MSH-5: malignant knee tumors timely detection index.

BACKGROUND: Bone neoplasms are usually misdiagnosed causing a delay in their treatment. Bone neoplasms are usually confused with tendinitis, 31% of the cases corresponds to osteosarcomas and in 21% to Ewing's sarcomas. OBJECTIVE: To create a clinical-radiographic instrument of high diagnostic suspicion of knee bone neoplasms to prevent a delay in diagnosis. METHOD: A clinimetric study (sensitivity, consistency and validity) was performed in the bone tumor service, Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, in México City. RESULTS: Characteristics of 153 patients were collected. For the sensitivity phase, 3 domains (signs, symptoms, and radiology) and 12 items were included. Consistency was evaluated with ICC (0.944), 95%CI (0.865-0.977), p < 0.001 and a-Cronbach (0.863). Index obtained a sensitivity of 0.80 and a specificity of 0.882 were obtained. The positive predictive value of the test was 66.6% and the negative predictive value was 93.75%. The positive likelihood ratio was 6.8 and the negative likelihood ratio was 0.2. Validity was evaluated using r-Pearson (0.894; p < 0.001). CONCLUSIONS: A high suspicion clinical-radiographic index was designed to detect malignant knee tumors with adequate sensitivity, specificity, appearance, content, criteria, and construct validity.

ANTECEDENTES: Los tumores óseos suelen ser subdiagnosticados, provocando un retraso en su tratamiento. El diagnóstico erróneo más frecuente es tendinitis, en el cual el 31% corresponden a osteosarcomas y el 21% a sarcomas de Ewing. OBJETIVO: Crear un instrumento clínico-radiográfico de alta sospecha diagnóstica de tumores óseos de rodilla. MÉTODO: Se realizó un estudio clinimétrico (sensibilidad, consistencia y validez) en el servicio de tumores óseos del Hospital de Ortopedia de la Unidad Médica de Alta Especialidad Dr. Victorio de la Fuente Narváez, Instituto Mexicano del Seguro Social, en Ciudad de México. RESULTADOS: El índice se realizó tomando las características de 153 pacientes. Para la fase de sensibilidad se incluyeron tres dominios (signos, síntomas y radiología) y 12 ítems. La consistencia se evaluó con coeficiente de correlación intraclase (0.944), intervalo de confianza del 95% (0.865-0.977), p < 0.001 y α de Cronbach (0.863). Se obtuvo una sensibilidad del instrumento de 0.80 y una especificidad de 0.882. El valor predictivo positivo de la prueba fue del 66.6% y el valor predictivo negativo fue de 93.75%. La razón de verosimilitud positiva fue de 6.8 y la razón de verosimilitud negativa fue de 0.2. La validez se evaluó mediante r-Pearson (0.894; p < 0.001). CONCLUSIONES: Se diseñó un índice clínico-radiográfico de alta sospecha para detectar tumores malignos de rodilla con adecuada sensibilidad, especificidad y validez de apariencia, de contenido, de criterio y de constructo.

Lymphoid progenitor cells from childhood acute lymphoblastic leukemia are functionally deficient and express high levels of the transcriptional repressor Gfi-1.

Acute lymphoblastic leukemia (ALL) is the most frequent malignancy of childhood. Substantial progress on understanding the cell hierarchy within ALL bone marrow (BM) has been recorded in the last few years, suggesting that both primitive cell fractions and committed lymphoid blasts with immature stem cell-like properties contain leukemia-initiating cells. Nevertheless, the biology of the early progenitors that initiate the lymphoid program remains elusive. The aim of the present study was to investigate the ability of lymphoid progenitors from B-cell precursor ALL BM to proliferate and undergo multilineage differentiation. By phenotype analyses, in vitro proliferation assays, and controlled culture systems, the lymphoid differentiation potentials were evaluated in BM primitive populations from B-cell precursor ALL pediatric patients. When compared to their normal counterparts, functional stem and progenitor cell contents were substantially reduced in ALL BM. Moreover, neither B nor NK or dendritic lymphoid-cell populations developed recurrently from highly purified ALL-lymphoid progenitors, and their proliferation and cell cycle status revealed limited proliferative capacity. Interestingly, a number of quiescence-associated transcription factors were elevated, including the transcriptional repressor Gfi-1, which was highly expressed in primitive CD34⁺ cells. Together, our findings reveal major functional defects in the primitive hematopoietic component of ALL BM. A possible contribution of high levels of Gfi-1 expression in the regulation of the stem/progenitor cell biology is suggested.

[Characteristics of pain in oncologic disease of the knee]. / Caracterización del dolor de la rodilla con patología oncológica.

BACKGROUND: 10% of > 55-year-old adults suffer some kind of non-neoplastic knee pain and 75% of the musculoskeletal neoplastic disease develops in the knee. OBJECTIVE: to identify clinical characteristics of knee pain in neoplastic knee pathology. METHODS: after appropriate authorization of the Local Committee of Investigation and under informed consent, we made a crosssectional and a risk analysis study. We included 160 patients who were seeking medical help due to knee pain. They answered a standardized questionnaire relating to the characteristics of their pain symptomatology. Data were integrated into two groups with knee pain; a) neoplasic (cases, n = 65), b) non-neoplasic (controls, n = 95) and analyzed (SPSS v.15™). We used homogeneity tests between groups (p > 0.05); inferential analysis (Student t test, χ(2)) and risk assessment (OR), p ≤ 0.05, (CI 95%), Statistical power was > 0.80. RESULTS: female gender predominated (55%); age was 40.3 ± 19.6 years. The most prevalent diagnoses were knee osteoarthritis 37% for non-neoplasic group; giant cell tumor 10% for benign neoplasic group and osteosarcoma 6.1% for neoplasic malignant group. Knee pain lasting < 4 months (OR 7.6; CI 95% 3.48-16.5) and severe intensity (OR 5.7; CI 95% 2.82-11.64), constant pain (OR 2.9; CI 95% 1.37-6.36), rapidly progressive fluctuation (OR 31; CI 95% 7.01-137) and nocturnal predominance (OR 7.72; CI 95% 3.2-18.5) were characteristics of neoplasic knee pain. CONCLUSIONS: the neoplasic knee pain was characterized for a rapid onset, severe and constant pain, progressive, fluctuation and predominantly by night-time.

El carpo: sus mediciones radiográficas en población mexicana sana de 20 a 70 años de edad / Carpal bones and joints: roentgenographic measurements in 20- to 70-year-old healthy Mexicans

Objetivo: identificar la antropometría radiográfica normal del carpo en población mexicana sana de 20 a 70 años. Material y métodos: se realizó el estudio en 112 pacientes sin antecedentes de patologías crónicas degenerativas como diabetes mellitus, artritis reumatoide, alteraciones congénitas o traumáticas de miembros torácicos. De forma estandarizada se realizaron radiografías posteroanterior y lateral del carpo. Las mediciones se efectuaron por dos observadores de manera independiente y cegada. Se aplicaron estadísticos de Kolmogorov-Smirnov-Lilliefors (K-S-L) (p > 0.05), t de Student, coeficiente de correlación intraclase (CCI), kappa y r de Pearson (p < 0.05). Resultados: los valores de K-S-L mostraron homogeneidad de los valores, con CCI 0.93-0.99. La altura carpal en los hombres fue de 34.6 + 4.4 mm (rango 29-40 mm) y en las mujeres de 32.0 + 3.3 mm (rango 22-41 mm), p = 0.001. El índice de altura carpal alternativo fue de 1.45 + 0.1. El ángulo escafosemilunar fue de 49.25 + 20.46° (rango 28.5-90°). Respecto al porcentaje de acuerdo en la congruencia de los arcos de Gilula, 68.7 % en el primero y 98.2 % en el tercero, con kappa de 0.55 y 0.66, respectivamente. Conclusiones: 31.3 % de desacuerdo en el primero y segundo arcos, evidencia que el uso de los arcos de Gilula no es del todo útil para determinar inestabilidad e incongruencia intercarpiana. Las diferencias referentes al sexo y edad de los valores encontrados permitirán buscar su asociación con patologías como túnel del carpo e inestabilidades dorsales o volares. Esto contribuye a la identificación de los parámetros de normalidad, sirviendo como punto de referencia.

BACKGROUND: We undertook this study to identify normal radiographic anthropometry reference values of the carpal bones and joints in healthy Mexicans between 20 and 70 years old. METHODS: The study was comprised of 112 subjects without diabetes mellitus, rheumatoid arthritis, congenital and/or traumatic diseases in upper limbs. Roentgenograms in postero-anterior and lateral views of carpal bones and joints were performed using standardized techniques. Measurements were done by two blinded observers. Statistical analysis was done applying Kolmogorov-Smirnov-Lilliefors test [K-S-L] (p >0.05), Student's t-test, intraclass correlation coefficient [ICC], Kappa test and Pearson correlation coefficient (p <0.05). RESULTS: The study sample showed homogeneity in the K-S-L test (p >0.05), ICC (0.93-0.99). The carpal height in men was 34.6 +/- 4.4 mm [2 SD] (29-40 mm), in women 32.0 +/- 3.3 mm [2 SD] (22-41 mm) p = 0.001. The alternative carpal height ratio was 1.45 +/- 0.1 [2SD]. The scapholunate angle was 49.25 +/- 20.46 degrees [2 SD] (28.5-90 degrees ). The inter-observer congruence agreement percentage of the Gilula's arches in first arch was 68.70% and 98.20% in the third; Kappa values were 0.55 and 0.66, respectively. CONCLUSIONS: The 31.3% disagreement in the first and second Gilula's arches demonstrated its poor utility for evaluating inter-carpal instability and incongruence. Anthropometric values by sex and age reported here will allow the study of the associations with pathologies such as carpal tunnel disease, DISI and VISI. This contributes to the identification of normal reference parameters.

Mediciones radiográficas de la articulación de la muñeca en mexicanos sanos / Radiographic measurements of the wrist in healthy Mexicans

Objetivo: determinar las mediciones radiográficas normales en muñecas de mexicanos sanos. Material y métodos: se tomaron 112 radiografías de muñecas sanas: 56 derechas y 56 izquierdas en adultos normales, cuyos padres y abuelos fueran mexicanos por nacimiento. Con técnica estandarizada se tomó una proyección anteroposterior y una lateral, no se incluyeron en el estudio sujetos con antecedentes traumáticos, fracturas o deformidades. La medición fue realizada por dos observadores cegados. Se evaluó angulación radial, inclinación palmar, varianza ulnar, ancho radial en proyección anteroposterior y en lateral. Resultados: encontramos una media en la angulación radial de 36.5 ± 4.62 grados, ancho radial en anteroposterior de 22.84 ± 3.23 mm, varianza de –1.13 ± 2.61 mm, inclinación palmar de 17.98 ± 2.25 grados y ancho radial en lateral de 19.3 ± 9.3 mm. No existieron diferencias entre muñecas izquierdas y derechas ni en la dominancia. Se encontró correlación entre la angulación radial, la inclinación palmar y el ancho radial en anteroposterior, también en la talla y el ancho radial en anteroposterior. Existieron diferencias significativas entre hombres y mujeres en la angulación radial, ancho radial en anteroposterior y lateral. Conclusiones: encontramos diferencias en la angulación radial e inclinación radial respecto a valores reportados en individuos de Estados Unidos y Suecia. En la varianza ulnar encontramos diferencias con individuos de Taiwán y Japón. La información concerniente a la normalidad en las mediciones radiográficas de muñeca puede ser utilizada en investigación clínica como valores de referencia para evaluación de métodos quirúrgicos de tratamiento y seguimiento de las afecciones de la muñeca, entre otros.

BACKGROUND: We undertook this study to determine normal radiographic measurements of the wrist in healthy Mexican persons. METHODS: We performed 112 roentgenograms of healthy wrists, 56 left wrists and 56 right wrists, in normal adults with Mexican parents and grandparents who were born in Mexico. We made two projections: frontal and lateral views of the wrist sing a standard technique. Not included in the study were subjects with a history of wrist trauma, fractures or deformities. The measurement was done by two observers blinded to the study. We measured ulnar lengths, radial angulation, volar shift, volar tilt and dorsal shift. RESULTS: We found a mean in radial angulation of 36.5 degrees +/- 4.62 degrees , dorsal shift 22.84 mm +/- 3.23 mm, ulnar lengths -1.13 mm +/- 2.61 mm, radial tilt 17.98 degrees +/- 2.25 degrees and volar shift of 19.3 mm +/- 9.3 mm. No significant difference between the left and right wrist or in the dominant wrist was found. We found a correlation between radial angulation, radial tilt and dorsal shift, and the height with the dorsal shift. There were significant differences among men and women in the radial angulation, dorsal shift and volar shift. CONCLUSIONS: There were differences in the radial angulation and radial tilt with respect to values reported in the U.S. and Sweden. In the ulnar lengths there were difference with respect to the values reported in Taiwan and Japan. Information regarding normal values in wrist measurements could be used as the normal reference value for the evaluation of surgical management and follow-up of the wrist.

[Radiographic measurements of the wrist in healthy Mexicans]. / Mediciones radiográficas de la articulación de la muñeca en mexicanos sanos.

BACKGROUND: We undertook this study to determine normal radiographic measurements of the wrist in healthy Mexican persons. METHODS: We performed 112 roentgenograms of healthy wrists, 56 left wrists and 56 right wrists, in normal adults with Mexican parents and grandparents who were born in Mexico. We made two projections: frontal and lateral views of the wrist sing a standard technique. Not included in the study were subjects with a history of wrist trauma, fractures or deformities. The measurement was done by two observers blinded to the study. We measured ulnar lengths, radial angulation, volar shift, volar tilt and dorsal shift. RESULTS: We found a mean in radial angulation of 36.5 degrees +/- 4.62 degrees , dorsal shift 22.84 mm +/- 3.23 mm, ulnar lengths -1.13 mm +/- 2.61 mm, radial tilt 17.98 degrees +/- 2.25 degrees and volar shift of 19.3 mm +/- 9.3 mm. No significant difference between the left and right wrist or in the dominant wrist was found. We found a correlation between radial angulation, radial tilt and dorsal shift, and the height with the dorsal shift. There were significant differences among men and women in the radial angulation, dorsal shift and volar shift. CONCLUSIONS: There were differences in the radial angulation and radial tilt with respect to values reported in the U.S. and Sweden. In the ulnar lengths there were difference with respect to the values reported in Taiwan and Japan. Information regarding normal values in wrist measurements could be used as the normal reference value for the evaluation of surgical management and follow-up of the wrist.

[Carpal bones and joints: roentgenographic measurements in 20- to 70-year-old healthy Mexicans]. / El carpo: sus mediciones radiográficas en población mexicana sana de 20 a 70 años de edad.

BACKGROUND: We undertook this study to identify normal radiographic anthropometry reference values of the carpal bones and joints in healthy Mexicans between 20 and 70 years old. METHODS: The study was comprised of 112 subjects without diabetes mellitus, rheumatoid arthritis, congenital and/or traumatic diseases in upper limbs. Roentgenograms in postero-anterior and lateral views of carpal bones and joints were performed using standardized techniques. Measurements were done by two blinded observers. Statistical analysis was done applying Kolmogorov-Smirnov-Lilliefors test [K-S-L] (p >0.05), Student's t-test, intraclass correlation coefficient [ICC], Kappa test and Pearson correlation coefficient (p <0.05). RESULTS: The study sample showed homogeneity in the K-S-L test (p >0.05), ICC (0.93-0.99). The carpal height in men was 34.6 +/- 4.4 mm [2 SD] (29-40 mm), in women 32.0 +/- 3.3 mm [2 SD] (22-41 mm) p = 0.001. The alternative carpal height ratio was 1.45 +/- 0.1 [2SD]. The scapholunate angle was 49.25 +/- 20.46 degrees [2 SD] (28.5-90 degrees ). The inter-observer congruence agreement percentage of the Gilula's arches in first arch was 68.70% and 98.20% in the third; Kappa values were 0.55 and 0.66, respectively. CONCLUSIONS: The 31.3% disagreement in the first and second Gilula's arches demonstrated its poor utility for evaluating inter-carpal instability and incongruence. Anthropometric values by sex and age reported here will allow the study of the associations with pathologies such as carpal tunnel disease, DISI and VISI. This contributes to the identification of normal reference parameters.