First Release Mar 1

ABSTRACT. Objective. To evaluate physician control of needle and syringe during aspiration-injection syringe procedures by comparing the new reciprocating procedure syringe to a traditional conventional syringe. Methods. Twenty-six physicians were tested for their individual ability to control the reciprocating and conventional syringes in typical aspiration-injection procedures using a novel quantitative needle-based displacement procedure model. Subsequently, the physicians performed 48 clinical aspiration-injection (arthrocentesis) procedures on 32 subjects randomized to the reciprocating or conventional syringes. Clinical outcomes included procedure time, patient pain, and operator satisfaction. Multivariate modeling methods were used to determine the experimental variables in the syringe control model most predictive of clinical outcome measures. Results. In the model system, the reciprocating syringe significantly improved physician control of the syringe and needle, with a 66% reduction in unintended forward penetration (p < 0.001) and a 68% reduction in unintended retraction (p < 0.001). In clinical arthrocentesis, improvements were also noted: 30% reduction in procedure time (p < 0.03), 57% reduction in patient pain (p < 0.001), and a 79% increase in physician satisfaction (p < 0.001). The variables in the experimental system -unintended forward penetration, unintended retraction, and operator satisfaction -independently predicted the outcomes of procedure time, patient pain, and physician satisfaction in the clinical study (p ≤ 0.001). Conclusion. The reciprocating syringe reduces procedure time and patient pain and improves operator satisfaction with the procedure syringe. The reciprocating syringe improves physician performance in both the validated quantitative needle-based displacement model and in real aspiration-injection syringe procedures, including arthrocentesis

The highly accurate anteriolateral portal for injecting the knee

<p>Abstract</p> <p>Background</p> <p>The extended knee lateral midpatellar portal for intraarticular injection of the knee is accurate but is not practical for all patients. We hypothesized that a modified anteriolateral portal where the synovial membrane of the medial femoral condyle is the target would be highly accurate and effective for intraarticular injection of the knee.</p> <p>Methods</p> <p>83 subjects with non-effusive osteoarthritis of the knee were randomized to intraarticular injection using the modified anteriolateral bent knee versus the standard lateral midpatellar portal. After hydrodissection of the synovial membrane with lidocaine using a mechanical syringe (reciprocating procedure device), 80 mg of triamcinolone acetonide were injected into the knee with a 2.0-in (5.1-cm) 21-gauge needle. Baseline pain, procedural pain, and pain at outcome (2 weeks and 6 months) were determined with the 10 cm Visual Analogue Pain Score (VAS). The accuracy of needle placement was determined by sonographic imaging.</p> <p>Results</p> <p>The lateral midpatellar and anteriolateral portals resulted in equivalent clinical outcomes including procedural pain (VAS midpatellar: 4.6 ± 3.1 cm; anteriolateral: 4.8 ± 3.2 cm; p = 0.77), pain at outcome (VAS midpatellar: 2.6 ± 2.8 cm; anteriolateral: 1.7 ± 2.3 cm; p = 0.11), responders (midpatellar: 45%; anteriolateral: 56%; p = 0.33), duration of therapeutic effect (midpatellar: 3.9 ± 2.4 months; anteriolateral: 4.1 ± 2.2 months; p = 0.69), and time to next procedure (midpatellar: 7.3 ± 3.3 months; anteriolateral: 7.7 ± 3.7 months; p = 0.71). The anteriolateral portal was 97% accurate by real-time ultrasound imaging.</p> <p>Conclusion</p> <p>The modified anteriolateral bent knee portal is an effective, accurate, and equivalent alternative to the standard lateral midpatellar portal for intraarticular injection of the knee.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00651625">NCT00651625</a></p

201207.dec

ABSTRACT. Objective. To investigate the effects of cigarette smoking and alcohol consumption on the development of systemic lupus erythematosus (SLE). Methods. We interviewed 125 patients with SLE and 125 controls in a case-control study. Demographically similar controls randomly selected from outpatient clinics were matched to SLE cases for sex and age. Clinical data, including cigarette smoking, drinking habits, and other demographic variables, were collected by an interview-administered questionnaire. Results. To minimize bias associated with reactive habits induced by disease, cigarette smoking before the diagnosis of SLE was the primary variable for subsequent analysis. Analysis of the data by multivariate conditional logistic regression revealed that both cigarette smoking before SLE diagnosis and ex-smoking before SLE diagnosis significantly increased the risk of development of SLE (OR 6.69, 95% CI 2.59, 17.28, p &lt; 0.001; and OR 3.62, 95% CI 1.22, 10.70, p = 0.02, respectively). This association remained even when statistically controlling for the effects of family history and education, indicating an independent effect. Alcohol did not place an individual at increased risk nor did it have a protective role. Conclusion. The results of this study provide further evidence that cigarette smoking may be an associated risk factor for the development of SLE. (J Rheumatol 2001;28:2449-53

Effects of intermittent cycle exercise on intramyocellular lipid use and recovery

The purpose of this investigation was to compare intramyocellular lipid (IMCL) changes in skeletal muscle in nine moderately trained subjects after 45 min of interval cycling and through 1 h of recovery. The exercise session was continuous with alternating cycling intensity achieving 50 (3 min) and 110% (2 min) of ventilatory threshold. Spectra from the vastus lateralis were acquired before, immediately after, and 60 min following exercise using a 1.5 T Signa whole-body magnet (point-resolved spectroscopy sequence, echo time 60 ms, transverse relaxation time 2000 ms, 128 acquisitions, and 20 mm3 voxel). Immediately following exercise, IMCL concentration decreased 38% compared to pre-exercise levels (P 0.05). In the 60-min recovery, IMCL was reduced 30% compared to baseline (P < 0.05) and did not recover. In contrast, a nonexercising control group showed no change in IMCL. Our results suggest that IMCL decreased significantly following 45 min of interval cycling, with little recovery in the hour following

Effect of lordosis on the position of the nucleus pulposus in supine subjects: A study using magnetic resonance imaging

Study Design - Healthy young women (N = 20) underwent magnetic resonance imaging while supine with their hips and knees flexed (flexed position) and supine with a lumbar roll under the low back (extended position). The posterior end anterior margins of the nucleus pulposus (MP) relative to posterior and anterior margins of the adjacent vertebral bodies were calculated from mid-sagittal T 2-weighted images to determine the position change of the NP as a function of two supine postures.Objectives - This study describes the effect of two commonly used supine postures on the position of the NP. Summary of Background Data - Management of patients with low back pain is often based on theorized positional changes of the NP during spinal extension and flexion, Date describing NP positional changes have not been reported for noninvesive measurements. Results - The distance of the posterior margin of the NP to the posterior margins of the adjacent vertebral bodies was greater in the extended compared with the flexed position. There was no difference in the anterior distance. Eight of the 20 subjects had at least one degenerative disc in the lower lumbar spine. The NFs of the degenerative discs did not move the same as normal discs. Conclusions - The use of a lumbar roll under the low back when supine causes an increase in the distance from the posterior margin of the NP to the posterior portions of the vertebral bodies in normal discs of healthy young females. Degenerative discs deform differently from non degenerative discs

Group comparison of cortical thickness differences between SLE patients (N = 16) and NPSLE patients (N = 21).

<p>Images show clusters of lower (blue clusters) cortical thickness values controlling for age. Clusters are displayed in the range of p≤.01 to p≤.0001 (color scale shows −log (10) p-value). Clusters which survived FDR correction for multiple correction (p≤.05 are encircled). Top left  =  left lateral hemisphere; Bottom left  =  left medial hemisphere; Top right  =  right lateral hemisphere; Bottom right  =  right medial hemisphere.</p

FA-Processing Speed z-score in NPSLE.

<p>Significant regions (red/yellow) in which NPSLE patients had significant correlations between FA and Processing Speed z-score. Left – coronal view (front to back of head); middle – axial view (top to bottom of head); right – sagittal view (side to side of head). Green represents the center of major white matter tracts which represent the total regions of statistical analyses.</p

Group comparison of cortical thickness relationships to age for the entire group of NPSLE, SLE, and control subjects (N = 58).

<p>Images show clusters of lower (blue clusters) cortical thickness values related to age. Clusters are displayed in the range of p≤.01 to p≤.0001 (color scale shows −log (10) p-value). Top left  =  left lateral hemisphere; Bottom left  =  left medial hemisphere; Top right  =  right lateral hemisphere; Bottom right  =  right medial hemisphere. Light blue regions indicate regions where age and cortical thickness were significantly related (p<.05) corrected for multiple comparisons (FDR).</p

FA-Total z-score relationships in non-NPSLE.

<p>Significant regions (red/yellow) in which non-NPSLE patients had significant correlations between Fractional Anisotropy and Total z-score. Left – coronal view (front to back of head); middle – axial view (top to bottom of head); right – sagittal view (side to side of head). Green represents the center of major white matter tracts which represent the total regions of statistical analyses.</p

Scatterplot showing individual cortical thickness values (in millimeters) obtained from the left rostrofrontal cortex for the sample.

<p>Red squares  =  NPLSE patients; Blue circles  =  SLE patients (blue circles); Black diamonds  =  control subjects, stratified by age. All three groups show decreasing trends for cortical thickness in all significant regions (light blue in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0009302#pone-0009302-g001" target="_blank">Figure 1</a>).</p