Validity of Radiographic Analyses Between Hand-Drawn and Computer-Aided Measurements: A Double-Blinded Test-Retest Trial

BACKGROUND

Spinal radiographic analyses are valid and reliable practices used for patient management in healthcare. Technologies and tools used for these analyses need to be valid and reliable.

OBJECTIVE

This study investigates repeated accuracy for validity and intra- and inter-examiner reliability of computer-aided lateral spinal radiograph measurements using PostureRay® EMR software.

METHODS

Rectangle renderings representing lateral spinal radiographic views were created to remove examiner interpretation of anatomical landmarks as performed on actual radiographs to examine the objective repeated accuracy of PostureRay® software. A blind, randomized, repeated measure design was performed using four examiners trained and experienced with the Harrison Posterior Tangent method of measurement. Each examiner analyzed the spine renderings using a hand-drawn and PostureRay® method multiple times. A fully crossed design whereby examiners performed multiple assessments per rendering using each analysis method was used to assess intra- and inter-examiner reliability within each method and a formal comparison of the two methods.

RESULTS

Using hand-drawn and PostureRay® methods, examiners displayed very high intra-examiner reliability with correlation values greater than 0.999 for each combination of trials. PostureRay® method showed consistent accuracy of measurements. Further, there was no statistical difference in average concordance between hand-drawn and PostureRay® methods for the lateral cervical, thoracic, and thoracolumbosacral spinal regions.

CONCLUSION

This study reports a very high degree of intra- and inter-examiner reliability of radiographic line drawing methods and establishes concurrent validity of PostureRay® EMR software in determining angles and displacements of lateral spinal alignment as an equivalent method to the hand-drawn method.

Correction of Grade 2 Spondylolisthesis Following a Non-Surgical Structural Spinal Rehabilitation Protocol Using Lumbar Traction: A Case Study and Selective Review of Literature

Objective

Discuss the use of non-surgical spinal rehabilitation protocol in the case of a 69-year-old female with a grade 2 spondylolisthesis. A selective literature review and discussion are provided.

Clinical Features

A 69-year-old female presented with moderate low back pain (7/10 pain) and severe leg cramping (7/10 pain). Initial lateral lumbar x-ray revealed a grade 2 spondylolisthesis at L4-L5 measuring 13.3 mm.

Interventions and Outcomes

The patient completed 60 sessions of Mirror Image® spinal exercises, adjustments, and traction over 45 weeks. Post-treatment lateral lumbar x-ray showed a decrease in translation of L4-L5 from 13.3 mm to 2.4 mm, within normal limits.

Conclusions

This case provides the first documented evidence of a non-surgical or chiropractic treatment, specifically Chiropractic BioPhysics®, protocols of lumbar spondylolisthesis where spinal alignment was corrected. Additional research is needed to investigate the clinical implications and treatment methods.

Metabolite Profiling in the Pursuit of Biomarkers for IVF Outcome: The Case for Metabolomics Studies

Background. This paper presents the literature on biomarkers of in vitro fertilisation (IVF) outcome, demonstrating the progression of these studies towards metabolite profiling, specifically metabolomics. The need for more, and improved, metabolomics studies in the field of assisted conception is discussed. Methods. Searches were performed on ISI Web of Knowledge SM for literature associated with biomarkers of oocyte and embryo quality, and biomarkers of IVF outcome in embryo culture medium, follicular fluid (FF), and blood plasma in female mammals. Results. Metabolomics in the field of female reproduction is still in its infancy. Metabolomics investigations of embryo culture medium for embryo selection have been the most common, but only within the last five years. Only in 2012 has the first metabolomics investigation of FF for biomarkers of oocyte quality been reported. The only metabolomics studies of human blood plasma in this context have been aimed at identifying women with polycystic ovary syndrome (PCOS). Conclusions. Metabolomics is becoming more established in the field of assisted conception, but the studies performed so far have been preliminary and not all potential applications have yet been explored. With further improved metabolomics studies, the possibility of identifying a method for predicting IVF outcome may become a reality.

Both isoforms of ketohexokinase are dispensable for normal growth and development

Dietary fructose intake has dramatically increased over recent decades and is implicated in the high rates of obesity, hypertension, and type 2 diabetes (metabolic syndrome) in Western societies. The molecular determinants of this epidemiologic correlation are incompletely defined, but high-flux fructose catabolism initiated by ketohexokinase (Khk, fructokinase) is believed to be important. The Khk gene encodes two enzyme isoforms with distinctive substrate preferences, the independent physiological roles of which are unclear. To investigate this question, and for testing the importance of Khk in metabolic syndrome, isoform-selective genetic lesions would be valuable. Two deficiency alleles of the mouse Khk gene were designed. The first, Khk3a, uses targeted “knock-in” of a premature termination codon to induce a selective deficiency of the minor Khk-A isoform, preserving the major Khk-C isoform. The second, the KhkΔ allele, ablates both isoforms. Mice carrying each of these Khk-deficiency alleles were generated and validated at the DNA, RNA, and protein levels. Comparison between normal and knockout animals confirmed the specificity of the genetic lesions and allowed accurate analysis of the cellular distribution of Khk within tissues such as gut and liver. Both Khk3a/3a and KhkΔ/Δ homozygous mice were healthy and fertile and displayed minimal biochemical abnormalities under basal dietary conditions. These studies are the first demonstration that neither Khk isoform is required for normal growth and development. The new mouse models will allow direct testing of various hypotheses concerning the role of this enzyme in metabolic syndrome in humans and the value of Khk as a pharmacological target.

Replicated item level factor structure of the MMPI: racial and sexual differences

Item-level factor studies of the MMPI date back to the work of Comrey (1957). Surprisingly, there are no extant studies of the items that clinicians use most in the course of daily MMPI interpretive reporting, namely, the 399 x 399 matrix that represents all of the items that comprise the traditional clinical and validity scales. Furthermore, there are no prior studies with adequate Ns that have examined the replicability of MMPI factor structure via available factor comparison techniques (Harman, 1976). In this study, 20,000 MMPIs were factored by the principal components method, followed by Varimax rotations of 6 through 25 factors. The coefficient of congruence was used to compare the factor structures of randomly divided subsamples, as well as males vs. females and Blacks vs. Whites. Differences in factor structure were found, and suggestions are made with regard to the significance of these findings in clinical and applied settings.

Coping strategies in rheumatoid arthritis

Our purpose was to investigate the importance of the coping process for patients with rheumatoid arthritis (RA). Eighty-four patients with classic or definite RA were examined. The relationship between coping strategies and psychological status, functional status, pain, and disease activity was analyzed. Coping was measured by an adapted version of the Ways of Coping Scale, and measures of psychological status, life stress, functional status, pain, and disease activity were also obtained. Canonical correlation revealed a significant relationship between the coping process and psychological status. Coping also was significantly related to functional status, but not to pain or disease activity. Patients who coped by restructuring life goals were found to have better psychological adjustment and functional status than patients who hoped for unrealistic solutions or engaged in self-blame.

Familial pulmonary hypertension. Evidence of autosomal dominant inheritance

A patient with primary pulmonary hypertension is the fourth member of a family proven to have the disease. The patient's father married twice; the disease appeared in both families, and was transmitted through two generations. Multiple genetic and environmental factors may result in pulmonary hypertension, but the distribution of cases in this family and in others reported is consistent with the autosomal dominant inheritance of a single genetic trait.