Progression of medial compartmental osteoarthritis 2–8 years after lateral closing-wedge high tibial osteotomy

Purpose

The primary purpose of this study is to investigate the progression of medial osteoarthritis (OA) following lateral closing-wedge high tibial osteotomy (HTO). Secondary outcomes included functional and pain scores.

Methods

This prospective cohort study analysed 298 patients treated with lateral closing-wedge HTO surgery for medial compartmental OA. OA progression was measured by comparing the minimum joint space width (mJSW) and Kellgren–Lawrence (KL) score on radiographs preoperatively and postoperatively. The WOMAC score and NRS score for pain were obtained preoperatively and postoperatively to assess secondary outcomes. Failure was defined as revision surgery; survival was estimated.

Results

Mean follow-up was 5.2 ± 1.8 years (range 2–8.5). Mean preoperative mJSW was 3.4 ± 1.6 mm, which changed nonsignificantly (p = 0.51) to 3.4 ± 1.7 mm postoperatively. Mean annual joint space narrowing was 0.02 ± 0.34 mm/year. Progression to 1 KL grade or more was seen in 132 (44 %) patients, and annual risk of KL progression was 8.6 %. No KL progression was seen in 56 % of patients. Mean NRS decreased from 7.3 ± 1.5 to 3.5 ± 2.5 (p < 0.001). WOMAC scores decreased from 48.0 ± 17.2 to 23.6 ± 19.7 (p < 0.001). Failure was seen in 21 patients.

Conclusion

Compared to demographic data in the literature, valgus high tibial osteotomy seems to reduce the progression of OA, reduces pain and improves knee function in patients with medial compartment OA and a varus alignment.

Level of evidence

III.

     

Comparison of initial and tertiary centre second opinion reads of multiparametric magnetic resonance imaging of the prostate prior to repeat biopsy

Objectives

To investigate the value of second-opinion evaluation of multiparametric prostate magnetic resonance imaging (MRI) by subspecialised uroradiologists at a tertiary centre for the detection of significant cancer in transperineal fusion prostate biopsy.

Methods

Evaluation of prospectively acquired initial and second-opinion radiology reports of 158 patients who underwent MRI at regional hospitals prior to transperineal MR/untrasound fusion biopsy at a tertiary referral centre over a 3-year period. Gleason score (GS) 7-10 cancer, positive predictive value (PPV) and negative (NPV) predictive value (±95 % confidence intervals) were calculated and compared by Fisher’s exact test.

Results

Disagreement between initial and tertiary centre second-opinion reports was observed in 54 % of cases (86/158). MRIs had a higher NPV for GS 7-10 in tertiary centre reads compared to initial reports (0.89 ± 0.08 vs 0.72 ± 0.16; p = 0.04), and a higher PPV in the target area for all cancer (0.61 ± 0.12 vs 0.28 ± 0.10; p = 0.01) and GS 7-10 cancer (0.43 ± 0.12 vs 0.2 3 ± 0.09; p = 0.02). For equivocal suspicion, the PPV for GS 7-10 was 0.12 ± 0.11 for tertiary centre and 0.11 ± 0.09 for initial reads; p = 1.00.

Conclusions

Second readings of prostate MRI by subspecialised uroradiologists at a tertiary centre significantly improved both NPV and PPV. Reporter experience may help to reduce overcalling and avoid overtargeting of lesions.

Key Points

? Multiparametric MRIs were more often called negative in subspecialist reads (41 % vs 20 %).? Second readings of prostate mpMRIs by subspecialist uroradiologists significantly improved NPV and PPV.? Reporter experience may reduce overcalling and avoid overtargeting of lesions.? Greater education and training of radiologists in prostate MRI interpretation is advised.

     

The orientation of the surgical epicondylar axis varies in varus and non-varus knees in the coronal plane

Purpose

To investigate the orientations of the surgical epicondylar axis (SEA) of varus and non-varus knees in the coronal plane.

Methods

One-hundred and sixty-two knees from 81 Chinese patients undergoing total knee arthroplasty (TKA) were retrospectively investigated. The angle between the medial side of the femoral mechanical axis and the SEA (MA-SEA), as well as the physiological valgus angle, was measured in the coronal plane using three-dimensional reconstruction. The joint line angle (JLA) and hip-knee-ankle angle (HKAA) were measured in long-leg weight-bearing radiographs. The mean of each parameter was compared between the varus (HKAA < 177.0°) and the non-varus knees (HKAA ≥ 177.0°) using an independent t test. Linear regression was used to assess the correlation between MA-SEA with JLA and HKAA.

Results

A total of 42 non-varus knees (6 valgus and 36 neutral knees) and 98 varus knees were measured, as 22 knees were abandoned due to unrecognizable bony landmarks. The mean MA-SEA and JLA were significantly larger in non-varus knees (both, p < 0.01). The mean physiological valgus angle was 5.9 ± 1.0° for Chinese TKA patients and was significantly larger in varus knees (p < 0.01). There was a strong positive correlation between the MA-SEA and JLA (R ² = 0.35, p < 0.05).

Conclusions

There were significant differences in the orientation of the SEA between varus and non-varus knees, which was strongly correlated with the orientation of the femoral joint line. These findings will enhance the current knowledge of knee anatomy and should prove useful for coronal alignment in TKA.

Level of evidence

III.

     

Early quantitative CT perfusion parameters variation for prediction of delayed cerebral ischemia following aneurysmal subarachnoid hemorrhage

Objectives

To prospectively evaluate the predictive value of cerebral perfusion–computerized tomography (CTP) parameters variation between day0 and day4 after aneurysmal subarachnoid haemorrhage (aSAH).

Methods

Mean transit time (MTT) and cerebral blood flow (CBF) values were compared between patients with delayed cerebral ischemia (DCI+ group) and patients without DCI (DCI- group) for previously published optimal cutoff values and for variations of MTT (ΔMTT) and of CBF (ΔCBF) values between day0 and day4. DCI+ was defined as a cerebral infarction on 3-months follow-up MRI.

Results

Among 47 included patients, 10 suffered DCI+. Published optimal cutoff values did not predict DCI, either at day0 or at day4. Conversely, ΔMTT and ΔCBF significantly differed between the DCI+ and DCI- groups, with optimal ΔMTT and ΔCBF values of 0.91 seconds (83.9 % sensitivity, 79.5 % specificity, AUC 0.84) and -7.6 mL/100 g/min (100 % sensitivity, 71.4 % specificity, AUC 0.86), respectively. In multivariate analysis, ΔCBF (OR?=?1.91, IC95% 1.13–3.23 per each 20 % decrease of ΔCBF) and ΔMTT values (OR?=?14.70, IC95% 4.85–44.52 per each 20 % increase of ΔMTT) were independent predictors of DCI.

Conclusions

Assessment of MTT and CBF value variations between day0 and day4 may serve as an early imaging surrogate for prediction of DCI in aSAH.

Key points

? CT perfusion values are an imaging surrogate for prediction of DCI.? Early variations (day0–day4) after aneurysmal subarachnoid haemorrhage predicted DCI.? A CBF decrease of 7.6 mL/min/100 g predicted DCI with 100?% sensitivity.? An MTT increase of 0.91 seconds predicted DCI with 83.9?% sensitivity.? DCI risk multiplied by 2 per 20?% ΔCBF decrease and by 15 per 20?% ΔMTT increase.

     

Factors Associated with Advanced Inferior Vena Cava Filter Removals: A Single-Center Retrospective Study of 203 Patients Over 7 Years

Purpose

To identify factors associated with advanced inferior vena cava filter (IVCF) retrieval to raise awareness on technical considerations, retrieval efficiency, and patient safety.

Materials and Methods

A single-center retrospective review was performed of 203 consecutive retrievable IVC filters placed between 2007 and 2014. Attempted retrievals were classified as advanced if the routine “snare and sheath” technique was initially unsuccessful after multiple attempts, or an alternate endovascular maneuver or access site was utilized. Patient and filter characteristics were recorded.

Results

203 attempted retrievals were reviewed (48.7 % male, 51.2 % female, mean age 52.7 years, mean dwell time 109 days). Advanced retrievals were observed in 20 patients (9.8 %) (15 females, 5 males). Fluoroscopy time (p ≤ 0.01, 34.3 ± 21.1 and 5.3 ± 4.5 min for advanced retrievals and routine retrievals respectively, same below), gender (p = 0.031), and retrieval tilt angle (p ≤ 0.01, 5.7 ± 5.10° vs. 11.9 ± 11.03°) were associated with advanced retrievals. Females were 3.16 times more likely to have an advanced retrieval performed than males with a significantly higher tilt angle in those with advanced retrieval. History of cancer (p = 0.502), dwell time (p = 0.916), retrieval caval diameter (p = 0.053), placement caval diameter (p = 0.365), filter type (p = 0.710), strut perforation (p = 0.506), placement tilt angle (p = 0.311), and age (p = 0.558) were not found significantly associated with advanced retrievals.

Conclusions

Women are at increased risk for advanced filter retrieval secondary to a significant change in filter tilt over time compared to men, independent of filter type or competing demographic or filter risks, likely placing them at increased risk for higher procedural fluoroscopy times.

     

Optimal load for the muscle power profile of prone bench pull in Brazilian Jiu-Jitsu athletes

Background

No studies were observed optimal intensity loads for the muscle power performance during prone bench pull exercise in Brazilian Jiu-Jitsu athletes (BJJ) and this exercise is more similar with grip technics.

Purpose

To identify the optimal intensity for the muscle power performance variables during PBP exercise in BJJ athletes.

Methods

Fifteen athletes (25.5 ± 4.9 years; 65.6 ± 12.2 kg; 177.5 ± 4.7 cm) performed PBP at 30, 40, 50 and 60% of one repetition maximum (1RM) in a random order. The mean power (MP), mean velocity (MV), mean propulsive power (MPP) and mean propulsive velocity (MPV) were determined by measuring the barbell displacement by a linear encoder.

Results

In all power performance variables, higher power output was observed at 40 and 50% 1RM when compared to 30 and 60% 1RM (MP: F = 29.07; p < 0.001; MV: F = 40.80; p < 0.001; MPP: F = 53.69; p = 0.003; MPV: F = 166.2; p > 0.001). Additionally, it was observed higher MPP at 50% 1RM when compared to 40% 1RM (F = 55.23; p < 0.001). The polynomial adjustment indicated that the optimal intensity load for producing highest power performance ranged from 45 to 50% 1RM (R ² = 0.938–0.989) across all variables.

Conclusion

The loads between 45 and 50% 1RM produced the optimal muscle power performance during PBP exercise in BJJ athletes.

     

Relationship between stature level and success in elite judo: an analysis on four consecutive Olympic Games

Purpose

The rationale of our study derived from the important changes in judo rules, with particular consideration of the leg grabs. Therefore, the present study aimed at demonstrating the relationships between stature and successful matches in elite judo, in relation to both genders and seven weight categories.

Methods

Stature levels and final ranking position of each participant were recorded on the base of the year of Olympic Game (Athens 2004, Beijing 2008, London 2012, Rio 2016), gender, and weight class. A one-way ANCOVA was applied to determinate possible differences (p ≤ 0.05) among judoka’s statures related to each Olympic Game.

Results

Results showed that no difference has been reported for stature level of each judo Olympic Game in all and only male judoka. On the contrary, for female, difference (p = 0.007) on judoka’s stature levels among ranking positions generally emerged, reporting increases in stature levels between the first and the fifth (from 163.62 ± 7.95 to 167.90 ± 8.88 cm; p = 0.004), and the seventh (from 163.62 ± 7.95 to 168.26 ± 8.53 cm; p = 0.016) ranking position.

Conclusion

Considering that no relationship between stature and successful matches in elite judo emerged in the analyzed four Olympics Games, it can speculate that no advantage can be attributed to the taller judoka’s for the rule changes regarding the leg grabs.

     

CTA/V detection of bilateral sigmoid sinus dehiscence and suspected idiopathic intracranial hypertension in unilateral pulsatile tinnitus

Purpose

This aimed to evaluate the prevalence and extent of bilateral sigmoid sinus dehiscence (SSD) and to explore the presence of idiopathic intracranial hypertension (IIH) in patients with unilateral pulsatile tinnitus (PT) with CTA/V.

Methods

Sixty PT patients (52 females; 40.4 ±?11.6 years [20–72]) who underwent CTA/V and 30 non-PT patients (27 females; 38.4 ±?14.7 years [12–62]) were enrolled in this study. The primary outcome measure was the radiographic presence of SSD. The index of transverse sinus stenosis (ITSS) was obtained by multiplying the stenosis scale values for each transverse sinus, and once was ≥?4, the presence of IIH was suspected.

Results

The prevalence and extent of SSD on symptomatic side (78%; maximum transverse diameter, MTD 0.49?±?0.23; maximum vertical diameter, MVD 0.50?±?0.26 cm) were significantly higher and larger than those on asymptomatic side (50%, P?<?0.001; MTD 0.35?±?0.18, P?= 0.006; MVD 0.30?±?0.15 cm, P?<?0.001) in the study group and those (20%, P?<?0.001; MTD 0.36?±?0.18, P?= 0.073; MVD 0.30?±?0.22 cm, P?<?0.048) in the control group. The presence of SSD showed significant correlation with both PT (logistic regression analysis, OR 4.167 [1.450–11.97]; P?=?0.008) and suspected IIH (OR 16.25 [1.893–139.5]; P?=?0.011).

Conclusion

In PT patients, SSD has a significant correlation with PT and a potential correlation with IIH.

     

Relationship between tibial spine size and the occurrence of osteochondritis dissecans: an argument in favour of the impingement theory

Purpose

Pathophysiology of osteochondritis dissecans (OCD) of the medial femoral condyle remains uncertain. Specifically, the relationship between the size of the anterior tibial spine (ATS) and the presence of OCD has not been explored. The purpose of this study was to evaluate the relationship between ATS size and the occurrence of OCD.

Methods

Seventy-nine children between 8 and 17 years of age were included in two groups: OCD (n = 37) and control (n = 42). The groups were matched in terms of age, gender, BMI and weight. Two independent observers performed an MRI analysis of the size of the tibial spine and intercondylar notch relative to the size of the respective epiphyses. For this study, the “S ratio” was calculated by dividing the height of the tibial spine by the height of the tibial epiphysis. The “N ratio” was calculated by dividing the height of the notch by the height of the femoral epiphysis. These two ratios for both groups were compared using Student’s t test.

Results

The mean value of the S ratio in the OCD group was 0.39 ± 0.06; the mean value of the S ratio in the control group was 0.32 ± 0.03 (P = 0.004). The mean value of the N ratio in the OCD group was 0.70 ± 0.08; the mean value of the N ratio in the control group was 0.70 ± 0.07 (n.s.).

Conclusion

This study’s findings confirm our hypothesis that patients with OCD have a more prominent tibial spine than in patients without OCD.

Level of evidence

IV.

     

Research of predictive factors for cardiac resynchronization therapy: a prospective study comparing data from phase-analysis of gated myocardial perfusion single-photon computed tomography and echocardiography

Background

Cardiac resynchronization therapy (CRT) reduces morbidity and mortality in chronic systolic heart failure. About 20% of implanted patients are considered as “non-responders”. This study aimed to evaluate gated myocardial perfusion single-photon emission computed tomography (GMPS) phase parameters as compared to echocardiography in the assessment of predictors for response to CRT before and after CRT activation.

Methods

Forty-two patients were prospectively included during 15 months. A single injection of ^99mTc-tetrofosmin was used to acquire GMPS phase pre- and post-CRT activation. Indicators of positive CRT response were improvement of functional status and 15% reduction in left ventricular end-systolic volume at 3 months.

Results

Phase parameters at baseline were similar in the two groups with no influence of perfusion data. Phase parameters after CRT activation were significantly improved in the responders’ group (Δ Bandwidth ?19°?±?24° vs. 13°?±?31°, p?=?0.001; Δ SD ?20°?±?30° vs. 26°?±?46°, p?=?0.001; Δ Entropy ?11?±?12 vs. 2?±?6%, p?=?0.001). Feasibility and reproducibility were higher for GMPS.

Conclusion

Acute phase modifications after CRT activation may predict response to CRT immediately after implantation, but not at baseline, even when adjusted to perfusion data.

     

Radiation dose reduction in paediatric coronary computed tomography: assessment of effective dose and image quality

Objectives

To assess the impact of different protocols on radiation dose and image quality for paediatric coronary computed tomography (cCT).

Materials and methods

From January-2012 to June-2014, 140 children who underwent cCT on a 64-slice scanner were included. Two consecutive changes in imaging protocols were performed: 1) the use of adaptive statistical iterative reconstruction (ASIR); 2) the optimization of acquisition parameters. Effective dose (ED) was calculated by conversion of the dose-length product. Image quality was assessed as excellent, good or with significant artefacts.

Results

Patients were divided in three age groups: 0–4, 5–7 and 8–18 years. The use of ASIR combined to the adjustment of scan settings allowed a reduction in the median ED of 58 %, 82 % and 85 % in 0–4, 5–7 and 8–18 years group, respectively (7.3?±?1.4 vs 3.1?±?0.7 mSv, 5.5?±?1.6 vs 1?±?1.9 mSv and 5.3?±?5.0 vs 0.8?±?2.0 mSv, all p?<?0,05). Prospective protocol was used in 51 % of children. The reduction in radiation dose was not associated with reduction in diagnostic image quality as assessed by the frequency of coronary segments with excellent or good image quality (88 %).

Conclusions

cCT can be obtained at very low radiation doses in children using ASIR, and prospective acquisition with optimized imaging parameters.

Key points

? Using ASIR allows 25?% to 41?% reduction in the ED.? Prospective protocol is used up to 51?% of children after premedication.? Low dose is possible using ASIR and optimized prospective paediatric cCT

     

Prospective 1-year follow-up pilot study of CT-guided microwave ablation in the treatment of bone and soft-tissue malignant tumours

Purpose

The aims of this work were to assess the feasibility, efficacy, short-term outcome and safety of microwave ablation (MWA) in the treatment of malignant musculoskeletal tumours.

Materials and methods

Sixteen bone and soft-tissue malignant tumours were prospectively included and were treated by CT-guided MWA. The percentage and size of necrosis of the lesions were measured by contrast-enhanced MRI before the procedure and after 1, 3, 6 and 12 months. mRECIST criteria were used to assess tumour response. Procedural success was defined as ≥80 % necrosis. Patient pain (as assessed using a numeric visual scale (NVS)) and side effects were noted.

Results

Six osteolytic metastases, five osteoblastic metastases and five soft tissue sarcomas were treated. At 1 month, 40 % were treated completely, the percentage of necrosis was 85?±?30.4 %, and the success rate was 80 %. At 3, 6 and 12 months the success rate was 80 %, 76.9 % and 63.6 %, respectively. At 12 months, four lesions (36.3 %) still had no recurrence. Mean NVS during the procedure was 3.5?±?2.8. One patient had transitory sciatica without neurological deficit that was treated medically.

Conclusion

CT-guided MWA of bone and soft-tissue malignant tumours is efficient, well tolerated and has good short-term anti-cancer effects.

Key Points

? CT-guided MWA is efficient in treating musculoskeletal malignant tumours. ? This prospective pilot study showed MWA induces high percentages of tumour necrosis. ? MWA has good short-term anti-cancer effects. ? MWA has healing potential when lesions can be completely necrosed. ? CT-guided MWA under equimolar mixture of oxygen-nitrous oxide inhalation is well tolerated.

     

Native myocardial T1 mapping in pulmonary hypertension: correlations with cardiac function and hemodynamics

Objectives

To analyze alterations in left ventricular (LV) myocardial T1 times in patients with pulmonary hypertension (PH) and to investigate their associations with ventricular function, mass, geometry and hemodynamics.

Methods

Fifty-eight patients with suspected PH underwent right heart catheterization (RHC) and 3T cardiac magnetic resonance imaging. Ventricular function, geometry and mass were derived from cine real-time short-axis images. Myocardial T1 maps were acquired by a prototype modified Look-Locker inversion-recovery sequence in short-axis orientations. LV global, segmental and ventricular insertion point (VIP) T1 times were evaluated manually and corrected for blood T1.

Results

Septal, lateral, global and VIP T1 times were significantly higher in PH than in non-PH subjects (septal, 1249?±?58 ms vs. 1186?±?33 ms, p?<?0.0001; lateral, 1190?±?45 ms vs. 1150?±?33 ms, p?=?0.0003; global, 1220?±?52 ms vs. 1171?±?29 ms, p?<?0.0001; VIP, 1298?±?78 ms vs. 1193?±?31 ms, p?<?0.0001). In PH, LV eccentricity index was the strongest linear predictor of VIP T1 (r?=?0.72). Septal, lateral and global T1 showed strong correlations with VIP T1 (r?=?0.81, r?=?0.59 and r?=?0.75, respectively).

Conclusions

In patients with PH, T1 times in VIPs and in the entire LV myocardium are elevated. LV eccentricity strongly correlates with VIP T1 time, which in turn is strongly associated with T1 time changes in the entire LV myocardium.

Key Points

? Native T1 mapping detects left ventricular myocardial alterations in pulmonary hypertension ? In pulmonary hypertension, native T1 times at ventricular insertion points are increased ? These T1 times correlate strongly with left ventricular eccentricity ? In pulmonary hypertension, global and segmental myocardial T1 times are increased ? Global, segmental and ventricular insertion point T1 times are strongly correlated

     

Restoring tibiofemoral alignment during ACL reconstruction results in better knee biomechanics

Purpose

Anterior cruciate ligament (ACL) reconstruction (ACLR) aims to restore normal knee joint function, stability and biomechanics and in the long term avoid joint degeneration. The purpose of this study is to present the anatomic single bundle (SB) ACLR that emphasizes intraoperative correction of tibiofemoral subluxation that occurs after ACL injury. It was hypothesized that this technique leads to optimal outcomes and better restoration of pathological tibiofemoral joint movement that results from ACL deficiency (ACLD).

Methods

Thirteen men with unilateral ACLD were prospectively evaluated before and at a mean follow-up of 14.9 (SD?=?1.8) months after anatomic SB ACLR with bone patellar tendon bone autograft. The anatomic ACLR replicated the native ACL attachment site anatomy and graft orientation. Emphasis was placed on intraoperative correction of tibiofemoral subluxation by reducing anterior tibial translation (ATT) and internal tibial rotation. Function was measured with IKDC, Lysholm and the Tegner activity scale, ATT was measured with the KT-1000 arthrometer and tibial rotation (TR) kinematics were measured with 3Dmotion analysis during a high-demand pivoting task.

Results

The results showed significantly higher TR of the ACL-deficient knee when compared to the intact knee prior to surgery (12.2° ± 3.7° and 10.7° ± 2.6° respectively, P?=?0.014). Postoperatively, the ACLR knee showed significantly lower TR as compared to the ACL-deficient knee (9.6°±3.1°, P?=?0.001) but no difference as compared to the control knee (n.s.). All functional scores were significantly improved and ATT was restored within normal values (P?<?0.001).

Conclusions

Intraoperative correction of tibiofemoral subluxation that results after ACL injury is an important step during anatomic SB ACLR. The intraoperative correction of tibiofemoral subluxation along with the replication of native ACL anatomy results in restoration of rotational kinematics of ACLD patients to normal levels that are comparable to the control knee. These results indicate that the reestablishment of tibiofemoral alignment during ACLR may be an important step that facilitates normal knee kinematics postoperatively.

Level of evidence

Level II, prospective cohort study.

     

Relationship of myocardial substrate characteristics as assessed by myocardial perfusion imaging and cardiac reverse remodeling levels after cardiac resynchronization therapy

Background

Cardiac resynchronization therapy (CRT) can provide cardiac reverse remodeling (RR), which may include mechanical reverse remodeling (MRR) and/or electrical reverse remodeling (ERR). However, uncoupling of MRR and ERR is not uncommon, and the underlying mechanisms are not clear. This study aimed to evaluate the relationship of myocardial substrate characteristics as assessed by myocardial perfusion imaging (MPI) and cardiac RR post-CRT.

Materials and methods

Forty-one patients (26 men, mean age 66 ± 10 years) with heart failure received CRT for at least 12 months were assigned to three groups according to their levels of RR: I, MRR + ERR (ESV reduced ≥15 % and intrinsic QRS duration reduced ≥10 ms); II, MRR only (ESV reduced ≥15 %); and III, non-responder (the others). All the patients also underwent MPI under transient CRT-off to evaluate the intrinsic myocardial substrates, including myocardial scar, LV volumes and function, systolic dyssynchrony, and activation sequences. In addition, ventricular tachycardia (VT) and ventricular fibrillation (VF) detected by the CRT devices during follow-up periods were also recorded.

Results

Quantitative analysis of MPI showed that there were significant differences for scar burden [15.9 ± 9.5, 26.8 ± 16.1, and 45.6 ± 15.1 % for group I (n = 15), II (n = 16), and III (n = 10), respectively, p < 0.001], EDV (136.6 ± 64.9, 221.6 ± 123.9, and 351.8 ± 216.3 ml, p = 0.002), ESV (82.6 ± 59.8, 172.3 ± 117.2, and 293.3 ± 209.6 ml, p = 0.001), LVEF (44.9 ± 15.0, 25.6 ± 10.9, and 21.5 ± 11.7 %, p < 0.001), systolic phase SD (23.4° ± 10.3°, 36.0° ± 16.2°, and 57.0° ± 22.2°, p < 0.001), and bandwidth (72.5° ± 31.1°, 113.4° ± 56.4°, and 199.1° ± 90.1°, p < 0.001). Myocardial scar interfered with the normal propagation of mechanical activation, resulting in heterogeneous activation sequences. Compared with group II (MRR only), group I (ERR + MRR) had significantly less initial activation segments (1.9 ± 1.0 vs. 2.6 ± 0.7, p < 0.05) and shorter maximal contraction delay (46.9° ± 12.9° vs. 58.8° ± 18.5°, p < 0.05). During the periods of follow-up, 21 patients developed VT/VF, including only 1 patient (1 VT) in group I (6.7 %), 8 patients (7 VT and 1 VF) in group II (50 %), and 9 patients (7 VT and 5 VF) in group III (90 %).

Conclusion

The characteristics of myocardial substrates as assessed by MPI differed significantly between different levels of cardiac RR post-CRT. Myocardial scar played an important role in the development of ERR. Different cardiac RR levels contributed to different incidences of ventricular arrhythmia, and the combination of ERR and MRR provided highest anti-arrhythmic effects.

     

Feasibility of test-bolus DCE-MRI using CAIPIRINHA-VIBE for the evaluation of pancreatic malignancies

Objectives

To evaluate the feasibility of test-bolus dynamic contrast-enhanced (DCE) MRI with CAIPIRINHA-VIBE for pancreatic malignancies.

Methods

Thirty-two patients underwent DCE-MRI with CAIPIRINHA-VIBE after injection of 2 mL gadolinium. From the resulting time–intensity curve (TIC), we estimated the arterial (AP) and portal venous phase (PVP) scan timing for subsequent multiphasic MRI. DCE-MRI perfusion maps were generated, and perfusion parameters were calculated. The image quality was rated on a 5-point scale (1: poor, 5: excellent). Goodness-of-fit of the TIC was evaluated by Pearson’s χ² test.

Results

Test-bolus DCE-MRIs with high temporal (3 s) and spatial resolution (1?×?1?×?4 mm³) were acquired with good-quality perfusion maps of Ktrans and iAUC (mean score 4.313?±?0.535 and 4.125?±?0.554, respectively). The mean χ² values for fitted TICs were 0.115?±?0.082 for the pancreatic parenchyma and 0.784?±?0.074 for pancreatic malignancies, indicating an acceptable goodness-of-fit. Test-bolus DCE-MRI was highly accurate in estimating the proper timing of AP (90.6 %) and PVP (100 %) of subsequent multiphasic MRI. Between pancreatic adenocarcinomas and neuroendocrine tumours, there were significant differences in the Ktrans (0.073?±?0.058 vs. 0.308?±?0.062, respectively; p?=?0.007) and iAUC (1.501?±?0.828 vs. 3.378?±?0.378, respectively; p?=?0.045).

Conclusions

Test-bolus DCE-MRI using CAIPIRINHA-VIBE is feasible for incorporating perfusion analysis of pancreatic tumours into routine multiphasic MRI.

Key Points

? Test-bolus DCE-MRI using CAIPIRINHA-VIBE is feasible for perfusion analysis of pancreatic tumours. ? CAIPIRINHA-VIBE enables DCE-MRI with high temporal and spatial resolution. ? Test-bolus DCE-MRI is highly accurate in estimating the proper timing of multiphasic MRI.

     

Role of computer-assisted surgery in osteotomies around the knee

Purpose

The goal of this article is to present our experience on navigation for osteotomies around the knee and especially osteotomies for coronal deformities. The first computer-assisted osteotomy was performed in March 2001 and since that time more than 1000 osteotomies have been performed in our department.

Methods

All the osteotomies were performed with the Orthopilot^® device (B-Braun-Aesculap, Tuttlingen, Germany). The main indication was for genu varum deformities but several cases were operated for genu valgum. The surgical procedure as well as the indications and the rationale for each osteotomy (high tibial osteotomy—HTO, double-level osteotomy—DLO, femoral osteotomy—FO) are addressed in the article.

Results

The results are focused on several papers published by the authors since more than 10 years. Regarding HTO for genu varum, the preoperative goal (HKA angle: 184° ± 2°) was reached in 96 % of cases and the difference was statistically significant compared to the non-navigated series (71 %: p < 0.05). Regarding DLO for genu varum, the preoperative goal was reached in 92.7 % for the HKA angle and in 88.1 % for the medial proximal tibial mechanical angle (MPTMA). Regarding genu valgum deformity, the preoperative goal was achieved in 86.2 % of cases for the HKA angle and 100 % of cases for the MPTMA.

Conclusion

According to these results, one can say that, regardless the type of osteotomy, the procedure is reliable, reproducible and accurate. Since 15 years, all the osteotomies around the knee are navigated in our department. Provided that one uses a reproducible radiograph protocol, navigation allows to perform double-level osteotomies, both for genu varum and genu valgum, with optimal accuracy in order to avoid oblique joint line, which will be difficult to revise to TKA.

Level of evidence

IV.

     

Eight weeks of <Emphasis Type="Italic">Capoeira</Emphasis> progressive training program increases flexibility of beginners

Background

No study has investigated the alterations in the flexibility of beginners using an experimental protocol with basic techniques of Capoeira.

Purpose

To analyze the effects of 8 weeks of Capoeira progressive training program on the flexibility of beginners.

Methods

Twenty-one individuals divided in two groups (Capoeira: n = 13; 26.1 ± 7.2 years; 22.7 ± 2.7 kg m^2(?1) and control: n = 08; 27.1 ± 0.5 years; 24.3 ± 3.3 kg m^2(?1)) participated in the study. The Capoeira group performed 8 weeks of Capoeira progressive training program (two sessions per week lasting 60 min each). The experimental protocol used was exclusively based on the basic techniques of a programmed Capoeira training system. Before and after the intervention, measurements were performed aiming to analyze (1) trunk flexion flexibility through a sit-and-reach test using a Wells’ Bench (WB_tf), (2) passive tension (PT_hf), and (3) maximum amplitude of hip flexion (MA_hf) through goniometry.

Results

A two-way ANOVA revealed a main effect of group by time interaction to PT_hf (F = 11.797; P = 0.003; η _p ²  = 0.383) and MA_hf (F = 9.650; P = 0.006; η _p ²  = 0.337). No significant main effect of group by time interaction occurred to WB_tf (F = 3.320; P = 0.084; η _p ²  = 0.149). The relative changes (? %) before and after the intervention in both groups showed that the Capoeira group significantly differed to the control group in the PT_hf (Capoeira: 46.2 ± 29.9 % vs. control: 5.7 ± 27.6 %; P = 0.003) and MA_hf (Capoeira: 22.4 ± 24.5 % vs. control: ?6.1 ± 13.1 %; P = 0.006).

Conclusion

Eight weeks of Capoeira progressive training program resulted in a significant improvement in angular flexibility for beginners.

     

Early weight bearing versus delayed weight bearing in medial opening wedge high tibial osteotomy: a randomized controlled trial

Purpose

The need for a period of non-weight bearing after medial opening wedge high tibial osteotomy remains controversial. It is hypothesized that immediate weight bearing after medial opening wedge high tibial osteotomy would have no difference in functional scores at one year compared to delayed weight bearing.

Methods

Fifty patients, median age 54 years (range 40–65), with medial compartment osteoarthritis, underwent a medial opening wedge high tibial osteotomy utilizing a locking plate without bone grafting. Patients were randomized into an Immediate or a Delayed (2 months) weight bearing group. All patients were assessed at one-year follow-up and the two groups compared. The primary outcome measure was the IKS score. Secondary outcome measures included the IKDC score, the VAS pain score and rate of complications.

Results

The functional scores significantly improved in both groups. The IKS score increased from 142 ± 31 to 171 ± 26 in the Immediate group (p < 0.001) and from 148 ± 22 to 178 ± 23 in the Delayed group (p < 0.001). The IKDC score increased from 49 ± 17 pre-operatively to 68 ± 14 one-year post-operatively in the Immediate group (p < 0.0001) and from 44 ± 16 to 69 ± 19 in the Delayed group (p < 0.001). The average VAS for pain 2 months after surgery was 3 ± 3 in the Immediate group and 3 ± 2 in the Delayed (n.s.). There was no significant difference between the two groups in any of the outcome measures. The mean mechanical femorotibial angle changed from 6° of varus (0°–15° of varus, SD = 3°) to 4° of valgus (5°–11° of valgus, SD = 3°) in the Immediate group and from 5° of varus (0°–10° of varus, SD = 3°) to 3° of valgus (2° of varus to 8° of valgus, SD = 3°) in the Delayed group. No difference was seen between groups, and no loss of correction was observed in any patient. Two cases of non-union occurred, one in each group. One infection and one deep vein thrombosis occurred in the Immediate group.

Conclusion

Immediate weight bearing after medial opening wedge high tibial osteotomy had no effect on functional scores at 1 year follow-up and did not significantly increase the complication rate. Immediate weight bearing after medial opening wedge high tibial osteotomy appears to be safe and can allow some patients a quicker return to activities of daily living and a decreased convalescence period.

Level of evidence

II.