Cartilage compositional MRI-a narrative review of technical development and clinical applications over the past three decades.

Articular cartilage damage and degeneration are among hallmark manifestations of joint injuries and arthritis, classically osteoarthritis. Cartilage compositional MRI (Cart-C MRI), a quantitative technique, which aims to detect early-stage cartilage matrix changes that precede macroscopic alterations, began development in the 1990s. However, despite the significant advancements over the past three decades, Cart-C MRI remains predominantly a research tool, hindered by various technical and clinical hurdles. This paper will review the technical evolution of Cart-C MRI, delve into its clinical applications, and conclude by identifying the existing gaps and challenges that need to be addressed to enable even broader clinical application of Cart-C MRI

Subsequent Surgery After Revision Anterior Cruciate Ligament Reconstruction: Rates and Risk Factors From a Multicenter Cohort

BACKGROUND: While revision anterior cruciate ligament reconstruction (ACLR) can be performed to restore knee stability and improve patient activity levels, outcomes after this surgery are reported to be inferior to those after primary ACLR. Further reoperations after revision ACLR can have an even more profound effect on patient satisfaction and outcomes. However, there is a current lack of information regarding the rate and risk factors for subsequent surgery after revision ACLR. PURPOSE: To report the rate of reoperations, procedures performed, and risk factors for a reoperation 2 years after revision ACLR. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 1205 patients who underwent revision ACLR were enrolled in the Multicenter ACL Revision Study (MARS) between 2006 and 2011, composing the prospective cohort. Two-year questionnaire follow-up was obtained for 989 patients (82%), while telephone follow-up was obtained for 1112 patients (92%). If a patient reported having undergone subsequent surgery, operative reports detailing the subsequent procedure(s) were obtained and categorized. Multivariate regression analysis was performed to determine independent risk factors for a reoperation. RESULTS: Of the 1112 patients included in the analysis, 122 patients (11%) underwent a total of 172 subsequent procedures on the ipsilateral knee at 2-year follow-up. Of the reoperations, 27% were meniscal procedures (69% meniscectomy, 26% repair), 19% were subsequent revision ACLR, 17% were cartilage procedures (61% chondroplasty, 17% microfracture, 13% mosaicplasty), 11% were hardware removal, and 9% were procedures for arthrofibrosis. Multivariate analysis revealed that patients aged <20 years had twice the odds of patients aged 20 to 29 years to undergo a reoperation. The use of an allograft at the time of revision ACLR (odds ratio [OR], 1.79; P = .007) was a significant predictor for reoperations at 2 years, while staged revision (bone grafting of tunnels before revision ACLR) (OR, 1.93; P = .052) did not reach significance. Patients with grade 4 cartilage damage seen during revision ACLR were 78% less likely to undergo subsequent operations within 2 years. Sex, body mass index, smoking history, Marx activity score, technique for femoral tunnel placement, and meniscal tearing or meniscal treatment at the time of revision ACLR showed no significant effect on the reoperation rate. CONCLUSION: There was a significant reoperation rate after revision ACLR at 2 years (11%), with meniscal procedures most commonly involved. Independent risk factors for subsequent surgery on the ipsilateral knee included age <20 years and the use of allograft tissue at the time of revision ACLR

Diagnosis, prognosis and prevention of severe pneumococcal disease

Streptococcus pneumoniae also known as pneumococcus is a major contributor to the disease burden in the world. Infections caused by this bacterium include a wide spectrum of different disease types, from non-severe upper respiratory tract infections to invasive disease forms like bacteremic pneumococcal pneumonia or meningitis, conditions attributed with a high rate of severe disease and mortality. An important feature of this bacterium is that it only causes disease under certain circumstances, and the most common outcome upon contact with this bacterium is transient nasopharyngeal colonization rather than disease from it. Some patient groups such as young children and older people are however at a substantially increased risk of severe disease from the pneumococcus. The aim of this thesis is to increase the understanding of factors of importance to severe pneumococcal disease. The first paper addresses the difficulties in obtaining an etiological diagnosis in pneumonias, which potentially would delay an optimal care and treatment of these patients. We were able to demonstrate that our RQ-PCR method targeting specific gene sequences within the bacteria S. pneumoniae, H. influenzae and M. catarrhalis, increased the diagnostic yield from sputum samples significantly and also that this method seemed especially valuable in finding the causative bacterium when the patient had received antibiotics prior to specimen sampling. The second paper addresses the issue of how to identify patients that are at special risk for a severe outcome from pneumococcal pneumonia. We investigated this by analysing the ability of three different severity score systems, initially developed for the assessment of severity in all cause community acquired pneumonia, to predict mortality and need of ICU admission in bacteraemic pneumococcal pneumonia. We concluded that these severity scores worked fairly well also in this subgroup of patients, but also identified the CURB-65 as the best score system since it was the most practical to use. The third paper addresses whether specific pneumococcal properties are able to influence the severity and outcome of invasive pneumococcal disease (IPD). We investigated the relationship between clonal affiliation / serotypes of pneumococci and patient characteristics and outcome of IPD. We concluded that some clones and serotypes seem more prone to cause severe disease among older patients burdened by comorbidities, and are thus behaving like opportunistic pathogens, while other clones and serotype tended to cause milder disease among younger and previously healthy individuals, thus behaving as primary pathogens. The fourth paper addresses the issue of preventing invasive pneumococcal disease. We investigated the effects of the large scale vaccination campaign with the 23-valent pneumococcal polysaccharide vaccine directed towards all elderly persons in Stockholm County between 1997 and 2001. We studied the effects on incidence and serotype distribution of IPD, and concluded that a substantial decrease in vaccine-type IPD was seen among the vaccinated population, but not among other age groups, and also that no serotype replacement occurred during the 5 year study perio

Alte und neue Zeit, oder, Die Reichsgrafen von Schelack

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Effects of a large-scale introduction of the pneumococcal polysaccharide vaccine among elderly persons in Stockholm, Sweden

In October 1998 Stockholm County launched a 3-year vaccination campaign with the 23-valent pneumococcal polysaccharide vaccine (PPV-23) directed towards all elderly persons. We analysed the impact of this campaign on the incidence and serotype distribution of invasive pneumococcal disease (IPD) in Stockholm County, where the vaccine coverage was 36%, as compared to Skane County, where no vaccination campaign was performed. The incidence of vaccine-type IPD in Stockholm declined significantly during the study period (1997-2001) in elderly persons, from 50 to 28.9/100,000, hot not in other age groups in Stockholm, nor in any age group in Skane. (C) 2008 Elsevier Ltd. All rights reserved

The IRIDICA PCR/Electrospray Ionization-Mass Spectrometry Assay on Bronchoalveolar Lavage for Bacterial Etiology in Mechanically Ventilated Patients with Suspected Pneumonia.

We studied the diagnostic performance of the IRIDICA PCR/electrospray ionization-mass spectrometry (PCR/ESI-MS) assay applied on bronchoalveolar lavage (BAL) samples, from 51 mechanically ventilated patients with suspected pneumonia, in a prospective study. In 32 patients with X-ray verified pneumonia, PCR/ESI-MS was positive in 66% and BAL culture was positive in 38% (p = 0.045), and either of the methods was positive in 69%. The following BAL result combinations were noted: PCR/ESI-MS+/culture+, 34%; PCR/ESI-MS+/culture-, 31%; PCR/ESI-MS-/culture+, 3.1%; PCR/ESI-MS-/culture-, 31%; kappa 0.36 (95% confidence interval (CI), 0.10-0.63). In pneumonia patients without prior antibiotic treatment, optimal agreement was noted with 88% PCR/ESI-MS+/culture+ and 12% PCR/ESI-MS-/culture- (kappa 1.0). However, in patients with prior antibiotic treatment, the test agreement was poor (kappa 0.16; 95% CI, -0.10-0.44), as 10 patients were PCR/ESI-MS+/culture-. In 8/10 patients the pathogens detected by PCR/ESI-MS could be detected by other conventional tests or PCR tests on BAL. Compared with BAL culture, PCR/ESI-MS showed specificities and negative predictive values of ≥87% for all individual pathogens, an overall sensitivity of 77% and positive predictive value (PPV) of 42%. When other conventional tests and PCR tests were added to the reference standard, the overall PPV increased to 87%. The PCR/ESI-MS semi-quantitative level tended to be higher for PCR/ESI-MS positive cases with pneumonia compared with cases without pneumonia (p = 0.074). In conclusion, PCR/ESI-MS applied on BAL showed a promising performance and has potential to be clinically useful in mechanically ventilated patients with suspected pneumonia. The usefulness of the method for establishment of pneumonia etiology and selection of antibiotic therapy should be further studied

Swedish guidelines on the management of community-acquired pneumonia in immunocompetent adults-Swedish Society of Infectious Diseases 2012

This document presents the 2012 evidence based guidelines of the Swedish Society of Infectious Diseases for the in-hospital management of adult immunocompetent patients with community-acquired pneumonia (CAP). The prognostic score 'CRB-65' is recommended for the initial assessment of all CAP patients, and should be regarded as an aid for decision-making concerning the level of care required, microbiological investigation, and antibiotic treatment. Due to the favourable antibiotic resistance situation in Sweden, an initial narrow-spectrum antibiotic treatment primarily directed at Streptococcus pneumoniae is recommended in most situations. The recommended treatment for patients with severe CAP (CRB-65 score 2) is penicillin G in most situations. In critically ill patients (CRB-65 score 3-4), combination therapy with cefotaxime/macrolide or penicillin G/fluoroquinolone is recommended. A thorough microbiological investigation should be undertaken in all patients, including blood cultures, respiratory tract sampling, and urine antigens, with the addition of extensive sampling for more uncommon respiratory pathogens in the case of severe disease. Recommended measures for the prevention of CAP include vaccination for influenza and pneumococci, as well as smoking cessation

Flow shart of the study patients.

<p>ICU, intensive care unit; BAL, bronchoalveolar lavage.</p

Individual mechanically ventilated patients without pneumonia with positive result obtained with either IRIDICA PCR/electrospray ionization–mass spectrometry (PCR/ESI-MS) or culture on bronchoalveolar lavage (BAL).

<p>Support for positive PCR/ESI-MS results is indicated in bold.</p