Factors affecting the success of CT-guided core biopsy of musculoskeletal lesions with a 13-G needle.

OBJECTIVE: To determine the value of CT-guided bone core biopsy and investigate factors that affect diagnostic yield and biopsy outcome. MATERIALS AND METHODS: The single-centre retrospective analysis included 447 patients who had CT-guided core biopsy with a 13-G needle (Bonopty®) from January 2016 to December 2021. Histological results or ≥ 6 months of clinical and radiological follow-up served as outcome references. A successful biopsy was classified as "diagnostic" when a definitive diagnosis was made and "adequate" when only the malignant or benign nature of the tumour could be determined. Biopsies were "nondiagnostic" when the nature of the lesion could not be determined. The occult lesions were defined as not seen on CT but visible on other modalities. RESULTS: In 275 (62%) females and 172 (38%) males, the overall success rate was 85% (383 biopsies), with 314 (70%) diagnostic biopsies and 69 (15%) adequate biopsies. There was no relationship between biopsy success and the localisation of the lesion, length of biopsy material, or number of biopsy attempts. The lesions' nature had a statistically significant effect on biopsy success with lytic and mixed lesions having the highest success rate. Occult lesions had the lowest success rate. CONCLUSION: CT-guided bone core biopsy is an effective method in the workup of musculoskeletal diseases with the highest success rate in lytic and mixed lesions. No apparent relationship was found between biopsy success and biopsy length, number of attempts, or localisation of the lesion.

Advancing 3D printed microfluidics with computational methods for sweat analysis.

The intricate tapestry of biomarkers, including proteins, lipids, carbohydrates, vesicles, and nucleic acids within sweat, exhibits a profound correlation with the ones in the bloodstream. The facile extraction of samples from sweat glands has recently positioned sweat sampling at the forefront of non-invasive health monitoring and diagnostics. While extant platforms for sweat analysis exist, the imperative for portability, cost-effectiveness, ease of manufacture, and expeditious turnaround underscores the necessity for parameters that transcend conventional considerations. In this regard, 3D printed microfluidic devices emerge as promising systems, offering a harmonious fusion of attributes such as multifunctional integration, flexibility, biocompatibility, a controlled closed environment, and a minimal requisite analyte volume-features that leverage their prominence in the realm of sweat analysis. However, formidable challenges, including high throughput demands, chemical interactions intrinsic to the printing materials, size constraints, and durability concerns, beset the landscape of 3D printed microfluidic devices. Within this paradigm, we expound upon the foundational aspects of 3D printed microfluidic devices and proffer a distinctive perspective by delving into the computational study of printing materials utilizing density functional theory (DFT) and molecular dynamics (MD) methodologies. This multifaceted approach serves manifold purposes: (i) understanding the complexity of microfluidic systems, (ii) facilitating comprehensive analyses, (iii) saving both cost and time, (iv) improving design optimization, and (v) augmenting resolution. In a nutshell, the allure of 3D printing lies in its capacity for affordable and expeditious production, offering seamless integration of diverse components into microfluidic devices-a testament to their inherent utility in the domain of sweat analysis. The synergistic fusion of computational assessment methodologies with materials science not only optimizes analysis and production processes, but also expedites their widespread accessibility, ensuring continuous biomarker monitoring from sweat for end-users.

Xenon Difluoride Dry Etching for the Microfabrication of Solid Microneedles as a Potential Strategy in Transdermal Drug Delivery.

Although hypodermic needles are a "gold standard" for transdermal drug delivery (TDD), microneedle (MN)-mediated TDD denotes an unconventional approach in which drug compounds are delivered via micron-size needles. Herein, an isotropic XeF2 dry etching process is explored to fabricate silicon-based solid MNs. A photolithographic process, including mask writing, UV exposure, and dry etching with XeF2 is employed, and the MN fabrication is successfully customized by modifying the CAD designs, photolithographic process, and etching conditions. This study enables fabrication of a very dense MNs (up to 1452 MNs cm-2 ) with height varying between 80 and 300 µm. Geometrical features are also assessed using scanning electron microscopy (SEM) and 3D laser scanning microscope. Roughness of the MNs are improved from 0.71 to 0.35 µm after titanium and chromium coating. Mechanical failure test is conducted using dynamic mechanical analyzer to determine displacement and stress/strain values. The coated MNs are subjected to less displacement (≈15 µm) upon the applied force. COMSOL Multiphysics analysis indicates that MNs are safe to use in real-life applications with no fracture. This technique also enables the production of MNs with distinct shape and dimensions. The optimized process provides a wide range of solid MN types to be utilized for epidermis targeting.

Label-Free Identification of Exosomes using Raman Spectroscopy and Machine Learning.

Exosomes, nano-sized extracellular vesicles (EVs) secreted from cells, carry various cargo molecules reflecting their cells of origin. As EV content, structure, and size are highly heterogeneous, their classification via cargo molecules by determining their origin is challenging. Here, a method is presented combining surface-enhanced Raman spectroscopy (SERS) with machine learning algorithms to employ the classification of EVs derived from five different cell lines to reveal their cellular origins. Using an artificial neural network algorithm, it is shown that the label-free Raman spectroscopy method's prediction ratio correlates with the ratio of HT-1080 exosomes in the mixture. This machine learning-assisted SERS method enables a new direction through label-free investigation of EV preparations by differentiating cancer cell-derived exosomes from those of healthy. This approach will potentially open up new avenues of research for early detection and monitoring of various diseases, including cancer.

Patellar resurfacing in total knee arthroplasty leads to better isokinetic performance.

BACKGROUND: For decades there have been concerns about patellar resurfacing (PR) in total knee arthroplasty (TKA) and the individual preference of the surgeon is still the main determinant of whether or not resurfacing is applied. According to preference, surgeons can be categorized in 3 main groups of those who usually, selectively, or rarely resurface. The aim of this prospective, randomized, controlled study was to compare the isokinetic performance and clinical outcome of TKAs with PR and without PR. METHODS: A total of 50 patients scheduled to undergo TKA for primary osteoarthritis of the knee were randomly assigned to either the PR or non-PR groups. There were no significant differences between the groups in respect of age, BMI, gender and preoperative Knee Society Score (KSS) and isokinetic performance. Patients were evaluated at postoperative 3, 6, and 12 months with KSS and at 6 months and 1 year with isokinetic measurements. RESULTS: The PR group had a higher mean score, especially in the functional component of KSS, but the difference was not statistically significant. Knee extension peak torque was significantly higher in the PR group at 6 months (p = 0.029) and 1 year (p = 0.004) postoperatively. There were no significant differences between the groups in respect of knee flexion peak torque values following TKA. CONCLUSIONS: The results of this study demonstrated that PR during TKA is associated with better isokinetic performance and higher knee scores. These results support routine/usually resurfacing of the patella. For surgeons who selectively resurface the patella, the advantage of better isokinetic performance may be taking into consideration in favor of resurfacing the patella where they are undecided. LEVEL OF EVIDENCE: Level I, therapeutic study.

Benchmarking a Microfluidic-Based Filtration for Isolating Biological Particles.

Isolating particles from complex fluids is a crucial approach in multiple fields including biomedicine. In particular, biological matrices contain a myriad of distinct particles with different sizes and structures. Extracellular vesicles (EVs), for instance, are nanosized particles carrying vital information from donor to recipient cells, and they have garnered significant impact on disease diagnostics, drug delivery, and theranostics applications. Among all the EV types, exosome particles are one of the smallest entities, sizing from 30 to 100 nm. Separating such small substances from a complex media such as tissue culture and serum is still one of the most challenging steps in this field. Membrane filtration is one of the convenient approaches for these operations; yet clogging, low-recovery, and high fouling are still major obstacles. In this study, we design a two-filter-integrated microfluidic device focusing on dead-end and cross-flow processes at the same time, thereby minimizing any interfering factors on the recovery. The design of this platform is also numerically assessed to understand pressure-drop and flow rate effects over the procedure. As a model, we isolate exosome particles from human embryonic kidney cells cultured in different conditions, which also mimic complex fluids such as serum. Moreover, by altering the flow direction, we refresh the membranes for minimizing clogging issues and benchmark the platform performance for multitime use. By comprehensively analyzing the design and operation parameters of this platform, we address the aforementioned existing barriers in the recovery, clogging, and fouling factors, thereby achieving the use of a microfluidic device multiple times for bio-nanoparticle isolation without any notable issues.

The development of musculoskeletal radiology for 100 years as presented in the pages of Acta Radiologica.

During the last 100 years, musculoskeletal radiology has developed from bone-only radiography performed by everyone to a dedicated subspecialty, still secure in its origins in radiography but having expanded into all modalities of imaging. Like other subspecialties in radiology, it has become heavily dependent on cross-sectional and functional imaging, and musculoskeletal interventions play an important role in tumor diagnosis and treatment and in joint diseases. All these developments are reflected in the pages in Acta Radiologica, as shown in this review.

The prognostic and predictive significance of serum thiols and disulfide levels in advanced non-small cell lung cancer.

Serum Total Thiol (TT), Native Thiol (NT), and Disulfide (SS) levels were found significantly lower in benign proliferative pathologies and cancer disease compared to healthy subjects. We conducted this prospective study to investigate the possible predictive and prognostic significance of these markers in non-small cell lung cancer (NSCLC), which is one of the most associated cancers with oxidative stress. This was a non-randomized, prospective, and case-control study of 120 subjects, including 60 patients with metastatic or inoperable NSCLC at the time of diagnosis and 60 demographically-matched controls. Morning fasting venous blood serum samples from both NSCLC and control group were stored at -80 °C for equal periods and then TT, NT, and SS levels were measured spectrophotometrically. Serum TT, NT, and SS levels were compared between groups and their relationships with demographic features and survival of NSCLC patients were analyzed. In results, Serum TT, NT, and SS levels were significantly lower in NSCLC patients than those in control group, with a low SS level being an independent indicator of poor survival.

No effect of vancomycin powder to prevent infection in primary total knee arthroplasty: a retrospective review of 976 cases.

PURPOSE: Vancomycin powder (VP) has been used to prevent periprosthetic joint infection (PJI). However, studies investigating the efficacy of VP to prevent infection in primary total knee arthroplasty (TKA) are very rare. The purpose of this study was to investigate the efficacy of VP application to prevent PJI in TKA. METHODS: Between 2012 and 2016, 976 consecutive patients who underwent primary TKA were included in the present study. Patients were divided into two groups. There were 474 patients (48.6%) in the VP group and 502 patients in the control group (51.4%). Except for VP, all procedures were the same in both groups. In the VP group, 2 g of VP was poured into the joint just before the fascia was closed. Average follow-up was 53.2 months (24-84 months). RESULTS: Infection was found in 4 (0.84%) of 474 patients in the VP group and 5 (0.99%) of 502 patients in the control group. There was no statistically significant difference between groups in terms of infection rates (p = 0.535). Staphylococcus aureus was found in 2 patients in the VP group. Two patients had S. aureus and 1 patient had Pseudomonas aeruginosa in the control group. There was no statistically significant difference between groups in terms of demographic parameters (p > 0.05). CONCLUSION: Intrawound VP administration doesn't change the infection rates in primary TKA. The VP administration for preventing PJI is not recommended in primary TKA. LEVEL OF EVIDENCE: III.

Is It an Overlooked Injury? Magnetic Resonance Imaging Examination of Occult Talus Lesions Concomitant to Tibial Shaft Fracture.

Long-term studies have shown that 10% to 20% of patients continue to experience ankle pain years after tibial fracture, which causes poor functional results and dissatisfaction. The aim of this study was to show that there could be a talus injury in patients with a tibial shaft fracture and to reveal occult talus lesions with magnetic resonance imaging (MRI) examination. Fifty-two patients with a tibial shaft fracture, with closed epiphyses, not extending to the joint and with no problems in the application of MRI examination were included. All patients underwent intramedullary tibial nailing. Patients with a lesion detected on MRI were planned to be examined by MRI again at mean of 12 months later. Ankle function of the patients were evaluated with the American Orthopaedic Foot and Ankle Society, Freiburg, and Weber scoring systems at 3, 6, and 12 months postoperatively. At the first MRI, 22 (42.3%) patients with tibial shaft fracture were found to have talus lesions: 7 (13.5%) had osteochondritis dissecans, 12 (23.1%) had edema, and 3 (5.8%) had cysts. A second MRI was planned for patients with edema and osteochondritis dissecans at a mean of 12 months. Finally, at 12 months, MRI examinations revealed osteochondritis dissecans and edema in 9 (17.3%) and 8 (15.4%) patients, respectively. In the evaluations of the patients according to the ankle scoring systems, the scores of the patients with pathology determined in the talus were significantly worse statistically than those of patients with no pathology determined at 3, 6, and 12 months postoperatively. Atalus lesion accompanied the tibial shaft fracture at a rate of 37%. The talus injuries were seen especially with an indirect mechanism of trauma, in distal third fractures, in spiral fractures, and when the tibial fracture was accompanied by a lateral malleolar fracture. In the presence of findings indicating talus injury in cases of tibial shaft fracture, the talus should be evaluated with ankle MRI.

Hand-Held Volatilome Analyzer Based on Elastically Deformable Nanofibers.

This study reports on a hand-held volatilome analyzer for selective determination of clinically relevant biomarkers in exhaled breath. The sensing platform is based on electrospun polymer nanofiber-multiwalled carbon nanotube (MWCNT) sensing microchannels. Polymer nanofibers of poly(vinylidene fluoride) (PVDF), polystyrene (PS), and poly(methyl methacrylate) (PMMA) incorporated with MWCNT exhibits a stable response to interferences of humidity and CO2 and provides selective deformations upon exposure of exhaled breath target volatilomes acetone and toluene, exhibiting correlation to diabetes and lung cancer, respectively. The sensing microchannels "P1" (PVDF-MWCNT), "P2" (PS-MWCNT), and "P3" (PMMA-MWCNT) are integrated with a microfluidic cartridge (µ-card) that facilitates collection and concentration of exhaled breath. The volatilome analyzer consists of a conductivity monitoring unit, signal conditioning circuitries and a low energy display module. A combinatorial operation algorithm was developed for analyzing normalized resistivity changes of the sensing microchannels upon exposure to breath in the concentration ranges between 35 ppb and 3.0 ppm for acetone and 1 ppb and 10 ppm for toluene. Subsequently, responses of volatilomes from individuals in the different risk groups of diabetes were evaluated for validation of the proposed methodology. We foresee that proposed methodology provides an avenue for rapid detection of volatilomes thereby enabling point of care diagnosis in high-risk group individuals.

Multitarget, quantitative nanoplasmonic electrical field-enhanced resonating device (NE2RD) for diagnostics.

Recent advances in biosensing technologies present great potential for medical diagnostics, thus improving clinical decisions. However, creating a label-free general sensing platform capable of detecting multiple biotargets in various clinical specimens over a wide dynamic range, without lengthy sample-processing steps, remains a considerable challenge. In practice, these barriers prevent broad applications in clinics and at patients' homes. Here, we demonstrate the nanoplasmonic electrical field-enhanced resonating device (NE(2)RD), which addresses all these impediments on a single platform. The NE(2)RD employs an immunodetection assay to capture biotargets, and precisely measures spectral color changes by their wavelength and extinction intensity shifts in nanoparticles without prior sample labeling or preprocessing. We present through multiple examples, a label-free, quantitative, portable, multitarget platform by rapidly detecting various protein biomarkers, drugs, protein allergens, bacteria, eukaryotic cells, and distinct viruses. The linear dynamic range of NE(2)RD is five orders of magnitude broader than ELISA, with a sensitivity down to 400 fg/mL This range and sensitivity are achieved by self-assembling gold nanoparticles to generate hot spots on a 3D-oriented substrate for ultrasensitive measurements. We demonstrate that this precise platform handles multiple clinical samples such as whole blood, serum, and saliva without sample preprocessing under diverse conditions of temperature, pH, and ionic strength. The NE(2)RD's broad dynamic range, detection limit, and portability integrated with a disposable fluidic chip have broad applications, potentially enabling the transition toward precision medicine at the point-of-care or primary care settings and at patients' homes.

Photonic crystals: emerging biosensors and their promise for point-of-care applications.

Biosensors are extensively employed for diagnosing a broad array of diseases and disorders in clinical settings worldwide. The implementation of biosensors at the point-of-care (POC), such as at primary clinics or the bedside, faces impediments because they may require highly trained personnel, have long assay times, large sizes, and high instrumental cost. Thus, there exists a need to develop inexpensive, reliable, user-friendly, and compact biosensing systems at the POC. Biosensors incorporated with photonic crystal (PC) structures hold promise to address many of the aforementioned challenges facing the development of new POC diagnostics. Currently, PC-based biosensors have been employed for detecting a variety of biotargets, such as cells, pathogens, proteins, antibodies, and nucleic acids, with high efficiency and selectivity. In this review, we provide a broad overview of PCs by explaining their structures, fabrication techniques, and sensing principles. Furthermore, we discuss recent applications of PC-based biosensors incorporated with emerging technologies, including telemedicine, flexible and wearable sensing, smart materials and metamaterials. Finally, we discuss current challenges associated with existing biosensors, and provide an outlook for PC-based biosensors and their promise at the POC.

Intraoperative rotation control in closed intramedullary nailing in tibia diaphyseal fractures: a prospective, randomised study.

The intraoperative determination of rotation in closed intramedullar nailing of tibial fractures is difficult. In this study, a more reliable method was used and it was a more practical means of checking rotation intra-operatively for tibia diaphysis fractures. 42 patients who presented with a unilateral tibia diaphyseal fracture. were randomly divided into two groups. In Group 1, the Intraoperative Rotation Control Method (IRCM) was used and compared with Group 2 as the control group. The Delta Rotation obtained from the MRI measurements were recorded and the Mean Delta Rotation (MDR) was obtained for each group separately. Malrotation was determined at a statistically significantly lower rate in Group 1. The MDR was statistically significantly lower in Group 1. This method does not require exposure to radiation like other radiological methods. Thus, the method used can be considered to be effective in the prevention of malrotation.

Emerging technologies for point-of-care management of HIV infection.

The global HIV/AIDS pandemic has resulted in 39 million deaths to date, and there are currently more than 35 million people living with HIV worldwide. Prevention, screening, and treatment strategies have led to major progress in addressing this disease globally. Diagnostics is critical for HIV prevention, screening and disease staging, and monitoring antiretroviral therapy (ART). Currently available diagnostic assays, which include polymerase chain reaction (PCR), enzyme-linked immunosorbent assay (ELISA), and western blot (WB), are complex, expensive, and time consuming. These diagnostic technologies are ill suited for use in low- and middle-income countries, where the challenge of the HIV/AIDS pandemic is most severe. Therefore, innovative, inexpensive, disposable, and rapid diagnostic platform technologies are urgently needed. In this review, we discuss challenges associated with HIV management in resource-constrained settings and review the state-of-the-art HIV diagnostic technologies for CD4(+) T lymphocyte count, viral load measurement, and drug resistance testing.

3D Breast Cancer Model on Silk Fibroin-Integrated Microfluidic Chips.

To imitate in vivo environment of cells, microfluidics offer controllable fashions at micro-scale and enable regulate flow-related parameters precisely, leveraging the current state of 3D systems to 4D level through the inclusion of flow and shear stress. In particular, integrating silk fibroin as an adhering layer with microfluidic chips enables to form more comprehensive and biocompatible network between cells since silk fibroin holds outstanding mechanical and biological properties such as easy processability, biocompatibility, controllable biodegradation, and versatile functionalization. In this chapter, we describe design and fabrication of a microfluidic chip, with silk fibroin-covered microchannels for the formation of 3D structures, such as MCF-7 (human breast cancer) cell spheroids as a model system. All the steps performed here are characterized by surface-sensitive tools and standard tissue culture methods. Overall, this strategy can be easily integrated into various high-tech application areas such as drug delivery systems, regenerative medicine, and tissue engineering in near future.

Monte Carlo simulation-guided design for size-tuned tumor spheroid formation in 3D printed microwells.

Tumor spheroid models have garnered significant attention in recent years as they can efficiently mimic in vivo models, and in addition, they offer a more controlled and reproducible environment for evaluating the efficacy of cancer drugs. In this study, we present the design and fabrication of a micromold template to form multicellular spheroids in a high-throughput and controlled-sized fashion. Briefly, polydimethylsiloxane-based micromolds at varying sizes and geometry were fabricated via soft lithography using 3D-printed molds as negative templates. The efficiency of spheroid formation was assessed using GFP-expressing human embryonic kidney 293 cells (HEK-293). After 7 days of culturing, circularity and cell viability of spheroids were >0.8 and 90%, respectively. At 1500 cells/microwell of cell seeding concentration, the spheroids were 454 ± 15 µm, 459 ± 7 µm, and 451 ± 18 µm when cultured in microwells with the diameters of 0.4, 0.6, and 0.8 µm, respectively. Moreover, the distance between each microwell and surfactant treatment before cell seeding notably impacted the uniform spheroid formation. The centrifugation was the key step to collect cells on the bottom of the microwells. Our findings were further verified using a commercial microplate. Furthermore, Monte Carlo simulation confirmed the seeding conditions where the spheroids could be formed. This study showed prominent steps in investigating spheroid formation, thereby leveraging the current know-how on the mechanism of tumor growth.

Acute on-chip HIV detection through label-free electrical sensing of viral nano-lysate.

Development of portable biosensors has broad applications in environmental monitoring, clinical diagnosis, public health, and homeland security. There is an unmet need for pathogen detection at the point-of-care (POC) using a fast, sensitive, inexpensive, and easy-to-use method that does not require complex infrastructure and well-trained technicians. For instance, detection of Human Immunodeficiency Virus (HIV-1) at acute infection stage has been challenging, since current antibody-based POC technologies are not effective due to low concentration of antibodies. In this study, we demonstrated for the first time a label-free electrical sensing method that can detect lysed viruses, i.e. viral nano-lysate, through impedance analysis, offering an alternative technology to the antibody-based methods such as dipsticks and Enzyme-linked Immunosorbent Assay (ELISA). The presented method is a broadly applicable platform technology that can potentially be adapted to detect multiple pathogens utilizing impedance spectroscopy for other infectious diseases including herpes, influenza, hepatitis, pox, malaria, and tuberculosis. The presented method offers a rapid and portable tool that can be used as a detection technology at the POC in resource-constrained settings, as well as hospital and primary care settings.

Effect of ozone therapy on neutrophil/lymphocyte, platelet/lymphocyte ratios, and disease activity in ankylosing spondylitis: a self-controlled randomized study.

This retrospective self-controlled randomized study was carried out with the participation of 53 patients diagnosed with ankylosing spondylitis according to the modified New York criteria. The patients who did not receive medical treatment or did not change their medical treatment within the last 6 months were included in the study. There was a statistically significant decrease in the patients' neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, monocyte/lymphocyte ratio, C-reactive protein, Visual Analog Scale, Bath Ankylosing Spondylitis Functional Index, and Bath Ankylosing Spondylitis Disease Activity Index scores measured after ozone therapy. There was a positive correlation between neutrophil/lymphocyte ratio, platelet/lymphocyte ratio, mean platelet volume/lymphocyte ratio, monocyte/lymphocyte ratio and C-reactive protein, Visual Analog Scale, Bath Ankylosing Spondylitis Functional Index, Bath Ankylosing Spondylitis Disease Activity Index before and after ozone therapy. Our study revealed that the changes in the decreasing tendency of the markers measured in complete blood count after ozone therapy were correlated with the disease activity, which can contribute to understand the effect of ozone therapy on biomarkers.