Wrist Arthrodesis: Clinical and Ultrasonographic Trial

INTRODUCTION: The wrist arthrodesis has become a well-established procedure on the treatment of various diseases that affect the radiocarpal joint with the objective of pain relief and restoration of joint stability, allowing a recovery of gripping function and lifestyle. OBJECTIVES: Evaluate the functional outcomes of wrist arthrodesis in patients with advanced symptomatic inflammatory or degenerative arthritis and evaluate the residual synovitis by ultrasonography. METHODS: Review the patients who underwent a total wrist arthrodesis in our Hospital between 1999 and 2009, by a comparative and functional study. The study population was divided into two groups: Inflammatory Rheumatic Disease (IRD group) and another that included the remaining cases (RC group). For functional evaluation we used the Buck-Gramcko&Lohman (BGL) Evaluation for Total Wrist Function and the Disabilities of the Arm, Shoulder and Hand (DASH) Score. Pain levels were measured pre- and postoperatively according to the Visual Analogue Scale (VAS). A General Electric P5 Power Doppler Ultrasound with a high-resolution linear 7-12 MHz array was used to identify local synovitis. Mann-Whitney, Wilcoxon and Chi-Square tests were applied for statistical evaluation. p <0.05 was considered statistically significant. RESULTS: According to the study criteria we selected 38 patients. From these, 7 were treated bilaterally, with a total of 45 total wrist arthrodesis evaluated (IRD group n=25 vs RC group n=20). The predominant gender was the female (78.4%), the average age at the time of surgery was 50.0 ±14.2 years and the mean postoperative follow-up was 4.8 ± 2.6 years. Regarding to the most common surgical indication, on the RC group we had 40% of post-traumatic arthritis and on the IRD group, 96% had rheumatoid arthritis.The most frequent surgical technique used on the IRD group was Mannerfelt (52%) vs AO/ASIF plate osteosynthesis (95%) on the RC group, Darrach procedure was associated in 37.8% of all cases. IRD group presented a greater time for bone union (3.6 vs 2.9, p=0.228), fewer postoperative complications (12.0% vs 35.0%, p=0.069) and fewer cases of material extraction (20.0% vs 25.0%, p = 0.481).There was a lower deficit of pronosupination on the RC group (76% vs 60%, p=0.204), and this group also presented a better assessment on the DASH score (13.0 vs. 22.4, p=0.153). 75.0% of the RC group had a BGL score with excellent to good results vs 32.0% on the IRD group, p = 0.005.All patients improved their VAS between pre-and postoperatively (8.0 vs 2.0 on the IRD group and 6.5 vs 1.5 on the RC group, p = 0.000). After surgery, most patients maintained the previous profession (90% on the RC vs 56% on the IRD group, p = 0.013).The ultrasonographic wrist evaluation of the IRD group revealed local synovitis in 2 cases as also as extensor tenosynovitis of the fingers in other 2 cases. All of these 4 cases were of low intensity and without inflammatory activity identified by power-Doppler signal. CONCLUSION: Although being a retrospective study it allows us to evaluate the effectiveness of wrist arthrodesis, on its various indications, with encouraging functional outcomes and pain relief levels on patients with and without inflammatory rheumatic disease

A mutate-and-map protocol for inferring base pairs in structured RNA

Chemical mapping is a widespread technique for structural analysis of nucleic acids in which a molecule's reactivity to different probes is quantified at single-nucleotide resolution and used to constrain structural modeling. This experimental framework has been extensively revisited in the past decade with new strategies for high-throughput read-outs, chemical modification, and rapid data analysis. Recently, we have coupled the technique to high-throughput mutagenesis. Point mutations of a base-paired nucleotide can lead to exposure of not only that nucleotide but also its interaction partner. Carrying out the mutation and mapping for the entire system gives an experimental approximation of the molecules contact map. Here, we give our in-house protocol for this mutate-and-map strategy, based on 96-well capillary electrophoresis, and we provide practical tips on interpreting the data to infer nucleic acid structure.Comment: 22 pages, 5 figure

Everolimus and long acting octreotide as a volume reducing treatment of polycystic livers (ELATE): study protocol for a randomized controlled trial

Contains fulltext : 97893.pdf (publisher's version ) (Open Access)ABSTRACT: BACKGROUND: Polycystic liver disease (PLD) is defined as having more than 20 liver cysts and can present as a severe and disabling condition. Most symptoms are caused by the mass effect of the liver size and include abdominal pain and distension. The somatostatin analogues octreotide and lanreotide have proven to reduce polycystic liver volume. mTOR inhibitors such as everolimus inhibit cell proliferation and might thereby reduce growth of liver cysts. This trial aims to assess the benefit of combination therapy of everolimus and octreotide compared to octreotide monotherapy. In this study we present the structure of the trial and the characteristics of the included patients. METHODS/DESIGN: This is a randomized open-label clinical trial comparing the effect of 12 months of everolimus and octreotide to octreotide monotherapy in PLD patients. Primary outcome is change in liver volume determined by CT-volumetry. Secondary outcomes are changes in abdominal symptoms and quality of life. Moreover, safety and tolerability of the drugs will be assessed. DISCUSSION: This trial will compare the relative efficacy of combination therapy with octreotide and everolimus to octreotide monotherapy. Since they apply to different pathways of cystogenesis we expect that combining octreotide and everolimus will result in a cumulative reduction of polycystic liver volume. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov: NCT01157858

Obesity and the risk of gallbladder cancer: a meta-analysis

We performed a meta-analysis of studies of the association between excess body weight and risk of gallbladder cancer identified from MEDLINE and EMBASE databases from 1966 to February 2007 and the references of retrieved articles. A random-effects model was used to combine results from eight cohort studies and three case–control studies, with a total of 3288 cases. Compared with individuals of ‘normal weight', the summary relative risk of gallbladder cancer for those who were overweight or obese was 1.15 (95% CI, 1.01–1.30) and 1.66 (95% CI, 1.47–1.88) respectively. The association with obesity was stronger for women (relative risk, 1.88; 95% CI, 1.66–2.13) than for men (relative risk, 1.35; 95% CI, 1.09–1.68). There was no statistically significant heterogeneity among the results of individual studies. This meta-analysis confirms the association between excess body weight and risk of gallbladder cancer

Extended fine structure and continuum emission from S140/L1204

Grating spectra, covering the wavelength range 45 to 187μm have been taken with the ISO Long Wavelength Spectrometer (LWS) at a series of pointing positions over the S 140 region, centred on the cluster of embedded young stellar objects at the south-west corner of the L1204 molecular cloud. Extended emission from [CII]158μm and [OI]63μm is seen, peaking near the position of the embedded stars. The measurements of the fine structure lines are interpreted in terms of PDR models for the emission, as well as the underlying thermal continuum for the heated gas and dust