Semiquantitative index of symptomatic minor instability of the lateral elbow at CT arthrography (SMILE index): clinical applicability and reproducibility study.

OBJECTIVE: To assess the applicability of a semiquantitative index for symptomatic minor instability of the lateral elbow (SMILE). MATERIALS AND METHODS: CT arthrograms of consecutive patients with lateral elbow pain who underwent ultrasound-guided CT arthrography at our orthopedic center between April 2019 and May 2022 were included. Images were acquired at 100 kVp and 80 mAs. An expert radiologist (R1) and a radiology resident (R2) retrospectively performed an independent, blinded evaluation of the arthrograms to assess the presence of imaging findings suggestive of elbow instability. The SMILE index (0-8) was obtained adding (I) radial head chondromalacia (0 - 1); (II) humeral capitellum chondromalacia (0 - 1); (III) humeral trochlear ridge chondromalacia (0 - 1); (IV) annular ligament laxity (0 - 2); (V) synovial thickening (0 - 1); (VI) humeroradial joint asymmetry (0 - 1); and (VII) capsular tear (0 - 1). R1 repeated the assessment after 14 days. Cohen's weighted κ statistic and raw concordance were used to appraise reproducibility. RESULTS: Eighty patients (median age 49 years, interquartile range 40-53 years, 49, 61% males) underwent CT arthrography at our center, and 10 (12%) of them underwent bilateral elbow examination, leading to 90 included CT arthrograms. Median SMILE index was 4 (IQR: 2-5) for R1, 4 (IQR: 2-5) for R2, and 4 (IQR: 2-5) for the second assessment by R1. Intra-reader agreement was excellent (κ = 0.94, concordance 87%), while inter-reader agreement was substantial (κ = 0.75, concordance 67%). CONCLUSION: The proposed SMILE index showed good reproducibility; further studies are warranted to correlate our index with clinical and surgical data. CLINICAL RELEVANCE STATEMENT: Our scoring system allows a standardized evaluation of patients with lateral elbow pain and instability suitable for application into clinical practice, complementing the orthopedic surgeon's clinical diagnosis with imaging findings that may aid treatment choices. KEY POINTS: • Lateral elbow pain is often interpreted clinically as lateral epicondylitis, but it can also encompass intra-articular pathology. • The proposed arthrographic index allows comprehensive quantification of lateral elbow pathology with good reproducibility and application times. • Our index provides the orthopedic surgeon with information regarding intra-articular findings, aiding treatment choices.

Impact of COVID-19 Pandemic on the Workload of Diagnostic Radiology: A 2-Year Observational Study in a Tertiary Referral Hospital.

RATIONALE AND OBJECTIVES: To evaluate the impact of COVID-19 pandemic on diagnostic imaging workload in a tertiary referral hospital. MATERIALS AND METHODS: Radiological examinations performed in pre-pandemic period (2015-2019) and in pandemic period (2020-2021) were retrospectively included. Based on epidemiological data and restriction measures, four pandemic waves were identified. For each of them, the relative change (RC) in workload was calculated and compared to the 5-year averaged workload in the corresponding pre-COVID-19 periods. Workload variations were also assessed according to technique (radiographs, CT, MRI, ultrasounds), body district (chest, abdomen, breast, musculoskeletal, head/neck, brain/spine, cardiovascular) and care setting (inpatient, outpatient, emergency imaging, pre-admission imaging). RESULTS: A total of 1384380 examinations were included. In 2020 imaging workload decreased (RC = -11%) compared to the average of the previous 5 years, while in 2021 only a minimal variation (RC = +1%) was observed. During first wave, workload was reduced for all modalities, body regions and types of care setting (RC from -86% to -10%), except for CT (RC = +3%). In subsequent waves, workload increased only for CT (mean RC = +18%) and, regarding body districts, for breast (mean RC = +23%) and cardiovascular imaging (mean RC = +23%). For all other categories, a workload comparable to pre-pandemic period was almost only restored in the fourth wave. In all pandemics periods workload decrease was mainly due to reduced outpatient activity (p < 0.001), while inpatient and emergency imaging was increased (p < 0.001). CONCLUSION: Evaluating imaging workload changes throughout COVID-19 pandemic helps to understand the response dynamics of radiological services and to improve institutional preparedness to face extreme contingency.

Development of analytical procedures to study changes in the composition of meat phospholipids caused by induced oxidation.

Lipid peroxidation affects quality of meat products. The aim of this study was to develop a model system and analytical procedures for evaluating the oxidation level of meat samples, by studying the changes in meat phospholipids (PL) composition and the compounds generated by induced oxidation. Different techniques (liquid-, dry column-, accelerated solvent extraction) were investigated to identify a suitable lipid extraction system for extracting PL from bovine meat and to induce lipid oxidation by using tert-butyl hydroperoxide, 2,2'-azobis(2-amidinopropane) dihydrochloride (ABAP) or Fe(2+) and Cu(2+) salts. Accelerated solvent extraction (ASE) gave results not significantly different from the other extraction methods, but offered the advantage of being a rapid and solvent-saving procedure. The method using a silica column proved to be valid in eluting and separating the components of the phospholipidic fraction and the PL standard mixture. The analytical techniques used to analyse oxidation products of PL included GC-FID, HPLC with corona charged aerosol detector (CAD), MDA determination and the spectrophotometric measurement of peroxide levels (PxL). By means of CAD, PL were quantified and their concentration in the lipid extract was 0.98%+/-0.17 (w/w+/-SD, n=10). The oxidation method induced by ABAP proved to be fast and did not produce any artifacts. Three oxidation times were monitored (0, 90 and 180 min). The oxidation levels after 180 min correlated with a significant increase in the peroxide levels PxL (+71%), MDA (+29%) and aldehydes (+75%), whereas a decrease or even total disappearance of some unsaturated fatty acids was observed. The results obtained demonstrate that the model used in this work is useful for studying oxidation of meat phospholipids. Also, the use of the innovative detector CAD proved to be a good complementary technique in the investigation of lipids.

Determination of selected mycotoxins in mould cheeses with liquid chromatography coupled to tandem with mass spectrometry.

A simple and feasible method is described for analysing nine mycotoxins in cheese matrix. The method involves liquid extraction followed by high performance liquid chromatographic separation and mass spectrometric detection of the analytes, and allows the determination of aflatoxins B1, B2, G1, G2 and M1, ochratoxin A, mycophenolic acid, penicillic acid and roquefortine C simultaneously. Average recoveries of the mycotoxins from spiked samples at concentration levels of 5-200 microg kg(-1) ranged from 96-143%. Within-day relative standard deviations at these concentration levels varied from 2.3-12.1%. The limit of quantification for aflatoxin M1 was 0.6 microg kg(-1) and for the other compounds 5 microg kg(-1). The method developed was applied for analysing these mycotoxins in blue and white mould cheeses purchased from Finnish supermarkets. Roquefortine C was detected in all of the blue mould cheese samples in concentrations of 0.8-12 mg kg(-1). One blue cheese contained also 0.3 mg kg(-1) mycophenolic acid. The other investigated mycotoxins were absent in the samples.

The effect of substrate on mycotoxin production of selected Penicillium strains.

Analytical methods are presented for detecting simultaneously 11 fungal metabolites (aflatoxins B1, B2, G1 and G2, citrinin, cyclopiazonic acid, mycophenolic acid, ochratoxin A, penicillic acid, penitrem A and roquefortine C) on different matrices. The methods were applied to determine the mycotoxins produced by different Penicillium crustosum, Penicillium nordicum and Penicillium verrucosum strains on yeast extract sucrose (YES) agar and cheese and bread analogues and are based on high-performance liquid chromatography (HPLC) and photodiode array detection (PDA). The growth substrate had a distinctive effect on the mycotoxin production ability of the fungi examined. The P. crustosum strains produced roquefortine C on all the substrates, with the highest amounts being detected on the cheese analogue. Penitrem A was synthesised on the cheese analogue only. The strains of P. verrucosum produced exclusively citrinin on YES, but both ochratoxin A and citrinin were detected in considerable amounts on the bread analogue. On the bread, toxin profiles varied significantly between the individual P. verrucosum strains. The cheese analogue was not favourable for the mycotoxin production of this species. The growth substrate had the least effect on the toxin production of the P. nordicum strains, which synthesised ochratoxin A in moderate amounts on all three media.

Levels of mycotoxins and sample cytotoxicity of selected organic and conventional grain-based products purchased from Finnish and Italian markets.

The contamination levels of 16 different Fusarium- and Aspergillus-mycotoxins were chemically determined from randomly selected organic and conventional grain-based products purchased from Finnish and Italian markets. The cytotoxicity of the samples was analyzed with an in vitro test using feline fetal lung cells. Overall, the concentrations of the mycotoxins studied were low in all of the samples. Enniatins B and B1 as well as deoxynivalenol were the most predominant mycotoxins in the samples, being present in 97%, 97%, and 90% of the samples, respectively. The geographical origin or the agricultural practice had no influence on the mycotoxin concentrations of the samples. The babyfoods included in the samples had significantly lower concentrations of mycotoxins than the other products with a mean total mycotoxin content of 47 microg/kg compared with 99 microg/kg for the other kinds of food. All the samples evoked toxicity in the in vitro test, but no correlation between cytotoxicity and the mycotoxin concentrations was observed.

Analysis of the Fusarium mycotoxins fusaproliferin and trichothecenes in grains using gas chromatography-mass spectrometry.

A method is described using gas chromatography-mass spectrometry (GC-MS) for the simultaneous detection of the Fusarium mycotoxins fusaproliferin and seven trichothecenes from grains. Sample purification of the raw extract was carried out with commercial solid phase extraction columns, and the recovery of the more polar analytes was increased by rinsing the column with acetonitrile. A significant matrix effect was found for the analysis of fusaproliferin and trichothecenes; thus, the calibrants should be prepared in a blank matrix. The response was linear in the range used. The mean recovery for fusaproliferin was 60.4 or 62.9%, depending on the spiking level. With respect to the trichothecenes, the recovery was generally higher (70.2-125.3%). The method proved to be repeatable for the analysis of fusaproliferin and trichothecenes. The limit of detection for fusaproliferin in the blank matrix mixture was 50 microg/kg, and that for trichothecenes was 5-15 microg/kg. Thirty-eight Finnish grain samples were analyzed for fusaproliferin and trichothecenes with the method developed. Fusaproliferin was not detected in any of the samples. The mean levels of deoxynivalenol, 3-acetyldeoxynivalenol, nivalenol, HT-2 toxin, and T-2 toxin in Finnish grain samples were 272, 17, 150, 40, and <20 microg/kg, respectively.

Antioxidant nutrients and mycotoxins.

Mycotoxins are fungal secondary metabolites that are toxic to vertebrates produced by organisms that occur as plant pathogens, soilborne fungi, airborne fungi and aeroallergens. They are distributed worldwide and may be recovered from a wide range of substrates. Their presence in food and feeds, as the result of fungal diseases in crops, can present a danger to animal and human health. Many mycotoxins have also been shown to be phytotoxic and in some cases, such as with trichothecenes produced by the wheat head blight fungus Fusarium graminearum, mycotoxins may act as virulence factors. Several natural (vitamin, provitamins, carotenoids, chlorophyll and its derivatives, phenolics, and selenium) and synthetic (butylated hydroxyanisole and butylated hydroxytoluene) compounds with antioxidant properties seem to be potentially very efficacious in protecting against the toxic effects of mycotoxins. The protective properties of antioxidants are probably due to their ability to act as superoxide anion scavengers, thereby protecting cell membranes from mycotoxin-induced damage and in some cases, antioxidant vitamins may play a role in preventing mycotoxicosis. However, much less information is available from studies carried out on antioxidants and mycotoxins, such as OTA, FB(1), T-2 toxin, ZEN, and citrinin. No such studies have been performed on recently discovered toxins such as beauvericin, fusaproliferin, moniliformin, and fusaric acid. However, supplementation with antioxidant nutrients to prevent mycotoxicosis has been controversial. The case for the use of supplemental antioxidant vitamins at the present time needs further research.

Application of manual and automated systems for purification of ochratoxin a and zearalenone in cereals with immunoaffinity columns.

A manual vacuum manifold and an automated solid phase extraction (ASPEC) system were applied for purification of ochratoxin A and zearalenone in wheat, rye, barley, and oat samples with immunoaffinity columns followed by separation with a high-performance liquid chromatograph and fluorescence detection. The immunoaffinity columns for manual sample purification were purchased from a different manufacturer than were those for the automated system. The limit of detection (LOD) for the method for ochratoxin A with a vacuum manifold and ASPEC was 0.1 microg/kg. For the method for zearalenone, the LODs were 1.5 microg/kg with a vacuum manifold and 3 microg/kg with ASPEC. For the methods for ochratoxin A at spiking levels of 0.6 and 2.5 microg/kg, mean recoveries for different cereals varied from 68 to 106%. For the methods for zearalenone, mean recoveries varied from 78 to 117% at spiking levels of 9 and 25 microg/kg. The relative standard deviations of repeatability with various cereals employing both methods were 2-15 and 2-19% for ochratoxin A and zearalenone, respectively.