Accuracy of magnetic resonance studies in the detection of chondral and labral lesions in femoroacetabular impingement : systematic review and meta-analysis

Background: Several types of Magnetic resonance imaging (MRI) are commonly used in imaging of femoroacetabular impingement (FAI), however till now there are no clear protocols and recommendations for each type. The aim of this meta-analysis is to detect the accuracy of conventional magnetic resonance imaging (cMRI), direct magnetic resonance arthrography (dMRA) and indirect magnetic resonance arthrography (iMRA) in the diagnosis of chondral and labral lesions in femoroacetabular impingement (FAI). Methods: A literature search was finalized on the 17th of May 2016 to collect all studies identifying the accuracy of cMRI, dMRA and iMRA in diagnosing chondral and labral lesions associated with FAI using surgical results (arthroscopic or open) as a reference test. Pooled sensitivity and specificity with 95% confidence intervals using a random-effects meta-analysis for MRI, dMRA and iMRA were calculated also area under receiver operating characteristic (ROC) curve (AUC) was retrieved whenever possible where AUC is equivocal to diagnostic accuracy. Results: The search yielded 192 publications which were reviewed according inclusion and exclusion criteria then 21 studies fulfilled the eligibility criteria for the qualitative analysis with a total number of 828 cases, lastly 12 studies were included in the quantitative meta-analysis. Meta-analysis showed that as regard labral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.864, 0.833 and 0.88 and for dMRA were 0.91, 0.58 and 0.92. While in chondral lesions the pooled sensitivity, specificity and AUC for cMRI were 0.76, 0.72 and 0.75 and for dMRA were 0.75, 0.79 and 0.83, while for iMRA were sensitivity of 0.722 and specificity of 0.917. Conclusions: The present meta-analysis showed that the diagnostic test accuracy was superior for dMRA when compared with cMRI for detection of labral and chondral lesions. The diagnostic test accuracy was superior for labral lesions when compared with chondral lesions in both cMRI and dMRA. Promising results are obtained concerning iMRA but further studies still needed to fully assess its diagnostic accuracy

A New Adenovirus Based Vaccine Vector Expressing an Eimeria tenella Derived TLR Agonist Improves Cellular Immune Responses to an Antigenic Target

Adenoviral based vectors remain promising vaccine platforms for use against numerous pathogens, including HIV. Recent vaccine trials utilizing Adenovirus based vaccines expressing HIV antigens confirmed induction of cellular immune responses, but these responses failed to prevent HIV infections in vaccinees. This illustrates the need to develop vaccine formulations capable of generating more potent T-cell responses to HIV antigens, such as HIV-Gag, since robust immune responses to this antigen correlate with improved outcomes in long-term non-progressor HIV infected individuals.. Moreover, we show that these improved responses were dependent upon improved TLR pathway interactions.The data presented in this study illustrate the potential utility of Ad-based vectors expressing TLR agonists to improve clinical outcomes dependent upon induction of robust, antigen specific immune responses

Ulnar-sided wrist pain. Part I: anatomy and physical examination

Ulnar-sided wrist pain is a common complaint, and it presents a diagnostic challenge for hand surgeons and radiologists. The complex anatomy of this region, combined with the small size of structures and subtle imaging findings, compound this problem. A thorough understanding of ulnar-sided wrist anatomy and a systematic clinical examination of this region are essential in arriving at an accurate diagnosis. In part I of this review, ulnar-sided wrist anatomy and clinical examination are discussed for a more comprehensive understanding of ulnar-sided wrist pain

The spine in Paget’s disease

Paget’s disease (PD) is a chronic metabolically active bone disease, characterized by a disturbance in bone modelling and remodelling due to an increase in osteoblastic and osteoclastic activity. The vertebra is the second most commonly affected site. This article reviews the various spinal pathomechanisms and osseous dynamics involved in producing the varied imaging appearances and their clinical relevance. Advanced imaging of osseous, articular and bone marrow manifestations of PD in all the vertebral components are presented. Pagetic changes often result in clinical symptoms including back pain, spinal stenosis and neural dysfunction. Various pathological complications due to PD involvement result in these clinical symptoms. Recognition of the imaging manifestations of spinal PD and the potential complications that cause the clinical symptoms enables accurate assessment of patients prior to appropriate management

Ulnar-sided wrist pain. II. Clinical imaging and treatment

Pain at the ulnar aspect of the wrist is a diagnostic challenge for hand surgeons and radiologists due to the small and complex anatomical structures involved. In this article, imaging modalities including radiography, arthrography, ultrasound (US), computed tomography (CT), CT arthrography, magnetic resonance (MR) imaging, and MR arthrography are compared with regard to differential diagnosis. Clinical imaging findings are reviewed for a more comprehensive understanding of this disorder. Treatments for the common diseases that cause the ulnar-sided wrist pain including extensor carpi ulnaris (ECU) tendonitis, flexor carpi ulnaris (FCU) tendonitis, pisotriquetral arthritis, triangular fibrocartilage complex (TFCC) lesions, ulnar impaction, lunotriquetral (LT) instability, and distal radioulnar joint (DRUJ) instability are reviewed

Ocean acidification affects acid–base physiology and behaviour in a model invertebrate, the California sea hare ( Aplysia californica )

Behavioural impairment following exposure to ocean acidification-relevant CO 2 levels has been noted in a broad array of taxa. The underlying cause of these disruptions is thought to stem from alterations of ion gradients ( HC O 3 − / C l − ) across neuronal cell membranes that occur as a consequence of maintaining pH homeostasis via the accumulation of HC O 3 − . While behavioural impacts are widely documented, few studies have measured acid–base parameters in species showing behavioural disruptions. In addition, current studies examining mechanisms lack resolution in targeting specific neural pathways corresponding to a given behaviour. With these considerations in mind, acid–base parameters and behaviour were measured in a model organism used for decades as a research model to study learning, the California sea hare ( Aplysia californica ). Aplysia exposed to elevated CO 2 increased haemolymph HC O 3 − , achieving full and partial pH compensation at 1200 and 3000 µatm CO 2 , respectively. Increased CO 2 did not affect self-righting behaviour. In contrast, both levels of elevated CO 2 reduced the time of the tail-withdrawal reflex, suggesting a reduction in antipredator response. Overall, these results confirm that Aplysia are promising models to examine mechanisms underlying CO 2 -induced behavioural disruptions since they regulate HC O 3 − and have behaviours linked to neural networks amenable to electrophysiological testing

Seawater carbonate chemistry and acid–base physiology and behaviour of the California sea hare (Aplysia californica)

Behavioural impairment following exposure to ocean acidification-relevant CO2 levels has been noted in a broad array of taxa. The underlying cause of these disruptions is thought to stem from alterations of ion gradients ([HCO3]−/Cl−) across neuronal cell membranes that occur as a consequence of maintaining pH homeostasis via the accumulation of [HCO3]−. While behavioural impacts are widely documented, few studies have measured acid–base parameters in species showing behavioural disruptions. In addition, current studies examining mechanisms lack resolution in targeting specific neural pathways corresponding to a given behaviour. With these considerations in mind, acid–base parameters and behaviour were measured in a model organism used for decades as a research model to study learning, the California sea hare (Aplysia californica). Aplysia exposed to elevated CO2 increased haemolymph [HCO3]−, achieving full and partial pH compensation at 1200 and 3000 µatm CO2, respectively. Increased CO2 did not affect self-righting behaviour. In contrast, both levels of elevated CO2 reduced the time of the tail-withdrawal reflex, suggesting a reduction in antipredator response. Overall, these results confirm that Aplysia are promising models to examine mechanisms underlying CO2-induced behavioural disruptions since they regulate [HCO3]− and have behaviours linked to neural networks amenable to electrophysiological testing