Citations

ObjectiveTo examine whether an underlying diagnosis of rheumatoid arthritis (RA) or osteoarthritis (OA) impacts the 90‐day readmission rates after total hip arthroplasty (THA) or total knee arthroplasty (TKA).MethodsWe analyzed prospectively collected data from an integrated health care system, Total Joint Replacement Registry, of adults with RA or OA undergoing unilateral primary THA or TKA during 2009–2011. Adjusted logistic regression models for 90‐day readmission were fit. Odds ratios with 95% confidence intervals (95% CIs) were calculated. Study year was an effect modifier for the outcome; therefore separate analyses were conducted for each of the 3 study years.ResultsOf the 34,311 patients, 496 had RA and 33,815 had OA. Comparisons of RA and OA patients, respectively, were 73% and 61% women, 45% and 70% white, and patients had a mean age of 61 versus 67 years (P < 0.001). Crude 90‐day readmission rates for RA and OA were 8.5% and 6.7%, respectively. The adjusted odds of 90‐day readmission increased from year to year for RA compared to OA patients, from 0.89 (95% CI 0.46–1.71) in 2009 to 1.34 (95% CI 0.69–2.61) in 2010, and to 1.74 (95% CI 1.16–2.60) in 2011. The 2 most common readmission reasons were joint prosthesis infection (10.2%) and septicemia (10.2%) in RA and joint prosthesis infection (5.7%) and other postoperative infection (5.1%) in OA.ConclusionRA is a risk factor for 90‐day readmission after primary THA or TKA. An increasing risk of readmissions noted in RA in 2011 is concerning and indicates that further studies should examine the reasons for this increasing trend.

Total eyelid loss, full thickness loss of the upper and lower eyelids, is uncommon and surgically challenging. Eyelid reconstruction after such injuries can be further complicated by loss of adjacent tissue. When tissue for local flaps is unavailable, free flaps must be considered. Few cases of total eyelid reconstruction via microvascular free flap have been reported, especially with an intact globe and good visual acuity. In this report, we describe the use of a microvascular free flap based on the radial artery for total eyelid reconstruction in a patient with an intact globe and useful visual acuity.

Abstract The tolerogenic cytokine IL9 promotes T regulatory cell function and allergic airway inflammation, but it has not been extensively studied in cancer. In this report, we used IL9-deficient mice to investigate the effects of IL9 in multiple models of breast and colon cancer development. Eliminating endogenous IL9 enabled sensitization of host T cells to tumors, leading to their early rejection without the requirement of vaccines or immunomodulatory therapies. Notably, IL9-deficient mice acquired immunologic memory, which actively protected from residual disease and tumor rechallenge, an effect linked to activation of CD8+ T cells. Depletion of either CD8+ or CD4+ T cells abolished the benefits of IL9 loss to tumor control. Adoptive transfer experiments showed that T cells from tumor-rejecting IL9-deficient mice retained their effector competency in wild-type animals. Moreover, neutralizing IL9 antibody phenocopied the effects of IL9 gene deletion by slowing tumor progression in wild-type animals. Our results show the ability of IL9 to function as an inhibitor of adaptive immunity that prevents the formation of immunologic memory to a growing tumor, highlighting the potential for IL9 neutralization as a unique tool for cancer immunotherapy. Cancer Res; 74(23); 6845–55. ©2014 AACR.

Case: A seventy-three-year-old woman who had been given the tentative diagnosis of spontaneous osteonecrosis presented to our clinic for a second opinion. Additional imaging and evaluation revealed the lesion to be a subchondral metastasis consistent with breast cancer. She received proper oncologic treatment and subsequent total knee arthroplasty. Conclusion: Orthopaedic surgeons should be aware of the possibility of metastatic disease manifesting itself in the form of an isolated subchondral lesion about the knee. For patients with such lesions, treatment in the form of total knee arthroplasty is a viable option that can provide excellent pain relief and function.

IntroductionLittle is known about the utility of plasma amyloid beta (Aβ) in clinical trials of Alzheimer's disease (AD).MethodsWe analyzed longitudinal plasma samples from two large multicenter clinical trials: (1) donezepil and vitamin E in mild cognitive impairment (n = 405, 24 months) and (2) simvastatin in mild to moderate AD (n = 225, 18 months).ResultsBaseline plasma Aβ was not related to cognitive or clinical progression. We observed a decrease in plasma Aβ40 and 42 among apolipoprotein E epsilon 4 (APOE ε4) carriers relative to noncarriers in the mild cognitive impairment trial. Patients treated with simvastatin showed a significant increase in Aβ compared with placebo. We found significant storage time effects and considerable plate‐to‐plate variation.DiscussionWe found no support for the utility of plasma Aβ as a prognostic factor or correlate of cognitive change. Analysis of stored specimens requires careful standardization and experimental design, but plasma Aβ may prove useful in pharmacodynamic studies of antiamyloid drugs.

Background. The SpyGlass Direct Visualization System (Boston Scientific, Natick, MA) is routinely used during single operator choledochoscopy (SOC) to identify biliary lesions or strictures with a diagnostic accuracy up to 88%. The objective of this study was to determine the interobserver agreement (IOA) of modified scoring criteria for diagnosing biliary lesions/strictures. Methods. 27 SPY SOC video clips were reviewed and scored by 9 interventional endoscopists based on published criteria that included the presence and severity of surface structure, vasculature visualization, lesions, and findings. Results. Overall IOA was “slight” for all variables. The K statistics are as follows: surface (K=0.12, SE = 0.02); vessels (K=0.14, SE = 0.02); lesions (K=0.11, SE = 0.02); findings (K=0.08, SE = 0.03); and final diagnosis (K=0.08, SE = 0.02). The IOA for “findings” and “final diagnosis” was also only “slight.” The final diagnosis was malignant (11), benign (11), and indeterminate (5). Conclusion. IOA using the modified criteria of SOC images was slight to almost poor. The average accuracy was less than 50%. These findings reaffirm that imaging criteria for benign and malignant biliary pathology need to be formally established and validated.

PurposeTo describe a model‐based reconstruction strategy for routine magnetic resonance imaging that accounts for gradient nonlinearity (GNL) during rather than after transformation to the image domain, and demonstrate that this approach reduces the spatial resolution loss that occurs during strictly image‐domain GNL‐correction.MethodsAfter reviewing conventional GNL‐correction methods, we propose a generic signal model for GNL‐affected magnetic resonance imaging acquisitions, discuss how it incorporates into contemporary image reconstruction platforms, and describe efficient nonuniform fast Fourier transform‐based computational routines for these. The impact of GNL‐correction on spatial resolution by the conventional and proposed approaches is investigated on phantom data acquired at varying offsets from gradient isocenter, as well as on fully sampled and (retrospectively) undersampled in vivo acquisitions.ResultsPhantom results demonstrate that resolution loss that occurs during GNL‐correction is significantly less for the proposed strategy than for the standard approach at distances >10 cm from isocenter with a 35 cm field‐of‐view gradient coil. The in vivo results suggest that the proposed strategy better preserves fine anatomical detail than retrospective GNL‐correction while offering comparable geometric correction.ConclusionAccounting for GNL during image reconstruction allows geometric distortion to be corrected with less spatial resolution loss than is typically observed with the conventional image domain correction strategy. Magn Reson Med 74:1019–1031, 2015. © 2014 Wiley Periodicals, Inc.