Accuracy and cost-effectiveness of dynamic contrast-enhanced CT in the characterisation of solitary pulmonary nodules-the SPUtNIk study.

INTRODUCTION: Solitary pulmonary nodules (SPNs) are common on CT. The most cost-effective investigation algorithm is still to be determined. Dynamic contrast-enhanced CT (DCE-CT) is an established diagnostic test not widely available in the UK currently. METHODS AND ANALYSIS: The SPUtNIk study will assess the diagnostic accuracy, clinical utility and cost-effectiveness of DCE-CT, alongside the current CT and 18-flurodeoxyglucose-positron emission tomography) (18FDG-PET)-CT nodule characterisation strategies in the National Health Service (NHS). Image acquisition and data analysis for 18FDG-PET-CT and DCE-CT will follow a standardised protocol with central review of 10% to ensure quality assurance. Decision analytic modelling will assess the likely costs and health outcomes resulting from incorporation of DCE-CT into management strategies for patients with SPNs. ETHICS AND DISSEMINATION: Approval has been granted by the South West Research Ethics Committee. Ethics reference number 12/SW/0206. The results of the trial will be presented at national and international meetings and published in an Health Technology Assessment (HTA) Monograph and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: ISRCTN30784948; Pre-results.

Assessment of effects of chromated copper arsenate (CCA)-treated timber on nontarget epibiota by investigation of fouling community development at seven European sites.

To assess the effect of the anti-marine-borer timber preservative CCA (a pressure-impregnated solution of copper, chromium, and arsenic compounds) on nontarget epibiota, fouling community development was investigated. Panels of Scots pine treated to target retentions of 12, 24, and 48 kg CCA per m3 of wood (covering the range of retentions recommended for marine use) plus untreated controls were submerged at seven coastal sites (Portsmouth, UK; La Tremblade [two sites], France; Ria Formosa, Portugal; Sagres, Portugal; Kristineberg, Sweden; Athens, Greece). The fouling community on the surfaces of the panels was assessed both qualitatively and quantitatively after 6, 12, and 18 months of exposure. Multivariate statistical methods were used to compare community structure between panel treatments. Panels treated to the three CCA loadings supported very similar fouling assemblages, which in most cases had higher numbers of taxa and individuals than assemblages on untreated panels. No detrimental effects on epibiota due to CCA preservatives were detected at any of the treatment levels at all seven exposure sites, suggesting that the range of environmental conditions at the sites had no bearing on preservative impact on fouling biota. Differences in community structure between CCA-treated and untreated panels may be due to enhanced larval settlement on CCA-treated timber by some species as a result of modifications to the surface properties of the timber by the preservative. Possible reasons for the higher numbers of certain species on the surface of CCA-treated panels are discussed.

Degenerative changes of the trapeziometacarpal joint: radiologic assessment.

The trapeziometacarpal joint is particularly prone to osteoarthritis due to the great amount of stress applied with everyday activities with the hands. In this essay, radiologic assessment and staging of "basal joint" osteoarthritis, treatments based on radiologic staging and intraoperative findings, and surgical complications are described.

Ligament reconstruction for the painful thumb carpometacarpal joint: a long-term assessment.

An extra-articular ligament reconstruction to stabilize the thumb carpometacarpal (CMC) (basal) joint by routing a portion of the flexor carpi radialis (FCR) through the base of the thumb metacarpal has been performed on more than 100 patients since 1967. This study reviews the first 50 consecutive reconstructions with an average follow-up of 7 years. Intractable pain was the primary indication for surgery. Each joint was examined both pre and postoperatively and rated as a stage I through stage IV according to the radiographic appearance. Of the patients with zero or minimal articular changes (stages I and II), 95% achieved good or excellent results because of having little or no postoperative pain. Of the patients with moderate to advanced degenerative changes (stages III and IV), 74% achieved good or excellent results. All stage I cases and 82% of stage II cases were free of recognizable degeneration on follow-up radiographs up to 13 years postoperatively. These findings suggest that ligament reconstruction that is now recommended only for stage I or stage II disease will restore stability, reduce pain, and possibly even retard joint degeneration in a large proportion of patients with painful instability of the thumb CMC joint.