The impact of elective total hip and knee arthroplasty on physical performance in orthogeriatric patients: a prospective intervention study.

BACKGROUND: Osteoarthritis is a prevalent condition in older adults that leads to reduced physical function in many patients and ultimately requires hip or knee replacement. The aim of the study was to determine the impact of hip and knee arthroplasty on the physical performance of orthogeriatric patients with osteoarthritis. METHODS: In this prospective study, we used data from 135 participants of the ongoing Special Orthopaedic Geriatrics (SOG) trial, funded by the German Federal Joint Committee (GBA). Physical function, measured by the Short Physical Performance Battery (SPPB), was assessed preoperatively, 3 and 7 days postoperatively, 4-6 weeks and 3 months after hip and knee arthroplasty. For the statistical analysis, the Friedman test and post-hoc tests were used. RESULTS: Of the 135 participants with a mean age of 78.5 ± 4.6 years, 81 underwent total hip arthroplasty and 54 total knee arthroplasty. In the total population, SPPB improved by a median of 2 points 3 months after joint replacement (p < 0.001). In the hip replacement group, SPPB increased by a median of 2 points 3 months after surgery (p < 0.001). At 3 months postoperatively, the SPPB increased by a median of 1 point in the knee replacement group (p = 0.003). CONCLUSION: Elective total hip and knee arthroplasty leads to a clinically meaningful improvement in physical performance in orthogeriatric patients with osteoarthritis after only a few weeks. TRIAL REGISTRATION: This study is part of the Special Orthopaedic Geriatrics (SOG) trial, German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.

Special orthopaedic geriatrics (SOG) - a new multiprofessional care model for elderly patients in elective orthopaedic surgery: a study protocol for a prospective randomized controlled trial of a multimodal intervention in frail patients with hip and knee replacement.

BACKGROUND: Due to demographic change, the number of older people in Germany and worldwide will continue to rise in the coming decades. As a result, the number of elderly and frail patients undergoing total hip and knee arthroplasty is projected to increase significantly in the coming years. In order to reduce risk of complications and improve postoperative outcome, it can be beneficial to optimally prepare geriatric patients before orthopaedic surgery and to provide perioperative care by a multiprofessional orthogeriatric team. The aim of this comprehensive interventional study is to assess wether multimorbid patients can benefit from the new care model of special orthopaedic geriatrics (SOG) in elective total hip and knee arthroplasty. METHODS: The SOG study is a registered, monocentric, prospective, randomized controlled trial (RCT) funded by the German Federal Joint Committee (GBA). This parallel group RCT with a total of 310 patients is intended to investigate the specially developed multimodal care model for orthogeriatric patients with total hip and knee arthroplasty (intervention group), which already begins preoperatively, in comparison to the usual orthopaedic care without orthogeriatric co-management (control group). Patients ≥70 years of age with multimorbidity or generally patients ≥80 years of age due to increased vulnerability with indication for elective primary total hip and knee arthroplasty can be included in the study. Exclusion criteria are age < 70 years, previous bony surgery or tumor in the area of the joint to be treated, infection and increased need for care (care level ≥ 4). The primary outcome is mobility measured by the Short Physical Performance Battery (SPPB). Secondary outcomes are morbidity, mortality, postoperative complications, delirium, cognition, mood, frailty, (instrumental) activities of daily living, malnutrition, pain, polypharmacy, and patient reported outcome measures. Tertiary outcomes are length of hospital stay, readmission rate, reoperation rate, transfusion rate, and time to rehabilitation. The study data will be collected preoperative, postoperative day 1 to 7, 4 to 6 weeks and 3 months after surgery. DISCUSSION: Studies have shown that orthogeriatric co-management models in the treatment of hip fractures lead to significantly reduced morbidity and mortality rates. However, there are hardly any data available on the elective orthopaedic care of geriatric patients, especially in total hip and knee arthroplasty. In contrast to the care of trauma patients, optimal preoperative intervention is usually possible. TRIAL REGISTRATION: German Clinical Trials Register DRKS00024102. Registered on 19 January 2021.

[Hallux saltans-rare diagnosis, often overlooked]. / Hallux saltans ­ seltene Diagnose, oft übersehen.

Hallux saltans is similar to digitus saltans and produces a spontaneous "snapping" of the big toe. This results in a constriction of the flexor hallucis longus tendon within the osteofibrous retromalleolar canal. The diagnosis was first described in 1940, and only a few case reports exist. We present the diagnosis and the treatment of a patient and give a review of the literature.

Animal experimental investigation on the efficacy of antibiotic therapy with linezolid, vancomycin, cotrimoxazole, and rifampin in treatment of periprosthetic knee joint infections by MRSA.

AIMS: Periprosthetic joint infections (PJIs) are rare, but represent a great burden for the patient. In addition, the incidence of methicillin-resistant Staphylococcus aureus (MRSA) is increasing. The aim of this rat experiment was therefore to compare the antibiotics commonly used in the treatment of PJIs caused by MRSA. METHODS: For this purpose, sterilized steel implants were implanted into the femur of 77 rats. The metal devices were inoculated with suspensions of two different MRSA strains. The animals were divided into groups and treated with vancomycin, linezolid, cotrimoxazole, or rifampin as monotherapy, or with combination of antibiotics over a period of 14 days. After a two-day antibiotic-free interval, the implant was explanted, and bone, muscle, and periarticular tissue were microbiologically analyzed. RESULTS: Vancomycin and linezolid were able to significantly (p < 0.05) reduce the MRSA bacterial count at implants. No significant effect was found at the bone. Rifampin was the only monotherapy that significantly reduced the bacterial count on implant and bone. The combination with vancomycin or linezolid showed significant efficacy. Treatment with cotrimoxazole alone did not achieve a significant bacterial count reduction. The combination of linezolid plus rifampin was significantly more effective on implant and bone than the control group in both trials. CONCLUSION: Although rifampicin is effective as a monotherapy, it should not be used because of the high rate of resistance development. Our animal experiments showed the great importance of combination antibiotic therapies. In the future, investigations with higher case numbers, varied bacterial concentrations, and changes in individual drug dosages will be necessary to be able to draw an exact comparison, possibly within a clinical trial. Cite this article: Bone Joint Res 2022;11(3):143-151.

[Treatment decision for femoroacetabular impingement syndrome : Differential diagnostic considerations and the introduction of a stage concept for treatment]. / Therapieentscheid beim Femoroazetabulären Impingement-Syndrom : Differenzialdiagnostische Erwägungen und Vorstellung eines Stufenkonzeptes für die Therapie.

Anamnestic findings, clinical examination and radiological findings are presented, as well as thoughts for differential diagnosis and the introduction of a stage concept for treatment. The treatment of FAI is based on a patient's individual symptoms, the clinical examination and radiological findings. The procedure depends on a number of facts. Individual conditions have to be considered, and the procedure needs to follow principal rules. Therefore, we propose a standard for treatment, which ranges from purely conservative measurements to extensive surgery.

Three-dimensional acetabular orientation during periacetabular osteotomy: a video analysis of acetabular rim position using an external fixator as navigation tool during reorientation procedure.

INTRODUCTION: Bernese periacetabular osteotomy is an effective procedure for treating acetabular dysplasia. However, limited visual control of the acetabular position during surgery may result in under- or overcorrection with residual dysplasia or femoroacetabular impingement. Thus, we wanted to find a simple method to control the effect of correction in the sagittal and coronal plane. METHOD: The acetabular coordinates are shown by two perpendicular tubes of an external fixator mounted onto a third tube that is fixed to the acetabular fragment with two Schanz screws. This method enables the isolated acetabular reorientation in the coronal, sagittal, and transverse plane. In a sawbone pelvis model, the acetabular rim is marked with a copper wire and a silicon adherent. To show the radiographic effect on acetabular parameters and the rim position, we visualized correction in the coronal and sagittal plane under fluoroscopic control. RESULTS: Lateral rotation of the acetabular fragment had the highest impact on radiographic lateral coverage of the femoral head. But also ventral coverage increased during isolated lateral rotation. Anterior rotation showed almost no effect on lateral coverage and just a little effect on ventral coverage but caused severe total acetabular retroversion. CONCLUSION: Three-dimensional control of the acetabular orientation during periacetabular osteotomy is important to avoid over- and under-correction. Isolated lateral rotation of the acetabular fragment should be the predominant direction of correction during periacetabular osteotomy. Ambitious anterior correction may be the main source for severe acetabular retroversion following periacetabular osteotomy.

Hospital Frailty Risk Score predicts adverse events in revision total hip and knee arthroplasty.

INTRODUCTION: The Hospital Frailty Risk Score (HFRS) is a validated risk stratification model referring to the cumulative deficits model of frailty. The purpose of this study was to evaluate the HFRS as a predictor of 90-day readmission and complications after revision total hip (rTHA) and knee (rTKA) arthroplasty. METHODS: In a retrospective analysis of 565 patients who had undergone rTHA or rTKA between 2011 and 2019, the HFRS was calculated for each patient. Rates of adverse events were compared between patients with low and intermediate or high frailty risk. Multivariable logistic regression models were used to assess the relationship between the HFRS and post-operative adverse events. RESULTS: Patients with intermediate or high frailty risk showed higher rates of readmission (30days: 23.8% vs. 9.9%, p = 0.006; 90days: 26.2% vs. 13.0%, p < 0.018), surgical complications (28.6% vs. 7.8%, p < 0.001), medical complications (11.9% vs. 1.0%, p < 0.001), other complications (28.6% vs. 2.3%, p < 0.001), Clavien-Dindo grade IV complications (14.3% vs. 4.8%, p = 0.009), and transfusion (33.3% vs. 6.1%, p < 0.001). Multivariable logistic regression analyses revealed a high HFRS as independent risk factor for surgical complications (OR = 3.45, 95% CI 1.45-8.18, p = 0.005), medical complications (OR = 7.29, 95% CI 1.72-30.97, p = 0.007), and other complications (OR = 14.15, 95% CI 5.16-38.77, p < 0.001). CONCLUSION: The HFRS predicts adverse events after rTHA and rTKA. As it derives from routinely collected data, the HFRS could be implemented automated in hospital information systems to facilitate identification of at-risk patients.

[Hygiene measures against COVID-19 in routine outpatient care : Acceptance by the patients?] / Hygienemaßnahmen bezüglich COVID-19 in der ambulanten Versorgung : Akzeptanz durch die Patienten?

BACKGROUND: To reduce the risk of SARS-CoV­2 infections, special hygiene measures apply to all German healthcare facilities. Despite the national goals and the existence of comprehensive testing for the detection of asymptomatic or presymptomatic SARS-CoV­2 infections in all inpatients, no equivalent screening with rapid antigen tests has yet been established for outpatients. The acceptance of such screening with associated waiting times and inconvenience for affected patients has been insufficiently investigated. OBJECTIVE: We performed a self-administered anonymous survey of outpatients on their willingness to comply with the hygiene requirements, to undergo rapid antigen screening tests for asymptomatic/presymptomatic infections with SARS-CoV­2 and to receive SARS-CoV­2 vaccination. RESULTS: From 7 to 15 December 2020, 534 patients completed the survey, 195 (37%) from rheumatism and 339 (63%) from orthopedic outpatient clinics. Most patients accepted wearing a mouth-nose covering (475/534, 89%) and attending clinics without an accompanying person to prevent overcrowding of the waiting areas (450/534, 84%). A large majority (428/534 patients, 80%) accepted mandatory screening with rapid antigen tests and the associated waiting time of 15-20 min outside the hospital (449/534, 84%). More than half of the responders reported willingness to receive a SARS-CoV­2 vaccination (yes, immediately 137 (26%), yes, maybe 142 (27%) patients), with significantly (p < 0.05) more male, more rheumatic and more patients older than 60 years indicating a wish to be vaccinated. CONCLUSION: The results revealed a high acceptance of COVID-19 hygiene measures including initial screening by rapid antigen testing.

Matched-Pair Analysis of Local Infiltration Analgesia in Total Knee Arthroplasty: Patient Satisfaction and Perioperative Pain Management in 846 Cases.

In the recent past, numerous studies evaluating local infiltration analgesia (LIA) with controversial results have been reported. Efforts have been made to improve patients' outcome regarding operation techniques and material, as well as pain management and anesthetic methods. In this study, postoperative pain management and patient satisfaction were evaluated in patients undergoing total knee replacement surgery with or without intraoperative LIA. Within the context of the "Quality Improvement in Postoperative Pain Management" (QUIPS) project, parameters were collected on the first postoperative day. All patients included in this study underwent primary knee replacement surgery with general anesthesia. Parameters were compared after performing a 1:1 matched-pair analysis within 14 orthopaedic departments. Pain levels and pain management satisfaction were measured using the numerous rating scales, and pain medication use was compared. From 2010 to 2015, 2,789 patients who underwent primary knee arthroplasty with general anesthesia were evaluated within the project, of whom a total of 846 patients could be compared after performing a matched-pair analysis. Pain scores were significantly better in the LIA group (p = 0.019 for activity pain, p = 0.043 for maximum pain, p < 0.001 for minimum pain), but pain management satisfaction was not superior (p = 0.083). Patients with LIA required less opioids in the recovery room (p = 0.048), while nonopioid medication did not differ significantly (p = 0.603). At the ward, 24 hours postoperatively, no significant difference in the use for nonopioids (p = 0.789) could be measured, whereas patients in the LIA group received significantly more opioids (p < 0.001). Although LIA achieved improvement in pain score outcome, and a comparable patient satisfaction level in the immediate postoperative course, the use of LIA in knee arthroplasty, controversially discussed in the current literature, was not able to reduce the need for opioid pain medication in this study.

The final implant position of a commonly used collarless straight tapered stem design (Corail®) does not correlate with femoral neck resection height in cement-free total hip arthroplasty: a retrospective computed tomography analysis.

BACKGROUND: In total hip arthroplasty, inadequate femoral component positioning can be associated with instability, impingement and component wear and subsequently with patient dissatisfaction. In this study, we investigated the influence of femoral neck resection height on the final three-dimensional position of a collarless straight tapered stem (Corail®). We asked two questions-(1) is neck resection height correlated with version, tilt, and varus/valgus alignment of the femoral component, and (2) dependent on the resection height of the femoral neck, which area of the stem comes into contact with the femoral cortical bone? MATERIALS AND METHODS: Three-dimensional computed tomography scans of 40 patients who underwent minimally invasive, cementless total hip arthroplasty were analyzed retrospectively. We analyzed the relationship between femoral neck resection height and three-dimensional alignment of the femoral implant, as well as the contact points of the implant with the femoral cortical bone. This investigation was approved by the local Ethics Commission (No.10-121-0263) and is a secondary analysis of a larger project (DRKS00000739, German Clinical Trials Register May-02-2011). RESULTS: Mean femoral neck resection height was 10.4 mm (± 4.8) (range 0-20.1 mm). Mean stem version was 8.7° (± 7.4) (range - 2° to 27.9°). Most patients had a varus alignment of the implant. The mean varus/valgus alignment was 1.5° (± 1.8). All 40 patients (100%) had anterior tilt of the implant with a mean tilt of 2.2° (± 1.6). Femoral neck resection height did not correlate with stem version, varus/valgus alignment, or tilt. Independent from femoral neck resection height, in most patients the implant had contact with the ventral and ventromedial cortical bone in the upper third (77.5%) and the middle third (52.5%). In the lower third, the majority of the implants had contact with the lateral and dorsolateral cortical bone (92.5%). CONCLUSION: Femoral neck resection height ranging between 0 and 20.1 mm does not correlate with the final position of a collarless straight tapered stem design (Corail®). LEVEL OF EVIDENCE: Level 3.

Course of pain after total hip arthroplasty within a standardized pain management concept: a prospective study examining influence, correlation, and outcome of postoperative pain on 103 consecutive patients.

INTRODUCTION: Postoperative pain management options are of great importance for patients undergoing total hip arthroplasty, as joint replacement surgery is reported to be one of the most painful surgical procedures. This study demonstrates pain outcome until 4 weeks postoperatively and evaluates factors influencing pain in the postoperative course after total hip arthroplasty. MATERIALS AND METHODS: A total of 103 patients were included in this prospective cohort trial and underwent total hip arthroplasty. Postoperative pain was described using a numerical rating scale (NRS); demographic data and perioperative parameters were correlated with postoperative pain. RESULTS: Evaluation of pain scores in the postoperative course showed a constant decrease in the first postoperative week (mean NRS 3.1 on day 1 to mean NRS 2.3 on day 8) and, then, a perpetual increase for 3 days (mean NRS 2.6 on day 9 to mean NRS 2.3 on day 12). Afterwards, a continuous pain-level decrease was stated (continuous to a mean NRS 0.9 on day 29). No correlation was found between the potential influencing factors sex, age, body mass index, duration of surgery, ASA score, and postoperative pain levels, but a high significant correlation could be stated for preoperative pain levels and postoperative pain intensity (pain while moving p < 0.02 to p < 0.05 depending on the time period "week 1 postoperatively", "week 2-4", or "week 1-4"; pain while resting p < 0.001, in all the measured time intervals, respectively). CONCLUSION: Increasing pain levels after the first week postoperatively, for 3 days, are most likely to be caused by the change to more extensive mobilization and physiotherapy in the rehabilitation unit. No significant influence or correlation on the intensity of postoperative pain could be found while evaluating potential predictors except preoperative pain levels. Pain management has to take these findings into account in the future to further increase patients' satisfaction in the postoperative course after total hip arthroplasty and to adapt pain management programs.

Multicenter cohort-study of 15326 cases analyzing patient satisfaction and perioperative pain management: general, regional and combination anesthesia in knee arthroplasty.

Numbers of knee replacement surgeries have been rising over the past years. After having ameliorated operation techniques and material, pain management and anesthetic methods have come into focus. All 15326 patients included had undergone primary knee arthroplasty within this multicenter cohort-study, conducted in 46 orthopedic departments. Parameters were evaluated on first postoperative day. Primary outcome values were pain levels (activity, minimum and maximum pain, and pain management satisfaction). Pain medication necessity was analyzed. Parameters were compared between the types of anesthesia used: general, regional and combination anesthesia. Pain scores and pain management satisfaction were significantly better in the groups of either spinal or peripheral anesthesia combined with general anesthesia (p < 0.001, respectively). Patients who received the combination of general and spinal anesthesia were associated with the lowest need for opioids (p < 0.001). The use of a combined general and spinal anesthesia as well as using a combination of general and peripheral anesthesia in knee arthroplasty was associated with a highly significant advantage to other anesthetic techniques regarding perioperative pain management in daily clinical practice, but maybe below clinical relevance. Furthermore they were associated with positive tendency considering side effects and subjective well-being parameters.

Efficiency and predictive parameters of outcome of a multimodal pain management concept with spinal injections in patients with low back pain: a retrospective study of 445 patients.

Low back pain is one of the most common diseases of modern civilization. Multimodal pain management (MPM) represents a central approach to avoiding surgery. Short-term results are published rarely and often incomparable because of different treatment concepts. This study compared the subjective and objective parameters as well as the anamnestic and clinical parameters of 445 patients with low back pain before and after inpatient MPM to investigate the influence of this type of therapy on short-term outcome. The majority of patients were very satisfied (39%) or satisfied (58%) with the treatment outcome. The median pain reduction for back pain was 3.0 (IQR 2.88) (numeric rating scale, NRS), thus 66% and 2.75 (IQR 3.38, 62%) for leg pain. The main pain reduction occurred within the first 10 days of treatment and was clinically significant from day 5 onwards. The outcome for patients with hospitalization of more than 10 days was significantly worse. The parameters female sex, BMI of > 30, local pain, and pain duration of 3-24 months had a significantly better outcome. In contrast, age, treatment cause, depression, anxiety, and other diseases had no statistically significant influence on outcome. MPM therapy for more than 5 days seems to be an efficient short-term approach to treating low back pain. Knowledge of some of the outcome predictors helps to early identify patients who require more intensive individual care. In the case of no clear indication for surgery, MPM can be an appropriate treatment option.

Predictors of Outcome After Primary Total Joint Replacement.

BACKGROUND: Total hip and knee replacements are frequently performed curative treatment options in end-stage arthritis. In this study, we analyzed clinical outcome, complications, and predictors of outcome in modern joint replacement. METHODS: In a retrospective analysis of over 2000 primary total hip and knee replacements from our institutional joint registry, responder rates for positive outcome as defined by the OMERACT-OARSI criteria, postoperative complication rates, and patient-reported outcome measures (EQ-5D, WOMAC) within the first year were compared between hip and knee replacements. Furthermore, preoperative risk factors associated with nonresponder rate were evaluated. RESULTS: Positive responder rate was higher for hip replacements with 92.8% (1145/1234) than for knee replacements with 86.1% (839/975, P < .001). Infection rates were lower (P = .04), whereas intraoperative fracture occurred more frequently (P = .001) in hip than in knee replacements. Patient-reported outcome measures 1 year after surgery were higher in hip than in knee replacements with EQ-5D (0.88 ± 0.17 to 0.81 ± 0.19, P < .001) and WOMAC (84.58 ± 16.73 to 74.31 ± 18.94, P < .001). Besides the type of joint replacement (hazard ratio [HR] 2.0, P < .001), high preoperative outcome measures (HR 7.4, P < .001) and male gender (HR 1.4, P = .05) were independent risk factors of nonresponders after joint replacement. CONCLUSION: Both total hip and knee replacements are safe procedures with low complication rates. Still, postoperative outcome is higher in hip than in knee arthroplasty. High preoperative clinical scores are a risk factor for poor clinical improvement following total joint replacement and can be used in counseling patients in the office.

Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA - An Experimental Study.

Purpose Accurate assessment of cup orientation on postoperative pelvic radiographs is essential for evaluating outcome after THA. Here, we present a novel method for correcting measurement inaccuracies due to pelvic tilt and rotation. Method In an experimental setting, a cup was implanted into a dummy pelvis, and its final position was verified via CT. To show the effect of pelvic tilt and rotation on cup position, the dummy was fixed to a rack to achieve a tilt between + 15° anterior and -15° posterior and 0° to 20° rotation to the contralateral side. According to Murray's definitions of anteversion and inclination, we created a novel corrective procedure to measure cup position in the pelvic reference frame (anterior pelvic plane) to compensate measurement errors due to pelvic tilt and rotation. Results The cup anteversion measured on CT was 23.3°; on AP pelvic radiographs, however, variations in pelvic tilt (±â€Š15°) resulted in anteversion angles between 11.0° and 36.2° (mean error 8.3°±â€Š3.9°). The cup inclination was 34.1° on CT and ranged between 31.0° and 38.7° (m. e. 2.3°±â€Š1.5°) on radiographs. Pelvic rotation between 0° and 20° showed high variation in radiographic anteversion (21.2°-31.2°, m. e. 6.0°±â€Š3.1°) and inclination (34.1°-27.2°, m. e. 3.4°±â€Š2.5°). Our novel correction algorithm for pelvic tilt reduced the mean error in anteversion measurements to 0.6°±â€Š0.2° and in inclination measurements to 0.7° (SD±â€Š0.2). Similarly, the mean error due to pelvic rotation was reduced to 0.4°±â€Š0.4° for anteversion and to 1.3°±â€Š0.8 for inclination. Conclusion Pelvic tilt and pelvic rotation may lead to misinterpretation of cup position on anteroposterior pelvic radiographs. Mathematical correction concepts have the potential to significantly reduce these errors, and could be implemented in future radiological software tools. Key Points · Pelvic tilt and rotation influence cup orientation after THA. · Cup anteversion and inclination should be referenced to the pelvis. · Radiological measurement errors of cup position may be reduced by mathematical concepts. Citation Format · Schwarz TJ, Weber M, Dornia C et al. Correction of Pelvic Tilt and Pelvic Rotation in Cup Measurement after THA - An Experimental Study. Fortschr Röntgenstr 2017; 189: 864 - 873.

Increased choline uptake in macrophages and prostate cancer cells does not allow for differentiation between benign and malignant prostate pathologies.

INTRODUCTION: Inflammatory cells may contribute to the choline uptake in different prostate pathologies. The aim of this study was (i) to assess if inflammatory cells incorporate choline and (ii) to potentially detect differences compared to FDG uptake. Therefore we investigated the uptake of [(3)H]choline and [(18)F]FDG in human prostate carcinoma cells and human inflammatory cells. METHODS: Macrophages were cultured from isolated mononuclear cells, gained by density gradient centrifugation of human buffy coats. T-lymphocytes, B-lymphocytes and granulocytes were enriched by density gradient centrifugation before cell sorting by means of flow cytometry was performed. [(3)H]choline and [(18)F]FDG uptake of isolated inflammatory cells as well as of LNCaP and PC-3 human prostate carcinoma cells was assessed simultaneously in dual tracer uptake experiments. RESULTS: Macrophages showed highest [(3)H]choline and [(18)F]FDG uptake compared to the tracer uptake rates of leukocytes. [(3)H]choline uptake of macrophages was in the same range as in prostate cancer cells. Lipopolysaccharide stimulation of macrophages resulted in an increase of [(18)F]FDG uptake in macrophages, but not in an increased [(3)H]choline uptake. CONCLUSIONS: The high [(3)H]choline uptake in macrophages may be a source of false-positive PET results in diagnosis of prostate cancer by choline-PET/CT. As already known from FDG-PET, discrimination between tumor and inflammation in prostate cancer patients is not possible via choline-PET. ADVANCES IN KNOWLEDGE AND IMPLICATIONS FOR PATIENT CARE: The application of choline-PET for reliable primary prostate cancer detection and delineation has to be queried.

Analytical method and interlaboratory study for the quantitation of aminocyclopyrachlor residues in vegetation by liquid chromatography/tandem mass spectrometry.

The quick, easy, cheap, effective, rugged, and safe (QuEChERS) and the U.S. Food and Drug Administration pesticide multiresidue methods were systematically tested for the analysis of aminocyclopyrachlor, a new synthetic auxin herbicide. Results revealed that these procedures are not suitable, highlighting the need for a publicly available residue method for this new active ingredient. Such a method has been developed and is reported herein for aminocyclopyrachlor residue analysis in vegetation, including white pine, Norway spruce, grass forage, and grass hay. Aminocyclopyrachlor residues were purified from plant tissue extracts by filtration through SPE cartridges with strong anion exchange stationary phases and analyzed using LC/MS/MS. This method was validated at five laboratories across the United States; their results were compared to evaluate reproducibility and ruggedness. The method LOQ was 0.01 mg/kg (ppm) and the LOD 0.003 mg/kg (ppm) for the matrixes tested. A qualitative procedure to confirm the molecular identity of residues based on retention time measurements and ion transition peak area ratios (m/z 214 --> 681m/z 214 --> 101) is also presented.

QuEChERS multiresidue method validation and mass spectrometric assessment for the novel anthranilic diamide insecticides chlorantraniliprole and cyantraniliprole.

The gas-phase dissociation reactions of chlorantraniliprole (Rynaxypyr) and cyantraniliprole (Cyazypyr) have been studied in triple-quadrupole, ion trap, and orbitrap mass spectrometers equipped with electrospray and desorption electrospray ion sources, revealing the formation of odd-electron fragment ions, the structures of which were elucidated. The odd-electron fragments were unusually abundant, and their formation is proposed to occur via a tricyclic intermediate. The applicability of the QuEChERS multiresidue method for the quantitation of chlorantraniliprole and cyantraniliprole was also assessed in this study. Four matrices representative of oily, watery, acidic, and dry crop groups were tested, with a targeted limit of quantitation (LOQ) of 0.01 mg/kg. Average recoveries ranged between 87 and 107%, with relative standard deviations (RSD) of ≤ 8%. Linear calibration functions with correlation coefficients r > 0.99 were obtained. The study provides an expansion of the QuEChERS method to include anthranilic diamides and a mass spectrometric assessment for these two novel agrochemical active ingredients.