Diagnostic performance of wrist magnetic resonance (MR) arthrography: comparison of three-dimensional isotropic T1 weighted fast spin-echo MR arthrography and two-dimensional MR arthrography.

OBJECTIVE: To compare the diagnostic performance of direct wrist MR arthrography (D-MRA) with two-dimensional (2D) T1 weighted fast spin-echo (FSE) and three-dimensional (3D) isotropic T1 weighted FSE sequences for detecting triangular fibrocartilage (TFC) central perforations and scapholunate ligament (SLL) and lunotriquetral ligament (LTL) tears. METHODS: 26 patients who had undergone pre-operative wrist D-MRA with 2D and 3D isotropic T1 weighted FSE sequences and subsequent arthroscopic surgeries were included. Each MRI sequence was independently evaluated and scored by two readers retrospectively for the presence of TFC central perforations and SLL and LTL tears. Arthroscopic findings were used as the reference standard. Diagnostic performance was evaluated by using the area under the receiver operating characteristic curve. The sensitivity, specificity and accuracy of both sequences for diagnosing the injuries were calculated. RESULTS: Arthroscopic surgery revealed 21 TFC central perforations, 7 SLL tears and 3 LTL tears. The area under the receiver operating characteristic curve value of 2D and 3D for central perforations in TFC and tears in SLL and LTL was identical or similar (0.667-0.947). The sensitivity, specificity and accuracy of both sequences for diagnosing the injury of each structure were not significantly different (TFC, 90.5/80/88.5% for both readers/sequences; SLL, 100/89.5/92.3% for both readers' 2D and Reader A's 3D, and 85.7/89.5/88.5% for Reader B's 3D; LTL, 66.7/100/96.2% for both readers' 2D and 33.3/100/92.3% for both readers' 3D). Interobserver agreements were substantial to excellent. CONCLUSION: In wrist D-MRA, the diagnostic performances of 3D isotropic and 2D T1 weighted FSE sequences are comparable for TFC central perforations and SLL and LTL tears. Advances in knowledge: The diagnostic performance of 3D isotropic T1 weighted FSE D-MRA and that of 2D T1 weighted FSE D-MRA were not significantly different in the diagnosis of central perforations in the TFC and tears in the SLL and LTL. 3D isotropic T1 weighted FSE D-MRA has potential for substituting 2D imaging.

Improvement of ovarian response and oocyte quality of aged female by administration of bone morphogenetic protein-6 in a mouse model.

BACKGROUND: Advancing female age remains a difficult problem in infertility treatment. Ovarian angiogenesis plays an important role in follicular development and the activation of ovarian angiogenesis has been emerged as a new strategy for the improvement of age-related decline of oocyte quality. BMP-6 affect gonadotropin signals in granulosa cells and it promotes normal fertility by enabling appropriate response to LH and normal oocyte quality. BMP-6 has a potential role in regulation of angiogenesis and regulates the expression of inhibitor of DNA-binding proteins (Ids). Ids involved in the control and timing of follicle selection and granulosa cells differentiation. Especially, Id-1 is well-characterized target of BMP-6 signaling. Therefore, this study investigated whether co-administration of BMP-6 during superovulation process improves ovarian response, oocyte quality and expression of Id-1 and vascular endothelial growth factor (VEGF) in the ovary of aged female using a mouse model. METHODS: Aged C57BL/6 female mice (26-31 weeks old) were superovulated by injection with 0.1 mL of 5 IU equine chorionic gonadotropin (eCG) containing recombinant mouse BMP-6 at various doses (0, 0.01, 0.1, 1, and 10 ng), followed by injection with 5 IU human chorionic gonadotropin (hCG) 48 h later. Then, the mice were immediately paired with an individual male. The aged control group was superovulated without BMP-6. Young mice of 6-9 weeks old were superovulated without BMP-6 as a positive control for superovulation and in vitro culture of embryos. Eighteen hours after hCG injection, zygotes were retrieved and cultured for 4 days. Both ovaries of each mouse were provided in the examination of ovarian expression of Id-1 and VEGF by reverse transcriptase-polymerase chain reaction, western blot, and immunohistochemistry. RESULTS: Administration of 0.1 ng BMP-6 significantly increased the number and blastocyst formation rate of oocytes ovulated and ovarian expression of Id-1 and VEGF compared to aged control mice. These increased levels were comparable to those of young control mice. CONCLUSIONS: This result suggests that BMP-6 during ovulation induction plays an important role in improvement of oocyte quality and ovarian response of aged female, possibly by regulating of ovarian Id-1 and VEGF expression.

The Disabilities of the Arm, Shoulder, and Hand questionnaire in intercollegiate athletes: validity limited by ceiling effect.

HYPOTHESIS: The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire has been validated as an effective upper extremity specific outcome measure. Normative scores have not been established for young athletes. This study was conducted to establish normative DASH scores for intercollegiate athletes. We hypothesized that DASH scores in intercollegiate athletes differ from published values obtained from the general population. MATERIALS AND METHODS: The DASH questionnaire was administered to 321 athletes cleared for full participation in intercollegiate sports. Their scores were compared with normative values in the general population and 2 other age-matched cohorts. RESULTS: Intercollegiate athletes had significantly better upper extremity function compared with the general population (1.37 +/- 2.96 vs 10.10 +/- 14.68, P < .001) and an age-matched cohort of employed adults (1.37 +/- 2.96 vs 5.40 +/- 7.57, P < .0001). The DASH was 0 for 65.1%. Within this cohort, men reported better upper extremity function than women (0.98 vs 1.82, P = .010). Athletes participating in overhead sports reported worse upper extremity function than nonoverhead athletes (1.81 vs 0.98, P = .042). DISCUSSION: We report normative DASH values for a group of intercollegiate athletes and show a significant difference between the scores of these athletes and the general population. Within our cohort of competitive athletes, overhead sports and female gender are associated with significantly lower DASH scores and sports module scores. The utility of using these results are limited by a substantial ceiling effect in this population of competitive athletes. Differences within our cohort and differences between our cohort and other populations are minimized by this ceiling effect. Various upper extremity outcome measures may be similarly limited by a ceiling effect and should be examined for appropriateness before use. CONCLUSION: Intercollegiate athletes report significantly greater upper extremity function than the general population; however, validity of the DASH in these athletes is limited and population differences may be minimized by a substantial ceiling effect.

Early treatment of degenerative arthritis of the thumb carpometacarpal joint.

Degenerative arthritis of the thumb carpometacarpal (CMC) joint is a common disorder that may affect anyone but most frequently affects the postmenopausal female population. Because of its high prevalence, the management of the condition has been a popular topic among hand surgeons and therapists worldwide. There are many decisions to consider when devising the appropriate treatment plan for each patient. In particular, early stages of thumb CMC joint arthritis may be treated nonoperatively or with less invasive surgical techniques to relieve symptoms, restore function and strength, stop the progression of the disease, and even potentially reverse the process. This article explores treatment options at the disposal of primary care physicians and hand surgeons for early thumb CMC arthritis.

The implication of proinflammatory cytokines in type 2 diabetes.

The incidence of type 2 diabetes (T2D) is rapidly expanding. Some of the more obvious pathologies associated with it include: defective glucose metabolism, obesity, cardiovascular disease and an inability to mount an effective immune response to infection by certain pathogenic organisms, leading to sepsis and death. A common tie linking these seemingly disparate complications is chronic inflammation. Today we know that inflammation is regulated locally and systemically by numerous biochemical signals. One of the most important of these signals is a class of molecules called cytokines. Cytokines can be generally classified as proinflammatory or anti-inflammatory and allow an organism to respond rapidly to an immune challenge by coordinating an appropriate immune response. In T2D, the balance between proinflammatory and anti-inflammatory cytokines is shifted toward proinflammation, potentially causing or exacerbating the health complications found in T2D. Over-nutrition has been shown to trigger the innate immune system but activation of the innate immune system, itself, induces hyperglycemia and insulin resistance. In all likelihood, diabetes and chronic inflammation are inseparable and act as a reciprocal feed-forward loop.

The carpal boss: review of diagnosis and treatment.

It is not uncommon to find a protruding mass at the dorsum of the wrist. The carpal boss is a commonly overlooked condition of unclear etiology. Minor trauma and persisting os styloideum are among the suspected causes of the condition. Long-standing carpal boss can lead to osteoarthritic damage in some patients. Many diagnostic tools, such as a "carpal boss view" radiographic study or a technetium bone scan, are available to help differentiate carpal boss from other, more common, masses of the dorsal aspect of wrist. For years, excision of the mass has been a commonly described treatment, because conservative treatment does not always give relief of symptoms. However, the benefits of wide excision must be balanced by the risks of instability at the involved joints, leading to persistent, and potentially worsened, symptoms.

Covered expandable nitinol stents for malignant gastroduodenal obstructions.

BACKGROUND AND AIM: The aim of the present study was to investigate the clinical effectiveness, safety, and outcome associated with the use of covered expandable Nitinol stents (Taewoong Medical, Seoul, Korea) for the treatment of malignant gastroduodenal obstructions. METHODS: Between March 2001 and October 2004, covered expandable Nitinol stents were placed in 68 consecutive patients under endoscopic and fluoroscopic guidance for the following reasons: gastric carcinoma (n = 49), recurrent carcinoma after partial gastrectomy (n = 7), or another malignant neoplasm involving the duodenum (n = 12). RESULTS: Technical success was achieved in 60 of the 68 patients (88.2%). After stent placement, mean dysphagia score improved from a mean of 3.5 to 1.2 (P < 0.001). The mean period of primary stent patency was 107.2 days. During follow up (mean 4.4 months; range, 1-15 months), major complications (migration [6], bleeding [3], perforation [1], ingrowth [1], overgrowth [7], fistula [1]) occurred in 19 patients (27.9%), and stent migration occurred in six (8.8%) (proximal migration into the stomach [n = 3], or distal migration [n = 3]). Recurrent dysphagia (mainly due to tumor ingrowth/overgrowth) occurred in eight patients (11.8%). CONCLUSION: Covered expandable Nitinol stents appear to offer an effective and feasible palliative therapy in patients with a malignant gastroduodenal obstruction.

p27kip1 deficiency confers susceptibility to gastric carcinogenesis in Helicobacter pylori-infected mice.

BACKGROUND & AIMS: Determining how Helicobacter pylori promotes gastric cancer and whether H pylori eradication decreases cancer risk would be helped by suitable murine models. Mice lacking the cyclin-dependent kinase inhibitor p27kip1 are susceptible to carcinogen-induced tumors. Furthermore, p27 stimulates gastric epithelial apoptosis and inhibits proliferation, expression is decreased by H pylori, and low levels are associated with a poor prognosis in gastric cancer. We therefore evaluated p27-deficient mice as a model for H pylori-associated gastric cancer. METHODS: Wild-type and p27-/- C57BL/6 mice were infected with H pylori mouse-adapted Sydney strain at 6-8 weeks of age and 6-10 mice of each type were euthanized 15, 30, 45, 60, and 75 weeks later. RESULTS: Uninfected p27-/- mice developed gastric hyperplasia. H pylori-infected p27-/- mice frequently developed intestinal metaplasia (40% at 30 weeks, 67% at 45 weeks), and after 60 weeks 7 of 12 mice developed significant dysplasia and gastric cancer, recapitulating human intestinal-type gastric carcinogenesis. Wild-type mice developed intestinal metaplasia only after 75 weeks of infection; significant gastric dysplasia was observed in 1 animal (P < .05 for each comparison with p27-/- mice). No disease developed in uninfected mice. H pylori infection in p27-/- mice was associated with significantly decreased apoptosis and increased epithelial proliferation, inflammation, and H pylori density compared with infection in wild-type mice. CONCLUSIONS: p27 loss and H pylori colonization cooperate to produce gastric cancer. The p27-deficient mouse affords opportunities to examine the pathogenesis of H pylori in gastric carcinogenesis and to test eradication and chemopreventive strategies.