Weight-bearing MRI with a knee flexion angle of 20°: a study on additional MRI investigation modalities to support a more accurate understanding of patellofemoral instability

Background

Diagnosing patellofemoral instability disorders correctly, weight-bearing MRI (WB-MRI) has become an option. Aiming for a best possible accuracy in displaying potentially underlying causes, the named MRI modalities were sporadically even investigated in different knee flexion angles. However, despite confirmed MRI-outcome-differences between WB-MRI and non-WB-MRI, none of the described MRI modalities have so far established themselves. Mainly this is due to an unfeasibility in daily clinical routine in regard to time and economic aspects. Thus, we intended to evaluate an additional but reduced patellofemoral MR-imaging solely in a relevant 20° of knee flexion under WB- and non-WB-MRI conditions.

Methods

Seventy-three subjects with and without patellofemoral instability were investigated under supine as well as under WB-MRI conditions in a 20° of knee flexion angle. Patellofemoral risk indices in the sagittal plane (Insall-Salvati-Index, Caton-Deschamps-Index, Patellotrochlear Index) and the axial plane (Patella tilt of Fulkerson and Sasaki) were detected and compared between the different MRI conditions. Significance, reliability and Cohen’s effect size was calculated.

Results

Nearly all assessed indices showed significant differences between patients and controls in the different MRI positions. Comparing pairwise, all measured indices failed to show significant differences between the two MRI positions. However, patella tilt angles of the patient group showed an elevation from supine to WB-MRI (14.00 ± 7.54° to 15.97 ± 9.10° and 16.34 ± 7.84° to 18.54 ± 9.43°). Here, Cohen’s d showed small to medium effects between supine and WB-MRI.

Conclusion

In comparison to standard MRI in supine position, axial risk indices seem to be accentuated under WB-MRI and a knee flexion angle of 20°. In particular, symptomatic cases with inconspicuous conventional MRI imaging, additional MRI imaging only in the axial plane in a 20° of knee flexion could be beneficious and useful in clinical daily routine.

Contamination and risk levels of metals associated with urban street dust in Riyadh, Saudi Arabia

Urban street dust was collected from 22 locations in Riyadh, Saudi Arabia, and nine metals (Pb, Cr, Zn, Co, Cu, Al, Fe, Mn, and Ni) were investigated. The concentrations of these metals were employed in several common contamination evaluation indices to examine the contamination and the health risk caused by metals. Evaluation of these indices showed that they had variable degrees of contamination sensitivity. For individual contaminating elements (Pb, Cr, Zn, Co, Cu, and Ni), the sensitivities of the contamination of contamination factor (CF), the potential ecological risk (Ei), and geo-accumulation index (Igeo) were very similar. Therefore, these indices should yield very similar results. However, enrichment factor (EF) exhibited a different sensitivity pattern for determining the contamination caused by metals compared with the contamination level indicated by the other indices used in this study. Therefore, to avoid potential false indication of contamination, it is not recommended to use EF alone for determining contamination level. As indicated by four contamination evaluation indices (CF, Ei, Igeo, and EF), Riyadh was mainly contaminated by Pb. However, the health risk assessment results revealed that the Pb contamination level did not exceed the significant risk level for non-cancer effects. The cancer risk values indicated a negligible cancer risk to inhabitants of Riyadh exposed to metals associated with street dust. Considering the comprehensive contamination evaluation indices, the ecological risk index (RI) showed that about 77% of the sampling locations featured high ecological risk of which approximately 41% also featured high contamination indicated by pollution load index (PLI).

Metrics to Evaluate Quality of Glycemic Control: Comparison of Time in Target, Hypoglycemic, and Hyperglycemic Ranges with "Risk Indices"

OBJECTIVE

We sought to cross validate several metrics for quality of glycemic control, hypoglycemia, and hyperglycemia.

RESEARCH DESIGN AND METHODS

We analyzed the mathematical properties of several metrics for overall glycemic control, and for hypo- and hyperglycemia, to evaluate their similarities, differences, and interrelationships. We used linear regression to describe interrelationships and examined correlations between metrics within three conceptual groups.

RESULTS

There were consistently high correlations between %Time in range (%TIR) and previously described risk indices (M₁₀₀, Blood Glucose Risk Index [BGRI], Glycemic Risk Assessment Diabetes Equation [GRADE], Index of Glycemic Control [IGC]), and with J-Index (J). There were also high correlations among %Hypoglycemia, Low Blood Glucose Index (LBGI), percentage of GRADE attributable to hypoglycemia (GRADE_{%Hypoglycemia}), and Hypoglycemia Index, but negligible correlation with J. There were high correlations of percentage of time in hyperglycemic range (%Hyperglycemia) with High Blood Glucose Index (HBGI), percentage of GRADE attributable to hyperglycemia (GRADE_{%Hyperglycemia}), Hyperglycemia Index, and J. %TIR is highly negatively correlated with %Hyperglycemia but very weakly correlated with %Hypoglycemia. By adjusting the parameters used in IGC, Hypoglycemia Index, Hyperglycemia Index, or in M_R, one can more closely approximate the properties of BGRI, LBGI, or HBGI, and of GRADE, GRADE_{%Hypoglycemia}, or GRADE_{%Hyperglycemia}.

CONCLUSIONS

Simple readily understandable criteria such as %TIR, %Hypoglycemia, and %Hyperglycemia are highly correlated with and appear to be as informative as "risk indices." The J-Index is sensitive to hyperglycemia but insensitive to hypoglycemia.

Distribution and larval breeding habitats of Aedes mosquito species in residential areas of northwest Ethiopia

OBJECTIVES

The Aedes mosquito is a vector for transmitting many arboviruses. Knowledge of the breeding habitat of this vector is vital for implementing appropriate interventions. Thus, this study was conducted to determine the breeding habitats and presence of Aedes mosquito species in the study areas.

METHODS

A house-to-house cross-sectional survey of Aedes mosquito breeding habitats was carried out in Metema and Humera, Ethiopia, in August 2017. All available water-holding containers present in and around houses were inspected for the presence of immature stages of Aedes mosquitoes, and they were collected and reared to the adult stage for species identification. In the larval survey, the house index, container index, and Breteau index were computed as risk indices.

RESULTS

Of the 384 houses surveyed for the presence of Aedes mosquito larval breeding, 98 were found to be positive for larvae. During the survey, a total of 566 containers were inspected, of which 186 were found to be infested with Aedes mosquito larvae, with a container index of 32.9, a house index of 25.5, and a Breteau index of 48.4. The most common Aedes mosquito breeding habitats were discarded tires (57.5%), followed by mud pots (30.0%). Of the 1,077 larvae and pupae collected and reared, Aedesaegypti (49.3%), Ae. vittatus (6.5%), and Culex species (44.2%) were identified.

CONCLUSIONS

Discarded tires were the most preferred breeding habitats for Aedes mosquitoes. Moreover, Ae. aegypti, the main vector of dengue and other arboviruses, was identified for the first time in this region, suggesting a high potential for arbovirus transmission in the study areas.

Human health risk assessment of polycyclic aromatic hydrocarbons (PAHs) in smoked fish species from markets in Southern Nigeria

Polycyclic Aromatic Hydrocarbons (PAHs) levels in four commonly consumed smoked fish species from markets in Southern Nigeria were assessed to evaluate possible human health risks associated with consumption. Varying levels of PAH congeners were observed in the fish tissues with the highest total concentration of PAHs in Scomber scombrus. High concentrations of benzo(a)pyrene was observed in Clarias gariepinus and Ethmalosa fimbriata with values above the guideline value of 0.05 mg/kg. The Dietary Daily Intake (DDI) value for total PAHs (∑PAHs) was highest for S. scombrus while the DDI value for the total carcinogenic PAHs (∑CPAHs) was highest for E. fimbriata. Carcinogenic human health risk assessment using carcinogenic toxic equivalents (TEQ), indicated that consumption of E. fimbriata has a higher potential to cause carcinogenic risks. TEQ values for all the fish species were however, below the estimated screening value (SV) of 3.556 mg/kg, while the estimated cumulative excess cancer risk (ECR) for E. fimbriata and C. gariepinus and PAH4 index for all the assessed fish species exceeded threshold values indicating potential carcinogenic risk from consumption.

Preoperative Evaluation: Estimation of Pulmonary Risk

Postoperative pulmonary complications (PPCs) are common after major non-thoracic surgery and associated with significant morbidity and high cost of care. A number of risk factors are strong predictors of PPCs. The overall goal of the preoperative pulmonary evaluation is to identify these potential, patient and procedure-related risks and optimize the health of the patients before surgery. A thorough clinical examination supported by appropriate laboratory tests will help guide the clinician to provide optimal perioperative care.

Deriving forest fire ignition risk with biogeochemical process modelling

Climate impacts the growth of trees and also affects disturbance regimes such as wildfire frequency. The European Alps have warmed considerably over the past half-century, but incomplete records make it difficult to definitively link alpine wildfire to climate change. Complicating this is the influence of forest composition and fuel loading on fire ignition risk, which is not considered by purely meteorological risk indices. Biogeochemical forest growth models track several variables that may be used as proxies for fire ignition risk. This study assesses the usefulness of the ecophysiological model BIOME-BGC's 'soil water' and 'labile litter carbon' variables in predicting fire ignition. A brief application case examines historic fire occurrence trends over pre-defined regions of Austria from 1960 to 2008. Results show that summer fire ignition risk is largely a function of low soil moisture, while winter fire ignitions are linked to the mass of volatile litter and atmospheric dryness.