Quantitative and Semi-Quantitative Assessment of Synovitis on MRI and the Relationship with Symptoms in Symptomatic Knee Osteoarthritis

Objectives: Synovitis in symptomatic knee osteoarthritis (KOA) is common and is associated with joint symptoms. Optimal synovial measurement on magnetic resonance imaging (MRI) is however, unclear. Our aims were to examine the relationship between MRI-measures of synovitis and knee symptoms in symptomatic KOA. Methods: Data from a randomised, multicentre, placebo-controlled trial (UK-VIDEO) of vitamin-D therapy in symptomatic KOA were utilised. Participants reported knee symptoms using WOMAC at baseline and annually. On contrast-enhanced (CE) MRI, synovial thickness was measured using established, semi-quantitative methods whilst synovial tissue volume (STV) was assessed as absolute STV (aSTV) and relative to the width of femoral condyle (rSTV). STV of the infrapatellar region was also assessed. Associations between synovial measures and symptoms were analysed using multiple linear regression modelling.Results: No linear association was observed between knee symptoms and synovitis thickness scores. Whole joint aSTV (0.88, 95% CI 0.17 to 1.59) and infrapatellar aSTV (5.96, 95% CI 1.22 to 10.7) were positively associated with knee pain. Whole joint rSTV had a stronger association with pain (7.96, 95% CI 2.60 to 13.33) and total scores (5.63, 95% CI 0.32 to 10.94). Even stronger associations were found for infrapatellar rSTV with pain (55.47, 95% CI 19.99 to 90.96), function (38.59, 95% CI 2.1 to 75.07) and total scores (41.64, 95% CI 6.56 to 76.72). Conclusions: Whole joint and site-specific infrapatellar STV measures on CE-MRI were associated with knee pain respectively. Volumes relative to the size of the femoral condyle may be promising outcome measures in KOA trials. Keywords: synovitis, knee, osteoarthritis, MRI, quantitative, semi-quantitativ

Self-expanding metal stents in malignant colonic obstruction: experiences from Sweden

<p/> <p>Background</p> <p>Acute surgery in the management of malignant colonic obstruction is associated with high morbidity and mortality. The use of self-expanding metal stents (SEMS) is an alternative method of decompressing colonic obstruction. SEMS may allow time to optimize the patient and to perform preoperative staging, converting acute surgery into elective. SEMS is also proposed as palliative treatment in patients with contraindications to open surgery. Aim: To review our experience of SEMS focusing on clinical outcome and complications. The method used was a review of 75 consecutive trials at SEMS on 71 patients based on stent-protocols and patient charts.</p> <p>Findings</p> <p>SEMS was used for palliation in 64 (85%) cases and as a bridge to surgery in 11 (15%) cases. The majority of obstructions, 53 (71%) cases, were located in the recto-sigmoid. Technical success was achieved in 65 (87%) cases and clinical decompression was achieved in 60 (80%) cases. Reasons for technical failure were inability to cannulate the stricture in 5 (7%) cases and suboptimal SEMS placement in 3 (4%) cases. Complications included 4 (5%) procedure-related bowel perforations of which 2 (3%) patients died in junction to post operative complications. Three cases of bleeding after SEMS occurred, none of which needed invasive treatment. Five of the SEMS occluded. Two cases of stent erosion were diagnosed at the time of surgery. Average survival after palliative SEMS treatment was 6 months.</p> <p>Conclusion</p> <p>Our results correspond well to previously published data and we conclude that SEMS is a relatively safe and effective method of treating malignant colonic obstruction although the risk of SEMS-related perforations has to be taken into account.</p

Prevalence of diffuse pancreatic beta islet cell disease with hyperinsulinism: Problems in recognition and management

Among 77 patients with endogenous hyperinsulinism seen in 2 medical centers, diffuse islet cell disease accounted for 17 (22%) patients. Since diffuse islet cell disease poses special problems in management, its prevalence is emphasized in this report. Among these patients with diffuse islet cell disease, there were 11 patients with adenomatosis, 4 with nesidioblastosis, and 2 with islet cell hyperplasia. Six of the 77 patients were found in multiple endocrine neoplasia, type I kindreds; diffuse islet cell disease was documented in 4 of these patients. We outline principles of management in patients with diffuse islet cell disease. Frozen section microscopy failed to identify nesidioblastosis or islet cell hyperplasia. Chez 77 malades, provenant de 2 centres médicaux, qui présentaient un hyperinsulinisme endogène, 17 cas de lésions diffuses des îlots de Langerhans ont été dénombrés. Ce fait est donc loin d'être exceptionnel et cette étude a pour but de le souligner. Parmi ces 17 malades, 11 présentaient des adénomes multiples (adénomatoses), 4 des nésidoblastomes (anomalies tissulaires multifocales), 2 des hyperplasies cellulaires insulaires. Chez ces 77 malades, 6 cas de MEN type I furent individualisés, 4 d'entre eux présentaient une maladie insulaire diffuse. Les auteurs, forts de cette expériences insistent sur les principes du traitement de ce type d'affection. Ils insistent sur le fait que l'étude histologique extemporanée ne permet pas d'identifier les nésidoblastomes et les hyperplasies cellulaires insulaires et que dans 70%–80% des cas les résections pancréatiques ne permettent pas d'obtenir la guérison. Un problema constante para el cirujano que opera pacientes con hiperinsulinismo endógeno es el de qué hacer cuando no se encuentre patología en el curso de la operación una vez realizada la exploración preliminar del páncreas. Los adenomas solitarios de células beta pueden pasar desapercibidos cuando no son palpables; la identificación de la enfermedad difusa de las células insulares plantea muchos problemas. Reconocemos tres alteraciones principales de tipo difuso: adenomatosis de células beta, nesidioblastosis e hiperplasia pancreática de células beta. Además, múltiples macroadenomas pueden coexistir o no con microadenomatosis o con hiperplasia en ciertos pacientes con hiperinsulinismo. Los desórdenes de células insulares de tipo multifocal son particularmente frecuentes en pacientes con Neoplasia Endocrina Multiple Tipo I.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/41314/1/268_2005_Article_BF01654942.pd

Multi-messenger searches via IceCube’s high-energy neutrinos and gravitational-wave detections of LIGO/Virgo

We summarize initial results for high-energy neutrino counterpart searches coinciding with gravitational-wave events in LIGO/Virgo\u27s GWTC-2 catalog using IceCube\u27s neutrino triggers. We did not find any statistically significant high-energy neutrino counterpart and derived upper limits on the time-integrated neutrino emission on Earth as well as the isotropic equivalent energy emitted in high-energy neutrinos for each event

In-situ estimation of ice crystal properties at the South Pole using LED calibration data from the IceCube Neutrino Observatory

The IceCube Neutrino Observatory instruments about 1 km3 of deep, glacial ice at the geographic South Pole using 5160 photomultipliers to detect Cherenkov light emitted by charged relativistic particles. A unexpected light propagation effect observed by the experiment is an anisotropic attenuation, which is aligned with the local flow direction of the ice. Birefringent light propagation has been examined as a possible explanation for this effect. The predictions of a first-principles birefringence model developed for this purpose, in particular curved light trajectories resulting from asymmetric diffusion, provide a qualitatively good match to the main features of the data. This in turn allows us to deduce ice crystal properties. Since the wavelength of the detected light is short compared to the crystal size, these crystal properties do not only include the crystal orientation fabric, but also the average crystal size and shape, as a function of depth. By adding small empirical corrections to this first-principles model, a quantitatively accurate description of the optical properties of the IceCube glacial ice is obtained. In this paper, we present the experimental signature of ice optical anisotropy observed in IceCube LED calibration data, the theory and parametrization of the birefringence effect, the fitting procedures of these parameterizations to experimental data as well as the inferred crystal properties.</p