How valid is the arthroscopic diagnosis of cartilage lesions? Results of an opinion survey among highly experienced arthroscopic surgeons

In general, arthroscopy is considered the "gold standard" for the evaluation of cartilage lesions. In this multicenter survey, we ascertained the general opinion of surgeons regarding arthroscopic cartilage diagnoses. A total of 301 highly experienced arthroscopists (instructors of the AGA, the German-speaking society of arthroscopy) were contacted in writing with a request to complete the survey. The data from 105 respondents (34.8% of those contacted) were used for the investigation. In the grading of the cartilage lesions, the Outerbridge classification was most frequently used (n = 87), followed by the ICRS protocol (n = 8) and the Insall score (n = 3). The majority (61%) of the arthroscopic surgeons felt that differentiation between healthy cartilage and low-grade cartilage lesions was simple. For differentiation between grade I and grade II lesions, and for differentiation between grade II and grade III lesions, 41.9 and 51.4%, respectively, thought that there was a "need for improvement". In the case of grade IV lesions, 70.5% of the surgeons thought that the diagnosis was valid. The respondents also judged the utility of incorporating objective measurements (e.g., intraoperative biomechanical tests): 13.3% (n = 14) responded that such measurements would be "very useful" and 61.9% (n = 65) responded that they would be "somewhat useful". Among surgeons, arthroscopy was not perceived to be as reliable as a "gold standard" for the diagnosis of cartilage lesions. The majority of experienced arthroscopists felt unsure of the results in general, or at least in some cases. A universal and definitive grading system for lesions appears to be needed. For questionable cases, measurement devices are needed for objective cartilage grading

Production of Radiobromide: new Nickel Selenide target and optimized separation by dry distillation

Introduction Radioisotopes of bromine are of special interest for nuclear medical applications. The positron emitting isotopes 75Br (T½ = 1.6 h; β+ = 75.5 %) and 76Br (T½ = 16.2 h; β+ = 57 %) have suitable decay properties for molecular imaging with PET, while the Auger electron emitters 77Br (T½ = 57.0 h) and 80mBr (T½ = 4.4 h) as well as the β−-emitter 82Br (T½ = 35.3 h) are useful for internal radiotherapy. 77Br is additionally suited for SPECT. The isotopes 75Br, 76Br and 77Br are usually produced at a cyclotron either by 3He and α-particle induced reactions on natural arsenic or by proton and deuteron induced reactions on enriched selenium isotopes [1]. As target mate-rials for the latter two reactions, earlier ele-mental selenium [2] and selenides of Cu, Ag, Mn, Mo, Cr, Ti, Pb and Sn were investigated [cf. 3–7]. Besides several wet chemical separation techniques the dry distillation of bromine from the irradiated targets was investigated, too [cf. 2, 4, 5]. However, the method needs further development. Nickel selenide was investigated as a promising target to withstand high beam currents, and the dry distillation technique for the isolation of n.c.a. radiobromine from the target was optimized. Material and Methods Crystalline Nickel-(II) selenide (0.3–0.5 g) was melted into a 0.5 mm deep cavity of a 1 mm thick Ni plate covered with a Ni grid. NiSe has a melting point of 959 °C. For development of targeting and the chemical separation, natural target material was used. Irradiations of NiSe were usually performed with protons of 17 MeV using a slanting water cooled target holder at the cyclotron BC1710 [8]. For radiochemical studies a beam current of 3 µA and a beam time of about 1 h were appropriate. To separate the produced no-carrier-added (n.c.a.) radiobromine from the target material a dry distillation method was chosen. The apparatus was developed on the basis of a dry distillation method for iodine [cf. 9,10] and optimized to obtain the bromine as n.c.a. [*Br]bromide in a small volume of sodium hydroxide solution. Changing different components of the apparatus, the dead volume could be minimized and an almost constant argon flow as carrier medium was realized. Various capillaries of platinum, stainless steel and quartz glass with different diameters and lengths were tested to trap the radiobromine. Results and Conclusion Nickel selenide proved successful as target material for the production of radiobromine by proton irradiation with 17 MeV protons. The target was tested so far only at beam currents up to 10 µA, but further investigations are ongoing. The optimized dry distillation procedure allows trapping of 80–90 % of the produced radiobromine in a capillary. For this purpose quartz glass capillaries proved to be most suitable. After rinsing the capillary with 0.1 M NaOH solution the activity can be nearly completely obtained in less than 100 µL solution as [*Br]bromide immediately useable for radiosynthesis. So, the overall separation yield was estimated to 81 ± 5 %. The radionuclidic composition and activity of the separated radiobromide was measured by γ-ray spectrometry. Due to the use of natural selenium the determination of the isotopic purity was not meaningful, but it could be shown that the radiobromine was free from other radioisotopes co-produced in the target material and the backing. The radiochemical purity as well as the specific activity were determined by radio ionchromatography. Further experiments using NiSe produced from nickel and enriched selenium are to be per-formed. The isotopic purity of the produced respective radiobromide, the production yield at high beam currents and the reusability of the target material have to be studied

Wingless-related integration site (WNT) signaling is activated during the inflammatory response upon cardiac surgery: A translational study

ObjectiveCardiac surgery and the use of cardiopulmonary bypass initiate a systemic inflammatory response. Wingless-related integration site (WNT) signaling is part of the innate immunity and has been attributed a major role in the regulation of inflammation. In preclinical research, WNT-5a may sustain an inflammatory response and cause endothelial dysfunction. Our aim was to investigate WNT signaling after cardiac surgery and its association with postoperative inflammation (Clinicaltrials.gov, NCT04058496).MethodsIn this prospective, single-center, observational study, 64 consecutive patients for coronary artery bypass grafting (CABG) ± valve surgery were assigned into three groups: off-pump CABG (n = 28), on-pump CABG (n = 16) and combined valve-CABG surgery (n = 20). Blood samples were acquired before surgery, at intensive care unit (ICU) admission and 4, 8, and 48 h thereafter. Plasma concentrations of WNT-5a and its antagonists Secreted frizzled-related protein 1 (sFRP-1), Secreted frizzled-related protein 5 (sFRP-5), and WNT inhibitory factor 1 (WIF-1) were determined by enzyme-linked immunosorbent assay. In addition, plasma concentrations of six inflammatory cytokines were measured by multiplex immunoassay. Parameters were analyzed for evolution of plasma concentration over time, interactions, intergroup differences, and association with clinical outcome parameters.ResultsAt baseline, WNT-5a, sFRP-1, and WIF-1 were present in a minimal concentration, while sFRP-5 was elevated. A higher baseline value of WNT-5a, sFRP-5, and WIF-1 resulted in higher subsequent values of the respective parameter. At ICU admission, WNT-5a and sFRP-5 reached their maximum and minimum value, respectively. WIF-1 decreased over time and was lowest 8 h after surgery. sFRP-1 changed minimally over time. While WNT-5a returned to the baseline within 48 h, sFRP-5 and WIF-1 did not reach their baseline value at 48 h. Of the investigated WNT system components, only WIF-1 partially reflected the severity of surgery. WNT-5a and WIF-1 had an impact on postoperative fluid balance and noradrenaline requirement.ConclusionWNT-5a, sFRP-5, and WIF-1 are part of the systemic inflammatory response after cardiac surgery. WNT-5a peaks immediately after cardiac surgery and returns to baseline within 48 h, presumably modulated by its antagonist sFRP-5. Based on this translational study, WNT-5a antagonism may be further investigated to assess potentially beneficial effects in patients with a dysregulated inflammation after cardiac surgery

Stochastic orbital migration of small bodies in Saturn's rings

Many small moonlets, creating propeller structures, have been found in Saturn's rings by the Cassini spacecraft. We study the dynamical evolution of such 20-50m sized bodies which are embedded in Saturn's rings. We estimate the importance of various interaction processes with the ring particles on the moonlet's eccentricity and semi-major axis analytically. For low ring surface densities, the main effects on the evolution of the eccentricity and the semi-major axis are found to be due to collisions and the gravitational interaction with particles in the vicinity of the moonlet. For large surface densities, the gravitational interaction with self-gravitating wakes becomes important. We also perform realistic three dimensional, collisional N-body simulations with up to a quarter of a million particles. A new set of pseudo shear periodic boundary conditions is used which reduces the computational costs by an order of magnitude compared to previous studies. Our analytic estimates are confirmed to within a factor of two. On short timescales the evolution is always dominated by stochastic effects caused by collisions and gravitational interaction with self-gravitating ring particles. These result in a random walk of the moonlet's semi-major axis. The eccentricity of the moonlet quickly reaches an equilibrium value due to collisional damping. The average change in semi-major axis of the moonlet after 100 orbital periods is 10-100m. This translates to an offset in the azimuthal direction of several hundred kilometres. We expect that such a shift is easily observable.Comment: 13 pages, 6 figures, submitted to A&A, comments welcom

Chains of Viscoelastic Spheres

Given a chain of viscoelastic spheres with fixed masses of the first and last particles. We raise the question: How to chose the masses of the other particles of the chain to assure maximal energy transfer? The results are compared with a chain of particles for which a constant coefficient of restitution is assumed. Our simple example shows that the assumption of viscoelastic particle properties has not only important consequences for very large systems (see [1]) but leads also to qualitative changes in small systems as compared with particles interacting via a constant restitution coefficient.Comment: 11 pages, 6 figure

Cross section measurements on 61Cu for proton beam monitoring above 20 MeV

Introduction All experimental studies involving charged particle induced nuclear reactions require a precise knowledge of monitor reactions. A number of well described proton induced monitor reactions exist in the lower energy range [1], which is covered by most medical cyclotrons. Concerning proton energies above 20 MeV, however, the accuracy of the monitor reactions declines as cross section data becomes scarcer. Furthermore, the growing interest in precise determination of projectile energies by comparing of ratios of monitor reaction cross sections demands new measurements and evaluations of known data for high threshold monitor radionuclides. In this work cross section measurements on the formation of 61Cu were done and energy de-pendent radionuclide ratios were calculated. Material and Methods For investigation of the natCu(p,x)61Cu reaction copper foils of natural isotopic composition (Goodfellow Ltd.) were irradiated. The targets were of 10 and 20 μm thickness, having a diameter of 15 mm. Proton bombardments up to 45 MeV incident energy were done in the stacked-foil arrangement at the accelerator JULIC of the Nuclear Physics Institute (IKP) of the Forschungszentrum Jülich. In addition to an internal irradiation possibility the cyclotron is equipped with an external target station which was used for most experiments. It can adapt standard and slanting solid target holders and is equipped with a water cooled four sector collimator and additional helium cooling of the entry foil. Several irradiations were executed. In each stack, besides copper samples, aluminium absorbers and additional nickel monitor foils were also placed, the latter for the determination of the respective beam current. The produced radioactivity of 61Cu was analysed non-destructively using HPGe γ-ray detectors (EG&G Ortec). Results and Conclusion Reaction cross sections of the natCu(p,x)61Cu process up to 45 MeV were measured and com-pared with existing data from the literature (FIG. 2). Except for the data of Williams et al. our results are in good agreement, showing a maxi-mum of about 165 mbarn at 37.5 MeV proton energy. The overall uncertainty of the new cross section data is between 8 and 10 %. In FIG. 3, the excitation functions of the relevant monitor reactions on Cu are shown. In combination with the excitation function of the natCu(p,xn)62Zn reaction, isotope ratios were calculated which can be used for determination of the proton energy within a target stack in the energy range of 22–40 MeV as described by Piel et al. [3]. FIGURE 4 shows the cross section ratio in dependence of the proton energy. Above this energy, 65Zn could be used to generate isotope ratios for energy determination, although the long half-life (T½ = 244.3 d) of that radionuclide may be a problem. Additional cross section measurements are planned in order to further strengthen the data base of this potential monitor reaction. The results of this work shall be evaluated in the framework of an ongoing Coordinated Research Project of the IAEA