Comparison of two-dimensional manual and three-dimensional SurgiCase and BLUEPRINT planning software measurements of glenoid version,inclination, and humeral subluxation

IntroductionVirtual planning for shoulder arthroplasty using preoperative computed tomography (CT) has been gaining popularity, and it is imperative for surgeons to recognize any differences in measurements that may exist amongst software platforms. The purpose of this study is to compare measurements of glenoid version, inclination, and humeral head subluxation between a manual approach and two varying automated software platforms using either a best-fit sphere technique (Wright-Medical BLUEPRINT) or an anatomic landmarks technique (Materalise SurgiCase).MethodsA case control study of 289 CT images from patients preoperatively planned for a total shoulder arthroplasty or reverse shoulder arthroplasty using SurgiCase (v3.0.110.5) were also successfully analyzed by BLUEPRINT (v2.1.6). Glenoid version, inclination, and subluxation were measured manually in a blind fashion by two separate investigators using axial and coronal images oriented to the scapular plane; interobserver and intraobserver reliabilities were measured using intraclass correlation coefficients (ICCs). Concordance correlation coefficients (CCCs), mean differences, and clinically relevant agreement in measurements between the software platforms and with the manual technique were compared. The impact of greater glenoid retroversion on the differences in measurements between the software platforms was further studied by correlation analysis.ResultsThe mean differences between SurgiCase and BLUEPRINT were + 0.5° for glenoid inclination (P = .064; CCC = 0.84), -0.9° for glenoid version (P < .001; CCC = 0.92), and -1.4% for humeral subluxation (P = .002; CCC = 0.88). Agreement within 5 units was 78.9% for inclination, 89.3% for version, and 64.1% for subluxation. Glenoid retroversion had no relation with the degree of variation in measured inclination (P = .59) or version (P = .56). There were significant differences between manual and 3D software measurements for glenoid inclination, version, and subluxation (P < .001). Both software measurements were more inferiorly inclined (average difference, SurgiCase -3.2° and BLUEPRINT -3.9°), more retroverted (average difference, SurgiCase -4.0° and BLUEPRINT -3.2°), and more posteriorly subluxated (average difference, SurgiCase + 3.4% and BLUEPRINT + 4.8%).ConclusionThe SurgiCase and BLUEPRINT preoperative planning software yield clinically similar measurements for glenoid version, inclination, and subluxation. The degree of glenoid retroversion does not impact the variability of inclination or version between the landmark and best-fit sphere software techniques. Compared to the 2D manual technique, both 3D software programs reported greater inferior inclination, retroversion, and posterior subluxation.Level of evidenceLevel III; Retrospective Diagnostic Study     

Management decisions for adolescent idiopathic scoliosis significantly affect patient radiation exposure

Background contextAdolescent idiopathic scoliosis (AIS) patients treated before the 1990s have a 1% to 2% increased lifetime risk of developing breast and thyroid cancer as a result of ionizing radiation from plain radiographs. Although present plain radiographic techniques have been able to reduce some of the radiation exposure, modern treatment algorithms for scoliosis often include computed tomography (CT) and intraoperative fluoroscopy. The exact magnitude of exposure to ionizing radiation in adolescents during modern scoliosis treatment is therefore unclear.PurposeTo determine the difference in radiation exposures in patients undergoing various forms of treatment for AIS.Study designRetrospective cohort.Patient samplePatients aged 9 to 18 years with a diagnosis of AIS, followed and/or treated with nonoperative or operative management for a minimum of 2 years.Outcome measuresNumber of radiographs and total radiation exposure calculated.MethodsThe charts and radiographs of patients managed for AIS at a single institution between September 2007 and January 2012 were reviewed. Patients were divided into three groups: operative group, braced group, and observation group. Patient demographics, Cobb angles, and curve types were recorded. The number of radiographs per year that each patient received and the total radiation dose were recorded. The plain radiographic radiation exposure was then combined with the direct exposure recording from ancillary tests, such as fluoroscopy and CT, and a radiation exposure rate was calculated (mrad/y). A single-factor analysis of variance (α=0.01) with a Tukey honest significant difference post hoc analysis was used to test significance between groups.ResultsTwo hundred sixty-seven patients were evaluated: 86 operative, 80 brace, and 101 observation. All groups had similar demographics and curve type distribution. The mean initial Cobb angle at presentation was significantly different between the groups: operative (57°±11°), brace (24°±7.9°), and observation (18°±9.4°) (p<.01). There was a significant difference among the groups in terms of the mean number of radiographs received per year; operative group, 12.2 (95% confidence interval [CI]: 10.8–13.5; p<.001); braced group, 5.7 (95% CI: 5.2–6.2; p<.001), and observed group, 3.5 (95% CI: 3.160–3.864; p<.001). The operative group received 1,400 mrad per year (95% CI: 1,350–1,844; p<.001), braced group received 700 mrad per year (95% CI: 598–716; p<.001), and observed group received 400 mrad per year (95% CI: 363–444; p<.001). Importantly, 78% of radiation in the operative group was attributable to the operative fluoroscopy exposure.ConclusionsSignificant differences exist in the total radiation exposure in scoliosis patients with different treatment regimens, with operative patients receiving approximately 8 to 14 times more radiation than braced patients or those undergoing observation alone, respectively. Operative patients also receive more than twice the radiation per year than braced or observed patients. Almost 78% of the annual radiation exposure for operative patients occurs intraoperatively. Because children are notably more sensitive to the carcinogenic effects of ionizing radiation, judicious use of present imaging methods and a search for newer imaging methods with limited ionizing radiation should be undertaken.     

Basic presynaptic functions in hippocampal neurons are not affected by acute or chronic lithium treatment

Lithium is an effective mood-stabilizer in the treatment of bipolar affective disorder. While glycogen synthase kinase 3-mediated and inositol depletion-dependent effects of lithium have been described extensively in literature, there is very little knowledge about the consequences of lithium treatment on vesicle recycling and neurotransmitter availability. In the present study we have examined acute and chronic effects of lithium on synaptic vesicle recycling using primary hippocampal neurons. We found that exocytosis of readily releasable pool vesicles as well as recycling pool vesicles was unaffected by acute and chronic treatment within the therapeutic range or at higher lithium concentrations. Consistent with this observation, we also noticed that the network activity and number of active synapses within the network were also not significantly altered after lithium treatment. Taken together, as lithium treatment does not affect synaptic vesicle release at even high concentrations, our data suggest that therapeutic effects of lithium in bipolar affective disorder are not directly related to presynaptic function.     

The effect of various in-vitro and ex-vivo parameters on irrigant flow and apical pressure using manual syringe needle irrigation: Systematic review

BackgroundFluid dynamics is a majorly neglected aspect to be studied in root canal irrigation. The fundamental rule to understand mechanics is to observe patterns of flow during the process. Thus, this work is conducted to do a systemic assessment of the in-vitro and ex-vivo based studies to evaluate the effect of various parameters on the irrigant flow and apical pressure on using a manual syringe needle for root canal irrigation.MethodsThe literature search was conducted through libraries such as PubMed (Medline), CINAHL, Embase, Scopus and other hand literature from Google Scholar, the British medical library etc. The systematic review was reported following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. As they include studies that were in-vitro and ex-vivo based, the risk of bias of the selected articles was assessed using a customized tool based on the previous literature and parameters evaluated in the studies included.ResultsThe literature search resulted in 101 items of which 19 records were included in this review. Results reported that multiple factors and parameters were assessed to evaluate the flow and apical pressures on using manual syringe needle irrigation.ConclusionsPresent systematic review gives insights in-depth about the irrigation dynamics of manual syringe needle irrigation. Besides, it is inconclusive to compile a single factor or a single parameter contributing to the enhanced irrigant flow and least apical pressures.     

HIF inhibitors for ischemic retinopathies and cancers: options beyond anti-VEGF therapies

Aberrant activation of the hypoxia inducible factor (HIF) pathway causing overexpression of angiogenic genes, like vascular endothelial growth factor (VEGF), is one of the underlying causes of ocular neovascularization (NV) and metastatic cancer. Consistently, along with surgical interventions, a number of anti-VEGF agents have been approved by FDA for the treatment of ocular neovascular diseases. These anti-VEGF agents, like ranibizumab/lucentis, have revolutionized the treatment in the past decade. However, substantial vision improvement is observed only in a subset of age-related macular degeneration patients receiving ranibizumab. Further, all current therapies are associated with limitations and side effects. For example, surgeries cause tissue destruction and inflammation while anti-VEGF therapies are expensive, require repeated administration, and offer temporary relief from vascular leakage. These factors impose significant cost and treatment burdens to both the patient and society. With an aging population in most western countries with a continually increasing number of patients on lifelong treatment for these retinal diseases, the focus of ocular drug development for neovascular diseases will be to improve efficacy while reducing treatment costs. Blocking the HIF pathway, a major regulator of ocular NV and cancer, offers an appealing therapeutic strategy. Therefore, this review summarizes HIF inhibitors that have been recently evaluated for the treatment of different cancers and ischemic retinopathies.     

Tranquilizers or anti-depressants for chronic schizophrenics: a long term study.

The relative efficacy of 4 tranquilizers was investigated in 66 chronic schizophrenics who had been hospitalized for 10.01 years (mean). The role of adding an anti-depressant was also studied. Following a 4 week placebo period, high dosage tranquilizers were given for 16 weeks and amitriptyline was added for the following 16 weeks. Statistical analyses of the various change measures revealed that patients worsened significantly on placebo, all 4 tranquilizers were significantly better than placebo for symptom reduction and maximum improvement was attained within 16 weeks of tranquilizer administration. No significant differences in efficacy were observed among the 4 tranquilizers and addition of amitriptyline did not confer any additional therapeutic advantage.