaction and living arrangements.

RESULTS:

Among those with concordant actual and preferred living arrangements, living in a nursing home increased the likelihood of life satisfaction, whereas living alone and living with a spouse decreased the likelihood of life satisfaction compared to living with the next generation and a spouse. Among those with discordant living arrangements, there were no differences in life satisfaction between the various living arrangements, except that living with a spouse increased life satisfaction compared to living with the next generation and a spouse.

CONCLUSIONS:

A discrepancy between actual and preferred living arrangements modifies the relationship between life satisfaction and actual living arrangement. Living in a nursing home is a good option for Chinese elder care only if the older individual emotionally accepts it. Living alone or with a spouse is not a good arrangement for elder care, even though it is often preferred by the elderly. Those with discordant living arrangements are more satisfied living with their spouses.     

The DePICTORS Study: discrepancies in preliminary interpretation of CT scans between on-call residents and staff

At many academic hospitals, radiology residents provide preliminary interpretations of CT studies performed outside of regular working hours. We examined the rate of discrepancies between resident interpretations and final reports issued by staff. We prospectively obtained 1,756 preliminary reports and corresponding final reports for computed tomography (CT) scans performed on call between November 2006 and March 2007. The overall rate of clinically significant discrepancies (those that would potentially alter the patient’s clinical course prior to issue of the final report) was 2.0%. Major discrepancy rates for abdominal/pelvic, chest, cervical spine and head CT were 4.1%, 2.5%, 1.0% and 0.7%, respectively. Senior residents had fewer major discrepancies compared to their junior colleagues. Time of interpretation was also evaluated, but a statistically significant relationship was not observed. In summary, this study demonstrates a low discrepancy rate between residents and staff radiologists and identifies areas where after-hours service may be further improved.     

Differences in finished case quality between Invisalign and traditional fixed appliances:: A randomized controlled trial

ObjectivesTo compare the treatment and posttreatment effects of Invisalign aligners that incorporated SmartForce features and attachments to traditional fixed appliances.Materials and MethodsThis randomized controlled trial included 66 patients, 32 aligners, and 34 fixed-appliance patients. The median ages of the aligner and braces patients were 26.7 (interquartile range [IQR]: 9.8) and 25.9 (IQR: 16.6) years, respectively. Pretreatment occlusion was assessed using the ABO Discrepancy Index. Posttreatment (T1) and 6-month retention (T2) occlusions were quantified using the ABO Objective Grading System (OGS) scores.ResultsThe braces group finished treatment significantly (P < .001) earlier (0.4 years) than the aligner group. The median DI scores for the aligner and braces groups were 4.5 and 7.0, respectively, which was a statistically significant (P = .015), but clinically insignificant, difference. There were no statistically significant between-group differences for the total OGS scores or any of the individual component scores at debond (T1) or after 6 months of retention (T2). During the posttreatment period, alignment and overjet worsened significantly in the aligner group, while buccolingual inclinations and occlusal relations improved. Over the same period, alignment worsened in the braces group and buccolingual inclinations improved. There was no statistically significant between-group difference in posttreatment changes of the total OGS scores.ConclusionsWhile patients with simple malocclusions require 4.8 months longer treatment times with aligners than traditional braces, the treatment and 6-month posttreatment occlusal outcomes are similar.     

Improvement in smile esthetics following orthodontic treatment: A retrospective study utilizing standardized smile analysis

Objective:To quantify smile esthetics following orthodontic treatment and determine whether these changes are correlated to the severity of the initial malocclusion.Materials and Methods:A standardized smile mesh analysis that evaluated nine lip-tooth characteristics was applied to two groups of successfully treated patients: group 1 (initial American Board of Orthodontics Discrepancy Index [DI] score <20) and group 2 (initial DI score >20). T-tests were used to detect significant differences between the low-DI and high-DI groups for baseline pretreatment measurements, baseline posttreatment measurements, and changes from pre- to posttreatment. A Spearman correlation test compared the initial DI values with the changes in the nine smile measurements.Results:Five of the smile measurements were improved in both groups following orthodontic treatment. Both groups demonstrated improved incisor exposure, an improved gingival smile line, an increase in smile width, a decreased buccal corridor space, and an improvement in smile consonance. Spearman correlation tests showed that initial DI value was not correlated to changes in any of the individual smile measurements.Conclusions:Smile esthetics is improved by orthodontic treatment regardless of the initial severity of the malocclusion. In other words, patients with more complex orthodontic issues and their counterparts with minor malocclusions benefitted equally from treatment in terms of their smile esthetics.     

Effects of discrepancy between imagined and perceived sounds on the N2 component of the event‐related potential

Two experiments were conducted to examine whether the N2 component of the event‐related potential (ERP), typically elicited in a S1‐S2 matching task and considered to reflect mismatch process, can still be elicited when the S1 was imagined instead of perceived and to investigate how N2 amplitude varied with the degree of S1‐S2 discrepancy. Three levels of discrepancy were defined by the degree of separation between the heard (S2) and imagined (S1) sounds. It was found that the N2 was reliably elicited when the perceived S2 differed from the imagined S1, but whether N2 amplitude increased with the degree of discrepancy depended in part on the S1‐S2 discriminability (as evidenced by reaction time). Specifically, the effect of increasing discrepancy was attenuated as discriminability increased from hard to easy. These results, together with the dynamic ERP topography observed within the N2 window, suggest that the N2 effect reflects two sequential but overlapping processes: automatic mismatch and controlled detection.     

The discrepancy hypothesis in children with language disorders: Does it work?

Objectives

Analysis of the relationship between verbal and nonverbal development in children with language problems.

Methods

From 134 children enrolled in a multidisciplinary diagnostic procedure in a speech and hearing clinic and diagnosed as having a language disorder, the language comprehension score (LCQ) and the nonverbal IQ score (SON-IQ) were compared.t-Tests were used to test whether the children's mean LCQ differs from their mean SON-IQ and to test whether the children with an inadequate LCQ differ from children with an adequate LCQ with respect to discrepancy. Plots inspired by Bland and Altman [18] display the measurement of mean value of verbal and nonverbal development against the discrepancy between these scores.

Results

All children had a language production problem (inadequate GDS). Out of the 57 children with an adequate language comprehension (LCQ > 80), 16 children (28%) show a discrepancy of 10 quotient points or more between their LCQ and SON-IQ. Out of the 77 children with an inadequate language comprehension (LCQ ≤ 80), 45 children (58%) show a discrepancy of 10 quotient points or more between their LCQ and their SON-IQ.There is a significant difference between the children with an adequate LCQ and an inadequate LCQ with respect to discrepancy with their SON-IQ (p = 0.013). Only in the group of children with an LCQ ≤ 80 the discrepancy is significant (p = 0.000). For the group of children with an LCQ > 80 the discrepancy is not significant (p = 0.084).

Conclusions

The discrepancy hypothesis, in our opinion, must be modified. There is not only verbal and nonverbal functioning but there is language production, language comprehension and nonverbal learning abilities. Between these three aspects discrepancies can be found.In 43% of the children there is a discrepancy between language production and language comprehension. When children also show language comprehension problems, 58% of these children show a discrepancy with nonverbal functioning.     

Clinico-pathological discrepancies in the diagnoses of solid malignancies

Autopsy is a valuable tool in evaluating diagnostic accuracy. Solid malignancies may have a protracted presentation, and diagnosis frequently requires imaging and deep-sited biopsies; clinical and postmortem diagnosis discrepancies may occur in a high rate in these diseases. Here, we analyzed the occurrence of clinico-pathological discrepancies in the diagnoses of solid malignancies in a Brazilian academic hospital. We reviewed charts and autopsy reports of the patients that died from 2001 to 2003 with at least one solid neoplasm. Patients were classified in concordant and discordant cases regarding cancer diagnosis. Discordant cases were categorized in undiagnosed cases (no suspicion of cancer) and in misdiagnosed cases (clinical suspicion of cancer but incompletely diagnosed). Among the 264 patients with a single non-incidental solid neoplasm, the clinico-pathological discrepancy rate was 37.1%. Liver (22.5%), lung (19.4%), and pancreatic cancer (15.3%) were the most frequent malignancies in the discordant group. Misdiagnosis category comprised 68% of the discordant cases, i.e., there was no correct knowledge about the tumor primary site and/or the histological type during life. Our data show that a high rate of discrepancies occurs in solid malignancies. Autopsies may provide the basis for a better understanding of diagnostic deficiencies in different circumstances.     

Diagnostic discrepancy between colposcopy and vaginoscopy: A case report

BACKGROUNDColposcopy currently plays a vital role in the diagnosis and treatment of lower genital diseases. Exposure and biopsy are two key steps in colposcopy. When the whole transformation zone or all lesions cannot be observed, we judge colposcopy as unsatisfactory. Unsatisfactory colposcopic examination may lead to the misdiagnosis of more severe diseases. The combination of colposcopy and vaginoscopy may contribute to accurate diagnosis and clinical decisions.CASE SUMMARYHere, we introduce a case of posthysterectomy deep vaginal apex not fully exposed by colposcopy, and the biopsy result was a vaginal precancerous lesion. We adopted vaginoscopy to extend the observed area and expose the lesion thoroughly, and the biopsy result was vaginal squamous cancer.CONCLUSIONThe patient received a precise diagnosis and early surgery due to the combination of colposcopy and vaginoscopy.     

Physeal injuries of the proximal humerus: long-term results in seventy two patients

Purpose  

The aim of this study was to evaluate our treatment methods of proximal humeral physeal injuries retrospectively and elucidate the relationship between the trauma mechanism, the radiographic injury pattern, the consequent therapy and the functional outcome, and to further deduct and verify prognostic criteria.