Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial.

Background: Greater trochanteric pain syndrome (GTPS) is characterized by gluteal enthesopathy involving the peritrochanteric space and associated with chronic pain and functional impairment. A corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain. However, it is important to investigate treatment options that will relieve pain in the peritrochanteric space. Purpose: To compare the clinical efficacy of subfascial platelet-rich plasma (PRP) injection and enthesis needling for GTPS. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 92 patients (90% women; mean age, 55 years old; mean body mass index, 25.3 kg/m2) were randomly divided into a subfascial PRP injection group and an enthesis needling group. Descriptive data and radiographic measurements of the pelvis-including leg-length difference, pelvic width difference, and pelvic trochanteric index-were recorded. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment. Results: Baseline demographic and radiological characteristics were similar between the groups. The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the HOS-SS subscore compared with the needling group (32.09 [95% CI, 28.99-40.20] vs 20.52 [95% CI, 11.99-29.05]; P = .048). At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of >20% (P = .040). After subfascial PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension (P = .006 and P = .004, respectively). The pelvic trochanteric index was predictive of HOS-ADL and HOS-SS outcomes (P = .011 and P = .022, respectively). The interaction between treatment modality and fascia nodule influenced HOS-ADL and HOS-SS outcomes (P = .021 and P = .023) as well as the interactions of treatment modality, fascia nodules, and calcifications (P = .027). Conclusion: Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the HOS-SS was greater in the PRP group. Registration: NCT04231357 (ClinicalTrials.gov identifier).

Sonographic pathoanatomy of greater trochanteric pain syndrome.

AIMS: To identify and highlight pertinent US features that could serve as imaging biomarkers to describe different patient phenotypes, within Great Trochanteric Pain Syndrome (GTPS) clinical diagnosis. MATERIALS AND METHODS: Using ultrasound we evaluated eighty-eight clinically diagnosed patients with GTPS, for tendon matrix changes and calcium deposits in the gluteus medius (superoposterior and lateral aspects) and in the gluteus minimus. Peritrochanteric examination included fascia lata, trochanteric bursa, cortical irregularities and the presence of enthesophytes. The association of pathological changes with pain and functionality was evaluated using multivariate regression models. RESULTS: Out of the 88 patients, 86 examinations (97.7%) detected gluteus medius tendinopathy, and 54 patients (61.4%) had gluteus minimus tendinopathy in addition. Calcium deposits were present in 97.7% of patients, associated with tenderness (p = 0.009), and most often located in the gluteus medius rather than in the gluteus minimus (p = 0.014); calcifications were associated with tendon thickness (p = 0.042), hypoechogenicity (p = 0.005) and the presence of partial tears (p = 0.030). Bursa swelling occurred in 36 patients (40.9%); multivariate regression models predicted less pain in patients with bursa distension (p = 0.008) and dysfunction in patients with gluteal muscle atrophy (p = 0.001) and loss of fibrillar pattern in the gluteus medius (p = 0.002). CONCLUSION: GTPS involves both degenerative calcifying gluteal tendinopathy and alterations in the peritrochanteric space associated with physical function and pain. The severity of GTPS can be assessed using ultrasound imaging biomarkers.

Implementation of an In-House 3D Manufacturing Unit in a Public Hospital's Radiology Department.

OBJECTIVE: Three-dimensional printing has become a leading manufacturing technique in healthcare in recent years. Doubts in published studies regarding the methodological rigor and cost-effectiveness and stricter regulations have stopped the transfer of this technology in many healthcare organizations. The aim of this study was the evaluation and implementation of a 3D printing technology service in a radiology department. METHODS: This work describes a methodology to implement a 3D printing service in a radiology department of a Spanish public hospital, considering leadership, training, workflow, clinical integration, quality processes and usability. RESULTS: The results correspond to a 6-year period, during which we performed up to 352 cases, requested by 85 different clinicians. The training, quality control and processes required for the scaled implementation of an in-house 3D printing service are also reported. CONCLUSIONS: Despite the maturity of the technology and its impact on the clinic, it is necessary to establish new workflows to correctly implement them into the strategy of the health organization, adjusting it to the needs of clinicians and to their specific resources. SIGNIFICANCE: This work allows hospitals to bridge the gap between research and 3D printing, setting up its transfer to clinical practice and using implementation methodology for decision support.

IgG4 related disease as a mimicker of metastatic pancreatic cancer.

A previously healthy 62-year-old female was referred to our hospital for epigastric discomfort in the previous month. Routine laboratory tests showed lipase and pancreatic isoamylase elevation. CT scan revealed an homogeneous mass arising from the pancreatic head-uncinate process in addition to multiple bilateral hypoattenuating lesions in the renal cortex and pulmonary nodules. US-guided biopsy of one of the kidney lesions was performed under the suspicion of pancreatic metastatic disease.

Psychological Adjustment in Adult Adoptees: A Meta-Analysis.

BACKGROUND: Little is known about the effect adoption status has on psychological adjustment (for instance, depression, anxiety, problem behaviour, or drug misuse) in adulthood. The aim of this study was to conduct a meta-analysis to study the impact of adoption status on adult adoptees' psychological adjustment. METHOD: The review included 18 quasi-experimental studies conducted between 1993 and 2019. RESULTS: Adoptees had significantly worse psychological adjustment than non-adoptees across all outcomes, except for the obsessive-compulsive disorder (OCD) and antisocial personality disorder (APD). The moderating analyses showed a significant effect for ethnicity and marital status. CONCLUSIONS: Our results shed light on the specific groups of adoptees at a higher risk of maladjustment. The outcomes most strongly influenced by adoptive status were angry emotions (hostility and anger), psychiatric care, drug abuse, and psychotic symptoms. These findings have clinical implications with regard to the support that practitioners can provide to adoptees and their families.

Psychological Adjustment in Adult Adoptees: A Meta-Analysis / Ajuste Psicológico en Adultos Adoptados/as: un Meta-análisis

Background: Little is known about the effect adoption status has on psychological adjustment (for instance, depression, anxiety, problem behaviour, or drug misuse) in adulthood. The aim of this study was to conduct a meta-analysis to study the impact of adoption status on adult adoptees’ psychological adjustment. Method: The review included 18 quasi-experimental studies conducted between 1993 and 2019. Results: Adoptees had significantly worse psychological adjustment than non-adoptees across all outcomes, except for the obsessive-compulsive disorder (OCD) and antisocial personality disorder (APD). The moderating analyses showed a significant effect for ethnicity and marital status. Conclusions: Our results shed light on the specific groups of adoptees at a higher risk of maladjustment. The outcomes most strongly influenced by adoptive status were angry emotions (hostility and anger), psychiatric care, drug abuse, and psychotic symptoms. These findings have clinical implications with regard to the support that practitioners can provide to adoptees and their families. (AU)

Antecedentes: sabemos poco sobre el efecto que la condición adoptiva tiene en el ajuste psicológico (por ejemplo, depresión, ansiedad, conducta problemática o abuso de drogas) en la etapa adulta. El objetivo de este estudio es realizar un meta-análisis sobre el impacto que la condición adoptiva tiene en el ajuste psicológico de adultos adoptados. Método: esta revisión incluyó 18 estudios cuasi-experimentales llevados a cabo entre 1993 y 2019. Resultados: los adultos adoptados presentaron más dificultades en todos los indicadores analizados, salvo en el trastorno obsesivo-compulsivo (TOC) y en el trastorno antisocial de la personalidad (TAP). Los análisis de moderación indicaron un efecto significativo para el grupo étnico y estado marital. Conclusiones: nuestros resultados arrojan luz sobre los grupos específicos con un riesgo más alto para las dificultades psicológicas. Los indicadores más fuertemente influenciados por la condición adoptiva fueron las emociones negativas, acceso a servicios psiquiátricos, consumo de drogas y síntomas psicóticos. Estos resultados tienen implicaciones clínicas en cuanto al apoyo que los profesionales puedan dar a las personas adoptadas y sus familias. (AU)

Osteotome sinus floor elevation without grafting material: Results of a 2-year prospective study.

OBJECTIVES: The aim of this prospective clinical trial was to evaluate the success implant rates during 24 months using OSFE procedure without grafting materials. STUDY DESIGN: 42 adult patients (22 female, 15 male) were selected according to Nedir et al´s inclusion criteria of which 5 patients were excluded, due to periapical pathology in adjacent teeth (n=3) and treatment with bisphosphonates (n=2). 37 patients aged 31-68 years were selected. Smokers were divided in two groups depending on the number of cigarettes consumed per day (a) 0-10, (b) 11-20. One patient was excluded because he was lost to follow-up at 24 months A total of 36 threaded implants were placed, ∅4,1mm Straumann® (Straumann AG, Waldenburg, Switzerland) and ∅3,5mm Klockner® (Klockner Implant System, Barcelona, Spain). The most used implant diameter was 4,1 mm (n=29), followed by 3,5 mm (n=7), and length used was 10 mm (n=32) and 8 mm (n=4). Initial RBH ranged from 4 mm to 9 mm. All statistical data were processed using the program R 3.0.2 for windows. RESULTS: A total of 36 threaded implants were placed. Residual bone height (RBH) at implant placement averaged 7,4 ± 0,4 mm. Mean bone gain was 1,8 ± 0,3 mm. Four implants showed a bone gain exceeding 3 mm. Mean implant protrusion length into the sinus amounted to 2.1 ± 0,3 mm. Regarding the relationship between smoking and periodontal probes, no statistically significant differences were found (P=0,25), neither in relation to the number of threads that the implants showed (P=0,29) or bone gain (P=0,79). After 24 months the implant success rate was 91,6%. CONCLUSIONS: Implant rehabilitation of edentulous atrophied posterior maxilla can be safely performed and simplified using the OSFE technique without grafting with reliable long-term results. Key words:Crestal bone loss, dental implants, internal sinus lift, no grafting, osteotome sinus elevation, grafting, sinus floor elevation.