Diagnostic accuracy of magnetic resonance images and weight-bearing radiographs in patients with arthroscopic-proven medial osteoarthritis of the knee

Aims: The aim of this study is to analyze the diagnostic value of weight-bearing radiographs, magnetic resonance images (MRI), and the combination of both in osteoarthritic knees when using arthroscopic findings as the “gold standard” to compare with. Methods: A total of 59 patients were studied because of chronic pain in 1 of their knees. Radiographs were classified according to Kellgren-Lawrence scale. Magnetic resonance images were classified according to Vallotton, and arthroscopic findings according to Outerbridge criteria. Results: Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were, respectively, 75.0%, 60.0%, 56.2%, 77.8%, and 66.1% for weight-bearing radiographs, and 70.8%, 88.6%, 81.0%, 81.6%, and 81.4% for MRI. Logistic regression analysis showed that a weight-bearing radiograph added to MRI offered no additional diagnostic value compared with MRI alone (P <.001). Conclusions: Magnetic resonance images presented higher specificity, positive and negative predictive values, and accuracy than weight-bearing radiographs for knee osteoarthritis. The combination of radiographs and MRI did not improve the diagnostic accuracy, compared with MRI alone

Concepciones de los docentes de básica primaria sobre educación inclusiva en la Institución Educativa María Inmaculada de San Benito Abad Sucre - Colombia

Esta es una investigación cualitativa cuyo objetivo fue conocer las concepciones sobre la educación inclusiva que tienen los docentes de básica primaria de la Institución Educativa María Inmaculada de San Benito Abad – Sucre, Colombia. Se realizó mediante el paradigma hermenéutico que interpreta la realidad de los docentes en un contexto particular, evitando generar interferencia. Se llevó a cabo un estudio de caso único. La información se recolectó a través de entrevistas semiestructuradas, observaciones no participantes, de cinco docentes de la Institución, para triangular su pensamiento y conocer la concepción de sus saberes sociales cristalizados en discursos que han sido construidos por la práctica directa y no mediada por los sujetos protagonistas de la acción. La importancia del presente estudio se evidencia en que con ella se puede propiciar la reflexión del quehacer pedagógico de los docentes, en cuanto al tema de la inclusión. Además, permite a partir de los resultados se genere otros estudios enfocados al tema

Reconstruction of the rotation center of the hip after oblong cups in revision total hip arthroplasty

Background The preoperative bone defect and the reconstruction of the center of rotation of the hip are critical in acetabular revision surgery. Uncemented oblong cups are employed in order to manage these issues. We analyzed the clinical results and rates of revision of two different uncemented oblong cups, the reconstruction of the center of rotation of the hip, as well as the rate of radiological loosening and possible risk factors. Materials and methods Forty-five patients (46 hips) underwent acetabular revision surgery using two different uncemented oblong cups.Weassessed the clinical results and the survival rate for revision and aseptic loosening. Intraoperative bone loss was classified according to Paprosky, and acetabular reconstruction was assessed according to Ranawat. The mean follow-up was 7.2 years (range 4–11 years). Results There were four re-revisions (three due to aseptic loosening); the survival rate for re-revision due to aseptic loosening was 60.1 % at seven years. The mean distance between the center of the femoral head prosthesis and the approximate center of the femoral head improved from 21.5 to 10.2 mm. Thirteen cups showed radiological loosening; the survival rate for radiological loosening at seven years was 40.54 %. A smaller postoperative horizontal distance was correlated with cup loosening. Conclusions Although optimal acetabular reconstruction can be achieved by using oblong uncemented cups in revision hip surgery, the clinical and radiological results are not encouraging. Excessive medialization of the cup may increase the rate of loosenin

Melodic intonation therapy in post-stroke nonfluent aphasia: a randomized pilot trial.

Objective: To collect data to estimate the sample size of a definitive randomised clinical trial to evaluate the effects of Melodic Intonation Therapy in poststroke nonfluent aphasia. Design: A randomised, crossover, interventional pilot trial. Setting: Departments of Neurology and Rehabilitation from a university general hospital. Participants: Stroke survivors with poststroke nonfluent aphasia. Interventions: Patients randomised to group 1 had treatment with Melodic Intonation Therapy first (12 sessions over 6 weeks) followed by no treatment; the patients in group 2 started active treatment between 3 and 6 months after their inclusion in the study, serving as waiting list controls for the first phase. Main measures: The Communicative Activity Log (CAL) questionnaire and the Boston Diagnostic Aphasia Examination (BDAE) were evaluated at baseline, and at 6 and 12 weeks. Results: Twenty patients were included. Four of the patients allocated to group 2 crossed over to group 1, receiving the treatment at first. Intention-to-treat analysis: after adjustment for baseline scores, the mean difference in the CAL evaluation from baseline in the treated group was 8.5 points (95% CI, 0.11–17.0; P=.043), with no significant change in any of the BDAE sections. Per protocol analysis showed similar results with a clear treatment effect (P=.043) on the CAL. Conclusions: Melodic Intonation Therapy might have a positive effect on the communication skills of stroke survivors with nonfluent aphasia as measured by the CAL questionnaire. A full-scale trial with at least 27 patients per group is necessary to confirm these results.pre-print490 K

Bridging the gap between researchers and patients: The role of the Institutional Review Boards in the informed consent process

Background: The Institutional-Review-Boards (IRB) frequently give unfavorable opinions to evaluated studies due to deficiencies in informed consent forms (ICFs), which delays the ethical approval of the study and increases waste in research. Objective: To analyze the extent to which IRB in our center gives unfavorable opinions due to documents deficiencies and to evaluate types of objection. Material and methods: Retrospective observational study of decisions during the first review by the IRB in our center (2012-2015). We carried out a systematic review of minutes when decisions on approval of studies are collected. If not approval, we analyzed appealed objections. Results: 1858 clinical studies were evaluated by the IRB. 1558 required informed consent for participating (83.9%, CI95%:82.1-85.5), 987 were not approved during the first review due to deficiencies in ICFs (63.3%, CI95%:60.9-65.7). The main causes of objections for non-approval were unreadability (11.7%, CI95%:10.6-12.9), inadequate information given about access to personal data rights (9.2%, CI95%:8.1-10.2), biological samples management (7.8%, IC95%:6.9-8.8), and expected benefits (7.6%, IC95%:6.7-8.6). Conclusions: Deficiencies in ICFs are an important reason for non-approval of protocols evaluated by an IRB. There are three fundamental weaknesses on which the IRB plays a key role: 1) improving readability; 2) adapting them to regulations concerning data protection and biological materials management; 3) avoiding misleading information towards enrollment

Bridging the gap between researchers and patients: The role of the Institutional Review Boards in the informed consent process

Background: The Institutional-Review-Boards (IRB) frequently give unfavorable opinions to evaluated studies due to deficiencies in informed consent forms (ICFs), which delays the ethical approval of the study and increases waste in research. Objective: To analyze the extent to which IRB in our center gives unfavorable opinions due to documents deficiencies and to evaluate types of objection. Material and methods: Retrospective observational study of decisions during the first review by the IRB in our center (2012-2015). We carried out a systematic review of minutes when decisions on approval of studies are collected. If not approval, we analyzed appealed objections. Results: 1858 clinical studies were evaluated by the IRB. 1558 required informed consent for participating (83.9%, CI95%:82.1-85.5), 987 were not approved during the first review due to deficiencies in ICFs (63.3%, CI95%:60.9-65.7). The main causes of objections for non-approval were unreadability (11.7%, CI95%:10.6-12.9), inadequate information given about access to personal data rights (9.2%, CI95%:8.1-10.2), biological samples management (7.8%, IC95%:6.9-8.8), and expected benefits (7.6%, IC95%:6.7-8.6). Conclusions: Deficiencies in ICFs are an important reason for non-approval of protocols evaluated by an IRB. There are three fundamental weaknesses on which the IRB plays a key role: 1) improving readability; 2) adapting them to regulations concerning data protection and biological materials management; 3) avoiding misleading information towards enrollment

KRAS Mutations in Primary Colorectal Cancer Tumors and Related Metastases: A Potential Role in Prediction of Lung Metastasis

BACKGROUND:KRAS mutations in colorectal cancer primary tumors predict resistance to anti-Epidermal Growth Factor Receptor (EGFR) monoclonal antibody therapy in patients with metastatic colorectal cancer, and thus represent a true indicator of EGFR pathway activation status. METHODOLOGY/PRINCIPAL FINDINGS:KRAS mutations were retrospectively studied using polymerase chain reactions and subsequent sequencing of codons 12 and 13 (exon 2) in 110 patients with metastatic colorectal tumors. These studies were performed using tissue samples from both the primary tumor and their related metastases (93 liver, 84%; 17 lung, 16%). All patients received adjuvant 5-Fluorouracil-based polychemotherapy after resection of metastases. None received anti-EGFR therapy. Mutations in KRAS were observed in 37 (34%) of primary tumors and in 40 (36%) of related metastases, yielding a 94% level of concordance (kappa index 0.86). Patients with primary tumors possessing KRAS mutations had a shorter disease-free survival period after metastasis resection (12.0 vs 18.0 months; P = 0.035) than those who did not. A higher percentage of KRAS mutations was detected in primary tumors of patiens with lung metastases than in patients with liver metastases (59% vs 32%; p = 0.054). To further evaluate this finding we analyzed 120 additional patients with unresectable metastatic colorectal cancer who previously had their primary tumors evaluated for KRAS mutational status for clinical purposes. Separately, the analysis of these 120 patients showed a tendency towards a higher degree of KRAS mutations in primary tumors of patients with lung metastases, although it did not reach statistical significance. Taken together the group of 230 patients showed that KRAS was mutated significantly more often in the primary tumors of patients with lung metastases (57% vs 35%; P = 0.006). CONCLUSIONS/SIGNIFICANCE:Our results suggest a role for KRAS mutations in the propensity of primary colorectal tumors to metastasize to the lung

An 8-gene qRT-PCR-based gene expression score that has prognostic value in early breast cancer

<p>Abstract</p> <p>Background</p> <p>Gene expression profiling may improve prognostic accuracy in patients with early breast cancer. Our objective was to demonstrate that it is possible to develop a simple molecular signature to predict distant relapse.</p> <p>Methods</p> <p>We included 153 patients with stage I-II hormonal receptor-positive breast cancer. RNA was isolated from formalin-fixed paraffin-embedded samples and qRT-PCR amplification of 83 genes was performed with gene expression assays. The genes we analyzed were those included in the 70-Gene Signature, the Recurrence Score and the Two-Gene Index. The association among gene expression, clinical variables and distant metastasis-free survival was analyzed using Cox regression models.</p> <p>Results</p> <p>An 8-gene prognostic score was defined. Distant metastasis-free survival at 5 years was 97% for patients defined as low-risk by the prognostic score versus 60% for patients defined as high-risk. The 8-gene score remained a significant factor in multivariate analysis and its performance was similar to that of two validated gene profiles: the 70-Gene Signature and the Recurrence Score. The validity of the signature was verified in independent cohorts obtained from the GEO database.</p> <p>Conclusions</p> <p>This study identifies a simple gene expression score that complements histopathological prognostic factors in breast cancer, and can be determined in paraffin-embedded samples.</p

Next-generation sequencing in bone marrow failure syndromes and isolated cytopenias: experience of the spanish network on bone marrow failure sundromes

© 2021 the Author(s).Inherited bone marrow failure syndromes (IBMFSs) are a group of congenital rare diseases characterized by bone marrow failure, congenital anomalies, high genetic heterogeneity, and predisposition to cancer. Appropriate treatment and cancer surveillance ideally depend on the identification of the mutated gene. A next-generation sequencing (NGS) panel of genes could be 1 initial genetic screening test to be carried out in a comprehensive study of IBMFSs, allowing molecular detection in affected patients. We designed 2 NGS panels of IBMFS genes: version 1 included 129 genes and version 2 involved 145 genes. The cohort included a total of 204 patients with suspected IBMFSs without molecular diagnosis. Capture-based targeted sequencing covered > 99% of the target regions of 145 genes, with more than 20 independent reads. No differences were seen between the 2 versions of the panel. The NGS tool allowed a total of 91 patients to be diagnosed, with an overall molecular diagnostic rate of 44%. Among the 167 patients with classified IBMFSs, 81 patients (48%) were diagnosed. Unclassified IBMFSs involved a total of 37 patients, of whom 9 patients (24%) were diagnosed. The preexisting diagnosis of 6 clinically classified patients (6%) was amended, implying a change of therapy for some of them. Our NGS IBMFS gene panel assay is a useful tool in the molecular diagnosis of IBMFSs and a reasonable option as the first tier genetic test in these disorders