Analytical Determination of Aflatoxin in Ground Corn Check Samples Completed by Multiple Laboratories over Several Years.

Mycotoxins are toxic molecules produced by multiple fungal species, including Aspergillus and Fusarium. Fungal infection of crops can result in mycotoxins entering the animal and human food supply. Enzyme-linked immunosorbent assays and other immunological assays have been developed to detect mycotoxins in foods. To calibrate the response of those methods, reference materials with known amounts of homogeneously dispersed mycotoxins are often utilized, where the mycotoxin concentrations have been determined using high-performance liquid chromatography coupled with absorbance or fluorescence detection methods, or high-performance liquid chromatography coupled with mass spectrometry detection methods. Therefore, it is important that the analytical methods provide accurate and precise quantitation of mycotoxins. The reference materials must also contain homogeneously dispersed known quantities of mycotoxin. To evaluate the accuracy and precision of mycotoxin reference materials and the analytical methods, quantitative results from multiple laboratories were completed each year for several years on ground corn check samples containing known levels of mycotoxins. Results for the quantitation of aflatoxin-containing corn reference samples are presented in this article.

Radiographic False Evidence of a Tibial Baseplate Fracture After Total Knee Arthroplasty.

Fracture of the tibial baseplate is a rare but dramatic cause of typically late fatigue failure in the setting of loosening after total knee arthroplasty. A 58-year-old female presented 4 months after total knee arthroplasty for evaluation of contralateral knee pain. Plain radiographs of the left knee incidentally suggested the possibility of tibial baseplate fracture despite minimal, expected postoperative symptoms. Subsequent computed tomography imaging demonstrated no confirmatory evidence of component failure or fracture. Malalignment and fatigue fracture are proposed etiologies of baseplate fractures. The presented case illustrates the importance of computed tomography imaging and clinical correlation when a diagnosis of baseplate fracture is suspected to avoid an unnecessary revision surgery.

Closed Incision Negative Pressure Wound Therapy for Elective Hip and Knee Arthroplasty: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Persistent wound drainage after total joint arthroplasty (TJA) increases the risk of surgical site infections (SSIs). Closed incision negative pressure wound therapy (ciNPWT) decreases infections in traumatic wounds, but evidence for its use after elective TJA is limited. The purpose of this meta-analysis of level I studies is to determine the effect of ciNPWT on risk of SSI and wound complications following TJA. METHODS: MEDLINE, EMBASE, CINAHL, and Cochrane Library were searched for randomized controlled trials comparing ciNPWT vs standard dressings after total hip (THA) and total knee arthroplasty (TKA). Studies exclusively involving THA for femoral neck fractures were excluded. Risk of SSI and noninfectious wound complications (blisters, seroma, hematoma, persistent drainage, dehiscence, and wound edge necrosis) following TJA were analyzed. RESULTS: SSI risk was lower with ciNPWT compared to standard dressings (3.4% vs 7%; relative risk [RR] 0.48, P = .007), specifically in revision THA and TKA (4.1% vs 10.5%; RR 0.41, P = .03). ciNPWT increased the noninfectious complication risk after primary TKA (RR 4.71, P < .0001), especially causing wound blistering (RR 12.66, P < .0001). ciNPWT decreased hospital length of stay by 0.73 days (P = .04) and reoperation rate (RR 0.28, P = .01). CONCLUSION: ciNPWT decreases SSI risk compared to standard dressings after revision TJA, but not primary TJA. ciNPWT is associated with >12-fold increased risk of wound blistering after primary TKA. ciNPWT plays a role in revision TJA management, but additional randomized controlled trials with uniform wound assessment methods must be performed to sufficiently power findings and draw conclusions on the use of ciNPWT after primary TJA.

Overview of Portable Assays for the Detection of Mycotoxins, Allergens, and Sanitation Monitoring.

BACKGROUND: Many food recalls are related to the presence of undeclared allergens and microorganisms in food products. To reduce these occurrences, portable diagnostic assay kits are available to quantitate mycotoxins, to detect allergens and gluten in foods and on environmental surfaces, and for sanitation monitoring. OBJECTIVE: This article reviews diagnostic kits that can detect sources of contamination in food and ingredients as well as on surfaces and clean-in-place rinses. METHOD: Mycotoxins and gluten were detected using lateral flow diagnostic assays. Sanitation monitoring of surfaces was completed using a chemiluminescent assay to detect adenosine 5'-triphosphate disodium salt hydrate (ATP) and another assay to detect protein. RESULTS: Gluten was detected at 10 ppm in spiked commodities and on wet and dry surfaces at 2.5 µg/100cm2. Deoxynivalenol was quantitated in dry distillers grains plus solubles and mean results were within two SDs of those determined by HPLC. The chemiluminescent assay had an LOD of 6 fmol of ATP and was able to detect a 1:10 000 dilution of orange juice from surfaces. The protein assay detected 5 µg of bovine serum albumin (BSA) directly applied to the sampler, 100 µg of BSA on surfaces, and detected 1:10 dilutions of Greek yogurt and raw beef from surfaces. CONCLUSIONS: Portable diagnostic kits evaluated in this work provided accurate, rapid, and sensitive results for detection of mycotoxins, gluten, proteins, and ATP. These methods can be used in facilities with minimal training and provide results that are important to ensure food safety. HIGHLIGHTS: Portable methods to detect gluten, mycotoxins, proteins, and ATP are presented.

POSSUM and P-POSSUM Scoring in Hip Fracture Mortalities.

INTRODUCTION: Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (POSSUM) and Portsmouth POSSUM (P-POSSUM) are general surgical tools used to efficiently assess mortality and morbidity risk. Data suggest that these tools can be used in hip fracture patients to predict morbidity and mortality; however, it is unclear what score indicates a significant risk on a case-by-case basis. We examined the POSSUM and P-POSSUM scores in a group of hip fracture mortalities in order to assess their accuracy in identification of similar high-risk patients. MATERIALS AND METHODS: Retrospective analysis of all consecutive mortalities in hip fracture patients at a single tertiary care center over 2 years was performed. Patient medical records were examined for baseline demographics, fracture characteristics, surgical interventions, and cause of death. Twelve physiological and 6 operative variables were used to retrospectively calculate POSSUM and P-POSSUM scores at the time of injury. RESULTS: Forty-seven hip fracture mortalities were reviewed. Median patient age was 88 years (range: 56-99). Overall, 68.1% (32) underwent surgical intervention. Mean predicted POSSUM morbidity and mortality rates were 73.9% (28%-99%) and 31.1% (5%-83%), respectively. The mean predicted P-POSSUM mortality rate was 26.4% (1%-91%) and 53.2% (25) had a P-POSSUM predicted mortality of >20%. Subgroup analysis demonstrated poor agreement between predicted mortality and observed mortality rate for POSSUM in operative (χ2 = 127.5, P < .00001) and nonoperative cohorts (χ2 = 14.6, P < .00001), in addition to P-POSSUM operative (χ2 = 101.9, P < .00001) and nonoperative (χ2 = 11.9, P < .00001) scoring. DISCUSSION/CONCLUSION: Hip fracture patients are at significant risk of both morbidity and mortality. A reliable, replicable, and accurate tool to represent the expected risk of such complications could help facilitate clinical decision-making to determine the optimal level of care. Screening tools such as POSSUM and P-POSSUM have limitations in accurately identifying high-risk hip fracture patients.

Psychometric evaluation of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function and Pain Interference Computer Adaptive Test for subacromial impingement syndrome.

BACKGROUND: The Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computer Adaptive Test (CAT) was previously validated for rotator cuff disease and shoulder instability. This study evaluated the psychometric properties of the PROMIS Physical Function (PF) CAT, PROMIS Pain Interference (PI) CAT, and the American Shoulder and Elbow Surgeons (ASES) Shoulder Function Score for subacromial impingement syndrome. METHODS: PROMIS PF CAT, PI CAT, and ASES (Pain, Function, Total) were collected on all visits for 2 surgeons between January 2016 and August 2016. New patients, aged 18 years and older, were selected by International Classification of Diseases code for impingement syndrome of the shoulder. The mean number of questions answered determined efficiency. Person-item maps were created to determine ceiling and floor effects as well as person reliability. Convergent validity was determined by comparison of PROMIS domains to ASES scores with Pearson correlations. RESULTS: For PROMIS PF CAT, the mean number of items answered was 4.54 (range 4-12). The ceiling effect was 1.56%, and the floor effect was 3.13%. The person reliability was 0.94. Pearson correlation coefficients between the PF CAT and ASES were 0.664 (ASES Function), 0.426 (ASES Pain), and 0.649 (ASES Total). For PROMIS PI CAT, the mean number of items answered was 4.27 (range 3-11). The ceiling effect was 4.69%, and the floor effect was 8.33%. The person reliability was 0.92. Pearson correlation coefficients between the PI CAT and ASES were: 0.667 (ASES Function), 0.594 (ASES Pain), and 0.729 (ASES Total). CONCLUSIONS: The psychometric properties of PROMIS PF and PI CATs were favorable for subacromial impingement syndrome.

Posterior Interosseous Nerve Proximity to Cortical Button Implant for Distal Biceps Repair With Single and 2-Incision Approaches.

PURPOSE: Fixation with a cortical button is the biomechanically strongest surgical approach for distal biceps repair, and utilization of the 2-incision approach may provide a more anatomical repair and improved terminal supination strength. The risk of injury to the posterior interosseous nerve (PIN) associated with this approach requires further investigation. METHODS: A distal biceps repair with a cortical button was performed on 10 cadavers, 5 utilizing the single-incision approach and 5 utilizing the 2-incision approach. Contrast was injected into the radial nerve and computed tomography scans were obtained. The distance between the drilled cortical perforation and the PIN was measured. RESULTS: The mean distance from the cortical perforation to the PIN was not significantly different between approaches (9.4 mm and 8.8 mm). A PIN entrapment was seen in 0 out of 5 for the single-incision approach and 1 out of 5 for the 2-incision approach. CONCLUSIONS: Distal biceps repair with cortical button fixation places the PIN at risk of injury regardless of the approach used. Methods of fixation that require bicortical drilling should be especially avoided when using the 2-incision approach. CLINICAL RELEVANCE: Distal biceps repair utilizing bicortical drilling for fixation through a 2-incision approach poses high risk of injury to the PIN and should be avoided.

Unifying the Silos of Subspecialized Radiology: The Essential Role of the General Radiologist.

As radiology becomes increasingly subspecialized, conversations focus on whether the general radiologist is trending toward extinction. Current data indicate that the vast majority of graduating radiology residents now seek fellowship training. Practicing entirely within the narrow confines of one's fellowship subspecialty area, however, is uncommon, with recent data indicating that more than half of all radiologists spend the majority of their work effort as generalists. From the traditional concept of the generalist as the non-fellowship-trained radiologist who interprets everything to the multispecialty-trained radiologist to the emergency radiologist who is a subspecialist but reads across the traditional anatomic divisions, the general radiologist of today and the future is one who remains broadly skilled and equipped to provide a wide spectrum of radiologic services. The successful future of many practices of all types and the specialty as a whole will require ongoing collaborative partnerships that include both general and subspecialized radiologists. This review article highlights various scenarios in which general radiologists provide value to different types of radiology practices.

Efficiency Analysis of an Interoperable Healthcare Operations Platform.

(1) Develop an enterprise platform to unify isolated information, software applications and team members. (2) Assess the efficiency of one benefit of the platform through comparative testing of employee document retrieval times. (3) Evaluate the level of satisfaction among our target audience. We developed an infrastructure to integrate information throughout our practice and make it available on a unified, secure, and remotely accessible platform. We solicited our practice for volunteers to test the new system. All interested volunteers participated. Thirteen employees searched for the same four items in both the new system and our legacy systems. Testing was performed in the pre-deployment stage. In our evaluation, we introduced an innovative method to precisely and objectively obtain data through the use of a widely available tool which could be leveraged for a variety of other studies. On average, it took our participants 7 min and 48 s to find four assigned items in our legacy systems. It only took our volunteers 1 min and 1 s to find the same items with the new platform (p-value 0.002). On a scale of 10 being the highest level of satisfaction, participants ranked the new system to be 8.7 while the traditional system was ranked at 6.3. An overarching enterprise platform is critical due to the ability to unify otherwise isolated applications, people and documents. Because navigating a new system would be expected to take longer than a familiar one, we were surprised by the dramatically improved efficiency and satisfaction of our new interoperable platform compared to the status quo. Since this platform was evaluated in the pre-deployment stage, we expect results to improve with employee experience as well as ongoing enhancements.

Scapular dyskinesis following displaced fractures of the middle clavicle.

PURPOSE: To evaluate the rate of scapular dyskinesis and resulting patient outcomes after treatment of displaced midshaft clavicle fractures. METHODS: Skeletally mature patients with isolated, displaced midshaft clavicle fractures treated with or without surgery over a 16-month period were recruited. The minimum length of follow-up at study examination was 12 months. Patient outcomes were documented using the SICK (scapular malposition, inferomedial border prominence, coracoid pain and malposition, and dyskinesis of scapular movement) Scapula Rating Scale, the Simple Shoulder Test, 3 visual analog scales (VAS) for pain, and shoulder range-of-motion and strength measurements. Of the 32 eligible patients, 24 (75%) were successfully recruited. RESULTS: The mean participant age was 46 ± 17 years, with a mean length of follow-up at study evaluation of 1.7 ± 1 years. Surgical fixation was performed in 12 patients (50%). Scapular dyskinesis was present in 37.5% of patients (n = 9). Patients with scapular dyskinesis had worse SICK scapula scores (5.8 ± 2.2 vs 3.1 ± 2.4, P = .01), worse Simple Shoulder Test scores (10.5 ± 1.6 vs 11.7 ± 0.8, P = .029), higher maximum VAS pain scores (4.1 ± 3.1 vs 0.97 ± 1.2, P = .002), and worse average VAS pain scores in the week before the examination (2.7 ± 2.5 vs 0.2 ± 0.4, P < .001) compared with patients without scapular dyskinesis. Range of motion and abduction strength were similar between the groups. Scapular dyskinesis developed in 1 patient treated with surgery (8% [1 of 12]) compared with 8 patients treated nonoperatively (67% [8 of 12]) (P = .009). CONCLUSIONS: Scapular dyskinesis is common after displaced middle-third clavicle fractures, and these patients have more pain and worse functional outcomes compared with patients without scapular dyskinesis. Surgical treatment may reduce a patient's risk of scapular dyskinesis developing and improve short-term outcomes.

Blood management strategies for total knee arthroplasty.

Perioperative blood loss during total knee arthroplasty can be significant, with magnitudes typically ranging from 300 mL to 1 L, with occasional reports of up to 2 L. The resultant anemia can lead to severe complications, such as higher rates of postoperative infection, slower physical recovery, increased length of hospital stay, and increased morbidity and mortality. Although blood transfusions are now screened to a greater extent than in the past, they still carry the inherent risks of clerical error, infection, and immunologic reactions, all of which drive the need to develop alternative blood management strategies. Thorough patient evaluation is essential to individualize care through dedicated blood management and conservation pathways in order to maximize efficacy and avoid associated complications. Interventions may be implemented preoperatively, intraoperatively, and postoperatively.