Order of importance of anatomical risk factors in Kienböck's disease: An artificial neural network study.

Anatomical variations in bony structures around the wrist have been considered as risk factors for Kienböck's disease: ulnar variance, Nattrass index, ulnar variance/capitate height ratio and presence of a lunohamate joint. This study aimed to assess the order of importance of these variations as risk factors for Kienböck's disease. Two groups were formed: patients (n = 58) and controls (n = 235). On posteroanterior radiographs in the two groups, these risk factors were examined by four raters. After inter-rater correlation analysis, an artificial neural network was used to estimate their relative importance. All parameters showed statistically significant inter-rater correlation (p < 0.05). The artificial neural network study showed that the three most important risk factors, in descending order, were: Nattrass index, ulnar variance/capitate height ratio and negative ulnar variance. The study determined the order of importance of the anatomical risk factors for Kienböck's disease measurable on posteroanterior wrist radiographs. Although these findings seem to be useful in the diagnostic algorithm of Kienböck's disease, multivariate analysis of all measurable risk factors is still needed. The artificial neural network approach could contribute to such a comprehensive study.

Effect of gadolinium perfusion magnetic resonance imaging on surgeons' management preferences in kienböck's disease. A survey study.

In literature, the use of gadolinium perfusion magnetic resonance imaging (GP-MRI) is recommended in Kienböck's disease to evaluate the lunate bone's perfusion. This survey study sought to assess how GP-MRI findings affect the management preferences of hand surgeons. A questionnaire consisting of 11 scenarios differing in ulnar variance, GP-MRI findings and management preferences was developed. The scenarios were designed based on the last published clinical guidelines. The questionnaire was sent to the members of a national hand surgery society consisting of 160 hand surgeons. Sixty-six surgeons completed the questionnaire. The surgeons' preferences changed significantly by ulnar variance in stages II and IIIA, and by GP-MRI in stages I and II. No need for other diagnostic tools was found in any of the scenarios. Management preferences of the study participants related to alterations in ulnar variance and treatment choices in all stages were in accordance with previously published clinical and survey studies. This study showed that GP-MRI findings significantly changed the management preferences of hand surgeons in early stages of Kienböck's disease. There was no significant tendency among the participants to use further assessment tools beyond direct radiography, MRI, and GP-MRI. Given the study results and the literature, we emphasize the limited and well-defined indications of GP-MRI in Kienböck's disease.

Do adipofascial flaps affect the mechanical properties of a repaired tendon? A biomechanical rat model study.

The aim of this study was to evaluate the effect of vascularized and non-vascularized fascial flaps on tendon healing, specifically the maximum strain, maximum stress, elasticity and resistance of the repaired tendon. Rats were randomly divided into 3 groups: Group 1 - primary repair; Group 2 - vascularized pedicled fascial graft; Group 3 - non-vascularized free fascial graft. The rats were euthanized after 2 weeks and 40mm-long samples were taken from the Achilles tendon and gastrocnemius muscle. To evaluate the mechanical properties of the tendons, maximum load, maximum deformation, energy stored until yield point and stiffness on the load-deformation curve were measured. Based on this mechanical testing, the best group in terms of tissue strength and quality was the primary repair group. When the samples were examined individually, the two samples with the highest breaking force after the control group were in the pedicled graft group. The worst results overall were in the free graft group. We believe that if the blood flow is preserved for the fascial flap in the pedicled graft group, the tendon's breaking force would be higher.

Protein composition of seminal plasma in fractionated stallion ejaculates.

Seminal plasma (SP) contains several types of compounds derived from the epididymides and accessory glands. The aim of this study was to examine the protein composition of different ejaculate fractions. Trial I: fractionated ejaculates were collected from two normal and two subfertile stallions. Samples containing pre-sperm fluid and the first sperm-rich jets (HIGH-1), the main sperm-rich portion (HIGH-2), the jets with low sperm concentrations (LOW), and a combined whole-ejaculate (WE) sample was centrifuged, and the SP was filtered and frozen. A part of each SP sample was stored (5°C, 24 h) with spermatozoa from HIGH-2 and skim milk extender. Sperm motility was evaluated after storage in extender mixed with the stallion's own SP or SP from one of the other stallions (sperm from a normal stallion stored in SP from a subfertile stallion and vice versa). Protein composition was analysed using reverse-phase liquid chromatography (RP-HPLC), N-terminal sequencing and mass spectrometry. The area-under-the-curve (AUC) was used for quantitative comparison of proteins within fractions. Trial II: semen samples were collected from seven stallions. Fractions with the highest (HIGH) and lowest (LOW) sperm concentrations and WE samples were examined using SDS-PAGE and densitometry. No significant differences emerged between fractions in the AUC-values of the Horse Seminal Protein-1 (HSP-1) and HSP-2 peaks, or the peak containing HSP-3 and HSP-4 (HSP-3/4). Levels of HSP-1, HSP-2 and HSP-3/4 were not significantly correlated with total sperm motility, progressive sperm motility or average path velocity after storage. Significant differences between ejaculate fractions in the amount of different protein groups present in SP were not found in Trial I; but in Trial II, the proteins in the 60-70 kDa range were more abundant in LOW than in HIGH and WE, indicating that this band contained proteins derived mainly from the seminal vesicles, which produce most of the SP in LOW.

Alkaline and acid phosphatase, ß-glucuronidase and electrolyte levels in fractionated stallion ejaculates.

Seminal plasma (SP) is a mixture of contents from the testes, epididymides and accessory sex glands. The sperm concentration is highest in the first few jets, or fractions, of the ejaculate, and the composition of SP varies between these fractions because accessory gland secretions are released in a specific order. The aim of this study was to compare the levels of Na, Cl, K, Mg, Ca, inorganic phosphate (Pi) and the enzymes alkaline phosphatase (AP), acid phosphatase (ACP) and ß-glucuronidase (BG) in the different fractions of the ejaculate and in different stallions. All semen collections were done using a computer-controlled phantom that collects the ejaculatory jets separately in five cups. The cups with the highest (HIGH) and the lowest (LOW) sperm concentration were analysed. In Trial I, semen was collected from three reproductively normal stallions. In Trial II, ejaculates of two reproductively normal stallions were compared to those of two subfertile stallions. In Trial III, semen was collected from seven stallions with varying reproductive history. The sperm-rich fractions contained the highest levels of AP, ACP, BG and inorganic phosphate, and the values were positively correlated to the sperm concentration. Significant differences between the subfertile and the fertile stallions pairs in HIGH:LOW ratios were found in Pi and Cl concentrations. The highest concentrations of Ca and Mg were found in the last fractions with low sperm concentrations, with no significant differences between the fertile and the subfertile stallion pairs. The concentrations of K, Na and Cl were similar in HIGH and LOW fractions and in whole ejaculate samples. Pre-sperm fluid contained the highest concentrations of Na and Cl. Some of the possible variation in storage tolerance between ejaculates and ejaculatory fractions could perhaps be explained by differences in the composition of SP.

Vaginal neurofibroma in a hysterectomized poodle dog.

A 15-year-old, spayed, female poodle dog was presented for evaluation of a mass of tissue prolapsed from the vulva. The dog had been hysterectomized when it was 5 years old. A vaginal mass had been removed approximately 10 months before presentation. Haematological and serum biochemistry analyses demonstrated mild leucocytosis and glycaemia. A vaginal smear was predominantly made up of parabasal cells and intermediate cells with no neoplastic cells. Thoracal and abdominal radiographic findings were unremarkable. The ovaries could not be identified using abdominal ultrasonography. A midline exploratory laparotomy identified both ovaries that were surgically excised. The vaginal mass was also removed following an episiotomy procedure. Histopathological examination of the mass demonstrated that it was a neurofibroma. Both ovaries had cystic changes. Four months after the surgery, the owner reported that the dog was clinically normal. To the authors' knowledge, this is the first reported case of a vaginal neurofibroma after an incomplete ovariohysterectomy in the dog.