MRI does not effectively diagnose ulnar-sided wrist pain in elite tennis players.

OBJECTIVES: Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players using a double-handed backhand technique. This study investigated the radiological changes of the non-dominant wrist in elite symptomatic and asymptomatic players using this technique as well as healthy controls. We compared clinical findings to radiological abnormalities. DESIGN: Cross-sectional design with blinded radiological assessment, and contemporaneous clinical assessment of symptomatic players. METHODS: Magnetic resonance images (MRI) of wrists related to non-dominant ulnar-sided pain, were taken in 14 symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls which were then independently reviewed for abnormalities by blinded radiologists. Total abnormalities and global between-group differences in the triangular fibrocartilage complex (TFC), ulnar collateral ligament (UCL), extensor carpi ulnaris (ECU) and supporting structures, osseous-articular lesions and ganglia were assessed. These were then compared to clinical examinations of the symptomatic players to assess agreement. RESULTS: Symptomatic players reported a mean 3.64 abnormalities, being exactly 1 abnormality greater than asymptomatic players (2.64) and controls (2.50), suggesting similar asymptomatic lesions in all three groups. Players with pain reported significantly more osseous-articular lesions, ECU tendon and dorsal radio-ulnar ligament abnormalities, while changes to the UCL may reflect an isolated problem in specific wrists. There were no between-group differences in the presence of ganglia, most TFC structures nor ECU subsheath tear and subluxation. CONCLUSIONS: Clinicians should carefully consider radiological changes alongside their clinical diagnosis of non-dominant wrist pain in tennis players due to possible tennis-related changes and/or asymptomatic findings.

Do magnetic resonance imaging abnormalities of the non-dominant wrist correlate with ulnar-sided wrist pain in elite tennis players?

OBJECTIVE: Ulnar-sided injuries of the non-dominant wrist are common in elite tennis players that use the double-handed backhand technique. This study aimed to define the relationship between ulnar-sided wrist pain in symptomatic and asymptomatic elite tennis players, and the presence of abnormalities on magnetic resonance imaging (MRI). MATERIALS AND METHODS: Fourteen symptomatic tennis players, 14 asymptomatic tennis players, and 12 healthy controls who did not play tennis, were analyzed prospectively, after undergoing MRI of their non-dominant wrist. Five anatomical regions were analyzed, thought to relate to ulnar-sided wrist pain. These consisted of the triangular fibrocartilage complex (TFCC), ulnar collateral ligament (UCL), extensor carpi ulnaris tendon (ECU), osseous-articular structures, and ganglia. Images were independently reviewed by two blinded musculoskeletal radiologists. RESULTS: Non-dominant, ulnar-sided, wrist pain in elite tennis players was not statistically significantly associated with an increased number of MRI abnormalities when compared with asymptomatic tennis players (p > 0.05). However, some evidence of statistical association was seen with an increased prevalence of ECU tendon abnormalities (OR = 8.0, 95% CI = (0.74, 20.00), p = 0.07). A statistically significant increase in MRI abnormalities of osseous structures (OR = 15.1, 95% CI = (1.56, 656.05), p = 0.02) and the dorsal radioulnar ligament (DRUL) (OR = 12.5, 95% CI = (2.15, 111.11), p = 0.03), was observed in symptomatic players compared with controls. CONCLUSIONS: Non-dominant, ulnar-sided, wrist pain in a subgroup of elite tennis players using a double-handed backhand technique is not associated with a statistically significant increased prevalence of MRI abnormalities when compared with asymptomatic tennis players, other than some evidence of statistical association with ECU tendon abnormalities. Therefore, significance of MRI abnormalities should be interpreted in the context of clinical findings.

Electrochemical assessment of water|ionic liquid biphasic systems towards cesium extraction from nuclear waste.

A room temperature ionic liquid (IL) composed of a quaternary alkylphosphonium (trihexyltetradecylphosphonium, P66614(+)) and tetrakis(pentafluorophenyl)borate anion (TB(-)) was employed within a water|P66614TB (w|P66614TB or w|IL) biphasic system to evaluate cesium ion extraction in comparison to that with a traditional water|organic solvent (w|o) combination. (137)Cs is a major contributor to the radioactivity of spent nuclear fuel as it leaves the reactor, and its extraction efficiency is therefore of considerable importance. The extraction was facilitated by the ligand octyl(phenyl)-N,N'-diisobutylcarbamoylphosphine oxide (CMPO) used in TRans-Uranium EXtraction processes and investigated through well established liquid|liquid electrochemistry. This study gave access to the metal ion to ligand (1:n) stoichiometry and overall complexation constant, ß, of the interfacial complexation reaction which were determined to be 1:3 and 1.6×10(11) at the w|P66614TB interface while the study at w|o elicited an n equal to 1 with ß equal to 86.5. Through a straightforward relationship, these complexation constant values were converted to distribution coefficients, δ(α), with the ligand concentrations studied for comparison to other studies present in the literature; the w|o and w|IL systems gave δ(α) of 2 and 8.2×10(7), respectively, indicating a higher overall extraction efficiency for the latter. For the w|o system, the metal ion-ligand stoichiometries were confirmed through isotopic distribution analysis of mass spectra obtained by the direct injection of an emulsified water-organic solvent mixture into an electron spray ionization mass spectrometer.

Correlation of stoichiometries for Rb+ extraction determined by mass spectrometry and electrochemistry at liquid|liquid interfaces.

The electrochemical extraction of rubidium at micro water|1,2-dichloroethane (w|DCE) and water|room-temperature ionic liquid (w|RTIL) interfaces housed at the tip of a 25-µm capillary using octyl(phenyl)-N,N-diisobutylcarbamoylmethylphosphine oxide (CMPO) in the TRans Uranic EXtraction (TRUEX) process, was examined. Rubidium is of great interest in a modern spent nuclear fuel cycle as well as toward myocardial perfusion imaging utilizing (82)Sr/(82)Rb isotopic generators. The ligand-to-metal stoichiometry (n:1) and overall complexation constant (ß) for interfacial complexation reactions induced by an applied potential were determined by the interfacial electrochemistry. One stoichiometry, n = 2, was observed at the w|DCE interface with ß = 3.3 × 10(4). In the w|RTIL system, two rubidium salt solutions were employed: RbNO(3) and RbNO(3) plus Rb(2)SO(4). The former demonstrated a stoichiometry of n = 2 and ß = 2.4 × 10(6), while the latter showed n = 4 and ß = 3.3 × 10(12). These stoichiometries of the reaction were confirmed by electrospray ionization mass spectrometry, using an emulsion generated by shaking water and DCE phases containing the dissolved metal and ligand, respectively. Both RbCMPO(+) and RbCMPO(2)(+) complexes were observed. The influence of ion pair interactions in this system will be discussed.

Formal and informal care utilisation amongst elderly persons with visual impairment.

OBJECTIVE: To examine the determinants of formal and informal care utilisation amongst persons with age-related macular degeneration (AMD). DESIGN: Cross-sectional hospital-based study. SETTING: Hospital eye clinic in Northern Ireland. PARTICIPANTS: 284 persons aged >or=50 years. MAIN OUTCOME MEASURES: Participants were questioned about their care, living arrangements, eyesight-related ability to self-care, and eyesight-related need to be more careful whilst undertaking everyday tasks. RESULTS: The percentage of older persons receiving formal and informal care rose with the level of visual impairment. 34.9% and 37.3% of those with no visual impairment received formal and informal care, respectively, compared with 51.6% and 69.9% of those with moderate visual impairment and 55.6% and 88.9% of those with severe visual impairment. Three factors (age, best corrected distance visual acuity in the better eye and living alone) were significant predictors (p<0.05) of care utilisation. The likelihood of someone utilising formal care rose with increasing age, severity of visual impairment and living alone. There is an approximate one-to-one trade-off between age and visual acuity such that a difference of one line of vision is equivalent to approximately 1 year of life to the affected individual as regards its impact on the probability of care utilisation. CONCLUSIONS: Care utilisation is predicted by age, visual acuity in the better eye and living arrangement. These findings question the validity of the current practice of defining the need for statutory services on the basis of visual acuity alone. These data may have implications for cost utility analyses of new therapeutic developments in macular degeneration.